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Prolia is a brand of denosumab. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 1,179 of 5,492 Medicare Part D and Medicare Advantage drug plans (21.5%) list Prolia on their formulary, across 59 of 286 formularies. The most common placement is tier 4 (994 plans, 84.3% of those covering it). 86 of the covering plans require prior authorization (7.3%), 0 step therapy and 1,178 a quantity limit.
120 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $42, 14 of them $0; 1,059 charge coinsurance instead — median 41% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 2,501 of 5,496 plans covered it (45.5%); 2027: 1,179 of 5,492 (21.5%).
Of 4,367 plans offered in both years, 9 added it to the formulary and 1,005 dropped it.
Among plans covering it both years, 4 moved it to a higher tier and 13 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 20 |
| Tier 3 | 165 |
| Tier 4 | 994 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 104 of 323 | 32.2% | 0% |
| Medicare Advantage with drugs (MA-PD) | 735 of 3,200 | 23% | 7.1% |
| Special needs plans (SNP) | 340 of 1,969 | 17.3% | 10% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 846 of 846 | Tier 4 | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 0 of 631 | No tier listed | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 83 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 0 of 74 | No tier listed | 0 |
| Wellpoint | 0 of 63 | No tier listed | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 37 of 37 | Tier 4 | 0 |
| Zing Health | 36 of 36 | Tier 4 | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 27 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 19 of 114 | 16.7% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 36 of 147 | 24.5% |
| Arkansas | 28 of 85 | 32.9% |
| California | 103 of 397 | 25.9% |
| Colorado | 19 of 106 | 17.9% |
| Connecticut | 7 of 54 | 13% |
| Delaware | 7 of 43 | 16.3% |
| District of Columbia | 1 of 12 | 8.3% |
| Florida | 115 of 545 | 21.1% |
| Georgia | 35 of 149 | 23.5% |
| Guam | 0 of 1 | 0% |
| Hawaii | 14 of 50 | 28% |
| Idaho | 11 of 45 | 24.4% |
| Illinois | 44 of 132 | 33.3% |
| Indiana | 41 of 138 | 29.7% |
| Iowa | 13 of 64 | 20.3% |
| Kansas | 19 of 84 | 22.6% |
| Kentucky | 44 of 121 | 36.4% |
| Louisiana | 48 of 125 | 38.4% |
| Maine | 23 of 52 | 44.2% |
| Maryland | 19 of 49 | 38.8% |
| Massachusetts | 16 of 89 | 18% |
| Michigan | 31 of 182 | 17% |
| Minnesota | 18 of 63 | 28.6% |
| Mississippi | 30 of 104 | 28.8% |
| Missouri | 42 of 170 | 24.7% |
| Montana | 17 of 27 | 63% |
| Nebraska | 10 of 51 | 19.6% |
| Nevada | 23 of 100 | 23% |
| New Hampshire | 9 of 25 | 36% |
| New Jersey | 14 of 73 | 19.2% |
| New Mexico | 14 of 68 | 20.6% |
| New York | 36 of 215 | 16.7% |
| North Carolina | 33 of 176 | 18.8% |
| North Dakota | 9 of 26 | 34.6% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 38 of 171 | 22.2% |
| Oklahoma | 23 of 81 | 28.4% |
| Oregon | 15 of 92 | 16.3% |
| Pennsylvania | 35 of 323 | 10.8% |
| Puerto Rico | 0 of 64 | 0% |
| Rhode Island | 3 of 29 | 10.3% |
| South Carolina | 23 of 89 | 25.8% |
| South Dakota | 11 of 30 | 36.7% |
| Tennessee | 29 of 156 | 18.6% |
| Texas | 73 of 407 | 17.9% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 15 of 53 | 28.3% |
| Vermont | 7 of 14 | 50% |
| Virginia | 45 of 144 | 31.3% |
| Washington | 22 of 114 | 19.3% |
| West Virginia | 21 of 69 | 30.4% |
| Wisconsin | 23 of 96 | 24% |
| Wyoming | 5 of 13 | 38.5% |
Medicare Part D paid for 2,652,212 30-day fills of Prolia in 2024 for about 284,849 enrollees, at an average total cost of $290.66 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Prolia and the rest of a client's list on every plan in their county.
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.