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Medicare · Coverage

Does Medicare cover Prolia?

Last reviewed October 28, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team

Yes. Medicare Part B covers Prolia when a health care provider gives you the shot and you need it to treat bone loss. Because the drug's price rose faster than inflation, your share right now is a bit less than the usual 20%. Here is what it costs and how coverage works.

Why Part B pays for Prolia

Most drugs you pick up at a pharmacy fall under Part D. Prolia is different. Its label says a health care provider should give the shot. Part B covers most drugs that a licensed provider gives you as a shot or an IV, usually in a doctor's office or a hospital clinic.

Prolia is approved to treat:

  • Women past menopause with osteoporosis and a high risk of broken bones
  • Men with osteoporosis and a high risk of broken bones
  • Bone loss caused by steroid medicine
  • Bone loss from some hormone treatments for prostate or breast cancer

Medicare pays when the shot is medically needed. Your doctor's notes should show your diagnosis, past fractures, and other bone drugs you tried.

In short: if your doctor's office gives you Prolia for bone loss, Part B is the part that pays.

What you pay

The dose is 60 mg, once every 6 months. From October to December 2026, Medicare's approved amount for that dose is about $1,791.

Normally you would pay 20%. But Prolia's price went up faster than inflation. When that happens, the law lowers your share. Right now your share is 17.885%, which is about $320 per shot instead of about $358. This rate is reset every 3 months, so it can change.

You pay this after you meet the $283 Part B deductible for 2026. The office visit may be a separate charge.

  • If you have a Medigap plan: every plan pays some or all of your share.
  • If you have Medicare Advantage: your plan sets its own copay or coinsurance. Check your plan's Evidence of Coverage.
  • If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.

Lower-cost versions called biosimilars

A biosimilar is a near copy of a drug like Prolia, made by another company. It has the same active drug, denosumab. Medicare Part B pays for several denosumab biosimilars. Each one has its own billing code and price.

From October to December 2026, the approved amount for a 60 mg dose of the biosimilars in Medicare's price file runs from about $461 to $1,722. You pay 20% of that amount after the deductible. Ask your doctor which version your office uses.

If you cannot get to the doctor's office

Medicare can cover a bone shot and a home health nurse to give it at home. This applies only if you are a woman with osteoporosis and all of these are true:

  • You qualify for Medicare home health care.
  • You have a broken bone that your doctor says is linked to osteoporosis after menopause.
  • Your doctor says you cannot give yourself the shot, and family or caregivers cannot or will not give it.

You pay nothing for the nurse's visit. You may still owe your share for the drug.

How to get it covered, step by step

  1. Talk with your doctor about your bone health. Make sure your record shows your diagnosis, any past fractures, and drugs you already tried.
  2. Get the shot at a doctor's office or clinic that takes Medicare. For Part B drugs, providers must accept assignment. That means they cannot charge you more than your share.
  3. Take calcium and vitamin D as your doctor tells you. The label calls for it, and Medicare's billing rules check for it.
  4. Keep the 6 month schedule. Medicare pays for the dose and timing on the drug's label.
  5. If Medicare says no, appeal. Your Medicare Summary Notice explains how. Ask your doctor for a letter about why you need it.

In short: get Prolia at an office that takes Medicare, and expect to pay about $320 a dose unless other coverage helps.

Common questions about Medicare

Quick answers, fast .

Tap any question to expand. Each links to a fuller standalone answer.

Is Prolia covered by Part B or Part D?

Usually Part B. Prolia is a shot a health care provider gives, and Part B covers most drugs a provider gives you in an office or clinic.

How much does Prolia cost with Medicare?

From October to December 2026, Medicare approves about $1,791 per 60 mg shot. After the $283 Part B deductible, you pay 17.885%, or about $320 per shot. A Medigap plan may pay some or all of that.

Why is my Prolia coinsurance less than 20%?

Prolia's price went up faster than inflation. When that happens, Medicare lowers what you pay for that drug. The rate is set every 3 months and can change.

Does Medicare cover Prolia given at home?

Only in a narrow case. A woman with osteoporosis who qualifies for home health, has a fracture linked to osteoporosis after menopause, and cannot give herself the shot can get a home health nurse to give it.

References

  1. Medicare.gov, Prescription drugs (outpatient)Which drugs Part B covers and what you pay.
  2. Medicare.gov, Osteoporosis drugsBone shots and home health nurse visits for women who qualify.
  3. CMS, Billing and Coding Article A52399: Denosumab and biosimilarsWhat the doctor's record must show and how each version is billed.
  4. CMS, Part B Drug Payment Limits (October 2026)Medicare's approved amount and coinsurance for each Part B drug.
  5. FDA label for Prolia (denosumab), via DailyMedApproved uses and the 60 mg every 6 months dose.

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