How Much Does Prolia Cost With Medicare in 2025?
Prolia, a powerful injectable medication used to treat osteoporosis, is life-changing for many seniors—especially postmenopausal women and men with high fracture risk. But its price tag can cause sticker shock. If you’re wondering how much does Prolia cost with Medicare in 2025, you’re not alone.
In this article, we’ll explore the current cost of Prolia, how Medicare Part B and Part D cover it, and the best ways to lower your out-of-pocket expenses while staying on this vital medication.
Understanding Prolia and Its Importance
Prolia (denosumab) is a monoclonal antibody prescribed to strengthen bones by blocking a protein responsible for bone loss. The treatment is injected every six months and is considered a gold-standard drug for severe osteoporosis. Approved by the FDA, Prolia helps reduce the risk of spine, hip, and other fractures significantly.
What Is Prolia Used For?
Prolia is primarily used for:
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Postmenopausal osteoporosis in women at high fracture risk
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Men with osteoporosis at high fracture risk
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Bone loss caused by cancer treatments
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Glucocorticoid-induced osteoporosis
It’s also sometimes prescribed for patients who haven’t responded well to other bone-building medications like bisphosphonates.
How Prolia Works in the Body
Prolia works by inhibiting RANK ligand—a protein essential for the formation, function, and survival of osteoclasts (cells that break down bone). By reducing bone breakdown, Prolia helps maintain and even increase bone density. Over time, this reduces the likelihood of debilitating fractures.
Average Retail Cost of Prolia Without Insurance
In 2025, the retail price of one Prolia injection is approximately $1,550 to $1,750 per dose in the United States. Since it is administered twice a year, the annual cost is around $3,100 to $3,500 without insurance.
These prices vary based on pharmacy location, administration fees, and whether you’re paying cash or using a discount card.
How Much Does Prolia Cost With Medicare in 2025?
This is the key question: how much does Prolia cost with Medicare? The answer depends on how you’re insured under Medicare.
Medicare Part B Coverage
If Prolia is administered in a doctor’s office and considered medically necessary, it may be covered under Medicare Part B. In this case:
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80% of the cost is covered by Medicare
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You pay the remaining 20% out-of-pocket, unless you have a Medigap plan, which may cover it fully
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You may also be charged an administration fee
For example, if one injection costs $1,600:
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Medicare pays $1,280
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You pay $320 (unless Medigap picks this up)
Medicare Part D Coverage
If you self-administer the injection or get it at a pharmacy, Part D may apply. Costs vary by plan, but typically:
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You’ll pay the deductible (up to $545 in 2025) first
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Then, co-insurance or co-pays, ranging from 25% to 33% of the drug price
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You may enter the donut hole, where costs can rise dramatically until you hit catastrophic coverage
Medicare Advantage Plans
Medicare Advantage (Part C) plans often offer integrated drug and medical coverage. Some plans provide $0 co-pays for Prolia when administered in-network. Others mirror Part D rules. It’s essential to check the formulary and cost-sharing structure of your plan.
What Affects the Cost of Prolia With Medicare?
Several factors influence your final Prolia cost:
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Type of Medicare plan
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Whether it’s administered at a clinic or pharmacy
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Whether you have supplemental coverage like Medigap
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Your income level (which can affect eligibility for assistance)
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The location of the provider
Additional Out-of-Pocket Costs You Might Face
Even with Medicare, you might encounter:
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Physician visit co-pays
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Drug administration fees
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Plan deductibles
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Coinsurance percentages
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Costs related to lab tests or imaging before/after administration
These can add several hundred dollars annually.
How to Reduce Prolia Costs With Medicare
Manufacturer Savings Programs
Amgen, the maker of Prolia, offers Amgen Safety Net Foundation and copay assistance programs for eligible Medicare patients. While these aren’t available for everyone with Medicare due to federal law, low-income applicants may qualify.
State Pharmaceutical Assistance Programs (SPAPs)
Many states offer SPAPs that help cover medication costs not paid by Medicare. These vary widely, so check with your state’s health department.
Extra Help Program
This federal assistance program helps lower-income seniors reduce drug costs under Medicare Part D. You may qualify if you have limited income and resources.
Alternative Medications Covered by Medicare
If Prolia is too costly, your doctor may suggest:
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Fosamax (alendronate) – oral tablet, less expensive
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Boniva (ibandronate) – available as a tablet or injection
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Reclast (zoledronic acid) – once-yearly IV infusion, often covered under Part B
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Evenity (romosozumab) – another injectable, newer, and slightly more expensive than Prolia
Tips to Get Prolia for Free or at Lower Cost
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Enroll in a Medicare Advantage plan with full coverage
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Use prescription discount cards for Part D coverage
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Apply for Amgen’s patient assistance or non-profit medication aid
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Ask your doctor to administer it under Part B to lower your coinsurance
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Shop around at different pharmacies for the lowest negotiated price
Prolia Coverage in Different Medicare Plans
The coverage for Prolia can vary depending on the type of Medicare plan you have. Here’s a breakdown:
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Original Medicare + Part B: Prolia is usually covered when administered in a doctor’s office. The estimated cost for each shot is between $300 and $350.
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Medicare Part D: If you get Prolia through a pharmacy, the cost typically ranges from $500 to $800 per shot.
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Medicare Advantage: Coverage can vary by plan, but generally, the cost per shot can range from $0 to $700, depending on the specifics of the plan.
Keep in mind that out-of-pocket costs can differ based on your specific Medicare plan and coverage details.
Cost Comparison: Prolia vs. Other Osteoporosis Drugs
Prolia is typically administered twice a year, with an estimated annual cost ranging from $3,100 to $3,500. While it falls in the mid-range for pricing, its efficacy and the convenience of being injected only twice a year make it an appealing choice for many.
In comparison:
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Reclast is a once-yearly infusion, costing between $1,000 and $1,300 annually.
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Fosamax is taken weekly as a pill, with an estimated annual cost of $300 to $500.
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Evenity, which requires monthly injections for one year, has a much higher cost, often exceeding $22,000 annually.
While Prolia may not be the cheapest option, its ease of use and effectiveness in treating osteoporosis are key reasons why some patients prefer it.
How Long Should You Stay on Prolia?
According to medical experts, Prolia is often prescribed for 3 to 10 years, depending on your fracture risk and bone density improvements. Stopping Prolia suddenly can cause rebound fractures, so long-term planning with your provider is crucial.
What to Ask Your Doctor Before Starting Prolia
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Will Medicare Part B or D cover my injections?
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Is there an administration fee I should know about?
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How long will I need this treatment?
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What are the alternatives if I can’t afford it?
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Can I apply for any cost-saving programs?
How to Talk to Your Medicare Provider About Coverage
When you contact your Medicare provider or plan:
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Request a full breakdown of Prolia coverage
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Ask for pharmacy cost comparisons
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Verify your deductible, coinsurance, and copayments
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Ask if it’s cheaper to get it administered in-office
Is Prolia Worth the Cost in 2025?
In many cases, yes—Prolia’s effectiveness at reducing fracture risk, combined with the convenience of twice-yearly dosing, justifies the cost. However, affordability is personal. Working closely with your provider and Medicare plan can help ensure it remains within your budget.
Real-Life Patient Stories and Cost Experiences
Many seniors report success in lowering their Prolia costs through Medigap coverage, extra help, and Medicare Advantage plans. Others have received financial aid from Amgen or reduced-cost injections from in-network clinics.
Common Side Effects and Long-Term Risks of Prolia
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Back pain
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Joint stiffness
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Increased infection risk
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Skin rashes
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Severe bone pain (rare)
Long-term use may also cause hypocalcemia or, very rarely, osteonecrosis of the jaw. Always review risks with your physician.
FAQs
Is the Prolia shot covered by Medicare Part B?
Yes, if administered in a doctor’s office and deemed medically necessary.
How to get Prolia cheaper?
Consider using Medicare Advantage, Extra Help, Amgen’s assistance, or administration via Part B.
How to get Prolia for free?
Low-income patients may qualify for assistance from Amgen’s foundation or state programs.
How many years should you get Prolia injections?
Usually 3–10 years, but only under a doctor’s close supervision.
Is Prolia more effective than Reclast?
Studies suggest both are effective, but Prolia may be preferable for patients unable to tolerate infusions.
Can I stop Prolia once I start?
Suddenly stopping Prolia can increase fracture risk—only stop under medical advice.
Final Thoughts
If you’re wondering how much Prolia costs with Medicare in 2025, the answer depends on your plan, income level, and whether it’s administered in-office or at a pharmacy. While the retail price is high, Medicare can significantly reduce your cost, especially under Part B. You can further minimize expenses by using patient assistance programs, pharmacy discount services, or choosing a Medicare Advantage plan with favorable drug coverage.
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