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Drug - Prolia (denosumab) [Amgen]

October 2013

Therapeutic area - Osteoporosis

Only healthcare professionals may administer Prolia. Bill using professional claim code J0897 (buy and bill).

Approval criteria

Patients must meet the following three criteria:

One of the following:

  • Patient is a postmenopausal woman with diagnosis of osteoporosis and at high risk for fracture
  • Patient is a man at high risk for fracture and receiving androgen deprivation therapy for nonmetastatic prostate cancer
  • Patient is a woman at high risk for fracture and receiving adjuvant aromatase inhibitor therapy for breast cancer

Patient has tried and failed 2 of the following drugs to increase bone mass: alendronate, calcitonin (Miacalcin), ibandronate (IV or oral), raloxifene, risedronate, or zoledronic acid.

Patient is currently taking calcium 1000 mg plus 400 IU of vitamin D daily.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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