Prolia

Generic: denosumab

60 MG — Prefilled Syringe

Bone Resorption Suppression And Related Agents

Also known as: denosumab PROLIA SOSY 60MG/ML
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 8 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 8 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Focus 2026
via Xgeva 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via Xgeva 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via Xgeva 		Tier 4 - Preferred Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 8 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HumanaChoice H5216-211 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Full Access H5525-034 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice Giveback H5525-035 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice H5525-049 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice H5525-070 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice H5525-083 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Choice H8145-004 (PFFS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice H5525-050 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE 001 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE 003 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE 005 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE 008 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice Giveback H5216-017 (PPO) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HumanaChoice H5525-050 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice H5525-083 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Choice H8145-004 (PFFS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring True Choice (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice H5525-049 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice Giveback H5525-035 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Full Access H5525-034 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice H5216-211 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice Giveback H5216-017 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring Preferred (HMO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring TotalCare (HMO D-SNP)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HumanaChoice H5525-070 (PPO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring Preferred Plus (HMO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring Preferred Savings (HMO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
HealthSpring Preferred Select (HMO)
via Xgeva 		Tier 5 - Specialty ✓ — ✓ 1.7 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 8 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 8 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Xgeva 		Tier 6 - Non-Preferred Brand Specialty ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026
via Xgeva 		Tier 6 - Non-Preferred Brand Specialty ✓ — — PA
NC State Health Plan - 80/20 Plus PPO 2026
via Xgeva 		Tier 6 - Non-Preferred Brand Specialty ✓ — — PA
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