All PlansPrior AuthHigh impact
Denosumab Products: (Prolia®); Denosumab-nxxp (Bildyos®); Denosumab-kyqq (Bosaya™); Denosumab-bnht (Conexxence®); Denosumab-qbde (Enoby™); enosumab-bbdz (Jubbonti®); Denosumab-dssb (Ospomyv™); Denosumab-bmwo (Stoboclo®)
BCBS Tennessee·Endocrinology, Rheumatology, Oncology +3 more·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
New comprehensive medical policy covering Denosumab products (Prolia and 7 biosimilars) for osteoporosis and cancer-related bone loss, establishing prior authorization criteria, documentation requirements, and quantity limits. Policy takes effect June 30, 2026, replacing current coverage guidelines.
Action Required
Before June 30, 2026: Update prior authorization workflows for all Denosumab products including biosimilars (Bildyos, Bosaya, Conexxence, Enoby, Jubbonti, Ospomyv, Stoboclo). Billing team must program 12-month authorization limits and 60mg every 6 months quantity restrictions. Providers must document T-scores, FRAX scores, fracture history, and bisphosphonate trial history in medical records. Update encounter forms to capture required documentation elements. Claims will require prior authorization and proper documentation for approval.