CommercialCoverageMedium impact
08.00.94v, Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®)
Independence Blue Cross·Endocrinology, Oncology, Rheumatology +1 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Updated policy for Denosumab (Prolia®, Xgeva®), related biosimilars, and Romosozumab-aqqg (Evenity®) medications. This pharmacy policy change affects bone health medications commonly used for osteoporosis and cancer-related bone complications.
Action Required
Before April 1, 2026: Billing team must review updated policy 08.00.94v for Denosumab and Romosozumab medications. Update prior authorization requirements, coverage criteria, and billing procedures in system for these bone health medications. Notify providers treating osteoporosis and oncology patients of any new requirements.