CommercialCoverageMedium impact
08.00.94u, Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®)
Independence Blue Cross·Endocrinology, Rheumatology, Oncology +3 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Medical necessity criteria for Denosumab (Prolia, Xgeva) and related biosimilars, and Romosozumab-aqqg (Evenity) have been updated for commercial plans. This affects bone health medications commonly used in osteoporosis and cancer treatment.
Action Required
By January 1, 2026: Billing team must review and update prior authorization requirements for Denosumab (Prolia, Xgeva) biosimilars and Romosozumab-aqqg (Evenity) prescriptions. Providers should ensure documentation meets new medical necessity criteria before prescribing these bone health medications. Access full policy details at the source URL to understand specific coverage requirements.