Medicare AdvantageCoverageMedium impact
MA08.052p, Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®)
Independence Blue Cross·Endocrinology, Geriatrics, Oncology +1 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
This policy governs coverage and reimbursement for Denosumab (Prolia®, Xgeva®), related biosimilars, and Romosozumab-aqqg (Evenity®) for Medicare Advantage members. The policy is effective April 1, 2026, and billing teams must ensure claims for these medications are processed according to the specific coverage criteria outlined in MA08.052p to avoid denials.
Action Required
By March 15, 2026: Billing team must obtain and review the full text of policy MA08.052p to identify specific coverage requirements, prior authorization needs, and reimbursement rules for Denosumab (Prolia®, Xgeva®), biosimilars, and Romosozumab-aqqg (Evenity®). Update billing system edits and prior authorization workflows in compliance with this policy. Notify prescribers of any new documentation or authorization requirements. Verify all claims submitted on or after April 1, 2026, align with MA08.052p requirements to prevent claim denials for Medicare Advantage beneficiaries.