Osteoporosis is a common condition in the United States. Over 10 million people have osteoporosis, and 44 million have bone density levels that are well below normal. People with osteoporosis live with limited mobility, pain, loss of height, and fear of bone fractures daily.
What Is Osteoporosis, and Are You At Risk?
Taken from the Greek language, osteoporosis means porous bones. It is a condition that promotes bone tissue deterioration and leads to brittle, fragile bones that are at greater than normal risk of cracking, breaking, or compressing under pressure. While there is no cure for osteoporosis, there are treatments that can help by slowing bone deterioration. They can help protect and strengthen bones, and even in some cases, stimulate new bone growth.
Osteoporosis is called a silent disease because there are typically no symptoms until you get a broken bone. The most common fractures occur in the hip, wrist, spine and shoulder.
The human body contains specific cells that are bone producing cells, and other cells that are bone removing cells. When this process is working normally, there is a continuous process of breaking down and building up of bone tissue, resulting in strong, healthy bones. In post-menopausal osteoporosis, the bone removing cells are more active which means the rate of bone loss is greater than the rate of bone building, resulting in brittle bones.
Osteoporosis most commonly occurs in women after menopause because estrogen levels decrease. Lower levels of estrogen are responsible for a higher rate of bone loss.
Some other conditions that increase the chances of osteoporosis are:
- Kidney disease
- Ovaries being surgically removed
- Sedentary lifestyle
- Taking certain medications
If you are a post-menopausal woman who has osteoporosis, your physician may suggest taking Prolia. Prolia, or the generic denosumab, is a prescribed injectable medication can be prescribed for post-menopausal women to reduce the incidence of vertebral, non-vertebral, or hip fractures. It can also be prescribed to increase bone mass in men with osteoporosis. Prolia helps bones retain mass and strength. It is worth your time to find out more about whether your Medicare insurance plan pays for treatment, if you are eligible, what to expect from this treatment, and if Prolia is right for you.
Does Your Medicare Coverage Include Prolia?
Original Medicare Part A and Part B may cover 80 percent of the cost of injectable medications for osteoporosis if you are a post-menopausal female and comply with the criteria for home health services. You must also meet the following requirements to be eligible:
- You have a bone fracture due to post-menopausal osteoporosis.
- You, or any other family member, is unable or unwilling to administer the injection
and your physician provides certification to back this up.
If you are eligible, Medicare covers 80 percent of the Medicare approved cost. You must also pay the deductible for Medicare Part B which is $185.00 in 2019.
Medicare Part D Coverage for Prolia
Many Medicare recipients enroll in Part D prescription drug plans to help cover the costs of medications. Most Part D plans will include Prolia on its formulary, or list of covered drugs. Through Medicare Part D, Prolia is covered for approximately 95 percent of its beneficiaries, 50 percent of whom do not need prior authorization. Because this coverage depends on your individual medical benefit coverage plan, it is best to discuss the details with your plan and your physician.