← Return to Forced to switch to biosimliar of Prolia by local provider clinic

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Profile picture for vic83 @vic83

Thanks for looking into it. Prolia is covered by Medicare Part B and not by Part D. It is a drug that must be administered in the doctor's office, apart from the training of where to inject it, the doctor can submit Part B claims. At the drug store it would go under Part D, if it is on your formulary and at a very different out of pocket cost!!!!
People on Medicare must be aware that certain drugs like vaccines, etc. should be done at the pharmacy and not in the doctor's office because they fall under Part D and Drs don't submit that type of claim, so one gets hit with extra cost. However if needed in the Urgent Care then it could be covered. Example is the tetanus vaccine, covered at Urgent Care if one has a wound, otherwise one must go to pharmacy.
My beef with local clinic is that they are switching people because they make more money, not because better for the patient.

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Replies to "Thanks for looking into it. Prolia is covered by Medicare Part B and not by Part..."

As a caveat, if you have a Medicare advantage plan, you can get your vaccines in the doctors office