IMPORTANT UPDATE:

For 2022, we are implementing an automatic re-enrollment process which will automatically extend any patient with activity in 2021 through 2022. This means there is no action required to re-enroll a patient at this time. Patients may continue to utilize their copay benefits and you may submit explanation of benefits (EOBs) as normal.

Patients
Healthcare
Providers
Specialty
Pharmacies

Does the patient have a
Prolia® (denosumab) Co-pay Card?

No

Please click the button below to begin the registration process.

Prolia® Co-pay Card is verified.

However, the patient must register.

Please click the button below to begin the registration process, which must be completed before the card is ready to use.

Need help? Call the Prolia® Co-pay Program at 1-844-369-9962 for assistance.

Downloadable Forms

Privacy Notice and Patient Authorization Form for the Prolia® Co-pay Program

Download Form

Check Request Form for the Prolia® Co-pay
Program

Download Form

The Prolia® Co-pay Program Prepaid MasterCard® is issued by Comerica Bank pursuant to license by MasterCard International Incorporated. No cash or ATM access. MasterCard is a registered trademark of MasterCard International Incorporated. This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted.

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