Medicare AdvantageCoverageMedium impact
We're encouraging select members to discuss biosimilars with their providers
Priority Health·Pharmacy, Oncology, Endocrinology +1 more·Pharmacy
We identified it
Aug 13, 2026
Summary
Priority Health is proactively outreaching to select Medicare members currently on Prolia® or Xgeva® to encourage discussions with providers about transitioning to covered biosimilars. The practice should expect member inquiries and be prepared to evaluate biosimilar alternatives (Jubbonti, Bildyose, Enobyx for Prolia; Wyost, Bilprevda, Xtrenbo for Xgeva) based on clinical appropriateness. This is a coverage/formulary guidance update with no immediate billing code changes required.
Action Required
Immediately: Clinical and billing staff should familiarize themselves with the covered biosimilar alternatives listed (Jubbonti, Bildyose, Enobyx for Prolia; Wyost, Bilprevda, Xtrenbo for Xgeva). Providers should be prepared to discuss biosimilar options with members who contact the office following Priority Health outreach. Billing team should verify coverage for biosimilar claims against the Medicare Part B Medical Drug List (MDL) and Medicare Part D Approved Drug List (ADL) before processing. No workflow changes are required at this time, but staff should acknowledge that treatment decisions remain based on clinical judgment and individual member needs. Refer to the source URL for the most current drug lists.