Access & Reimbursement

For Your Practice:

Amgen Assist®

For comprehensive reimbursement support

Amgen provides a dedicated reimbursement specialist with knowledge of local coverage and reimbursement policies to assist your practice with:
- Prior authorization
- Insurance verification
- Reimbursement support

Approximately 70% of XGEVA^® patients are expected to have $0 out-of-pocket cost¹*

*Estimated amount of Medicare beneficiaries with supplemental coverage and commercially insured patients with no OOP cost; based on XGEVA^® payor mix and coverage of XGEVA^® and other similar products.
XGEVA FIRST STEP™ Coupon Program can help your commercially insured patients meet their out-of-pocket costs:
- No income eligibility requirements
- $0 out-of-pocket cost for initial dose (single-use vial)
- $25 maximum out-of-pocket cost for subsequent doses (single-use vial)
Patient may not participate in Medicare, Medicaid, or another federally funded healthcare program. Total program benefits $5,000 per patient per 6-month-calendar period. Patient is responsible for costs above this amount. Program does not cover office visit, physician, staff, or administrative charges associated with administering XGEVA^®. The program is not valid where prohibited by law. Other restrictions may apply. Amgen reserves the right to revise or terminate this program, in whole or in part, without notice at any time. For a complete list of eligibility requirements and restrictions, call 1-888-657-8371.

To learn more, go to www.AmgenFIRSTSTEP.com
XGEVA^® patients who need help may be eligible for financial assistance from:
- Independent co-pay foundations
- The Safety Net Foundation (XGEVA^® at no cost for eligible patients)

XGEVA^® (denosumab) is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors.

XGEVA^® is not indicated for the prevention of skeletal-related events in patients with multiple myeloma.

Hypersensitivity

XGEVA^® (denosumab) is contraindicated in patients with clinically significant hypersensitivity to any component of the product.

Hypocalcemia

XGEVA^® (denosumab) can cause severe symptomatic hypocalcemia, and fatal cases have been reported. Correct pre-existing hypocalcemia prior to XGEVA^® treatment. Monitor calcium levels and administer calcium, magnesium, and vitamin D as necessary. Monitor levels more frequently when XGEVA^® is administered with other drugs that can also lower calcium levels. Advise patients to contact a healthcare professional for symptoms of hypocalcemia.
Based on clinical trials using a lower dose of denosumab, patients with a creatinine clearance less than 30 mL/min or receiving dialysis are at greater risk of severe hypocalcemia compared to patients with normal renal function. The risk of hypocalcemia at the recommended dosing schedule of 120 mg every 4 weeks has not been evaluated in patients with a creatinine clearance less than 30 mL/min or receiving dialysis.

Osteonecrosis of the Jaw (ONJ)

Osteonecrosis of the jaw (ONJ) can occur in patients receiving XGEVA^® (denosumab), manifesting as jaw pain, osteomyelitis, osteitis, bone erosion, tooth or periodontal infection, toothache, gingival ulceration, or gingival erosion. Persistent pain or slow healing of the mouth or jaw after dental surgery may also be manifestations of ONJ.
Perform an oral examination and appropriate preventive dentistry prior to the initiation of XGEVA^® and periodically during XGEVA^® therapy. Advise patients regarding oral hygiene practices. Avoid invasive dental procedures during treatment with XGEVA^®.
Patients who are suspected of having or who develop ONJ while on XGEVA^® should receive care by a dentist or an oral surgeon. In these patients, extensive dental surgery to treat ONJ may exacerbate the condition.

Atypical Subtrochanteric and Diaphyseal Femoral Fracture

Atypical femoral fracture has been reported with XGEVA^® (denosumab). Causality has not been established as these fractures also occur in osteoporotic patients who have not been treated with anti-resorptive agents. A number of reports note that patients were also receiving treatment with glucocorticoids at the time of fracture. Any patient who presents with thigh or groin pain should be suspected of having an atypical fracture and should be evaluated to rule out an incomplete femur fracture. Interruption of XGEVA^® therapy should be considered, pending a risk/benefit assessment, on an individual basis.

Pregnancy

Women should be advised not to become pregnant when taking XGEVA^® (denosumab). If the patient is pregnant or becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

Adverse Reactions

The most common adverse reactions in patients receiving XGEVA^® (denosumab) were fatigue/asthenia, hypophosphatemia, and nausea. The most common serious adverse reaction was dyspnea. The most common adverse reactions resulting in discontinuation were osteonecrosis and hypocalcemia.