is Prolia always prescribed first?

http://www.breastcancer.org/research-news/prolia-r...

FWIW - Zometa works differently from Prolia but also shows reduction in bone metastases.

While it is an infusion as opposed to the simplicity of an injection, it is significantly less expensive than Prolia, so insurers may be more inclined to cover it. Both are dosed at 1x every 6 months and have similar side-effects.

I just had my second infusion of Prolia on Tuesday. All good so far, didn't notice it.

My insurance plan changed in January, so I had to go through a new approval process. It is my understanding that most private insurance plans in the US cover Prolia for women who had breast cancer, are on AI and have increased osteopenia while on AI. They do require a pre-approval before covering the drug but if you fall under this condition, the approval is easy and quick. I was shipped Prolia in self-injectable syringe. I took it to my hospital clinic to be injected but I think i might do it myself next time. The nurse recommended I do it myself if the insurance agrees to it (will call them in a couple of months.) The medication cost was covered 100% by pharmacy coverage.

I wanted Prolia—my baseline DexaScan done just before starting radiation and two months before starting my AI (letrozole) showed moderate osteopenia. But when the time came, my MO said that my Medicare Part B supplement carrier denied it because it wasn’t a “treatment” but rather an “injectable drug;” and my Part D carrier refused to authorize it because of price. I can’t take oral bisphosphonates because I have GERD (hiatal hernia). So my MO had me do an infusion of the I.V. bisphosphonate Zometa (aka Reclast). Because it was administered I.V. in the chemo suite, Part B considered it a “treatment” and covered it.

Never again. Because I can use only my left arm for needle sticks, they had to try 5 times (even with the infrared Accu-Vein lamp) before they could get a good vein; it hurt like hell with every pulse of the pump; and I was sick as a dog with “faux-flu” for several days. I had bone and muscle aches (the bone pain was lessened by switching my antihistamine from Zyrtec to Claritin), high (102+) fevers and foot neuropathy so painful I had to take Lyrica.

When I told my PCP, he hit the ceiling. He said that bisphosphonates (oral or I.V.) protect against only spinal fractures, not long bone fractures. In fact a rare side effect of Zometa can be atypical “paradoxical” horizontal fractures of the femur (that’s right—the thighbone snaps in two) without any precipitating trauma. Moreover, though both Zometa & Prolia protect against &/or delay progression of bone mets, Prolia is more effective. Most of the other side effects are more common with Zometa; only the risk of infection is higher with Prolia because it’s a biologic. But if you have a good immune system and are very careful, you probably won’t get those infections (and if you do, they can be treated with powerful antibiotics or antivirals). Yes, Prolia costs more—list price is $5K per shot. But with a GoodRx coupon, it costs anywhere from $900-1200 depending on where you buy it. And the insurance companies are being short-sighted. I got my BCBS Part B EOB last week—and that Zometa infusion was $3800 for the drug alone; adding the bloodwork, chemo suite fee and nurse & phlebotomy services brought the bill up to $5K!

And an AI alone can raise your LDL cholesterol, glucose and a1c. Welcome to the stage of life where you can’t fix one thing without breaking something else, and fixing that breaks yet another thing, and...

My most recent DEXA showed I slid into osteoporosis after 4 years of aramidex. My PCP wrote, and I picked up the rx for fosomax. Then I read the 6 pages of warnings that came with it. Scared me to pieces. Jaw necrosis. That it can CAUSE fractures. Plus a lot of things that could affect me from my other issues.

Then I looked at Prolia. That scared me more!! If I read correctly it doesn't play nice with most chemo if your cancer reoccurred. And that's assuming insurance will pay for it.

So I had appt. with PCP today, and I'm not going to take the pill or infusion. He said the best thing to do was walk.

I do take 1200 calcium and 5000 D3 daily.