Q5173 Inj, denosumab-adet, 1 mgInjection, denosumab-adet (ponlimsi), biosimilar, 1 mg
Status E: excluded from the PFS by regulation.
6 of 6 payer prior-auth lists that name Q5173 require prior authorization or set conditions: Aetna, Cigna, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Aetna | Medicare Advantage | All | prior auth required | May 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Commercial | All | prior auth required | May 1, 2026 | Participating provider precertification list for Aetna® | |
| Cigna | ACA/IFP | All | prior auth required | eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients | Oct 1, 2026 | Master Precertification List (For Health Care Providers) |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 |
Q5173 appears in 2 coverage policies from Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Denosumab and Biosimilars for Non-Oncologic Indications (RX501.140) HCPCS Codes C9399, J0897, J3490, J3590, J9999, Q5136, Q5157, Q5158, Q5159, | listed, no stance | Jan 1, 2027 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Oncology and Supportive Care Medications (RX502.061) oysk | Hycleta™ | listed, no stance | Jan 1, 2027 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.