Denosumab biosimilars — every Q-code, priced and compared

All nine denosumab biosimilar pairs, compared FDA Purple Book verified Sep 2026

Each row pairs a 60 mg Prolia-line brand with a 120 mg Xgeva-line brand under one BLA and one HCPCS code, except Boncresa/Oziltus (two BLAs, two codes). Prices are Q4 2026 Medicare ASP+6%.

* First denosumab biosimilar designated interchangeable; own decision date. † Shared date — see interchangeable dates explained below. ‡ BLA holder Samsung Bioepis; US NDC/DailyMed labeler is Cordavis Limited. § BLA holder Shanghai Henlius Biotech; US NDC/DailyMed labeler is Organon LLC. ¶ Boncresa and Oziltus are the one exception to the shared-code pattern: Amneal filed them as two separate BLAs, so CMS assigned two separate HCPCS codes rather than one shared code — Q5171 is Boncresa (60 mg), Q5165 is Oziltus (120 mg). ** Q5173 was not independently verified against a primary CMS document this review cycle; treat as pending. Ponlimsi itself has no DailyMed listing or NDC directory entry as of this review, so it does not appear to be commercially launched despite FDA licensure since March 27, 2026, and no Xgeva-line partner brand was found for it. "Not published" means CMS has not published a Q4 2026 ASP payment limit for that code — verify the payer's own contracted rate instead of assuming a Medicare figure.

Why most interchangeable dates read October 29, 2025 FDA Purple Book verified Sep 2026

Every currently licensed denosumab biosimilar carries the FDA's interchangeable designation — but the date attached to most of them isn't when each was individually decided.

Jubbonti and Wyost were designated interchangeable on March 5, 2024, first in the class, and held a 12-month first-interchangeable market exclusivity. Other denosumab biosimilars could not launch as interchangeable until it ran out on October 29, 2025. That is why seven of the other eight pairs in the table carry that date in the Purple Book: six were licensed earlier in 2025, and Osvyrti/Jubereq was licensed that same day. Boncresa/Oziltus (December 19, 2025) and Ponlimsi (March 27, 2026) came later, so their interchangeable dates equal their approval dates.

How to bill a denosumab biosimilar CMS verified Sep 2026

Three rules apply across all nine pairs, regardless of which biosimilar was administered.

1. Its own Q-code, never J0897

J0897 is reserved for reference Prolia and Xgeva. Every biosimilar in this class has its own distinct HCPCS code — billing J0897 for a biosimilar, or a biosimilar's code for the reference product, is a clean claim-accuracy error regardless of which molecule was actually given.

2. NDC matches the syringe or vial drawn

Because a shared Q-code can cover two brand names (the 60 mg and 120 mg lines), and in Stoboclo's case two separate NDC listings for the same brand, the NDC entered on the claim has to match the exact package actually administered — not just the generic suffix or the brand name in the chart.

3. JZ is the norm

Every product in this class ships in a fixed-dose single-use syringe or vial that matches the fixed 60 mg or 120 mg dose exactly, so the JZ no-waste modifier belongs on nearly every claim. JW applies only when a syringe or vial is opened and the full dose isn't administered. A hospital billing Medicare for 340B-acquired product uses TB; CMS retired JG on January 1, 2025.

Single-code billing detail, worked claim-form examples, and admin codes: Jubbonti · Stoboclo · Prolia/Xgeva.

Payer preference, payer by payer 27-payer corpus, reviewed Sep 2026

27 of 30 commercial payer policy sets surveyed hold a denosumab policy at all. Preference is not uniform, and four payers illustrate why the 60 mg and 120 mg dose lines can't be read as one rule.

Counting a payer once if it prefers either brand on a code: Q5136 (Jubbonti/Wyost) is preferred or step-first at 11 of 27 payers, Q5162 (Bildyos/Bilprevda) at 10, and Q5157 (Stoboclo/Osenvelt) at 9. Some of those count only one line. Centene prefers Wyost, Bilprevda and Osenvelt for oncology, and Regence prefers Wyost and Bilprevda in its malignancy policy. So on the 60 mg side the counts are Jubbonti 9, Bildyos 8 and Stoboclo 8. UnitedHealthcare's two preferred products are brand Prolia and Stoboclo.

Preference splits by dose line at four payers

These four payers write a separate rule for each dose line, and at one of them the reference brand's status flips with the line billed:

• BCBS Massachusetts is the clearest split: brand Prolia is non-preferred on the osteoporosis side (Jubbonti, Conexxence, and Stoboclo are preferred instead, and Prolia needs two failed biosimilar trials first), but brand Xgeva is preferred on the oncology side, alongside Wyost, Bomyntra, and Osenvelt. Same reference J-code, opposite preference status, depending only on which dose line the claim represents.
• Anthem/Elevance keeps the two dose lines as separate rule cells too, but doesn't reverse anything: brand Prolia is preferred on the osteoporosis cell and brand Xgeva is preferred on the oncology cell, with every biosimilar non-preferred on both.
• BCBS Nebraska also runs two cells, each naming its own trio of preferred biosimilars (Bildyos, Jubbonti, and Stoboclo on the osteoporosis side; Bilprevda, Wyost, and Osenvelt on the oncology side) while keeping both reference brands non-preferred on both sides.
• Florida Blue asks Prolia-line requests (Prolia, Boncresa, Bosaya, Conexxence, Enoby, Ospomyv, Osvyrti) to show failure of Bildyos, Jubbonti and Stoboclo. It asks Xgeva-line requests to show failure of Bilprevda, Wyost and Osenvelt. Reference J0897 is non-preferred on both lines.

Full step-therapy and preferred-product detail for each code: Jubbonti payer policies · Stoboclo payer policies.

Price spread & assistance status CMS Q4 2026 (live) + program records checked May–Sep 2026

Medicare ASP+6% spans nearly 4x across this class, and assistance-program coverage is uneven.

Enoby and its 120 mg twin Xtrenbo (Hikma) carry the lowest Medicare payment limit of any denosumab product with a published Q4 2026 ASP — about half of Bildyos/Bilprevda's $15.336, the next lowest, and about 74% below reference Prolia/Xgeva. Unlike every other biosimilar pair in this comparison with a published price, no manufacturer assistance program was found for Enoby in our program file — no co-pay card, no free-drug program. A patient with high cost-sharing exposure on Enoby has no manufacturer program to fall back on, unlike patients on Jubbonti, Stoboclo, Conexxence, Bosaya, or Bildyos, each of which carries at least one open assistance program.

Frequently asked questions

How many denosumab biosimilars are there?

Nine FDA-licensed brand pairs, each a 60 mg Prolia-equivalent plus a 120 mg Xgeva-equivalent, sharing one HCPCS code in eight of the nine cases. One brand in those pairs, Xbryk, has no DailyMed or NDC directory listing as of September 21, 2026. A tenth product, Ponlimsi (Teva), is licensed and interchangeable but also has no listing, so it does not appear to be on the market.

Are all denosumab biosimilars interchangeable with Prolia and Xgeva?

Yes. Every currently licensed denosumab biosimilar carries the FDA's interchangeable designation, not merely biosimilar. Jubbonti and Wyost were first, designated interchangeable on March 5, 2024. Most of the others carry an interchangeable-approval date of October 29, 2025, which is when Jubbonti/Wyost's 12-month first-interchangeable market exclusivity expired, not each product's own individual decision date.

Do I bill a denosumab biosimilar under J0897?

No. J0897 is reserved for reference Prolia and Xgeva only. Every biosimilar bills its own distinct Q-code — Q5136 for Jubbonti/Wyost, Q5157 for Stoboclo/Osenvelt, and eight more — never J0897. Match the HCPCS code to the NDC actually drawn, and append JZ when the full dose is administered with nothing discarded, which is the norm for this class.

Which denosumab biosimilars do payers prefer?

It depends on the plan and, at several plans, on the dose line. Across 27 commercial payer policies, Q5136 (Jubbonti/Wyost) is on 11 preferred lists, Q5162 (Bildyos/Bilprevda) on 10 and Q5157 (Stoboclo/Osenvelt) on 9, counting a payer if it prefers either brand on the code. UnitedHealthcare prefers Prolia and Stoboclo together. BCBS Massachusetts prefers Jubbonti/Conexxence/Stoboclo on the Prolia line but brand Xgeva itself on the oncology line — the same reference J-code flips from non-preferred to preferred depending on which line is billed.

What is the price spread across denosumab biosimilars?

Wide. Q4 2026 Medicare ASP+6% ranges from $29.856 per mg for reference Prolia/Xgeva down to $7.681 per mg for Enoby/Xtrenbo (Hikma) — about 74% lower. Our program file has no assistance program for Enoby. The Jubbonti, Stoboclo, Conexxence, Bosaya and Bildyos pairs each have at least one open program; the Ospomyv, Boncresa/Oziltus and Osvyrti pairs have none on file.

Source documents

1. FDA Purple Book Database — full monthly data file, August 2026 release
   BLA numbers, approval dates, interchangeable-designation dates for all nine pairs plus Ponlimsi
2. CMS MCD Article A52399 — Billing and Coding: Denosumab and biosimilars
   HCPCS code assignments, including the Boncresa/Oziltus split-code exception
3. CMS — Medicare Part B Drug ASP Pricing File
   Q4 2026 quarterly file, all eleven HCPCS codes checked
4. openFDA NDC Directory — denosumab listings
   Marketing status: which brands have an NDC listing (Xbryk and Ponlimsi do not)
5. CareCost Estimate — Prolia reference (J0897)
   ICD-10 by indication, boxed warnings, MUE, 96372 admin rate
6. CareCost Estimate — Jubbonti reference (Q5136)
   Single-code billing detail, Sandoz assistance program status
7. CareCost Estimate — Stoboclo reference (Q5157)
   Single-code billing detail, Celltrion assistance program status
8. CareCost Estimate — Xgeva reference
   120 mg oncology dose line detail

About this page

The pricing column ties directly into CareCost's ASP data layer, so it moves the day CMS ships a new quarterly file. The comparison itself — codes, interchangeable status, payer preference, assistance status — gets a fresh pass at least quarterly, sooner if a manufacturer or a payer changes something first.

Found an error? Email hello@carecostestimate.com.

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About the reviewer

Change log

• Sep 21, 2026 — First version of this page: the nine-pair-plus-Ponlimsi table, an explainer on why most interchangeable dates read the same, the three billing rules that apply across the whole class, the payer-preference split-by-line analysis (Anthem, BCBS Massachusetts, BCBS Nebraska, Florida Blue), the BCBS Mississippi non-coverage note, and the Q4 2026 price spread against assistance-program status.

Methodology

Nothing in the comparison table is estimated. Approval and interchangeable-status data come from the FDA Purple Book's full monthly data file; HCPCS assignments come from the current CMS billing article; pricing is read live off the CMS Part B ASP file; payer rules come from each plan's own published policy; assistance status comes from each manufacturer's own program page, not a summary of it. A figure we can't trace to one of those sources doesn't appear here rather than getting filled in from memory or a vendor blog. We flag anything not yet SME-verified rather than assert it.