Prolia FIRST STEP Program Registration

Welcome to the Prolia FIRST STEP Program. Please complete the online form below to register your card.

If you have any questions or problems using your card after registration, please call 1-888-65-STEP1 (1-888-657-8371) from 9 a.m. to 8 p.m. ET, Monday-Friday.


ENTER CARD INFORMATION: STEP 1 OF 2


* Required Data

* Enter the last 4 digits of the 16-digit MasterCard number that appears in the middle of the card:
* Please enter the 8 digit Card number that appears on the bottom left of your card starting with PR:
Are you a resident of one of the 50 United States or Puerto Rico?
  • Yes
  • No
*Date of Birth (for verification): (DD-MM-YYYY):
Do you belong to or have prescriptions paid for by any: i) federal government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD) or TRICARE, or ii) any similar state-funded program such as a state pharmacy assistance program?
  • Yes
  • No
The Amgen FIRST STEP Program is not valid for patients who belong to any federal, state or government-funded healthcare program and you must have commercial or private healthcare insurance to be eligible for this program. Should you at any time begin receiving health insurance under such a federal, state or government-funded healthcare program, you will no longer be eligible to participate in the Amgen FIRST STEP Program. Do you agree with this statement?
  • Yes
  • No
Do you have commercial or private healthcare insurance?
  • Yes
  • No
Are you a patient who is enrolled in a plan offered through the Health Insurance Exchanges?
  • Yes
  • No

Indications

What is Prolia?

Prolia® is a prescription medicine used to:

  • Treat bone loss in men who are at high risk for fracture receiving certain treatments for prostate cancer that has not spread to other parts of the body.
  • Treat bone loss in women who are at high risk for fracture receiving certain treatments for breast cancer that has not spread to other parts of the body.

Important Safety Information

Do not take Prolia® if you have low blood calcium, are pregnant or plan to become pregnant, as Prolia may harm your unborn baby; or are allergic to denosumab or any ingredients in Prolia®.

What is the most important information I should know about Prolia®?

If you receive Prolia®, you should not receive XGEVA®. Prolia® contains the same medicine as XGEVA® (denosumab).

Prolia® can cause serious side effects:

Low calcium levels in your blood (hypocalcemia). Prolia® may lower the calcium levels in your blood. If you have low blood calcium, it may get worse during treatment. Your low blood calcium must be treated before you receive Prolia®.

Your doctor may prescribe calcium and vitamin D to help prevent low calcium levels in your blood. Take calcium and vitamin D as your doctor tells you to.

Serious allergic reactions have happened in people who take Prolia®. Call your doctor or go to your nearest emergency room right away if you have any symptoms of a serious allergic reaction, including low blood pressure (hypotension); trouble breathing; throat tightness; swelling of your face, lips, or tongue; rash, itching, or hives.

Severe jaw bone problems (osteonecrosis). Severe jaw bone problems may occur. Your doctor should examine your mouth before you start Prolia® and may tell you to see your dentist. It is important for you to practice good mouth care during treatment with Prolia®.

Unusual thigh bone fractures. Some people have developed unusual fractures in their thigh bone. Symptoms of fracture include new or unusual pain in your hip, groin, or thigh.

Before taking Prolia®, tell your doctor if you:

  • Are taking a medicine called XGEVA®. XGEVA® contains the same medicine as Prolia®.
  • Have low blood calcium.
  • Cannot take daily calcium and vitamin D
  • Had parathyroid or thyroid surgery (glands located in your neck)
  • Have been told you have trouble absorbing minerals in your stomach or intestines (malabsorption syndrome)
  • Have kidney problems or are on kidney dialysis
  • Plan to have dental surgery or teeth removed
  • Are pregnant or plan to become pregnant
    • If you are a man and you receive Prolia®, small amounts of Prolia® may be in semen. If your sexual partner is pregnant, some Prolia® from your semen may reach the unborn baby. While the risk is likely to be low, it is important to talk to your doctor if your partner becomes pregnant while you are taking Prolia®.
  • Are breastfeeding or plan to breastfeed

What are the possible side effects of Prolia®?

It is not known if the use of Prolia® over a long period of time may cause slow healing of broken bones or unusual fractures. The most common side effects of Prolia® in patients receiving certain treatments for prostate or breast cancer are joint pain, back pain, pain in your arms and legs, and muscle pain.

These are not all the possible side effects of Prolia®. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see full Prescribing Information, including Medication Guide.