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:
*
Enter your 4-digit year of birth for verification (YYYY):
Do you belong to any state or federally funded health care
program such as Medicare, Medicare Advantage, Medicaid or TRICARE?
Yes     No
Do you have healthcare insurance?
Yes     No
Do you live in, or get treated in, the state of Massachusetts?
Yes     No
   

Please verify that all the information is correct and press submit when complete.

Indications

Prolia® is indicated as a treatment to increase bone mass in men at high risk for fracture receiving androgen deprivation therapy for nonmetastatic prostate cancer. In these patients Prolia® also reduced the incidence of vertebral fractures.

Prolia® is indicated as a treatment to increase bone mass in women at high risk for fracture receiving adjuvant aromatase inhibitor therapy for breast cancer.

Important Safety Information

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.

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®.

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
  • Are breast-feeding or plan to breast-feed

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 http://www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see full Prescribing Information, including Medication Guide for more information about Prolia®.

The Prolia FIRST STEP™ Program is issued by The Bancorp Bank pursuant to license by MasterCard International and this card may not be used everywhere Debit MasterCard is accepted.  No cash or ATM access.  MasterCard is a registered trademark of MasterCard International Incorporated.  The Bancorp Bank; Member FDIC.