New member with questions about Zytiga for 91yo dad on Medicare

I need some advice regarding ZYTIGA. My father is 91 his PSA is 10 he was diagnosed in 2000 and his PSA was .1 a year ago . He saw his urologist and he said he wants my father to start ZYTIGA. I checked with my dad's insurance and my fathers co-payment would be $2700 month Dr. said he would be on it for 11 months to start. I know this will deplete his part D benefit. Does anyone have any experience with this medication or any advice. My dad is currently getting Zoladex injection every 3 months which the Dr. said for him to continue with the ZYTIGA.
My dad is very sharp and although he has other ailments bad arthritis and diabetes he has a great attitude. I just don't want him to loose his spirit or suffer with side effects from the ZYTIGA including the expense.
Please help.

Gave your thread a title.

Post Edited By Moderator (PeterDisAbelard.) : 2/22/2014 9:25:23 PM (GMT-7)

Ricky ....

   I do have some experience with the Zytiga and its costs. I was on Zytiga in 2012 for a total of 5-months ... along with prednisone at 10mg daily. I am on medicare and do have part D coverage .... and did at that time also.

   Costs ... thru Part D:

My first month cost me $2600. BUT the

Second month was much less (about $500.) because of the donut hole.

The third month was around $350. as I was approaching the next phase.

And from there on, it was about $250. per month after the above phase.

   I think the second phase is "disaster" phase or similar and phases in at around after $4500. has been spent in a given year.

   So, the first month is very expensive ..... then the Part D really does help. What seemed like it might cost close to $30,000. at $2700. per month ...... really should be closer to $6000. with the greatly declining costs after the first month.

   In 2012, my total cost of meds (out-of-pocket) were $6000. and that included some expensive inhalers like Spiriva and Advair + 5-months of Zytiga + all my other meds for the year.

   Please double-check his insurance coverage for Part D.

Peace and wellness

Rob & Gizmo

 

A couple of thoughts ...

1. Perhaps there is a doctor adminsitered treatment that falls under part B rather than part D. That is the case for the Lupron and Xgeva I am on, but not sure about the more advanced treatments after pSA starts to rise.

2. The donut hole is supposed to be closing until eventually it goes away in year 2020 or so, but that would not be until he is 97.

Here's an article I found on Google about donut hole actually going the other direction in 2014 but if you Google donult hole you can find others about it eventually going away,

www.reuters.com/article/2013/02/21/us-column-miller-medicare-idUSBRE91K13J20130221

See

www.medicare.gov/pubs/pdf/11493.pdf

which includes the following explanation of the slowly disappearing doughnut hole: "Over the next several years, you pay less in the coverage gap until it’s closed by 2020. By 2020, you’ll pay only 25% for covered brand-name and generic drugs during the gap—the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the out-of-pocket spending limit (up to $4,750 in 2013)."

There is something to say for Logo's advice to do nothing as he enjoys the next 10 years of his journey to the century mark, as long as he remains pain free.

LupronJim

I locked the duplicate thread. Please continue that discussion here.

Ricky ......

   Please double check the Zytiga One instant savings card.

   There are several exclusions, minimums or maximums .... implying that the $10./month savings is available only after spending $12,000. on the med itself (as a deductible) in one year ... or two other conditions related to a 12-month time period to be met first before the $10./month rate is available.

   And ..... it is NOT available to anyone on medicare or medicare part D! I did find one notation where it is available for some private insurance companies - but still, it implies a $12,000. deductible.

   So .... at best, it's only available for some people not on medicare .... and only after they spend a huge deductible first.

   Always read the fine print.

Peace and wellness

Rob & Gizmo

 

  

Ricki ......

   I had a different Part D insurer and my Zytiga was in 2012 ..... BUT what you were told by Humana is exactly how my coverage operated two years ago .... just slightly more money two years later.

   You can check the Zytiga website - and they will give you a list of possible side effects in percentages of likelihood.

Good luck to both of you.

Rob & Gizmo