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Price of ZYTIGA

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Posted 7/1/2017 2:23 PM (GMT 0)
Just a quick question: Is ZYTIGA as expensive as it is seen online?!!!
Who can afford $300 per day?
Posted 7/1/2017 3:27 PM (GMT 0)
That is not what one pays depending on their insurance plan.

I just consulted my drug insurance plan, Silverscript, and found that the cost is about $450 per month. I did not check the cost of the Prednisone that is taken wit Zytiga but I understand it is not expensive.
Posted 7/1/2017 5:48 PM (GMT 0)
"I just consulted my drug insurance plan, Silverscript, and found that the cost is about $450 per month. "

I think they quoted you what your co-pay would be......

Both Zytiga and Xtandi list for between $8000 & $10,000 for a months supply, $120,000 a year....

If you are on Medicare, the first month or two you pay a $1600 co-pay..Then you hit the doughnut hole for a month (you will pay more) but by the 4th month you fall into the catastrophic coverage category and the co-pay is substantially reduced.. If you are still alive a year later, it starts over again..

But don't despair... There are many pathways open to you to get help paying for these drugs..It all depends on your income and assets. If you don't want the drug companies and the government to get it all, give it to the kids NOW...When you are broke or nearly so, there are a half-dozen programs that will pick up your pharmacy tab at little or no cost to you..If you are a Veteran, don't forget that pathway to low cost prescriptions..
Posted 7/1/2017 8:09 PM (GMT 0)
What they quote is what it would actually cost me. That is what matters. You quote list prices but nobody pays the list price and we all know they don't matter. The insurance companies negotiate the price and we pay premiums and copay and deductibles. Again what we actually pay is what matters not the list price. Just like cars. None pays the MSRP.
Posted 7/1/2017 8:33 PM (GMT 0)
Thanks for all the answers, my father lives in Iran and his income is less than 300 USD per month (Retired some years ago with their minimum wage). Therefore I might be the one who will support him if the doctor puts him on this medication. I live in Canada.
Hope things go well and I can do something about it.
Posted 7/1/2017 8:43 PM (GMT 0)
It is hard for those of us in the US to speak to what these meds cost outside of the US. My Zytiga really was somewhere near $8000 per month, negotiated price.

My Xtandi really is $10002 per month, negotiated price. The insurance company is paying that much.
Posted 7/1/2017 9:59 PM (GMT 0)
I understand your worry Farz53. It is scary to think about having to pay that $300 a day. I started Zytiga last year after I had already hit my annual deductible on my marketplace plan, so my cost was $0. This year, I switched insurers to another one in the marketplace. Even at the beginning of the year with my deductible reset to $0, I still did not have to pay anything.

Janssen is the maker and they had a pretty good procedure mentioned on their website for folks without insurance in need of financial help. As it turned out, I did not have to pursue that angle, but it is there. And with all of the guys taking it here and in other forums and support groups I follow, I can't remember anybody paying anything like that quoted retail price. Good luck to you and your father.
Posted 7/1/2017 11:48 PM (GMT 0)
It might not be that bad.....Outside the United States, Zytiga is called abiraterone acetate and a low-cost generic version might be available..Sometimes overseas drug companies change the name of expensive drugs they are knocking off to avoid getting into patent disputes with the U.S. patent holder...other times backstage agreements are made with the patent holder so the drug can be made available in third world countries at a price the locals can afford..If you dig deeper, things can get pretty murky and worthless counterfeit drugs concocted by backyard "pharmacists" flood the market..
Posted 7/2/2017 2:24 AM (GMT 0)
You guys are awesome!
@Fairwind: That's so helpful you mentioned the generic name. My cousin is a pharmacist Ph.D. in Iran and she can help me know about the availability of any local product with this name.
Just as an example, I buy Fluoxetine (an antidepressant) in Canada as 1 CAD per tablet, while it only cost 1 CAD for 30 tablets in Iran, as a local product.
Posted 7/2/2017 3:44 AM (GMT 0)
Farz53. I'd love to know how you make out with your cousin in Iran. We live in Canada too. The cost/year is in the order of $100,000 for 1000mg daily dose. (Ontario)
However, it's covered only for castrate-resistant men. My husband is very high risk and likely metastatic but no evidence. Because of the recent study published in the NEJM, we think he'd benefit from adding Zytiga to his hormones. Doc will write the prescription but we'd have to pay the whole thing ourselves. He said Janssen would not likely fund it because my husband is not newly diagnosed.

A recent phase 2 trial found that a man can use just 25% of the full dose if he takes the med with a low fat breakfast. /sciencelife.uchospitals.edu/2017/02/14/taking-a-high-priced-cancer-drug-with-a-low-fat-meal-can-cut-cost-by-75/

I've also heard that there is a generic version of the drug in India.
Posted 7/2/2017 5:05 PM (GMT 0)
I like the idea of taking just one pill (instead of four) with a carefully controlled breakfast...
Posted 7/2/2017 5:39 PM (GMT 0)
Haven't heard that about breakfast, but you do have to take Zytiga two hours after eating, and then you have to wait one hour to eat after taking the pills. Drink plenty of water. Best to both of you.
Michael
Posted 7/2/2017 6:09 PM (GMT 0)
You are going to love this one....

/www.keionline.org/node/2662

Also, there are least 3 different pharma companies making and selling generic versions of Zytiga...(but not legally in the U.S.)

Intas calls it Abiratas
Cadila " " Abretone
Glenmark " " Abirapro

The same is true for Xtandi
Posted 7/2/2017 7:59 PM (GMT 0)
I wrote to one of the authors of the zytiga with breakfast study and asked him if taking 1/4 of the dosage would mean that the drug would work longer and he replied that he didn't think so. I asked him if one could expect the same response if the man was not castrate resistant but still hormone sensitive and he responded that he believed it would be the same.

It seems to me that taking 1/4 of the dose for the same effect of any medication would decrease toxicity.
Posted 7/2/2017 10:41 PM (GMT 0)
Annie88, did the study authors say specifically what the breakfast was that the people in the clinical trial ate? One pill vs 4 a day makes sense to me if the outcomes are the same (which is what the study says), especially at $10,000 co-pays/year which many of us unfortunately have to pay. I'm sure the Zytiga manufacturer wants to bury that study!
Posted 7/2/2017 11:58 PM (GMT 0)
It says in info that comes with Zytiga that taking the pills with food could lead to an overdose..So they do the 1000mg dose into an empty stomach to get the blood level of the drug where they want it...Apparently if taken with food, the absorption rate into the blood is higher, much higher..But if you took the time to experiment with the food a little you could achieve the same blood level while taking much less of the drug..Since the idea is to maintain a certain blood level the side-effects can be expected to be the same using either the high dose with no food or a lower dose with carefully selected food...

The trial you mention where they are looking into this, it would be interesting to see who is funding the trial.....
Posted 7/3/2017 1:05 AM (GMT 0)
@Annie88: I just sent her a message and once she answers, I will post it here.
Posted 7/3/2017 2:34 AM (GMT 0)
The abstract of the study just says, "Low fat breakfast".
ascopubs.org/doi/abs/10.1200/JCO.2017.35.6_suppl.176

The clinical trial information just says "conventional low fat breakfast". /clinicaltrials.gov/show/NCT01543776

Can't go wrong with a bowl of oatmeal with fruit (no sugar).

My guess is that the requirements for fasting before and after enable greater control on outcomes, especially if what a person eats might affect effectiveness. It says that the concentration of the drug can increase as much as 17-fold with a high fat meal. I suppose it's considered safest if everyone fasted.

Regarding the price, if everyone started to take 1/4 of this med with a low fat breakfast, my guess is that the price of the drug would soon quadruple!

Trial was "sponsored" (funded?) by the NCI and the University of Chicago.

Mtnwife, I'm amazed that such a study got this far, especially given what we are led to believe about pharma influence.
Posted 7/3/2017 2:53 AM (GMT 0)
@Annie88: Unfortunately they don't make it in Iran labs. :'(
Posted 7/3/2017 2:55 AM (GMT 0)
The low-fat breakfast has been advised for people who take Thyroxine after thyroidectomy (I am one of them), as the absorption would be affected by fat.
Posted 7/3/2017 1:07 PM (GMT 0)
Some time ago a poster on Inspire named BillyT gave a lot of information about this. My recollection is that he said he was a Ph.D. chemist in Brazil, and he gave precise information about using oil and 1/4 tablet instead of 4. www.inspire.com/BillyT
Posted 7/3/2017 1:50 PM (GMT 0)
Thank you Farz53 for getting back to me. Looks like India might be the country of choice.

Thanks Cigafred for this reference. I wonder how BillyT is now? From reading his posts, I was able to trace back to some interesting history preceding the Zytiga+breakfast abstract that we've been discussing.

In 2011, one of the researchers in the Zytiga+breakfast study published this letter about food, fasting and Zytiga. ascopubs.org/doi/10.1200/JCO.2011.37.1617

There was a response by Janssen representative ascopubs.org/doi/full/10.1200/JCO.2011.39.7851

This confirms that fasting is related to safety and control- very understandable.
Posted 7/3/2017 2:37 PM (GMT 0)
What Jansenn does not understand: By choosing the price-point that they did, MANY patients who have been prescribed the drug will look for ways to reduce their cost even if it means resorting to risky changes in how the drug is administered...If one's supply of the drug can be extended by a factor of 15 or 17 by simply changing how the pills are taken, you can be sure there will be people willing to take the risk in order to reduce their cost..You must remember, these are mostly terminal cancer patients who are taking these drugs...We have a completely different viewpoint about drug safety than healthy people do......The patients who are under 65 with limited or no health insurance would be VERY interested in the information revealed in this thread.....Not to mention the multitudes living in foreign countries who are priced out of receiving these medications...
Posted 7/3/2017 2:55 PM (GMT 0)
True, Fairwind. Another example is those who are hormone-sensitive and desperate to start Zytiga now in response to the NEJM publication.

I might be wrong, but I think that Janssen might be providing the drug on compassionate grounds in the short term until the various regulatory bodies and insurance companies respond to the publication.

In my husbands case, as he is not exactly "newly diagnosed" but not recurrent either, we are unlikely to obtain any discount at all if we choose to add Zytiga. One hundred thousand dollars per year is hard to swallow, especially as it may be for 2+ yrs and when costly out of country scans are likely in the future.
Posted 7/4/2017 2:41 AM (GMT 0)
Thank you to everyone who provided the links and additional information. This has been so helpful. My husband's oncologist has patients on 2 Zytiga pills a day but we will definitely be asking about one. (He's waiting to start a new treatment after he gets an Auxumin scan in a couple weeks to see what we are dealing with. His PSA is up to 7 while on Casodex and orchiectomy but bone scan is clear.) I personally don't see a downside; lower cost, lower potential toxicity, and the ability to go back to the 4 pill a day fasting protocol if it doesn't work.

Annie88, I can't wrap my head around spending $100,000/year for x years (some of the guys on this forum have been on it almost three years!) to extend life for a relatively short amount of time. Maybe if it cured the cancer, but even then I would struggle with it.

One more question: If you are supposed to fast before breakfast so you don't get too high of a dose, what about the other 3 pills a day? Do you have to fast for 2 hours before taking each of them? As if our lives all don't revolve enough around cancer--now we have to schedule meals and pills. Sigh.
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