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what do you pay for ADT drugs

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Posted 4/21/2022 1:32 PM (GMT 0)
I need your help in finding out what my expected cost of ADT drugs will be. I'm on Medicare Advantage insurance (AARP United Healthcare). I know that since both surgery and RT have failed, the next step is ADT plus either Zytiga or Xtandi. All these ADT drugs are tier 5 and carry a hefty cost that can break the bank. Your help is appreciated.
Posted 4/21/2022 3:07 PM (GMT 0)
I'm sorry I can't help you as I'm not on Medicare, and I will more than likely stay will working until I can't.
Why?
Because my insurance pays 100% for both my Orgovyx and Xtandi.
And yes, they are hefty, Orgo is about 3000/mth, while Xtandi is 15000/mth.

I hope someone will chime in with help for you!!
May God bless you brother on your journey!!
Posted 4/21/2022 3:24 PM (GMT 0)
Ed, I am on the the same health care. My Orgovyx is $40.00 a month. Looks like I need to get on alephnull’s insurance. One thing that is a fact is that ADT is very expensive without a representatives help of some kind. Looks like the pharma companies would like for some to die if you don’t have insurance. What’s up with that? My best to you and keep up the positive attitude.
Jack
Posted 4/21/2022 3:29 PM (GMT 0)
The May issue of Consumer Reports on page 27 has a table of online pharmacies that offer discounted prices for many prescriptions. I don't want to name those businesses here but you can find a copy of CR at your local library if you don't subscribe.

I looked up Abiraterone Acetate 1000 mg per day at each of the pharmacies listed in the CR article. Some of the pharmacies didn't offer it. But of those who did, one listed a month's supply at only $80 with free shipping. Another listed it 200.99 for a month's supply. Based on that, if I didn't have my VA coverage, I would skip my Blue Cross plan and buy from one of those vendors.

I get my Lupron quarterly at Dana-Farber for just my $40 Blue Cross Advantage co-pay for the visit. As an Vietnam veteran with Agent Orange exposure I'm able to get my Abiraterone Acetate (generic for Zytiga) and Prednizone, for free from the VA - an option that I know isn't available to most people. If I got it under my Blue Cross plan - where it is a Tier 3 drug I'd have to pay 25% for the first couple of months then 5% for the rest of the year - potentially over $10,000.
Posted 4/21/2022 5:06 PM (GMT 0)
Bohemond,
Darn!! BCBS does that to you.
Wow I guess my employer sure got a deal from them.
BCBS/KS through Washburn University.
All oral cancer drugs are paid at 100%.

This is why I probably will never retire.
Posted 4/21/2022 5:20 PM (GMT 0)
I have Medicare AARP through United Health. My insurance pays about $250 and my share is now about $200 through Walgreens. I just received copay assistance through the PAN Foundation. There are other copay assistance funds as well.
Posted 4/21/2022 5:41 PM (GMT 0)
Thank you all for your help. when i search on ADT drug prices I was shocked to see how expensive they are and what the out of pocket costs are. Now I can't complain about my wife's type 2 diabetes drug costs.
Posted 4/21/2022 7:41 PM (GMT 0)

Several of us here were on ZYTIGA, when Johnson & Johnson lost a fiercely fought court battle over their patent rights to this medication.

Long story, short --- the generic version ABIRATERONE ACETATE became available. Less expensive, but still HIGH in price!

Many of us here were then "boxed into a corner" by our medical insurance providers, to transfer over from name-brand ZYTIGA to the generic version --- for obvious, cost-saving reasons.

My oncologist filed paperwork with my insurance company, and I remained on ZYTIGA for a time --- but, in the end, my insurance provider stated I needed to transfer over to the generic version --- or bear the full cost of name-brand ZYTIGA.

Basically, it was a forced "choice" ...

I have had NO issues with the generic, whatsoever.

With ZYTIGA --- there were cost-saving programs in place, handled by an insurance nurse at my treatment center.

These days --- with my current work insurance through Blue Cross/Blue Shield --- once I hit a $500 out-of-pocket annual total for all my medications, my co-pays go to ZERO for the rest of the year for all my prescriptions.

It's a "good day" when I hit that $500 out-of-pocket limit, then my prescription co-pays plummet to ZERO for the rest of the year!

C-Y-C-L-O-N-E ~~~ # Iowa State University
Posted 4/21/2022 7:56 PM (GMT 0)
Follow-up: Johnson & Johnson Foundation is now accepting applications for Zytiga financial assistance for Medicare recipients. They never used to do that.
Posted 4/21/2022 8:03 PM (GMT 0)

alephnull said...
Bohemond,
Darn!! BCBS does that to you.
Wow I guess my employer sure got a deal from them.
BCBS/KS through Washburn University.
All oral cancer drugs are paid at 100%.

This is why I probably will never retire.

When my MO wanted to start me on Zytiga he warned me it could be very expensive but that depended on my insurance plan and how successful the Dana-Farber team might be at negotiating a better price for me.

According to what is in the BC Medicare Advantage published prescription plan and formulary I would have to pay 25% until I entered Medicare catastrophic coverage and then pay 5% for the rest of the year - then start all over again the next year. If they bill at list price that would be $10,000 or more out of pocket. Maybe the team at Dana-Farber could talk them down to something more reasonable. But I told them not to try because I had free coverage through the VA.
Posted 4/22/2022 12:05 AM (GMT 0)
Ed - Went through this what-if drill last year when I was reevaluating Part D drug plans. Your Advantage plan has a Part D plan embedded in it so you don't buy separately. My experience was similar to Bohemond's.

Xtandi (proprietary) was expensive in all plans that I checked and was in the $2-$3K/mo range which tops out at around $10K-$12K/yr after catastrophic care cost levels are reached.

Abiraterone Acetate (generic Zytiga) was all over the place with the plans with an AARP/Walgreens plan being the cheapest by a lot ($1,400/yr vs $10,000/yr). You may have the good drug plan in Texas with AARP. Can not explain why but no one can when it comes to drug pricing in the US.

On the other hand, cash pricing on Abiraterone Acetate could be around $200/mo at a few local pharmacies so I figured I could cover that instead of $10K/yr if I needed to take it someday. In fact, we pay cash for a few drugs since the insurance plans are so goofy and check all the time when any med is over $20.

On problem on Medicare and other government programs is that you can't get coupons for drug costs like one may get with private insurance. Private insurance can also have very favorable drug coverage as alephnull noted and subsidized by the employer. They can also have crap plans as well.

The key is to pursue all the opportunities available. My wife had to pay $2800 for one month of a BCa drug then was approved for free drugs directly from Pfizer going on 3 years now. Just have to stay after this stuff and find advocates for your cause.
Posted 4/23/2022 6:29 PM (GMT 0)
Thank you all so much for your input. I'm starting this research knowing what is coming down the line having failed surgery and radiation. I'm hoping that with all the various information provided I can keep my drug expenses to an affordable amount. So much for health care debate on drug prices that no politician wants to talk about.
Posted 4/23/2022 6:39 PM (GMT 0)
They don’t talk about it because they receive campaign financing from the pharmaceutical companies. That will never change in our for profit health extortion racket.
What about setting up a go fund me account. Not sure how they work but if you tell your story about what you are facing you may receive money to cover the expenses
Posted 4/23/2022 7:26 PM (GMT 0)
If any of you guys are veterans I hope you have looked into help from the VA. All of my drugs are free.
Posted 4/24/2022 2:42 PM (GMT 0)
I went on the generic form of zytiga about two years ago and while it was less expensive it was still around three thousand for the first two months. I am on a Medicare Advantage plan through Kaiser Permanente. This cost has consistently gone down over the last couple of years and last year I remarked to my pharmacist that I could now afford to stay alive, to which he gave me a sideways smirk. At that point it was $111.00 per month. It has now gone down to such a low level that I no longer need a pan foundation grant. My advice would be to shop around for the best plan available and check the cost through the drug formularies.
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