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Abiraterone affordability

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Prostate Cancer
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Posted 6/12/2023 4:24 PM (GMT 0)
PSA up to 8 in Nov,2022. Had been around 1.0 or less for the last 2-3 years. Started on Lupron shots and Abiraterone in Nov, 2022. My insurance found me an "exceptional" rate for the first three months but has been $160/mo for the last couple of months and will stay there. Who can afford that? $5 per pill per day. Any solutions out there?

Jim
Posted 6/12/2023 7:19 PM (GMT 0)
Jim - This has come up before and remains a problem for a supposed "generic" drug. Are you on Medicare? Part D plan?

There are some Medicare Part D plans that treat Abiraterone acetate much more favorably than others so you could search for those at your next signup periods. You could try Mark Cuban Cost Plus Drug's online site and possibly get a little cheaper. The $160 per month (4 pills x 250mg) is about as low as it goes unless you can find a better insurance plan.

ps: there are lot more expensive drugs that this in the prostate cancer world. The good news is Medicare should have a $2,000 out of pocket limit in 2025 if understand our government at all.
Posted 6/13/2023 2:31 AM (GMT 0)
Thanks, Mumbo. I will switch my drug plans on part d in the fall. Also, I'll try to find out where I am on the co-pays on Medicare. it's ridiculous how the only option top doc's have is to put you on a way-overpriced drug.
Posted 6/13/2023 3:01 AM (GMT 0)
We have a BCBS (Blue Options) plan. When I logged into our Express scripts account and priced Abiraterone Acetate 250 Mg Tab (30 day supply) online, it says that the plan pays $1966.88 ($4,110.88 for 500 mg) and I would pay $8.33 for either strength (cost per day: $0.28).
Posted 6/13/2023 3:07 AM (GMT 0)
OMG! I'll try that one, too. Thanks, Djin!
Posted 6/13/2023 12:26 PM (GMT 0)
Djin - I have been unable to find Abiraterone Acetate (4 x 250mg daily) that cheap in MN with Part D plans (AARP plans are cheapest for that specific drug but cost around $30/mo). The cheapest looks to be $77 per month after deductible and prior to other levels. Retail $155/mo, Cost After Ded. $77/mo, Gap Coverage $39/mo, Catastrophic $8/mo. Any insight? Do you get coverage through previous employer?

Jim - The new laws for Part D in 2024 and beyond are explained at alert (top of page)
http://www.medicare.gov/.

$2,000 max seems like a lot but is nothing when looking at other proprietary drugs where costs can exceed $10K per year without assistance.
Posted 6/13/2023 1:19 PM (GMT 0)

Mumbo said...
Djin - I have been unable to find Abiraterone Acetate (4 x 250mg daily) that cheap in MN with Part D plans (AARP plans are cheapest for that specific drug but cost around $30/mo). The cheapest looks to be $77 per month after deductible and prior to other levels. Retail $155/mo, Cost After Ded. $77/mo, Gap Coverage $39/mo, Catastrophic $8/mo. Any insight? Do you get coverage through previous employer?
....

Mumbo, I am not on ADT--when I read this thread, I was curious about what my plan would charge should I need it. Express scripts has a member feature on their website that lets you price the cost of any medicine under your insurance plan. That is what I used to get a quote. I have no other experience/info about ADT pricing.

I have only Part A (hospitalization/inpatient) Medicare coverage because I choose to be covered by spouse's employee BCBS (NC) plan. For any surgery/inpatient care, Medicare (Part A) pays first and then BCBS may kick in so I don't pay any more than what BCBS would charge--they work it out between them. When I retired, the cost of Medicare Part B plus a supplemental plan came out to roughly what my BCBS coverage costs, and its benefits seem better. Probably because this is a BCBS plan through a univ./hospital, both the "negotiated" charges on bills and medication copays are very good.

Each year I get a reminder from BCBS that I can choose Medicare Part B instead; however, they say they strive to keep their plan comparable in terms of coverage.

Djin
Posted 6/13/2023 2:41 PM (GMT 0)
Djin - I am not on Abiraterone either but I am always interested as I/we may be some day and I go through this with my wife's drugs so it is an annual process looking at plans and expected drug requirements. Drug cost is a cat & mouse game when on straight Medicare + Part D as the plans vary so much. Take a look at Part D plans where you live on the Medicare site and add abiriterone acetate to the drug list and see what pops up.

I suspected you were not on standard Part D. I have no employer benefits and am on standard Medicare. My wife is retired from a school system where they offer qualified retirees a BCBS Advantage plan with an extremely favorable drug plan (where their cost was $280/month for an Advantage plan?). We chose to take a Medicare Supplement plan + Part D like many do without employer sponsored plans for the best medical coverage, however, the Part D drug coverage is not so good until 2025.

Jim - Sorry to get on a sidetrack but it may provide some insight to the problem.
Posted 6/13/2023 5:48 PM (GMT 0)

Mumbo said...
…Drug cost is a cat & mouse game when on straight Medicare + Part D as the plans vary so much….

Yes, to put it mildly. We meet with our agent for an annual “check up” for the Part D and he works all the angles. My wife is on a variety of things, some quite pricey, and he puts them in and out of the plans as he also compares them to using the GoodRx coupon and getting them through CostPlus and it usually turns out to be a combination of all three.
Posted 6/13/2023 9:09 PM (GMT 0)
Check Drugrx.com. I found a local Pharmacy who only charges 200.00 per month. I am not sure how, but I have confirmed the price.
Posted 6/14/2023 2:42 AM (GMT 0)
Vince - I do the same thing myself every year. We pay cash for some drugs as our cheap Part D plan has some formulary problems. On the other hand, the basic blood pressure and cholesterol meds are free. Part of it is the deductible where the first $500 per person is on us for many drugs so paying cash avoids that.
Posted 6/14/2023 12:21 PM (GMT 0)
614…. - Did you mean https://www.wellrx.com ?
Posted 6/14/2023 2:43 PM (GMT 0)
I don't know if it has been mentioned on this thread, but there are co-pay assistance coupons for almost every manufacturer of abiraterone acetate, and they are not exclusive do you, Jansen Oncology and the Zytiga name brand. I currently have a coupon and I've had it for so long now that I can't remember who it's through but I suppose I can go to CVS and see what they have on file for me, but I pay nothing, after my insurance, I pay absolutely nothing and it is save me a ton of money each year.
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