United Health Care Medicare Advantage

The big question would be "How is your Lupron administered?"
Since (for me, on another plan) mine is administered in the office as an injection, it is not important that it be on the Part D drug list, as it falls in Part B. For an Advantage plan, it should be the same.

UNLESS -
Your provider orders it as a prescription, then administers it. I am still trying to work a similar situation out for my upcoming Jevtana.

Regardless, get their answer in writing so you can refer back to it. Your doc can also help by explaining how they bill it.

I will answer my own question.
Called UHC and talked to someone who knows what he is doing. Lupron is on the list
For 2019. I take a 3 month injection at the urologist office.
I still would like to know about zytiga tier 5 and bicalutamide tier 2. Anyone taking these
Having Care Improvement Plus (UHC)

Echo, most anything that is administered by the doctor or hospital is not on the prescription drug list. The drug list is the formulary for prescription drugs that are self administered. There are legal guidelines that require most all FDA approved drugs to be covered and for cancer treatment at least one drug in every class must be included,

Both Zytiga and Casodex are self administered by taking pills and you see them on the formulary list. Lupron, eligard, firmagon, and other ADT drugs are administered by the doctor. They are covered by your insurance, but not as prescribed drugs, thus they are not on the formulary. Other examples of treatments that use drugs would be chemotherapy and Provenge. These are administered by the doctor, not the patient, thus are not on the formulary.

Recently we have seen a rise of very expensive immuno-therapies like Keytruda. While many these are administered by the doctor, the Centers for Medicare and Medicaid have determined that they are subject to the Part D prescription drug rules. This has the effect of shifting the cost from the government to the private insurance companies and patient. Check your formulary and you will see many of them listed.

I could be wrong about this, but I think as a tier 5 drug, Zytiga has a copay of around $1800 a month...(20%)..When you reach the doughnut hole in a few months, you take a big hit but then you will quickly reach your annual copay limit ($5000-$6000) and go into "catastrophic coverage" for the rest of the year with greatly reduced copays.. There are "foundations" out there that will sometimes pick up the copays for you.