Co-pay shock

This is how the drug industry works...

In the early 1990s, Mike Jarman, Elaine Barrie, and Gerry Potter of the Cancer Research UK Centre for Cancer Therapeutics in the Institute of Cancer Research in London set out to develop drug treatments for prostate cancer. With the nonsteroidal androgen synthesis inhibitor ketoconazole as a model, they developed abiraterone, filing a patent in 1993 and publishing the first paper describing it the following year.[6][42] Rights for commercialization of the drug were assigned to BTG, a UK-based specialist healthcare company. BTG then licensed the product to Cougar Biotechnology, which began development of the commercial product.[43] In 2009, Cougar was acquired by Johnson & Johnson, which developed and sells the commercial product, and is conducting ongoing clinical trials to expand its clinical uses.[44]

Abiraterone acetate was approved by the United States Food and Drug Administration on April 28, 2011.[7][8] The FDA press release made reference to a phase III clinical trial in which abiraterone use was associated with a median survival of 14.8 months versus 10.9 months with placebo; the study was stopped early because of the successful outcome.[45] Abiraterone acetate was also licensed by the European Medicines Agency.[46] Until May 2012 the National Institute for Health and Clinical Excellence (NICE) did not recommend use of the drug within the NHS on cost-effectiveness grounds. This position was reversed when the manufacturer submitted revised costs.[47] The use is currently limited to men who have already received one docetaxel-containing chemotherapy regimen.[48][49] In May 2019 the US Court of Appeals for the Federal Circuit upheld a Patent Trial and Appeal Board decision invalidating a patent on Johnson & Johnson’s prostate cancer drug Zytiga.

Today, there are several, much less expensive generic alternatives. A well known and respected Indian pharmaceutical company, Cipla, sells a generic called Xibra for a list price of $960 for a months supply. If you have a 20% co-pay, that's $190 cost to patients.. J&J lived high off the hog for 6 or 7 years before they lost their patent..

Fairwind said...

The use is currently limited to men who have already received one docetaxel-containing chemotherapy regimen.[48][49] In May 2019 the US Court of Appeals for the Federal Circuit upheld a Patent Trial and Appeal Board decision invalidating a patent on Johnson & Johnson’s prostate cancer drug Zytiga.

I'm enrolled in a clinical trial that is investigating whether earlier use of Abiraterone Acetate and/or Apalutamide might be beneficial. I was randomized into the control group getting Degarelix (Firmagon) only, which is the same treatment I'd be getting if I wasn't in the trial. Because Abiraterone Acetate has only been used in more advanced stages of PCa it remains an open question whether it would add benefit for patients like me who have failed primary and salvage treatment but are not castrate resistant.

Jim

From the get-go, Zytiga was / is manufactured by a small Canadian generic drug firm under contract to J&J..I think it's safe to say this same company manufacturers the generic version too...I'm not a chemist but I don't think it's that difficult to manufacture Abiraterone Acetate. Outside the United States, there are several low-cast generics available but these drugs have not been approved for sale in the U.S. or Canada..

Its called the cubicle effect...its the latest rage in all institutions...operative word...rage..

Hello Wings of Eagles,

Your story of ZYTIGA is my story, as well.

I have been on ZYTIGA, continuously, for almost four years now.

When the new generic became available a few months ago, my insurance company began to "kick up the dust" --- which I understand, due to the high monthly cost of name brand ZYTIGA.

I think that some of us us "worry" that somehow, the generic might not match in its effectiveness to name brand ZYTIGA. While this might be an unfounded worry, those of us who have been on ZYTIGA for a while DO have an emotional attachment and reliance upon this medication which has helped many of us here.

For a few months, my doctor kept the insurance "wolves" at bay, so to speak, insisting that I stay on name brand ZYTIGA.

This worked for a short time ---- but then the letters from the insurance company arrived in my mailbox, stating that if I continued on name brand ZYTIGA, my co-pay would be several thousand dollars.

I agree with you --- your insurance company should have let you know in advance. Your doctor might be able to appeal that hefty bill that you received. There are times that they will "erase" the payment for that last month, as long as you show that you are transferring over to the generic. It's a power play, isn't it? I felt like a pawn in a chess game that I didn't sign up for between my insurance provider and the specialty pharmacy that handled my monthly ZYTIGA prescription order.

Wings of Eagles --- there IS a copay assistant program that was instantly put into place when I was eventually "transferred" over to the new generic for ZYTIGA.

My copay for the new generic is now just $5.00 a month, with my insurance card. Ironically, this past month, the new generic was free of charge.

The specialty pharmacy enrolled me in the copay deal for the new generic. It was not complicated at all, which surprised me. Anyone in this situation should talk to their doctor first, their insurance provider, and then their pharmacy provider. Those steps should help others decide what is best for them --- name brand ZYTIGA or the newly approved generic.

Our comrades out there need to check things out carefully, if starting a new ZYTIGA prescription or starting on the newly approved generic version. It can create a stressful situation. I assume in time, the new generic will emerge as the "preferred" version, with the lower cost.

Lessons learned ---- be your own advocate --- stay informed --- and be sure to inform other "battle brothers" on topics like this that concern all of of us.

Thanks for your informative post, Wings of Eagles!

Handshake, friendship, comradeship,
CYCLONE ~ Iowa State Cyclone

Union98 has a good point.

Generics are qualified by the active ingredient. Everything else (coating, binders, pill size) can be very different. I've had problems with "generics" in the past. Pity is that we are pretty much forced to them.

Almost comical note - in my Medicare Part D, some new "generics" are actually more expensive than the name drug this year, because the generic came out after the year's formulary was established. "Generic" does not always mean cheaper in the Part D world.

GoBucks said...
I really don't want a generic( although intellectually I know they are the same-but are they really?)

142 said...
I've had problems with "generics" in the past. Pity is that we are pretty much forced to them.

about generics... though now after Wings' latest post it is 'much ado about nothing', but I was on a generic version of another drug for several years and experienced a relapse when the pharmacy changed suppliers. That sort of thing isn't supposed to happen. There was no physical difference in the appearance of the capsule. After speaking with the pharmacist she recommended that my doctor specify to use only the manufacturer that I'd been using previously. Things are now back to normal. So they are supposed to be the same, but sometimes they aren't.