Madness

So herself and I are currently doing a three week walkabout in England. Love Europe in March, as so many pleasures are indoors or at comfortable outdoor cafes. Also hate hot weather. London has been jammed with people and events this month who, like us, are actually walking to stuff. In three days we have seen three all time great plays and opera. Samuel Johnson’s famous observation still holds: “If a man is tired of London, he is tired of life.”But I digress. Having just done a six month stint on XTANDI at a pop of $12,000 a month, I was curious about the rack rate here. Turns out the National Health used its leverage to reach a price of about $3400 a month. Other countries are even cheaper. XTANDI’s price in the US is particularly galling because development of enzalutamide was heavily subsidized by Uncle Sam. We Government could challenge the price scheme through authorizing generics, but prefers to simply let the patent run out in 2027. Madness. American style…. Bill

Bill - You just missed the recent changes to Medicare Drug plans. The 2024 maximum annual out-of-pocket is around $3,400 and 2025 will be $2,000.

I know this well as my wife is on an equally expensive BCa drug which is around $12+K/month which would have cost around $3,000/mo at 25% copay (round numbers). The annual expense would have topped out around $12K+ after navigating the various Medicare levels.

However, she used to get the drug for free from from Pfizer but with the changes to Medicare, everyone has figured out to not to provide the free annual benefit program to those with Medicare and save for those with other insurance or none. In our specific case, the Pfizer benefit was pulled in 2024 and she got a grant to cover the $3,400 out of pocket from a separate cancer assistance fund so we are in same place.

This logic makes sense to me in a perverted way but the drug cost issue remains the same, just moving the money and funding around