USA Payer news re Xtandi

Recently, Humana, CVS and WellCare changed their Medicare Part D Prior Authorization policy regarding the use of Xtandi – These payers no longer require step therapy for Xtandi. These three Medicare Part D plans currently represent approximately 33% of all Medicare Part D lives nationally. We hear this from one of our oncologist friends

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  • Good. In the USA, if doctors want to prescribe Xtandi first for their patients, the patients should not be put between a rock and a hard place, financially, by having the Insurance companies force them to take Zytiga + Prednisone first, when both are FDA approved and on the same insurance coverage Formulary.

  • Quiz???

    3 years Decapeptyl injections.

    PSA 8.0

    8 months took Zytiga. PSA 50

    8 Sessions Chemotherapy Daxotere PSA rose to 97.

    15 Sessions of Jevtana Chemotherapy PSA rose to 155.

    35 days ago I took an injection of Decapeptyl and started taking XTANDI 4 tablets a day. 3 days ago I did a blood test and PSA went down from 155 to 19.

  • Point made!

    Nalakrats

  • Darryl,

    By CVS do you mean Silver Scripts? Xtandi is off Silver Scripts formulary as of 1/1/17. Second, what do you mean by "step therapy"?

  • An example of how Step Therapy is often applied is described here:

    bcbsm.com/medicare/help/und...

    Charles

  • Thanks, I think I like the idea.

  • My PSA was rising, from its low hovering around nearly zero (on Zolodex implant plus Bicalutemide for many months) .... up a steeper gradient to PSA = 7.5. Then we arm wrestled with Humana and the Xtandi company, finally to be allowed onto their patient assistance program. After three weeks of Xtandi, daily 120 mg (4 capsules), my PSA went down to 0.85,

    then to 0.05. It has stayed at 0.05 for two lab tests now. I was getting some strange toxicity so oncologist has lowered to three capsules (90 mg) daily. we will see how the next June PSA test results go. Xtandi has really worked, then. I have had some struggles with side effects that are hard to pin down, no particular ache or symptom or sign, just feeling very 'off' and a bit out of it in some vague but persisting global sense. I am grateful to be able to get access via the patient access program at the Xtandi company. I have Humana for my Part D coverage and I would never be able to afford the 2500/month copayment.

  • Everybody's cancer is different. I lasted 32 months on XTANDI, disagnosed as Stage 4, multiple bone mets, Gleason 9, PSA 14.7. Course, now, struggling with Taxotere, end is near.

  • bb66hotflash,

    So very sorry to hear of your pain and suffering over your last several posts and replies. Are you really feeling that the "end is near"?

    If so, do you think it might help if you perhaps started a new Post of your own, as a sort of Journal of where you are and how you are feeling as "the will of your body" and your disease continues? It might help you. It would certainly help us.

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