Zytiga is so expensive. Can my prescription drug plan dump me because of the high cost?
Zytiga Cost: Zytiga is so expensive... - Advanced Prostate...
Zytiga Cost
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lincolnj8
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I believe, in October or November of this year, Zytiga goes off patent which will result in a big price drop.
Rich
Has your doctor checked into the Patient Access Network, or xtandi Support Solutions. You can find info on these on web.
Thanks for the info
BigRich is right; however, this is being fought legally by J & J. If they win on appeal, there could be a delay. I am hoping there won't be as Zytiga is on my horizon. Drug formularies vary between plans; costs may vary as your copays can vary. I would check with the insurance commissioner's office in your state if your plan has dropped you because of your drug needs. There may be restrictions that prevent that if you can prove it.
If you're talking about Medicare supplemental part d plan, they can't drop you.
Other plans are governed by Obamacare, where you are protected from discrimination if you apply to a new plan, so long as you do it at the start of a new insurance year.
There are new plans where they can screw you in so many ways. They can drop you in the middle of an insurance year. Then you are sort of screwed.
Oh brother..
I would welcome any factual corrections or supplementary facts by anyone regarding private insurance options for prostate cancer patients in the U.S., preferably without including any political ideology into the discussion.
I'm new to this game, being in it for 8 months. MO has me on prednisone, zytiga along with Lupron and monthly infusions for the bones. Oscal is also in the picture. Having gone from my Christmas surprise which included a hospital stay, blood transfusions and wondering what was happening, to a PSA under 1 (was 800) and leading a fairly normal life. relying on insurance companies shelling out thousands of dollars every month is scary for me and my wife. Don't understand a lot of tech on the site, but find all input useful. Private insurance options in Ohio is a quagmar in my mind. I'm on medicare with supplemental insurance through Anthem. Using Aetna for my prescriptions The for profit industries scares me because I now am costing them money instead of making money for them. This site helps many of us newbees . Outside of my complaining, I hope some of this info helped.
in reply to cesanon
You can apply through the Affordable Care Act if you are dropped between open enrollment dates. Anyone who loses their healthcare can apply outside of open enrollment, at least at this point in time.
Special Enrollment Period (SEP)
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.
Source: healthcare.gov/glossary/spe...
lincolnj8 in reply to
Thanks for the information gregg57
There are private organizations which may help to subsidize some of the costs. For the rest, I think we're going to have to wait until after November, both for political and open enrollment purposes. If we're still too young for Medicare the Justice Dept has stated that they will no longer defend the preexisting conditions part of the ACA so, for me I don't even know if I will HAVE insurance next year. For both the ACA and Medicare the White House and Congress will run parallel stripped down plans with lower premiums for those who are healthier. Since this reduces the pool of policy holders it will drive up costs on the exchande. The stated purpose has been to further weaken the ACA and I think this goes for Medicare too, though the motivation has been less publicly stated. The new programs aimed at undermining the ACA are already being advertised. That's the political side of things. It remains to be seen how the insurance companies will respond. We cost our insurance company about $375,000 this year between my PCa costs and my wife's hip replacement. My zytiga was no cost after I met my $6,650 deductable in January. Our total premiums and deductibles were just under forty grand. I have to buy my insurance on the open market and don't qualify for any subsidies. Since our healthcare system is for-profit I don't see any hope of them making a profit on us. We're currently looking at contingency plans which could mean anything from early retirement to relocating internationally. Not our preference but we may have no other choice.
Good Sunday morning lincolnj8,
If you are on a Medicare prescription drug plan, they cannot drop you, but their formulary may change year to year. I am on Medicare and have Humana for drugs and in 2016 my retail drug bill was $312,000. Copay was $20,000, but thanks to an AT&T Catastrophic Prescription Drug Plan (I am a retiree), I was reimbursed for every $ over $5000 out of pocket.
I joke that I am not going to die of advanced PCa, but from a contract hit from Humana, as monthly premiums are under $20.00!
Best wishes. Never Give In.
Mark, Atlanta
Interesting thing on the drug plans. I am finding it cheaper to buy my drugs directly using goodrx coupons, than using my part d drug insurance with it's copays.
I still buy the part d coverage for when I will need xtandi or zytiga.
But it looks like these plans are making more money on the copays than on the insurance premiums.
They also get legal kickbacks from the drug manufacturers to get included in the formularies under favorable use conditions.
This is done through what are called pharmacy benefit managers.
en.m.wikipedia.org/wiki/Pharmacy_benefit_management
I am an ATT retiree and was quite surprised by the company picking up the cost of prescriptions after $5k out of pocket. I saw some info that plan is extended thru 2022 or 2023.
Not sure your plan. Sounds like a medicare advantage plan. Standard Medicare Part D: medicare pays ~ first $3,000. But 1 bottle of zytiga , xtandi, yonsa, or erleada puts a patient through that into the “doughnut hole” where the patient is 100% responsible for ~$2,500. This takes them out of the doughnut hole and the patient is then responsible for 5% per month for rest of calendar year then has to meet doughnut hole again. 5% of $10,000/mo drug is still $500 per month. Astellas (co-owner of Xtandi) says 40% of their new Xtandi prescriptions dont get filled!! Thats a tragedy.
Sad thing is most drug companies developing drugs for whatever reason thing the “holy grail” is a pill but that puts more financial burden on patients. Any cancer drug given by needle: shot, IV, IM , or subcutaneously are covered well under Medicare part B/supplement leaving little to no cost for patients.
"Any cancer drug given by needle: shot, IV, IM , or subcutaneously are covered well under Medicare part B/supplement leaving little to no cost for patients."
There are plans to change that to reduce Medicare costs. If they do, it will be done behind doors in markup, then approved in a non-accountable voice vote.
I'm 67 and also on Medicare and Aetna is my drug plan. Costing them $10,000 a month for zytiga. Just worried about getting dropped. Zytiga is working great for me at this time. Monthly premiums are under $20 also. Just to think, a year ago I was fine. Then the Christmas surprise. Thanks for the info vandy69
At the start of the insurance year I spent a whole lot of time checking all the available formularies for the more costly prostate cancer drugs.
Next time I'll take notes and post them here. There were a few clear winners. Aetna was the one I went with.
For most reasonably priced drugs, it seems you are better off purchasing them with goodrx discounts.
If you change drug companies, will they accept you if you have PC and expensive drug needs?
"If you change drug companies, will they accept you if you have PC and expensive drug needs?"
I don't know. I just learned that the plan b supplemental insurance can do that.
I thought the plan d supplemental couldn't. But maybe they can.
Does anyone else know the answer to this question?
Lincolnj8.
Simple answer no they cant. These drugs are outrageously priced. If you are a medicare patient there are foundations (PAN and PAF) that if you qualify will cover your out of pocket costs. If you are under medicare age often your doctors office should take the time to sign u up for a copay card from Janssen and that would allow u free or minimal cost ($10/mo). Also you could qualify for a clinical trial that would provide the zytiga for free. If someone has a dramatic treatment response but is paying a significant amount out of pocket then i will often cut the dose in half to get 2 months out of one bottle. I hope this helps!
Great information. 67 years old now and don't want my wife and I living in our car over drug costs. Thanks again for the info
I agree when i start a medicine for a patient i always focus on 3 things: 1) whats benefit 2) whats the side effects or change in quality of life 3) not to break the bank!
Thanks for the insight..
Check out YONSA (Google Search - what else.) That is the non-patent version of Zytiga that is supposed to come out when Zytiga patent expires.
Thanks for the info..Found the info on Yonsa. Yonsa (abiraterone acetate) from Sun Pharma is a unique, ultramicrosize (smaller particle size) formulation of the oral CYP17 inhibitor abiraterone acetate (approved as Zytiga). Sun Pharma's Yonsa is approved to be used in combination with methylprednisolone for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). Yonsa contains the same active ingredient of Zytiga, also used to treat prostate cancer. Abiraterone acetate is converted in the body to abiraterone. wonder what this one costs.
Yonsa is approved and available now. My center helped do the research to get it approved. Was owned by Churchill pharma was bought out by Sun Pharma. Sad thing is price isnt much less than standard Zytiga .....nearly $7,000/month cost.
What's the cost of the hmmm "BIG SLEEP PILL?" Don't like the thought of jumping in front of a subway train...hate to make all those passengers late for work...Don't like the idea of a gun because they're illegal in New York.....Don't like the idea of jumping off the George Washington Bridge.... cause I can't swim.... Hate the Idea of hanging since I dislike wearing ties....
Good Luck and Good Health.
j-o-h-n Sunday 08/26/2018 6:58 PM EDT
Wow if Zytiga’s cost in the US is $10,000 a month, that is way way way too expensive!!! Here in the Philippines it is $2,400 a bottle per month less PWD discount it becomes roughly at $2,000. However, most of you are still very lucky for having medical insurance to cover for your meds unlike here 😢😢😢
With insurance and foundations (if you're not rich) it's doable
The cost of Zytiga 5oo mg tabs from Canadian pharmacies is approximately 4200 per monthly dose. That’s better than 9000..
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