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Advanced Prostate Cancer
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Which Medicare Part D Drug Plan are you Choosing for 2019 and Why?

Which Medicare Part D Drug Plan are you Choosing for 2019 and Why?

There are probably only a few good ones for those of us who are, or who may in the near future, be taking expensive prostate cancer medications like Zytiga.

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EDIT:

OK here is what I have found so far.

I went on Medicare and put the following drug list in (you really can't predict at the start of the year what you might be on at the end of the year, so I put everything in). The least cost per year plan was "Express Scripts Medicare - Saver (PDP) (S5660-233)".

Express Scripts included all of the drugs in the formulary and imposed no step therapy requirements... which is a good start.

They all require prior authorizations. That's OK I guess. The last three have quantity limits. That is probably OK for most patients.

Erleada TAB 60MGTier 5: Specialty Tier Y

Firmagon INJ 120MGTier 4: Non-Preferred Drug

Lupron Depot (3-Month) INJ 22.5MGTier 5: Specialty Tier

Xtandi CAP 40MGTier 4: Non-Preferred Drug

Yonsa TAB 125MGTier 5: Specialty Tier

Zytiga TAB 250MGTier 4: Non-Preferred Drug

Express Scripts Total Out of Pocket Cost per Year is $19,618 (that is if you are taking all of them at the same time)

Next in line are:

Mutual of Omaha Rx Value (PDP) (S7126-049-0) Annual: $19,710

Mutual of Omaha Rx Plus (PDP) (S7126-016-0) Annual: $19,801

Express Scripts Medicare - Value (PDP) (S5660-119-0) Annual: $20,022

My current plan (which used to be the lowest cost for this combination) is Aetna Medicare Rx Select (PDP) (S5810-291-0). It has now jumped to Annual: $92,975. Most likely as a result of its recent merger acquisition.

I did learn that no matter what you do, advantage plan or not, they are going to charge you up to 5% copay even after the donut hole. No matter where you run, where you hide you are going to have to pay that 5% on these expensive cancer drugs.

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There are no great deals in part d. They are not in competition. Government pays insurance company to administer plans. No profit incentive. Money for drugs comes from Congress not from insurance company pockets.

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At the moment I don't even use the drug coverage. For what I am currently using, they charge me cpays that are greater than the cost of buying on my own.

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Under Part D I pay $540 a month or 5% of the cost of Zytiga since I am at the catastrophic level of coverage. In January I will likely have to pay $5100 to cover all the various out of pocket payments required to get to the catastrophic level.

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Are you saying even after you get out of the donut hole you still have to pay 5 percent copay on Zitiga or any other expensive drug?

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That is correct. When you get to catastrophic level you pay 5% on all drugs.

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So even if you purchase the supplemental part D coverage, you still pay 5 percent.

What is the copay after the donut hole if you don't purchase the supplemental?

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What do you mean please by catastrophic level? I will start on ADT in 2019 and have no ideas about this. I have a company insurance through my wife and on Medicare. Thanks

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I believe "catastrophic level" means having paid so much that you have exited the so called donut hole.

I need to check this out, but it seems that if you are on an advantage plan as opposed to a supplemental plan, you can never get rid of expensive copays.

And once you have selected an advantage plan and are diagnosed with cancer you can never leave it. Part of the compromise that had to be made with conservative legislators in order to get Obamacare passed (which they never repaid with their votes) was to keep pre-existing conditions alive for Medicare after your initial enrollment.

When you change Medicare supplemental plans, you are subject to discrimination if you have a cancer diagnosis.

In our case, the cranky old white men, who reliably vote conservative, got what we deserve. No protection from pre-existing condition discrimination. We basically voted for it, and we basically got it.

Thanks Carlos

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I don't know about that. I was on the cheap-ee advantage plan where I had no co-pays for primary care physician but co-pays for specialists. After I was diagnosed with prostate cancer I upgraded to supplemental plan F, primarily because I didn't need referrals to see specialists and I escaped in-network confines. I also don't have co-pays to see specialists. More each month but a much better plan for me, now that I am dealing with serious stuff.

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"After I was diagnosed with prostate cancer I upgraded to supplemental plan F"

That's interesting. I have been told by multiple sources that they evaluate you for pre-existing conditions before taking you.

Did they know you had cancer before they accepted you to transfer to the supplemental? How long ago did you do it?

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Yes, I conveyed that info when I filled out the forms with the help of a Medicare insurance broker -- just someone, not affiliated with Medicare or any insurance company, who helps walk you through the process and gets a modest fee (which you don't pay) in return. I was diagnosed July of 2016. I chose plan F that fall, before the Dec 7th sign-up deadline and the plan F policy was in effect Jan of 2017 and has been since then.

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if u pay over 500 a month for zytiga then u have $$$$. zytiga is a 10,600 per month. i'm on foundations for a year then i have to fight for it again and hopefully ther are foundations that are willing to give up some of their wealth to share. u have to face it ,in usa we all pay thru the drug companies and pharmacies in canada most likely not so

we should be entitled for free meds since all of what we use has been around for years

charlie

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In Canada they pay 70 percent of their income to the government. No good deal there.

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"In Canada they pay 70 percent of their income to the government. No good deal there."

Carlo, please go away. We don't need your unthinking parroted off topic misinformation/disinformation.

By the way, why don't you free market types just all migrate to Samolia. No laws. Can pollute to your hearts content. 2nd amendment based voting rights. The purist implementation of the conservative ideal of a health plan: "Don't get sick. And if you do, die quickly". It saves you the effort of having to remake the USA into your self image. And you never ever pay for the healthcare of others. Ever.

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"we should be entitled for free meds since all of what we use has been around for years"

The pharmas when would be hurt, are able to block this from happening because of conservative Supreme Court rulings that essentially enable them to use campaign contributions to buy protection from our elected officials. Give the recent lifetime appointments to the court. This problem is unlikely to be corrected any time soon.

The only proposed solution recently announced by the current administration, is to permit Medicare supplemental plans to shift the cost of expensive drugs, such as Zytiga, 100 percent to the patient.

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the problem is they only pay 80% for tier 5 specialty drugs so a bottle of Xtandi costs $2000...look at advantage plans with the lowest maximum out of pocket you can find and once you reach that they pay 100%

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I thought that once you make it out of the donut holes, you don't have to pay more?

Isn't there a maximum amount per year, total, that you must pay? Or do they just keep bleeding you no matter what?

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I believe the maximum out of pocket is $5100 for all Part D plans.

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My out of pocket for Zytiga was 8500

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Earlier this year my first co-pay for Erleada was $2700. This put me into catastrophic coverage so every refill cost me about $560(5%). Come January I will again pay the $2700 co-pay and be in catastrophic coverage. There is no maximum co-pay.

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again as long as u make that kind of $$$ then its not a problem but look at the low income males out there they can't afford to pay it

charlie

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Generic is coming soon. Hope it is a 4 dollar drug at Walmart.

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In the past, there were "Foundations" operated by the drug companies backstage that would pick up the co-pays as long as you had some form of insurance to cover the bulk of it..The PAN foundation comes to mind..

Most of these very expensive cancer drugs are dispensed through "Special Pharmacies". The Special Pharmacist can usually help you get relief from onerous co-pays..They know all the angles..

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Drug companies do have Foundations that will give you certain drugs at no cost, including Zytiga (Johnson and Johnson) if your income is below

a certain level.

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Most, if not all, insurers use a third party to evaluate and approve your need for a certain drug. Most medical centers have personnel who will help patients navigate the cost and co-pay issues. They also have information on which Foundations cover costs of certain drugs. Your MO should refer you to them for help.

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true but johnson & johnson requires certain guidlines and if u don't fit in it they might givde u 3 months i've been there

charflie

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Use the Medicare website to input all of your current prescription meds as well as abiraterone (Zytiga) or anything else on the horizon. This will then given you your choice of Part D plans. And do seek the "financial aid" provided by the drug companies. My urologist's office ran that gauntlet for me and got me a serious discount for abiraterone.

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remember zytiga is a level 1,2,3,4, so there isn't any break unless u got the $$$

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Huh? Please explain using more words.

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if u want to pay nothing for some of the special drugs u definitely don't want the advantage plan. u have to go with the supplement plan

charlie

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Huh? Please explain using more words.

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zytiga's cost to purchase is 10,600 and i have no idea what my co-pay is until met it in january. foundations if applied right away one person might get a year of the drug and u pay nothing. ss,and my supplement insurance covers the balance. the jan for the next year u have to reapply thru a foundation for $$$$$ again and will continue until it doesn't work anymore and there are no new drugs

charlie

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I’m not sure how much it is going to be but my pharmacist has a generic Zytiga in stock. They said they could not price it to me because I just refilled my script of Zytiga. I’ll know the 18 th of dec. Sounds like bull but I didn’t argue. I do believe it is available. If you can get your Dr to write a prescription for it you can find out.

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Supposedly the patents on Xytiga expired or were cancelled within the past month. Two other companies had FDA approval for their generics so perhaps they are now available. I have my Part D through United Health Care and the premium is deducted monthly from my Social Security payment.

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I had my blue cross agent tell me to go to the area agency on aging and ask that question there. He said some companies pay different amounts for certain drugs. He did it himself for his mother so you might give it a shot. You have until dec7.

Good luck

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My zytiga cost is also 550.00 a month. And my January cost will be 5 thousand! But it is keeping me alive!

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Is that your cost using a Medicare Part D plan.

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"Is that your cost using a Medicare Part D plan."

Also, is it on an advantage plan or on a regular supplemental plan.

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A regular supplement plan. And every January I have to hit the catastrophe before they pay. Hope I can get on generic

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In US sit down with insurance agent that sells policy. Give a list of drugs, agent will run through computer and you learn best options. There is some difference. I can buy drugs through Doc at wholesale, some care less then co-pay, so I check.

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Go to Medicare.gov and input your medication that you take and the system will tell you which drug plan is best for you.

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Im sorry if I hurt your feelings. Cost of taxation to pay for drugs isn’t off topic. I just choose how to spend my money instead of the government choosing. I could go down to the Mexican border and cut the wire so everyone could come in and let me pay a little more. Nope. Let’s root for generics.

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Go start your own thread to spread your Fox news echo chamber crap. Or better yet, move to Somalia, where you can get the taste of economic freedom that you deserve.

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When the Somalians all get to the Mexican border I’ll check it out

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No need to wait. Grab your money and your guns and parachute right into a pure capitalist economy. No longer will you have others freeloading off you. And the best part is you will cease freeloading off of me.

Hey why don't you just voluntarily stop freeloading? Nothing stopping you from paying for your own drugs.

Get a prescription, go to the drugstore, tell them you aren't relying on government handouts. And get a price for whatever drug you want.

But I still prefer the Somali solution for you.

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You hurt my feelings by being an ungrateful Leach.

Did you know that almost all the red States are welfare states. Taking more from Washington then they send. The highly productive blue states are forced to make up the difference.

That's why I like the Somalian solution for ingrates that take more than they contribute, yet whine about others.

They should be stripped of their citizenship, dropped into Somalia, where they can pursue whatever they want without government taxation or interference. You can pollute, run a piracy business, and even refuse to hire minorities for your piracy business. And never any need to provide or pay for socialized healthcare for those employees.

Ohhh the catch is you have to do it without benefit of your white man privilege. But how hard can that be?

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I take it you didn’t vote for Trump as I did. We are never going to see things the same. Good luck with your cancer.

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Carlos

Another Somali advantage. You don't have to worry about Democrats voting your favorites out of office.

Somalia may be your only opportunity to avoid darker skinned people from sharing in the largess that I am compelled to contribute to you.

It's pure private pay over there. And no pesky interference by the FDA. You can slough off government regulations in a way you could never accomplish here.

The only reason to stay is to continue to accept government handouts, which you clearly don't believe in. Or you just against that for certain types of people?

Seems that if you were principled at all, you would go private pay, and remove your hands from my pockets.

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Where are you from. I’ve never encountered anyone so mad at capitalism. Without it Zytiga would have never been invented.

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Dear Carlos,

Alternative facts LOL

Nothing wrong with capitalism. It is pretty darn efficient. I like it. It produces Teslas and Spacex Rockets. (you want to talk about Tesla, take it to your thread please)

Crony Capitalism not so much (Boeing and Lockheed over priced non-performing so-called rockets).

But you and I are talking about people who:

(a) are unable to discern policies that favor themselves over others. Who are easily manipulated to vote against their own self interests.

(b) and who are willing to cut their noses off to spite their face,

(c) are willing to sabotage a president (and our economy) because of his sin of being president while black,

(d) who are hypocrites (entitlement for me, but not them, especially if they are a darker shade of skin)

(e) rail against leaches, while leaching themselves (and being too dense to even see that).

So why don't you get off the public dole and go private pay? Please. Why should I have to pay for your healthcare costs if you are unwilling to show even a crumb of gratitude?

Thank you

PS: Why don't you start your own on-topic thread instead of spamming this one? You have to leach that way as well? I would be pleased to contribute to your thread. But what you are doing here is spamming with propaganda that takes bandwidth away from the subject at hand.

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Sad but true info. Here's a couple of things to factor in. Medicare Drug D plans may vary from state to state. I see Carlos will be able to get a price on 12/19, but should he wait til Jan 1 if he can? Again, check Medicare site. Also, throw in the issue of lower dose Zytiga when taken with food (yes, off label, but it reportedly works for some--I have no facts).

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I also don’t know if it’s cheaper. Hopefully it is a bunch.

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Carlos is spreading more misinformation. Sigh.

It has just been announced yesterday that the U.S. Food and Drug Administration (FDA) has approved a generic version of Zytiga, the new drug’s name is Yonsa. It is a novel formulation of abiraterone acetate that needs to be used in combination with methylprednisolone for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC).

The announcement by Abhay Gandhi, CEO - North America, Sun Pharma read, “We are pleased to add Yonsa to our growing oncology portfolio and continue to deliver on Sun Pharma’s commitment for enhanced patient access to innovative cancer therapies.”

Like Zytiga, Yonsa is a CYP17 inhibitor, but it uses proprietary SoluMatrix Fine Particle Technology™ to create a micronized (smaller particle size) formulation of abiraterone acetate tablets that needs to be used in combination with methylprednisolone. The active ingredient is converted in vivo to abiraterone, an androgen biosynthesis inhibitor that inhibits 17 α-hydroxylase/C17,20-lyase (CYP17). The CYP17 enzyme is expressed in testicular, adrenal and prostatic tumor tissues and is required for androgen biosynthesis.

Because of the fine particle technology used in this new drug a person taking it needs to avoid substitution errors which could lead to overdoses. Yonsa tablets may have different dosing and food effects than other abiraterone acetate products like Zytiga. Like Zytiga, men receiving Yonsa should also receive a gonadotropin-releasing hormone (GnRH) analog9like Lupron) concurrently or should have had bilateral orchiectomy.

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drugs.com/price-guide/yonsa

This Yonsa price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies. The cost for Yonsa oral tablet 125 mg is around $9,623 for a supply of 120 tablets, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

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close to price of zytiga ..

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So the generic is almost the same cost as the original zytiga? I don't know whether to laugh or cry. Luckily I'm on Xtandi. Ha, ha. Here is my deal. I'm 68 paying $134 mo for part B medicare. Dropped my no cost low co-pay advantage plan when I knew I was getting sick and went to $20 month Kaiser advantage plan with much higher co-pays after being sent to urologists with waiting room full. Filled paperwork outside on a clipboard. Realized if wife was still alive she would have said "run monte run." Qualified for Kaiser's low income medical assistance so I pay $0 for Xtandi and all other drugs plus all treatment. I still have to pay $20 monthly premium plus $20 monthly for optional dental/vision. They only looked at income and not assets (Northern Ca Plan). For any of the health care plans getting a cancer patient is like getting the goose that lays golden eggs. Medicare picks up most of the costs. Others have said to avoid advantage plans. Something about preexisting conditions not being covered if you switch plans. So look before you leap. I can't afford to go to centers of excellence or Europe so it is what it is. Standard of care is what I have to settle for. If this helps just one person - great! Is it possible to get the Yonsa from India where its like way cheaper? And Germany has a generic by another name also? Don't know if that is legal or possible, but someone might want to check into that. I would avoid Somalia.

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I am going to try to sort out this copay issue on advantage vs regular supplemental.

What is clear is that if you want to change plans they get to run you through an underwriting process and can discriminate against you for pre-existing conditions.

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Yonsa is not a generic. It is an alternative to Zytiga but not being sold as a generic.

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Yes. It is currently the closest thing to a generic that is out there... and it sort of isn't exactly quite out there yet... but should be available real real real soon.

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OK here is what I have found so far.

I went on Medicare and put the following drug list in (you really can't predict at the start of the year what you might be on at the end of the year, so I put everything in). The least cost per year plan was "Express Scripts Medicare - Saver (PDP) (S5660-233)". It included all of them in the formulary and imposed no step therapy requirements... which is a good start.

They all require prior authorizations. That's OK I guess. The last three have quantity limits. That is probably OK for most patients.

Erleada TAB 60MGTier 5: Specialty Tier Y

Firmagon INJ 120MGTier 4: Non-Preferred Drug

Lupron Depot (3-Month) INJ 22.5MGTier 5: Specialty Tier

Xtandi CAP 40MGTier 4: Non-Preferred Drug

Yonsa TAB 125MGTier 5: Specialty Tier

Zytiga TAB 250MGTier 4: Non-Preferred Drug

Total Out of Pocket Cost per Year is $19,618 (that is if you are taking all of them at the same time)

Next in line are:

Mutual of Omaha Rx Value (PDP) (S7126-049-0) Annual: $19,710

Mutual of Omaha Rx Plus (PDP) (S7126-016-0) Annual: $19,801

Express Scripts Medicare - Value (PDP) (S5660-119-0) Annual: $20,022

My current (which used to be the lowest cost for this combination) is Aetna Medicare Rx Select (PDP) (S5810-291-0). It has now jumped to Annual: $92,975. Most likely as a result of its recent merger acquisition.

I did learn that no matter what you do, they are going to charge you up to 5% copay even after the donut hole. No matter where you run, where you hide you are going to have to pay that.

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Hey! Who ya callin a cranky old white man? Oh shit! I just looked in the mirror and I look just like a cranky old white man...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/29/2018 6:10 PM EST

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I just signed to change drug plans. Surprisingly, until I include Zytiga my annual cost was down for 2019. With Zytiga, it becomes about $9k/yr, regardless of which plan I use. HOWEVER, YONSA (Zytiga generic!) made me laugh. The plan I chose, and many others, will cost me about $34K/yr instead! That's not a very attractive generic for me.

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Not a generic. Different structure from Zytiga...

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Hmmm when I was online, it was yonsa that was clearly the cheaper of the two.

Though it isn't quite available.

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Yonsa vs Zytigan cost from Medicare.org (before applicable insurance coverage)

Yonsa TAB 125MG $2,220.20per Month

Zytiga TAB 250MG $9,867.12per Month

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Cesanon, it depends on the state and the drug plan...and the drug store! In wonderful today's USA even Medicare cannot negotiate prices for drugs, so each drug co does their own thing. I noticed Yonsa was listed as a Class 5, Zytiga as a Class 4 drug, thus different rates. I also suspect Yonsa is not 'in formulary" for some drug plans. But an increase from <$500 for all other drugs (not Zytiga) to $34,000 for Yonsa does raise some questions.

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"But an increase from <$500 for all other drugs (not Zytiga) to $34,000 for Yonsa does raise some questions."

Herb I am not certain that I understand? Can you explain? Its seems Yonsa is a lot cheaper than Zytiga.

Interestingly on the Medicare site they say

Yonsa Tier 5: Specialty Tier

Zytiga TAB 250MG Tier 4: Non-Preferred Drug

Xtandi CAP 40MG Tier 4: Non-Preferred Drug

Tier 4 sounds better. But non-preferred definitely sounds like they are going to give you trouble.

Are there any substitutes for Zytiga or Xtandi? I don't think so. Other than maybe Yonsa?

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Jansen Oncology may have an assistance plan if you cannot afford Zytiga. Also have your MO or Uro contact the Patient Access Network.

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What are the income requirements for assistance?

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For the Patient Access Network I believe the upper limit for income is somewhere in $60,000 range. I am retired and on a fixed income just below that so I qualified.

I am currently on Xtandi and receiving assistance through Xtandi Solutions.

All of these programs are set up through your Uro, MO, or RO.

By the way these programs are funded through the Fed Gov and there is a push to reduce this funding. Write your reps in Washington and protest.

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