Does anyone know if there has been a recent change in Medicare Part D approval criteria for Zytiga?
I ask because I'm experiencing a delay in refilling my Zytiga prescription through UnitedHealthCare. As some of you know, UHC's Part D plan requires Zytiga to be obtained through Optum (previously Briova). I received (pricey) Zytiga from Optum/Briove throughout 2019, so I'm confident that I met all criteria. I'm also confident of this because you can find these criteria with a search (and they have appeared in MaleCare posts), and I meet them. But now I'm told there is a Prior Authorization problem even though my oncologist has recently approved prescription refills.
I'm just now learning how this system works, so I may not have used the correct terminology to ask this question.
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Gearhead
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I don't know what state you are in but I switched out of United Healthcare Part D. The premium was high and they didn't pay for much of anything. I switched to Silver Scripts. Maybe you need to shop around next open enrollment.
FYI, I think I may have answered my own question. What happened is that the new year, or a UnitedHealthCare, or a Medicare Part D change of policy triggered a hold because I had been receiving (and paying my share for) brand Zytiga and not generic Abiraterone. Continuing with brand Zytiga requires special prior authorization, which I'm told takes more time and isn't easy to justify. So I presume I'll just switch to generic Abiraterone (prior threads have discussed generic vs. brand Zytiga).
A source of my confusion was that the Optum phone person kept saying that my doctor has to prescribe 250 mg tablets without ever mentioning generic vs, brand and the fact that generic Abiraterone is not available as 500 mg tablets.
What is (pricey) Zytiga? What was you cost in dollars/mo?
List price is $14,500/mo. On most
Part D insurance, comes out around
$9,500 yearly.
Try to get on a foundation that gives grants.
We should not have to worry about these Insain drug pricing, as we live with cancer.
Best luck.
My part d from blue cross of Kansas for the generic version of Zytiga would/ will be 205 per month. I bought the 57$ plan. Zytiga would be over 500$ a month. I just went off hopefully forever but I’m not holding my breath. Anyway 205$ is my number per month.
Gearhead, I found your post from last year and I am going thru a very similar scenario today. I do not know the exact price yet, but I also have Anthem Blue Cross part d and they quoted me $951 per month. I cant afford that so I am trying United Helthcare RX plan thru my work and was denied so far due to the need for prior authorization BS. Someone says I have to go thru Medicare Part d first. How did your situation play out??
Wings: I think my problem at the time of the above post was triggered by generic abiraterone becoming available unbeknownst to me. My oncologist's PA modified my prescription to the generic to save me some money, I presume. A complicating issue is that my Zytiga prescription was for 500 mg (2/day) but the generic is available only as 250 mg (4/day). On the phone, Optum/Briove never mentioned that the generic was replacing my Zytiga prescription. But they did say 250 mg, so I said there must be a mistake it's 500 mg, to which they replied that a prior approval would be required for that.
After I learned that the basic issue was associated with generic replacing Zytiga, I asked my PA to approve both because I was unsure about the new generic. But after a couple of months, I got comfortable with the generic, and I've been receiving that ever since.
I'm sorry that this confusing explanation probably isn't much help to you. BTW, as you probably know, the generic abiraterone isn't exactly cheap. With my United HealthCare Walgreen's Rx Part D plan, my copay was $672.60 for my refill in Jan (Stage 1). But I will quickly progress to the "Catastrophic" Stage 4, and, last year, my copay was $48.68 per 1-mo refill in this stage.
That's good to hear, that's probably why it is being denied right now, the Dr's PA probably order "Zytiga" instead of the generic. I am still waiting to hear back. I am on the generic already because my previous insurance at Aetna would not pay for the brand name Zytiga, Except for those initial payments, until I reach catastrophic, I can easily afford $50 a month after that limit is met. Insurance is sure hard to figure out. Thanks much for your info!!!!
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