Tamoxifen - prescription drug coverage

[shueswim]

I'm asking my MO this week about prescribing Tamoxifen (20mg/day) for gynecomastia Issues related to ADT over the last 14 months. Since Tamoxifen is not FDA approved to treat gynecomastia, I'm wondering if it would be covered by my prescription drug plan? Has anyone using Tamoxifen for this purpose had issues with their insurance coverage?

[Blueslover]

Hope you're doing OK Gene

[shueswim in reply to Blueslover]

I'm doing great Hugh, I hope you are as well!

[Blueslover]

Pretty good thanks

[noahware]

Off-label uses of cheaper generics are usually not a coverage problem, even if scrip is not the official "on-label" use. More expensive drugs get push back, but I expect not this oldie. (I hope this one isn't ,because I may be using it myself soon!)

The OptumRx formulary lists it as Tier 1 (=cheap generic) so I assume it will not cost that much at all, if your plan is half decent.

Before you proceed, you might want to research potential side effect. I'm still doing that, but if I recall, your doc will want to monitor liver enzymes. I know the dose you mention is what I was looking at, but I recall there is some indication that an eventual reduction in dose may reduce side effects without reducing efficacy.

Also be aware... this drug will likely NOT reverse any growth already experienced. Obviously this doesn't help now, but is best started early. Probably better late than never, though.

Are you using it to counter Casodex or estrogen, or something else?

[CrocodileShoes in reply to noahware]

I can confirm its ineffectiveness. I had a dose of radiation - no real difference. Then Tamoxifen. If anything the boobs got bigger. I' still taking it but not sure why. I'm asking for liposuction, so that I can get back to a reasonable level of cleavage - hope fully the tamoxifen might keep that in check....

[noahware in reply to CrocodileShoes]

I assume you were doing casodex, as monotherapy? If so, just wondering: what was the tamoxifen dose that you took, and when did you start it in relation to casodex?

[shueswim in reply to noahware]

I'm planning to use it to counter the effects of Firmagon and Abiraterone. I read that there is actually a good chance of reversing the growth I've experienced. Nothing however is certain so only time will tell.

[noahware in reply to shueswim]

Yeah, I think it's worth a try. In general, it does not seem to have high rates of adverse effects. My debate would be, do I start at 10 and go up to 20 if it's not working, or start at 20 and go down to 10 if it is? I hate using too much when less will work, but no point in not taking enough, either!

[dadzone43]

Instead of wondering why not ask your insurer?

[shueswim in reply to dadzone43]

Just curious at this point. I'll be discussing with MO on Friday. It turns out that this isn't a very expensive drug anyhow so cost won't be a barrier either way.

[Bethpage]

Hmmm. My husband started taking Casodex 50 mg in March of last year as a prelude to radiation in June. By the end of May, he was starting to feel some tenderness in one breast. I read Tall_Allen's caution about taking Tamoxifen 10 MG with the Casodex in order to avoid gynecomastia. Even though my husband had already been taking Casodex for a couple of months, at the first opportunity, I asked radiologist and an MO about adding Tamoxifen. Both were happy to write the script. Our insurance, commercial Florida Blue, covered it 100%. When the first 6-month script expired, I asked husband's uro to write another script. Again, no problem writing it and no problem with insurance coverage. The Tamoxifen not only stopped the gynecomastia cold, it actually reversed it to a remarkable degree. I guess this is an individual thing... I'd check with the insurance company and then go for it!

[Max135]

shueswim

this is a drug I can provide some information on since I took it for most of three years. MDA in Houston advised that they prescribe it from time to time for guys that are worried about gynecomastia verses zapping the gland with radiation. Tamoxifen does work but I can tell you it is a drug to not take without knowing the side effects. So here it is.... this drug is an estrogen-blocker some of the possible side effects for men taking Tamoxifen include headaches, nausea, hot flashes, skin rash, fatigue, sexual dysfunction, and weight and mood changes. The two in the list that had me the most without me even knowing it where fatigue and mood changes. It was not until after I stopped taking the drugs that I realized how bad.

as for the cost BCBS did pay for most of the it (80%) my co-pay was something like $12-$17 per month. hope this helps....

Max

[noahware in reply to Max135]

Curious... can you attribute those side effects only to the tamoxifen? Just wondering what other meds you were on at the same time, and if when you stopped the tamoxifen you stopped or started anything else, too.

I ask, because ANYTHING (except estrogen itself) that is used to bring testosterone down to castrate levels is going to effectively act as an estrogen-blocker, because men derive their estrogen from testosterone.

Tamoxifen selectively blocks some (not all) effects of estrogen, but where is a man's estrogen coming from, if not from testosterone? Without estrogen we are going to get side effects even without an agent that blocks its effects.

Three years of tamoxifen sounds like something that would go along with either Casodex monotheray or estradiol monotherapy. I am considering those, and considering tamoxifen, so would appreciate your input and knowing what your treatment was. Thanks!

[Max135 in reply to noahware]

noahware

at the same time..... ADT (Lupron) for 3.5 years! and yes it has some of the same side effects. just notice a very big change in my overall fatigue and mood after it was stopped. hope this helps....

Max

[noahware in reply to Max135]

Okay, thanks... so the question remains, which effects were just from the Lupron, which from the tamoxifen, and which perhaps were from the combination. My reading suggests probably more from the Lupron, which is why I'm considering skipping it and doing just the casodex and tamoxifen... that should leave me with a little more estrogen for mental health, but less gynocomastia, hopefully.

[Max135 in reply to noahware]

noahware

very much hope you have good results in the path you are taking. live strong and live in the moment when possible!

Max

[noahware in reply to Max135]

Thank you!

[Max135]

Sorry shueswin,

forgot one item that is important... if at the moment you are taking Abi you may not want to take Tamoxifen since they do not play well together. check with you doc at MDA to confirm.

Max

[Hidden]

I had my first injection of Lupron in April 2003 along with Casodex; fourteen months later a six month trial with chemotherapy and hormone therapy, followed with nine more months of Casodex. In February 2010, I ask able to stop hormone injections. Do I have a nice rack? Hell yeah, and proud of them.

I once asked my research medical oncologist and cardiologist if I should take something or have radiation? Both of the. Responded with a, “No. Take care of your cancer and body.” I previously in November 2002, I had a double bypass for an aortic aneurysm.

Not self conscious at all. Gives a great lead-in to talk about metastatic prostate cancer. I wish ya’ll well and take care of your body and your cancer.

GD

[CrocodileShoes]

Hi Noah,

Initially I was on Casodex as a monotherapy (and taking Tamoxifen) For the past 5 months I've been on Lupron and low dose Casodex (and a lower dose of Tamoxifen (10mg) The breast have gotten a little bigger, I feel. So, for me, the Tamoxifen has not been effective - and yet I'm still taking it!!

[MateoBeach]

If gynecomastia is already well established there is not much to do medically. Lose fat overall and breasts will also diminish somewhat. Surgery, such as micro-cannula liposuction under local anesthesia, can correct it.

But if you are on or starting a treatment known to cause gynecomastia such as bicalutamide without a LHRH drug (ADT) or Estradiol Patches, then you have two options.

First would be to see a radiation oncologist. If you have any gynecomastia, you can get coverage to have RT (tangential RT or electron beam) to the breast tissue, typically in 2 to 4 treatments. Very easy. Covered by Medicare in the USA>

Tamoxifen is the other option. 10 mg per day should be sufficient with minimal or no side effects for most.

[j-o-h-n in reply to MateoBeach]

Tit or Tat?.............

I'm starting to like mine...........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/12/2020 10:46 PM DST