Orgovyx and insurance

[StayingOptimistic]

Does anyone please know if this drug covered by Medicare? I have regular Medicare ( A and B) and drug supplements prescribed insurance ( Humana). I called Humana and they told me it’s not covered. I also have a separate insurance Etena insurance. Any knowledge about this would be appreciated.

[Teddy28]

My Medicare Part D drug plan with United Healthcare covers it and the cost is around $925 for 30 tablets - that is for one month. I recommend you look at your plan online and possibly they will cover it. Perhaps the agent is incorrect or did not have the latest information

[jmurgia]

I looked it up on my BC/BS Medicare Advantage plan and the Part D cost was about $1800.00 for 90 days. My plan charges only the 60 day price for a 90 day prescription. I always do my research online before I make any calls.

[wilcoxsaw]

Anthem blue cross PPO supplement covers it for me with a $50/month copay.

[Concerned-wife]

You need to look up under your Part D or MA plan. My husband said it would be $650 per month under ours.

In the fall, when there is a open Enrollment, you can go to Medicare.gov and check all the plans and decide whether to change plans. We did that this year and abiraterone is so much less expensive under a new plan.

[Explorer08]

My Medicare Part D provider is CVS/Caremark. My oncologist prescribed Orgovyx with CVS/Caremark last Friday. I received a call from them on Saturday stating that I was denied due to lack of substantiating information to their satisfaction. Further, CVS/Caremark sent me two letters dated that same Saturday, one stating the Orgovyx is not in the CVS formulary and was, therefore, denied. The second letter, in a separate envelope stated I was denied due to a lack of substantiating detail from my doctor. I received both letters this Wednesday so I went from prescription to double denial in the space of four days.

It seems as though I was denied for two different and, perhaps, competing reasons. The second letter seemed to imply that if they had more information they could approve it. The first letter, however, claimed they don't even have Orgovyx in their formulary.

[StayingOptimistic in reply to Explorer08]

Thank you for your message. I guess I am gonna stick with firmogon for now.