Im getting different answers from the different "kind" folks at Kaiser in Socal.
The funniest answer is we dont know until we have your RX. .............. What??????
Im debating moving to Xtandi from Zityga.
I would appreciate knowing from anyone here on Xtandi while on Medicare with Kaiser?
What is the Part D copay you are paying?? (Before the donut hole.)
Thanks in advance.
Kaiser has a Formulary online. You should be able to look it up and see your costs. Open your browser and search "kaiser formulary". there are different formularies for Northern Calf, Southern Calf, etc. Each has a separate PDF file you can look over.
They do not show costs.
I just tried it. It's very clunky but after you select your location you have to download the pdf file and use the ctrl + F function on your browser to search for the drug you want. It then tells you what "tier" the drug is on. You will have to go the intro to find the tier designation means in terms of cost,
they don't make this easy. That's the point. If you need further help send me chat message and I can walk you through it.
It's really clunky. You have to go to the pdf page and use the ctrl + f function on your browser. Search for xtandi find the "tier" for drug and the intro information will tell you the cost.
If you need help, sent me a chat message.
I don't need to be walked through it.
Im a computer programmer.
I know its a Tier 5 drug.
The formulary does NOT state a price.
I know its 33%, but 33% of what???
My original question was:
What is someone on Kaiser Socal on Medicare paying for Xtandi.
A proud IT guy that doesn't need help? Well knock me over and call me the 7 and 10 split.....You guys never need help since it's always the User's fault......
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 03/25/2023 10:34 PM DST
Xtandi will be a tie 5 drug, I’m not on Kaiser I’m on Humana. But I get my Xtandi through a specially pharmacy at no cost. Check with your doc and see if you can through Astellas Pharma.
Unfortunately Astellas will not discount to Medicare patients.
I’m on Humana PPO Advantage plan. Didn’t think about regular Medicare. Do you have a drug card. I have been on Advantage plans since I turned 65, I’m 72 now and haven’t had any problems.
My original question was:What is someone on Kaiser Socal on Medicare paying for Xtandi.
I was charged $5 for 1 month supply, , same as what they charge me for Zytiga.
Kaiser? Medicare? Xtandi?
The average cost is 12K a month, and tier 5 is a 33% copay
I dont think Xtandi is $5
BTW Zytiga generic Abiraterone is $3 at Kaiser
If you know.... why ask?
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 03/25/2023 10:37 PM DST
I dont know!!
12K a month is the national average
Medicare copay for tier 5 is 33%
Here's why I dont know:
Lupron 6 month, 12K is the going rate. My cost at Kaiser was 20% of their cost which 1.5K. So I paid $300
See why Im asking.
I just want to know what someone is paying for Xtandi at Kaiser on Medicare. The $5 answer is not correct.
I did some more research, you pay $5 at Kaiser because you are on Kaiser insurance.
My question was, how much if you are on Kaiser MEDICARE advantage.
My cost after going through the donut hole, to catastrophic coverage would be $7,500 year.
Sorry for the delay in responding. I'm not sure you understand how Medicare Advantage works. The idea is: a one-stop shop for all services--hospital, doctor visits, and prescriptions--as contrasted with "traditional Medicare", where you shop for each of these separately. In many parts of the country, the only Medicare Advantage programs are for-profit insurance companies with very poor ratings. In other parts,such as where I live, there are non-profit options like Kaiser Permanente.
You are incorrect in stating I have "Kaiser insurance". When I was working, my employer offered many choices, one of which was a contract with Kaiser. Since I've been in Kaiser since I was 4 years old (I am now 78) and was very happy with it, I chose Kaiser through my employer as my health care choice. When I retired, my Retirement Plan also offers Kaiser Medicare Advantage as a choice. Kaiser has literally DOZENS of plans, each with its own set of benefits and co-payments. They have plans for individuals, plans for small businesses, plans for large employers including governments, etc. My benefits and co-pays are at the extremely generous end, due to the contract terms negotiated by my (very large) retirement plan. My sister, on the other hand, who was a Kaiser employee for 30 years!, does not have nearly as generous benefits as I do. She pays more for doctor visits, she doesn't get some benefits I do (such as 30 free rides to doctor appointments per year, and free membership in health clubs), etc.
I suggest you get the Medicare Book that is published each year, and carefully read the descriptions of traditional Medicare vs. Medicare Advantage. Then you can look in the book for your particular geographic area to determine the various offerings, benefits, co-pays, etc. that are available to you.
I do know what Medicare Advantage is, what I was saying is that you are on Kaiser where your premiums are NOT paid by CMS. Ive been with Kaiser 20 years, 2 companies that paid the premium, COBRA, where I paid the premium, and Individual that I paid heavily for a bit. Then I rolled into Kaiser Medicare Advantage at 65.
I DO know what regular Medicare is also. The hunt for viable Drs in LA is slim pickings, as they delay your appointments, knowing they will have to deal with CMS.
But you actually did not read the question I posted? You replied $5, but you're NOT on Medicare Advantage.
rogerandme told me exactly what I found out. The cost of Xtandi on KAISER MEDICARE ADVANTAGE is $3380 the first month, since the cost is $12,000 a month, you skyrocket past the donut hole, directly into catastrophic coverage at $12 every month after until the year roll over.
Kaiser Medicare Advantage means unlimited office visits with NO Dr copays, none. $50 for PSMA/PET and CT, no copay labs, and X-rays. Basic prescriptions, most have no copay. The ones that do, wave copay on 3 month mail order. Thats like 48 hours turnaround. Oh, yeah, free gym memberships too!!
Xtandi cost me 3000 dollars one the 12 dollar after that….
meant to say 3000 once a year then 12 monthly
Kaiser Northern California I have no problems getting answers
Kaiser Hospice Care
Next steps after Xtandi and Zytiga 
Xtandi failure?
New employer/ New insurance= Kaiser
Xtandi and part D Medicare question 
