due to pre Auth issues I am going to run out of Zytiga …..I’m guessing I’ll be without it for at least a few days possibly a week…..haven’t heard back from MO about how to make the best use of what I have left and whether I should continue to take the prednisone. I have 4 days left at this point…..thoughts? Take 250 mg with something to eat? Let it lapse and wait it out? I’m rather aggravated about this whole situation as the refill was handled in plenty of time but the insurance company denied it wants a new pre authorization for 2024.
running out of Zytiga….: due to pre... - Advanced Prostate...
running out of Zytiga….
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Tommyj2
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can you make a call to your insurance company ( number on the back of your card). Requesting an urgent pre- auth approval on a previous approval be made on this?
A generic online cash-only pharmacy only needs your Dr. to send the scrip. I use scriptco.com . Delivery can be fast if you want to pay a small upcharge. $90/month for abi.
I can try….but there are financial considerations…..the whole situation is rather complicated and will take a few days to iron out….mostly I need to know about the efficacy of 250mg with food and continuing the prednisone……thank you for responding I,lol try your suggestion.
I have been taking 250mg Zytiga + 5mg Prednisone for well over a year. Taken with fasting two hours before, then one cup of whole milk for one cup of plain cereal (e.g., wheaties), then one hour of fasting afterward.
Everyone is different but this has worked out well for me.
Your insurance company deserves to be shot! Yes, 250mg with high-fat breakfast and do not stop the prednisone.
Wasn’t the University of Chicago study with low-fat. I have also found and shared a Rutgers suggested low-fat breakfast with abi
Fat increases absorption - more fat, more absorption.
You are right that the U of Chicago trial (which is what Rutgers based their recommendation on) only looked at absorption with a low-fat breakfast in mCRPC men. They found that on average the PSA-response was no worse:
ascopubs.org/doi/10.1200/JC...
That study is highly problematic for Tommyj2. It only looked at mCRPC men ,and the inter-patient variance was found to be so high that another trial could not make a recommendation in a Dutch study.
U of C did not look at high-fat meals, or abiraterone use in hormone-sensitive men (which is now how it's used for the most part). Tommyj2 is recurrent and still hormone sensitive. This small trial looked at abiraterone taken with either low fat meals, high fat meals, or fasting among men who were still healthy and hormone-sensitive. They found that abiraterone absorption increased 10-fold for high-fat vs. 5-fold for low-fat:
accp1.onlinelibrary.wiley.c...
If he wants to extend the pills he's got, he is better off taking 250mg with a high-fat breakfast.
Of course, with cheap generics available now ($124/mo on costplusdrugs) most can afford to take the more reliable 1000 mg dose fasting:
costplusdrugs.com/medicatio...
Good info…..thanks TA.
This is par for the course for these insurance companies who add no value to US healthcare, Actually get in the way of the practice and delivery of healthcare and add incredible stress to Medical professionals, patients and their families. The presuite of maximizing profits on the backs of US patients through the US insurance industry is sinful. They just seek to deny and slow down needed care whenever and wherever they possibly can.
I'd be very surprised if you could find a million dollar a year hospital administrator in favor of single payer. Of course insurance companies are a plague but the medical industry is also culpable.
Healthnet??
What is health net?
Insurance (HMO)
Ate you adking a question? What does your response mean?
is. your. insurance. Healthnet??
got it
Are you saying he wouldn’t have this problem with Healthnet nsurance?
I was asking since Healthnet denies everything.
HMOs as well as the whole US insurance industry is just a formal way to ration healthcare. Is a system to give Peter more coverage and care than what Paul or Mary gets. It's rationing at its core level. It appeals to the greed and hate inside the US consumer to exist and is fully backed up by the US political and legal system
No…..Humana.
I’ve been there before too, Tommy. I’ve been on it for 7 years so this has happened to me several times. TA’s advice of the 250mg w high fat meal is best course. Depending on your relationship with your doc, they may have bottle they can give you as a space filler…they might have a few promotional bottles of the Zytiga name brand stashed here and there.
Worth an ask….thanks for the response. This whole business got very complicated all of a sudden……copay of 550.00 when for the last 4 months I paid nothing….. have a few days to resolve it if I follow the 250mg protocol…..
Something to ponder. I just checked GOODRX.com
$136.16 for 120 tabs at Rite Aid!!!
$143.75 at Walmart.
I used Goodrx coupons for 2 years when I was on COBRA.
I have one packed bottle let me know if you need… need shipping label I can drop ups
You're a winner.......
Good Luck, Good Health and Good Humor.
j-o-h-n
Tommy, a breakfast of 300 calories and 9 grams of fat is your target. This is what was used in the clinical trial of 250 mg of abi. The food and fat carry the abi into your system. My husband has been doing this for over a year with good results. Continue your prednisone with this regimen.
is this instead of 1000mg after fasting 2 hours min? The fat helps the 250mg be absorbed by the body?
Just eating food makes it be absorbed more than on a fasting stomach.
With fat the absorption is increased even more.
Yep, exactly. We call it his "abi breakfast". Then he doesn't eat anything for a couple of hours.
What food does he get his fat from?
It depends, he has several favorite breakfasts (he doesn't care for cereal or eggs, which some guys do). One is english muffin with canadian bacon and a slice of cheese, toasted/melted (check labels, add up calories and fats and tweak as necessary). I make veggie soups with lean meat (beef barley, chicken pasta) - again, look up fat content in meat (say, 90% lean beef, or chicken breast chunks). Divide into servings to get appropriate fat and calories. Another is toast with sliced chicken, lettuce, low fat mayonnaise. Cuban black beans & rice. Takes some math and tweaking, use olive oil for very low fat foods to get a serving up to 9g fat. Most recipes online have nutrition info with calories and fat...I just tweak them as necessary.
If you don't mind, what does his breakfest consist of ?
It depends, he has several favorite breakfasts (he doesn't care for cereal or eggs, which some guys do). One is english muffin with canadian bacon and a slice of cheese, toasted/melted (check labels, add up calories and fats and tweak as necessary). I make veggie soups with lean meat (beef barley, chicken pasta) - again, look up fat content in meat (say, 90% lean beef, or chicken breast chunks). Divide into servings to get appropriate fat and calories. Another is toast with sliced chicken, lettuce, low fat mayonnaise. Cuban black beans & rice. Takes some math and tweaking, use olive oil for very low fat foods to get a serving up to 9g fat. Most recipes online have nutrition info with calories and fat...I just tweak them as necessary.
Thank you so much. Think I can design something.
I know this doesn't answer your question, but we pay out of pocket for my husband's Zytiga (abiraterone). We are Costco members and their price is $122 for a one month supply. The cost of the prednisone is about $4.00 a month. It was actually going to cost more to use the medicare drug supplement.
You really should try GoodRx
Costco was higher then Rite aid
Thanks. We don't have Rite Aid in our area and GoodRX shows everyone else higher than Costco.
Interesting comments about taking Zytiga with breakfast...I've been on Zytiga (4 pills =1,000 mg) for a month now...and I was told specifically to take Zytiga on an empty stomach, and don't eat for an hour...I take the prednisone an hour later with breakfast. Perhaps different instructions due to the dosage amounts I'm taking ?
To get back to the subject at hand...I've heard insurance companies just 'stop approving a medication after a certain time. Best of luck !!
Yes, because of the initial cost of zytiga a study was done on a lower dose with food.
Thank you for the clarification !!
I have been given the same instruction when I start it but am still riding the Xtandi bus.
costco. $122
So, I see some people on here instructed to take Zytiga with food? I was instructed, nothing for 2 hours prior, and wait an hour to take Prednisone with food. Do I need to ask the Dr check his answers? Concerned
Looks like nobody replied to your question. See Tall_Allen's response earlier in this post. "If he wants to extend the pills he's got, he is better off taking 250mg with a high-fat breakfast. Of course, with cheap generics available now ($124/mo on costplusdrugs) most can afford to take the more reliable 1000 mg dose fasting."
I was in the same situation. Three days left, my MO told me about Bio+ pharmacy. I talk to them and they told me if I am a retired person and income low I could get a zero copay. Give it a try.
I have about 25 Zytiga pills left over from when I stopped taking it. There yours if you want them.
Get the scrip and go over to pharmacy and buy some. Only $15K/month.... I went through the same shit.
Probably not a big deal. Somehow I lost an entire month (new Rx) of Erleada; my doc told me not to worry about it. The lapse ended up being a little more than 2 weeks. You can check with your doc but my impression is that ADT meds have a long half life.
I had some casodex from 2+ years ago so I took that until my refill arrived.
If you have a Medicare Part D drug plan, the $550 could be your copay, depending on your plan. If this is your first refill this year, again it may be your copay. You really should be communicating this with your doctor. They can speed up the prior authorization process.
the$ side - Kaiser uses a generic - Abiraterone. Zytiga is a brand product, more $$.
Sometimes I write Zytiga just to save my thumbs on my iPad.
There is actually another prescribing recommendation where as you take 1 -250mg tablet with low fat breakfast. This is from the specialty pharmacy pharmacist. I would however first consult your doctor. When we were facing the possibility of supply line shortages I considered doing this. I didn’t have to.
I've heard of that approach too. Something like take 1000mg while fasting or 250mg with food. My memory is horrible since ADT but I think a year or two ago I had to do this myself for a few days because my drug store could not get any for a stretch of roughly a week. My memory is gone but I am still here. 
The only studies I found involved low dose abiraterone (250mg) with low fat meal…in all it was found to be “non-inferior” with respect to PSA levels……this was only a cursory search and might not be representative overall particularly as I read in this forum to take it with a high fat breakfast…….still, considering the results and immense cost savings I would think larger studies are in order?
I agree with you. The only thing is that it is easiest for scientist to test for the drug on fasting subjects. When people eat, what they end up eating becomes a variable factor as it is unlikely that every subject will be eating the exact same meal. But yes, the cost saving is important.
I have some ideas but probably best to talk through them rather than type. Sent you a text.
FYI- I thought I should mention that apparently missing a few doses, while definitely disconcerting, is not a nightmare situation. I just had hip surgery a week ago and was advised by my MO to go off my abiraterone for 5 days prior in order to avoid issues with anesthesia and my liver. I was told missing 5 days was not “a big deal”….So, you may wish to keep this in mind no matter how you end up dealing with the unfortunate situation.
Try good RX look it up and see which drugstore has the best price. When we were in between Rite Aid was our best price pay out of pocket wasn’t much
My MO is notoriously hard to get in touch with……to use GoodRx I need a new script. You are right re Rite Aid. 136.00
250 mg with low fat meal is an excellent choice. That is what I am doing for the past 8 months. All those pills will hurt your organs. My readings just increased from .01 to .02 and I will now take 1000mg.
Why not jump it to 500mg with food? Are you planning on standard protocol of fasting 1000mg? I wish there were more definitive studies on effectiveness of lower doses with food……
I can only say the research was stopped after 13 with complete success. The reason they stopped? Could it be that if it continued success for a longer period of time. Big pharma would lose millions and millions in profit. So if they stop the research you will be wondering if you should continue with 250mg. If you want longer research, you only have to look at India who has been doing 250mg, with success, for some time. It's catch 22, the more pills you take, the more side effects, the more pills you take the more side effects. Your kidneys and liver are not functioning properly, so you take pills for that to. And before you know it, your body organs and yourself, have lots of medical issues. YOU are what you EAT!
Take 250mg, eat, sleep and especially exercise to have a healthier body to fight cancer.
I started 250 Abi Sept 8 with a Psa just under 20. It dropped to 4.7 in 25 days. 2.6 a month later and 1.2 two months after that, 1/9/24. I take it with a 300 to 350 calorie low fat breakfast. $120 for a bottle of 120 tablets last me almost 4 months.
Glad it’s working for you…results have been even more robust for me 18 to 0.04 inside of 4 months on 1000mg daily along with leuprolide sub cu…..thanks for the response. Am going to talk to my MO about lowering the dose.
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