I’ve been on Orgovyx since mid December, and it seems effective and the side-effects are tolerable. Today my wife went to pick up my next month’s supply, and Ambetter, my insurance company, has suddenly decided to stop paying for it, and wants me to get a shot, instead.
I’m currently 1/3 of the way through my EBRT, and in the middle of it, they want to change my meds for… I’m guessing for monetary reasons? In the middle of my radiation treatments? I know it’s expensive (@ $83 a pill) but so is cancer. What medical reason can they give for screwing with my treatment at this juncture?
Shit-weasels! There is a special circle of hell for insurance companies.
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Jpburns
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Yeah, but what I object to is changing my meds for no medical reason. I don’t like the idea of discovering different side effects in the middle of radiation treatments.
Lupron has higher chance of cardiovascular side effects. If you, your siblings or your parents have any history of heart disease, your doctor could make an appeal with the insurance company that Orgovyx is justified to reduce potential life-threatening cardiovascular side effects. This will scare their legal department because in the event you died of a heart attack while on Lupron, the denial of your appeal could be very stong evidence in a lawsuit.
The other big downside to the Lupron shot that your insurance company could give a crap about is that it takes many months once you stop for your testosterone to come back than it does for Orgovyx.
What's strange is that they paid for it to begin with then changed their mind!? This is the complete opposite of what typically happens as once a drug with a superior side effect profile comes on the market it typically gets MORE acceptance by the insurance companies the longer it's out there not less accepted.
Not sure how long the appeal process takes but you might see if you qualify for assistance from the manufacturer, at least for a portion of time:
I see you are 64.....at 65 you could probably find a Part D Medicare plan that would cover Orgovyx, and your max out of pocket in any given year, after Biden changes, is $2000-$3000, depending on which year starting now. Yes, these insurers seem to care little about a patient's QOL !!!!
Was orgovyxx helping you avoid many of the SEs reported with Lupron?
I’ve only been on Orgovyx so far. Don’t really want to experience new meds in the middle of radiation treatments. What sort of side effects are common with Lupron? (I could search, but I’m being lazy…)
TA has an excellent blogsite...here is an article including Lupron SEs and mitigations. I should note that it is generally agreed that most SEs are caused by loss of T and the lowering of estrogen that goes along with that.....one mitigation method is use of estrogen patches or gel while doing conventional ADT. Since you have been Ok with SEs with Orgovyx, you would probably do fairly well with Lupron...especially if adding estrogen. BTW, another option is firmagon, whose mechanism is identical to Orgovyz, and firmagon is SOC.....believe monthly shots only? will you be 65 soon??
When I had to switch health insurance (small business), I was able to get 3 months worth for free from Orgovyx manufacturer. They also have a program to get for free if you meet certain income requirements. I have had aFib, so my doctor prescribed to reduce heart complications.
The Lupron shot is maybe $2500 every 3 months, and comes under medical coverage . The Orgovyx pill is about $2700 a day, and comes under prescription drug coverage. Very different costs and coverages for two drugs that do about the same thing.
You can look up side effects of each; Lupron can be bad, while I have had none from Orgovyx. since Jan 2024 my Orgovyx copay is $75 a month. Orgovyx would charge me only $10 a month if I met lower income requirements.
I am on Medicare with a Blue Cross supplement that used to have zero copay, but in Jan 2024 under Part D reform, the payer changed from the supplement to Medicare.
Here's what I understand...ORGOVYX® (relugolix) is the pill version that works like a monthly injection of Firmagon (Degarelix). I have been receiving the monthly injection for several years. If you are on Medicare (or when you go on it) it is paid for thru Part B and not Part D. For me Firmagon has significantly less side effects than Lupron type injections (was on that for a year or so ) . However, it is not without its issues, must be given every 30 days or so, thats the worse part. You start it by getting two shots and then just one thereafter. The shot is given in the abdomen (really not as bad as it sounds). If your current insurance will pay for Firmagon, that might be worth talking to your Doctor about as it's pretty much the same as Orgovyx..or works the same way...not sure. Orgovyx remains unaffordable thru my Part D plan.
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