I’ve been very lucky (well, not the cancer part) when it comes to the expenses for my treatment. I just wanted to make sure that new folks here are aware of the Orgovyx patient support out there.
I signed up for it shortly after moving to Medicare, and I’m getting free Orgovyx (3 months at a time) from the manufacturer. I filled out the form, and confirmed some things on the phone, and voila! Roughly $2400 saved per month.
This is interesting. I just received a letter from Orgovyx support stating if I go on Medicare or any other government plan this December when I'm 65 that I would no longer be eligible for the assistance that I'm now receiving. Only commercial insurance plans were eligible for support.
I get both Orgovyx and Erleada free from the manufacturers too, and I’m on Medicare. If this is changing at all next year it may be due to the fact that part D Medicare (medications) cannot go above a $2,000 limit starting in 2025.
That’s encouraging news. Did you have to submit income verification for this? Also, when I investigated Orgo’s website, if you were on Medicare, their program for cost mitigation didn’t apply. I’m also scheduled to start Abi (haven’t decided for sure about this even though I have the tabulates, including prednisone) so come January the big bills start again until I hit the max OOP expense which is supposed to be capped at $2000 (versus 2800 in 2024) in 2025. I have an Aetna drug plan which is a whopping $2/month. It has worked very well.
I fear that you dodged a bullet. Over and over, I see: Zero pay (if on commercial insurance) and if on Medicare, my co-pay for Orgovyx was to be $900. It feels very, very predatory. On the other hand, with the switch to the $2,000 cap, it won't matter as much next year. I have the Orgovyx that I bought on my trip to India for the rest of this year. Next year I'll just pay $2,000 and be done for the year (I hope)
Well, their first response was saying it would cost me x number of dollars with my insurance, and I said, ‘Hey! I thought I was getting patient support!?’
They said, wait a minute, put me on hold, came back and said “you’ve been accepted! And it’s been free since then. So it pays to be persistent.
As a side note, I just got a note from the Orgovyx patient assistance program saying that they determined that my income would be too high to qualify for free meds next year, and would end at the end of the year. I don’t think they’re right, as I’ve taken SS early, and my wife’s income, since she’s retired, is also low. I think I’m considerably below their threshold. It’s kinda our strategy to deal with this period of our life. We’ll see what happens.
I think the law was written to avoid one drug manufacturer from giving patients kickbacks in order to promote their drugs over a competitor’s drugs. Sounds like avoiding competition to me.
The laws that define Medicare. One of which is the provision that says that Medicare can't negotiate drug prices and was recently amended to allow 10 drugs per year to be negotiated.
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