Xtandi and part D Medicare question

[CousinGrandpa]

Does anyone know if Xtandi is covered under Medicare part D?

I am currently getting it under a program but received a letter indicating the program ends Dec 31st. Just wondering about the new $2000 maximum out of pocket for Xtandi and weather it’s included.

Ty

[fireandice123]

Check your plan’s formulary that lists which meds are covered and see if Xtandi is listed. I have the United Healthcare/AARP plan and it would be covered. Since Xtandi is part of the SOC I’m betting it is on your plan as well. If it is, the new $2000 cap for 2025 should cap your Xtandi cost, and the costs of any other med you’re on at $2000 for all meds.

[Still_in_shock in reply to fireandice123]

It might be SOC, but many PDPs have removed a lot of meds from their formulary.

So check carefully. Not only on the Medicare site, but on the insurers site. Medicare as issues right now reporting correctly.

[fireandice123 in reply to Still_in_shock]

Good point.

[Still_in_shock in reply to fireandice123]

I also have AARP/UHC starting January, they have the best coverage with no deductible, albeit not cheap premiums.

[fireandice123 in reply to Still_in_shock]

Agreed. Happy with the coverage but not happy they doubled the premium for next year - $34.50 to $69.

[Still_in_shock in reply to fireandice123]

$69? Its $115 in Cali. AARP Medicare Rx Preferred from UHC (PDP)

[fireandice123 in reply to Still_in_shock]

Ouch! I’m in Vermont. Is $115 for the basic plan? Here the basic plan will be $69 and $107 for the preferred plan.

[Still_in_shock in reply to fireandice123]

Preferred.

[85236442968]

CousinGrandpa

As the other responses indicate, you will have to check your Plans Formulary/drug listing.

I use Well Care Value script and they call it a tier 5. That means they do not touch it. Also Good RX does not touch it.

Also as it is enrollment time. a good look at plan D suppliers is in order.

I have found on these type of meds, that a discussion with you pharmacy/supplier is in order.

With Abiraterone I was better off paying cash than running it thru my insurance, The Pharmacy (attached to the cancer center) helped me with just cash, then they helped get on with a Non-Profit organization that covers the co-pay.

Ask

Best wishes on your journey

[Hunt4Fun in reply to 85236442968]

I have same plan and for 2025 they cover Xtandi using Kroger. Since monthly premium is zero. (monthly premiums DO NOT count toward max) my annual out of pocket will be $2000.00.

I confirmed this with a call to Well Care.

Happy Trails

PCO

[Hunt4Fun in reply to Hunt4Fun]

I should add that due to the enormous cost of Xtandi, the max out of pocket (2K) will be reached in January 2025.

Medicare does have some sort of payment plan of which I know little about...yet.

[j-o-h-n in reply to Hunt4Fun]

Your UserID caught my eye .

Sorry. I couldn't resist temptation. So here I go.

A Travelling salesman is lost in a very rural area, when he stops his car to ask an elderly man siting on his porch for directions.

Well he asks and gets directions from the old man.

The Salesman is about to leave but he asks the old man one more question. What do they do for entertainment in this town?

The old man replies "We hunt and we F***"

Salesman asks "What do you hunt?"

The old man replies "Something to F***".

Good Luck, Good Health and Good Humor.

j-o-h-n

[mountain6 in reply to 85236442968]

When you say that Well Care Value script doesn't touch it do you mean that they don't cover it at all and so the $2000 cap doesn't apply?

[85236442968 in reply to mountain6]

mountian6

We were discussing Xtandi.

WellCare value script has designated it as a Tier 5.

c

[85236442968 in reply to 85236442968]

mountian6

I am guessing you are getting it from a specialty pharmacy attached to the Cancer Center you use. Ask them what help is available including Non profits that pick up co-pays.

[Explorer08]

My Xtandi was covered under my United Health Medicare Advantage PPO plan this year. Copay of $75 per month which dropped to zero after hitting the “catastrophic” level.

[Break60]

it is covered. The copay depends on the plan you have.

[dk73]

we had UnitedHealthcare drug plan part D in 2021 when he went on. $3000 for first month, then dropped to around $650 a month after that. He was put on again in 2023 with same pricing. We didn’t qualify for financial assistance or grants. But it stopped working so won’t have to go through that again

[j-o-h-n in reply to dk73]

Thank you for your post. Hopefully a new/different meds is working for him now,,, Keep fighting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[dhccpa]

My new Plan D and my old one both seemed to cover Xtandi, Erleada, or Darolutamide and hold to the $2K limit. Both plans are Wellcare plans. I haven't tested it in the field yet, though!

[CousinGrandpa in reply to dhccpa]

I have WellCare also, and that’s the same answer I got.