America's bizarre medical system (Abiraterone)

[Spinel_Cutter]

Gleason 8, a bit extraprostatic, so "advanced." I'm on Orgovyx + Abiraterone.

Last year both were something like $500 co-pay on my Medicare, capped at $7,000.

Screw that, I thought, and since I was in a class in Mumbai, India I bought a few months of both, for about US$135 a month made by Cipla.

Then, my doc said there is a program, and now I'm paying zero for Orgovyx.

Then, another program and so I'm paying zero for Abiraterone.

But.... get this, today the Abi folk said: "Well, we're not sure that you are eligible for the free program," but the co-pay is only $500."

I think I made the CS uncomfortable when I said, "then no not send it, if I must pay you a co-pay, why would I pay you $500 when I can buy 3 months of abiraterone for that same $500?"

Yes, look at:

costplusdrugs.com/medicatio...

If you buy 250 it'd cost you at Mark Cubans site, $170 (250 x 4/day)

If you buy the 500mg it'd cost you $189 (500mg x 60 tabs/month)

Now, go to Good Rx

Good Rx = (250mg x 4/day = 120) $144.

Good Rx = (500 mg x 2/day = $853.28

This is my theory, at least with Good Rx, and the place I get my "free" 500mg tab of Abi.

I think that the 500 mg is the branded version and the 250 is a generic.

It's just bizarre with prices all over the place and with my "freebie" drug plan now telling me that my "share will be a mere $500."

I cannot help but wonder that if I had said, "well $500 is better than thousands..." I'd be knocked off the free plan.

But I said: "Then don't send it to me, I'll just stop taking it (theirs)" That drew a gasp.

Now I wonder, just what is the US Medicare paying the "freebie" drugstore for my meds? Maybe they are getting paid full retail? "The average retail price of Abiraterone Acetate is about $9,803.58 for 120, 250MG Tablet."

When, with a slight shift in Medicare policy, Medicare might simply send me to a Good RX and save $9659/month or $11,549/year.

America's health system is often very, very bizarre.

[Huzzah1]

I think I have 30-60 days of Abi that I don't need. Free.

[Grandpa4]

same issue 3 years ago. My insurance company wanted $1800 per month until copay max was reached at $6000. I found it from Krogers for $200 a month when I did not use insurance. Very confusing. I don’t think they even had generic back then.

[Spinel_Cutter]

Thank you for the offer. The Pharmacy is going to tell me if I will continue to get it for free sometime in the next 3-4 days, if they are going to start charging me $500, I'm history and will reach out to you then.

[petabyte]

It's not just the US. Here all brands of Abi are about the same price including Zytiga (approx EUR500).

Price per tablets is identical (suspicious).

Since insurance won't pay, I get mine from Germany ( I pay around EUR130).

Pricing makes no sense. A pack of 56 can be one tenth the price of a pack of 60 in the same brand.

internet-apotheke-freiburg....

[Ollie366]

It's crazy getting qualified for the "free" plans from the manufacturers. However, they absorb the cost and don't get $ from Medicare. If you're on a specialty drug like orgovyx, your out of pocket is capped this year at $2000 by Medicare. Then every other prescription drug is no cost for the rest of the year.

[DesertDaisy]

The Medicare prescription drug plans are a joke. We get my husband's abi at Costco, typically for under $150 a month. It seems to change a little from time to time when we refill. Neither of us have ever once used our prescription drug plans.

[85236442968]

Spinel_Cutter

Yes I do agree there is something strange about the price of Abiraterone. It just seems to be all over the place from around $130 for a months supply (4 tabs per day for 30 days) to around $6000 per month.

So as I get it, The drug name is Zytiga, then the generic version is Abiraterone Acetate. Both come in a 250 mg tablet

If you search for a generic Abiraterone Acetate, the generic of the generic. It seems you get a lot of hits that just say Abiraterone Acetate and come in either 250mg or 500 mg tablets. There is not a lot of data on who the vendors are and the manufacturers seem to be just plain scams.

While you make your decision on what you buy or use, please be careful.

I do not understand how come the prices vary so much on Abiraterone, I do tend to surmise it is due to supply agreements or a pharmacy that does not have a supply agreement with the manufacturer will get you some, but you will pay handsomely for it.

I personally have not used Good RX or Single Care, for Abiraterone but I like the Idea that you can get it from a local pharmacy, ie Rite Aid or Discount drug mart and Good RX is less than the Pharmacy cost.

I also do not understand why your Cancer Center pharmacy has not hooked you up with a foundation or Non-Profit that will cover your copay at 100%. Maybe you should ask them.

Best wishes on your Journey

[j-o-h-n]

Bizarre...........Which reminds me of a bizarre text I got the other day, informing me how to read maps backwards.......it was just spam.,

Good Luck, Good Health and Good Humor.

j-o-h-n

[Explorer08]

I get Xtandi and Orgovyx through OptumRx (United Health Care) for $75 copay each per month. By March, however, I'm in the "catastrophic" column for medications and the copay drops to zero for the rest of year. Yes, the American health insurance system is truly insane, inconsistent and most assuredly unfair.

[Spinel_Cutter]

Yes, most say, "unfair." However both Xtandi on Orgovxy "retails" (if you believe it) for $3,000 a month, therefore both would cost $72,000 per year. And with the new Medicare changes, the max out-of-pocket is $2,000. Frankly, I'm thrilled to have two meds that is likely to be a major factor in actually curing me (While I'm high-risk, it's all near the prostate, to potentially curable) for $167 per month. Unfair to some, insane, yes, inconsistent, yes.

The other side of the coin: One day South of Cebu City (Philippines) four men were carrying a young fellow on a stretcher, down the path by my house. I said te the guys, "he looks like he's dying, what are you doing?" One answered, "we're taking him home." "Yikes," I said, "he needs to go to a hospital." The fellow answered, "we tried that, but between us, we didn't have enough money, so they wouldn't take him."

I asked, "what happened to him?" "A brick fell on his head, at the worksite," one told me. I said: "Why wasn't he wearing a hard-hat? The three sort of stared at me, then one said: "What's a hard-hat?"

The next day the four came back and carried the fellow out of the Barangay (village) to be buried.

True story.

Let us appreciate what we have, even if it's not always perfect.

[Almabari]

Big Pharma is a greedy, selfish group mega corporations who thrive off of human suffering. Everything legally possible should be done to destroy these parasitic profit machines and place their CEOs and stockholders in a position where they can experience poverty and exploitation. I recently went to a "very prestigious" medical group here in new york to try and get an hour's consultation on my current treatment and possible alternatives. I was told I should change my supplementary insurance to their preferred insurer choice. I asked what would it cost for the hour if I paid out-of-pocket? With a calm voice there agent on the phone replied $3500.00. If I was a multi-billionaire I'd never pay them that. How many posh villas do these consulting doctors need? How many Mercedes? They are no doubt Big Pharma stock holders. Make no mistake, if you are poor and need treatment for advanced prostate cancer, don't expect higher tier drugs to be easily available to you. If the plug is pulled on Medicare/Medicaid many of us will simply have to let the cancer take its course.

[dac500]

My copay for Abiraterone 120 tab is $58 on medicare plan D

[Professorgary]

my last bottle of Abi from Mark Cuban Cost Plus drugs was $84. It it actually lower than when I started taking it 16 months ago.

[Spinel_Cutter in reply to Professorgary]

Please be very careful. It could be that you are on an untypical lower than normal dosage. The normal dosage for almost all is 1 gram (1,000mg) per day, taken at once.

Today, at Mark Cuban's website the price is cheaper than it was two weeks ago.

For 250 milligrams Cuban does NOT quote 120 tablets, but 30 tablets, today = $23.69

So, if most men were to go with the 250mg, they would have to buy 4 x 30 tabs / month.

$23.68 x 4 = $94.76 which is the best price I know about.

costplusdrugs.com/medicatio...

Is it possible that you used to take 2, 500 milligram tabs/day, and are now taking only 2, 250 milligrams tablets, which would be 1/2 normal dose? Or, are you on a lower than what is normally recommended?

The Cuban 500 mg tab price today is, for 30 tabs = $97, so most men would need to buy double or two x $97 = $194. Therefore buying and taking 4 tabs of 250 mg each day is more economical.

A few guys "cheat," and take one pill a day with a "low-fat" meal. The "low-fat" meal affects the amount absorbed.

Many believe that this will reduce adverse effects. In reality, it may, or it may make them worse.

Here's an example, it's totally made up but you'll get the point:

Let's say a 280lb guy takes 1 gram/day, and ends up with 100 nanograms/milliliter of blood level.

Then that person takes only two 250mg (or a single 500mg) with a "low-fat breakfast." What will the blood level be? The reality is, we don't know. Maybe it'll be 100 nanograms/millileter, as it shoulrdbe, but maybe it'll be 150 nanograms/ml. If the latter, then we'd expect that the person would be saving $, but that there would likely be more adverse effects.

Looking at a complexly different med, Sirolimus, there is an online group that has done some research in how adding Grapefruit juice and Olive oil (a tablespoon, eww) when taking a dosage and that group has done several +2 hours and +2 day blood level lab tests. The effect has been, "... we’ve seen people here (from blood work) get anywhere from 3 to 6 or 7X increase in bioavailability with GFJ and EVOO."

Since we have no lab blood tests of folk that took, let's say 1/2 the 1 gram dosage, we have no idea what the eventual blood level would be. I would not be surprised to see a doubling or quadrupling of blood level. Now, a doubling would save 1/2 the price and be right where it should be. But a 4x puts the person at greater risk of adverse effects.

It's too bad that someone simply does a trial with ten guys, taking for instance, 1 piece of buttered toast, and 1 scrambled egg." It that causes a double then, sure many could save 1/2, but I doubt that's likely to happen soon.

[Professorgary in reply to Spinel_Cutter]

The things I look at are Testosterone level which is undetectable on 250 mg with food and liver numbers. I have been on 1000 a day for several months and liver numbers are good and in two weeks I’ll have the Testosterone tested. There have been studies which show a 300 to 350 calorie low fat breakfast increases absorption by 4.4 times. These studies are what prompted me to try low dose and my own study will determine if I go back to it.

[Spinel_Cutter]

If I were in a "can't pay" boat, I'd do what you did. What is sad is that there is no available blood level, lab test available (that I know). The folk who "play" with sirolimus have lab tests available for usually less than $100 each. So that group has essentially come up with a data base (not official, of course). By drinking grapefruit juice and olive oil = 7x the dosage. So 1 milligram of sirolimus, doing the GFJ + EVO has the same blood level as a person taking 7 milligrams.

People think: Well, it's better absorbed with food, but that is not necessarily the case, at all. As with Sirolimus, Abi is predominantly cleared by the body's Cytochrome P450 3A4 enzymatic system. I think, but I'm not sure that the GFJ in Sirolimus case, and the breakfast in your case is not "better absorption," but rather the body's 3A4 system is temporarily crippled, thus allowing (in your case 4x) the amount into the blood stream.

Docs would be too fearful to ever say, "Play with that," but if pushed, I would.

An interesting story, that I cannot find googling, today. In Germany there was a doc who had some sort of need for sirolimus. But he was still active in practice. One patient he knew gave him some Grapefruit jam and he loved the stuff (this is a real story). Well, his blood levels soared (those on, for instance a liver or kidney transplant) take Sirolimus, every day. He ended up in ED. There, they took a Sirolimus blood level and it was off the chart, and traced it back to the grapefruit jam.

It's good that you are doing liver and T checks, but be careful (like you are doing).

I found it but you must pay, or.........find it another way but this is the link

link.springer.com/article/1...

It wasn't Sirolimus it was Tacrolimus (an analog of Sirolimus)