Connect
← Return to What's your experience with Orgovyx (relugolix)?
Discussion
What's your experience with Orgovyx (relugolix)?
Prostate Cancer | Last Active: Mar 17 5:59pm | Replies (277)Comment receiving replies
@georgemc Express Scripts/ TRICARE approved me for Orgovyx last fall with no issues. I would definitely request reconsideration. It may be that your RO or MO did not complete the form correctly. Question 4 asks if the diagnosis is advanced prostate cancer or other. If other, question 5 has a text block for the provider to write the diagnosis. (It cannot be approved for uses other than prostate cancer.) Then question 6 asks if it is NCCN category 1, 2A or 2B. If you're approved for proton radiation of your prostate, you must have had a positive biopsy indicating at least NCCN tumor stage T1 or T2a or T2b. In my case, the MRI indicated PIRADS 4 and the biopsy discovered 3 of 20 specimens at grade group 2.
I recommend Orgovyx. It has given me very few side effects, but more importantly to me, it knocks down testosterone levels within days - not weeks. And you might want to consult with a pharmacist at your local military pharmacy who could be more attuned to these pre-authorization forms. Good luck.
Replies to "@georgemc Express Scripts/ TRICARE approved me for Orgovyx last fall with no issues. I would definitely..."
Connect
@edwardbrown1 I am in the process of appealing the ExpressScripts denial of my doctor's request for pre-authorization of Orgovyx. The denial letter says "Coverage is provided in situations where the diagnosis is cited in the National Comprehensive Cancer Network (NCCN) guidelines as a category 1, 2A, or 2B recommendation." It appears the rationale for denying the request is that I fall into NCCN category 2c, in that I have involvement of both halves of the prostate, one is a RADS 4, 1.5ml lesion and the other a RADS 4, 0.7ml lesion. My biopsy involved 14 samples, 5 of which (3 on one side and 2 on the other) were "positive." One evaluated as Gleason 3+3=6 (Group 1), three evaluated as Gleason 4+3=7 (Group 3), and one evaluated as Gleason 3+4=7 (Group 2). Someone arbitrarily has identified these 3 categories as worthy of Orgovyx, while all others are not. My oncologist says such an arbitrary decision is not based upon medical considerations as far as he can see. The number and types of the specimens should be the the deciding medical consideration, not the side of the prostate on which they may have been found. Have you any suggestions as to how I might convince ExpressScripts that they should reverse their earlier denial? I would seriously consider buying Orgovyx "out of pocket," but at roughly $100/day for 4-5 months That is a stretch I wold prefer not to make. My onclogist is looking at starting with Eligard, then shifting, after a month, to another med (didn't catch the name of it, might have been Lupron), for an additional 3 months. Anyone out there have experiences with Eligard to share? Lupron?