After insurance approval, how long did it take to receive Orgovyx?

Posted by aprapr @aprapr, Mar 8 7:30am

After insurance approval, about how long did it take to receive Orgovyx? MO told us will come from a specialty pharmacy. Think it will be prescribed to husband when we meet again with MO Wednesday at Mayo. Thank you.
History: He had prostate removed 2014, all good until 2024 when psa detected and increased to .24. low decipher, RO did 33 treatments of salvage radiation, fall 2025. 1st PSA 6 months after radiation was undetectable, 6 months later .11, then .13. PSMA PET clear. Another PSA test on Wednesday then appt with MO to determine newest plan with ADT.

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Because Orgovyx in USA is a high priced / high profit item Sumitomo Pharma hands out lots of professional samples. Your doctor may be able to provide you with your first 30 days at no charge. Just good business with the remaining months costing you & your insurance about $2K per month. This also starts the treatment while going through the approval process.

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In our experience Orgovyx arrives pretty quickly once insurance approves it. I’d say three or four days. Our doc did give us two months worth of free samples to start but we only used one.

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Profile picture for jim18 @jim18

Because Orgovyx in USA is a high priced / high profit item Sumitomo Pharma hands out lots of professional samples. Your doctor may be able to provide you with your first 30 days at no charge. Just good business with the remaining months costing you & your insurance about $2K per month. This also starts the treatment while going through the approval process.

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@jim18 thank you! Will ask for samples!

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Profile picture for ucla2025 @ucla2025

In our experience Orgovyx arrives pretty quickly once insurance approves it. I’d say three or four days. Our doc did give us two months worth of free samples to start but we only used one.

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@ucla2025 thank you!

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Profile picture for aprapr @aprapr

@jim18 thank you! Will ask for samples!

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@aprapr I had to get my Orgovyx thru Sloan Kettering - either mailed or pick up.
They also had a financial aid program if you had income lower than a certain amount and you could get a break on the price; I’d look into this as well.
Phil

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My insurance offered a price break for a 90-day supply, but local pharmacies didn't fill more than 30 days. Biologics by McKesson, a national cancer pharmacy, filled mine and found a grant that covered my first year. Income qualification was no more than 5X poverty level. I believe Oncor is another such pharmacy but I have not used them.

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The specialty pharmacy should be able to deliver it within a few days. On Medicare Rx with the $2,000 cap, after a few months the co-pay limit will be reached.

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My oncologist sent me home with a sample with instructions to begin taking immediately following PSMA PET. His office houses a specialty pharmacy, and it was pretty obvious that there was no concern about insurance approval. I get a call each month when refills are ready. Have Medicare Part D coverage so between Orgovyx and Nubeqa, I just write a check for the $2,100 maximum the first week of January and all scripts for the rest of the year are covered @ 100%. Then start saving $200/month for next year.

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Profile picture for lsk1000 @lsk1000

The specialty pharmacy should be able to deliver it within a few days. On Medicare Rx with the $2,000 cap, after a few months the co-pay limit will be reached.

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@lsk1000 yes, counting on that. Thank you.

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If on commercial insurance there is an Orgovyx Savers Program (Google it if needed) that will reduce your copay to $10 per month. Capped at $10,000 per year, but that will cover a 40% copay for the entire year.

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