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im62at2024 avatar

One year PO and now it seems I'm Stage 4 :-(

Prostate Cancer | Last Active: Jun 10 7:15am | Replies (42)

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@heavyphil
I got a wonderful call from the hospital network speciality pharmacy or whatever the lady called it telling me that Orgovyx would be covered for me at a $0 copay. Not sure how that happened but I'm glad it did. Something about it would have been $1000/month but it would be $0. Not sure if they ran through the Orgovyx payment plan or what.

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Replies to "@heavyphil I got a wonderful call from the hospital network speciality pharmacy or whatever the lady..."

@im62at2024 If you have commercial insurance what they did was submit the application and got approval for the Orgovyx savers program. That covers copays up to $10K per calendar year. Pharmacy puts in bin/pcn/grp that charges the copay to the pharma company. They are willing to accept what the insurance will pay. At a $0 or $10 copay you have no incentive to switch to Lupron. The kicker is that the insurer is not always notified so the copay may or may not be credited to an annual maximum.