Trying to get Nubeqa instead of Zytiga/ prednisone

@jeffmarc I was quoting the full abbie cost for 3 months, not one. With insurance coverage it would be a lot less. Even if it was $1K the insurance companies will resist a move to a $10K Nubequ, Erleada, or Xtandi. They may not cost the patient more but do cost the insurer. Therefore, preapproval with a good reason why the generic cannot be used is almost always required.

Lowest cash price is from Mark Cubans Cost Plus Drugs (zip 33810 if location required). There 90-day price is about $195 with shipping for both. They carry a very limited number of brand drugs and no specialty brand drugs so none of the ARSIs, Orgovyx. Mail order only so no doctor or pharmacist assisted (Lupron, Firmagon, etc.) or scheduled drugs either. A fixed per fill fee + medication so generics can get very cheap if you can get a 360-day prescription. For 5mg Tadalafil it is $22.80 for 360 and $16.75 for 180 pills (includes US shipping but not any state taxes). Length is limited by any state regulations.

If one "demands" certain drug and doctor prescribes it, insurance will cover it.

We had at least 3 cases here that proved that actually working. So, no harm in trying with valid cause. If somebody has any heart issues, Abi is really not something "to try first". Yes, it will be offered first as the cheapest option, but one can mention that one has heart issue and ask for heart friendlier medication such as Nubeqa.

New studies show that using ARSI with ADT gives actually better cancer control as well as better delay of castration resistance ( @northoftheborder knows which one, I always forget the name ).

@ kcraff777 dad is 81 - he looks for quality of life and is not imagining living to be 108, so having Nubeqa now would be a preferred way to go for many reasons. Even if he develops resistance in 5 years , he will have available Pluvicto or chemo etc. , and he may never develop resistance. As we can see here on our forum - there are members on ADT for more than 11 years and did not develop resistance. With PC one just never knows what will happen in any particular case. If this person is looking for quality of life, IMHO Nubeqa is definitely something that this person might prefer to try.

Abiraterone (Zytiga) is somewhat less effective than the 2nd generation ARSIs (the -lutamides), but the main argument against it is that it requires taking a steroid (Prednisone) at the same time, and the steroid brings its own set of serious side-effects for some people.

The patents for Enzalutamide (Xtandi) start expiring this summer; by 2028, we should start seeing the first inexpensive generic -lutamide on the market, which will reduce the economic pressure from insurers to settle for Abiraterone + Prednisone as an "it's good enough for you" treatment.

p.s. Currently, the -lutamides are still ridiculously expensive here in Ontario, but not quite as bad: if you walked into a commercial pharmacy with a prescription for Apalutamide (Erleada) and no private insurance or government drug benefit, you'd pay the equivalent of about US $3,000/month (v.s. $15,000–20,000/month in the U.S. itself).

But here, as in the U.S., few people (if any) would pay out of their own pocket. In my case, the province's Trillium Drug Program picks up the cost; when I turn 65, it will switch over to the universal Ontario Drug Benefit (ODB).