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← Return to Lupron or Not at 76?
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First, make sure Orgovyx is in your Part D plan formulary, and check if there are limits (mine only covers it for 12 months). If it is in your Part D formulary, the maximum out of pocket expense for 2026 Part D medications is $2100. This rule applies to every Part D provider, you can read for yourself on Medicare.gov . After that you have no costs whatsoever. My copay was $646 per month, but once I hit $2100 all of my RXs are at no cost through the end of the year. I am Gleason 8 with Crib and IDC and my oncologist is hell bent on 18 months of ADT. If I can't talk him into 12 months I'll need to switch Part D providers this fall during open enrollment for 2027. I think max out of pocket next year will be $2200-$2400, and you can sign up to spread that out into equal payments throughout the year.
Replies to "@tbgb50 First, make sure Orgovyx is in your Part D plan formulary, and check if there..."
@carlsbadguy
Thanks, I'll check. I know it's in the formulary but do not know how long it is covered. I'm meeting the the doctor today to see if I can get him to approve Orgovyx.
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@carlsbadguy You are definitely going to need those 12 months of ADT…so why get worked up now about a longer course of 18 months?
When the time comes you can then decide what you want to do depending on how you feel; remember, the oncologist can only ‘recommend’ - he can’t force the pills down your throat.😉
That’s the great thing about Orgovyx - YOU can stop it at any time if it is really affecting you. With Lupron, that shot will take many months to get out of your system before you get back to normal.
After the one year is up and your numbers look good, that would be the time to negotiate the further duration. A lot can happen in a year and your Doc may then be more amenable to your wishes. No real need to rock the boat now. Best,
Phil