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What's your experience with Orgovyx (relugolix)?

Prostate Cancer | Last Active: 6 days ago | Replies (185)
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@seasuite

@michaelcharles Thanks for the comeback and I have to say I'm so impressed with this functional Mayo site, and Mayo in general, that allowed me to easily post a photo. I tried to get a 'video' second opinion from Mayo Urology/Radiology, but, was told I'd need to come to Rochester even for telemedicine.

I'd be happy with 25% copay. As mentioned, mine was 50% and yes, I think that if I continue (I need 4 months min.) it will drop according to the chart I've attached. My guess is that you were initially in 'coverage gap' as the next step is 'Catastrophic Coverage' (AKA you should have bought the pharma stock).

I'm going to write up my experience and send to Stanford Med. so they can bring in their Orgovyx rep. Apparently, they used my income data, however, I didn't provide any directly. Looking at last year makes no sense as I retired this year and went on SS. As a last resort, I usually look up the CEO (Pfizer?) and send an email. Surprisingly, that has worked well for me with several past unrelated escalations, however, I had very strong cases in prior situations.

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seasuite | @seasuite | Oct 6, 2023

The file said it's attached, but, I can't see it. In any case, here is the information:
Medicare Pharmacy Coverage Details
How your Pharmacy Part D Drug Plan Works
Your plan has 4 stages. The amount you pay depends on which stage you are in.
1 Deductible
In the deductible stage, you pay 100% for Tier 4 and Tier 5 drugs until you meet your $100.00 deductible. There is no deductible for drugs in other tiers.
Deductible Remaining
$0.00
Met: $100.00
$0.00 to $100.00
You're in Stage 2
2
Initial Coverage
In the initial coverage stage , you and the plan begin to share costs until you spend a combined $4660.00.
Initial Coverage Limit Remaining
$1,964.90
Met: $2,695.10
$0.00 to $4,660.00
3 Coverage Gap
In the coverage gap stage , you and the plan continue to share costs until your out-of-pocket spending reaches $7400.00.
Coverage Gap Limit Remaining
$5,995.52
Met: $1,404.48
$0.00 to $7,400.00
4 Catastrophic Coverage
The plan pays most of the costs for Medicare-covered drugs. The catastrophic coverage stage continues through the end of the calendar year.

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