Thanks for replies. I'm also going to make one more run at Orgovyx financial support since I'm in that same boat, they used last year's income and now I'm on SS.

For others who may be interested, my medical provider suggested these avenues, in addition to working with Orgovyx:
Contact Cigna to request a “tier exception”, which (if approved) would provide high tier medication at a lower tier price.
Apply for Medicare's Extra Help program
Apply for Medicaid
Apply for foundation assistance via the Prostate Cancer Health Equity Fund"

If all else fail, I'm planning to email the CEO of Pfizer, albert.bourla@pfizer***, since I've had good luck with other escalations.

Here's a brief recap of my, all bad, experience trying to get help paying for Orgovyx. I'm wondering if I should start a separate thread as a warning to others:
- After a multitude of calls and appeals, Orgovyx told me that my income of Social Security only, for my wife and I (I retired at 70), exceeded the limit for assistance. That is insane to me!
- After 3 appeals of my denial for a Tier Exception from Cigna, including an independent review, I gave up this effort.
- My provider offered a voucher, free one month supply, but it says only for those who have never tried Orgovyx.

So, the claim on orgovyxpricing.com that 3 of 4 patients with Plan D supplement will have less than $100 co-pays, reminds me of two animals, bulls and horses.