Does Medicare cover Orgovyx?

Slight correction to my numbers. My insurance covers 29% of the cost. My copay (71%) is still $975/month.

I’ve been on Orgovyx for 9 months. After the $2000 co-pay is met, it is zero dollars with Medicare. As a side effect (no pun), so are all your other medications.

So yes it covers it, after a substantial yearly copay.

Absolutely resounding YES!, many hospital specialty pharmacies have grants that cover your copays. I make fairly substantial income but my hospital assigned me to a grant to cover all copays. Then strangely enough since the grant paid copays my other expensive medications eliquis and trelegy ended up having no copays at Walmart. Check with your treatment facility for grants you may obtain.

That is great information to have !!! Thanks so much for sharing .

I have Aetna Medicare Advantage, using Express Scripts for medications. When I started Orgovyx, my copay was going to be $125/month. Insurance offered $250 for three months, a significant savings, but I couldn't find a pharmacy that would fill a 90-day supply. After several referrals from local pharmacies and about 10 days of phone calls, I am using Biologics by McKesson for 90-day supplies, and they had access to grant programs. They got me approved through the PAN Foundation for the first year, and my co-pay is $0! Another national pharmacy that may be an option is Onco360, specializing in cancer medications. Good luck! Caveat: Biologics kept getting rejection responses from Express Scripts when trying to approve my 90-day supply. If you have a similar issue, contact your prescription provider (in my case, Express Scripts) and ask for their pharmacist-only phone number. Someone at Express Scripts had to "override" a setting in their software to get the approval. All has been seamless since then, but Biologics had to make that personal call.

@trchar I think I've discovered that regarding copay, it's not what you personally pay but what you've filed with insurance. As soon as I had the combination of Eliquis and Orgovyx, I had met the copay maximum even though a grant was paying for my Orgovyx. I'm grateful!

Yes, I’m grateful too. If a grant pays it’s the equivalent of if we actually paid ourselves. So that grant copay pay covers our responsibility.