Insurance and Xtandi

Does your doctor think that Zytiga (abiraterone) will work for you? Zytiga generally offers lower out-of-pocket costs due to available generics.

Maximum annual prescription expense on Medicare is $2100. Once you pay that, all other scripts are free for the remainder of the year. Hit my maximum with one refill of Nubeqa last week. Orgovyx was free. You said your SS is $2500. If you are 65+, you should be on Medicare. If that is SS disability, you should qualify for Medicare as well.

It’s my understanding that the Medicare annual out-of-pocket prescription drug maximum (which is $2,100 in 2026) does not apply to drugs that are not on the plan's formulary.
The cap only counts towards covered Medicare Part D drugs, meaning we will pay 100% of the cost for non-formulary, uncovered medications.

@brianjarvis
Yep. That's why it's important to check the formulary when choosing a part D plan to make sure all drugs are covered. If the OP is not on Medicare yet, when signing up, he can check to make sure his meds are covered when selecting part D (or Medicare Advantage if that's his choice) at the same time.

@brianjarvis
While this is true I have found every drug I have been prescribed is covered. I take a wide variety of drugs. All ARPI drugs are covered as are incontinence drugs and blood pressure drugs. The formulary is quite comprehensive.

@jeffmarc I just took another look at my Part D formulary.

It lists Erleada, Nubeqa, and Xtandi, but not Zytiga.

On the other hand, it lists Abiraterone, but not apalutimide, darolutimide, or enzalutimide.

Interesting.

So, if it ever comes down to it, I could navigate through this. (Plus, since my prostate cancer has been determined to be military service-connected, I could choose to go down that path.)

@brianjarvis
Erleada, Nubeqa and Xtandi are apalutamide, Darolutamide and Enzalutamide.

Abiraterone (Zytiga) is listed As you mentioned. One of them has two names.

Also need to keep in mind that all part D plans are not the same. I looked at 2 this last go around that did not cover Orgovyx, Nubeqa, or Entresto. My annual drug cost on those plans would have been $250,000+.

@mjp0512
I was surprised to see that part D. is not the same for everyone. Do you have an HMO or do you have a supplemental plan that would cover any of these?

Might be worth changing health plans for the next time you get a chance.

@jeffmarc
Plans change every year and are different depending on where you live. I review plans each year to make sure my meds (or possible meds) are covered. Medicare supplement plans (Medigap) are regulated. Supplement plan A, B, or G covers exactly the same no matter which company is selling it. Some charge more but benefits are exactly the same. Not so for part D drug coverage. You have to pay attention to each individual plan's formulary.