I took orgovyx for 3 months in 2023 before I had medicare, and I had to pay $4000. The urologist I was seeing at the time did not want to prescribe it, and I had to argue with him to get it. I did not see him again after I started taking it.
I started taking it again in Dec 2024, and I have not had to pay anything. I received 3 bottles from TC Scripts pharmacy. This time it was prescribed by the RO - the salesman that calls on him gave me one bottle for free that I got at the RO's office, and I received the other 3 bottles in the mail. I was expecting to have to pay the $2000 medicare co-pay, but for some reason I was not charged. I have no idea why, and the RO said he does not know. They did not ask me for any information, financial or otherwise. I will need two more bottles to complete my treatment, so we will see if I get charged for those.
A one month supply of Orgovyx (30) pills is $2,932.00. Medicare will pay the bulk and co-pay is $920.00 a month. The good news is maximum out of pocket this year is $2,000.00. So thankful for that $2,000.00 cap. I’m on Orgovyx for 18 months so the cap is a lifesaver. $2,000.00 is bad enough but much better than $11,000.00 a year. Best of luck with your treatments
Ken
Go to savon 1 800 683 1074...my doctor and pharmacy gave me the number and it got approved 6 months refills..no out of pocket...one month cost for this drug is 900..
It is actually Sav-on, the drug store chain. I’d really be interested in hearing how you were able to get Orgovyx for free for six months. There had to be some requirements did you have to fill out forms, list income. Was there one particular insurance company that was covering it?
Just wondering because I wanted to know if everybody could get this.
OK thanks. I’m not on it yet , but I’m planning for the future. I’ll have to go for a PSMA scan down the road , and if it shows a spot or 2 then we might radiate them .
I think @scottbeammeup is right on target. There is tremendous variability from one insurance provider to another. Under the Medicare Advantage plan I have, paid for by my former employer, I have been paying just $75/month for Orgovyx. Surprisingly, my insurer seems to be paying pretty much full price for the drug - over $2500/month (everything else related to my treatment, they have "negotiated discounts" of 75-90% off list price).
If it looks like the cost under your Part D plan is going to be steep, definitely talk to your oncologist and your specialty pharmacy - there are many deals to be made.
Go to savon 1 800 683 1074...my doctor and pharmacy gave me the number and it got approved 6 months refills..no out of pocket...one month cost for this drug is 900..
Go to savon 1 800 683 1074...my doctor and pharmacy gave me the number and it got approved 6 months refills..no out of pocket...one month cost for this drug is 900..
My Orgovyx was a "covered drug" on my Part D plan; with a 25% co-insurance.
I believe that a medication must be a "covered drug" under the Part D plan, and then your out of pocket for all "covered drugs" is capped at $ 2000.
I have some knowledge of Medicare, but I am not an expert.
I do know quite a bit about Medicare and you are absolutely correct that the prescribed drug has to be a covered drug under the Medicare Part D plan in order for the out of pocket cost to count toward the $2,000 annual cap.
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I took orgovyx for 3 months in 2023 before I had medicare, and I had to pay $4000. The urologist I was seeing at the time did not want to prescribe it, and I had to argue with him to get it. I did not see him again after I started taking it.
I started taking it again in Dec 2024, and I have not had to pay anything. I received 3 bottles from TC Scripts pharmacy. This time it was prescribed by the RO - the salesman that calls on him gave me one bottle for free that I got at the RO's office, and I received the other 3 bottles in the mail. I was expecting to have to pay the $2000 medicare co-pay, but for some reason I was not charged. I have no idea why, and the RO said he does not know. They did not ask me for any information, financial or otherwise. I will need two more bottles to complete my treatment, so we will see if I get charged for those.
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1 ReactionI'm on SSD Medicare.covered mine
A one month supply of Orgovyx (30) pills is $2,932.00. Medicare will pay the bulk and co-pay is $920.00 a month. The good news is maximum out of pocket this year is $2,000.00. So thankful for that $2,000.00 cap. I’m on Orgovyx for 18 months so the cap is a lifesaver. $2,000.00 is bad enough but much better than $11,000.00 a year. Best of luck with your treatments
Ken
It is actually Sav-on, the drug store chain. I’d really be interested in hearing how you were able to get Orgovyx for free for six months. There had to be some requirements did you have to fill out forms, list income. Was there one particular insurance company that was covering it?
Just wondering because I wanted to know if everybody could get this.
-
Like -
Helpful -
Hug
2 ReactionsOK thanks. I’m not on it yet , but I’m planning for the future. I’ll have to go for a PSMA scan down the road , and if it shows a spot or 2 then we might radiate them .
I think @scottbeammeup is right on target. There is tremendous variability from one insurance provider to another. Under the Medicare Advantage plan I have, paid for by my former employer, I have been paying just $75/month for Orgovyx. Surprisingly, my insurer seems to be paying pretty much full price for the drug - over $2500/month (everything else related to my treatment, they have "negotiated discounts" of 75-90% off list price).
If it looks like the cost under your Part D plan is going to be steep, definitely talk to your oncologist and your specialty pharmacy - there are many deals to be made.
Thanks. Good to know 👍
Go to savon 1 800 683 1074...my doctor and pharmacy gave me the number and it got approved 6 months refills..no out of pocket...one month cost for this drug is 900..
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Like -
Helpful -
Hug
2 ReactionsI do know quite a bit about Medicare and you are absolutely correct that the prescribed drug has to be a covered drug under the Medicare Part D plan in order for the out of pocket cost to count toward the $2,000 annual cap.
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4 ReactionsOK . Thank you !