After insurance approval, how long did it take to receive Orgovyx?

My first year on Orgovyx was mostly covered by a grant that was secured for me by Dana Farber Cancer institute in Boston MA. The list price for 30 Orgovyx pills in this area is just over $2,900.00 or just about $100.00 per pill. My original co-pay was $920.00 per month. After I paid one month the grant paid the rest. So grants are not available for 2026 and I get a call to refill my Orgovyx in January the co-pay is $1,339.50. I said HA, don’t send it and I’m not paying. Been retired for 17 years and fed up shelling out hundreds of thousands of dollars since retirement. Long story short…… after about 6 days of phone calls and forms along with personal documentation the manufacture of Orgovyx will supply me for the entire year at NO CHARGE. Check with them, if you are retired for a stretch and have an “outdated” income you have a shot at FREE Orgovyx.

@aprapr, how did things work out for you? Have you received your prescription and started treatment with Orgovyx now?

@colleenyoung his psa went down to .11 from .13! Never expected that….So back to active surveillance. Another PSA in 3 months. Thanks for followup.

I decided to start on Orgovyx two days ago, & my oncologist put the order in (along with Nubeqa). Yesterday I received a call from the hospital pharmacy asking if I wanted a grant. I said, that'd be nice, but I have the income & there are other more needy people. She said, "there is plenty of money," so I said "OK". I sent in my IRS 1040 to qualify my income, being sure I would be DISqualified, but no, it was approved. Today I picked up my pills & got the requisite counselling. Prescription renewals will be delivered by courier.

So, two days.

It took me about four weeks to get my Orgovyx, but let me explain. I am on Medicare and Tricare for Life (military retiree). This combination normally works like a Medicare Advantage plan which includes Part D (medications). Normally that would automatically take care of prescriptions, with Medicare paying nothing, and Tricare for Life being on the hook for 100%. However, Orgovyx is a "special case," requiring pre-authorization. Approval can be given only AFTER a pre-authorization review. My MO submitted the prescription for review, and the request for the required pre-authorization was DENIED. The denial letter explained that there were alternaties whichdidnot require pre-authorization. Also, it noted that I had a right to request a reconsideration, but that it would take about 60 days to get a reply. I called the denying authority and was told that if I went ahead and purchased Orgovyx out of pocket, and a subsequent request for reconsideration resulted in approval, I could file for a reimbursement of any funds expended to purchase Orgovyx. I decided that I did not want to delay the start of the ADT portion of my treatment any more than was necessary, but I didn't have the funds to pay out the $5121.42/month list price. So, the MO and I decided to go ahead and start ADT immediately with Firmagon, which did not require pre-authorization, and was covered under the normal rules affecting prescriptions. At the same time, I filed a request for reconsideration. Lo and behold, 3 weeks after starting the Firmagon, and four weeks after my initial request for Orgovyx pre-authorization, I received a response to the reconsideration request. They reversed the earlier decision and authorized Orgovyx. Within 2 days of receiving that reversal, I had the Orgovyx in my hand, and started the Orgovyx regimen that same day. I apologize for the length of this comment, but I thought anyone else finding themselves in my position would like to know that sometimes it is worth asking for something, even if it is very long shot. The worst they can do is say "no," and you haven't lost anything.