Xtandi patient on Medicare — with supplement — pays $441.97 per month
Astellas has claimed that patients taking Xtandi face very small co-payments. One patient living in Arizona contacted KEI with proof that Astellas' claims just aren't true. The patient, who is on Medicare, provided a copy of a summary of his expenses for the first quarter of of 2016.
His monthly patient co-payment is $441.97 a month.
Xtandi (enzalutamide) is an expensive prostate cancer drug that was invented at UCLA on grants from the US Army and the National Institutes of Health. Astellas sells the drug to U.S. residents at prices two to four times higher than other high-income countries. KEI recently requested that the NIH use its authority under the Bayh-Dole Act to allow a generic company to manufacture Xtandi. More information here: http://keionline.org/xtandi.
Astellas Pharma, the Japanese pharmaceutical company that markets Xtandi, issued a press statement in late March in which they asserted that "79% of Medicare patients paid nothing out of pocket per month for Xtandi," despite the fact that their patient assistance program covers only uninsured or underinsured patients.
The total cost for a one-month supply of Xtandi (120 pills) as listed on in the “Explanation of Benefits” document comes out to $8,839.49, or around $73.66 per pill, $294.64 per day, and $107,617.26 per year. This is the reduced price for medicare patients.
In March 2016, the patient paid $441.97 in out-of-pocket costs, equaling 5-percent of the total monthly cost for the prescription, while the plan paid for $8,397.52 of the prescription cost. Generally, Medicare and plan sponsors share costs after a patient reaches a certain spending threshold (more information here).
Medicare beneficiaries pay five-percent coinsurance on covered Part D brand-name drugs when they reach Catastrophic Coverage, the phase after the patient leaves the Coverage Gap (more commonly known as the “donut hole,” when a patient’s out-of-pocket costs range between $3,310 and $4,850).
The plan that this patient is on lists Xtandi as a tier 5 drug, with a 33-percent coinsurance rate before the Coverage Gap. Coinsurance spikes to 45-percent for all branded drugs within the donut hole, with the plan covering 5-percent of the cost and the manufacturer paying a mandatory 50-percent discount on behalf of the patient. (The discount counts towards true out-of-pocket costs, or TrOOP.)
This patient has already reached $5,815.59 in out-of-pocket costs for 2016, with some covered by the mandatory 50-percent manufacturer discount that applies during the Coverage Gap stage. The patient’s payments for Xtandi for April through December of 2016 will total $3,977.73 in coinsurance, assuming the price remains the same.
In an email, the patient informed us that his out-of-pocket costs for 2015 were $9,769.41. “The bulk of this was for Xtandi as the only other prescription drug I take is Metformin which only costs $2.65 per month,” he wrote.