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.
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.