...what should I expect for out of pocket for Zytiga & prednisone on a monthly basis?
That's difficult to say. Every plan can negotiate base prices, and set their own formulary.
Zytiga, in my plan, is allowed as a tier 5.
You have to meet a deductible, with mine that is $380 / year, so the first month will hit that.
During the initial coverage phase, my copay would be 25%, until I hit $3820 (the "donut hole").
During the Coverage Gap (aka donut hole), I would pay 25% up to an out of pocket of $5,100.
Then we are off to Catastrophic. There the copay comes down to 5% plus a part of the "dispensing costs".
You have to do all this based on a specific plan if you want real numbers.
I ran it through my 2019 plan:
FULL COST OF DRUG $10,805.65
Initial and Coverage Gap Months $2,701.41
Catastrophic Coverage Months $540.28
So you would burn through the $5100 to get to catastrophic pretty quickly.
My Part D has a blanket exemption for my generic prednisone, so it is no charge to me.
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Moderator - Prostate Cancer(Not a medical professional)
IGRT journey (2010) - www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 9/12-3/13, 6/14 to present
Prolia 6-mo inj 12/12 to present
Casodex 12/14, end 3/15 after psa 30% rise
Zytiga 04-07/15 Xtandi 04/16-8/17
RT for spine mets 9/18
Post Edited (142) : 12/31/2018 8:17:10 PM (GMT-7)