Abiraterone Cost With & Without Insurance

Abiraterone acetate (commercially known as Zytiga) is an oral agent used to treat metastatic prostate cancer. Abiraterone acetate inhibits the production of androgens (male hormones), which may stimulate the cancerous growth of prostate cancer cells. Abiraterone is a very successful treatment, and yet the cost of Abiraterone may provide difficulty for many of its patients and their families. The price of Abiraterone is variable based on several factors, such as insurance coverage, prescription assistance programs, or the place of purchase. This article provides a thorough analysis of the cost of Abiraterone with and without insurance, as well as possible avenues to obtain financial assistance.

Abiraterone Cost Without Insurance

Abiraterone can be extraordinarily expensive for patients without health insurance. The average retail cost for a one-month supply (250 mg tablets, typically taken at a dose of 1,000 mg each day) is approximately $9,000 to $13,000 in the United States. 

The cost of Abiraterone can vary by:

• Dosage and duration prescribed by the oncologist 

• Location and markup of the pharmacy

• Brand name vs. generic options such as Abirapro (generic abiraterone acetate is typically much lower than Zytiga)

Most patients taking Abiraterone will find that out-of-pocket costs without the help of commercial or Medicaid insurance or a patient assistance program are probably going to be quite expensive.

Abiraterone Cost with Insurance

Health insurance markedly decreases the financial impact of Abiraterone. The majority of insurance plans, including Medicare Part D, identify Abiraterone on their specialty drug tier, which can still be subject to copays, coinsurance, and/or deductibles depending on insurance policy type and patient eligibility.

• Commercial Insurance Plans: Copays may range from $50 to $200 per month, depending upon the range of drug formulary and the choice between generic and brand-name prescriptions.

• Medicare Part D: Costs may vary significantly due to regulatory changes, such as "donut holes" that limit coverage. Therefore, total annual out-of-pocket costs can fall between $500 and $2,500 depending on Medicare Part D eligibility.

• Medicaid: Most state Medicaid programs cover Abiraterone, and most likely, if so, the patient won't have to pay anything out of pocket or a very low deductible or copay.

Patients should always ensure they understand the coverage and reimbursement of their medications to avoid overpriced bills.

Factors Affecting Abiraterone Pricing

There are a few variables that will affect the final price that patients pay:

• Brand vs Generic - Generic abiraterone acetate became available in 2018, with lower pricing than Zytiga. In fact, generics can have savings of up to 80%.

• Pharmacy - Specialty pharmacies have different pricing structures than retail pharmacies.

• Manufacturer Discounts - Janssen, the manufacturer of Zytiga, has copay assistance and patient support programs.

• Geographic Limits - The price of medications can differ between states and within local pharmacies.

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Financial Help Programs for Abiraterone

Patients who have difficulties paying for the cost of abiraterone may qualify for one of the following financial help programs:

• Manufacturer Copay Cards: Janssen CarePath provides resources for qualifying commercially insured patients and offers costs down to less than $0 per month.

• Patient Assistance Foundations: Nonprofit organizations such as the Patient Advocate Foundation or CancerCare may be available to help with copays or can provide grants.

• Generic Discounts: Pharmacies like Costco, Walmart, or online retailers may have competitive prices for generic abiraterone.

• Clinical Trials: Depending on the research study, there may be opportunities related to clinical research where the medications are provided at no charge.

While abiraterone is still an expensive drug in the U.S., the cost is often much lower in other countries. For example:  

• In Canada, generic abiraterone may cost the patient between $2,000 and $3,000 per month.

• In India, it may cost a few hundred dollars a month

Some patients may ultimately explore international pharmacies, although patients want to be careful and explore carefully with their doctor to understand drug authenticity and safety.

Final Words

The expense of Abiraterone can vary tremendously based on insurance coverage, pharmacy choice, and financial assistance options. If patients do not have any insurance, they could pay as much as $10,000 or more per month, whereas those who do have insurance could pay drastically less, sometimes only a couple of hundred dollars. In many cases, the generic and patient-subsidized options provide a lot of relief.

Regardless, anyone prescribed Abiraterone should proactively plan - know the insurance benefits, seek out financial assistance, and price compare when possible. By doing so, patients can reduce their costs and patients can stay on effective treatment for their prostate cancer.