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Comparing Medicare Drug Plans May Ease Prostate Cancer Financial Toxicity

For patients with advanced prostate cancer, financial toxicity associated with  use of oral androgen inhibitors can be reduced by comparing Medicare Part D plans.

Enzalutamide and abiraterone are increasingly prescribed by urologists for earlier prostate cancer stages and for longer periods.

In a study, Benjamin Pockros, MD, of the University of Michigan in Ann Arbor, and colleagues compared the costs associated with these drugs across plans available in 12 different zip codes using the free online Medicare Part D Plan Finder. Available plans ranged from 19 in New York, New York (Manhattan) to 28 in Phoenix, Arizona.

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Median annual out-of-pocket (OOP) costs were $11,626 for enzalutamide and $9275 for abiraterone, the investigators reported in Urology Practice. Enzalutamide out-of-pocket costs ranged from $9854 to $13,061 per year and abiraterone costs from $1379 to $13,274 per year. The costs reflect both hospital and mail-order pharmacies. Financial assistance programs were excluded.

Less than 30% of patients report comparing drug costs before selecting a Medicare Part D plan. Within certain zip codes, patients could potentially save $2512 on enzalutamide and $9321 on abiraterone annually by choosing the least vs most expensive plan, Dr Pockros and colleagues reported. The median difference in OOP costs between enzalutamide and abiraterone was $8758.

The investigators noted that there is currently no limit on individual OOP spending under Part D coverage.

“Open enrollment season for plan selection occurs annually from October 15 to December 7. Physicians should reach out to their patient panel during these weeks, emphasize that OOP drug costs can substantially vary between Part D plans, disseminate the link to, and encourage their patients to compare costs before selecting a new drug plan.”

In an accompanying editorial, Daniel Carson, MD, and Yaw A. Nyame, MD, MS, MBA, of the University of Washington in Seattle, noted:

“Featuring other tools (ie, GoodRx and Mark Cuban Cost Plus Drug Company) and pending legislation (Inflation Reduction Act, beginning 2025) aimed to mitigate rising costs for medications are key as we work toward making the affordability and access to cancer medications equitable for patients with prostate cancer.”


Pockros B, Shabet C, Stensland K, Herrel L. Out-of-pocket costs for prostate cancer medications substantially vary by Medicare part D plan: An online tool presents an opportunity to mitigate financial toxicity. Urol Pract. 2023 Sep;10(5):467-475. doi:10.1097/UPJ.0000000000000421