Astellas Pharma’s Xtandi Support Solutions program offers patient assistance services to eligible patients who are prescribed Xtandi (enzalutamide) for metastatic castration-resistant prostate cancer (Table).
Xtandi Support Solutions has several financial assistance programs for Xtandi, including Xtandi Patient Savings Program for insured patients, and Astellas Access Program for uninsured and underinsured patients.
For patients with Medicare coverage with out-of-pocket costs, Xtandi Support Solutions may help determine eligibility assistance from independent copay foundations.
Xtandi Patient Savings Program
This program is designed for patients who have private health insurance but who may not be able to pay their out-of-pocket costs. There are no income requirements. Patients are not eligible for the program if they have prescription drug coverage in part or in full from any state-funded or federally funded programs; there also are other rules and restrictions.
Each medication refill will cost patients no more than $20 a month, for a savings of up to $5000 per prescription and up to $25,000 annually.
Astellas Access Program
This program is for patients without health insurance, although some Medicare Part D patients may be eligible, and provides Xtandi free to patients who meet certain criteria. Patients must meet the following eligibility guidelines:
- Have a prescription for Xtandi for an FDA-approved indication or in accordance with an authorized compendia listing
- Be uninsured, waiting on the determination of their eligibility for public assistance (eg, for Medicaid), or be denied coverage of Xtandi by their health insurance plan
- Have an annual household adjusted gross income <$100,000
- Have a verifiable shipping address within the United States.
Referral to an Independent Copay Foundation
Third-party foundations provide patients, including patients who are privately insured or those with Medicare or Medicaid coverage who cannot afford out-of-pocket costs, assistance with their copayments associated with using Xtandi.
The Xtandi Support Solutions staff can help determine whether this option is appropriate for individual patients and can connect patients with foundations that may be able to help them. Each foundation has its own eligibility criteria and enrollment process.
Application & Enrollment
To determine whether a patient qualifies for payment assistance, his or her healthcare provider should fill out the Patient Enrollment Form at www.astellaspharmasupportsolutions.com and fax it to 855-982-6341.
The provider can call Xtandi Support Solutions or can access Astellas eService to verify benefits and cost-sharing requirements and to obtain more information about assistance options.
Documentation, such as a copy of the patient’s most recent tax return or most recent W-2 form, is required as proof of the patient’s income.
On receipt of the Patient Enrollment Form, Xtandi Support Solutions performs the benefits verification, which evaluates the patient’s insurance coverage requirements for Xtandi, requirements for prior authorization, cost-sharing responsibility (including deductibles, coinsurance or copayment, and out-of-pocket maximums), and a list of specialty pharmacies that participate in the patient’s insurance coverage.
Xtandi prescriptions can only be filled at specialty pharmacies participating in the Xtandi network or by dispensing physician practices; a list of participating specialty pharmacies and specialty distributors for dispensing physician practices is available online. Xtandi Support Solutions informs patients of network specialty pharmacies that participate with the insurer.
Astellas notifies patients and their prescribers regarding enrollment in the Astellas Access Program. Patients receive a 30-day supply of Xtandi shipped directly to their home; 30-day refills are sent automatically to the patient’s home for the duration of the approval period, which may be up to 1 year.
At 45 days before the end of the approval period, a representative will contact the patient and his or her healthcare provider to discuss re-enrollment. The healthcare provider can then reapply on the patient’s behalf.
A 14-day supply of Xtandi is offered to eligible patients who have a delay in obtaining approval for coverage of Xtandi by their insurance provider. Astellas’s Quick Start+ program is for patients who are beginning to use Xtandi.
A physician, pharmacy, or Xtandi Support Solutions staff can initiate the program after the prescriber completes the Quick Start+ portion of the Xtandi Support Solutions Patient Enrollment Form.