Prostate cancer is a disease that affects men of all ages, but it is more prevalent in men over the age of 60. In some cases, prostate cancer treatment consists of traditional methods, up to and including surgery to remove the prostate gland altogether.
For some men, traditional methods are ineffective, and even when prostate cancer has not spread, it may be labeled as advanced prostate cancer. Over time, advanced prostate cancer is more likely to metastasize to other parts of the body, thereby making it a serious health concern. Regardless of the situation, advanced prostate cancer generally requires the introduction of prescription medications that are meant to slow the progression of the disease rather than eliminate it. One drug used today to do this is Xtandi.
What is Xtandi and How Does It Work?
Xtandi (enzalutamide) is a drug used in the treatment of advanced prostate cancer, and it works by inhibiting androgen receptors. These receptors are essentially blocked from receiving androgen while taking Xtandi, and this action reduces testosterone levels which may be causing tumor growth. Once again, in advanced prostate cancer cases, the goal is to slow the progression of the disease as opposed to eliminating it, so Xtandi is considered a treatment that is designed to prolong life while living with advanced prostate cancer. With a reduction in testosterone processing, the cancer still exists, but its development is inhibited.
Does Medicare Cover Xtandi?
Because senior men are more likely to be Medicare recipients compared to younger men, and because advanced prostate cancer is more common in older men than younger men, it’s important for aging males to know whether Xtandi is covered by Medicare benefits. Fortunately, Medicare Part D, the prescription drug benefit, does cover Xtandi in many cases. As with any Medicare coverage for a prescription drug, the medication must be listed on your plan’s formulary in order to be eligible, so you will need to review your plan’s unique list of covered drugs to know your exact coverage details.
For Xtandi in particular, additional methods of treatment may need to be attempted first before Xtandi can be prescribed as a covered medication. This is because Xtandi is meant to be used as a treatment option when other treatment methods have proven unsuccessful. As a result, it would be a good idea to work with your doctor to ensure that all conventional treatment options have been exhausted prior to taking Xtandi to ensure that you are not only receiving the right treatment for your case, but also to reduce the chance for a problem in obtaining Xtandi as a covered drug as part of your Medicare benefits.
Medicare Part A provides coverage for temporary care in a skilled nursing facility or when you are admitted as an inpatient into a hospital, so if Xtandi is provided as a treatment during such a stay, it may be billed under Part A. The stipulation in this case would be that the drug would need to be prescribed for treatment that is related directly to the stay.
Individuals with Medicare Advantage plans will have the same Part A and Part B coverage as under Original Medicare, but if your plan includes prescription drug coverage, Xtandi may be covered. Costs and coverage can vary between plans, so check with your plan directly to find out details.
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