Enzalutamide

Medicare

Part D (self-administered)

Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026). Xtandi was selected for Medicare price negotiation in January 2025; the negotiated price takes effect 1 January 2027.

Commercial insurance

step therapy common

Covered with prior authorisation; several PBMs require a trial of generic abiraterone first in metastatic castration-resistant disease unless abiraterone is contraindicated.

Assistance programmes

• Astellas Pharma Support Solutions
• Pfizer Oncology Together
• Pfizer RxPathways
• PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
• HealthWell Foundation
• CancerCare Co-Payment Assistance Foundation
• Patient Advocate Foundation Co-Pay Relief

Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.

Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap) · CMS: Medicare Drug Price Negotiation Program. Not medical or financial advice; verify with your plan.

Appraised for

Metastatic castration-resistant prostate cancer after docetaxel

Notes

Before chemotherapy: TA377 (2016). Hormone-sensitive metastatic disease: TA712 (2021). Non-metastatic CRPC: TA580 (2019).

NHS England

Routinely funded for the appraised indication (or via managed access)

Sources: NICE TA316 · SMC advice: enzalutamide. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.