Hormone therapy for advanced prostate cancer is a commonly used treatment, one that is necessary for about one-third of all prostate cancer patients. But it comes with a steep and wide-ranging price tag.
The 10-year cost of hormone therapy can range anywhere from $34,000 to more than $650,000. The dramatic difference in costs is mostly due to the type of hormone therapy and the specific drugs that are used in your treatment.
Most health insurance plans will cover at least part of hormone treatment, but your out-of-pocket costs may be a lot. Get answers you need from your doctors and your insurance providers before you start treatment so you can focus on a healthy recovery, rather than the sticker shock of an effective – but expensive – treatment.
Why Treatment Is So Important
Prostate cancer is the most common cancer in men, after skin cancer. It affects about 1 in 8 men, and accounts for about 35,000 deaths in the United States each year.
While any person assigned male at birth is at risk of prostate cancer, some groups face significantly increased risks. For example, prostate cancer affects Black Americans more than men of any other race. And more than half of all prostate cancer cases happen in men over the age of 65.
What Is Hormone Therapy?
Androgens are male sex hormones responsible for the health and function of your prostate, among other functions. If cancer forms in the prostate, androgens also help fuel the cancer’s growth.
The goal of hormone therapy, also known as androgen deprivation therapy (ADT), is to lower the levels of androgens in the body or block their activity. The two main ADT approaches are orchiectomy, the surgical removal of the testicles, or the use of luteinizing hormone-releasing hormone (LHRH) agonists or LHRH antagonists. These drugs block the secretion of androgens in the testicles.
LHRH antagonists are drugs that block androgen receptors and help prevent androgens from fueling prostate cancer. They may be given along with LHRH agonists to help prevent “tumor flares.” Those are spikes in testosterone levels that sometimes happen with LHRH agonists.
Among the more common and effective drugs that help block formation of androgens made by cells outside of the prostate are CYP17 inhibitors. Unlike LHRH agonists and LHRH antagonists, CYP17 inhibitors don’t stop the testicles from producing androgens. Instead, they work on other cells in the body that secrete androgens.
Hormone therapy is sometimes used for early prostate cancer that has an increased risk of coming back. The treatment is mostly for advanced prostate cancer and if the cancer has not responded to radiation therapy or surgery. Prostate cancer that has come back may also be treated with hormone therapy.
Hormone therapy by itself is not a cure for prostate cancer, so it is often used along with other cancer treatments.
The Costs of Hormone Therapy
The cost of hormone therapy for advanced prostate cancer can vary widely. Some of the things affecting cost include:
- The type or types of hormone therapy you receive
- How long you get treatment
- The area of the country where you live and receive treatment
Research suggests that the costs of prostate cancer treatment in general are rising, and that part of this increase is due to newer treatments, including drugs such as abiraterone and enzalutamide, which are used in hormone therapy.
If you are age 65 or older and qualify for Medicare, you may find that much of your hormone treatment will be covered. Medicare Part B, for example, often covers up to 80% of cancer treatment. Having a Medicare supplement plan may help with all or most of the remaining 20%. That could be helpful, since the out-of-pocket costs for prostate cancer patients with the Medicare Part D drug plan can range from $9,854 to $13,061 for enzalutamide and $1,379 to $13,274 for abiraterone.
Hormone therapy is also not a one-time procedure. You may need to take ADT medications for several years. One review of hormone treatment costs suggests that the first-year costs of hormone treatment can average around $10,000, building up to about $23,000 over five years. Again, costs can vary for many reasons, so don’t rely too heavily on averages. Consulting directly with your health care providers and insurers will give you the best idea of your specific costs.
Another important part of cost to consider is the difference between surgical removal of the testicles and the use of medications to reduce androgen levels and activity. Though removal of the testicles is a less popular alternative to medical hormone therapy, it is significantly less expensive, too. In a study comparing the costs of surgery and chemical ADT, researchers found that the average cost of surgery was $13,000. But in less than a year, half of the chemical ADT patients had gone beyond those expenses. And within two years, almost all of them were billed for charges greater than those connected to surgery.
What You Can Do
If your doctor recommends hormone therapy, you should learn what kind of coverage your health insurance provider offers. Having a copy of your health insurance plan will help, but you may need to talk directly with someone with your insurance provider to get a more detailed understanding of how much of your treatment will be covered.
Try to get as complete an estimate as possible of what your costs will be at first and over time. Understand that costs may vary over the course of your treatment. Your response to treatment may determine whether more medications or treatments may be necessary or may not be needed.
To help lower the chances of delays or other problems with your insurance provider, get a referral letter from your doctor detailing the nature of your cancer and why hormone treatment is the preferred treatment option.
You may also want to look around for other insurance plans that may provide greater coverage. Just don’t cancel your existing plan until your new plan goes into effect.
Once you start getting bills for your treatment, the American Cancer Society recommends waiting to pay any bill until you receive your insurance provider’s final explanation of benefits (EOB) statement. The EOB should summarize exactly what treatments and care you received and what (if any) portion was covered by the insurer, and what is expected of you. You may also be able to access your EOB through your insurance provider’s website.
You should also carefully read through your bills to check for errors, such as duplicate charges or charges for medications or treatments that you didn’t actually get.
And if you receive notice that specific bills are being turned over to a collection agency, try to pay those bills first to protect your credit rating and your assets.
Keep in mind that health care costs – and particularly those involved with cancer treatment – are huge challenges for many people who – like you – may be wondering and worrying about how to pay for care.
If you have no health insurance, talk with someone in your doctor’s office or hospital about your situation and see if some costs can be negotiated downward. Many hospitals have social workers or patient navigators to assist people with financial questions and other concerns.
See if you can work out a payment plan that might fit your budget. This may also be helpful even if you have health insurance with a high deductible and a high out-of-pocket limit.
You can also ask whether you can get similar discounts as those given to people with Medicare or other insurance plans. If you haven’t already, you may want to see if you qualify for Medicaid, a health insurance program for individuals and families who make below a certain income. Medicaid eligibility is determined by the state where you live.
If you need help, as many people do, the National Cancer Institute keeps an up-to-date list of agencies and organizations that have financial aid, mental health counseling, and other support services. The Prostate Cancer Foundation also maintains a list of companies and organizations that give discounts on medications and other programs to help lower the costs of prostate cancer treatment.
If you are denied coverage, contact your insurance provider to get a detailed explanation of that decision. It may be something as simple as missing documentation from your doctor or a piece of incorrect information supplied to the insurer. Most insurance plans have an appeals process, though you may need to get your health care provider involved to make the appeal. Before an outside agency – such as a state insurance review board – can get involved, you will likely need to first go through your insurer’s appeals process.
Show Sources
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SOURCES:
MD Anderson Cancer Center: “Prostate Cancer Treatment.”
National Cancer Institute: “Support Organizations,” “Hormone Therapy for Prostate Cancer.”
Journal of Managed Care and Specialty Pharmacy: “Cost-Effectiveness of Adding Androgen Deprivation Therapy to Radiation Therapy for Men with Advanced Prostate Cancer from a U.S. Payer’s Perspective.
Journal of the National Cancer Institute: “Cost-effectiveness analysis of 7 treatments in metastatic hormone-sensitive prostate cancer: a public-payer perspective.”
American Cancer Society: “Key Statistics for Prostate Cancer,” “If You Have Problems Paying a Medical Bill,” “Hormone Therapy for Prostate Cancer.”
National Cancer Institute: “Hormone Therapy to Treat Cancer.”
Prostate Cancer Research Institute: “Does Medicare Cover Prostate Cancer?”
Urology Practice: “Out-of-Pocket Costs for Prostate Cancer Medications Substantially Vary by Part D Plan: An Online Tool Presents an Opportunity to Mitigate Financial Toxicity.”
Translational Andrology and Urology: “Significant financial differences of chemical and surgical androgen deprivation in a contemporary cohort.”
Johns Hopkins Medicine: “Hormone Therapy for Prostate Cancer.”
National Library of Medicine: “Hormone Therapy for Prostate Cancer.”
Journal of Cancer Research and Therapeutics: “CYP17 inhibitors improve the prognosis of metastatic castration-resistant prostate cancer patients.”
Boston University Shipley Prostate Cancer Research Center: “Medical Insurance Coverage for Prostate Cancer.”
Prostate Cancer Foundation: “Financial Resources.”
Medicaid.gov: “Where Can People Get Help With Medicaid & CHIP?”
