How Much Does Xtandi Cost in 2027?
Xtandi (enzalutamide) is a capsule or tablet taken daily used for prostate cancer. Its 2024 list price is about $13,480 for a 30-day supply. Starting January 1, 2027, Medicare has negotiated a price of $7,004 for a 30-day supply, 48% below list. That does not automatically become your copay, and below we explain exactly what it does and does not change for you.
- Medicare's negotiated price for Xtandi is $7,004 per 30-day supply starting January 1, 2027, down from a $13,480 list price, a 48% reduction.
- The negotiated price is what Medicare and your plan pay, not your copay. It helps most if your plan charges coinsurance (a percentage) rather than a flat copay.
- Whatever your plan charges, your total Medicare Part D out-of-pocket is capped at $2,400 in 2027, after which covered drugs cost you nothing for the rest of the year.
What You Actually Pay
Figures are for a 30-day supply. List and negotiated prices are from CMS; what you pay depends on your coverage.
| Your situation | Typical cost |
|---|---|
| Medicare negotiated price, 2027 | $7,004 / 30 days |
| Medicare Part D, your share | up to $2,400 / year |
| Commercial insurance | copay or coinsurance |
| Uninsured, cash | ~$13,480 (list) |
What Medicare's 2027 Negotiated Price Does, and Does Not, Change
The headline number is not your copay.
$7,004 is the maximum fair price, the amount Medicare and your Part D plan pay for a 30-day supply of Xtandi starting January 1, 2027. What you are charged at the counter is still set by your plan's tier and cost-sharing rules.
It helps you directly if you pay coinsurance
Many plans charge a percentage of the drug's price on specialty and brand tiers. If you owe 25% of $13,480, that is far more than 25% of $7,004. When your share is a percentage, a lower negotiated price lowers your bill directly.
It may not change a flat copay
If your plan charges a fixed dollar copay for that tier, your copay can stay the same even though the plan is paying less. The benefit then shows up in the program's overall costs rather than your receipt.
It changes how fast you hit the cap
Your spending counts toward the $2,400 annual Part D out-of-pocket cap in 2027. A cheaper drug means a smaller share each month, which can mean you reach the cap later or not at all, so the year-end picture differs from past years.
It does not change coverage rules
A negotiated price does not force a plan to cover Xtandi, drop prior authorization, or change its tier. Plans still set their own formularies, so check yours before you assume the new price applies to you.
Because tiers and cost-sharing vary so much between plans, the only way to know your real 2027 cost is to check Xtandi against each plan's formulary. If you would rather have that done for you, our Find My Medicare Plan service checks your specific drugs against the plans available to you for a flat $99.
Does Insurance Cover Xtandi?
Usually, with conditions
Most commercial plans and Medicare Part D cover Xtandi for prostate cancer, but expect prior authorization and sometimes step therapy, where you must try a cheaper option first. It typically sits on a specialty or non-preferred brand tier.
If you are denied
A denial is not the end. Your prescriber can submit a letter of medical necessity, and you have formal appeal rights. See how to appeal an insurance denial.
How to Pay Less
Check the tier before you commit to a plan
The same drug can cost very different amounts across plans in the same ZIP code. During open enrollment, compare Xtandi on each plan's formulary, and remember the plan that was cheapest last year may not be this year.
On commercial insurance, use the manufacturer copay card
Astellas Pharma offers a savings program that can cut a commercial copay substantially. By law it cannot be used with Medicare, Medicaid, or other federal coverage.
On Medicare, look to foundations and Extra Help
Independent charity foundations grant copay assistance for specific diagnoses when their funds are open, and these are allowed with Medicare. Also check Extra Help (the Low Income Subsidy), which can sharply reduce Part D costs and whose income limits are higher than most people expect. The Medicare Prescription Payment Plan can also spread your Part D costs evenly across the year instead of front-loading them, and you can opt in through your plan.
Push back on a bill you have already received
If you were billed more than you expected, or a claim was processed wrong, CareRoute Bill Defense reviews and disputes medical bills, with no fee unless we save you money.
Not sure which plan covers Xtandi best?
For a flat $99, we research the Medicare plans available to you and check them against your specific drugs and doctors, then hand you a clear comparison. We are independent, sell no insurance, and take no commissions.
Frequently Asked Questions
How much does Xtandi cost without insurance?
Xtandi (enzalutamide) has a 2024 list price of about $13,480 for a 30-day supply, which is the wholesale acquisition cost drug companies publish. This is a specialty drug filled through a specialty pharmacy, so very few people pay cash. If you are uninsured, go straight to the manufacturer and foundation assistance below. Your actual price depends on the pharmacy, your dose, and any discount you use.
What is Medicare's negotiated price for Xtandi in 2027?
Medicare negotiated a maximum fair price of $7,004 for a 30-day supply of Xtandi, effective January 1, 2027. That is 48% below the $13,480 list price. Xtandi was one of 15 drugs in the second round of the Medicare Drug Price Negotiation Program, chosen because it was among the highest-spending Part D drugs without generic competition. About 35,000 people with Part D used it in 2024, accounting for roughly $3.4 billion in Part D drug costs.
Will the negotiated price lower what I actually pay for Xtandi?
It can, but it is not your new copay. The maximum fair price is what Medicare and your Part D plan pay the pharmacy, not automatically what you are charged. If your plan charges coinsurance (a percentage of the drug price), a lower negotiated price lowers your share directly. If your plan charges a flat copay for that tier, your copay may not change at all. Either way, the negotiated price pulls you toward the annual out-of-pocket cap more slowly, and your total Part D out-of-pocket is capped at $2,400 in 2027.
Does insurance cover Xtandi?
Generally yes. Xtandi is covered by most commercial plans and Medicare Part D, though plans commonly require prior authorization and sometimes step therapy, meaning you try a cheaper alternative first. Because Xtandi is expensive, it usually sits on a specialty or non-preferred brand tier, so your share can be substantial until you reach your plan's out-of-pocket limit. Check your plan's formulary for the tier and any restrictions before you fill it.
Is there a generic version of Xtandi?
Medicare only selects drugs for negotiation that had no generic or biosimilar competition at the time they were chosen, and Xtandi was selected on that basis. That means there is normally no cheaper generic equivalent to switch to. Generic availability can change, so it is always worth asking your pharmacist whether one has launched.
Related
Sources
- CMS, Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027 (maximum fair price, list price, and utilization figures)
- CMS / Medicare.gov (Part D out-of-pocket cap, $2,400 in 2027, and the $700 maximum deductible)
- Astellas Pharma published list price and savings-program terms (commercial plans only)
- FDA (enzalutamide prescribing information and approved indications)
Prices are national figures for a 30-day supply and vary by pharmacy, dose, and plan. List prices are CY 2024 wholesale acquisition costs as published by CMS. This page is educational and is not medical or financial advice. Last updated October 26, 2026.