Key takeaways:
Xtandi (enzalutamide) is an oral medication that treats certain types of prostate cancer. A 30-day supply of Xtandi can cost over $15,000 without insurance.
Almost all Affordable Care Act and commercial insurance plans cover Xtandi, as do most Medicare and Medicaid plans. But prior authorization is often required. Check with your plan to learn more.
A manufacturer copay card or a patient assistance program can help make your Xtandi prescription more affordable. Don’t hesitate to ask your specialty pharmacy team for help.
Save on related medications
Xtandi (enzalutamide) is an oral medication that treats certain types of prostate cancer. It’s an antiandrogen medication. This means it works by blocking the effects of androgen hormones in the body, such as testosterone.
Xtandi comes in 40 mg capsules as well as 40 mg and 80 mg tablets. The recommended dosage is 160 mg once daily for most people. But Xtandi is a limited distribution drug. This means it’s typically not available at a local pharmacy. Instead, you’ll need to use a specialty pharmacy to fill your prescription. It also means that Xtandi is more expensive than a typical prescription pill.
Let’s look at how much Xtandi costs without insurance, along with ways to save on the cost of your prescription.
Good to know: Unless you’ve had surgery to remove both testicles, you’ll need another medication along with Xtandi to treat prostate cancer. This can increase your monthly costs, since the two medications are billed and administered separately.
How much does Xtandi cost?
Xtandi’s list price is around $15,000 per month, according to the manufacturer. But the average retail cash price is typically higher because of wholesaler and pharmacy markups.
The table below shows the average cash price for a 30-day supply of the most common Xtandi dosages, using the different forms available.
Xtandi dosage | Average cash price |
|---|---|
160 mg daily (#60 80 mg tablets) | $20572.71 |
160 mg daily (#120 40 mg tablets) | $19492.55 |
160 mg daily (#120 40 mg capsules) | $21081.95 |
What factors affect the cost of Xtandi?
Several factors can affect the cost of Xtandi, including:
Location: Where you live can affect the cost of your medication. For example, medications are typically more affordable in Denver than in New Orleans, according to GoodRx research.
Specialty pharmacy: Cash prices can vary from one specialty pharmacy to another. It’s a good idea to check a few options before filling your prescription.
Dosage: Prices can vary for different doses of Xtandi. Your prescriber will determine your dosage based on your symptoms, your health history, and how you respond to the medication.
Insurance formulary tier: Most insurance plans have tiers, or levels, within their formulary (list of covered medications). Lower-tier medications typically have a lower copay, while higher-tier medications typically have a higher copay. How much you pay for Xtandi will depend on where your insurance plan places it within its formulary.
Does insurance cover Xtandi?
Xtandi is covered by almost all Medicare, Medicaid, and commercial insurance plans. It’s also covered by almost 94% of plans accessed through the Affordable Care Act (ACA) marketplace.
A prior authorization is required for most Medicare and ACA insurance plans and about 75% of commercial plans. But only about 50% of Medicaid plans require it. This means your prescriber may need to submit information explaining why Xtandi is medically necessary before your plan will cover it.
Step therapy (a requirement to try other treatments or explain why you aren’t able to take them) isn’t common for any type of insurance when it comes to covering Xtandi.
Keep in mind that since Xtandi is typically filled at a specialty pharmacy, the staff there are trained to help you find coverage for your medication. They can also be a helpful resource for additional savings opportunities. So don’t hesitate to ask them for assistance.
How different insurance plans cover Xtandi
The table below breaks down the percentage of enrollees who have coverage for Xtandi by insurance type. It also shows the likelihood of having prior authorization and step therapy requirements.
Insurance type | Enrollees covered for Xtandi | Enrollees required to get prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
93.5% | 84.3% | 4.6% | |
Commercial plans (excluding ACA plans) | 98.9% | 75.3% | 8.7% |
Medicare (Medicare Advantage and Part D plans) | 100% | 96.7% | 2.4% |
Medicaid, including state-run and managed care plans | 99.9% | 52% | 9.5% |
Source: Managed Markets Insight & Technology, LLC™, as of January 10, 2026 (See methodology below.)
If your insurance doesn’t cover Xtandi, try these options:
Lower your cost with a manufacturer copay savings card or patient assistance program.
Submit a formulary exception request for Xtandi with your insurance plan. Your prescriber may need to provide documentation and a letter of medical necessity explaining why this medication is required for your condition.
If the formulary exception request is denied, file an appeal.
Ask your prescriber about switching to an Xtandi alternative, such as Casodex (bicalutamide), that your insurance may cover.
Compare insurance plans during the next open enrollment period to find one that offers better coverage for your medications.
Ways to save on Xtandi
There are several ways to save on the cost of Xtandi. Some options depend on your insurance coverage, while others can help reduce the cash price. GoodRx can help you compare options to find the best fit for your needs.
1. See if you qualify for a copay savings card
If you have commercial insurance, you may pay as little as $0 per prescription for Xtandi using a copay card from the manufacturer.
To qualify for the Xtandi copay savings card, you must:
Have private or commercial insurance.
Not be enrolled in a government health insurance program, such as Medicare or Medicaid.
Live in the U.S., including Puerto Rico, Guam and the U.S. Virgin Islands.
There is an annual maximum benefit of $7,000 per calendar year. You can enroll online or by calling 1-855-217-8311.
2. Check if you’re eligible for a patient assistance program
The Astellas Patient Assistance Program offers Xtandi at no cost if you’re uninsured or underinsured and meet program requirements. Savings are also available for people with Medicare Part D coverage. Your prescriber will need to enroll you in the program to get started. Call 1-855-898-2634 for more information.
3. Tap into your HSA, FSA, or HRA
If you have a health savings account (HSA), a flexible spending account (FSA), or a health reimbursement arrangement (HRA), you can use it to help cover your out-of-pocket costs for Xtandi. These tax-advantaged health accounts let you pay for eligible expenses with tax-free dollars.
Pay directly with your HSA or FSA card at the pharmacy, or cover the cost yourself and submit a request for reimbursement. The funds in an HSA or an HRA typically roll over annually, but you have to use your FSA dollars before the deadline or they’ll expire.
The bottom line
Xtandi (enzalutamide) is an oral medication that treats certain types of prostate cancer. A 30-day supply of Xtandi can cost over $15,000 without insurance. But it’s covered by almost all commercial and Affordable Care Act insurance plans, as well as Medicare and Medicaid.
In most cases, you’ll need a prior authorization for your insurance to cover Xtandi. A manufacturer copay card or patient assistance program can also help make your prescription more affordable — even if you’re uninsured or underinsured. Don’t hesitate to ask your specialty pharmacy team for guidance on other ways to save.
Why trust our experts?
Methodology
We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of January 2026.
We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel.
We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel.
Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel.
These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including ACA plans, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).
References
Astellas Pharma. (2025). Xtandi- enzalutamide capsule, Xtandi- enzalutamide tablet [package insert].
HealthCare.gov. (n.d.). Appealing a health plan decision. Centers for Medicare & Medicaid Services.
Medicaid.gov. (n.d.). Managed care. Centers for Medicare & Medicaid Services.
Xtandi. (n.d.). Helping eligible patients pay for Xtandi. Astellas Pharma.
Xtandi. (n.d.). Pricing information. Astellas Pharma.
Xtandi. (n.d.). Welcome to the Xtandi patient savings program. Astellas Pharma.
