Xtandi is one of the clearest examples in American pharmacy of a price that depends entirely on who is paying. The cash counter price is roughly $15,000 a month. Medicare will pay $7,004 a month starting in 2027. And a different prostate cancer pill in the same treatment neighborhood, generic abiraterone, costs less than $300 a month at retail.
None of that tells you which drug is right for anyone, and this guide does not try to. What it does is put the real 2026 numbers side by side so that a self-pay patient walking into a pharmacy knows what the quote should look like and what levers exist. Every figure below was researched on September 3, 2026.
What Does Xtandi Cost Without Insurance?
Dosing comes from the FDA-approved prescribing information, last updated July 28, 2026: 160 mg once daily, taken as four 40 mg capsules, four 40 mg tablets or two 80 mg tablets. Cash retail comes from the Drugs.com price guide. The Medicare rows come from the CMS Part D Spending by Drug file for 2024 and from the CMS fact sheet on negotiated prices for 2027, published November 2025.
| Prostate cancer drug purchase | Low | Average | High |
|---|---|---|---|
| Xtandi 40 mg capsule or tablet, per unit | $125.04 | $125.04 | $125.04 |
| Xtandi 80 mg tablet, per unit | $250.08 | $250.08 | $250.08 |
| Xtandi 30-day supply at 160 mg daily | $13,301.45 | $14,153.05 | $15,004.65 |
| CMS-published Xtandi list price, 30-day supply, 2024 | $13,480 | $13,480 | $13,480 |
| Medicare negotiated Xtandi price, effective Jan 1 2027 | $7,004 | $7,004 | $7,004 |
| Erleada (apalutamide), 30 days at 240 mg daily | $14,504.10 | $14,930.50 | $15,356.89 |
| Nubeqa (darolutamide), average per Part D claim, 2024 | $12,783.10 | $12,783.10 | $12,783.10 |
| Generic abiraterone, 30 days at 1,000 mg daily | $92.95 | $184.01 | $275.07 |
| Astellas patient assistance price for eligible uninsured | $0 | $0 | $0 |
The low and high on the Xtandi 30-day row are the two independent reads: $13,301.45 is the 2024 CMS Part D average paid per prescription claim, and $15,004.65 is the September 2026 Drugs.com cash price. CMS’s separately published 2024 list price of $13,480 sits between them, which is a useful sanity check that the cash counter number is real rather than a padded sticker.
On the abiraterone row, the $92.95 low is the CMS NADAC acquisition cost of $0.77462 per 250 mg tablet effective August 19, 2026, carried out to the 120 tablets a 1,000 mg daily dose consumes in 30 days. The $275.07 high is the top of the Drugs.com published cash range for the same 120 tablets. That is a roughly 55-fold gap against Xtandi for a drug in the same broad treatment category.
For scale, Medicare Part D covered $3,401,099,000 of Xtandi for about 35,000 enrollees in 2024, making it the second-largest oncology line item in the entire negotiation program’s second cycle.
What Drives the Price
A single manufacturer with no marketed competitor. CMS Part D lists exactly one manufacturer for Xtandi. FDA has approved a generic, but no one is selling it yet. That is a monopoly in practice even though it is no longer one on paper.
The generic exists on paper only. FDA granted Sandoz final approval on April 20, 2026 for AB-rated enzalutamide 40 mg and 80 mg tablets, and Drugs@FDA carries both products with prescription marketing status rather than tentative approval. Three more applications, from Zydus, Haimen and Hikma, are still tentative, meaning FDA cleared the science but patents or exclusivity block a launch. Three earlier capsule generics from Actavis, Apotex and Zydus are listed as discontinued. Meanwhile the CMS NADAC survey returns zero rows for enzalutamide at any strength, and Drugs.com publishes no generic price, both of which are what you would expect if nothing has actually shipped.
Flat pricing across every form and strength. The 40 mg capsule, the 40 mg tablet and the 80 mg tablet all price out to $15,004.65 for 30 days. Switching forms for convenience costs nothing. It also means there is no cheaper presentation to ask for.
The Medicare negotiated price does not reach cash payers. CMS agreed a maximum fair price of $7,004 per 30-day supply with Astellas, effective January 1, 2027, a 48 percent discount off the 2024 list price of $13,480. That number is a Medicare price. If you are uninsured and paying cash, it does not apply to you, though it is a very useful benchmark to quote when you are negotiating.
List price has been climbing. CMS’s weighted average Part D spend per dosage unit rose from $146.13 in 2023 to $150.09 in 2024, and the Drugs.com 2026 cash figure of $15,004.65 is about 11 percent above the CMS-published 2024 list price of $13,480. Expect the cash number to keep drifting up until a generic actually launches.
Cash Price vs. Insurance
This is a drug where any coverage at all beats cash by an enormous margin. Astellas runs the XTANDI Patient Savings Program for eligible commercially insured patients taking Xtandi tablets: as little as $0 per prescription, a 12-month enrollment period, a maximum of $7,000 per calendar year, and no income requirements. It is explicitly not valid for patients with Medicaid, Medicare, Medigap, DoD, VA, TRICARE or state assistance programs.
If you are uninsured, the savings card is closed to you and the route that matters is the XTANDI Patient Assistance Program, run through Astellas Pharma Support Solutions at 1-855-898-2634. Astellas states that program provides Xtandi at no cost to patients who have no prescription drug insurance, have a verifiable U.S. shipping address, have been prescribed Xtandi for an FDA-approved indication, and meet the program’s financial eligibility requirements. Astellas does not publish the income threshold, so ask for it directly when you call.
One thing worth knowing: because Xtandi is dispensed as an ordinary retail prescription rather than through an infusion center, the drug cost lands entirely on you rather than on a hospital bill. That removes hospital charity care as a lever for the drug itself, though not for the visits and scans around it.
How to Pay Less
Call Astellas before you fill, not after. At $15,005 a month, the patient assistance application is the highest-value phone call in this entire process. Ask for the patient assistance program specifically, not the savings card, and start it while the prescription is being written because approval takes time.
Quote the $7,004 Medicare number when you negotiate. CMS published, in a public document, that this drug is worth $7,004 for 30 days. That is real leverage with a specialty pharmacy or a manufacturer hardship desk, and it is the kind of concrete anchor our medical bill negotiation guide is built around. Our negotiation script tool gives you the wording.
Ask about a 340B pharmacy. Federally qualified health centers and disproportionate-share hospitals buy drugs at steeply discounted 340B prices, and many pass some of that through to uninsured patients on a sliding scale. Our guide to free and sliding-scale clinics covers how to find one.
Compare discount cards, but do not expect much. On a $15,000 specialty drug the percentage discounts that work well on ordinary generics barely move the number. Our GoodRx vs SingleCare comparison explains where cards do and do not help, and this is squarely a case where they mostly do not.
Ask what the total treatment plan costs, not just the pill. Xtandi is usually one line in a bill that also includes monitoring labs and imaging. See our PSA test cost guide and PET scan cost guide for what those pieces should run as a cash payer, and use the fair price checker to sanity-check quotes.
Recheck generic availability at every refill. One generic already has final FDA approval. When it launches, the price on this page could fall by most of its value in a single quarter. Ask your pharmacist at each fill whether generic enzalutamide has shipped.
The Bottom Line
Xtandi is a $15,005 monthly purchase at cash retail in September 2026, against a 2024 CMS-published list price of $13,480 and a Medicare-negotiated price of $7,004 that starts in 2027 and does not apply to you if you are uninsured. Astellas will supply the drug free to uninsured patients who qualify, which for most self-pay patients is the only realistic path.
Watch two things. Sandoz’s generic has final approval and no launch date, and the 2027 Medicare price will reset what everyone considers this drug to be worth. If cost is the constraint you are working under, the conversation to have with your oncologist is about the whole menu, including drugs like generic abiraterone that cost under $300 a month. For related oncology pricing, see our guides to chemotherapy costs and Keytruda costs.