Considering the cost of anticoagulation therapy

Warfarin was initially approved by the FDA (Food and Drug Administration) for use in humans to prevent blood clots in 1955.1 For more than half a century, warfarin has been the only pill option for patients who needed to take an anticoagulant, or ‘blood thinner.’ However warfarin is not without issues, including requiring frequent blood test monitoring due to possible food and drug interactions. Since 2010, several new drugs have been approved for use in treating and preventing blood clots. The first drug was approved in October, 2010 and is called dabigatran (Pradaxa®).

In the years that followed, three additional drugs were approved: rivaroxaban (Xarelto®), apixaban (Eliquis®), and edoxaban (Savaysa®).3 The new drugs, sometimes called NOACs (Novel Oral Anticoagulants) or DOACs (Direct Oral Anticoagulants) target very specific factors in the very complex clotting process.2

Cost as a factor

When taking a prescription, cost can be an important factor to consider. With the NOACs being new drugs available for anticoagulation therapy, there is a considerable discrepancy between what a patient could pay for any of them as compared to warfarin. Even prudent consumers of medications who ‘shop around’ will find that the newer medications often cost several hundred dollars per month, as much as 100 times more expensive than warfarin. This comparison includes factoring in the cost of routine INR monitoring for patients who remain on the affordable warfarin either at a lab, doctor’s office or at home.

While there are free 30 day medication vouchers widely available for some of the NOACs, these often run out at some point and the higher price will be paid through their insurance or ‘out-of-pocket’ costs.4 Transitioning from one form of therapy to another can often leave a patient unprotected from clotting risks if there is any waiting period for a physician order or insurance authorization. Maintaining a consistent therapeutic level of anticoagulation is of utmost importance for safety.

There are many factors that play into making a choice between warfarin and a NOAC for anticoagulation. Armed with all the information you need, it’s wise to discuss this complex decision with your health care provider to find the solution that best meets your individual needs.

References:

  1. Finkel, R. Coming Upon Coumadin: How Warfarin was Discovered. Drug Information and Side Effects Database (Drugsdb.com). Aug 2, 2012. Retrieved from the website: http://www.drugsdb.com/blog/coming-upon-coumadin-how-warfarin-was-discovered.html.
  2. Hanley, C.M. et al. Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? J Thorac Dis. 2015 Feb; 7(2): 165-171.Retrieved from the website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321074/.
  3. Drugs.com Pradaxa Approval History. 2017. Retrieved from the website: https://www.drugs.com/history/pradaxa.html.
  4. Mandrola, J. Novel Oral Anticoagulants vs Warfarin: The Truth is Relative. Medscape. Dec 18, 2013. Retrieved from the website: http://www.medscape.com/viewarticle/818013

Pradaxa® is a registered trademark of Boehringer Ingelheim Pharmaceuticals, Inc.. Xarelto® is a registered trademark of Janssen Pharmaceuticals, Inc. Eliquis® is a registered trademark of Bristol-Myers Squibb Company. Savaysa® is a registered trademark of Daiichi Sankyo, Inc.  Alere is not affiliated or associated with the noted trademark owners or their related trademarks.