Is Pradaxa Worth The Extra Cost?

Posted , 5 users are following.

After my new onset AF was diagnosed last month, I was prescribed Pradaxa due to my 30 mile bike rides as my EP was concerned with falls as Pradaxa is the only one of the new blood thinners that is reversible.

After speaking with my insurance pharmacist, they recommended to talk with my doctor about switching to their “preferred” alternative medication Eliquis or Xarelto which has fewer bleeding events and side effects and costs less,than a third of Pradaxa.

I did speak to my EP about the switch and he reaffirmed the reason he prescribed Pradaxa (possible fall from bike) but acknowledged that none of his other AFib patients had had an issue using the alternative meds and he would make the switch if I wanted to.

I agreed to continue the Pradaxa and just refilled a 90 day supply (my copay is $458) but will consider switching to one of the alternatives on my next refill.

Can anyone justify the additional cost to continue with Pradaxa?

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13 Replies

  • Posted

    My EP suggested he could stop bleeding with Eliquis or  Xerelto. I assume he was talking about the same reversal agent they use for Pradaxa, but you might want to talk to an EP about that. That said, nothing beats  old school Warafin for fast reversal and low cost. The trade off is that you will need to have periodic blood tests to monitor your INR.

    Jim

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  • Posted

    Can't comment as I live in the UK and all treatment and meds are free on the NHS

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  • Posted

    Hello Patrick, like Sarah, I'm also in the UK and benefit from the NHS, and am not aware of the cost differentials between the various anti-coagulants.

    However I am a cyclist, not sure I manage 30 miles each day, but I take Eliquis and accept the risk, understanding that the only reversal for Eliquis is a blood transfusion, suitably timed before bleeding out. You say Pradaxa is the only NOAC that has a reversal agent, but Jimjames suggests that there may be a reversal agent for Eliquis. This sounds like something I should discuss with my EP at my next review in April.

    Allan

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    • Posted

      Thanks for all the responses. The consensus points me to a switch to Eliquis after my current 90 day supply runs out. FWIW, I have never had a fall from my bike *knock on wood* so am more inclined to take the risk and perhaps be even more cautious on my rides. When I picked up my refill and explained my dilemma to the pharmacist, he suggested dressing in layers to minimize any abrasions if a fall was to happen. I ride on a paved trail where motorized vehicles are prohibited, so I don’t have to deal with the possibility of crashes with motorized vehicles which minimizes the risk of accidents, which was the reason I was prescribed Pradaxa instead of Eliquis to begin with.

      Improved health to all,

      Patrick

      PS: I am envious of all of you in the UK with better health care options. I am hopeful when we find a decent candidate to replace the current occupant of the White House, we can move more in that direction!

       

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  • Posted

    Hi Patrick, you say your “copayment” is $458 per 90 day’s; what percentage of the actual cost is that?

    As someone over 65, I do not have to pay prescription charges in the UK, if I did have to pay, I believe it would be around £9 for a month’s supply of any single item of medication.

    Interestingly I have had an internal bleed, or at least a significant bruise, and that was when I had my only ablation, having been on Eligius for several months beforehand. A deep purple bruise from my groin to the back of my knee, covering the entire back of my leg took over six weeks to appear and disappear, This was caused by the small incision made for the catheter insertion in the groin, so a good demonstration of the effect of taking an anticoagulant.

    As for the present incumbent of The White House, any comment I might make would almost certainly get moderated.

    Allan

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    • Posted

      Hey Allan,

      The $458 copay represents 40% of the total cost for a 90 day supply for Pradaxa. Eliquis and Xeralto cost less than a third of that but do not have reversal agents in case of a major bleed.

      Yes, a sad state of affairs in our healthcare system here in the US when one has to forego needed care and medication or accept additional risk due to personal budgetary restrictions. 

      I had a giggle at your comment about our current White House incumbent!😂

      Cheers to you and carry on!

      Patrick

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  • Posted

    Hi Patrick, glad I made you giggle, always good to laugh!

    An interesting thread, I suppose I've just accepted the risk of a fall from my bike, and 99% of mine is on roads, albeit mostly minor roads, but not entirely, as opposed to your track cycling. This risk is not something I have hitherto discussed with my GP or EP, but I will. I have a one year review since my ablation coming up in April, and will discuss this issue.

    In late July I am planning to do the Ride London, the cycling equivalent of the London Marathon, a 100 mile sportive, albeit on closed roads. However, amongst 25,000 other cyclists the opportunity for an accident is probably higher than riding locally.

    Thanks for your food for thought.

    Best Wishes

    Allan

     

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  • Posted

    There is no reversal agent yet approved for apixaban, which is only an issue if you end up in intensive care,  Dabigatran does increase your heart attack risk and, maybe, so do other NOACs to some extent,  None of the NOAC increase life expectancy, would you believe!
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    • Posted

       Thanks for your response! I had not heard that Pradaxa increases the risk of heart attack so I will discuss this with my ER next time. I will most probably be switching to Eliquis at the end of my 90 day supply. 

       Improved health to you and thanks again! 

      Patrick

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  • Posted

    Hi Patrick, just completed the first 30 miler of the year, and come back to this conversation thread. A question, have you or anyone else on this thread had cause to use "WoundSeal", or even to carry it in case.

    Given the most likely problem of falling from bike, assuming not a direct hit from a moving vehicle, is grazed arms or legs, I wondered if this product might not be a sensible addition to the "on-bike" kit.

    Regards

    Sherpa Al

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    • Posted

      I cut my fingers in the kitchen while on thinners and probably would have been OK with pressure and bandages but went to the local urgent care center just to be safe. They put on something I believe similar to Wound Seal. Later, I went home, did some "googling" and ordered Wound Seal. Still haven't used it yet but the reviews are good. That said, I believe it's just for superficial wounds like small cuts and scrapes.

      Jim

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    • Posted

      I'm sure that's right Jim, but for the skinned knee or elbow, which is the worst I have so far managed coming off my bike, it would probably be a good precaution to stop bleeding. It's not too expensive so I shall most likely add it to my "on the road" kit.

      Allan

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