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The Rising Cost of Blood Thinners: A Burden on Medicare and Patients

The Rising Cost of Blood Thinners: A Burden on Medicare and Patients

According to a new report by Patients for Affordable Drugs, Medicare spent an astonishing $46 billion on just two blood thinners between 2015 and 2020.

These are Xarelto by Johnson & Johnson and Eliquis by Bristol Myers Squibb and Pfizer. The list prices of these medications have more than doubled since their introduction to the market, posing a significant burden on the healthcare system and patients.

Why Rising List Prices Matter

While list prices are not the final cost of medications after rebates and negotiations between drug manufacturers and payers, they hold significant weight. Particularly concerning is the impact of these rising list prices on Medicare Part D cost-sharing arrangements. Medicare beneficiaries are directly affected, as they have to pay more out of pocket when these list prices increase.

The Changing Landscape of Blood Thinners

Blood thinners are far from a niche medication. Over 8 million Americans depend on them regularly to manage various conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism. Before 2010, warfarin was the go-to option for blood thinning. Though cost-effective, warfarin carries a substantial risk of heavy bleeding, making its use challenging to manage.

However, the landscape began to change in 2011, when Johnson & Johnson introduced Xarelto, followed by Eliquis in 2013. These new entrants promised a better safety profile, reducing the risk of severe bleeding associated with warfarin. However, the cost was significantly higher; while warfarin could be bought for a fraction of the price, these new drugs entered the market with list prices upwards of $200 for a month’s supply.

The Escalating Cost: A Snapshot

Over time, the list prices for both Eliquis and Xarelto have surged, and they now stand at over $500 for a month’s supply. While these medications offer advantages in terms of safety and efficacy, the price inflation remains a point of concern. By 2020, Eliquis became Medicare’s top-spending drug, and Xarelto was not far behind as the third-most costly. With nearly 4 million Medicare beneficiaries relying on one of these two drugs, the financial ramifications are hard to ignore.

The Domino Effect on Healthcare

The rising costs of these blood thinners can have a domino effect on healthcare expenditures and resource allocation. When the healthcare system is burdened with high medication costs, there could be less available for other essential services, diagnostics, and treatments. Moreover, exorbitant out-of-pocket costs could discourage patients from adhering to their medication regimens, risking complications that are costlier to manage in the long term.

Conclusion: A Need for a Paradigm Shift

The need for affordable yet effective medication is a pressing concern. The significant spending on blood thinners like Eliquis and Xarelto is a stark reminder that balancing drug innovation with affordability remains a critical challenge. As policymakers ponder over healthcare reforms, the findings by Patients for Affordable Drugs offer compelling evidence that change is not just desirable, but urgently needed.

Starting Sept. 1, 2024, a crucial change will occur in the way Medicare deals with high-cost blood thinners like Eliquis and Xarelto. Medicare will pay a negotiated rate for these drugs, a departure from the earlier model, which led to skyrocketing costs. While this is a step in the right direction, for users like myself who rely on Eliquis, the financial burden remains severe. With the existing rates, my insurance and I will still be facing a staggering cost of over $6,000 for my prescription.

A Step Toward Affordability?

While the decision to move to a negotiated rate is commendable, the question remains: is it enough? Again, the list prices for these drugs have more than doubled since their introduction to the market.

Given the scale of the problem, simply introducing a negotiated rate might not be a sufficient solution.

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Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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