AF Association
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Eliquis (apixaban) sticker shock in USA - how is it in UK?

When I picked up my first 30 day supply of Eliquis I was told that it costs $420.00.

After pharmacist checked with my drug insurance it came to $199.00.

The first thing that came to my mind was how can so many people without insurance afford to get it. Many elderly live on Social Security check of 1,500.00 and that is not the only prescription they need.

What is the cost of this drug in UK and how it works in your system?

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I take Apixiban, I have no idea of the cost I get it free on the NHS; at the moment.

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I take Apixaban which I believe costs our National Health Service £64 per month. As I am over 60, my supply is free to me, most under 60's pay a fee for prescriptions but nothing like the figures you quote - scary!

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In the UK the approx. cost per month is, I believe, in the region of £55-£60 , which I guess is around 75 dollars.

Over the age of 60 there is no charge.

Just one more reason to be grateful for the NHS.......warts and all.

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I'm on Apixaban..and doesn't cost me any thing cos I'm 60

But if you were to get it on prescription it costs £8...depends on how many things you get on the prescription then could cost more

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People on very low incomes don't pay and people who don't qualify for free prescriptions can buy a prepayment certificate if they have regular prescriptions and that limits the cost.

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Thanks for all replies. You guys in UK are REALLY lucky.

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We are! I don't know how anyone in the states affords medical care - my husband works in the US but can't afford to visit anymore because of the health insurance costs.. I think you have to be either very rich or very poor and be on Medicare.

Drugs for another condition I take cost in the region of £400 a month in the U.K. And a LOT more in the US. Many of the people on a forum for that condition can't work so can't pay their insurance anymore and therefor can't afford the drugs - many of them have died. So tragic.

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I overheard a couple of ladies on a plane discussing a friend whose husband had left her and taken the medical insurance with him. She was trying to treat cancer with herbs. I could have cried.

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ouch........it is truly tragic. Let us hope we can hang on to our NHS! I wouldn't mind paying something toward my prescription costs if it meant preserving our NHS as I could afford a contribution - in fact I tried to but the pharmacist told me that as there is no system set up for this - it would cost him more in admin fees than the proposed contribution. Ridiculous or what?

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I have been fully expecting that with the rise in the pension age, the age at which prescriptions are free (60) will rise as well. I don't think it will happen in ththe current political climate though!

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Hi CDreamer. We have to be 65 to be able to get full benefits from Medicare and it's sort of a joke because they only pay portions of many claims ,and there are somethings they will not cover . People on fixed incomes here some of the people just go with out medication because they cant afford them . The drug companies here have special programs but you have to very down and out to qualify .If you qualify you may get a drug for no charge . What a mess . They talk about quality of life so if you spend the money you do have for doctors and drugs what quality is that ? NONE.

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Very sad stage of affairs all round.

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And we really don't appreciate it do we?? 😃

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Yes Lucky indeed . Through my health insurance supplement here in the Us. I get a 90 day supply and its $420.00 . Over here they don't care if your 100 yrs old you pay or go with out .Having said that ,I have also asked my doctor for samples on more than one occasion and they happily give me about 2 or 3 months worth . I have only asked for samples If I ran short on those two times . National health care pays most everything .The down side is the waiting period for so many things . Over here we just have to get worked into the doctors schedule for any surgery. And then we have co-pays for most everything . When your on a fixed income it is a burden for sure.

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30 Xeralto costs $99 at my pharmacy in Canada

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Prescriptions are free in Wales, but the downside is that in our health region none of the NOACs are allowed (to the best of my knowledge, that is: probably if your leg falls off when you take warfarin you'd be given one...)

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Hi, where I live in Wales I was offered the choice of Apixaban or Warfarin, I chose Apixaban and have used it for over a year with no problems.

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Where are you? We're in the north, Betsi Cadwaladr health board...

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Sorry I did reply earlier but it seems to have disappeared.....I live in Abertawe Bro Morgannwg Health Board. I think Apixaban was suggested first because I work quite long ours and can't guarantee I will have meals at regular times and also having to have had regular INR tests would have been quite restricting. I have just had a second cardioversion and have stayed in NSR for the last 6 weeks, hopefull it will continue. Still on quite a cocktail of drugs though.

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It does feel like a cocktail sometimes, doesn't it? It's good to know that it's possible to get NOACs somewhere in Wales... Our Drs just say 'warfarin is what the board says we must use', and I think it's probably a case of sticking with what they know as much as anything. Plus warfarin is cheap as chips, of course...

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Yes, it works out at about £2 per day for the apixaban as opposed to a couple of pounds a month for warfarin. My consultant seemed to prefer apixaban and I wasn't about to argue.

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I am on apixaban due to asthma so I can't take warfarin so was prescribed it .We are so lucky tohave the NHS as an asthmatic and nowe have AF.Thanks tof these drugs I am still alive.

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I live in Australia am over 65 so get my scripts for $6.20

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I have a pre-payment card and pay £104 yearly, I take apixaban along with 7 other items, i each prescription would be £8.60 a month .

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We don`t get it free it is just paid for through our taxes to be there when needed.

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Why are treatment/drugs in the US mpre expensive than the UK? OK we have the NHS but it is NOT free. We pay for it, just (mainly) not at the point of use.

Everything else is the US is usually cheaper than "rip-off" Britain, so why not drugs?

Do the drug companies sell to us at cheaper prices because they like us, don't think so? You'd think hard hitting American buyers would be buying cheaper than UK.

????

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I think it is the same as Australia - there is a price paid to the Drug Companies then the Aust./ UK patients get it subsidized at point of purchase. In UK it is your National Health which carries the cost 100% , in Australia we get it at $37.80 per script (US$28) irrespective on the quantity 60 or 30 tablets.

The health budget carries the actual cost here not Medicare = NHS in UK

To cover the lost margin to the pharmacies who dispense the drugs they are given a dispensing fee on top of any margin applied per script.

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I think the issue is the NHS buys in massive bulk, whereas in the US pharmacists buy as needed. Even a chain of pharmacists wouldn't have the buying power of the NHS. The same problem exists in Switzerland where whilst there is a state supported form of health insurance, you first pay the pharmacist the true cost which is quite eye opening for us Brits.

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I agree NHS - negotiate in bulk and they use generic rather than brands wherever possible. I have experience of this with other meds - obviously NOACs are still so recent there are no generics yet.

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Another point I forgot to mention is that US television is wall to wall adverts for drugs !! That would be pointless here even if it was allowed so that's a huge cost removed.

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Koll you pose a good question. I don't know the answer either but some how it's politics , has to be. Seems like over here in the U.S. they can get any $ amt . they want because the lobbyist are filling the politicians pockets with cash. What ya think?

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Here in Poland the subsidised cost is about £25 for 28 days worth, and rising, providing you are covered by the health service. This is very expensive for people here, so I can only assume that most people are on warfarin.

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I know a guy in the States with a life threatening illness. He has a choice: food on the table or medication. He is going without his meds until his illness progresses to a point he needs the drugs then food is rationed.

There is a rich couple in the UK who live in Florida and keep a London flat. Every three months they return to the UK for a medication review and pick up three months supply of drugs. Is that morally right?

We may have paid for the NHS treatment in our taxes over a life time. How many of us have paid enough to cover the cost of the treatments we have received over the years? i suggst few if any of us.

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My point is not HOW it is paid for but the actual cost. In th US it is apparently $400 whereas the NHS says it is about a quarter of this figure. So where's the money going?

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Big Pharma. that's the principal issue. The US 'system' thinks that's just fine and dandy. The rest of the world doesnt.

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Most of us get it free on the NHS.

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But we have paid all our National Insurance payments all our lives until we are 60 to support this.

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What would you typically pay?

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No such thing as a free lunch, as they say, but it would require a huge analysis of taxes/health insurance costs to determine the bottom line. I think I prefer that which I am used to, the NHS. My hubby happily takes his apixaban for 'free'.

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Adriatico, I'm also in the US (Colorado) and under my insurance plan I pay a $200 co-pay the first month, then a $45 co-pay each month. It is indeed pricey.

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Two years ago I ran short Apixaban and took the packaging to the local pharmacy in Spain where I have a holiday home and was quoted 95 euros for a months supply (56)

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Did you need prescription?

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Apparently not, as it turned out I got my wife to renew my prescription at home and bring them out to me.

I had to do some rationing and reduce to just one a day towards the end.

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Hi , I get a yearly certificate that costs me £90 . But that's the whole years worth of all medications. If I had to pay for them per month it would be £7.00 each I think ? As for why medication is so expensive in other countries I would say that here in the U.K. We have the drug companies that make a lot of medications and ship it out to other countries. You would be very very shocked at the actual price of medications before they are sold on with a price ££££££ the pharmaceutical companies are making an absolute fortune off drugs over here . I watched a documentary on it Years ago , and the antidepressants and anxiety meds were raking it in. Also do you have an antidote over there yet for that medication?? I am doing as much research as possible on them as I am on warfarin at the moment until my ablation procedure but want to no a lot more before I change on to them.

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Actually most of my meds are made out of the UK and shipped in. I have worked for some pharmaceutical companies and not so much is manufactured in UK, some under license, more in Ireland though. And you have to remember that the cost of R&R is also massive. There is a lot of hype around Big Pharma - some of which has mileage - some of which does not. The costs of producing new drugs and getting them licensed in the US is part of the reason for the cost difference along with NHS able to negotiate bulk rates - US is trying to change that though so we may see a change in costs after Bexit. Europe is going that way, but not quite there yet.

Sam you need not worry about the antidote, in the event of a traumatic, massive bleed there is a procedure that can remove the drug from your blood - and the half life of the NOACs are a fraction of Wafarin.

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google.co.uk/amp/s/amp.peop...

Actually I think I will take my chances with warfarin! And it is very conserning if something like this happened as at least they can stop it with VK on warfarin. If you bleed out you might not be able to wait 24 hours.

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We're is the information about how they can remove the drug from your blood ? As that would be reassuring to me to read ?

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Yes but you don't need to worry about an antidote.

In the VERY unusual circumstances that you would have a major internal bleed, which are the only ones you need to concern yourself with, you would be in an emergency room which has clear procedures for this eventuality. I don't have any links but if you ask your doctors they should be able to give you an explanation.

As was explained to me by 2 EPs :- the drug is active for 12 hours (the half life). This is why you take every 12 hours. It would be very unusual to have to have emergency surgery within a time line that would put you at risk of bleeding out so surgery could be delayed until the drug cleared your system - which is why if you go for surgery you will be asked to stop your anticoagulants.

In the event of it being SO urgent that immediate surgery is required clotting factors can be added and/or a procedure similar to plasmapheresis (similar procedure to dialysis) can be performed during surgery and clotting factors added.

Normal, everyday cuts normally mean applying pressure for a little longer than you would without anticoagulants - but that would be the same for Wafarin.

Only you can decide which you would prefer but in my book NOACs are infinitely preferable to Wafarin for the following reasons:-

Wafarin requires regular blood monitoring to ensure your INR stays inside the recommended range. As this is a 'snapshot' you could be in range when you have your test and out of range the following day.

INR's can go up and down and sometimes take quite a while to do either - eat an extra dollop of spinach and you may find yourself out of range quite quickly. I eat a LOT of greens.

There is some evidence that modern NOACs have a lower incidence of brain bleeds although some studies show a very slight increase in GI bleeds (GI bleeds can be reversed without too much damage, brain bleeds are more damaging)

Some people have side effects with Wafarin such as thin nails and thinning hair.

Variance of diet can affect the efficacy of Wafarin so you adjust the dosage to the diet and the last INR reading. My diet varies too much depending upon location.

I originally chose NOACs because I travelled a lot and therefore INR testing was going to be just too complicated and I didn't want to self-monitor. I originally went on Pradaxa in 2013, changed to Apixaban in Sept 2017 and I have absolutely no concerns.

I do carry a card and when travelling use an SOS bracelet. Apart from that I am more concerned that I am adequately protected from stroke risk than worrying about the very small risk posed by bleeding caused by Apixaban.

But we are all different and some do like the reassurance of an anti-dote and INR testing - only you will know what feels right for you.

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I understand that about in only certain cases but if you were unfortunate enough to have say a bleed from a fall or a car accident then it would need to be stoped as soon as possible! It can happen to anyone at any time . Apparently they had an antidote but it's been discontinued, also it's worrying that a lot of patients like myself were given it and not told of the risks . It's been on the market since 20012 and still no solid antidote? That's quite conserning for me . Until I see proof about this procedure your talking about I don't think I would be ok with these . But every person is different and it's up to that person if they no the risks if they still want to take them . It's worrying about the lawsuits that have been taken against the company as well . That's a lot of unhappy people that have lost some one or had problems themselves. But every one has an opinion on this and unless I had to take one of these I would definitely not at this time .

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There is a whole saga which happened in the US regarding bleeds for various reasons - but don't transfer what happens in the US to here! There were a lot of class actions against the NOAC companies - but then the lawyers in the US were advertising on TV for people to come forward.

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Maybe that's because it's been available in the us longer than over here ??? So we might see an increase in people having problems in the U.K. Like I said what might be suitable for one may not be suitable for another person. One of my family members Carnt tolerate warfarin so is on this medication but she was warned of the risks and told about the dangers of the drug and chose to take it and is doing fine on it . I am just not ok with it at this moment until I see more proof of the antidote!

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There is a reversingagent for rivoroxiban

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I think we should all be careful about talking about reversal for apixaban because we are not haematologists (as far as I am aware). As stated it does have a shortish half life.

You also have to define a "major bleed" . Some surgeons are still juggling major and minor surgery - ditto the dentists. The main issue I suspect would be - can you find the source of the bleed not can you reverse the chemistry.

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I have Apixaban on the NHS and I pay the normal prescription charge (£8.60) for 3 months supply.

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Just an FYI to US patients on this forum, all pharmaceutical companies of the new generation anti-coagulates offer savings cards. For anyone on private insurance, they will reimburse your co-pay. I take Xarelto and have never paid a penny.

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On our National Health Service in England each prescribed dry costs about 9USD, unless you are an old codger like me and over 60 years old then they are all free. All drugs are free in Wales. I'm not sure about Scotland or Northern Ireland.

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Hi, I take Flecainide, Dabigatran, Amlodopine and Atorvastatin for my AF plus hay fever meds. Same as the others, as now I'm 60 I don't pay for my medication. Prior to turning 60 I paid £108 a year for a pre-paid prescription card. Prior to that, the tablets I take each day used to cost me around £40 every three months. The prepaid card saved me a considerable sum. Often wondered how people in the US cope with these expenses. Not sure how much most of my meds cost but I do know the Dabigatran is £5 per tablet and I take two a day.

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hi -- i'm in San Francisco, Ca, have Medicare and Kaiser Advantage supplement. Eliquis copay is $100 for 30 day supply. it's a 'tier 3' brand drug, no generic equivalent. Kaiser is pretty big and negotiates prices. Pradaxa, more common and has an antidote available, is about $50/month copay. My cardio prescribed warfarin, citing cost ($10/month). BUT the blood draw lab co-pays are $35 per visit, which makes it more expensive with weekly INR tests until the INR stabilizes. What's the solution? Obvious, when you think about it.....

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Thanks so much for the comment. I am on Medicare too and I will see if I can switch my Plan D to a more reasonable place like Kaiser.

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How would someone like me, who had a cardiac defect from birth, even get affordable medical insurance in the US?

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Don't even think about it.

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Before the Affordable Care Act, known as Obamacare, someone like you would not have been able to buy health insurance at all, or at least not insurance that would cover any needs arising from your cardiac defect because it was a "pre-existing condition" before you bought the insurance. Now you would be able to buy insurance, but you might not find it very affordable. The Trump administration is trying to make insurance more affordable by making lower-quality insurance available again, so you'd be able to buy insurance, but it wouldn't help very much if you were sick or injured. Our health-care system is a mess that gets only marginally better. Obamacare did nothing about the huge administrative staff at each hospital whose sole job is to convince insurance companies to pay claims or the huge administrative staff at insurance companies whose sole job is to deny as many claims as possible. We have this vast adversarial private bureaucracy, and paying for it is part of why our medical costs are so high.

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We are paying around $50k for a months supply. B

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Sorry meant $50 for a month’s supply. B

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