November 8, 2010

Will Medicare Part D Pay for Pradaxa, the New Coumadin Alternative?

Posted in Heart Disease in the News, Heart disease tips, Helpful Heart Links, Uncategorized tagged , , , , , , , , , , , , , , at 7:09 pm by keepyourhearthealthy

Product photo from Boehringer Ingelheim website press release

In it’s short life-span, Pradaxa has already turned the world of cardiology news upside down.  Boehringer Ingelheim has brought us the first good Coumadin alternative in 50 years, but they have yet to get it officially on the Medicare Part D list.

What To Do When You Have Heart Disease Blog has covered the topic of Pradaxa (dabigatran) extensively over the past month since the FDA voted to approve this history-changing alternative to Coumadin.  Patients with atrial fibrillation can now take Pradaxa 150mg twice a day to significantly reduce their risk of stroke.  According to the Pradaxa website, over 2.3 million Americans have atrial fibrillation and having this rhythm disturbance makes a person five times more likely to have a stroke.

Ever since the 1950’s Coumadin has been given to patients with atrial fibrillation because it significantly reduces clotting events such as stroke.  One trial (AFFIRM) even reported that patients taking Coumadin had a 69% lower risk of stroke.  Now the new drug Pradaxa has a large trial (RE-LY) showing that Pradaxa prevents 35% more strokes than Coumadin!

So far, the choice between Pradaxa and Coumadin is a no-brainer.  Pradaxa prevents more strokes and is way less hassle.  Unlike Coumadin, Pradaxa does not require monitoring or dose-changes.  Pradaxa is not affected by foods or other drugs. Quite frankly, the Coumadin regimen was just too complex for some patients to handle…and it carried some very significant risks of bleeding and hemorrhage!

When Will Medicare Pay For Pradaxa?

Now that Pradaxa is finally here to rescue heart patients from the clutches of Coumadin, will they be able to afford it?  Out of pocket costs can be about $250 per month. With prescription coverage (most companies will consider it a “non-preferred drug” right now) the cost can go down to $40 per month.  As of January, 2011, Pradaxa is NOT listed as a covered drug under Medicare Part D. That means that patients who use Medicare Part D will have to pay out-of-pocket if they switch from Coumadin to Pradaxa.  For the retired community relying on Medicare, $250 per month could mean missing a few meals!

There have been some reports of Boehringer Ingelheim working on getting Medicare Part D approval for Pradaxa.  Pradaxa is still not listed in the Medicare database (Medicare Drug Database) today but it may be too soon after it’s FDA approval for the Medicare website to be updated.  Even after calling the main Medicare number though, they confirmed that Pradaxa is not being covered.  I am certain that many Medicare patients will be basing their decision to switch to Pradaxa on cost so hopefully Part D adds it soon!  Check here for updates posted in the future.

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