April 27, 2011

Pradaxa Now Covered by Medicare Part D!!

Posted in Heart disease tips, Helpful Heart Links tagged , , , , , , , , at 8:25 pm by keepyourhearthealthy

A patient having his blood pressure taken by a...

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The new Coumadin alternative, Pradaxa, has recently become available on the Medicare Part D formulary.  Medicare recipients finally have an affordable option to Coumadin.

The first Coumadin alternative for atrial fibrillation became available late last year and Medicare patients have been anxiously waiting for it’s inclusion in the Part D formulary ever since.  With a hefty out-of-pocket cost at $250 a month, Pradaxa was much too expensive for most of the retired community.

Even though Pradaxa prevents more strokes than Coumadin, has no interactions with food (not even spinach) and requires NO monitoring (seriously, no more fingerstick checks!), many seniors could not rationalize paying $250 a month compared to Coumadin or warfarin which can cost as little as $4 per month.  Now, 6 months after Pradaxa was approved by the FDA, Medicare Part D has multiple plans which will cover the cost of this expensive new drug.  By searching the website www.medicare.gov, patients will be able to find Part D coverage and compare prices for individual plans.  The monthly drug cost is still fairly expensive (from $30 to $50 a month) but this is still significantly less than out-of-pocket cost.

Patients who plan to switch to Pradaxa should confirm with their Part D provider that the drug is covered before trying to get the prescription filled.  Here are some important tips to help make the switch:

  • Your INR needs to be 2 or less before you can start Pradaxa
  • You must take Pradaxa twice a day!
  • You CAN take Pradaxa while also taking Plavix but only if your cardiologist feels it is safe in your situation
  • Pradaxa starts working within 30 minutes to 2 hours
  • Pradaxa is generally no longer effective if you miss 2 doses
  • You cannot take Pradaxa if you are also taking Rifampin
  • Pradaxa is not currently indicated for people with mechanical heart valves (although this may be coming within the next few years)
  • The pills expire within 30 days of opening the bottle
  • The most common side effect is heartburn (GI upset)

July 5, 2010

The Dreaded Donut Hole and Medicare Part D Prescription Coverage for Plavix

Posted in Heart disease tips tagged , , , , , at 12:37 am by keepyourhearthealthy

pic by Salvatore Vuono

Are you just now getting to the point of signing up for Medicare Part D prescription coverage?  Believe me, it is just as confusing as everyone makes it out to be.  My grandmother refused to sign up because she could not figure out which plan would actually cover her prescriptions!  If you do not already know by now, there are multiple plans in each state and some only cover certain medicines.  So, even if you sign up for a specific plan, not all of your medicines may be on that formulary (list of drugs covered).  Plus, all the plans have different monthly costs and deductibles.

I found a search tool online that allows you to look for plans in your state based on a particular medication.  Given that Plavix is one of the most popular cardiac drugs (and one of the most expensive!), I searched the plan database for prescription coverage of Plavix.  You’ll see on the results page that monthly premiums range from $21 to over $100 a month.  This monthly cost is in addition to the cost of each prescription per month.  For Plavix you may pay an additional $10 to $80 a month for a 30 day supply.

You might be thinking, “Why would anyone pay $100 a month for a drug program when they can pay as little as $21 on another plan?”  Good question!  The reason that some people might find the $100 a month plan appealing is because that plan offers a $0 deductible and full gap coverage.  The $21 plan requires that you pay $310 to start off with and they will not cover you during the dreaded Medicare Part D “donut hole.”  During the donut hole, cheaper plans will not pay for any prescriptions once the company has paid for $2,380 worth of medications.  You continue to make monthly premium payments but you also must pay for the full cost of each drug as well.  The donut hole does eventually end once you have paid $4,550 for your prescriptions out of pocket.  However, if you pay for a more expensive plan that covers you during the donut hole you will not need to worry about gaps in coverage at all!  It’s a tough decision which is why having a plan comparison tool like this is such a great find!  Click on the link below to go straight to the plan finder:

PDP-DrugFinder: Find which 2010 Medicare Part D plans best covers your drugs.

If you want to learn more about the specifics of the donut hole, here is a great article: http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm

I wish you the best of luck finding the perfect plan for you!