View Full Version : Cost of Coumadin
November 24th, 2001, 08:58 AM
I have heard that Coumadin is very expensive.
What's an average dose, what's the cost per month and has anyone had trouble with insurance companies covering it.
November 24th, 2001, 09:54 AM
I run an anticoagulation clinic and have a website about warfarin. www.warfarinfo.com
I'm not sure of the cost but it is not an EXPENSIVE drug. It has been around for more than 50 years. Your insurance will cover it, but they may require you to take the generic version warfarin.
The average dose is about 5 mg per day but that is not important. What is important is maintaining your INR in the desired range,
November 24th, 2001, 01:50 PM
I think Coumadin is rather expensive. I pay $40.00 for 30 pills, doesn't matter what strength. This price is with insurance. The retail price is $120.00 without insurance, I was told by the pharmacist.
I am still on 20mg a day, so it does get costly for me. I always have to have some "ones" on hand just in case the dosage gets changed and even for 30 "ones" I pay the same $40.00. I was told by the pharmacy that I could get my doctor to "override" this price and be able to pay the "Warfarin" price for Coumadin and have tried several times, but the insurance company won't even answer our request.
If I were to change to the generic "Warfarin" the cost would be $10.00 with insurance. My doctor doesn't trust the generic "Warfarin" either, and has instructed me never to take the generic over Coumadin.
AVR 8/7/00 & 8/18/00
Coumadin 20mg a day.
November 24th, 2001, 01:53 PM
Jennifer, At my Rite-Aid Drug Store in McLean VA the cost for 100
5 mgm Coumadin is $69.90-- for 100 generic warfarin the cost is $51.90------ for 2.5 mgm Coumadin $68.99...generic warfarin-$54.99 I have faith in Coumadin and pay the small markup over generic because I had touble getting my INR stabilized on warfarin which I was on when I left the hospital. My cardiologist who took over in the post op period switched me to Dupont Coumadin because he said "patients on generic warfarin are all over the place". Later I had the opportunity to discuss this with Dr. Scott Kaatz a national authority in anticoagulation and director of the clinic a t Henry Ford Hospital , Detroit. He said the generic compound was "pure" but you couldn't rely on the quanity in each pill and this is why Coumadin is one of only three brand drugs in the formulary at his hospital. Now having said this we may get another opinion from our resident Warfarin guru-
AL LODWICK !
November 24th, 2001, 04:27 PM
I have never been able to understand the price of Coumadin. The stuff is over 50 years old and was discovered by accident so there was never any research money involved. I know that there are several pills available that are over $5.00 each, so my statement that it was not too expensive was relative.
MATXR already knows my opinion on generic but I'll rise to the challenge again. I mainly manage some of the lowest income people in Colorado. Even one extra $20.00 insurance co-pay for them would mean a choice between eating or paying for heat, light etc. So I have almost everyone on generic. I had all of these people (over 100) on Coumadin before the generic came out and then monitored their switch. There were no major problems. Brand loyalty is a lot like other forms of love -- you can't account for it scientifically.
November 25th, 2001, 04:07 AM
I just thought I would add my personal experience to the thread. After surgery, my surgeon made it very clear to me that I should never get the generic brand for Coumadin. So, I have been sticking with the name brand Coumadin ever since. I have also read many stories on this and other medical related sites that have tried to use the generic and have had problems stabilizing their INR.
As for generic versus name brand products, the quality specs for the generic have a wider tolerence for the amount of the drug used in each pill. What this means is that the name brand for a drug may call for 5 mg. The manufacturing process may allow for a "+" or "-" factor of lets say "0.1" mg. But, the specifications for the genieric brand may have a wider tolerence factor of let's say "+" or "-" 0.5 mg. This means that the generic brand could cause more or less doasage than prescribed.
While it is true that both brands have the same quality, they may not have the exact same amount of the drug.
Now, all that being said, let's not forget the possibility of "Name Brand" loyalty. Afterall, the drug companies are the ones that wine and dine the doctors! So, who's name brand loyalty is it? Ours, or the doctor who told us to take it. Just another thought.
Personally, I stay for the most part within my recommended INR range on Coumadin, so that is my prefered drug of choice. Medically speaking that is!
Wishing everyone good health and safe holidays,,
November 25th, 2001, 07:03 AM
As far as the tolerance issue goes, when the generics for Barr labs were tested, they were found to be in a tighter range than Coumadin. The DuPont people immediately shut up aboput this issue. I used to give talks at those wine and dines for doctors that were sponsored by DuPont. But when I would not say that Coumadin was better than the generic, they quit booking me. I killed the goose that laid the golden egg, but I had to be honest with myself.
I do not know of any testing of generics from other companies from Barr. These may be at a wider tolerance and there could be problems if people switched from Coumadin to various other generics and even among generics. We just do not know about that issue.
November 25th, 2001, 10:54 AM
Al, I knew what you would say and I love you! In my brain, I know you are right but my ticking heart tells me to buy Coumadin. Now I work for a big HMO , Kaiser Permanente, who take care of about 600, 000 members in this area. They have a superb anticoagulation clinic run by pharmacists ( two of them PhD's). As I have previously noted,in my view, pharmacists, like Al do the best job of managing anticoagulation.What does Kaiser prescribe? You guessed it.......generic warfarin (Barr). Another thought ;my pharmacist friend who runs the clinic, Dr. X thinks he has a job for only another two or three years when the rat poison will be replaced by direct thrombin inhibitors like Exanta now in trial!
November 25th, 2001, 01:16 PM
Thanks all for the replies.
I am also really interested in the new drugs that many of you hope will replace Coumadin. They will still be blood thinners, right? So there will still remain the fears of either bleeding incidence or clotting?
Is the only improvement actually that they will hopefully be easier to regulate? Or are there others?
November 25th, 2001, 02:59 PM
Marty, I have another windmill for us to joust against. How about suggesting to Kaiser that they look at their database to see if they can find any relationship between taking warfarin and macular degeneration. As far as I know, nobody has ever done a paper on this. It will be very difficult because taking warfarin for a long period of time will be similar to aging - which is the major unmodifiable factor. However, there was an article published in Archives of Ophthalmology in October in which an Australian group found a relationship between macular degeneration and smoking for over 40 years. So maybe people with big databases could tease this out. Possibly it would have to be then entire Kaiser Permanente system. I suggested this to Don Tillman, one of the Kaiser pharmacists in anticoagulation back in May when we were in Washington, but have heard nothing back from him. I also e-mailed the doctor in Australia to see if he was interested.
For those of you who are interested in Exanta, I was on a committee that met in San Diego last January to advise AstraZeneca, the manufacturer of this drug. There are a whole series of events which take place when blood needs to clot. This is called the clotting cascade. Warfarin works at several points along the cascade. It also does very little directly. Instead its effect is dependent on its effect on other things such as vitamin K. It is also susceptible to many interactions caused by interrupting enzymes in the liver. These are the reasons that it is so difficult to regulate the dose. The last step in the clotting cascade is for prothrombin to be turned into thrombin. This is the stringy stuff that holds a clot together. It is at this step that Exanta works and it works directly on the conversion. It is not subject to many of the interactions that affect warfarin. For this reason, it appears that it is going to be a one dose fits all and no monitoring drug. It is currently being tested for blood clot prevention after surgery, prevention of recurring blood clots in the legs and stroke prevention when people have an irregular heart beat called atrial fibrillation. The one drawback, as far as I know, is that it is not being tested on people with mechanical heart valves. However, if it works on all of these other things that warfarin works on, there is little reason to believe that it will not eventually be used for mechanical valves also. You can read more about this at http://www.astrazeneca.com/NewsSection/NewsReleases/press_release_145.html
I am planning on moving into another field besides anticoagulation too, because it is not too hard to see that warfarin will be replaced in the next several years.
November 25th, 2001, 04:28 PM
I have been fortunate that the insurance I have pays for the brunt of the cost. I pay only $5.00 per trip. I have been lucky so far, but maybe not for long it sounds like. Health insurance, such as HMO's are taking advantage of our misfortune of 09-11-01 and raising the cost of coverage. So no telling of the choices I might have to take soon also. Just hang in there. Something has got to give in the cost of medicines. It costs too much even to take an asprin the hospital.
Aortic valve replacement
St. Judes' valve
November 26th, 2001, 04:43 AM
I'm really enjoying being a spectator of this "jousting" tournament between Coumadin and the Generic Barr products.
Even though my heart is cheering for Coumadin, I have to be on Barr's side because once you're there you can't switch teams. That would mess up INR's worse than they possibly are.
My prescription for Barr Warfarin runs me $18.00 at Walgreens (in Northern Chicago suburbs) for a 30 day supply (which actually turns into an approximate 2-month supply because my two doses, 2.5 and 5.0 are taken on alternate days). So it costs me $36.00 for approx. 1-1/2 months worth and I'm at 20% co-pay.
Hope that helps somebody.
Go Exanta! Go Exanta!
Gail in Ca
November 26th, 2001, 08:14 PM
I have been on warfarin (barr) since my surgery 6/00. My INR is stable and I feel the generic is fine for me. My nurse just said to monitor my inr if I ever change brands as the binding agent may change the INR.
My husband's insurance is great- no charge for 90 day supply if I use the mail in pharmacy!!
I will be shocked I'm sure if someday I have to pay full price.
I was a pharmacy tech for 13 years and feel that this generic is fine. I think my cardilogist would know if I shouldn't take a generic of a particular drug.
For those of you who's doctor says do not take generic, why do they feel this, when people like myself take generic warfarin and have had no problems regulating the INR?
November 27th, 2001, 03:37 PM
Hi Gail, That was a terrific testimonial for Barr generic warfarin. I think you just had the last word!
November 27th, 2001, 05:08 PM
I thought the same thing, Marty. I was going to keep my mouth shut (fingers clasped.) But that was yesterday!!!
John & Joann
December 16th, 2001, 10:52 AM
Joann has taken the Dupont Coumadin for 30 years. We were told by many physicians not to use the generic for this prescription.
My insurance provides for 3 months supply (just reduced from 4 months) for 10.00. They agree that the generic is not a good substitute for Joann. We are changing from Merck-Medco to PCS Jan. 1,2002. All rules are suppose to be the same, but we expect many changes in the next 30 years. Joann goes to a Coumadin Clicic rather than home testing. The use the Coaguchek System. She had blood drawn from her arm for 28 years. Has scar tissue of a drug addict.
Coumadin is not a big issue at our home. Life goes on with coumadin! Thank you Dupont for discovering this drug by accident.
December 16th, 2001, 02:00 PM
I'll add that Joe, who's been on Coumadin for 24 years, has always used brand name Coumadin, never the generic.
He also has his blood drawn at a lab nearby in the hospital and has it read and prescribed by his primary care doctor.
His INR is relatively stable.
John, I laughed at Joann's scar tissue issue, Joe has those also. But the lab is always able to draw blood. He probably gets the most experienced phlebotomist.
Not a big issue at our house either.
December 16th, 2001, 02:11 PM
I pay $15 for the Brand under insurance. Usually get 100 tablets depending upon how my RX is written. That's a 3 month plus supply. Recently upon changing insurance....the actual cost came up because my new information had not been provided.
Figure it would cost roughly $20 for a 30 day supply without coverage for the brand. That's very cheap compared to other medications!
December 16th, 2001, 06:14 PM
My insurance changed as of July 1st 2001.
Before that date I always paid $8.00 per Coumadin prescription for a 30 day supply. Now with the changes I pay $40.00 per prescription for a 30 day supply, doesn't matter which strength. I asked if they could give me a 90 day supply, but there was no difference in cost. That would still cost me $120.00.
If I would agree to take Warfarin instead of the Coumadin brand the cost would only be $10.00 per prescription for a 30 day supply. Walgreens pharmacist told me that the doctor could override this price, and that the insurance company would have to give me the Coumadin brand for the Warfarin price. I have tried and tried since July, but without success.
Since I am on 20mg a day I need a lot of Coumadin per week, and I always have to have (ones) on hand just in case the dose needs changing. Get's rather expensive, but what can I do?
AVR's 8/7/00 & 8/18/00
Coumadin 20mg a day.
December 18th, 2001, 07:00 PM
DuPont did not discover this, they are only the company that currently holds the rights to the name. The has been bought and sold many times over the years. The first four letters of the name comes from Wisconsin Alumni Research Foundation. They provided the money that was used to track down the reason that the cows were dying. A small technicality, but they do not deserve credit for anything except making money.
Don't forget that those of you who took warfarin between March 1, 1997 and August 1, 2001 can get money back from DuPont. They were forced to put up a $44.5 million bond for falsely saying that Coumadin was made to a higher standard than generic. You are entitled to the money even if you think that Coumadin is better -- the settlement was about overcharging after the generic was approved. You have to file before April 30, 2002. A copy of the claim form is available on my website at
Your pharmacy can provide you with copies of the receipts.
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