Coumadin/Warfarin Cost

[tommy]

My employer is changing insurance. The new plan will "discourage" brand name medicines by upping the copay, and requiring that I pay the difference in cost of the brand name over and above the cost of the generic. It seems like double jeopardy to me. And there are two catagories of brand drugs - perferred and non-preferred with still higher copay for the non-preferred. At best my copay will triple. At worst it will go up by a factor of 10 plus the difference. Ouch!

I'll admit that I've been spoiled. Now I feel like I'm getting the shaft. I know that any cost is worth it to be alive, but I would like to know why I would shell out a bunch of extra dough?

My questions are

1. What are your opinions on Warfarin for AVR mechanical St Jude? My cardio has been insistent that Warfarin and Coumadin are not the same, and that I should only take Coumadin. Is it advisable for me to twist his arm a bit to use Warfarin? What are the risks?

2. What do y'all pay for Coumadin and Warfarin?

3. Is Coumadin considered brand "prefered"? Are there other choices?

Any help/advise/experieince/wisdom would be appreadiated.
Thanks.

 

[Ross]

Twist his arm and get Warfarin. Warfarin and Coumadin are the same. You'll have some say they swear there more stable on Coumadin, but I've taken both, combined both, and can tell you I've never seen a lick of difference besides the price you pay.

Brand Name Coumadin
Generic Warfarin

These are the only 2 choices that I know of.

Cost wise, I was getting 60 5mg tabs for $26 Warfarin
Coumadin would have been almost $20 more. I'll have to double check my prices. It's been a while since I payed for it. I've got a ton left yet.

30 tablets 90 tablets

Coumadin
tablets
5MG $22.99 $61.99


Generic Warfarin Sodium
tablets
5MG $13.99 $34.99

 

[DickV]

I believe it effects people differently. I can't get stable on warfarin. Tried twice and gave up twice. I pay more for Coumadin and my 18 month average INR on it is 2.9. You will hear both sides and some really strong opinions but I do not believe it is as cast in stone as many claim. Try warfarin and if it works, pocket the savings. If it doesn't result in what you believe to be the same results, plunk out the extra coin and go back to coumadin.

I am not sure what I pay for coumadin. I get 90 days at a time and order several dosages. Good luck whichever way you go.

 

[JimChicago]

I wonder if it matters who makes the warfarin - I've been taking the ones by Barr and they seem to work OK. I've seen there is at least one other manufacturer of the generic ones too.

 

[JimL]

I called my insurance company and asked them what was the best way to get my warfarin. They said to get a prescription for a 3 month supply, with three refills (thus a year), and to get it mail order from Walgreens in Florida. I pay $20 for each three month supply of warfarin.

 

[catwoman]

Tom:
I'm facing the same problem with my insurance for next year. And, if I heard our HR people correctly, my doctor can no longer specify Coumadin, with no generic accepted. If there is a generic available, the pharmacy **will** substitute. I suppose doctors can jump through hoops to avoid the generic, but I didn't hear of any appeal process.

Since INR is affected by so many factors, how can anyone know positively that Coumadin is more effective/better/whatever than warfarin? You'd have to have identical diets, identical physiological factors, etc., for a test.

I've been on Coumadin, but will be changing to warfarin. Have alerted my PCP's office about it, and they're not happy.

Marsha

 

[rcatalano]

Tom,

I'm kind of new at this and can't answer the Coumadin vs Warfarin issue. Like you, my cardiologist's prescription for coumadin says 'no substitutes'.

I can see that the charge for 30 5mg Coumdin is $22.99. Not sure what they would charge for warfarin, but I pay the same $5.00 copay regardless of which one I get.

Let us know how it goes with you. I have a feeling its only a matter of time until my insurance company 'encourages' me to use generics also.

 

[Christina]

I get a 3 month supply (180 tabs) for $20.00 through the mail from the Insurance pharmacy. (PacifiCare).
I have paid as much as $40.00 for 90 tabs in the past, but I requested a 3 month supply when I was going to Europe last year and they charged me $20.00. This is a real deal, but things do change as you all know.
Keeping fingers crossed.
ooh, I can only take Coumadin. Cannot get regulated on Warfarin.

 

[catwoman]

I'm paying $20 for 1 month at Costco right now. Have been waiting to determine what dosage I will be on before mail-ordering my Coumadin.
On Jan. 1, it will be $10 PLUS the difference between the full cost of the generic and brand-name drug for 30-day supply, at specific pharmacies. Co-pay for preferred drug is $25 for 30-day supply.
Mail order will be $20 co-pay for generics (90-day) and $65 co-pay for preferred brand. Not sure why preferred brand is given when I was told pharmacists won't be giving preferred brands when a generic is available.

What with 2 visits per month to PCP for PT/INR going from $10/visit to $15/visit, I'd rather go to warfarin, if I can achieve the same stability on that as on Coumadin. I've been pretty consistent 6-8 weeks now.

 

[Ross]

I have 18 months to go before I qualify for medicare.

.......And then you'll still have problems. I'm on a medicare kick right now. I'm very angry with the changes. Even on a Medicare HMO, it's quickly becoming unaffordable.

 

[tommy]

Here's an update after a conference call with my HR folks. Thanks for your input, it's been really helpful.

The three tier prescription drug plan will be in place Jan 1.

Three month supply:
$25 copay for generic Warfarin
$50 copay for brand (preferred) Coumadin + the difference in cost
$100 copay for brand (non-preferred) + diff in cost (yikes - glad this doesn't apply here - what a stab).

They will make an exception to the "diff in cost" rule if my cardio submits a letter indicated medical necessity for the brand drug Coumadin. The letter has to be approved by the insurance company.

This seems like a reasonable compromise to me. My guess is that the cardio will need to be convincing in his letter. I hope that they aren't just offering the compromise to blow me off, and plan on being pretty stingy with the approvals. We'll see.

I've been a little hard to keep stable, so I'm inclined to pay the extra $25 every three months (brand preferred Coumadin) and count my blessings. But if the letter doesn't get approved, I'll be pushing the cardio pretty hard to try the warfarin.

Also, since the medical and prescription insurance plans are both changing, HR wasn't sure which insurance company I will need to submit receipts for coagucheck supplies. HR will investigate and get back to me.

Thanks again for your responses.

 

[Guest]

I'll be interested to find out if the insurance company approves Coumadin after your doctor's letter. The reason is that every study (no exceptions) in medical journals says that there is no difference. If your doctor cannot cite a reference in a journal it seems very unlikely that it will be approved. The docotr's idea that there is a difference came from the advertising department, not any studies. To get an approval for an individual will probably require convincing proof that you either had a bleed or clot that required hospitalization.

Sometimes insurance companies do strange things but usually their motto is "Don't pay $1.01 when $1.00 is due."

 

[Lisa in Katy]

I am another one who wasn't able to get stable on Warfarin, despite what the articles say. I pay about $5 for a 30 day supply, but I have to buy 6 mg and 1 mg. I only take the 1 mg every other day, so it's about $7.50 per month. Mail order would be similar in price.

Depending on what state you're in and how strong managed care is, Coumadin might be approved. I find that in Texas, most exceptions are approved, unless there is an extreme difference in cost, which is not the case here.

 

[khan2]

There is really no proof that Coumadin is better. However, the people that make Coumadin have published ads with data showing their pills have much less variability in the amount of warfarin in them than the generics are allowed to have. For example, if the FDA allows a 15% variation in dose, a generic 10 mg tablet could have 8.5 mg or 11.5 mg. Coumadin has much less variability than the FDA limit.

However, I have never seen any data actually showing how much variation there is in the generic warfarin, all of which is made by one company (I think). That company filed a lawsuit against Coumadin and won an injunction against Coumadin publishing the ads or representing in any way that they were better than generics.

My take on all this is that generic warfarin is OK to try for most patients. If you have no problems with your INR (which is likely) stay on the generic. If you start having a lot of variation in INR and need frequent doseage changes, it may be worth getting the brand name Coumadin. If cost is no issue or the co-pay is the same or the difference in cost is minimal, I would opt for name brand Coumadin.

 

[Guest]

I suspect that the warfarin gets made by the same manufacturer and then gets made into pills by different companies.

 

[Ross]

I suspect that the warfarin gets made by the same manufacturer and then gets made into pills by different companies.

Ortho Pesticides=Dcon

 

[tommy]

So when you buy it from Walmart, it's in the Home and Garden Dept?

 

[Ross]

So when you buy it from Walmart, it's in the Home and Garden Dept?

 

[Lisa in Katy]

The generics that I took looked like tiny Milk-Bone Dog Biscuits.

 

[tommy]

Today I logged into the website for Medco - the new prescription drug insurer, and guess what? On a search for Coumadin, it is listed as "Brand (preferred) - no generic available". Go figure.

I'll file my first prescription for Coumadin under the new plan and not rock the boat.