Eliquis and AFIB

Posted by lenmayo @lenmayo, Apr 18 10:07am

Does anyone who has occasional AFIB not take Eliquis?

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@justwannasay

RE: the cost of Eliquis, I was paying $100. per month until about a year ago when a generic brand of Apixaban became available. Now it costs $30.00 per mo.
That's for 5mg.x 2 per day. I have Paroxysmal A-fib....I don't even know when or if I'm having episodes. I think mine is caused by a bicuspid aortic valve.

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Thanks for. your comments I too have paroxysmal AFIB.. Infrequent attacks..You mentioned generic Apixaban.. Is this widely distributed.?.My local Pharmacy Walgreens does not have it.
any info would be welcome..
Thanks

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People develop bradycardia due to a number of problems, chiefly a defective SA node, but also in response to rate control drugs such as beta-blockers and calcium channel blockers. Metoprolol is a beta-blocker which clips the heart's intensity from beat to beat. This keeps tachycardia arrhythmias like SVT and AF at lower rates, but it also has the effect of keeping blood pressure somewhat lower. This helps those with borderline hypertension to fall back down into the 'good' range, at least for a while. But, for those with some combinations of anti-arrhythmic drugs AND metoprolol, it can cause bradycardia when the heart reverts back to sinus rhythm.

Some people with advanced heart disorders who can't maintain normal sinus with or without drugs have to be placed on a pacemaker. It's simply too dangerous and too hard on the heart to just leave it in an elevated HR and beating erratically for long because of myocyte damage, valve damage, fibrosis due to enlargement of the left atrium in those with AF, and so on. At some point, the EP will ask you if you want a pacemaker. This means living much more normally, but it also means, as far as I have heard, destroying the SA node and the AV node. This is a big deal, but the pacemaker will be confounded by signals continuing to come from a disordered SA node, or from an AV node if the SA node is dead and no longer functioning. You'll just get out-of-sync beats again, meaning more arrythmia, meaning you're no further ahead! So, the two nodes must be neutralized, and the new device does all the electrical signaling from then on.

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@spmgka

@bill0996 - I am a bit confused with your answer - are you saying you had to get a pacemaker because you went off Eloquis? Or, are you saying you ended up with Bradycardia because of the Eloquis and then had to get a pacemaker?

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LBBB diagnosed in 05. LBBB causes Bradycardia. Afib episode in 08/19, ablation in 02/20. First EP big believer in Eloquis which I had been on since 09/19. I wore monitor after surgery and then about 24 mos later. Neither time recorded any evidence of Afib. In Fall of 22 assigned to a new EP. 2nd EP implanted pacemaker in 08/23 due to “chronotropic incompetence” or a HR that did not respond as desired during a stress EKG. My minimum HR now is set at 60. While my HR was never below 46 while I was awake, the pacemaker is there due to sick sinus syndrome, or the heart’s internal pacemaker. As I understand, the pacemaker makes certain that my heart properly responds to a load placed on it. During my initial three visits with the new EP, without trying, I convinced him that I constantly monitor my HR via my Fitbit. With the 11/23 visit hospital visit to “adjust” pacemaker, he decided that I would be ok to go off Eloquis. While I was a little apprehensive, I was also relieved to get off the med. I do have a small pocket pill carrier that I always travel with some left over Eloquis. In 08/23, the RN tech conducting the stress EKG stopped the test 12 minutes while I thought that I was a “beast” with everything that she threw at me, she said that the test was stopped early as my heart was not responding properly to the load. I hope that this explains how I got here. I really believe that my first EP would still have me on Eloquis. I really trust my cardiologist who I will see in July to give the most “down to earth” explanation.

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@bill0996

I think that @gloaming gave you the best advice. It is a personal decision. After my ablation in 19, my EP believed very highly in staying on Eloquis which I did. The first EP moved, the second EP looked at two different weeks when I wore the monitor with no evidence of Afib plus my telling him that at least every hour I check my HR via a Fitbit, he took me off Eloquis. And 8 months ago, I have a pacemaker implanted for Bradycardia. Too many factors for each individual risk, if there is any doubt, I would stay on the med. .

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@bill0996 - I am a bit confused with your answer - are you saying you had to get a pacemaker because you went off Eloquis? Or, are you saying you ended up with Bradycardia because of the Eloquis and then had to get a pacemaker?

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@blinken

sherryzitter, this was my original post. I just want to clarify that this $70 price was for 180 capsules-3 month supply, not for one month. So that works out to $25 or less for one month, which is a great relief, financially, especially since both my husband and I need this medication!

The last refill ordered earlier this week was $73.11 which includes shipping. We order through the Canadian site LifeRx and choose their pharmacy located in India. They also offer ordering from the UK, Canada, Mauritus...but the Indian supplier is the least expensive and it's the same generic (Apixaban) which will eventually be available in the US, hopefully in 2026. We are very satisfied with this company which operates under strict regulations, equal to those the US pharmaceutical manufacturers follow. We are thankful that our primary care physician provided us with this option in order to continue taking this medication.

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Wow, that’s great news! 🙏🏻👍🙏🏻

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@sherryzitter

Re-posting from another thread if helpful, but $70/mo rather than $30 (still much better than $700/mo!):

My husband and I entered into the so called donut hole last year and both are on Eliquis. I asked my PCP about drugs from Canada and he gave me information about a pharmacy that other of his patients had used successfully. LifeRx is the one we are using to get Apixaban/generic Eliquis. They offer several options as to amount, strength and source for the drug including the UK, India and, of course, Canada. It took awhile and some calls to their help line to order from their somewhat confusing website and at the time the payment methods included American Express as the only credit card they would accept. The other option was to use wire transfer which is what we use. I received notice that they now do not accept any credit card for payment. You must provide them with a prescription from your doctor...ours gave us one on a full 8X10 sheet. Easily legible and fax-friendly. LifeRx notifies us when we are eligible for refills and the refill process is quick and easy. The cost of my 3 month supply was under $70 the first time but the cost increased the next time to $76. This included shipping. The price fluctuates. Expect a wait time between 2-3 weeks to receive. I'll admit I was nervous about ordering from them and was anxious waiting for the shipment to get here but we are very satisfied with the price and the help line is available.

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sherryzitter, this was my original post. I just want to clarify that this $70 price was for 180 capsules-3 month supply, not for one month. So that works out to $25 or less for one month, which is a great relief, financially, especially since both my husband and I need this medication!

The last refill ordered earlier this week was $73.11 which includes shipping. We order through the Canadian site LifeRx and choose their pharmacy located in India. They also offer ordering from the UK, Canada, Mauritus...but the Indian supplier is the least expensive and it's the same generic (Apixaban) which will eventually be available in the US, hopefully in 2026. We are very satisfied with this company which operates under strict regulations, equal to those the US pharmaceutical manufacturers follow. We are thankful that our primary care physician provided us with this option in order to continue taking this medication.

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I saw a new cardiologis today who said, despite my CHADS score of 1-2 (depending on whether gender is included), suggests anticoagulation. She sent me to an electrophysiologist for discussion of ablation.

This was depressing. I need a rogue cardiologist. I have had afib once a year or once every two years for 10 years now. For reasons I can easily explain, I had a few more this year, mainly traced to moving (lifting, stress).

She also did not seem to think short term anticoagulation was a possibility but I know some people are doing this. My afib converts on its own in a few hours so that may be why.

I didn't get any protocol for steroid use. That was the trigger for this last one. Just 4mg.

I understand that having afib makes us prone to stroke, and not just from episodes but because of the dysfunction of that part of the heart. But my stroke risk is low too.

Unhappy.

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@lenmayo

You are not eligible if you have a Prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs.
You are not eligible if you are not covered by prescription drug insurance.
You are only eligible if you have Commercial prescription drug insurance through an employer-sponsored or private health plan or the Federal Employee Health Benefit Plan.

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True, and I mentioned that in my post. But if you are eligible by virtue of having a commercial drug insurance, a private health plan, or the FEHB plan ( unless it's been switched to a Medicare Part D plan, as the federal Blue Cross insurance covering retirees who have Medicare did effective Jan 1 of this year, we opted out), it's a substantial savings. I figure there are any number of people who may fall into the eligible category if they're not retired yet, working with employer covered insurance, or retired with drug coverage in an employer-based commercial insurance plan ( similar to the FEHB but private sector employers).

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@marybird

For those bothered by the high cost of Eliquis, ( and who isn't?) here's some information I found immensely valuable to help with that cost.. The manufacturer ( Bristol Meyers Squibb) offers a coupon that can be used to pay for a 30 day supply of Eliquis for a copay of $10. The coupon can be used for a period of two years worth of refills ( or a $6600 limit, not sure how that is applied). Customers with private drug plan insurance ( not government insurance such as the Part D Medicare drug plans, Medicaid or Tricare) who live in the US are eligible for this discount. The card is available on the manufacturer's website- ( link below), following the instructions on the site ( starting with the cost, savings and support tab on the left) and filling out the questionnaire to determine eligibility, the card with a unique ID can be printed. This card is taken to the pharmacy with the prescription ( or the information added to a patient's existing information there), and the refill, along with subsequent 30 day refills will be $10. The pharmacy has to be a participating member of the program to get this, but it looks as though the larger chain pharmacies are ( as was my little chain pharmacy) though the website also has a form that can be filled out and submitted by an eligible customer for direct reimbursement if their pharmacy does not participate in the program.
It's certainly been a worthwhile thing for me, I'm happy to pay $10 instead of the $110 I was paying for a 30 day supply of Eliquis. Just something to consider, for those who might be eligible.
Oops, as a new member, I can't post the link. But anyone interested can google the Bristol Meyers Squibb website, Eliquis savings, or something similar and find the information.

Jump to this post

You are not eligible if you have a Prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs.
You are not eligible if you are not covered by prescription drug insurance.
You are only eligible if you have Commercial prescription drug insurance through an employer-sponsored or private health plan or the Federal Employee Health Benefit Plan.

REPLY

For those bothered by the high cost of Eliquis, ( and who isn't?) here's some information I found immensely valuable to help with that cost.. The manufacturer ( Bristol Meyers Squibb) offers a coupon that can be used to pay for a 30 day supply of Eliquis for a copay of $10. The coupon can be used for a period of two years worth of refills ( or a $6600 limit, not sure how that is applied). Customers with private drug plan insurance ( not government insurance such as the Part D Medicare drug plans, Medicaid or Tricare) who live in the US are eligible for this discount. The card is available on the manufacturer's website- ( link below), following the instructions on the site ( starting with the cost, savings and support tab on the left) and filling out the questionnaire to determine eligibility, the card with a unique ID can be printed. This card is taken to the pharmacy with the prescription ( or the information added to a patient's existing information there), and the refill, along with subsequent 30 day refills will be $10. The pharmacy has to be a participating member of the program to get this, but it looks as though the larger chain pharmacies are ( as was my little chain pharmacy) though the website also has a form that can be filled out and submitted by an eligible customer for direct reimbursement if their pharmacy does not participate in the program.
It's certainly been a worthwhile thing for me, I'm happy to pay $10 instead of the $110 I was paying for a 30 day supply of Eliquis. Just something to consider, for those who might be eligible.
Oops, as a new member, I can't post the link. But anyone interested can google the Bristol Meyers Squibb website, Eliquis savings, or something similar and find the information.

REPLY
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