Price of two expensive drugs has cost Medicare Part D $46 billion since 2015

Photo: Jeff Lagasse/Healthcare Finance News

Eliquis and Xarelto, two blood-thinning medications that are already among Medicare's costliest, have seen their list prices more than double since entering the market, finds a new report by Patients for Affordable Drugs.

Both drugs promise less risk than warfarin, a blood thinner that is inexpensive but also carries a high risk of bleeding and requires frequent lab tests to monitor the bleeding risk.

Both Eliquis and Xarelto carried a price of more than $200 for a month's supply, a marked increase from the $10 for the cost of a month's supply of warfarin.

The sticker shock doesn't stop there, however. The prices of both drugs have risen every year, far outpacing the rate of inflation. As of January 2022, the prices of a month's supply of Eliquis and Xarelto are $529 and $516, respectively.

Eliquis was the fourth best-selling drug in the world in 2020, the report found, yet Americans pay five times more for it than patients in other countries. It was the costliest drug for all of Medicare in 2020, and that year, an estimated 2.6 million Medicare Part D beneficiaries took Eliquis.

Xarelto has shown a similar trajectory. In 2020 it was the world's 10th highest-selling drug, and the price is 10 times higher in the U.S. than in other countries. It was the third costliest drug for Medicare in 2020, with 1.1 million Medicare Part D beneficiaries taking it that year.

Since 2015, Medicare Part D has spent more than $46 billion on the two drugs, according to the report.

The report blames the price hikes on a number of different factors. One is shadow pricing – a practice in which a company mimics a competitor's price increases in order to maintain high prices, and of course, profits.

Secondly, there are no generic competitors on the market for either Eliquis or Xarelto, with manufacturers essentially allowed to dictate prices. Instead of competing for customers by undercutting each other's prices in an effort to gain market share, the companies have instead increased their prices in lockstep over the past decade. This tacit agreement, the report concluded, allows both companies to extract increasing amounts of profit without any meaningful changes to the drugs.

A third potential factor is the COVID-19 pandemic. In 2021, the National Institutes of Health found that treating certain COVID-19 patients with blood thinners improved outcomes. Both Eliquis and Xarelto have since been recommended as part of treatment guidelines for COVID-19.

Early in the pandemic, reports that Eliquis could prevent strokes in patients seriously ill with the virus prompted a spike in demand for the drug. Despite the public health implications and rising demand, Johnson and Johnson and Pfizer have both hiked the prices of Eliquis and Xarelto twice during the pandemic.

Blood thinners may become even more critical in the future due to emerging evidence that long COVID-19 patients are at an increased risk of blood clots.

WHAT'S THE IMPACT

The price hikes carry implications for consumers of the drugs. Many patients who are prescribed blood thinners are Medicare beneficiaries, who have a median income of $29,650. A recent report from the Department of Health and Human Services found that 3.5 million adults age 65 or older had difficulty affording medications, with the highest rates reported among Black and Latino adults. 

Many patients who struggle to pay for their blood thinner may be forced to switch to warfarin because it is more affordable than Eliquis and Xarelto, the report said. This switch puts them at higher risk of dangerous bleeding and necessitates burdensome, frequent lab tests.

Taxpayer-funded programs such as Medicare disproportionately shoulder the burden of the rising prices for medications, the report found. Price increases and a rising number of beneficiaries taking the medications have catapulted both drugs to the top of the list for the most costly medications for all of Medicare Part D. 

Since 2015, Medicare Part D has spent more than $46 billion on the two drugs. In 2020, Eliquis and Xarelto were the most costly and third-most costly drugs for the program, respectively. Medicare Part D's spending on Eliquis in 2020 was a record-breaking $9.9 billion.

THE LARGER TREND

While prescription medication prices are no longer the fastest-growing commodity or service, prescription drug costs have still increased 2.5% since the beginning of the COVID-19 pandemic, according to data from GoodRx published in February.

In 2021, the cost of car rentals, tobacco, beef, and moving expenses all outpaced the cost of prescription drugs. Yet drug prices have also historically grown faster than the rate of inflation: Since 2014, drug prices have increased 35%, while the cost of all items and services has increased 19%.

Prescription drug prices have also outpaced wages, gas, food, tuition, transportation, telephone and internet services, personal care, and new and used cars prices.

Linking the cost of prescription drugs in the U.S. to the prices paid in other high-income nations could have reduced American spending for the drugs by at least half in 2020, a RAND study found this past September.

Modeling a proposal that would cap U.S. prices at 120% of what is paid in six other nations, researchers found that such a move would have cut U.S. spending on insulins and 50 top brand-name drugs by 52% during 2020 – a savings of $83.5 billion. These savings are on top of already-lower U.S. "net" prices after rebates negotiated between drug companies and insurers.

According to HHS data, Americans pay more than $1,500 per person for prescription drugs, far higher than other comparable nations. Since prices for brand name drugs are rising faster than the rate of inflation, it has led many to not take their medications as prescribed due to their cost. HHS has identified lack of competition as a key driver of these rising drug costs.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com