Warfarin Alternatives: Are Eliquis and Xarelto Worth the Cost?

Katie Mui
Katie Mui is on the Research Team at GoodRx.
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Eliquis (apixaban) and Xarelto (rivaroxaban) are part of a new group of anticoagulant drugs called NOACs (novel oral anticoagulants) used to prevent blood clots, stroke and embolism, especially in people with atrial fibrillation. Approved by the FDA several years ago, Eliquis and Xarelto quickly became two of the most popular blood thinners on the market.

Before these drugs, people mostly relied on warfarin (Coumadin) which came to market 64 years ago. Warfarin is still the most prescribed anticoagulant today, but NOACs as a whole have been quickly gaining ground. With several warfarin alternatives to choose from, patients and their physicians can now compare factors like cost, side effects and hassle to decide which one is best for them.

 

 

How much do these anticoagulants cost?

NOACs, being relatively new drugs, are only available as brand-name and are therefore expensive. The average retail price of either Eliquis or Xarelto is around $520 for a monthly supply. For people enrolled in Medicare Part D, Eliquis and Xarelto prices are generally over $400 per month. Warfarin, which is a generic, only costs $18 out of pocket. This might explain why warfarin is still the most popular anticoagulant despite being a hassle to take, which we’ll talk about next.

Drug name Average retail price Lowest GoodRx price
warfarin $18.26 $4.00
Eliquis $522.36 $424.65
Xarelto $521.76 $424.69

 

Will there be a generic version of Eliquis or Xarelto anytime soon?

The earliest an Eliquis generic alternative could be approved by the FDA is 2018, but it may take as long as 2022 or beyond. The patent for Xarelto will expire in 2021, after which, the generic version, rivaroxaban, may become available.

Are Eliquis and Xarelto worth their price tag?

Warfarin treatment requires regular blood work to make sure the dosage is correct, and how much needs to be taken depends on diet, exercise and alcohol use. These are not requirements when taking NOACs, and for the most part, patients see this as a positive. It’s probably the main reason why many are willing to make the switch from warfarin.

To see how Eliquis and Xarelto fare against warfarin in terms of value and effectiveness, we took a look at survey responses collected by our partner website, Iodine.com. Iodine tells you what to expect from medications by combining real-life experience from thousands of people and expert guidance from pharmacists and the FDA.

Drug name Worth it Worked well Big hassle
warfarin 61% 54% 21%
Eliquis 47% 58% 21%
Xarelto 45% 45% 9%

 

A little bit about the scores above: People taking or who have taken the medication are asked to rate their experience with it, or how worth it the medication is, taking upsides and downsides into consideration. They are also asked to rate how well they think the medication works (effectiveness) and how much of a hassle it is.

Although 21% of people who’ve taken warfarin thought it was a big hassle, more than half thought the benefits of the medication made up for it overall. Eliquis and Xarelto have similar worth it scores, but Xarelto seems to be less of a hassle. All three treatments scored close together when it came to how effective people thought they were, but even then, only one out of two people thought they worked well as a group.

It’s worth noting that all anticoagulants carry the risk of bleeding-related side effects such as unexpected nosebleeds, bruising, blue or purple toes, and even internal bleeding (with signs like dark urine or bloody stools). People taking Eliquis and Xarelto are also more likely to feel nauseous or have an upset stomach.

 

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What are people are saying about their anticoagulants?

Digging into Iodine’s user tips for the three medications gives us an idea of what people really think about their anticoagulants:

This 69-year-old man thinks warfarin was somewhat of a hassle: “If you’re taking Coumadin (warfarin), find an anticoagulant clinic to help you through the process. It’ll be worth every mile you have to drive to get there versus taking the newer drugs, such as Xarelto.”

A 67-year-old woman is a champion for blood monitoring on warfarin: “For anyone whining about ‘inconvenience’—Warfarin is the only anticoagulant that can be tested (at a lab, hospital, or home), so you and your doctor know exactly where your coagulation status is. I always know right where I am, and if I am at serious risk for either a clot OR a bleed.”

On the flip side, here’s a 65-year-old woman who loves the freedom of Eliquis: “My body stopped reacting properly to Coumadin so I was switched to Eliquis. So nice. No monthly blood draws, less bleeding when I get a cut. I can eat my favorite greens to my heart’s content. With insurance, only $10 a month—the Eliquis, not the greens!”

This 75-year-old man taking Eliquis does not think it’s worth it due to side effects and cost: “Much too expensive and with Medicare, users will reach ‘donut hole’ costs. Bleeding from small wounds and bruising are excessive.”

A 73-year-old man likes the low hassle of Xarelto, and luckily has it covered by Medicare: “Works well for me, saves many trips to control Coumadin which I used before. I think it is safe, my doctors say it is. Is not cheap but Medicare covers it with $33 copay (per month).”

 

 

So which anticoagulant is best for me?

It depends. If price is the main deciding factor, your doctor will probably start you off on warfarin. If you find the regular blood monitoring, changes in diet or unwanted side effects hard to deal with, you may want to switch to another anticoagulant.

Ask your doctor about warfarin versus NOACs, and always check your health insurance plan to see which medications are covered and what they cost. NOACs like Eliquis (apixaban), Xarelto (rivaroxaban), Pradaxa (dabigatran) and Savaysa (edoxaban) are all only available as brand-name medications but could be covered by your insurance.

For more information on anticoagulants and warfarin alternatives, compare warfarin, Eliquis and Xarelto on Iodine.com.

 

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