I have had atrial fibrillation, or an irregular heartbeat, for at least 20 years. It doesn’t bother me and hurt like some other cases I’ve known.

But the irregular blood flow can easily coagulate, get stuck in your veins somewhere and cause a stroke.

I have taken medicine to thin my blood and reduce clotting ever since I developed atrial fib. The pills were Coumadin (warfarin) and required taking blood samples on a regular basis. Any anomalies required a change in dosage.

Before this, my doctor in Massachusetts put me in the hospital for a day so I could get the electric heart “paddles,” which are administered to bring the heart rhythm back into sync. They worked, but only for a few days before an irregular pulse returned.

Two years ago last fall, I returned home from a Pinecrest football game, got out of my car and fell on the cement floor of our garage. My balance had been unsteady earlier in the evening. I began to have terrible headaches and decided in was time for the emergency room at FirstHealth Moore Regional. I had suffered a cerebral hemorrhage, as a tiny spot of blood showed up on the MRI. I was diagnosed with a stroke.

I was extremely lucky, since the only thing the stroke left with me was a balance issue. Doctors concluded that the problem was created by Coumadin, the purpose of which was to prevent strokes. I was taken off Coumadin for about five months.

So I was left at risk without the Coumadin. Like a double-edged sword, blood thinners are supposed to prevent strokes but can also produce them. Weird. But I resumed the dosages and felt OK until last December, when I was admitted to the hospital because of unstoppable nosebleeds. Again, I was taken off Coumadin.

Not wanting me to be at further risk again with blood clotting and the possibility of another stroke, my doctor put me on a new blood thinner called Xarelto.

I learned that if you have atrial fibrillation and are taking Coumadin, your risk of having a stroke is about 1.6 percent per year. New blood thinners Pradaxa, Xarelto and Eliquis don’t improve this number very much. The new blood thinners do not require you to monitor your blood coagulation. And they have very few interactions — as opposed to Coumadin, which interacts with hundreds of medications.

Imagine my shock at the pharmacy today when they told me my insurance didn’t cover Xarelto because of the high cost of that medicine. I was further stunned learning that my 30-day prescription cost $281, or $9.37 per pill!

The pharmacy is going back to my doctor to get him to contact the insurance company and with limited assurance tells me that the drug will be paid for by the insurance people eventually.

New drug costs are high because of the process, which involves identifying the basis of disease; finding a target; and assessing the drug in animals to make sure that it’s effective in a model of the human disease and that there are no side effects. Somewhere between one in 10 and one in 100 projects successfully pass these tests and can move from this stage to three phases of clinical trials

The total cost of that process for one drug is estimated to fall between $500 million and $1.2 billion. The chances that a drug will fail at any of the stages of development are enormous. To take, or not take, a blood thinner — either way seems like living on the edge.

(2) comments

Mark Hayes

Now just how would this work for those who now are on such low cost programs created by ACA, where and who will be responsible to make up a difference, the drug company certainly could not be responsible, they are in business to make money, your insurer who will ultimately be forced to eat the cost, or will it be you paying for those pills, really just asking and would like to know how this all works out, just how will these health insurance carriers be able to withstand many of these high cost drugs prescribed by Doctors, especially when there is not a generic in the market place. Long term coverage for those with problems that require the taking of high cost prescriptions eventually will have a very expensive impact on these companies, forcing many out of the healthcare insurance business. Your article is very thought provoking and should bring awareness to the question of "how" will these companies prevail.

Andy ThomasJhDQR

The insurance company finally accepted my Xarelto prescription

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