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Why are Eliquis and Xarelto So Expensive?

October 19, 2020

high drug prices

According to researchers at Georgetown University, over 131 million Americans are taking at least one prescription medication — that's about 66% of the population, and doesn't include people taking over-the-counter (OTC) medications. Of these prescription drugs, antithrombotics (like Eliquis and Xarelto) are among the most commonly prescribed.

Of course, Americans are struggling with what seems to be a never-ending price increase in prescription medications, and given the number of people taking them, the effects of their exorbitant costs are far-reaching.

One of the most common questions we get from American consumers is how we're able to sell the exact same prescription drugs — even medications like Eliquis and Xarelto — for so much cheaper than our American competitors. The answer is rather simple, but the reasoning is rather complicated. Here's why drugs like Eliquis and Xarelto are so expensive in general, and outrageously expensive in the U.S.

Antithrombotics and Their Uses

First of all, it's important to understand why drugs like Eliquis and Xarelto are so highly sought after. In this case, they're applicable under many circumstances and are considered lifesaving, as blood clots can be deadly.

Because antithrombotics have multiple purposes, their prevalence in medicine cabinets should come as no surprise. Antithrombotics have been approved in cases of atrial fibrillation (AFib, or AF), venous thromboembolism (VTE), deep vein thrombosis (DVT), acute coronary syndrome (ACS), and in patients in need of extra protection from embolism after a mechanical valve replacement.

There are two types of antithrombotics: antiplatelet agents, such as aspirin, ticlopidine, and dipyridamole, and anticoagulants. The most common anticoagulants in the past have been warfarin and heparin. However, newer agents have been developed in the past couple decades that have proven to be just as effective (if not more effective) with fewer risks of bleeding and negative drug interactions.

An Increasing Number of People on Anticoagulants

While anticoagulants are useful in multiple health situations, and therefore, many people find them useful, it would appear as though their use is accelerating on a general level. An uptick in the number of people diagnosed with Afib was getting researchers' attention all the way back in 2007 — and based on more recent data, this trend hasn't taken a downturn.

A 2015 study of the use of direct oral anticoagulants (DOACs) found that their use "is rising rapidly and accounts for half of all anticoagulant use during atrial fibrillation office visits." Furthermore, researchers noted that "DOAC use is rising among venous thromboembolism office visits, largely replacing the use of warfarin. Our findings suggest that DOAC adoption is associated with an increase in the number of atrial fibrillation patients treated with anticoagulant therapy."

Even simple principles of economics would suggest that with higher demand, the price could be set higher than it would if demand were lower. With so many people needing antithrombotics — particularly ones that offer fewer risks than previously popular medications — it isn't surprising that pharmaceutical companies are taking advantage.

What Eliquis Costs in Canada vs. America

Released in 2014, Eliquis is the brand name of a drug that is used to prevent blood clots.. The active ingredient is apixaban, which first started making headlines after a study showed that it was more effective than aspirin at "preventing dangerous blood clots or strokes in people with the abnormal heart rhythm atrial fibrillation." It is often used as an alternative to warfarin.

In America, Eliquis presents a couple challenges. Consumers may have a hard time finding the generic that has been approved, since it's still very new. The FDA approved two applications in December 2019, so production and distribution are still the works. For the time being, patients buying in the USA will be forced to purchase the brand name medication, which costs about $297 for a 30-day supply, working out to be just under $10 per pill for the lowest dose (2.5mg).

By contrast, sells both the brand name and the generic. Brand name Eliquis is about $225 for a 56-day supply, which is about $4 per 2.5mg pill. The generic version is about $72 for a 30-day supply, coming out to about $2.40 per 2.5mg pill.

What Xarelto Costs in Canada vs. America

Xarelto is an anticoagulant first approved by the FDA in 2011 for use in patients recovering from knee or hip replacement surgery in order to prevent deep vein thrombosis (DVT) blood clots. Since then, it has been expanded to multiple other uses, all surrounding the prevention of blood clots, particularly after surgery, or to prevent heart episodes or stroke. There is no generic currently available for Xarelto.

In the United States, the lowest dose of Xarelto (2.5mg) costs about $296 for a 30-day supply, working out to be just under $10 per pill. sells Xarelto for a much more affordable price — about $112 for a 56-day supply, which is about $2.00 per pill.

Overpriced Antithrombotics in America

United States residents pay far more for prescription medications than anyone else in the world. The reason for this boils down to one simple difference: the United States government doesn't have restrictions on what pharmaceutical companies can charge for prescriptions sold within the U.S.

Most countries have regulations in place that limit the markup on prescription drugs. The entire purpose of this is to ensure the price stays within a more affordable range for the average resident. One could argue that this is a matter of priorities — countries like Canada are more concerned with making sure everyone has access to healthcare, where the United States is more concerned with making sure companies are profitable.

The theory of course, is that profitable companies will invest back into new products, their communities, and their employees. Whether or not pharmaceutical companies are doing this to a satisfactory degree is another matter, but they're certainly not hurting for cash. Pfizer — the largest pharmaceutical company in the world — pulled in more than $50 billion in revenue in 2019. The tenth largest pharmaceutical company in the world (AstraZeneca) made more than $23 billion in revenue.

One myth that Americans are sometimes sold as the reason for the extremely high prices of their drugs is that, by the act of other governments regulating their prices, pharmaceutical companies are unable to turn a profit in countries that restrict profit markup. While it's true that they won't be able to make such a significant profit in countries like Canada, they're certainly not losing money. If drug companies could not make money selling the same pharmaceuticals in places like Canada at lower prices, they simply wouldn't sell those products there at all.

The Role of Patent Law

It would be hard to believe that Governments are interested in limiting the price of prescriptions to a degree that the pharmaceutical companies will refuse to do business in their country. Doing so would negatively impact their citizens and eventually lead to turmoil from residents who need life-saving medications that are being withheld because of bureaucracy.

The Role of Patent Law

The other major consideration in the price of prescription drugs in the United States is in reference to patent law. Most drug patents hold an exclusivity period for about 20 years, which should allow drug companies enough time to make back their research and development costs (and then some).

However, many pharmaceutical companies make minor amendments to their products, whether that's a formula change or a delivery method change (think caplets to gelcaps), which can also be patented, thereby extending their patent period.

Of course, the purpose of this is to prevent generic drugs from entering the marketplace. Generic drugs are (almost) always more affordable than brand name drugs, and as a result, insurance companies favor them heavily. When a drug is prescribed for which there is a generic available — even if it's the brand name on the prescription — the generic is typically filled instead at the pharmacy. It's cheaper and it's preferred by nearly everyone, including patients because the copay for generic drugs is lower than brand name drugs.

Generic drugs can be priced lower because they don't have the same research and development hoops to jump through in order to get a drug approved. Essentially, they've already had a head start, and don't have as much work to do before the generic version is approved. Furthermore, much like with any other off-brand product, consumers aren't paying for the marketing of the brand name product.

The Effects of Expensive Anticoagulants

When medication is too expensive for patients to afford, they might choose to take a smaller dose than prescribed (such as cutting pills in half, taking only one pill instead of two, or skipping days of medication), or even skipping the medication altogether.

The lack of medication adherence is a significant problem for overall health. Medications are tested based on consistent dosage and how long the medication stays in a person's system. When the medication wears off (whether that be every 12 or 24 hours or some other frequency), a new dose must be administered in order for it to be effective. If someone is choosing to skip a dose at the 12-hour mark because they cannot afford it, the medication might not be effective from hours 12 to 24.

Under-administration of medication is almost akin to skipping it entirely. The estimated cost of medication nonadherence is as much as $300 billion dollars annually. This includes more serious health complications as a result of neglected medical care — something that could prove deadly for people on antithrombotics.

Consequences of Undertreatment

There are many negative health outcomes associated with undertreatment of AFib, DVT blood clots, VTEs, and ACSs. Choosing to forego treatment because of financial strain could — quite literally — have deadly consequences, if not as a direct result of the condition itself, then as a side effect of a poorly treated condition that can lead to other deadly health events.

AFib is one of the most common types of irregular heartbeat, also called an arrhythmia. This occurs when the heart's upper chambers and lower chambers aren't in sync, and therefore, beat too slowly, or too quickly, or in an irregular pattern. Aside from the possible complications this could create, AFib is sometimes linked to strokes.

According to the Centers for Disease Control and Prevention, "[w]hen standard stroke risk factors were accounted for, AFib was associated with a four- to fivefold increased risk of ischemic stroke." In general, it's believed that AFib is an underlying cause in about 1 in 7 strokes.

Furthermore, the strokes related to AFib are more serious in nature. The CDC states that "strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes."

DVT and VTE blood clots are dangerous in that they cut off blood flow, but what makes them deadly is when they break apart and travel in the body. One of the most dangerous ways in which these blood clots tend to manifest themselves is when they make their way to the lungs, in which case they're referred to as a pulmonary embolism (PE).

PE blood clots can not only damage your lungs, but they can decrease the oxygen levels in your blood, which can cause damage to other vital organs as well. PE blood clots are not always fatal, but they certainly can be if the clot is big enough, or is located in a major artery in the lungs.

And of course, the most well-known negative health outcome is via acute coronary syndromes (ACSs), which is a broad term used to describe interruptions in blood flow to the heart, including heart attacks (myocardial infarction).

As with most other health diagnoses, the more serious it is, the more expensive it is to treat. Taking a daily medication to prevent blood clots is far less expensive than a hospital stay for a heart attack or stroke, and the subsequent rehabilitation and possible in-home health aids to assist in your recovery.

Looking Abroad for Expensive Medications

Americans who are struggling to pay for their prescriptions at U.S. pharmacies can look to international online pharmacies for hope and necessary access to more affordable drugs. U.S. residents have been doing this for many years, if not decades. More recently, the CBC reported that Canadian pharmacists have noticed a "quiet resurgence" in Americans crossing the border for medication. As if that wasn't good enough news, the best news is that you can order your medication from the privacy of your own home.

Not only can you get the medication you need, can ship it directly to your front door. If you need assistance with your order — or have any questions at all — our customer service representatives are always available to help. They'll walk you through the entire process from start to finish.

Navigating prescription drug costs is almost always stressful and overwhelming. At, our goal is to help you save money on your prescription medications. For more information, you can call us toll free at 1-866-539-5330 or contact us online.

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