Expenses (US) for coumadin/warfarin... what should I expect?

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cuoricino

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I'm currently living in Italy, and looking at AVR #2 sometime this month. I have a tissue valve now which will be replaced with a mechanical valve. I'm 36 so I expect to have a lot of life in front of me and my family and I tend to be quite nomadic. Since 2003 I've spent about equal time living between Italy and the US in 6-7 year chunks, and I travel often - sometimes for months at a time. (Needless to say, coumadin dosing and testing while keeping up with any semblance of this treasured lifestyle is really daunting me.)

I feel fortunate to have found myself back in Italy for AVR #2 not only because my first surgery was here, and they have excellent cardiothoracic surgeons, but also because of how the health system is set up. Health care is "free" (yes, I know I pay taxes for it), and patients normally just pay a small standard fee for specialist appointments and exams (usually around €30). Medications are usually very affordable as well. But, all of my heart stuff is fully covered simply by being a tax-paying resident with a pre-existing condition. This includes no fee for appointments, surgery, etc, as well as some medications if they fall under my pre-existing condition, and I believe coumadin is covered.

This is a far cry from how the US health system is set up. So, I'm curious: if we end up moving back to the US one day -- what are expenses like to keep up with anti-coagulation? I imagine if we do move back there will be a brief transition period where we find ourselves without good, employer-sponsored insurance. Would you mind sharing your experiences with costs (with and without insurance?)

If there have already been threads about this, please drop a link! I didn't have much luck finding anything. Grazie!
 

pellicle

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Hi

Firstly I'm Australian, but have lived in the EU a fair bit (Finland) I have visited the USA, but have no desire to live there. I only noticed the paragraph seeking US experiences as I'd already started this reply, so apology for that.

Anyway my views on warfarin management are well summarised on my blog post here: Managing my INR (some practical tips observations and theories)

If you travel often you'll totally need to be self testing, and preferably self managing.
Even as an Australian living in FInland I could just go and buy Warfarin (Marevan) and pay 12Euro for 100 pills of (say) 5mg.
The experience you have in the USA may not be as supportive of this (depending on your insurance) as it is in Europe. My view is that even out of pocket you'll find the actual drugs (Warfarin) cheap, and even if you just buy them on prescriptions from your European Doctor (or find a good one in the USA) it will be pretty low cost. I suggest that you remain brand loyal because there is significant evidence that some people respond badly to generics (meaning INR management is fraught).

I know there are a couple of uninsured warfarin users here, but depending it may take some time for them to see this and reply.

Best Wishes.
 

LoveMyBraveHeart

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We are insured and my Fiance is on warfarin. Our insurance only dispenses 60 days of warfarin at a time, and that amount totals about $1.60 for each strength (he gets both 2.5mg and 5mg pills). So about 3-6$ every couple months depending on any dosage changes. Warfarin is very inexpensive for us, unsure about brand name Coumadin...we've never gotten brand name before. As far as meters and strips go, our particular clinic hasn't started the home testing program, so we pay for testing strips out of pocket currently. They run about 5$ per strip, which is pretty spendy for some folks (us being in that group, we are trying to get married and buy a house, so testing weekly at $5-7 per test adds up quickly). Our meter was gifted to us, used. New meters can be found on Ebay for a pretty penny.

I hope this was at least a little bit helpful!
 

johnmarkos

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I’m looking over my recently filled prescriptions: it looks like I paid a $5.00 co-pay, and my insurance saved me $15-$22. So the total cost without insurance would be $20-30 US. This is for 30 doses of generic Warfarin in various dosages, because things are still getting sorted out for me.
 

DachsieMom

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I used to pay $10 for 90 day supply, but now it is covered at no charge. You may be able to get it at Walmart on their $4 per month plan without insurance.
 

ForeverThankful

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I'm in the US. When I buy it without insurance I pay $10 for 90 pills. I buy three sizes, 1mg, 4mg and 5mg. The interesting thing is that the price is the same no matter what strength I buy. I expected the 5mg to cost a little more than the 1mg but they don't.
 

vitdoc

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Warfarin is cheap. The cost of self testing is around $4-5/test plus the cost of the meter. You do need a prescription to get Warfarin but that usually is good for at least a year. So you won’t go broke dealing with anti coagulation.
 

tom in MO

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...So, I'm curious: if we end up moving back to the US one day -- what are expenses like to keep up with anti-coagulation? I imagine if we do move back there will be a brief transition period where we find ourselves without good, employer-sponsored insurance. Would you mind sharing your experiences with costs (with and without insurance?)

If there have already been threads about this, please drop a link! I didn't have much luck finding anything. Grazie!
My costs for warfarin are <$5 for a 30 day supply. My meter is free, 12 strips cost ~$350 through insurance until my copay is satisfied, then ~$50. Many here buy strips on-line, that could be an option for you. Insurance is available through the Affordable Care Act to anyone irrespective of employment.

I work with a charity funding group called United Way. One group we fund that helps immigrants saw a drop of migrants from 200 pre-Trump to 80 this year. Trump will probably get re-elected, so anticipate more restrictions on immigration until he's out of office in 2025. If you want to come to the US, sooner rather than later may be a good idea.

Also if you have a job lined up ahead of time, your employer can help with immigration. For example, in 2018 my son was hired to start an Italian restaurant, but after the place was up, running and making money, the owners imported an Italian chef for "star power" and fired him. I think the way it's facilitated is you come in on a 3-month work visa that then is extended.
 

Protimenow

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$350 for 12 strips? Is that right? You can get a box of 48 CoaguChek XS strips for less than that, and, if you're using Coag-Sense, you can get 50 for about $250 - if you don't shop for a better price.

If you're actually paying THAT MUCH for the strips, think closely about dropping that service and doing it out of pocket. This sounds WAY TOO HIGH.
 

Superman

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$10 cash for 90 days here in Michigan as well.

Self testing varies widely depending on insurance and service you use.
I pay about $12 a month out of pocket. The rest is billed to insurance and covers the use of the machine and the cost of the strips. Actually pay less than I did for labs because, for whatever reason, my deductible doesn’t apply. I’m covered from day one of the new benefit year.
 

Superman

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$350 for 12 strips? Is that right? You can get a box of 48 CoaguChek XS strips for less than that, and, if you're using Coag-Sense, you can get 50 for about $250 - if you don't shop for a better price.

If you're actually paying THAT MUCH for the strips, think closely about dropping that service and doing it out of pocket. This sounds WAY TOO HIGH.
Their meter isn’t free. The $350 monthly covers the use of the meter, provision of all supplies (strips and lancets), and the reporting service, where you submit results, and they communicate with the doctors office. Same type of deal I have except my coverage is a bit better.
 

Protimenow

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So - Superman -- you pay $12 a month out of pocket, and your insurance is hit for the other $338? This is for a meter that retails for, maybe, $1000, and for strips that they probably get in volume for a couple dollars each.

Yes, $12 a month is less than you'd pay for strips if you tested weekly. ($50 a month, if your earlier message is right - is more than the cost of the strips and lancets). $4200 a year, billed to your insurance carrier, is another matter entirely. No wonder medical insurance is so expensive - and the testing services have a strong bottom line, with nice bonuses at year's end to the executives who arranged this drug deal.
 

cuoricino

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Wow, thanks for all the insight. It looks like there's a lot of variation and it's hard to tell what actual out-of-pocket costs might be sans insurance. I'm from the US and was on Medi-Cal when I took some time off work in 2018, so I know that's an option before I can get on an employer-sponsored plan (unless the current administration continues to tear the ACA apart...) Either way, sounds like the cost is much lower than I was expecting. Hurray! I'm a little surprised the test strips cost so much, but seems to be doable. I appreciate everyone's responses. Grazie
 

Superman

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Wow, thanks for all the insight. It looks like there's a lot of variation and it's hard to tell what actual out-of-pocket costs might be sans insurance. I'm from the US and was on Medi-Cal when I took some time off work in 2018, so I know that's an option before I can get on an employer-sponsored plan (unless the current administration continues to tear the ACA apart...) Either way, sounds like the cost is much lower than I was expecting. Hurray! I'm a little surprised the test strips cost so much, but seems to be doable. I appreciate everyone's responses. Grazie
Not to get too political, but keep in mind, regardless of what happens with the ACA, it has nothing to do with cost. It strictly deals with who’s paying for it and when. Shuffling deck chairs on the titanic.

Regarding overpaying for the service, protimenow, I agree. I’m afraid it’s fear of liability that drives the current set up. Cardiologist requires the Coumadin Clinic monitoring or he’ll kill me (I mean won’t write a prescription). Coumadin Clinic and insurance require “professional monitoring” because I’m stupid.
 

Superman

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I
as much as I do love Tom Waits I believe its Dr Demento.

I can’t tell the date that it’s from, other than MTV was around in the 80’s. Tom said it on the talk show, “America Tonight” back in the 1970’s. Of course, MTV could be playing something older. Guessing it’s an old expression going back to the beginning of lobotomy’s.
 
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