FOR MEDICARE PART D SENIORS

ALERT: Eliquis is moving to Tier 4 on many Part D plans. This basically means is your plan will pay for only 50% of the cost of Eliquis AFTER you have met your $505 dollar deductible.
Check your plan to see if you are affected like this.
ON most plans, Xarelto is Tier 3. That is a big difference in money.
Now I said 50% but that is just a close figure. This has happened before.
If you are on Medicare Prescription drug plan, check out your plan.
It is so crazy how greedy these 🤬are.
Cutting 20 mg of Xarelto in half is almost impossible because of it’s shape.

This is into the weeds, as I am Canadian and not (yet) affected, but what is the shape of the Xarelto? Most pills, except maybe the teensiest, can be scored and then split with a pill splitter. True, it's a pain where the sun don't shine, but.....if you have to, you have to. I have a hobby Optivisor (that brand name) that is very useful in my hobby, but also in the garden examining the undersides of leaves to look for mites and tiny aphids. I use it in the winter to pluck fir splinters out of my hands after getting firewood. Pretty sure you can use it, with a hobby knife or sharp paring knife, to score and to split a pill if it must be split.

You can also crush it and then split it. Pretty easy to eyeball half of a small pile of powder, or you can get a lab scale if you really want precision.

Quote
smackman
ALERT: Eliquis is moving to Tier 4 on many Part D plans. This basically means is your plan will pay for only 50% of the cost of Eliquis AFTER you have met your $505 dollar deductible.
Check your plan to see if you are affected like this.
ON most plans, Xarelto is Tier 3. That is a big difference in money.
Now I said 50% but that is just a close figure. This has happened before.
If you are on Medicare Prescription drug plan, check out your plan.
It is so crazy how greedy these 🤬are.
Cutting 20 mg of Xarelto in half is almost impossible because of it’s shape.

Lookup a picture of 20 mg of Xarelto. It sorta looks like a mountain.

I can only believe that shape was chosen specifically to thwart splitting. Pill identifier tools like this one don't even have a choice for that shape. They can't claim it was to make the pill identifiable because that could be done with a simple imprint, so why else make it an unusual shape like that?

I use a single edge razor blade on a cutting board as well as a 0.001 g scale to microdose prednisolone (1/7 of a 5 g pill) for my cat & 10mg of flec out of a 100 mg pill for myself. What I do is weigh a full pill, then compute what the weight of the dose I want is. For example, from memory, my 100 mg Tambocor (branded flecainide) weighs 270 mg. Hence I want 27 mg weight for my 10 mg doses. If you are cutting in half, this is much easier than what I'm doing, cutting into 10 parts. So I eyeball a 27 mg dose. Say I get a 15 mg sliver. I then will eyeball a 12 mg sliver and put it in the tray on the scale as well. I'm not concerned about being over or under a bit.

This is the scale I use and it works pretty well. Sometimes on really small weights (like 5 mg), it takes a moment to register. But for the money, I'm satisfied. [smile.amazon.com] Others have suggested for these mg amounts to not have the scale around vibration - like in the kitchen when the fridge is running. I do mine in my basement, which is slab on grade.

I use a small piece of cardboard (separate ones for me and the cat so the meds don't mix) as my cutting board so I can just pick it up and push the sliver or tiny pieces with the blade.

I use a pill holder to put just these doses in, so there can be multiple pieces - I don't put any others in and I'll do a week or two at a time.



Edited 2 time(s). Last edit at 10/07/2022 09:03PM by GeorgeN.

I use this. It’s perfect. Align the pill exactly in half where the letter is. I can also quarter my drugs.

[www.amazon.com]

Quote
susan.d
I use this. It’s perfect. Align the pill exactly in half where the letter is. I can also quarter my drugs.

[www.amazon.com]

Have you halved a 20 mg Xarelto? Look at a picture of one if you have not. If you have, did you have success? This is a Pricey pill cutter so I need more input before I purchase one that price.

I use Eliquis so I don’t know. They have a free return policy so if you don’t like it, return it within 30 days.

I looked at the 20mg Xarelto photo. Yes odd shape. Get your dr to write a rx for 10mg twice a day instead of 20mg once a day. The 10mg is round.



Edited 1 time(s). Last edit at 10/08/2022 03:45PM by susan.d.

The cutter I use has a couple of approximating dams that start wide and then constrain whatever is between them by getting smaller. The lid contains a razor embedded to halve and then to quarter the pill.

Mine looks a lot like this, except the plastic is clear amber:

[www.amazon.ca]

I had that one. The razor wore out.

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susan.d
I use Eliquis so I don’t know. They have a free return policy so if you don’t like it, return it within 30 days.

I looked at the 20mg Xarelto photo. Yes odd shape. Get your dr to write a rx for 10mg twice a day instead of 20mg once a day. The 10mg is round.

That does not help. Twice the amount will double the cost and it probably would not be approved.

Quote
smackman

I use Eliquis so I don’t know. They have a free return policy so if you don’t like it, return it within 30 days.

I looked at the 20mg Xarelto photo. Yes odd shape. Get your dr to write a rx for 10mg twice a day instead of 20mg once a day. The 10mg is round.

That does not help. Twice the amount will double the cost and it probably would not be approved.

I have a retirement drug insurance. It’s different. 30 days supply is the same cost as 90. 5mg is the same price as 20 (Crestor as an example). I pay one $12 co pay for generic/$30 brand and there is no yearly deduction. It’s an union benefit.

Why wouldn’t it be approved?



Edited 1 time(s). Last edit at 10/11/2022 04:06PM by susan.d.

It wouldn't be approved if it's not a standard dosage and twice daily isn't. The only dosages approved for afib are once daily.

And you have a rather magical Plan D if a 30-day supply costs the same as a 90-day supply and it allows you to switch dosages from the dosage the prescription calls for.

Since you stop Xarelto 2 days prior to most surgeries, I figure your blood is suffiently thinned one day after taking a pill. So I skip a day ( or two) a week. Makes Xeralto last longer with same effectiveness.

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LoisA
Since you stop Xarelto 2 days prior to most surgeries, I figure your blood is suffiently thinned one day after taking a pill. So I skip a day ( or two) a week. Makes Xeralto last longer with same effectiveness.

I think for someone like me who has had his LAA isolated AND told by Dr. Natale not to stop blood thinner, that is playing with fire. I am catching Hell trying to get a Colonoscopy without stopping blood thinner or aspirin. Aspirin is 81 mg and for a heart stent.
I will not play with my life.

It's also playing with fire if your CHADS-Vasc score is high. Xarelto has a half-life of only 5-9 hours, so after 24 hours you could be below 6% effectiveness.

And yeah, anyone who's had their LAA isolated and didn't get passing grades from a subsequent TEE should never skip a dose, not even one.

Surgeons are the worst about refusing to be educated about the LAA, insisting on stopping anticoagulants, and refusing to use heparin bridging for such patients. Their stubbornness and arrogance is mind boggling. I can't count how many times I've heard of people running into this dilemma with their surgeon simply refusing to cooperate with their EP to coordinate treatment. This was one of my reasons for wanting a Watchman. My LAA is fully isolated and I had grossly inadequate flow velocity afterwards, so I was in the boat of never being able to miss a single dose. Given that I could live another 30 years, what are the odds I won't need to stop Eliquis during that time? The answer is a big fat zero. But thanks to the Watchman, I can now safely stop Eliquis any time I want.

Some of the pharma companies are playing games with their prices. Medicare's part D plan finder told me my insurance won't cover name brand Cardizem, so I would have to pay $40,000 cash annually for the pills if I wanted them. This is for something that has had generic equivalents for awhile now. Their meds are only for the very rich. Common people are left in the lurch.

Why would you pay for brand name Cardizem and where did they get that $40K figure? The highest dosage of brand name Cardizem can be had for about $14K per year paying out of pocket. Generics can be had for about $360 per year, usually paid mostly or entirely by insurance.

That number was provided by Medicare Part D plan selector. I don't know where they got it. 14K is still steep.

When I was having a time of it finding Sun brand generic, I explored the possibility of name brand. I was on that for awhile and did okay.

Insurance only seems to want to pay for Ingenus brand, which didn't work out so well in the past. So I have just been paying cash for Sun brand. I have had to keep switching pharmacies though, since they don't always carry it.



Edited 2 time(s). Last edit at 10/10/2022 02:10AM by Michael777.

Quote
susan.d


I use Eliquis so I don’t know. They have a free return policy so if you don’t like it, return it within 30 days.

I looked at the 20mg Xarelto photo. Yes odd shape. Get your dr to write a rx for 10mg twice a day instead of 20mg once a day. The 10mg is round.

That does not help. Twice the amount will double the cost and it probably would not be approved.

I have a retirement drug insurance. It’s different. 30 days supply is the same cost as 90. 5mg is the same price as 20 (Crestor as an example). I pay one $12 co pay for generic/$30 brand and there is no yearly deduction. You must use Medicare drug plan.

Why wouldn’t it be approved?

Could you PLEASE give me the name of this awesome Part D drug plan you have? I have Never seen coverage like this. I would love to apply for this plan this year.
😊
You must be on a company retirement drug plan and using Eliquis “savings card”.



Edited 1 time(s). Last edit at 10/10/2022 01:33PM by smackman.

Update on Medicare Part D plan finder price on Cardizem 360. The new full retail price listed by the plan finder is $2724.12 annually. Much improved compared to the previous year's number. Its now barely affordable if I have to pay cash for name brand because of complicated procedures for finding pharmacies carrying Sun brand Cardizem generic.

OptumRx. It is part of our union Rx benefit plan that you may not be able to get since it’s not included in your retirement package.
[www.optumrx.com]



Edited 2 time(s). Last edit at 10/11/2022 04:05PM by susan.d.