Generic DOACs in AFib: What Lower Costs Could Mean for Patients

"Generic DOACs in AFib: What Lower Costs Could Mean for Patients" addresses how an evolving generic market could affect patients and prescribers.

Dr. Barnes observes that clinicians have gained a great deal of experience over the last 15 years in discussing anticoagulant costs with patients, because cost is a burden for many. He says the field is excited about generic DOACs. The hope is that they will lower costs and ease one of the main barriers to adherence and continued therapy.

Rivaroxaban was the first DOAC to become available as a generic in the United States. However, only the smallest dose, 2.5 milligrams, has been released. As a result, no generic exists yet at an atrial fibrillation dose. Dr. Barnes hopes that will arrive soon, and he believes it will change the landscape.

He then turns to apixaban, which is the anticoagulant most commonly used for stroke prevention in atrial fibrillation in the United States. It is not yet generic. He anticipates a generic version within the next couple of years. He calls that potentially a game changer, since it could remove cost as a major obstacle to patients accessing their medications, taking them as prescribed, and staying on them long term.

Dr. Barnes emphasizes that cost is a constant topic in his conversations with patients. He and his colleagues are always working through different strategies to make sure they do whatever is possible to prevent a cardioembolic stroke.

His comments connect directly to the adherence and discontinuation problems described earlier. If lower-priced generics reduce the number of patients who skip doses or stop therapy because of expense, more patients would stay protected. Until atrial fibrillation-dose generics arrive, however, clinicians continue to rely on individual cost strategies for each patient. Dr. Barnes remains optimistic but measured about the timing.

In "Navigating Formularies and Coverage for AFib Anticoagulant Therapy," Dr. Barnes will discuss how formularies and insurers influence which drug a patient receives.