The Blood Thinner Costing Utah Medicare $110 Million a Year

Somewhere in the Utah Medicare Part D billing records for 2023, there's a number that stops you cold. One drug, not the most prescribed, not one most people could name, cost the system $110.9 million in a single year.

The drug is Apixaban, sold under the brand name Eliquis. If you or someone in your family is over 65 and has been diagnosed with atrial fibrillation (AFib), there's a reasonable chance it's already in the medicine cabinet.

Here's why that number matters, and what it might mean for your wallet.

What is Apixaban, and why do so many seniors take it?

Apixaban is a blood thinner. Its main job is reducing the risk of stroke in people who have AFib, a heart rhythm condition where the upper chambers of the heart beat irregularly. AFib is one of the most common heart conditions in people over 65. The older you get, the higher your odds. By age 80, roughly one in ten people has it.

The problem with AFib isn't just the irregular heartbeat. It's that blood can pool in the heart and form clots. Those clots can travel to the brain and cause a stroke. Blood thinners like Apixaban disrupt that process.

So it's genuinely useful medication for a lot of older adults. The question isn't whether it works, it's whether you know what you're paying for it.

The cost gap is hard to ignore

Atorvastatin, the cholesterol drug that's Utah's single most prescribed medication, costs about $14 per prescription on average. Apixaban costs $926. That's not a typo. It's the same category of drug (prescription, taken daily, managed by a primary care doctor), but the price difference is roughly 65x.

Apixaban's high cost comes down to the fact that it's still under patent protection in the U.S. There are older blood thinners that work similarly, Warfarin being the most common. Warfarin costs almost nothing. The reason doctors moved to newer drugs like Apixaban is that Warfarin requires monthly blood tests to manage the dosage safely, while Apixaban doesn't. For patients who travel, or who live an hour from a lab, that matters.

What this means for your Part D plan

If you're on Apixaban, your Part D plan tier placement determines how much of that $926 comes out of your pocket each prescription. Most plans put it on Tier 3 or Tier 4, the higher tiers, which means higher cost-sharing for you.

Starting in 2025, Medicare's $2,000 out-of-pocket cap on Part D gives some relief. But you can still hit that cap faster than you'd expect if Apixaban is one of your regular medications. People living in rural parts of Utah, places like Richfield, Roosevelt, or Price, face the same drug costs as someone in Salt Lake City, but often have fewer plan options to choose from during open enrollment.

Questions worth asking before your next enrollment period

If you're already taking Apixaban, ask your doctor whether the clinical reason you started is still the same. Treatment needs change. Some people start on Apixaban after a procedure and stay on it longer than necessary. Others might be candidates for a different approach entirely, that's a conversation worth having, not an assumption to make.

If you're approaching 65 and have a history of AFib or other clotting conditions, check where Apixaban falls on your specific plan's formulary before you enroll. Not all plans cover it the same way. Some put it on a preferred tier; others don't.

The $110.9 million Utah figure isn't a scandal. In many cases, Apixaban is the right drug for the right person. But when a single medication costs Medicare more than the next two biggest drugs combined, it's worth understanding why, especially if it's in your medicine cabinet.

Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. Utah state-level data.