Eliquis, Pradaxa, and Savaysa Will Not Be Covered By Some 2022 Insurance Plans
Take Action NOW If You’re Faced with Switching or Paying 100% of the Cost
Dallas, December 13, 2021
- Summary: Some 2022 Insurance Plans Will No Longer Cover Eliquis, Pradaxa, and Savaysa—Here’s What You Can Do
- Reading time: 3–5 minutes.
UPDATE: CVS Caremark has reinstated Eliquis, as of July 1, 2022. Learn more here.
What is the problem?
We have become aware that CVS Caremark, the company that manages the prescription medications for many US health insurance plans, has decided to drop coverage for Eliquis, Pradaxa, and Savaysa from many of these plans in 2022.
This means that if you’re on one of these three anticoagulants (blood thinners), your choices are likely to be:
- Pay 100% of the cost of your anticoagulant next year, or
- Switch medication, choosing either Xarelto or warfarin, or
- Switch insurance plans (if that is even a choice)
This is called “non-medical switching.” That means that neither you nor your doctor asked for this change; the insurance company powers-that-be are forcing this change upon you.
Changing a medication you’re stable on may be detrimental to your health. Further, this could be especially problematic if your current medication is taken twice per day and the new one is taken once per day, or vice versa. This could cause an accidental overdose, putting you at risk of a bleed, or not getting sufficient medication, putting you at risk of a stroke.
At this time, it appears to be strictly CVS Caremark commercial plans that are affected. In addition, it seems that Medicare plans are not affected.
However, some Medicare insurance plans have been trying non-medical switching for a few years. We must stop this trend in both commercial and Medicare plans.
If you’re not affected this time, you could be next time. Please keep reading anyway, so you’re armed with what to do. Please especially see the section below on what everyone can do.
What are we doing?
We believe that everyone should have access to the medications they need. It is unconscionable for an insurance plan to drop most options and not grandfather in those who are stable on their existing medication to be able to continue on them, covered by the plan
StopAfib.org is one of 14 organizations working together to address this. The Partnership to Advance Cardiovascular Health (PACH) leads this effort with a multipronged approach. Together, we have been actively working on this through many different channels.
We’re encouraging CVS to grandfather those currently stable on these medications. To help with that, I reached out (via social media) to the afib community to find people directly affected by this change. Many replied and were willing to help, so I connected them with PACH. Unfortunately, all had received letters from CVS Caremark informing them that their anticoagulant will not be covered next year. Thus, they will need to pay the total cost or change to a different covered medication.
CVS seems to think this is “No Big Deal.” We believe it is a huge deal, and you shouldn’t have to change!
What can you do if you’re affected?
A few people may be affected who have not received letters to that effect. If you have not received a letter but are covered by a CVS Caremark commercial plan, you may not be in the clear. We encourage you to check your 2022 formulary (drug guide) to ensure your anticoagulant will be covered.
If you’re one of those whose anticoagulant is being dropped next year, you can start checking with your doctor now.
- Your doctor can apply to the drug plan for what is called a “Prior Authorization.” If approved, prior authorization can cover your medication as though it were still on the plan’s formulary. But, a Prior Authorization may not be easy, and it may be time-consuming. For example, it generally requires proving that you’ve tried and had problems with the medications currently on the plan. Or, you must prove that you have a specific medical reason that you cannot take the medications on the plan.
- Your doctor has likely been in touch with the drug company reps, or soon will be, and may know of things that could help you.
If your doctor doesn’t know of things to help, you can contact the drug companies directly to ask if they can help. Their patient sites generally provide ways to contact the companies. Look for words such as Support or Savings on the patient sites listed below.
What can everyone do?
This is just the start of a trend where we will see more and more non-medical switching. A few insurance plans have tried this in recent years, but this appears to be the most extensive effort so far at non-medical switching.
CVS Caremark is one of the Big Three “Pharmacy Benefits Managers” (PBMs). The others are watching to see if CVS gets away with it so they can try it, too.
We cannot let that happen, or we will all be forced to change medications that we are stable on. The PBMs have forced pharma companies to bid to see who gets their business. If we let them get away with limiting us through this tactic, that will be the end of doctor and patient autonomy.
Please help, even if this doesn’t affect you now. The next one just might.
Here are some things you can do:
- Sign the Change.org petition set up by PACH. Watch the video on the left side of the page and sign the petition on the right side.
- Share this information all over social media to help anyone affected by this. For example, here is a post you can use on social media:
When your health plan stops covering your stroke prevention medication (Eliquis, Pradaxa, or Savaysa), it IS a big deal. Join @stopafib in speaking out on non-medical switching. Learn more about what you can do. #NoBigDeal https://www.stopafib.org/afib-news-events/news/eliquis-pradaxa-and-savaysa-will-not-be-covered-by-some-2022-insurance-plans/
- Send denial or switch letters to PACH at [email protected]
- Submit personal stories to PACH at https://www.advancecardiohealth.org/no-big-deal#share or [email protected]
- Read “Medicare Part D Access Challenges A National Survey of Cardiovascular Patients & Health Care Providers.” This was done by PACH to understand the impact of such strategies that limit choice.
StopAfib.org was founded in 2007 by atrial fibrillation patients for afib patients. Its mission is to improve the quality of life for those living with afib and save lives by raising awareness and decreasing afib-related strokes. StopAfib.org is the top arrhythmia site and holds HON Code Certification from the Health on the Net Foundation, signifying a credible, trustworthy medical website. To learn more about the organization, visit www.StopAfib.org.