Cost Is One of the Biggest Barriers to Pradaxa Adherence

You prescribe Pradaxa (Dabigatran Etexilate) because it works. It reduces stroke risk in atrial fibrillation, treats DVT and PE effectively, and offers real advantages over Warfarin — no routine INR monitoring, no dietary restrictions, and a dedicated reversal agent (Praxbind) for emergencies.

But none of that matters if your patient can't afford to fill the prescription.

Anticoagulant non-adherence is a well-documented problem, and cost is consistently cited as a leading cause. Patients who skip doses, stretch supply, or abandon prescriptions entirely face increased risk of stroke, systemic embolism, and venous thromboembolism recurrence — outcomes that are far more expensive (and dangerous) than the medication itself.

This guide gives you practical tools to help your patients access Pradaxa at a price they can manage. Whether they're commercially insured, on Medicare, or uninsured, there are options available.

What Your Patients Are Paying

Understanding the current cost landscape helps you have informed conversations:

• Brand Pradaxa (cash price): $394–$530/month for 60 capsules of 150 mg
• Generic Dabigatran (retail, no discount): ~$394/month
• Generic Dabigatran (with discount card): $45–$200/month, depending on pharmacy and card used
• Insurance copay (generic): Typically Tier 2–3 ($15–$75/month for most commercial plans)
• Insurance copay (brand): Typically Tier 3–4 ($50–$150/month; may require prior authorization or step therapy through generic)
• Medicare Part D: Coverage varies by plan. Patients in the coverage gap ("donut hole") may face significantly higher out-of-pocket costs until catastrophic coverage kicks in.

For patients paying cash — whether uninsured or facing high-deductible plans — the difference between $530/month and $45/month can determine whether they take the medication at all.

Manufacturer Savings Programs

Boehringer Ingelheim Savings Card (Brand Pradaxa)

Boehringer Ingelheim offers a copay savings card for commercially insured patients taking brand-name Pradaxa. Key details:

• Eligibility: Patients with commercial (non-government) insurance
• Not eligible: Medicare, Medicaid, Tricare, VA, or other government-funded insurance
• Benefit: Reduces out-of-pocket copay costs for brand Pradaxa
• How to access: Patients can enroll online at the Boehringer Ingelheim website or through their pharmacy

If your patient is commercially insured and their plan covers brand Pradaxa but with a high copay, the savings card can meaningfully reduce their monthly cost.

Boehringer Ingelheim Cares Foundation Patient Assistance Program

For patients who are uninsured or underinsured and meet income requirements:

• Benefit: Pradaxa provided at no cost
• Eligibility: Based on income and insurance status
• How to apply: Call 1-800-556-8317 or visit boehringer-ingelheim.com
• Your role: You or your staff will typically need to complete a prescriber section of the application and provide a prescription

Patient assistance programs (PAPs) can take 2–4 weeks to process. If your patient needs medication immediately, consider a short-term fill with a discount card while the PAP application is pending.

Coupon and Discount Cards

For patients paying out of pocket or facing high copays on generic Dabigatran, prescription discount cards can dramatically reduce costs. These are free to use and accepted at most major pharmacies:

• GoodRx — Widely recognized; often shows generic Dabigatran prices as low as $45–$80/month depending on pharmacy
• SingleCare — Another major discount platform with competitive pricing
• RxSaver — Price comparison tool that aggregates discounts
• Optum Perks — Backed by UnitedHealth Group; often has strong pharmacy network pricing
• BuzzRx, Inside Rx, America's Pharmacy — Additional options worth checking, as pricing varies by pharmacy and location

Important notes for your practice:

• Discount cards cannot be combined with insurance — they're an alternative payment method
• They work best for generic Dabigatran. Brand Pradaxa discount card prices are typically much higher.
• Prices vary by pharmacy. Encourage patients to compare prices at 2–3 nearby pharmacies using any of these platforms.
• Consider keeping a stack of GoodRx or SingleCare cards at your front desk or in exam rooms for patients to grab.

Generic Alternatives and Therapeutic Substitution

Generic Dabigatran

Generic Dabigatran Etexilate is now available and is bioequivalent to brand Pradaxa. For most patients, switching to generic is the single most impactful cost-reduction strategy:

• Cash price with discount cards: $45–$200/month vs. $394–$530 for brand
• Most insurance plans prefer or mandate generic dispensing
• Same active ingredient, same dosing, same efficacy

Unless there's a specific clinical reason to remain on brand (rare), generic Dabigatran should be the default recommendation.

Therapeutic Alternatives

If cost remains prohibitive even with generic Dabigatran, consider therapeutic substitution to another DOAC that may be priced more favorably on the patient's formulary:

• Eliquis (Apixaban) — Twice-daily Factor Xa inhibitor. Generally considered to have the lowest bleeding risk among DOACs. Generic availability and pricing should be checked against the patient's plan.
• Xarelto (Rivaroxaban) — Once-daily Factor Xa inhibitor. May be preferred by patients who struggle with twice-daily dosing compliance.
• Savaysa (Edoxaban) — Once-daily Factor Xa inhibitor. Less commonly prescribed but may be a formulary option.
• Warfarin — The most affordable option at a few dollars per month. Requires INR monitoring and dietary management, but for patients who cannot afford any DOAC, Warfarin remains an effective alternative with decades of clinical evidence.

When considering therapeutic substitution, factor in the patient's renal function, indication, compliance history, and formulary coverage. A medication the patient can afford and will actually take is better than one they can't.

Building Cost Conversations into Your Workflow

Many providers underestimate how often cost affects adherence — and many patients are reluctant to bring it up. Proactively addressing cost can improve outcomes:

At the Point of Prescribing

• Default to generic when clinically appropriate. Write prescriptions for "Dabigatran Etexilate" rather than "Pradaxa" unless brand is specifically needed.
• Ask about cost concerns directly: "Is the cost of this medication something you're worried about?" Normalizing the question makes patients more likely to be honest.
• Provide savings resources before the patient leaves. A printed GoodRx card, a note about the manufacturer savings program, or a handout with the PAP phone number (1-800-556-8317) takes seconds and can prevent abandonment at the pharmacy counter.

At Follow-Up Visits

• Check adherence and ask specifically about cost: "Have you had any trouble affording your medication?"
• Review refill history if possible. Gaps in refills often indicate cost barriers, not forgetfulness.
• Reassess formulary coverage annually. Insurance plans change formularies each year. A medication that was Tier 2 last year may be Tier 3 this year.

Staff and Workflow Integration

• Train front-desk and nursing staff to ask about cost concerns during intake
• Keep discount card information readily available in exam rooms
• Designate a staff member (or use your EHR's tools) to check prior authorization requirements and formulary status before prescribing
• Use Medfinder for Providers to help patients locate pharmacies that have Pradaxa or Dabigatran in stock, reducing fill delays

Additional Resources

Point your patients to these resources for more information:

• Patient guide to saving money on Pradaxa
• How to check pharmacy stock without calling
• Alternatives to Pradaxa
• NeedyMeds (needymeds.org) — Comprehensive database of patient assistance programs
• RxAssist (rxassist.org) — Another PAP directory

Final Thoughts

Pradaxa is an excellent anticoagulant, but its value to your patient is zero if they can't afford it. By proactively addressing cost, defaulting to generic Dabigatran, connecting patients with savings programs, and building cost conversations into your workflow, you can significantly improve adherence and outcomes.

The tools exist. Generic Dabigatran brings the monthly cost down to under $100 for most patients. Manufacturer programs cover uninsured patients entirely. Discount cards fill the gaps. Your role is to connect the dots — and that starts with asking the question.

For more provider resources, visit Medfinder for Providers.