Cost Is an Adherence Barrier — Here's How to Help

Ticagrelor (Brilinta) is a cornerstone antiplatelet therapy for patients with acute coronary syndrome, coronary artery disease, and ischemic stroke. But when patients can't afford their medication, they don't take it — and the clinical consequences of Ticagrelor non-adherence are severe: increased risk of stent thrombosis, recurrent MI, stroke, and cardiovascular death.

Cost remains one of the most common reasons patients skip or abandon Ticagrelor prescriptions. As a prescribing provider, you're in a unique position to proactively address this barrier. This guide covers the savings programs, generic options, and workflow strategies that can help your patients stay on therapy.

What Patients Are Paying

Understanding the cost landscape helps you anticipate which patients need support:

• Brand Brilinta without insurance: approximately $400–$500 for a 30-day supply (60 tablets)
• Generic Ticagrelor without a coupon: approximately $444 retail
• Generic Ticagrelor with a discount card: as low as $31 for a 30-day supply (e.g., via SingleCare)
• With commercial insurance: generic Ticagrelor is typically Tier 1 or Tier 2, with copays ranging from $5–$30
• Medicare Part D: generic Ticagrelor is generally covered as a preferred generic, though patients in the coverage gap may face higher out-of-pocket costs

The key takeaway: generic availability has dramatically improved affordability since 2023, but patients who aren't aware of generic options or discount programs may still face sticker shock at the pharmacy counter — especially those paying cash or with high-deductible plans.

Manufacturer Savings Programs

Brilinta Savings Card (AstraZeneca)

AstraZeneca offers the Brilinta Savings Card for eligible commercially insured patients. Key details:

• May reduce copay to as low as $18/month
• Available to patients with commercial insurance (not Medicare, Medicaid, or other government programs)
• Patients can enroll at brilinta.com or by calling the number on the card
• Useful for patients whose plans cover brand Brilinta but with a high Tier 3 copay

Note: With generic Ticagrelor now widely available, most commercially insured patients will get better pricing on the generic. The savings card is most relevant for patients whose formulary specifically covers brand Brilinta or who have clinical reasons to remain on brand.

AZ&Me Patient Assistance Program

For uninsured or underinsured patients who meet income eligibility criteria:

• AstraZeneca's AZ&Me program provides Brilinta at no cost
• Patients apply at azandmeapp.com or call 1-800-292-6363
• Requires documentation of income and insurance status
• Your office may need to submit prescribing information as part of the application

Consider having your care coordinators or social workers keep AZ&Me applications on hand for eligible patients.

Coupon and Discount Cards

For patients paying cash or facing high copays on generic Ticagrelor, prescription discount cards can significantly reduce costs:

• SingleCare — generic Ticagrelor as low as ~$31/month
• GoodRx — prices vary by pharmacy, typically $35–$70 for generic
• RxSaver, Optum Perks, BuzzRx — additional options that may offer competitive pricing depending on pharmacy

Key points for providers:

• Discount cards are free for patients — they simply show the card (physical or app) at the pharmacy
• They work at most major chains (CVS, Walgreens, Walmart, Costco, etc.)
• They cannot be combined with insurance — the patient pays one or the other, whichever is lower
• Encourage patients to compare prices across pharmacies, as generic pricing varies significantly

You can also direct patients to Medfinder to check pharmacy availability and pricing in their area.

Generic Alternatives and Therapeutic Substitution

Generic Ticagrelor

Generic Ticagrelor has been available since 2023–2024, with multiple manufacturers now producing it. For most patients, generic Ticagrelor is the single biggest cost-saving opportunity:

• Same active ingredient, same FDA-approved dosage forms (60 mg and 90 mg tablets)
• Bioequivalent to brand Brilinta
• Priced at approximately $31–$80 with discount cards vs. $400–$500 for brand

If you're still writing prescriptions for "Brilinta" by brand, consider switching to generic Ticagrelor unless there's a specific clinical reason to stay on brand. Most pharmacies will automatically substitute generic unless "Dispense As Written" is specified.

Therapeutic Alternatives

For patients who truly cannot afford Ticagrelor even at generic pricing, consider therapeutic alternatives:

• Clopidogrel (Plavix) — Generic Clopidogrel is available for as low as $4–$10/month. While clinical data shows Ticagrelor has superior outcomes in ACS (per the PLATO trial), Clopidogrel remains an acceptable alternative, especially for cost-constrained patients. Be aware of CYP2C19 poor metabolizer status — consider genetic testing if switching.
• Prasugrel (Effient) — Generic Prasugrel is available and priced between Clopidogrel and Ticagrelor. It offers potent, consistent platelet inhibition but has higher bleeding risk and is contraindicated in patients with prior stroke or TIA.

Document the clinical rationale for any therapeutic substitution in the patient's chart and ensure appropriate follow-up.

Building Cost Conversations into Your Workflow

The most effective intervention is often the simplest: asking about cost before it becomes a problem.

At the Point of Prescribing

• Ask: "Do you have any concerns about the cost of this medication?"
• Mention that generic Ticagrelor is available and significantly cheaper than brand
• If the patient is uninsured, proactively offer the AZ&Me application or discount card information
• Send prescriptions as "Ticagrelor" (generic) rather than "Brilinta" (brand) unless clinically necessary

At Follow-Up Visits

• Ask: "Have you been able to fill your Ticagrelor prescription without any issues?"
• Watch for signs of non-adherence: missed refills, inconsistent platelet function testing, or recurrent symptoms
• If a patient reports cost difficulty, reassess whether a discount card, patient assistance program, or therapeutic substitution could help

Empower Your Staff

• Train medical assistants and care coordinators to screen for medication cost concerns during intake
• Keep printed information about the Brilinta Savings Card, AZ&Me program, and discount card options in your office
• Consider adding a "medication affordability" question to your standard intake forms

For additional tools to help your patients find and afford their medications, visit Medfinder for Providers.

Final Thoughts

Ticagrelor non-adherence due to cost is a preventable cause of adverse cardiovascular outcomes. With generic options now available at approximately $31/month, manufacturer assistance programs for eligible patients, and free discount cards, most patients can find an affordable path to staying on therapy.

The key is making cost part of the clinical conversation — not an afterthought. By integrating affordability screening into your prescribing workflow, you can help more patients stay adherent to the antiplatelet therapy they need.

For more clinical resources on Ticagrelor, see our provider guides on shortage updates and helping patients find Ticagrelor in stock. Visit Medfinder for Providers to access our pharmacy availability tools.