Years ago I used to keep patients in the hospital for days just to receive their Lovenox shots. Then most drug companies came up with their own drug assistance programs and Congress passed the unfunded Medicare Part D benefit plan that sacrificed the future standard of living for our current generation in favor of senior votes. With many expensive drugs turning generic over the last decade, I have been thrilled that many of my patients have low cost or no cost alternatives to taking their medications.
This era may go down in history as the golden age of medication availability for hospitalist discharge. Now, I have received word that Sanofi-Aventis, the maker of Lovenox, has ended their Lovenox (enoxaparin) drug assistance program in December, 2011. That means uninsured patients with no medication insurance will be required to pay cash up front to their local pharmacy if they want to treat their deep venous thrombosis, pulmonary emboli, stroke related atrial fibrillation or any other potentially life threatening medical condition that require Lovenox bridging anticoagulation as an outpatient.
Or they can stay in the hospital for an extra week at $3,000 a day minimum to get outpatient administration of their $100 prefilled Lovenox syringes injected by a nurse who, I'm sure, has much better things to do with their time. Getting Lovenox shots at your local pharmacy will set you back $1,000 or more for a standard course of full dose anticoagulation, although the transition into generic territory promises to reduce this cost substantially over time.
So what's the market solution here? Patients could stay in the hospital for a week or more as proposed above and let the hospitals eat the cost as a government expense of doing business. Better yet, hospitals could start their own free Lovenox program. The best solution, I think, might be to start prescribing Arixtra (fondaparinux) for most of my insured and uninsured patients alike as a matter of default. Arixtra carries many of the same FDA indications for therapy and, as far as I know, GlaxoSmithKline has not discontinued their assistance program. In addition, the recent FDA approval of Xarelto and their drug assistance program offers an alternative to Lovenox for patients. If you need help with free medications, make sure to check out Needymeds.org to find resources that may get you your medications for free.