May: Facing the High Cost of Lifesaving Medication

Last December, May’s life changed in an instant when she was diagnosed with a pulmonary embolism, a dangerous blood clot in her lungs. Doctors immediately prescribed blood thinners to prevent another one from forming. The diagnosis was frightening, but what shocked her most was the price of the medication she needed to survive. “I was on Eliquis for ten months. For three months, it was $300 with insurance. And I have good health insurance, too. I think on GoodRx it was still over $1,000.” she said.

Even with coverage through her employer, the financial burden weighed on her. “I was lucky enough to be able to pay it, but if one of my grandparents had to take that, there’s no way they could afford that. And that was even with insurance.”

The high cost felt especially unreasonable given the risks of going without treatment. “Pulmonary embolisms are so dangerous, because your reoccurrence for another one within the first year, I think, is 10%. So, without blood thinners, you have a 1 in 10 chance of getting one again.” May explained. “For something that can be so deadly, and to pay $300 for three months for it, especially if you have to do that for your entire life, that just makes it super inaccessible. And there’s still the patent out, so they can’t make the generic until 2028, I think? Once there’s a generic, it’ll be cheaper. But it definitely makes it super inaccessible to people who have a higher risk for blood clots, which can travel to your lungs or your brain and heart and kill you.”

The medication was also not only costly but took a toll on her body. “I was struggling with taking it twice a day, because it made me sick,” she explained. When she asked to switch to a once-daily option, her doctor resisted. “She pushed me very hard to stay on Eliquis,” May recalled. “Definitely made me think she was getting a little bit of kickbacks.

Eventually, May convinced her doctor to let her try Xarelto. “I was on that for two months. Then I got a second opinion, and that hematologist was like, ‘You don’t have to be on blood thinners anymore.’”

Even while taking the medication, she faced constant worry. “I had my heart racing a lot. And I had to worry about if I hit my head, ‘Oh, I have to go to the ER now!’” The only comfort was the reassurance that the medicine reduced her chance of another blood clot. “I guess the only pro I really had was that peace of mind that this is going to lower my risk of another blood clot to 1%.”

May also lives with asthma and struggles with affording her medications for this as well. Her original inhaler was $100 a month, so she switched to Breo Ellipta because it was cheaper at $30. “I took it for a month, but I ended up hating how it tasted, so I switched to a different one.”

Despite having what most would consider high quality coverage, May felt trapped by the system. She makes too much to qualify for assistance programs but too little to realistically afford her medications. When her doctor suggested patient assistance programs, she laughed. “I make way too much money to get any assistance for this,” she said, while still knowing the expense was unattainable.

Looking back, May remembers how isolating it was to juggle side effects, constant financial pressure and the uncertainty of her health. “I was lucky enough to afford it,” she reflected, “but not everyone is.”

Her story is a stark reminder that no one should have to fight both illness and the crushing cost of medication at the same time. When lifesaving drugs are priced out of reach, individuals and families are forced to choose between their health and their financial security.