With all the news about high drug prices recently—which drugs are actually costing Americans the most money? What about the prescriptions that are being used the most? Take a look, and we’ll guide you through the highlights of the new GoodRx Top 10s, based on a sample of claims reported by pharmacies across the country.
Which drugs are the most expensive?
- Treatments for rare diseases make up a good portion of the list, particularly for hereditary angioedema (HAE). If you’ve been diagnosed with this rare genetic disorder, be prepared for high costs of treatment. Cinryze tops the list at $80,300 per month, and other HAE drugs aren’t much better—Firazyr comes in at an estimated $37,100 per month.
- Some good news: the very effective and very expensive hepatitis C meds are starting to decrease in cost very slightly. Harvoni shows the biggest drop, down from $82,000 to $61,000 per month (though the costs are higher for a full course of treatment). Almost all of the new treatments are still in the top 10 however, including Sovaldi and Viekira Pak.
- Other expensive to treat conditions include cystic fibrosis (newly approved Orkambi), familial hypercholesterolemia (Kynamro treats this form of inherited high cholesterol), and skin cancer (Targretin).
- See the full list for more.
Which drugs are most frequently prescribed?
- Pain medication hydrocodone/acetaminophen (Vicodin, Norco) tops the list this quarter. Between the available brands and generics, this combination of Tylenol and opioid hydrocodone is the most frequently filled prescription in the US. There has been plenty of controversy over how frequently narcotic pain medications are prescribed, with arguments both that it’s necessary and that there are other, non-narcotic alternatives that work just as well. For more information on alternatives, see Dr. O’s post on NSAIDs vs hydrocodone here.
- Thyroid meds like Synthroid and levothyroxine come in second, followed by prednisone, a steroid. These are both very common, inexpensive first-line treatments (the first option your doctor may try). Prednisone is also prescribed for many different conditions.
- Standard heart and diabetes prescriptions lisinopril (Zestril,Prinivil), atorvastatin (Lipitor), and metformin (Glucophage) are still very popular—no surprises there. These are also first-line treatments, with inexpensive generic options. They treat some of the most common conditions in the US: Diabetes affects almost 10% of Americans, and high cholesterol affects almost 13%.
- What else is on the list? Antibiotics like amoxicillin, anti-epileptic gabapentin (Neurontin), and mental health meds sertraline (Zoloft) and alprazolam (Xanax).
- Take a look at the full list to see what else folks are taking most frequently.
HIV Pre-exposure Prophylaxis, or PrEP, is an important new HIV prevention option for folks who do not have HIV infection, but are at significant risk for acquiring it. Did you know that you can take one pill a day to prevent acquiring HIV?
The medication approved by the FDA for HIV PrEP is emtricitabine/tenofovir (Truvada).
Truvada can reduce the risk of HIV infection by up to 92 percent when taken once a day as prescribed. PrEP obviously does not replace other methods of risk reduction like consistent use of condoms—but with the advent of PrEP, we have the opportunity to significantly lower the number of new infections.
Who should use PrEP?
Gay men and other men who have sex with men, transgender persons, persons who inject drugs, and others at high risk for infection. PrEP can be provided by all health care providers as part of primary care.
Is PrEP covered by insurance?
Yes, in many cases. PrEP medicine is covered by major private insurance programs, as well as Medicare, Medi-Cal and Covered California.
What if I don’t have insurance?
Financial assistance may be available for PrEP. The Fair Pricing Coalition website has a great summary of PrEP assistance programs.
Where can I find more information on PrEP?
The first FDA approved biosimilar for distribution in the United States is now available!
Zarxio is considered a specialty medication but will be available for open distribution. Open distribution means that the medication can be dispensed by any licensed pharmacy—and you won’t need to order through a specialty pharmacy.
What kind of savings can I expect with Zarxio?
Zarxio should save you about 15% compared to Neupogen. Novartis, the brains behind Zarxio, has said that the U.S. wholesale list price for Zarxio will be $275.66 for the 300 mcg syringe and $438.98 for the 480 mcg. The same dosages of Neupogen currently cost $324.30 and $516.45, respectively.
Zarxio has been available in Europe since 2009 and started out at the same 15% cost savings but has since increased to a savings of 20-30% compared to Neupogen, so it’s likely the cost will continue to come down over time.
Yes. Zarxio can be used for the same five FDA-approved indications as Neupogen (at a reduced cost). This includes helping your body make more white blood cells to prevent infection during chemotherapy.
How will Zarxio be dispensend?
Zarxio comes in a single-use pre-filled syringe in both 300 mcg/0.5 mL and 480 mcg/0.8 mL strengths.
NO. This is where biosimilars differ from regular generics. Zarxio is a biosimilar NOT an interchangeable product like most generic medications.
Interchangeable generic medications can be substituted for a brand name drug if they’re available, without needing to consult your prescriber.
Your doctor must write your prescription specifically for Zarxio if it’s the medication you will be using.
What are the side effects of Zarxio?
The most common side effects include aching in bones/muscles, and redness, swelling, or itching at the injection site.
Want more information on Zarxio?
You can also check out the manufacturer website here.
More than 29 million Americans have diabetes. That’s more than 10% of the US—and that number continues to rise. More than 1.7 million adults were diagnosed with diabetes in 2012 alone.
Fortunately, several new medications for diabetes have recently been approved—Toujeo (a new insulin product), Synjardy (a new combination of empagliflozin/metformin) and others. These new drugs provide several benefits such as fewer side effects or foolproof self-dosing with an insulin pen.
Unfortunately, these new drugs aren’t cheap—they may do a better job of keeping your diabetes under control, but brand-name prescriptions also mean more cost for you.
So what can you do to keep your costs down? Here’s 5 tips to help you find the best balance between cost and effectiveness.
1. Generics when you can.
This is obvious, but metformin (Glucophage) and metformin XR (Glucophage XR) remain the first thing your doctor will prescribe. These drugs are very inexpensive generics, though the extended release can run a little bit more expensive. If your co-pay is high, check on GoodRx to look for a cheaper cash price—regular metformin is available at many pharmacies for under $5 per month. Also check to see if taking two 500 mg tablets will be cheaper than a single 1000 mg tablet, or if splitting your pills can save you some dough.
2. Compare long-acting insulins.
The duration of action for Levemir is shorter (15 hours vs 24 hours for Lantus). It may require twice daily dosing, while Lantus is once daily—think of this when paying big bucks. Always check the formulary for your insurance coverage for their preferred long acting insulin so you don’t get stuck paying out of pocket.
Your next step is to look at the manufacturer savings programs for both, though Medicare patients aren’t eligible. Both Lantus and Levemir have savings programs than can reduce your cost to $25 per pen. You can find more info on the Lantus program here, and the Levemir program here.
Finally, ask your doctor for samples if you still can’t afford your insulin. You should know that NPH insulins like Humulin N or Novolin N are a cheaper option—though they may not be as cost effective given your higher risk of low blood sugar.
These drugs will be expensive for you, but they are more cost effective than cheaper options like glyburide and glipizide because you don’t have the risk of low sugars and avoid the side effect of weight gain.
Onglyza (saxagliptin) 2.5 mg and 5 mg tablets are the same price, so you can split if needed. Januvia (sitagliptin) 50 mg and 100 mg are also the same price—and if you take both Januvia and metformin, they come combined in Janumet, which will cost you the same as Januvia.
4. Compare the newer injectables (GLP-1 receptor agonists).
Victoza (liraglutide) and Trulicity (dulaglutide) are expensive brand-name injectable pens, but they are good for lowering A1c and weight loss. These drugs are definitely pricey but if you’re stuck paying cash for them, know that the price of one month (4 pens) of Trulicity may be cheaper than a month of Victoza.
Byetta (exenatide) is less practical because it’s used twice daily. Another thing to consider: Bydureon (exenatide) and Trulicity are once a week, while Victoza is used once daily, which could affect your total cost, especially if you’re paying out of pocket.
5. Don’t pay for supplies (if you don’t have to).
Glucometers and test strips should be covered by your insurance, sometimes at no cost to you. Aetna and Anthem, for example, will cover 100 strips a month through an in-network pharmacy. Like insulin though, make sure you check your formulary to see which brand your plan will cover.
Don’t have insurance? Check prices for test strips online. You can save significantly over buying diabetes supplies in a brick-and-mortar pharmacy.
However you get your strips, don’t pay for a glucometer without doing some quick research into getting it free. Most test strip companies will give away a free meter in hopes that you’ll continue to buy the test strips to go with it. You can find more information on how to get free meters here.
The best treatment in diseases such as atherosclerosis, or coronary artery disease, is prevention. Lifestyle changes like exercise, quitting smoking and changing your diet are an important place to start, but sometimes you just need more help.
Drugs like the statin medications work well to lower cholesterol but may come with some side effects. I am often asked by patients: what natural remedies really work to lower cholesterol?
There are some options out there, but before I show you some promising and well-studied plants that may help lower cholesterol, please remember a few things: these are unregulated and may carry issues of toxicity. Talk to your doctor about medication interactions. And if a natural remedy isn’t working for you after a few months, don’t waste your time or money. Most importantly, consider taking these under the care of a traditional herbal medicine doctor.
- Artichoke (Cynara cardunculus). Artichoke leaves work as a diuretic and stimulate the release of bile from the liver. Some animal studies suggest artichoke leaves may inhibit cholesterol production in the liver. One study on adults found that artichoke leaves lowered cholesterol by 18.%. The optimal dose for lowering cholesterol is not known, though 6 grams a day of the dried herb is used for indigestion.
- Alfalfa (Medicago Sativa). Research done on monkeys suggests that alfalfa seeds can decrease cholesterol. Several warnings here though: alfalfa has estrogen-like properties and contains high amounts of Vitamin K, so folks using warfarin (Coumadin) should stay away. The seeds also contain L-cavanin, a substance that can cause an issue with blood cells. Until we know more, perhaps stay away from this.
- Fenugreek (Trigonella foenum graecum L). Studies done on lab animals and some humans suggest fenugreek decreases the level of blood sugar in diabetics and may lower cholesterol. Human studies have shown fenugreek lowers triglycerides and raises HDL cholesterol, possibly by increasing biliary cholesterol excretion. The usual dose is 5 to 30 grams of the plant seed powder, three times a day.
- Garlic (Allium sativum). Although it is often claimed that garlic decreases cholesterol, results are mixed. Some studies in the ’80s and ’90s showed it decreased cholesterol, but more recent evidence has shown contrary results. The consensus now is that the enteric-coated garlic supplements have potential to improve the cholesterol profile of those with mild to moderate high cholesterol, when used along with a low fat diet.
- Soybean (Glycine Max). Studies have suggested soybean can lower LDL cholesterol as much as 12%. The U.S. FDA recommends 25 grams of soybean protein to decrease blood cholesterol. Caution here: soy decreases the level of testosterone in men and has estrogen-like properties.
- Silimaryne (Silybum marianum L). Silmaryne is an herbal drug believed to lower cholesterol synthesis in the liver. Silimaryne 420 mg a day was shown to lower cholesterol in a study on 14 patients.
- Red Yeast Rice. Red yeast rice has been reported to lower cholesterol in the same way as statins. One of the compounds in the yeast works as an HMG-CoA reductase inhibitor which is how statin drugs (Crestor, atorvastatin, simvastatin) work. A product called colistin obtained from this yeast is given 1.2 to 2.4 grams daily to lower cholesterol. The same warnings apply here as with statins and those with liver issues should stay away from it.
- Guggul (Commiphora mukul). Guggul is an adhesive gum obtained from the Mukul myrrh tree. In a study on 61 people, taking guggul at 100 mg a day lowered LDL cholesterol by 12.7%. Additional studies have shown improvement in triglycerides and total cholesterol.
- Plantago Psyllium. This is a fiber derived from Plantago ovate seed husk. 6 to 8 weeks of psyllium treatment can lower cholesterol by about 5%. The dose is 5 to 15 grams of the seed husk to lower blood cholesterol.
- Guar Gum (Cyamopsis retragonoloba). Guar gum is the nutrient derived from the edible seed of this plant. Guar gum at a dose of 15 grams per day has been shown to lower cholesterol in adults. Another plus: it suppresses appetite as well.