In 2016, 1,685,210 new cases of cancer are projected to occur in the United States. Hard to believe, but that actually means it’s getting better. Something’s working. Whether it’s more appropriate screening or the effects of diet- and exercise-shaming finally soaking in, death rates from cancer have declined and are continuing to go down. Here is what we learned from the American Cancer Society (ACS) this month.
- The decline in cancer death rates in the US over the past 20 years has resulted in an overall drop of 23%, with more than 1.7 million cancer deaths averted.
- There are three principal reasons for the decline: reduction in cigarette smoking, improvements in treatment (surgery, chemotherapy, radiation), and the success of age-appropriate screening.
- Despite this, cancer is still the leading cause of death in 21 states . . . partially because we’ve gotten better at treating heart disease, the previous #1.
- It’s not all good. Incidence rates have increased for liver, pancreas, thyroid, tongue, tonsil, kidney and some leukemia subtypes. Liver and pancreas cancer are two of the most deadly cancers.
- Good news for the colon. In 2012, 55% of people between the age of 50 and 75 had a screening colonoscopy compared to only 19% in 2000. Colon cancer rates have declined 3% per year because of this and changes in risk factors (smoking, diet).
- Bad news for the uterus. One of the surprises in the data released was an increase in uterine lining cancer, called endometrial cancer. Deaths from uterine cancer are now just short of deaths from ovarian cancer in the US. Why? Excess weight increases endometrial cancer risk by 50% for every 5 body mass index (BMI) units. More obesity = more endometrial cancer.
- What about the prostate? As you know, current consensus is to not routinely screen all men with the prostate cancer blood test, the PSA. So half of the drop in cancer cases is related to declines in prostate cancer diagnoses as PSA testing decreases.
- Which is the most rapidly increasing cancer? Thyroid. Thyroid cancer rates have increased in both men and women 5% each year—but that’s partially due to overdiagnosis due to increased use of advanced imaging techniques.
- Tobacco is still a problem. Despite some of the progress seen, 80% of deaths from lung cancer and half of deaths from esophageal, oral and bladder cancer are from cigarette smoking.
- What are the chances you’ll have cancer? With these new statistics, we know the lifetime probability of developing invasive cancer for Americans is 42% for men and 38% for women.
Hidden deep within your health plan is an important document most people never read.
Your “formulary”—the list of drugs your insurance company covers—determines whether you’ll share the cost of your prescription with your insurance company or you’ll be stuck paying a high price at the counter.
This list can change during the plan year—drugs are removed, new drugs are added, restrictions may be added or removed, and coverage levels may change throughout the year. (Changes are the most likely when it’s re-enrollment time.)
Nobody wants to be stuck paying the full cost of their prescription, so you’ll want to be diligent in checking to make sure your current prescriptions are covered by your plan’s formulary. You can usually find it on your health insurer’s website.
GoodRx has teamed up with Consumer Reports Best Buy Drugs to answer five common questions about how to make sure your prescriptions are covered—and what to do if they’re not.
1. What if my prescription drug is dropped entirely by my insurance plan?
If your drug is no longer covered, first ask your doctor about other drugs on your formulary that may be just as effective and safe for your condition. Most plans will offer one or more alternatives to a medication they no longer cover.
If using an alternative isn’t possible, your doctor can file an exception called a “prior authorization” through your insurer, requesting that the drug be covered because it’s medically necessary. Your plan should approve or deny your request within a few days, and there is usually a mechanism for appeal.
2. I noticed a new tier on my formulary: non-preferred generic. What does that mean?
“Tiers” on insurance plan formularies are essentially a way to determine how much you’ll pay out of pocket for your medications. Most plans have about four levels, or tiers, of coverage, but in the last few years, many insurers have added a fifth tier by splitting the “generics” tier into two: One is “preferred” and the other is “nonpreferred.”
Companies do this to encourage you to choose less expensive medications. Your copay for a drug in the non-preferred generic tier, for example, may be $15, compared to a preferred generic in the lowest tier, where your copay could be $5 or less.
3. How does my deductible affect how my drugs are covered?
Your deductible is the set amount you need to spend each calendar year before your plan’s benefits kick in. In other words, you’ll pay full price for most services (including prescription medications) until you reach your deductible.
Some plans apply the “general medical” deductible to prescriptions as well, which means that the plan won’t make any payments for your medications until you’ve met your entire medical deductible. Other plans have a (generally) lower deductible that applies specifically to prescription coverage. Check with your insurer’s Summary of Benefits to find out how much you’ll pay out of pocket before your drugs are covered.
4. If my drug is no longer covered, can I appeal to my insurance plan to have it covered?
Yes, but it can be a lengthy process. You may have a few options, including the prior authorization route mentioned above. Depending on the medication, some plans may also require that you agree to “step therapy” first, which means trying other treatments before they approve the drug your doctor was going to prescribe. If the other treatments don’t work for you, you can work with your doctor to go through an appeal. You’ll need to fill out a form provided by your insurer or write a letter that include the name of the drug, why you need it covered, and any other supporting documents from your doctor. Your insurer can take up to 60 days to complete the appeal and get back to you.
If your insurance company denies your appeal, you can file for an independent review with your state’s insurance regulator, which will make the final decision. If your state doesn’t have an external review mechanism, the Department of Health and Human Services (HHS) or an independent review organization will oversee the process. This decision can also take up to 60 days. It’s free if handled by the HHS, but may cost you to $25 if it’s handled by your state or an independent review organization.
For more details on the appeals process, go to HealthCare.gov. For tips on how to write and submit an appeal, go to Patient Advocate Foundation (if you’re on Medicare, go to CMS.gov). To find your state regulator’s contact information, visit the National Association of Insurance Commissioners website.
5. What are some other ways to get help paying for my prescriptions?
Before you start a search for financial assistance, ask your doctor or pharmacist to review everything you’re taking; it could be that some of your medications are no longer needed.
If you’re facing high out-of-pocket costs, consider shopping around for lower prices. GoodRx price comparisons and Consumer Reports’ secret shoppers have found that prescription prices can vary widely from one pharmacy to the next, even in the same zip code.
If you don’t have health insurance or have a plan without drug coverage, look into applying for a patient-assistance program (PAP). PAPs have restrictions based on income, but if you qualify, you could get drugs at a deeply-discounted price, or even for free. For more cost-lowering tips, see Consumer Reports’ advice.
And of course, you can always check your prescriptions prices on GoodRx to find discounts and other savings offered in your area.
Consumer Reports Best Buy Drugs is a public education project dedicated to helping you talk to your doctor about prescription drugs and helping you find the most effective and safest drugs for the best price.
The CVS acquisition of Target pharmacies has made the news recently, but it may be hard to figure out how it will directly affect you if you fill at either one: Target or CVS.
To help you understand what will happen to your prescriptions (and prices), we have answers to 5 of your questions about the change.
1. Will the Target and CVS generic discount programs stay the same?
Unfortunately, no. Target has discontinued their pharmacy rewards program, and are no longer consistently honoring their list of generics priced at $4 for a 30-day supply.
The CVS Health Savings Pass program, a membership program offering a list of generic drugs priced at $11.99 for a 90-day supply, has also been discontinued. CVS will continue to offer their ExtraCare rewards program.
If you have joined a membership program or gotten a discounted generic price at either pharmacy in the past, we recommend checking GoodRx again to compare prices in your location. You may be able to find a lower price by using a new discount, or by filling at a different pharmacy.
2. Will I need to transfer my Target prescriptions to CVS?
No. When Target finishes converting their systems, your prescription will be transferred automatically. This makes it easy for you if you’d like to keep filling at the same pharmacy, but it’s something to be aware of if you’d prefer not to fill your prescription with CVS.
3. Will my insurance still be accepted?
Most likely, yes—CVS says that coverage will be uninterrupted for most people. However, you should check with your insurance provider and your pharmacy to find out for sure.
4. I have a GoodRx discount on file—will my price stay the same?
We strongly recommend checking prices and bringing a new coupon with you every time you fill or refill a prescription, especially as Target and CVS continue to transition. As with insurance plans, your discount will likely stay on file, but prices may change.
You can avoid surprises by having the most up-to-date discount with you at the pharmacy, either from a printed coupon or on our mobile app, and asking the pharmacist to be sure to enter the new coupon information.
5. Where can I find more information on the changes at Target and CVS?
You can check whether your Target pharmacy has already made the change to CVS branding here.
If you’ve been watching the news, you may be starting to worry about the Zika virus. A generally mild illness on its own, it can cause serious birth defects and is spreading rapidly via mosquito bites.
Here’s what you need to know:
1. Where does the Zika virus come from?
The Zika virus is transmitted by Aedes mosquitoes. It is typically associated with tropical climates and was originally reported in tropical Africa, Southeast Asia, and the Pacific Islands.
2. What are Aedes mosquitoes?
Aedes is a genus of mosquitoes that are known to transmit many different viruses. Some others you may have heard of include Dengue fever, yellow fever, and chikungunya.
These mosquitoes are considered aggressive daytime biters but can also bite at night.
3. What is it like for an adult to be infected with Zika virus?
Believe it or not, only about 1 in 5 people infected with the Zika virus will actually get sick.
For those who do get sick, the symptoms are relatively mild and last several days to a week. The most common signs and symptoms include fever, skin rash, pink eye (conjunctivitis), muscle and joint pain, a general feeling of discomfort, and headache.
4. What about the birth defect complications?
This is what has everyone worried. The Zika virus can cause microcephaly in the unborn baby of a pregnant woman who has been bitten by an infected mosquito.
Microcephaly is a rare birth defect that results in abnormal smallness of the head. It is associated with incomplete brain development.
See the CDC’s Q&A on Zika and pregnancy for more information.
5. Is there a vaccine available to prevent Zika?
No. There is no vaccine available yet. There is also no medication to treat Zika.
6. Where should I be worried about traveling?
There is a travel advisory from the CDC for Zika virus in the following areas:
- Pacific Islands
- Central America
- South America
- Cape Verde
You should use caution when considering traveling to these destinations, especially if you’re pregnant—in this case, that may mean postponing your trip, or taking extra care to prevent mosquito bites if traveling is unavoidable.
7. Have there been any cases of Zika in the US?
Only travel-associated cases—so, only cases in travelers visiting or returning to the US from countries where Zika is found.
However, there are Aedes mosquitoes in the US that could spread the Zika virus, and it it likely that the virus could start to spread locally here. It’s a good idea to take precautions now to protect yourself from mosquito bites.
8. How can I better protect myself against mosquito bites?
These steps will go a long way toward keeping mosquito bites to a minimum:
- Wear insect repellent
- Wearing light-colored clothing that covers as much of the body as possible
- Use physical barriers to protect your home, like screens or closed doors and windows
- Sleep under mosquito nets
- Make sure you have no standing water near your house where mosquitoes can breed
Want more information? Check out this Zika virus overview from the CDC.
Opioid pain medication is an emotional topic for everyone. Patients who struggle with chronic noncancer pain and need opioid medications feel they are portrayed as addicts when they ask for refills. Each week I see many patients using opioids for the appropriate reason, who have tried and failed with other medications and yet feel stigmatized by the use of medicine they need.
The flipside, however, is that more and more of us are dying from prescription pain medication overdoses, in addition to heroin overdoses when addicts move from Oxycontin to heroin. Many heroin addicts report their addiction started when a doctor prescribed them an opioid pain medication for something: wisdom teeth, knee surgery, or many other common uses.
You see the struggle here—these medications work when used for the right reason, but can cause massive destruction when it is not indicated.
Alarmingly, a recent study revealed that 91% of patients who were hospitalized for opioid medication overdose were prescribed opioids by their doctor AFTER their overdose. So physicians are largely to blame there, and rightly so.
New prescribing guidelines are being set for opioid pain medications that will lead many to feel frustrated that their doctor “doesn’t want to give them pain meds.” Here are the points on both sides, please weigh in. The struggle is real.
- What medications are we talking about? Common examples are hydrocodone (Norco, Vicodin), hydromorphone (Dilaudid), and oxycodone (Oxycontin).
- Set in stone. It is a fact that treatment of chronic noncancer pain with prescription opioids has increased dramatically in recent decades, and so have deaths from overdoses.
- Overdose. It is also a fact that a recent large study of patients hospitalized for opioid overdose (while using opioids for noncancer pain) found that 2,567 (91%) of them received one or more opioids after overdose. You heard that right? On days 31 to 60 after the overdose, 69% to 71% of patients had an active opioid prescription on any given day. Even in the month after overdose, between 31% and 36% of patients received high-dose daily opioids.
- The evil twin. It is a fact that using benzodiazepines (Xanax, Ativan, Valium, or their generics) along with opioids increases the risk of overdose. Yet, in the post-overdose period 58% of patients received one or more of benzodiazepine prescriptions. Sadly, this is largely the doctor’s fault.
- Clear guidelines. Prescribing guidelines for doctors clearly state that misuse of opioids and adverse effects (overdose being THE major adverse effect) are reasons to discontinue opioids. So, are doctors unaware their patients have overdosed, or just still willing to prescribe the opioids anyway?
- What should doctors be doing? Before starting you on opioid pain medications, your doctor should conduct a physical exam and take your pain history, past medical history, and family/social history. We should consider all treatment options and use opioids only when alternative treatments are ineffective—for example, NSAIDS, muscle relaxants, physical therapy, acupuncture, referral to specialist etc. Physicians must start patients on the lowest effective dose and use much greater vigilance at high doses. Using safe and effective methods for discontinuing opioids (tapering, referrals to medication-assisted treatment, substance use specialists, or other services) is also a must.
- Lower is better, especially when it comes to opioid pain meds. When doctors did prescribe opioids after overdose events, prescribed dosages were substantially lower than those given in the 90 days before the event—and dosages stabilized at those lower levels, showing that a lower dose was just as effective.
- Turning overdose into opportunity. Folks hospitalized for conditions related to substance abuse show a readiness to change, so help during and right after hospitalization can turn a potentially devastating event into an opportunity.
- Haters gonna hate. I prescribe opioid pain medications to my patients but only after we’ve exhausted all other options, because of the destruction they can cause. As a physician and blogger, the most hateful comments I receive will be after articles on non-opioid options for pain control so I’ll expect it again here. Having said that, we can no longer ignore the increasing number of patients taking these medications and the crisis of prescription drug overdose. Weigh in.