With all of the attention on EpiPen prices recently, you may not be surprised to find that other drugs have seen similar price increases.
In the case of Aloquin, though, the rising cost is even more puzzling. Over the past year, Aloquin has increased from around $250 per tube of gel to over $9000—a price hike of more than 3500%.
Is Aloquin a one-of-a-kind drug?
Sort of. Aloquin is the only combination of just iodoquinol, an anti-fungal treatment, and aloe. BUT you can get generic iodoquinol combined with hydrocortisone for $40 – $50 per tube . . . and buy aloe over-the-counter at your local store.
Is the price justified?
In this case, it’s a pretty clear no. As an example—Caremark, one of the largest providers of prescription insurance will no longer cover Aloquin. Why? Aloquin falls under their new “hyperinflationary drugs policy.” It’s considered a product “with egregious cost inflation that [has] readily-available, clinically-appropriate and more cost-effective alternatives.”
What does that mean? Basically, a drug that has seen a drastic, unjustified increase in price can be excluded if there are reasonable alternatives on the market.
Why the huge price hike then?
Manufacturer Novum immediately increased the price by more than 10x in 2015 within a month of purchasing Aloquin from Primus Pharmaceuticals—from that initial $250 to over $2500 per tube. Since then Novum has continued to raise prices.
Novum also purchased a couple of other skin meds at the same time—including Alcortin A and Novacort—which have seen similar drastic price increases. After the purchase in mid-2015, Alcortin A jumped from around $200 to $2500, and Novacort from around $130 to $2500.
What are my options?
Fortunately, unlike with EpiPen, there are lots of options out there to help acne, eczema, and the fungal infections Aloquin is used to treat. If your doctor has prescribed you Aloquin, ask about generic hydrocortisone/iodoquinol. Some people are prescribed Aloquin because they may not be able to use hydrocortisone. In that case, ask whether another medication altogether might work for you.
There are discounts out there for Aloquin, but they may not do you much good. If you’re paying out of pocket, a GoodRx discount can save you almost $6000 . . . but would still leave you with a $3500 price tag.
Novum also offers a patient savings card that claims most insured patients will pay $0, and cash patients could pay as low as $35. However, as with most manufacturer offers, you should be aware that if your plan doesn’t cover Aloquin—or if you’re paying cash—your costs could be higher.
Skin abscesses are more common than you might think, and are usually caused by bacteria that live on the skin or adjacent mucous membranes (like in the nose). More often than not, the staphylococcus aureus bacteria is the most common culprit. In extreme cases, the staphylococcus aureus bacteria can cause MRSA (methicillin resistant staph aureus), an infection that is resistant to many common antibiotics.
What’s in a name? A skin abscess is a collection of pus that develops under the skin. A common skin abscess that you might have heard of is a boil. A boil (also known as a furuncle) is an infection of the hair follicle that causes a painful pus-filled bump on your skin. I know, I know, these sound gross, but they are actually very common!
How do I treat it? There is good news! For most of the small boils and abscesses, a warm towel compress may be all you need for the pus to drain on its own. If this works, make sure you cover it with a clean bandage to prevent the bacteria from spreading further. In some cases, if a compress doesn’t work, you might need to visit your doctor. During this visit, your doctor might numb the abscess and drain it, a procedure known as “incision and drainage” or “I and D.” This drainage, or pus, may be cultured in the lab to help guide potential antibiotic use.
After drainage, do I need antibiotics? Antibiotics are recommended for abscesses larger than 2 cm at the time they were drained. In fact, people treated with Bactrim (sulfamethoxazole/trimethoprim 160 mg/800 mg) twice daily for 7 days had a higher cure rate than those who didn’t take antibiotics after incision and drainage.
Wait, but what if I have a sulfa allergy? If you have a sulfa allergy, you most likely won’t be able to take Bactrim, but there are alternatives. Other good options are clindamycin, and minocycline. An expensive brand name medication, Zyvox, is available now as generic linezolid but it’s still pricey. Taking linezolid twice daily is also an option.
For many, back to school also means back to sports—football, soccer, swimming, wrestling, and cheerleading, among others.
With so many kids coming through the same locker rooms, and sometimes sharing equipment, your child’s favorite sport can mean they’re more susceptible to fungal infections like athlete’s foot.
The good news: there are many non-prescription options out there that can help.
Are antifungals available over-the-counter?
Yes. If your child has come into contact with ringworm from the wrestling mat or athlete’s foot from a gym shower, you can find treatments in the aisles of your local pharmacy or grocery store.
The most common OTC antifungals include clotrimazole, miconazole, tolnaftate, and terbinafine. They can also be found under a variety of brand names including Lamisil, Lotrimin, Tinactin, and Zeasorb to name a few. They come in several forms, including creams, ointments, gels, sprays, and powders.
What you may not know: most of these products can be found in the foot care aisle of your local store—even though they can be used for other areas of the body.
What symptoms do these OTC antifungals treat?
OTC antifungals can treat itching, burning, cracking, scaling, and chafing.
Are there any limitations?
Yes. Non-prescriptino antifungals don’t treat fungal infections of the scalp or nails.
How can my child avoid getting a fungal infection when playing sports?
There are a few ways your kids can play it smart:
- Keep skin dry and clean
- Keep nails short and clean
- Keep all sports gear and equipment clean
- Change socks and underwear at least once a day
- Don’t share any personal items like towels, clothes, combs, sports equipment
- Don’t walk bare foot in public areas such as the locker room or shower
- Don’t share any personal items like towels, clothes, combs, sports equipment
How do I know when my child needs to see a doctor for a fungal infection?
If you think your child may have a more serious fungal infection (or an infection on the scalp or affecting their nails), contact your doctor for an appointment.
You should also consider contacting your doctor if your child has used an OTC antifungal treatment for 2 weeks but continues to have symptoms.
Your doctor can confirm and give an diagnosis a resistant or more serious fungal infection, and provide prescription treatment if necessary.
What prescription treatments are available to treat fungal infections?
Common prescription treatments for fungal infection include:
- Ketoconazole (Brand: Nizoral)
- Itraconazole (Brand: Sporanox)
- Fluconazole (Brand: Diflucan)
- Griseofulvin (Brand: Gris-Peg)
- Terbinafine (Brand: Lamisil)
Your child’s doctor will be able to tell you if one of these prescription treatments is needed.
Fioricet (butalbital/acetaminophen/caffeine) has been around forever and is used by many for the treatment of chronic migraine or tension headaches. It is a mixture of a barbiturate, Tylenol (acetaminophen) and caffeine.
Now, many formularies are no longer covering Fioricet capsules. For those of you who have relied on it for years, this (understandably) may make you nervous.
Well, it turns out it doesn’t really work that well—and there are much better options out there.
- Fioricet and Fioricet with Codeine are not as effective for acute migraine as newer medications. There isn’t any evidence that shows that barbiturate-containing meds (the butalbital in Fioricet) help for migraine treatment. In fact, the use of Fioricet with Codeine often results in chronic migraine and a “medication overuse headache.”
- NSAIDS. Start with these instead. There is good evidence that nonsteroidal anti-inflammatory drugs—ibuprofen, naproxen, and others—work well for the treatment of acute migraine.
- Triptans. Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan), and Frova (frovatriptan) are examples. Used alone or in combination with an NSAID, triptans work well for moderate to severe headaches that aren’t relieved by NSAIDs alone. Wondering which to choose? They generally work the same but you may notice fewer side effects with one over the other. Cost can also be an issue so you’ll want to pick a triptan that is covered by your insurance plan. It’s also a good idea to check GoodRx to see if the cash or discount price beats your co-pay.
- Adding a nausea medication. For folks with moderate to severe migraine accompanied by nausea or vomiting, adding Reglan (metoclopramide) , Zofran (ondansetron) or Compazine (prochlorperazine) also helps.
Bottom line is . . . while your Fioricet capsules may no longer be covered, better options exist.
Americans are clearly unhappy about the rising cost of prescription drugs and healthcare, and the leading 2016 presidential candidates have proposed all sorts of ideas to fix the problem. Here’s a snapshot of what the candidates have said on these important issues.
Where the Major Candidates Agree
It’s hard to imagine Clinton and Trump agreeing on anything, but they actually have some ideas in common. Here’s a summary:
- Both Trump and Clinton advocate importing prescriptions from overseas. Brand-name drugs are significantly more expensive in America than elsewhere throughout the world, as most Americans know. Both candidates propose legalizing the importation of prescriptions from other countries to help reduce the rising cost of brand drugs.(Interesting side fact: Many generics are actually the same price, or even cheaper, in America than they are in many other countries, including Canada.)
- Both Trump and Clinton support allowing Medicare to negotiate prices with drug companies. Most Americans agree that it’s outrageous that Medicare isn’t allowed to negotiate to reduce the cost of the prescriptions Medicare purchases for seniors. (Just for reference, in 2014 that cost was $143 billion). This issue seems to be one that has universal support among candidates.
- Both have called for more transparency in health prices.
- Both want to increase innovation and reduce time-to-market for new prescription drugs.
Where the Candidates Disagree
Donald Trump hasn’t provided many details regarding his plan for healthcare, but he has some specific proposals that would impact healthcare costs and services in this country. Specifically:
- Repeal Obamacare. Trump wants to repeal Obamacare (the Affordable Care Act or ACA) and restore free market principles. He believes the ACA has caused runaway healthcare costs, higher premiums, and fewer choices, among other issues. He has promised to repeal Obamacare on “day one” of his administration.
- Insurance. While anti-Obamacare, he still supports the mandate that everyone be required to have health insurance (and also said no one should be required to have insurance). He wants to change current laws to allow the sale of health insurance across state lines, stating that increased competition will drive down prices. He also wants to allow insurance premiums to be tax-deductible.
- Immigrants. Trump blames illegal immigrants for high prescription prices, saying it costs $11 billion annually to insure them.
Hillary Clinton, by contrast, has posted extensively about her plans to expand Obamacare and tackle the high cost of prescription medications. She was very vocal during the EpiPen price controversy during the summer of 2016 when she demanded an explanation from the manufacturer. Here’s a summary of Clinton’s positions:
- Defend and expand Obamacare & Medicare. Expand the program, and let Americans 55 and older buy into Medicare.
- Costs. Reduce co-pays, deductibles and out of pocket limits, especially for patients with chronic conditions. She proposes a limit of $250/month per person, and says it will help 1 million Americans annually.
- Advertising. Prohibit the pharmaceutical industry from advertising directly to consumers.
- Limits. Require drug companies that get taxpayer support to invest in research, not marketing, and limit “excessive” profits.
- Brand drugs. Clinton has proposed penalties to drug manufacturers who raise drug prices without justification, as well as government intervention to find other manufacturers or solutions when a brand-name drug increases in price.
- Patents. Reduce patent protection for specialty drugs from 12 years to just 7, so Americans can get access to generics quicker. Also prohibit the practice of letting drug companies pay to delay the expiration of drug patents.
- FDA. Clear out the FDA backlog of unapproved drugs.
Both candidates have made claims which appear to be factually inaccurate.
In a March 2016 debate, Trump claimed the government could save “hundreds of billions of dollars in waste” through negotiating prescription drug prices. However, the annual budget for Medicare Part D is less than that amount.
In a January 2016 advertisement, Clinton’s campaign claimed that drug prices have doubled in the last seven years. While brand name drugs have increased in price, generic drug prices have actually dropped significantly. The average increase for all drug purchases, while hard to measure, is likely not double.
What about the other presidential candidates?
Other presidential candidates may be less well known, but they’ve touched on healthcare reform.
Jill Stein (Green Party)
Stein believes strongly in the role of the government to provide quality healthcare for Americans. From her campaign website: “(Jill will) establish an improved ‘Medicare For All’ single-payer public health insurance program to provide everyone with quality healthcare, at huge savings.” Her plan would eliminate co-pays, premiums and deductibles, as well as any limitations whatsoever. Her platform does not indicate how these expanded benefits would be funded. Like Clinton and Trump, she also wants to use bulk purchasing negotiations by the government to reduce the cost of prescriptions.
Gary Johnson (Libertarian Party)
Johnson does not specifically mention drug prices on his campaign website. Typically, libertarian candidates prefer market forces to legislation, so one could presume that he would generally be against new laws or interference with the private market. Gary believes “the government should never regulate prices of private businesses.” While not directly related to prescription drugs, Johnson also advocates legalizing the use of marijuana.
Where does GoodRx stand? What’s the right answer?
The best candidate to tackle high drug prices is . . . nah, we’re not going to go there.
Providing quality, affordable healthcare is a very complicated problem, and it likely requires more than a bunch of campaign promises to solve. The solution requires big changes to the way our system currently works—Congress, insurance companies, employers and, yes, patients will all have to reset expectations.
Regardless of which candidate wins, we’ll continue to do our part to help Americans understand the system and find ways to afford their healthcare.