Many of you are experiencing price gouging at $10 – $14 a pill for your erectile dysfunction medications. I was reminded today by a patient, who takes 50 mg of Viagra as needed, that we can save you some money. Here is what you need to know before you spend the dough:
1) Viagra will cost roughly the same amount per pill whether it’s 25 mg, 50 mg or 100mg. Have your doctor prescribe you a 100 mg pill which you can cut in half or in fourths 30 minutes prior to intercourse. Those six 100 mg tablets that your insurance company allows will last you longer.
2) The same goes for Cialis which comes in 2.5 mg, 5 mg, 10 mg and 20 mg doses. Ask your doctor about prescribing the 10 mg or 20 mg tablets, which you can cut into smaller doses to use prior to intercourse.
3) Levitra is also available in escalating doses, so you can get a prescription for a 10 mg tablet and break it in half as needed.
4) Viagra is set to become generic in March 2012, so this game will change for the better for patients. We hope.
What have you paid?
All strengths of Viagra tend to be priced from $10 to as much as $25 per pill. Cialis varies in pricing, from around $5 per pill for the 2.5 mg and 5 mg doses, to as much as $20 – $30 for the 10 mg and 20 mg doses. All strengths of Levitra tend to be priced from $15 – $20 per pill. All three are not covered by many insurance plans, but will likely be considered Tier 2 or Tier 3 medications when they are covered, meaning a moderate to high co-pay.
Update for clarification:
The patent for Viagra was approved by the FDA for Pfizer on March 27th 1998 and expires March 27th 2012. Whether or not someone (a drug company) will make and market a generic version once the patent expires is not yet known.
Teva pharmaceuticals tried to market a generic Viagra (sildenafil) starting March 2012 when Pfizer’s patent was set to run out. Pfizer sued Teva in Federal Court and won in August 2011. So, Teva can’t market an erectile dysfunction drug, BUT sildenafil (the drug which is the active ingredient in Viagra) still comes up for grabs in 2012. It sounds confusing, but though it will be until 2019 before anyone but Pfizer could market sildenafil as an impotence drug, it will still be available in 2012. Tricky I know, but there is a lot of money at stake so games are being played.
What’s the story with Pradaxa (dabigatran)?
The buzz created by the heavy marketing campaign from Boehringer Ingelheim, the makers of Pradaxa, has made its mark because many of my patients are asking: what’s the story with the new and better warfarin? Physicians and patients alike have been anticipating the arrival of this new blood thinner because it eliminates the need for weekly blood tests to check levels. So, it is worth the buzz?
Coumadin (warfarin) has been the mainstay of treatment for those with atrial fibrillation (the most common kind of abnormal heart rhythm) to prevent stroke. One of the huge downsides of warfarin is that patients need to be monitored with blood tests to check their INR levels (to measure whether the level of blood thinner is appropriate). That’s a hassle when it means coming to visit the doctor or pharmacist every 1 – 3 weeks.
Pradaxa (dabigatran) eliminates the need for visits to check blood levels, resulting in an immediate love affair with both physicians and patients. Hold on though; let’s make sure we know the facts. Pradaxa is used to reduce the risk of stroke in patients with atrial fibrillation who don’t have significant valve disease, which we call non-valvular atrial fibrillation.
Pradaxa 150 mg twice a day reduces the risk of stroke in those patients with fibrillation often more effectively than warfarin. Pradaxa also resulted in fewer cases of intracranial hemorrhage (bleeding in the brain) than warfarin and that’s all good.
Now what are the downsides of Pradaxa? The first obvious one will be cost, because Pradaxa will be much more expensive than warfarin. Pradaxa also resulted in a higher rate of major gastrointestinal (GI) bleeds and of GI bleeds in general compared to warfarin. In patients 75 years and older the risk of major bleeding may be greater with Pradaxa than with warfarin. Finally, the risk of heart attack was slightly higher in patients who received Pradaxa than in those on warfarin: 1.5% vs. 1.1%.
So is eliminating visits for INR checks worth it? You and your doctor will decide.
Generic warfarin should be covered by most insurance plans as a Tier 1 generic, meaning you’ll pay your minimum copay. Warfarin may also be available for as little as $4 for a 30-day supply. Pradaxa was introduced last year and does not have a generic equivalent. It is considered a Tier 2 drug by many insurance plans, meaning you’ll pay a moderate copay. Pradaxa is typically $230 – $250 out of pocket for a 30-day supply.
What are the most dangerous medications? Results from a recent study highlight four drugs that are responsible for a shocking number of negative effects. Data from 2007 – 2009 shows that these four drugs were involved in more than two-thirds of the hospitalizations of older patients for harmful drug reactions and incidents.
Researchers looked at emergency hospitalizations of adults aged 65 years and older that were attributed to the use of a drug, or a drug-specific adverse effect. This included vaccines, dietary supplements, and prescription and over-the-counter medications.
First, why should we care? In this two-year period almost 100,000 patients older than 65 had emergency hospitalizations for dangerous drug reactions or incorrect dosages. Four medications taken alone or in combination were linked to 67% of the cases!
– Almost all of these hospitalizations involved unintentional overdoses. In the case of warfarin, a blood thinner, an overdose means the blood is too thin (usually referred to as an INR or International Normalized Ratio that is too high).
2) Insulin = 13.9% of hospitalizations
– Most patients were hospitalized because of low blood sugar (hypoglycemia) from taking too much insulin.
3) Oral antiplatelet medications = 13.3% of hospitalizations
4) Oral diabetes medications = 10.7% of hospitalizations
– Most hospitalizations in these cases were due to low blood sugar from an overdose of these diabetes medications.
What should we learn from this? These four drugs are excellent, important medications that need close attention and monitoring. Clearly the management of blood thinners and diabetes drugs is not ideal, and that is our fault as physicians. Newer diabetes medications exist which do not result in low blood sugar (hypoglycemia): metformin, Januvia and Actos. Newer long-acting insulin options also exist, like Lantus and Levemir, which carry much less risk of hypoglycemia—though they are expensive. Are they worth it to avoid low blood sugar episodes? I think so, but talk to your doctor about your options.
Generics warfarin, ticlopidine, glipizide, glyburide, and metformin are all typically covered by insurance as Tier 1 medications, meaning you’ll pay your minimum copay. Some may also be available for as little as $4 for a 30-day supply. Because warfarin is an approved generic for Coumadin, if it Coumadin covered by insurance, it will likely be a Tier 3 drug requiring the highest copay. Januvia, Actos, Glucotrol, Lantus, and Levemir are all typically covered as Tier 2 drugs, meaning you will pay a moderate copay. Cash prices for the brand name medications vary greatly, from around $80 for a 30-day supply for Glucotrol to around $220 – $250 per month for the rest.
For those of you paying big bucks for your cholesterol medication Lipitor: you have an early Christmas present. Finally, atorvastatin, a generic alternative to Lipitor, has been shipped! On November 30, 2011, the Food and Drug Administration (FDA) approved two generic versions of the cholesterol lowering drug Lipitor (atorvastatin), made by Ranbaxy Laboratories and Watson Pharmaceuticals. Atorvastatin is a cholesterol medication known as a statin, similar to the already available generic simvastatin and the brand name drug Crestor.
Atorvastatin is used along with a low-fat diet to reduce the “bad” cholesterol (the LDL cholesterol) and free fatty acids (triglycerides) in the blood. Atorvastatin lowers the risk for heart attack, stroke, and chest pain in patients with heart disease or risk factors for heart disease such as age, smoking, high blood pressure, or family history of early heart disease.
Is atorvastatin equivalent to Lipitor? Yes, and what is interesting is that Pfizer, the maker of Lipitor, has an exclusive supply and distribution agreement with Watson Pharmaceuticals. This means that Pfizer manufactures and supplies Watson with all dosage strengths of atorvastatin.
Ranbaxy Laboratories has gained approval to make generic atorvastatin tablets in 10 mg, 20 mg, 40 mg, and 80 mg strengths.
Generic atorvastatin began shipping November 30th, so discuss changing to the generic version with your doctor.
Lipitor and atorvastatin should be available at most pharmacies. Lipitor 10 mg typically ranges in cost from $115 to $200 for a 30-day supply, while atorvastatin 10 mg should be around $80. Lipitor is covered by some insurance plans; it is typically a Tier 2 or Tier 3 drug, meaning you’ll likely pay your middle to maximum copay, or full price. This may change with the introduction of atorvastatin. Generic atorvastatin will likely be covered by insurance as a Tier 1 drug, meaning you’ll pay your minimum copay.
Pfizer also offers a Lipitor co-pay card, which reduces payments by $50 per month, to as low as $4. More information can be found at: https://www.lipitor.com/patients/lipitorforyou.aspx
Insomnia has a huge impact on people’s lives, with many relying on a medication for sleep. Sales of Ambien and Lunesta were over $3 billion in 2007. Ambien and Ambien CR then became available as generics (zolpidem and zolpidem er) so the hunt was on for new brand name insomnia medications, which are big money makers.
There is a new kid on the block for insomnia, but as it turns out it’s not so new. The insomnia drug Intermezzo has just been approved by the FDA for treatment of middle-of-the-night awakening.
What is Intermezzo?
Intermezzo is sublingual (dissolvable on the tongue) zolpidem. It is indicated for people who wake up in the middle of the night and want to get back to sleep immediately for a few hours. At this time, Intermezzo is the only prescription sleep medication indicated for dosing in the middle of the night.
How is it used?
– The recommended dose of Intermezzo is 1.75 mg for women and the elderly and 3.5 mg for men.
– It is taken only once per night as needed if a middle-of-the-night awakening is followed by difficulty returning to sleep.
– Intermezzo is not supposed to be taken when you have fewer than 4 hours of bedtime remaining before your planned time of waking.
The peak effect of Ambien and zolpidem 5 mg or 10 mg tablets is 90 minutes. The peak effect of Intermezzo (sublingual zolpidem) is 35 – 75 minutes. It is much shorter, meaning Intermezzo works faster. Is that worth the cost? You decide . . .
Intermezzo was approved by the FDA on November 23, 2011 and does not yet have a projected release date. As a new brand name drug, it will likely be expensive, possibly in the current range of Ambien ($90 – $180 for a 30-day prescription without insurance), and may not be covered by some insurance plans.
Update for clarification:
Similarly, the generic version of Sonata (zaleplon) is also a short-acting sleep medication in the same class. The onset of action of zaleplon is 30 minutes, similar to Intermezzo, yet it lasts a little longer at about 4 hours. So if you took zaleplon when you woke up in the middle of the night, which is the approved indication for Intermezzo, you would need to have more than 4 hours of sleep left.