The latest updates on prescription drugs and ways to save from the GoodRx medical team

Acne Stinks, But Treatment Doesn’t Have to Cost You Hundreds

by Dr. Sharon Orrange on March 29, 2012 at 11:51 am

Here are some commonly prescribed meds for acne that cost big bucks
, along with some secrets to help you save money. First, meet the players in the fight against acne: topical (to rub on your face) Retin-A derivatives, topical antibiotics and oral antibiotics.

 

Retin-A Derivatives (Topical Retinoids):

Topical retinoids are a compelling option for maintenance therapy of acne instead of oral antibiotics. They are available in multiple strengths and formulations with lower strength preparations causing less irritation.

Tretinoin is available as a generic and as brand name versions (Retin-A and Renova). Tretinoin comes in different strengths and will be your cheapest option, at as low as $35 – $50 for a tube of tretinoin cream, depending on the strength.

Adapalene is a generic gel that comes in different strengths and it more expensive than tretinoin; Differin is the brand name version. Adapalene is only available as a 0.1% gel, for around $160 for a tube, while Differin is available in both 0.1% and 0.3% strengths.

Epiduo is a combination of adapalene and benzoyl peroxide where you get your retinoid and antibiotic together. It’s expensive, likely around $250 for a tube of gel, and because benzoyl peroxide is usually quite cheap it may not be worth paying for the combo. It’s up to you.

Retin-A Micro is microsphere preparation of tretinoin that may cause less irritation but is more costly, at $260 – $320 for a tube of gel.

Avita gel is another form of tretinoin that may cause less irritation, but again, it will cost big bucks (about $150 – $175 for a tube) because it’s brand name only.

Tazorac (tazarotene) is used for the treatment of acne as well as psoriasis. It has been considered the most effective but also the most irritating topical retinoid. It’s also brand name only and crazy expensive, at $200 – $250 for only of gel.

 

Topical Antibiotics:

Benzaclin is a popular gel of 1% clindamycin and 5% benzoyl peroxide. This, you can afford at about $75 – $90 for a tube of the generic version, clindamycin and benzoyl peroxide.

Acanya is a gel for acne that is very expensive. A good secret is that Acanya is a mixture of clindamycin gel (1%) and benzoyl peroxide gel (2.5%), both of which are generic. Mix those two and you will have Acanya. Acanya is about $260 for a tube, while you can find  a tube of clindamycin 1% for as low as $4 – $10 through some generic discount programs, and a 30 gram tube of benzoyl peroxide 2.5% for as low as $15 – possibly coming in under $20 – $25 for the same medication.

Duac is another brand name gel that is the same thing as Benzaclin, and tends to be more expensive, at just over $200 for 45 grams.

– 
Ziana is another expensive acne gel, and another case where you can make your own by mixing two generic gels: clindamycin 1% gel and tretinoin 0.025% gel. Ziana is around $225 – $250 for 30 grams, where 30 grams of clindamycin gel can cost as little as $4 – $10, and 45 grams of tretinoin 0.025% gel as little as $50 – $100, making the combination purchased separately less than half the cost of the brand name.

 

Antibiotic Pills:

Doxycycline is the standard treatment, prescribed at a dose of to twice a day. It’s generic and cheap, as little as $4 for a 30-day supply through some generic discount programs, regardless of strength.

Oracea is an expensive tablet of doxycycline used to treat acne. Oracea is equally effective to a dose of generic doxycycline and it’s really expensive, over $400 for a 30-day supply.

Minocycline is less photosensitizing (less likely to cause a rash when in the sun) than doxycycline, and is also available as a cheaper generic. Minocycline to capsules twice a day is the dose used for acne, and it can be found for as low as $12 – $30 for a 30-day supply (60 capsules, in this case).

Solodyn is an extended release version of minocycline (more convenient at once daily dosing) but it’s super expensive, as a brand name or generic, as much as $560 up to almost $1000 for a 30-day supply. Regular minocycline capsules will be hundreds of dollars cheaper than Solodyn or other brands Minocin or Dynacin, so know there are options before you pay the big bucks.

 

There you have it.

Dr. O.

Where generic versions are available for these medications, they will most likely be covered by insurance as Tier 1 medications, meaning you will pay only your lowest co-pay. Brand name coverage varies, even for individual drugs among different insurance companies. Most are Tier 2 or 3 medications, meaning a higher co-pay, but check with your insurance company to find your particular coverage.


Dude, Where’s My Voltaren Gel?

by Dr. Sharon Orrange on March 26, 2012 at 5:30 pm

Many arthritis sufferers are in a panic over the shortage of Voltaren gel (diclofenac sodium gel) and I get why they are worried. Voltaren gel is a prescription topical anti-inflammatory gel used for all kinds of arthritis pain: rheumatoid arthritis, lupus, and osteoarthritis of the knees, hands and hips. People who have stomach issues from taking anti-inflammatories by mouth can bypass that problem with Voltaren gel.

Endo Pharmaceuticals, the maker of Voltaren 1% gel, is the sole supplier and they have released a statement that Voltaren gel is on back order and they cannot estimate a release date. Hmm. Endo also could not provide a reason for the shortage, though it is suspected that cross contamination problems at the plant that manufactures Voltaren gel are the culprits.

What are your options now?

1) Flector patches (diclofenac epolamine 1.3%) are still available and an option to think about. The Flector patch is FDA approved for the treatment of pain due to strains and sprains.

2) Pennsaid solution (diclofenac sodium 1.5%) is another topical treatment similar to Voltaren gel (also made by Endo) that is approved for the treatment of knee arthritis symptoms. The recommended dose is 40 drops per knee, four times a day.

3) Lidoderm patches are patches with topical lidocaine, which works as a pain reliever. Lidoderm can work for low back pain among other things. Lidoderm, unlike Flector patches and Voltaren gel, is not a topical anti-inflammatory but rather a numbing medicine applied to the skin.

4) An over the counter option, though not as well studied, is Aspercreme cream, which is a topical salicylate (aspirin) pain reliever. It works by reducing swelling and inflammation in the muscle and joints.

Hang in there.

Dr. O.

None of these alternatives are available as generics, and some have better insurance coverage and pricing than others. Voltaren is typically considered a Tier 2 medication by insurance companies, meaning a moderate co-pay, and can be found for around $35 – $40 for 100 mg of gel. In contrast, if Flector patches are covered by insurance, they will likely fall under Tier 3, or your highest co-pay, and run about $175 for 30 patches. Lidoderm patches are more likely to be covered as Tier 2 drugs by insurance, but they’re a bit pricier at around $230 for 30 patches. Pennsaid is also typically a Tier 2 or 3 drug, and can be found for $180 for a 150 ml package.


Can Your Cholesterol Medication Cause a Fuzzy Head?

by Dr. Sharon Orrange on March 20, 2012 at 9:58 am

For years, many of you taking statins to lower your cholesterol have complained of a fuzzy head and less clear thinking. Statins are among the most prescribed medications in the US, including simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), and Crestor (rosuvastatin).

While studies have not shown statins to cause memory impairment, the FDA decided to listen to patients and add a warning on the label of statin drugs.

So, what are the supposed behavioral and cognitive effects of statins, and will you lose your mind over them?

  1. Depression and suicide. Although concerns have been raised about increased suicidal tendencies in patients treated with statins, they do not appear to be associated with an increased risk of suicide or depression.
  2. Irritability and aggression. There have been case reports of patients developing severe irritability and aggression associated with the use of statins. This has been reported but it is rare.
  3. Memory loss. Concerns have been raised about cognitive dysfunction and memory loss associated with statin use. However, a review of reports to the FDA up to 2002 found only 60 reports of patients who had memory loss associated with statins.

Are some statins worse for memory loss than others? Statins that cross the blood-brain barrier are called “lipophilic” statins. Simvastatin and atorvastatin are the most lipophilic while pravastatin and Crestor are the least. The statins that cross the blood-brain barrier have more reported memory and “fuzzy head” problems. While patients have reported these symptoms, further research does not show that statins cause memory loss. Some trials on simvastatin have shown some evidence of minor decreases in cognitive function, measured by neuropsychological testing, and that is important to know.

What do I do if I feel I have memory loss from my statin? If you recently started taking statins and develop memory loss associated with lipophilic statin therapy—simvastatin, Mevacor (lovastatin), atorvastatin, or Lescol (fluvastatin)—and you have a strong indication for lipid lowering therapy, it would be reasonable to talk to your doctor about treatment with a more hydrophilic statin—pravastatin or Crestor.

But don’t statins help prevent dementia? That’s why it’s hard to come up with a blanket recommendation about fuzzy head, memory loss, and statins. There have been several studies that suggest statins may have a role in the prevention of dementia.

See the pickle we are in?

Dr. O.


It’s Finally Here, the Generic for Lexapro! Meet Mylan Pharmaceuticals’ Escitalopram

by Dr. Sharon Orrange on March 13, 2012 at 1:35 pm

March 14th will be a great day for those of you who have been paying $50 – $100 a month for Lexapro. The patent for Lexapro runs out this month, and Mylan pharmaceuticals will launch escitalopram, the first generic equivalent to Lexapro.

Escitalopram 5 mg, 10 mg, and 20 mg will be available at a much cheaper price than you have been paying for your Lexapro and that is good news.

Lexapro is a commonly prescribed selective serotonin reuptake inhibitor (SSRI) medication for the acute and maintenance treatment of major depressive disorder in adults and adolescents ages 12 – 17, and for the treatment of generalized anxiety disorder in adults.

Escitalopram, the same medication in generic form, will now be available for the same indications.

Cheers!

Dr. O.

Escitalopram will likely be considered a Tier 1 medication by insurance plans, meaning you’ll pay only your lowest co-pay. Lexapro is covered by some insurance plans as a Tier 2 or 3 medication, meaning a higher copay, but this may change with the introduction of the generic option. Lexapro 10 mg tablets can be found for around $100 for a 30-day supply, up to about $150. Escitalopram 10 mg tablets, in contrast, will start at closer to $80 for a 30-day supply.


Medications for Nausea: How to Avoid a Stomach Ache When Paying for Them

by Dr. Sharon Orrange on March 8, 2012 at 1:22 pm

As a physician I believe everyone should have a medication for nausea in their medicine cabinet. After surgery, with a viral gastroenteritis, or if you get sick from a food borne illness you will need a medication to control nausea and vomiting (an antiemetic). There are huge differences in the costs of nausea medications so you need to know there are great new medications available as generics that are so much more affordable.

The oral nausea medication that changed the frontier when it was released, and is now available as a generic is ondansetron (Zofran is the brand name). It was the first selective serotonin blocking agent to be marketed. It is similar to granisetron, which made available as a generic in 1994. Ondansetron is an extremely safe and highly effective antiemetic that has greatly improved the ability to give chemotherapy. It is also used for nausea during pregnancy. Patients’ quality of life has been superior with ondansetron and granisetron than with older, traditional antiemetics.

Now what about cost? Granisetron (Kytril, which has been discontinued) is much more expensive than ondansetron, yet they are equally effective.

The orally disintegrating tablet Zofran ODT, or ondansetron ODT, which does not require water to aid in swallowing, is also much more expensive than the regular tablets, so many people wonder if the ODT is better. No, not really. Following oral administration ondansetron tablets and orally disintegrating tablets (ODT) are bioequivalent (essentially the same). Yes, it may make sense that a dissolvable tablet on your tongue is easier to take if you can’t keep a pill down even for 20 minutes but you and your doctor need to decide if it’s worth the higher cost for the ODT.

There are two older nausea medications that deserve mention if you can’t tolerate ondansetron for some reason. Prochlorperazine (Compazine, which has been discontinued) is an antipsychotic medication used for the management of nausea and vomiting but it shares many of the actions and adverse effects of the antipsychotics.

Prochlorperazine has had many setbacks, and in 2008 a black box warning was added regarding an increased risk of death in elderly patients with dementia receiving these drugs for behavioral problems.

Another older nausea medication is trimethobenzamide (Tigan). Interestingly, the exact mechanism of action of trimethobenzamide is unknown, but it may be mediated through the chemoreceptor trigger zone (CTZ). Also strange is that this medication is expensive, because it’s been around forever.

Dr. O.

Ondansetron and granisetron are typically considered Tier 1 medications by insurance companies, meaning you should only be responsible for your lowest copay. Regular ondansetron is often included in discount generic programs, and the 4mg tablet can be found for around $25 for 30 pills. Ondansetron ODT is slightly more expensive at around $30 for 30 pills. Granisetron 1mg tablets are significantly more, starting at around $500 for 30 pills.


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