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

Battle of the Asthma Inhalers

by Dr. Sharon Orrange on September 20, 2012 at 4:06 pm

Asthma sufferers not only deal with a chronic problem but the high cost as well. When it comes to asthma there are quick-relief inhalers and long-term controller inhalers. Once your doctor has decided you need a long-term control inhaler (not just your albuterol inhaler), you will be faced with a choice of three. All three are expensive but which one is right for you?

Long acting bronchodilators (LABAs) mixed with an inhaled steroid have become the mainstay of asthma treatment for those with moderate asthma symptoms. These are long-term meds that reduce inflammation in the airways.

Why do we put a long acting bronchodilator (LABA) with a steroid in one inhaler? It’s more convenient, though more expensive. More importantly, steroid/LABA inhalers are safer for you and more effective. The addition of a LABA to your steroid inhaler makes it so you don’t have to increase the dose of steroid. The use of LABAs WITHOUT steroid inhalers is not as safe. Each of the LABA/steroid combination inhalers is available in different strengths.

So what are your choices?

1. Symbicort (budesonide and formoterol). This combination may stand out only because it has also been shown to be useful as a reliever medication (not just maintenance) in persistent asthma.

2. Dulera (mometasone and formoterol)

3. Advair Diskus or Advair HFA (fluticasone and salmeterol).

All are essentially created equally, and all are effective. The bad news is that all are also expensive, so find out which one is covered by your insurance and ask about starting on that. The good news is that the patents for Advair are set to expire in the next year or so, making a generic possible, but nobody is lining up to make the generic version. So don’t hold your breath on that yet.

Dr O.

Symbicort, Dulera, Advair Diskus and Advair HFA all range from around $200 – $300 per inhaler, depending on strength. Most insurance plans will cover the inhalers as Tier 2 medications, meaning a moderate copay, though they are considered Tier 3 or not covered by some plans. Each inhaler also has a manufacturer discount available, for reducing copays, a small cash discount, or free trials.

Get to Know the EpiPen

by Dr. Sharon Orrange on September 10, 2012 at 4:43 pm

An extreme life-threatening allergic reaction, anaphylaxis, from a bee sting or food allergy requires quick attention to save lives. Epinephrine auto-injectors (the EpiPen being the most common) are the best treatment for anaphylaxis. Severe allergic reactions from food allergies are more common than ever, so we need to make the EpiPen cheap, accessible, and less scary for regular folks.

Here are key points we all need to know about epinephrine auto-injectors (the EpiPen):

1. In most states, a prescription is needed for a child or adult to receive epinephrine injections. Some states have changed this so a child can receive an epinephrine injection even without a prescription on file.

2. The renewed focus on the EpiPen should help teach people how and when to use them and dispel fears many have about adverse effects.

3. Adverse effects of epinephrine are minor and pass quickly, contrary to what most of us believe. Tremor, dizziness, palpitations, anxiety, restlessness, and headache may occur but dissipate quickly.

4. All patients who have experienced anaphylaxis should have access to epinephrine for self-treatment as it is the best treatment available.

5. Ask your primary care doctor or pediatrician which auto-injector is best for you but here are your choices:

EpiPen: 0.3 mg per dose

EpiPen Jr: 0.15 mg per dose

Twinject: 0.3 mg per dose (provides two 0.3 mg doses in one device)

Twinject: 0.15 mg per dose (provides two 0.15 mg doses in one device)

Adrenaclick: 0.3 mg per dose

Adrenaclick: 0.15 mg per dose

6. Carry the auto-injector at all times. This seems obvious, but most severe reactions occur when people are out of their normal routines (during exercise, while dining out, attending celebrations and banquets, or traveling).

7. When to use it: If you are an adult, use your EpiPen if you are having trouble breathing, feel tightness in the throat, feel lightheaded or think you might pass out

8. How to use it: Epinephrine should ideally be injected into the mid-outer part of the thigh, into the underlying muscle. Intramuscular injection is preferable to subcutaneous injection (under the skin), as it results in more rapid systemic absorption

9. A second dose may be needed 5 to 15 minutes after the first.

Dr O.

Epinephrine pens, EpiPen, Twinject, and Adrenaclick are sold in kits of 2 pens. The cost may vary between the two packages sizes, and it is occasionally less expensive to purchase 2 single pens than the 2-pen package. Prices range from about $60 – $150 for single pens, and from about $120 – $300 for 2-pen kits. EpiPen, EpiPen Jr, Twinject, and Adrenaclick are covered by many insurance plans as Tier 2 drugs, meaning a moderate co-pay, while epinephrine pens are often covered as Tier 1 drugs with the lowest co-pay.

Patch Over Pill

by Dr. Sharon Orrange on September 7, 2012 at 10:42 am

Women have fallen in love with estrogen patches instead of pills for hormone replacement therapy, yet are continually stung by the cost. There is now a generic option for an estrogen patch that has become a game changer, so let’s get to know our options.

Estradiol is used to prevent osteoporosis and relieve symptoms associated with menopause. Estradiol is the principal intracellular human estrogen and is available in many dosage forms, including transdermal patches, topical creams, gels or sprays, vaginal creams, oral tablets, vaginal rings, and injections.

Why do patients and doctors love estrogen patches?

1. Transdermal (a patch worn on the skin) administration of estradiol avoids first-pass metabolism. This means the liver and gut don’t have to do much work or feel the strain.

2. Estrogen patches allow for continuous delivery of the hormone.

3. Estradiol is minimally metabolized in the skin, so higher estradiol blood levels are present which more closely mimic natural premenopausal concentrations.

4. Estrogen patches have a short half-life so levels of estradiol return to normal within 4 to 8 hours of patch removal.

Estradiol patches are available in different doses and until recently the options were all expensive. Now Climara patch is available as a generic estradiol patch. Vivelle-Dot (which has largely replaced the older version, Vivelle) is also available but it is brand name only so is more expensive. FemPatch is another option though not as commonly prescribed. The only estradiol patch that also has progesterone is the Combipatch, also expensive but your only combo patch option.

Dr O.

Climara runs about $95 for 4 patches without insurance, while the generic estradiol ranges from around $30 – $50 for 4 patches. Vivelle-Dot and Combipatch are slightly less at $70 – $75 for 8 patches. Estradiol patches are likely to be covered as a Tier 1 medication by most insurance plans, meaning you’ll pay your lowest co-pay; Climara is likely to be either not covered or a Tier 3 drug, falling under your highest co-pay. Vivelle-Dot and Combipatch are  likely to be considered Tier 2 by insurance companies, with a moderate co-pay.

Qsymia, Another Weight Loss Drug, Wins FDA Approval

by Dr. Sharon Orrange on September 4, 2012 at 2:00 pm

And away we go! Another weight loss drug, Qsymia, has won FDA approval.

Surprise! The “new” medication for weight loss is a combination of two existing medications. On the heels of Belviq, a weight loss medication approved a month ago, we now have a combination of phentermine and topiramate (Topamax) called Qsymia.

Qsymia is a combination of the FDA-approved drugs phentermine and topiramate (Topamax) in an extended-release formulation. Phentermine has been used for years for short-term weight loss and Topiramate is used for the treatment of seizures and the prevention of migraine headaches.

Here are the stats on Qsymia:

1. The average weight loss is about 9 – 10%.

2. The most common adverse reactions with Qsymia were tingling sensations of the hands and feet, dizziness, altered taste, insomnia, constipation, and dry mouth.

3. People who CAN’T use Qsymia are: those with glaucoma, hyperthyroidism or those with a history of heart disease or stroke.

4. If you don’t have weight loss after 12 weeks on Qsymia you should consider discontinuing it.

For those of you interested in prescription medications for weight loss you now have two new options: Qsymia and Belviq, which work by different mechanisms to help out with weight loss.

For more information on Belviq see my previous blog.

Dr O.

Qsymia is available in pharmacies as of September 2012.

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