Finacea (azelaic acid 15% gel) works just as well as a topical retinoid (similar to Retin-A) called adapalene (Differin) for women with adult acne. Finacea was tested for 9 months against the topical adapalene gel in a 2014 study.
Results showed that Finacea gel was similar in effectiveness to adapalene 0.1% gel and that Finacea had a clear advantage in terms of tolerability. Skin redness, dryness and scaling were much lower in the Finacea (azelaic acid) treated group. That’s a big deal.
Azelaic acid 15% gel is currently used for the treatment of rosacea, but used twice a day it improved acne to the same extent as the most commonly used gels—the Retin-A (retinoid) gels.
Of note, azelaic acid 15% gel’s approved indication is in treating mild to moderate rosacea. The other bummer is the cost: a 50 gram tube of Finacea (azelaic acid 15%) is expensive, more expensive than adapalene gel 0.1% which is now available as a generic. Worth it?
Finacea is available as a brand name only, and will likely cost over $200 per 50 g tube, even with a discount card. If covered by insurance, it is typically considered a Tier 2 or 3 drug, meaning you’ll pay a moderate to high co-pay, though there is a manufacturer coupon that will take $10 off for insured patients. Generic adapalene is less expensive but still pricey if you’re paying out of pocket—starting at about $80 with a discount for a 45 g tube of gel. However, if you’re insured, adapalene will likely be covered as a Tier 1 drug, meaning you’ll pay only only your lowest co-pay.
For many Americans with health insurance, more than 50 popular brand-name drugs may no longer be covered starting in January 2014. Express Scripts and Caremark, companies that handles pharmacy benefits for more than 200 million Americans, are removing almost 50 brands from their formularies at the end of 2013. More information is below.
What are Express Scripts and Caremark?
Express Scripts and Caremark are companies that administer prescription drug benefits for many health insurance companies and Tricare. While you may have health insurance from Anthem, Aetna or another insurer, your pharmacy benefits are usually handled by these companies or their competitors. They also set the formulary for everyone under their prescription drug benefit.
What does this change mean for you?
The drugs listed below are brand names for which there may be a less expensive brand or generic alternative available. If your benefits are provided by Express Scripts or Caremark, you will pay the full cash price at the pharmacy for these brands in 2014. (You can see estimated cash prices on GoodRx by clicking on a pharmacy name after you look up a drug.)
If your coverage is changing, talk to your doctor to see if a covered alternative might work for you. If you can’t switch, you may be able to use GoodRx or find patient assistance programs to help cover the cost.
Which drugs are affected?
Under Express Scripts, many asthma, COPD, and diabetes drugs will no longer be covered, as well as a number of heart meds, cancer treatments, hormones, and nasal sprays. Some of the most notable drugs that will no longer be covered: Advair HFA and Advair Diskus, Flovent HFA and Flovent Diskus, and Proventil HFA inhalers, diabetes meds Novolin, NovoLog, Victoza, and all blood glucose test strips and meters except OneTouch.
These changes do not apply to Medicare plans; if your Medicare benefit is managed by Express Scripts, you should check your coverage with your pharmacist or online through the Medicare.gov portal.
Caremark also made significant changes in 2013, and is adding around thirty more exclusions in 2014. There is some overlap with Express Scripts on the drugs excluded, particularly when it comes to nasal sprays and hormones, and on the general categories covered, but most drugs appear only on one list or the other. For example, Caremark still covers insulins Novolin and NovoLog, while adding Humalog and Humulin to their exclusion list instead.
See the excluded medications below. For a full list of excluded drugs and covered alternatives, see the Express Scripts list here and the Caremark list here. If you’re not sure which company provides your pharmacy benefit, contact your insurance company.
2014 Excluded Drugs (*drugs excluded by Caremark in 2013)
Advair Diskus (Express Scripts)
Advair HFA (Express Scripts)
Apidra (Express Scripts)
Asacol HD (Caremark)
Atacand HCT* (Caremark)
Auvi-Q (Express Scripts)
Avinza (Express Scripts)
Bayer Meters & Strips (both)
Beconase AQ* (both)
Betaseron (Express Scripts)
Bravelle (Express Scripts)
Breo Ellipta (both)
Cimzia (Express Scripts)
Detrol LA* (Caremark)
Diovan HCT (Caremark)
Exalgo (Express Scripts)
Flovent Diskus (Express Scripts)
Flovent HFA (Express Scripts)
Follistim AQ (Express Scripts)
Fortesta (Express Scripts)
Jentadueto (Express Scripts)
Kadian (Express Scripts)
Kombiglyze XR* (Caremark)
Lescol XL (Caremark)
Maxair Autohaler* (both)
Micardis (Express Scripts)
Micardis HCT (Express Scripts)
Nipro Meters & Strips (Express Scripts)
Novolin (Express Scripts)
NovoLog (Express Scripts)
Nutropin AQ* (both)
PegIntron (Express Scripts)
Proventil HFA (Express Scripts)
Rhinocort Aqua* (both)
Roche Meters & Strips (Express Scripts)
Sanctura XR* (Caremark)
Simponi (Express Scripts)
Staxyn (Express Scripts)
Stelara (Express Scripts)
Suboxone film (Caremark)
Teveten HCT* (both)
Tradjenta (Express Scripts)
Tudorza Pressair (Caremark)
Ventolin HFA (Caremark)
Victoza (Express Scripts)
Xeljanz (Express Scripts)
Xopenex HFA* (both)
Zioptan (Express Scripts)
We’ve expanded the selection of prescription and over-the-counter pet meds listed on GoodRx—you can now find and compare prices from four online pharmacies:
All of the pharmacies we list are licensed and US-based, and certified by the National Association of Boards of Pharmacy to advertise prices and fill prescriptions online.
We’re continuing to expand our selection of pet meds and pharmacies, so check back in the coming months for more new additions!
Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your doctor prescribed something for you, and you brought in your prescription, shouldn’t that be enough? What exactly is a prior authorization, and why can’t you just pick up your prescription? Here is what you need to know about the process of prior authorizations.
What exactly is a prior authorization?
It’s an approval from your insurance company, not your doctor. Prior authorization is a step put in place by insurance companies in order to decide whether or they will pay for certain medicines. It doesn’t affect cash payment for prescriptions, and it’s only required on those prescriptions when billed through insurance—so if you’re uninsured or if you decide to pay in cash, you won’t need to worry about getting prior authorization.
What types of prescriptions generally require prior authorization?
Insurance companies want to review prescriptions before paying for them in a variety of situations, including:
– Brand name drugs prescribed when a generic is available
– Drugs that are intended for certain age groups or conditions only
– Drugs used only for cosmetic reasons
– Drugs that are not preventative, or used to treat non-life threatening conditions
– Drugs that may have adverse health effects, including higher than standard doses, or possible interactions, abuse, or misuse
– Drugs that are not covered by your insurance but deemed medically necessary by your provider
In many cases, prior authorizations are intended to be a control to ensure drug use is appropriate and the most clinical and cost-effective therapy is being used.
What should you expect if you need a prior authorization?
In most cases, the pharmacy will notify your healthcare provider, who will provide the necessary information to the insurance company. The insurance company will then decide whether to accept or deny coverage on the medicine.
Since the process takes several steps, it may take some time before the pharmacy has a response. You can usually expect a delay of at least 1 to 2 days, although sometimes it can take longer. If approved, prior authorizations are only valid for a set amount of time and may require periodic re-approval.
What do you do if your prior authorization is denied?
If your prior authorization is denied, your insurance won’t cover the prescription. At this point, you may want to talk to your pharmacist and healthcare provider about alternatives that would be covered. You can also decide to pay out of pocket, and compare discount cards, cash prices, and assistance programs to determine what works best for you.
Some cases when your insurance may decide not to cover your prescription? Cosmetic medicines (such as Retin-A for acne in adults, Propecia for hair growth) or in non-essential medicines (Cialis or Viagra for erectile dysfunction).
Till next time,
The GoodRx Pharmacist
Originally posted June 18, 2013:
We have a problem in the U.S. Vicodin (hydrocodone/acetaminophen) is the number one drug prescribed for any reason in this country. Most folks are shocked to hear that. Should we make it harder to get and if so, how?
This has been a discussion for years that heated up in January 2013 when the FDA voted in favor of reclassifying hydrocodone-containing drugs (Vicodin, Norco, Lortab) from schedule III to schedule II drugs.
Ok, so what does that really change? Rescheduling from schedule III to schedule II means you cannot receive refills of this drug without a new triplicate prescription written out by your doctor. Some schedule II drugs you may know include Oxycontin, Dilaudid, morphine, and fentanyl (Duragesic) patches.
There is no question a prescription for a schedule II drug is harder to get. Electronic prescribing, done by most physicians now, is not allowed for schedule II drugs so you have to visit your doc to get an actual triplicate prescription. Every thirty days.
Schedule II drugs are tracked more carefully, so if multiple doctors are prescribing it or patients are refilling them at different pharmacies we will know this. Again, refills are not allowed with schedule II drug prescriptions so you get thirty days at a time. Trust me, this is a hassle for patients, pharmacists, and physicians.
Will rescheduling Vicodin curb abuse? Nobody really knows. Many doctors already shy away from prescribing schedule II drugs because they feel the burden of refilling triplicate prescriptions is too much to handle in their practices. Maybe the burden of making hydrocodone a schedule II drug will help us appreciate how potent this medication is, so we take it more seriously. The abuse and misuse of these medications in this country cannot be ignored and I wonder if this kind of intervention will be effective in curbing this problem.
Updated October 24, 2013:
The FDA has just made the recommendation to reclassify hydrocodone combination painkillers from schedule III to schedule II.
What does this mean for you? You will be able to get up to a 90-day supply at one time, but you will need to see their prescriber and bring a physical prescription into the pharmacy for each refill. This is half the current supply you can get without a new prescription—at the moment you can refill a prescription up to five times in six months without revisiting your healthcare provider.
The change will also affect who is allowed to prescribe hydrocodone combinations in some states, and how those drugs are stored and tracked in pharmacies.
The FDA’s decision follows a recommendation from an advisory panel in January, and there are a few more steps before the change becomes part of the law. The FDA will submit an official recommendation by December, and changes will not take effect until some time in 2014.