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

Voltaren Gel: Behold the Awesomeness

by Dr. Sharon Orrange on November 27, 2013 at 10:03 am

Voltaren 1% gel has a huge fan base, rightly so. Voltaren 1% gel (topical diclofenac) works as well as anti-inflammatory pills for hand and knee pain due to arthritis, with way fewer side effects. Let’s get this straight. Yep, results from 34 studies were reviewed and the topical anti-inflammatory Voltaren gel alleviated pain in the hands or knees more often than oral NSAIDS (ibuprofen, advil, naproxen as examples).

Although skin reactions are more common with Voltaren gel than with pills, the gel does not carry the risk of gastrointestinal bleed (bleeding ulcers and gastritis) or kidney problems. This is a big deal. Many patients will prefer to go the route of rubbing a gel on the sore joint rather than taking a pill that can irritate the gut and the kidneys.

Currently, topical NSAIDS like Voltaren gel should be considered first line treatment for knee and hand pain due to arthritis. Voltaren gel is often used successfully for foot and ankle pain as well. Voltaren gel has not been well studied for pain in hips, spine and shoulders and you can imagine it’s harder to rub the gel on larger areas but I imagine for localized pain (shoulder as an example) we may be heading there with Voltaren gel.

Dr O.


Dropped by Insurance: Will Your Allergy Nasal Spray Be Covered in 2014?

by The GoodRx Pharmacist on November 26, 2013 at 12:23 pm

Express Scripts and Caremark have removed certain medications from their formulary starting in January 2014. These companies handle prescription benefits for more than 200 million Americans, so your prescription coverage will likely be changing in the new year.

We’re reviewing which prescriptions will no longer be covered and the suggested alternatives to give you a better picture of your options. Listed below are some changes to the coverage of steroid nasal sprays for allergy symptoms from each formulary that might affect you:

Caremark and Express Scripts

Removed medications: Veramyst, Beconase AQ, Rhinocort Aqua, Zetonna, Omnaris, Qnasl
Suggested Alternatives: flunisolide, fluticasone propionate, triamcinolone, Nasonex, Qnasl

I see a lot of patients using Veramyst, however, the alternatives all seem to be good choices—in particular fluticasone propionate (generic Flonase). Veramyst is very similar to Flonase so I don’t think patients will have issues converting.CC by Anna Gutermith

The coverage on both formularies is almost identical in this category, with the exception of Qnasl, which is covered by Caremark but NOT by Express Scripts.

Nasonex has a prescription savings card available from the manufacturer, as does Qnasl.

If you’re taking one of the removed drugs, what should your next steps be?
•  Find out which company handles your prescription coverage. You can often check online, or call the number on your insurance card for more information.

•  Double check the exclusion list to review the removed medications and alternatives: Express Scripts and Caremark.
•  If your prescription won’t be covered next year, contact your doctor or healthcare provider and explain that your pharmacy coverage has changed and that there is a suggested alternative for your current medication.

•  You and your doctor can then decide which alternative to try, or whether to explore other options for coverage.

What if you can’t / don’t want to switch to the covered alternative?

Particularly for specialty pharmacy prescriptions, there are assistance programs out there that may be able to help if your prescription is no longer covered by your insurance plan, and switching isn’t an option for you. Organizations like the Partnership for Patient Assistance and NeedyMeds can help you find which programs you’re eligible for.

Check the official website for your medication. In addition to prescription savings cards, the manufacturer will often offer a patient assistance program. You must meet income requirements or be uninsured for some programs, but others can help if you don’t have coverage for a particular drug.

If all else fails, it never hurts to ask to see if your prescription can still be covered. Have your doctor write a note, plead your case, make some noise – we’ve heard about coverage exceptions for some patients.

One last option: if you’re able to change your insurance plan, many of the drugs excluded by Express Scripts are covered by Caremark and vice versa. If you can find a plan that works for you with the prescription benefit offered by a different company, you may be able to keep your coverage.

The GoodRx Pharmacist


The Six Billion Dollar Pill: Is Nexium Worth the Money?

by Dr. Sharon Orrange on November 21, 2013 at 11:02 am

Proton pump inhibitors (PPIs) work well for the treatment of heartburn, gastroesophageal reflux disease (GERD), and gastric ulcers. Nexium, a brand name PPI not available as a generic, made CC by Rennett Stoweover 6 billion dollars this past year with so many of you paying big money for it.

Why pay for Nexium? Proton pump inhibitors are available over the counter (Zegerid OTC, Prilosec OTC and Prevacid 24HR) as well as many prescription generic forms like pantoprazole (Protonix). So why would you pay for an expensive PPI when a cheaper one is available? I don’t know why. Nexium has never been shown to be superior to any of the other PPIs with the exception of a few drug-company sponsored studies which looked at “maintenance of healing of erosive esophagitis” and Nexium 20 mg edged out lansoprazole (Prevacid) 15 mg a day.

For the most part, all PPIs are created equally. It’s not just Nexium we can wonder about—Dexilant is another expensive brand name PPI—yet Nexium is still raking in an astounding 6 billion dollars a year because you (our patients) are buying it and we (some doctors) are prescribing it. Has the advertising gotten to us?

Just say no to expensive brand name drugs, when a good generic is available and essentially equivalent.

Dr O.


Dropped by Insurance: Will Your Pain Prescriptions Be Covered in 2014?

by The GoodRx Pharmacist on November 20, 2013 at 2:10 pm

Express Scripts and Caremark have removed certain medications from their formulary starting in January 2014. These companies handle prescription benefits for more than 200 million Americans, so your prescription coverage will likely be changing in the new year.

We’re reviewing which prescriptions will no longer be covered and the suggested alternatives to give you a better picture of your options. Listed below are some changes to the pain med coverage from each formulary that might affect you:

Caremark

Removed medication: Flector patches   ||   Suggested Alternative: diclofenac, meloxicam, or naproxen

The convenient Flector patch will be an excluded medication as of 2014. Unfortunately, none of the formulary alternatives are available in patch form. I have seen an increase in the use of Flector patches, especially among pain management doctors and the elderly population due to its indication for post-herpetic neuralgia AKA pain from shingles. A lot of patients have issues with compliance and remembering to take pills or applying gels throughout the day so patches are great for those individuals. Patches are perfect for patients with arthritis due to the ease of application and administration. The removal of Flector Patches from the formulary may unintentionally cause an increase in the prescribing of lidocaine patches for the same reasons I have listed above.

Express Scripts

Removed medications: Avinza, ExalgoKadian   ||   Suggested Alternatives: morphine ER, oxymorphone ER, Opana ERNucynta EROxycontin
Kadian is the concern here—it’s a long-acting morphine, but in capsule form where the covered alternatives are only available in tablet form. This can be problematic because the long-acting opioids cannot be crushed or chewed due to their long-acting ability and this is where a capsule dosage form like Kadian plays a role. The capsules can be opened and sprinkled onto applesauce and then swallowed. This is important for patients who may have issues swallowing tablets—which believe it or not affects a lot of patients.

If you’re taking one of the removed drugs, what should your next steps be?
•  Find out which company handles your prescription coverage. You can often check online, or call the number on your insurance card for more information.

•  Double check the exclusion list to review the removed medications and alternatives: Express Scripts and Caremark.
•  If your prescription won’t be covered next year, contact your doctor or healthcare provider and explain that your pharmacy coverage has changed and that there is a suggested alternative for your current medication.

•  You and your doctor can then decide which alternative to try, or whether to explore other options for coverage.

What if you can’t / don’t want to switch to the covered alternative?

Particularly for specialty pharmacy prescriptions, there are assistance programs out there that may be able to help if your prescription is no longer covered by your insurance plan, and switching isn’t an option for you. Organizations like the Partnership for Patient Assistance and NeedyMeds can help you find which programs you’re eligible for.

Check the official website for your medication. In addition to prescription savings cards, the manufacturer will often offer a patient assistance program. You must meet income requirements or be uninsured for some programs, but others can help if you don’t have coverage for a particular drug.

If all else fails, it never hurts to ask to see if your prescription can still be covered. Have your doctor write a note, plead your case, make some noise – we’ve heard about coverage exceptions for some patients.

One last option: if you’re able to change your insurance plan, many of the drugs excluded by Express Scripts are covered by Caremark and vice versa. If you can find a plan that works for you with the prescription benefit offered by a different company, you may be able to keep your coverage.

The GoodRx Pharmacist


Ten Things You Can Do to Prevent Illness from an Antibiotic-Resistant Bacteria

by Dr. Sharon Orrange on November 20, 2013 at 11:13 am

Antibiotic resistance is a big problem. You’ve all heard about Methicillin-Resistant Staph Aureus (MRSA) causing skin and soft tissue infections but now there is a growing group of resistant bacteria. What this means is many folks may CC by NIAIDface treatment with an intravenous antibiotic or older more toxic antibiotic to treat common infections like E. Coli urinary tract infections. This is because the bacteria have gotten smart and know how to resist penicillins, ciprofloxacin and Bactrim among others.

There are some ways you can try not to be part of the problem:

1. Just say no. Viral infections like colds, flus, most coughs, bronchitis and sore throats don’t need antibiotics. Patients come every day asking for antibiotics for these problems and they won’t help you, and may even hurt you. Symptom relief is the answer here.

2. Every time you take an antibiotic, sensitive bacteria are killed but resistant germs may be left to grow and multiply. Clostridium difficile (C-diff) diarrhea is just one example of what can “overgrow” when we take antibiotics.

3. When you are sick, ask your doctor whether an antibiotic is beneficial for your illness and ask what else you can do to feel better sooner. Please know this often does not include antibiotic therapy.

4. Do not save some of your antibiotic for next time you get sick, throw away any leftover medication.

5. If you do need an antibiotic, have your doctor use one that is targeting the likely pathogen and not a “big gun” antibiotic they may have samples of. Patients often says things like “I want something stronger than amoxicillin,” but know that stronger is not necessarily better and a targeted antibiotic is what you want.

6. The use of antibacterial-containing products (for hand washing and cleaning surfaces) has not been proven to prevent the spread of infection better than products that don’t contain antibacterial chemicals. We don’t know yet whether this may contribute to antibiotic resistance but in some animal studies it does.

7. Long-term antibiotics, like minocycline or doxycycline for acne as an example, will contribute to the development of antibiotic resistance. Use topical or other options first.

8. While many skin and soft tissue infections do require antibiotics, many others don’t. Ingrown toenails, a stye on your eye, or an inflamed bug bite don’t need antibiotics. Not everything that is red and puffy is infected, and your doctor can reassure you if it’s something that will resolve without antibiotics.

9. Antibiotics in your food. Treatment of farm animals with antibiotics accounts for half of the world’s antibiotic use. This has selected for resistant bacteria that may contaminate the food produced. Examples include antibiotic-resistant enterococci and staphylococci from animals that are found in food when the bacteria survive the production processes, as in raw cured sausages and raw milk cheeses.

10. When in the hospital as a patient or a visitor you may see “contact isolation” signs on the doors. Isolation from any bacteria means you must use the disposable gowns/gloves and wash your hands before and after you enter. Don’t spread the problem.

Dr O.


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