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

Type 2 Diabetes: Oral Medication Basics

by The GoodRx Pharmacist on December 30, 2013 at 4:15 pm

In a non-diabetic person, insulin is released from the pancreas with each meal and it helps the body either use or store the glucose it gets from the food. Patients who have type I diabetes don’t produce insulin, and must inject themselves with insulin to mimic the body’s natural process.

Type II diabetics, on the other hand, still produce insulin but their bodies do not use it properly. Type II diabetics can be treated with oral medications, insulin, other injectables, or a combination of different medications.

There are several different types of oral medications that can be used to treat Type 2 diabetes and your doctor will determine which medication is right for you. Treatment also includes lifestyle changes, using medications in combination with proper diet and exercise.CC by Erich Ferdinand

So what are the most common oral prescriptions for type II diabetes, and what do you need to know about them?

Biguanides (Metformin)

Most patients that are newly diagnosed with type 2 diabetes are often prescribed a biguanide, metformin (Glucophage) as one of their first medications. Metformin helps the body respond more effectively to insulin by increasing the absorption of glucose. Metformin has also be known to aid in weight loss which is important for a lot of type 2 diabetics. The most common side effect of metformin is upset stomach with diarrhea. Metformin is usually taken once or twice daily and is available in regular and extended released formulations.

Sufonylureas (Glipizide, Glyburide, Glimepiride)

The second most common class of medications for type 2 diabetics is the sulfonylureas, however, they are no longer considered one of the best or safest treatment options (see more information here). Sulfonylureas work by telling the pancreas to release more insulin. The most common medications in this class are glipizideglyburide, and glimepiride. The most common side effect is hypoglycemia, and these medications are usually taken once or twice daily before meals.

Glinides (Starlix, Prandin)

Another class of medications that work by telling the pancreas to release more insulin are the glinides or meglinitides Prandin (nateglinide) and Starlix (repaglinide). Similar to the sulfonylureas, these can also cause hypoglycemia. These medications are typically taken three times daily before breakfast, lunch, and dinner, and if you skip a meal, you are supposed to skip that dose.

Glitazones (Avandia, Actos)

The glinides or thiazolidinediones have seen a lot of controversy over the past few years which lead to strong restrictions on one drug in the class, Avandia. However, Actos (pioglitazone) is still more readily available. These medications improve the effectiveness of the insulin produced and decrease the amount of glucose made in the liver. However, they can cause increased risk of liver problems, bladder cancer, and heart problems.

Alpha Glucosidase Inhibitors (Precose, Glyset)

An older class of medications, alpha glucosidase inhibitors like Precose and Glyset are rarely used. They need to be taken with the first bite of a meal and work by slowing the absorption of carbs in the intestine to lower the after-meal levels of glucose. Alpha glucosidase inhibitors can cause gas and bloating which has lead to their less frequent use. Similarly to the glinides, these medications are taken three times daily of a meal, and if you skip a meal, you skip that dose.

Bile Acid Sequestrants (Welchol)

The bile acid sequestrants are another less common class of medications for treating diabetes, though they are used more often to treat high cholesterol. Welchol is one example. Some doctors will prescribe Welchol in combination with another oral diabetes medication or insulin. The most common side effects of bile acid sequestrants are gas and constipation.

SGLT2 Inhibitors (Invokana)

A newer class of medications, Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors, works differently than any other available. Invokana is the only drug in this class, and it works to help remove excess sugar from the body via urination rather than allowing it to be reabsorbed by your kidneys. Invokana is usually taken once daily, before your first meal of the day. The most common side effects are yeast and urinary tract infections.

Diabetes can be overwhelming, especially if you have been newly diagnosed. It is important to understand your condition and your options so that you work can work with your doctors to make informed decisions for yourself in the future. Look for more information in upcoming posts about other treatment options and general knowledge.

The GoodRx Pharmacist


Dropped by Insurance: Will Your Epinephrine Pen Be Covered in 2014?

by The GoodRx Pharmacist on December 23, 2013 at 12:17 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. Express Scripts has made a change in their coverage of emergency allergic reaction meds that may affect you:

Removed medication: Auvi-Q   ||   Suggested Alternatives: EpiPen, EpiPen Jr
Auvi-Q is the new injectable that literally talks you through the injection process if you are having an anaphylactic allergic reaction. It is more expensive and also brand new compared to the formulary alternative, EpiPen. A lot of allergists have been prescribing Auvi-Q recently so problems may arise at first, but there isn’t too much cause for concern here—EpiPen and EpiPen Jr. are solid alternatives.

Both EpiPen and Epipen Jr also have savings available from the manufacturer, which you can find here.

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.

•  If Express Scripts handles your coverage, double check the Express Scripts exclusion list to review the removed medications and alternatives.

•  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


Dropped by Insurance: Will Your Suboxone Be Covered in 2014?

by The GoodRx Pharmacist on December 20, 2013 at 7:15 am

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. Caremark has made a change in their coverage of opioid dependence meds that may affect you:

Removed medication: Suboxone film   ||   Suggested Alternatives: buprenorphine/naloxone sublingual tablets

Caremark’s coverage of Suboxone film is being replaced by the sublingual tablet form, which is now only available as generic buprenorphine/naloxone—brand name Suboxone sublinguals have been discontinued.

The Suboxone films and their unit-dose, child-resistant packaging are intended to help limit the accidental pediatric exposure that was an issue with the sublingual tablets. The U.S. Poison Control Centers found out that accidental pediatric exposure with the tablets was 7.8 – 8.5 times greater than with the Suboxone film. Therefore, we may see an increase in the exposure rate of buprenorphine/naloxone tablets in children with parents on Caremark insurance, which is an alarming thought.

Also, the sublingual tablets are not available in the same strengths as the films which may hinder treatment when converting from films to tablets at first. The Suboxone films are available in the following strengths: 2 mg/0.5 mg, 4 mg/1 mg, 8 mg/2 mg, and 12 mg/3 mg. The buprenorphine/naloxone tablets only available in the 2 mg/0.5 mg and 8 mg/2 mg strengths. The 4 mg/1 mg and 12 mg/3 mg film strengths will no longer be an option when switching products.

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.

•  If Caremark handles your coverage, double check the Caremark exclusion list to review the removed medications and alternatives.

•  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


Can I Switch From Warfarin (Coumadin) to Xarelto?

by Dr. Sharon Orrange on December 19, 2013 at 11:39 am

The newer anticoagulants like Xarelto (rivaroxaban), known as Factor Xa inhibitors, save you from repeated blood tests for INR checks that you will need while on Coumadin (warfarin). Many folks wonder how they can change from Coumadin to the newer medications.

First, who can use Xarelto? Xarelto is a pill approved for use in folks with a known clot in their leg (deep venous thrombosis or DVT), a clot in their lung (pulmonary embolism or PE), prevention of clot/stroke in people with atrial fibrillation who do NOT have valve disease, and to decrease the risk of forming a clot in your leg or lung after hip or knee replacement surgery.

So how can you transition to newer anticoagulants (Xarelto, Eliquis, or Pradaxa) from warfarin? Only switching warfarin to Xarelto has been specifically studied and the recommendation is that rivaroxaban be started only when the INR is < 3.0 and you’ve stopped your warfarin. There have been no studies that have evaluated the optimal method of switching patients from warfarin to either Eliquis or Pradaxa. Until we have done these studies the current recommendations are as follows: dabigatran (Pradaxa) or apixaban (Eliquis) may be started after you discontinue your warfarin AND your INR is < 2.0.

Dr O.


Long Acting Insulin Pen Essentials

by The GoodRx Pharmacist on December 16, 2013 at 3:49 pm

There are several different medications on the market that can help you manage your diabetes, and insulin is an important part of that regimen, used to control type 1 diabetes, or type 2 diabetes that isn’t being adequately managed by oral drugs. There are a few types of insulins available, categorized by how quickly they take effect and how long they last. These include rapid-acting, regular- or short-acting, intermdiate-acting, and long-acting insulin.

What are the benefits of using long-acting insulin?

Long-acting insulin is slowly absorbed after injection over a period of 24 hours and mimics the body’s natural secretion of insulin. The long acting ability allows for slow and even absorption with no peak, which permits the convenient ONCE-DAILY dosing. Currently, there are two types of long acting insulin, Lantus and Levemir.

Both Lantus and Levemir are available in conventional vials as well as convenient prefilled disposable pens. The conventional method of drawing insulin up into a syringe is becoming less popular because it can be tedious and hard to do if you have dexterity or vision problems. In contrast, insulin pens are gaining popularity due to their convenience and ease of use.

Many insurance plans will only cover either Lantus or Levemir, but if you have a choice, there are a couple of things to weight about each option. Below is some information about the different pens that might help you make that decision, including manufacturer assistance, features, how to use the pens, storage information, and which pen needles to use.

 

Lantus SoloStar Pen

Lantus is the long-acting insulin option from Sanofi-Aventis. It’s available in the SoloStar pen, sold in boxes of 5, or in individual 10 ml vials.

The Basics:

• The manufacturer offers a guide and video on how to inject Lantus using the SoloStar Pen.

Lantus can be used in patients 6 years of age and older.

Lantus is considered pregnancy category C, which means that use during pregnancy isn’t recommended unless your doctor determines that the benefits outweigh the risks.

• It is the only 24 hour insulin approved exclusively for ONCE DAILY dosing.

• It helps control blood sugar for up to 24 hours with no pronounced peak.

• Dosing is in units.

• Pens last for 28 days once in-use.

• Cost: about $300+ for a box of 5 SoloStar pens. There are also manufacturer discounts available.
Lantus SoloStar Pen Features:

• The SoloStar pens can use ultrafine needles, which means less painful injections.

• The dosing window has large print for easier visibility.

• You can use the dial to increase or decrease your dose.

• There is a button at top of the pen that you push for an easy injection.

• The pens are disposable.

How should I store Lantus?
Not in-use (unopened):

• Store in the original carton in a refrigerator at 36ºF to 46ºF (2ºC to 8ºC).

Lantus can be refrigerated until the expiration date. Once that has passed it needs to be thrown out.

• If not stored in a refrigerator, it must be used or discarded within 28 days.

• Before using, remove the pen from the fridge for 1-2 hours (since cold insulin can be more painful to inject).

In-use (opened):

• Once in use DO NOT refrigerate—keep at room temperature.

Always throw away used pens after 28 dayseven if there is still insulin remaining.

Which pen needles do I use with Lantus?
Lantus is designed to be used with BD Ultra-Fine pen needles:

• BD original pen needle 29G 12.7mm

• BD mini pen needle 31G 5mm

• BD short pen needle 31G 8mm

• BD nano pen needles 32G 4mm

 

Levemir FlexPen

Levemir is the long-acting insulin option from Novo Nordisk. It’s available in the FlexPen, sold in boxes of 5, or in individual 10 ml vials. There is a new version coming soon as well: the Levemir FlexTouch Pen, which will have a dosing mechanism that ensures the push-button does not extend at any dose—this means the pen will be as easy to use for large doses as for small doses.

The Basics:

• The manufacturer offers a guide and video on how to inject Levemir using the FlexPen.

Levemir can be used in patients as young as 2 years old with type 1 diabetes. This is several years younger than the recommended age for Lantus (6 years old).

Levemir is considered pregnancy category B, which means studies have failed to demonstrate a risk to the fetus during pregnancy.

• It helps control blood sugar for up to 24 hours with no pronounced peak.

• It can be used once or twice daily.

• Dosing is in units.

• Pens last for 42 days once in-use.

• Cost: about $300+ for a box of 5 FlexPens. There are also manufacturer discounts available.
Levemir FlexPen Features:

• FlexPens are prefilled with 300 units of insulin.

• The pens have a large dosing window, which makes it easier to get an accurate dose adjustment.

• You can use the dial to increase or decrease your dose.

• There is a button at top of the pen that you push for an easy injection.

• The pens are disposable.

How should I store Levemir?
Not in-use (unopened):

• Keep your pens in the refrigerator, between 36° to 46°F (2° to 8°C).

In-use (opened):

• Once in use DO NOT refrigerate. Pens can be used for up to 42 days when kept at room temperature, below 86ºF.

• Your in-use pen be stored with the rest of your diabetes supplies—that means NO cooler needed for travel.

Always throw away used pens after 42 dayseven if there is still insulin remaining.

Which pen needles do I use with Levemir?
Levemir is designed to be used with Novofine pen needles:

Novofine 30G 8mm

Novofine Autocover 30G 8mm

Novofine 32G 6mm

Novotwist 30G 8mm (this is a NEW pen needle option)

 

Also, look for more information on different types of insulin, mixes, and new treatment options in upcoming posts!

The GoodRx Pharmacist


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