Gonal-F (follitropin alfa) is a hormone and fertility medicine from manufacturer Serono that stimulates egg production in the ovary. In general, the higher the dose, the more eggs are stimulated to grow. Gonal-F comes in two forms: a cartridge (450 IU, and 1050 IU) that fits in to an easy-to-use pen, and a 75 IU vial requring mixing (also known as Gonal-F RFF). It is similarly effective to other drugs from the same family (gonadotropins).
What are the pros of using Gonal-F in fertility treatments?
Gonal-F has a long record of being a safe and effective treatment. Both forms have benefits as well: the Gonal-F pen can be adjusted in small increments, allowing for precise dosing. The Gonal-F RFF vial is slightly less expensive and can be mixed with other fertility medicines, allowing for fewer injections. The pens also provide a good value though—the cartridges each come with over 100 IU of overfill that can still be used.
What are the downsides to Gonal-F?
Does Gonal-F have a generic? Will there be one available in the future?
There are currently no generic alternatives available, but it is possible that one may hit the market in 2016.
Are there any ways to reduce my costs?
If you have insurance, the manufacturer offers a co-pay card that can reduce your costs by up to $200.
If you are uninsured or paying cash, the manufacturer offers a $10 mail in rebate.
However, if you are uninsured and meet income requirements, you could be eligible to save 25%, 50%, or 75% off the price at the pharmacy.
What are the side effects of Gonal-F?
A local reaction to the shot, with redness and swelling, is by far the most common side effect. More significant allergic reactions are possible, but they are rare. Even more rarely, Gonal-F can be associated with over-stimulation of the ovary. This can cause ovarian hyperstimulation syndrome—and that would mean you would need to cancel your treatment cycle.
This is part of a series of guest posts from fertility doctor Dr. Mousa Shamonki. Have any questions or requests for more information? Let us know.
In December 2015, Ventolin HFA (albuterol) inhalers were recalled. The reason for the recall: there were a small number of canisters that did not have enough propellant—meaning the inhalers wouldn’t deliver the full 200 puffs the labeling promises.
Which manufacturer and strengths are affected?
The shortage is affecting GlaxoSmithKline’s Ventolin HFA, in both sizes (8 gram and 18 gram) of the metered dose inhaler.
You may have other options if you can’t get Ventolin HFA:
There are actually three different brand-name albuterol inhalers available in the US. Unfortunately, no generic alternatives are currently approved.
Be aware though—if you have insurance, your plan may only cover one of these options. If Ventolin HFA your only covered albuterol inhaler, your pharmacist or your doctor may be able to help you appeal for an override. Contact your individual plan for more information.
Are any of the other albuterol inhalers unaffected by the shortage?
- Yes. These manufacturers are not having production problems and are still supplying their albuterol inhalers.
- Merck has Proventil HFA available.
- Teva has ProAir RespiClick available. However, Teva’s other inhaler, ProAir HFA, is being rationed and only distributed in small quantities. Teva is trying to prevent a shortage, so pharmacies can still place orders at the moment, just not for a large amount at one time.
What’s the reason for the backorder?
GlaxoSmithKline couldn’t provide a reason for the shortage. However, the recent recall is more than likely the cause.
When will Ventolin HFA be available again?
According to GlaxoSmithKline, the 8 gram inhaler will be available again late this month (February 2016), however, they do not have an estimated release date on the larger 18 gram inhalers at this time.
What can you (and your pharmacist) do about the Ventolin HFA backorder?
You and your pharmacist have a few options, depending on your doctor, your insurance, and the availability of Ventolin HFA:
- If your insurance will only cover a specific brand of albuterol sulfate (Ventolin HFA), they typically will not pay for ProAir or Proventil. However, due to the shortage, your pharmacy can call your insurance company for an override.
It may take a little longer to process your prescription, but the whole process can actually be handled by your pharmacy. One thing to keep in mind though: some insurance companies will only override prescription claims between the hours of 9:00 am to 5:00 pm, so there’s a chance you may not be able to get the override until the next day.
- If your pharmacy doesn’t have Ventolin HFA in stock, but there is another pharmacy nearby that does have it, your pharmacist can transfer your prescription for you. Transferring a prescription will also take a little longer, so plan ahead if you have any time constraints.
- If you have coverage for more than one brand, or if you’re paying cash (or using a GoodRx discount), your pharmacist can fill your prescription with one of the other available brands. However, your pharmacist may need to call your doctor to authorize the change.
- You can contact your doctor’s office directly, and your doctor can call in a prescription for a different medication—either another albuterol inhaler, or another similar medication like Xopenex HFA. For more information on Xopenex HFA check out the manufacturer website here.
A new combination pill is available that will save lives from heart failure. Entresto has been shown to reduce hospitalizations and save lives from heart failure in certain patients. Entresto is a promising pill that is a mixture of old and new—here’s what you need to know.
- Entresto, just approved in July, is a mixture of two medications: valsartan (generic Diovan) an angiotensin receptor blocker (ARB), and sacubitril which is a neprilysin inhibitor.
- What’s new about it? Sacubitril is the newer half of Entresto. Bear with me for some details. Inhibiting neprilysin raises levels of several peptides (small proteins) that have beneficial effects on blood flow in patients with HF. Remember that low cardiac output (low blood flow because the heart can’t squeeze well) is the main problem in heart failure. Saccubitril, the neprilysin inhibitor in Entresto, improves blood flow to the kidneys and improves removal of fluid (diuresis), among other things.
- Does it work? Yes. Entresto reduced mortality and morbidity compared to ACE inhibitors like lisinopril when used in combination with other standard heart failure drugs. So, folks on Entresto had fewer deaths and hospitalizations from heart failure than those on ACE inhibitors or ARBs alone.
- Why does it work? Well, controlling the hormone system that regulates blood pressure is key in the treatment of heart failure patients—and that’s what the valsartan half of Entresto does. The other benefit comes from sacubitril, mentioned above.
- Who will use Entresto? Current recommendations will change once Entresto has been around longer, but right now it’s recommended for people with heart failure and a reduced ejection fraction (forward squeeze of the heart) of < 40%, or for people who have been hospitalized for heart failure in the past 12 months.
- Entresto is used in place of which other drugs? It is recommended in place of an ACE inhibitor (lisinopril, enalapril, benazepril) or an angiotensin receptor blocker (ARB) which include losartan and valsartan. Remember, Entresto contains valsartan—the combination is what makes it more effective.
- Changing tide. As we get more experience with Entresto, it will likely be recommended for a more people, across a broader range.
- Are there downsides to Entresto? A washout period of 36 hours is required prior to starting Entresto. This means you will need to stop taking all ACE inhibitors or ARBs for 36 hours prior to starting Entresto. It’s also new, so there doctors and patients alike have limited experience with it. Finally, as a new drug, the cost will be high.
- Will Entresto replace other heart failure medications like ACE inhibitors? Maybe, but because it’s so new there are no guidelines that have addressed the use of Entresto as an alternative to ACE inhibitor or ARB therapy alone. Stay tuned. [Update August 2016: Guidelines have been updated to recommend Entresto as an alternative to ACE inhibitors or ARBs.]
- How is Entresto taken? Your doctor will decide on your starting dose, and help you increase the dose as you can tolerate it. Generally speaking, the starting dose is a 49 mg/51 mg tablet taken twice daily.
Fertility treatment can be confusing—and expensive, whether you have insurance or not. You may be prescribed several different types of drugs, and they can vary based on the type of treatment you’re receiving.
Progesterone, a natural hormone essential for pregnancy, is one type of medication used in fertility treatments. Examples include progesterone injections (also known as progesterone in oil), Endometrin, Prometrium, and Crinone. Progesterone is used throughout your fertility treatment cycle.
What does progesterone do?
In a natural ovulation cycel, progesterone rises just before ovulation, and causes changes in the lining of the uterus (the endometrial lining). This allows an embryo to implant in the uterus. After implantation, progesterone is essential for maintaining a healthy pregnancy until delivery.
When would I use progesterone?
You may start taking progesterone at various points in your fertility treatment, depending on the type of treatment. Regardless of when your doctor starts you on progesterone, you’ll continue using it for several weeks into your pregnancy, until the placenta starts to take over natural progesterone production.
Here’s what you can expect depending on your particular treatment:
- You may first receive progesterone 1 – 3 days after ovulation.
- During an IVF cycle, where an embryo is transferred soon after the eggs are retrieved, progesterone is generally started 1 – 2 days after the eggs are removed from the ovary instead.
- During a frozen embryo transfer cycle, progesterone is started after estrogen has been used to develop the lining of the uterus, and the embryo transfer is timed with the start of progesterone.
What are the side effects?
Progesterone in oil, because it is an intramuscular injection, can cause redness, swelling, pain, and lumps at the site of the injection. It’s rare, but some people may have a mild allergic reaction to the oil component.
The other forms of progesterone (Prometrium, Crinone, and Endometrin) can cause vaginal discharge and irritation. Again, this is rare, but you can also experience an allergic reaction to one of the components in the tablet, capsule, or gel.
How can I save on my prescription?
Like most fertility drugs, progesterone is likely not covered through your insurance—or you may have a very high co-pay or coinsurance. Fortunately, there still are a few things you can do to bring down your costs.
GoodRx offers discounts at your regular pharmacy, as well as prices from MDR Pharmaceutical Care, a popular online fertility pharmacy. You can save hundreds over the course of your treatment by shopping around.
Endometrin also has a couple of manufacturer offers available. You can save up to $100 each month with the Endometrin Instant Savings Program. The manufacturer also offers an assitance program that will let uninsured patients save even more on Endometrin (and other fertility meds).
There are no manufacturer discounts available for Prometrium, Crinone, or progsterone in oil—but it’s still worth taking a look on GoodRx or asking your doctor how to find a lower price. Additionally, progesterone in oil is a generic medication, which already means you’ll be paying less.
This is part of a series of guest posts from fertility doctor Dr. Mousa Shamonki. Have any questions or requests for more information? Let us know.
So you’ve used GoodRx to compare prices on your prescription, and you found a less expensive pharmacy. But transferring your prescription is a pain, right? It’s actually easier than you may think! Generally, your new pharmacy will want to make the transfer as smooth as possible—and there are a few things you can to do keep things simple:
- Let your new pharmacy know that you want to transfer your prescriptions from your old pharmacy. You’ll need to get them the name, strength, and prescription number of each prescription, along with the phone number of your old pharmacy. You can do this by calling, stopping by the new pharmacy in person—or you may be able to do a transfer online if your new pharmacy offers transfer services on their website or mobile app.
- You’ll also need to give your new pharmacy some personal information, and your insurance information. If they offer online transfers, you can also send this information through their website. The new pharmacy will typically need to know:
- Your first and last name
- Date of birth
- Telephone number
- Any allergies you may have
- Wait for your prescriptions to be transferred. The amount of time your new pharmacy need can depend on how many prescriptions need to be moved over. I recommend giving the pharmacy at least 1 to 3 days before you need to pick up your refills. That way, any issues can be taken care of behind the scenes before you go into the store. If you want the pharmacy to alert you to any possible issues during the transfer process, be sure they have the best phone number to reach you.
- If you want to use a discount or your prescription insurance, make sure you have the coupon or your insurance card with you when you go to fill. The pharmacist will need to enter some information to get you the right price.
If you’re on top of your medication regimen and know which of your prescriptions are eligible to be refilled, transferring your prescriptions should be an easy task. There are still a few things that can keep you from transferring smoothly—though keeping in contact with your doctor’s office can help make sure you don’t run into any of these hiccups in the transfer process:
- Your prescription is out of refills. If your prescription is out of refills your new pharmacy can contact the doctor on your behalf in hopes of getting you a new prescription. I also encourage my patients to reach out to their doctor’s office—you can be out of refills for reasons that your pharmacist won’t be able to resolve (for example: you need a follow-up appointment or blood work, or you no longer need that medication).
- Some prescriptions can’t be transferred. Schedule II controlled substance medications cannot be transferred—at all. They also aren’t eligible for refills; your doctor will need to give you a new prescription every time you fill. Some common examples include Adderall (amphetamine salt combo), Concerta (methylphenidate ER), Vicodin (hydrocodone/acetaminophen), Percocet (oxycodone/acetaminophen), and Oxycontin (oxycodone ER).
- Some prescriptions can only be transferred once. Schedule III, IV, and V controlled substance medications can only be transferred one time, no matter how many refills you have left. If you need to transfer again, you’ll need a new prescription from your doctor. Some common examples of this type of medication include Ambien (zolpidem), Tylenol with codeine (acetaminophen/codeine), testosterone, Ultram (tramadol), and Xanax (alprazolam).