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

New EpiPen Generic Approved In Response to Concerns Over Pricing

by Elizabeth Davis on August 29, 2016 at 4:28 pm

In response to criticisms over EpiPen pricing, manufacturer Mylan will be offering an authorized generic alternative sometime in Fall 2016.

For more background on EpiPen pricing, and other less-expensive alternatives, see the previous GoodRx articles on EpiPen here and here.

Here’s what you need to know about the new EpiPen generic.

How much will the new generic cost?

Mylan has said that the new generic will have a list price of $300, about 50% of the cost of brand name EpiPen.

When will the new EpiPen generic be in pharmacies?

As of August 2016, the manufacturer estimates that it will be several weeks before you will be able to fill a prescription for generic EpiPen. The generic release is currently waiting on some labeling changes, but if all goes well you should see it in pharmacies soon.

What can I do to save in the meantime?

You have a few options:

  • Adrenaclick‘s authorized generic epinephrine is available for as low as $150 with a GoodRx discount. There is also a co-pay card for the generic that could reduce your cost by $300—again, to as low as $150 depending on where you fill.
  • Brand name EpiPen also has a co-pay card available. Mylan just increased the savings per fill from $100 to $300. This should help, especially if you have prescription insurance with a lower co-pay. However, if you’re paying cash, your out of pocket cost for EpiPen or EpiPen Jr would still be at least $300, even with the card.
  • Keep your coverage in mind if you have insurance. Generic Adrenaclick may have a much lower co-pay (Tier 1) vs brand name Adrenaclick or EpiPen (Tier 2) on many plans.

Using an expired epinephrine pen is NOT a good way to cut costs. Epinephrine pens usually expire about a year from when you fill your prescription, and they do get less effective over time. If the medication in your pen is discolored or has visible particles, you’ll want to throw it out immediately—don’t use it.

Will there still be ways to save on brand name EpiPen?

Mylan has said that the EpiPen co-pay card will remain available. This is good news, because many manufacturers drop this kind of discount program after a generic is released. The current co-pay card expires on 12/31/2016, but could be renewed to last at least another year.

Mylan will also launch a direct shipping program for both EpiPen and the EpiPen generic that will let you order straight from the manufacturer at the new discounted price.

If you are eligible, Mylan will also continue to offer need-based financial assistance for EpiPen.

How does this compare to prices for other new generics?

At 50% of the cost of brand name EpiPen, the new epinephrine pen will offer better savings than many other new generic releases. Most start at around 80% of the brand name price, and will decrease from there.

Some food for thought though—even at a 50% discount, the new generic will still be three times the cost of EpiPen before prices started to increase (from $100 for a two-pack in 2007).

What are the upsides of the new EpiPen generic?

  • Cost. The cash price with no discounts or insurance coverage will be the lowest of any epinephrine pen out there ($300 vs $400 – $450 for the next lowest, the Adrenaclick generic). You may still be able to get a better price elsewhere using a discount.
  • Coverage. If you have insurance, the new generic will likely be covered under your lowest tier or least expensive co-pay. Brand name EpiPen and Adrenaclick tend to be Tier 2 or preferred brands, with higher out of pocket costs for you.
  • Ease of use. If you already use EpiPen, you won’t need to learn how to use a new autoinjector. Mylan has said that the device functionality will be identical in the brand and generic.

Are there any downsides?

Cost again. It will still pay to compare your options. Depending on your coverage and the discounts you use, the Adrenaclick generic will remain the least expensive for now.

Is there anything else I should know?

You may need a new prescription to get the new generic. Depending on where you live, your pharmacist may or may not be able to automatically substitute if your original prescription was for EpiPen or EpiPen Jr.

If you want to take advantage of the new savings, ask your doctor to prescribe you generic epinephrine.

EpiPen vs Adrenaclick: You Have Options

by Dr. Sharon Orrange on August 25, 2016 at 10:45 am

EpiPen has been in the news lately and you should know why. Mylan, the pharmaceutical company that manufactures EpiPen, increased the price of their auto-injector by 400% since 2007.

What no one seems to be talking about: there are much less expensive alternatives out there.

When it comes to preloaded epinephrine pens (like EpiPen), you now have three choices.

Auvi-Q was recalled in the U.S. in 2015, so don’t use this.

Why would I need an EpiPen?

Because you’ve had a severe allergic reaction (anaphylaxis). Anaphylaxis does NOT have to mean anaphylactic shock. Anaphylaxis has many different signs and symptoms. Here are some examples:

  • 90% of people will have skin symptoms: hives, flushing (redness), swollen lips or tongue, and swelling around the eyes.
  • 70% of folks having anaphylaxis will have breathing symptoms including runny nose or nasal congestion, change in voice, a sensation of throat closing or choking, shortness of breath, and wheezing or cough.
  • 45% of those having anaphylaxis will have gastrointestinal issues like nausea, vomiting, diarrhea, and crampy abdominal pain.
  • 45% of people experiencing anaphylaxis will have the scarier cardiovascular symptoms including fainting or near-fainting, dizziness, fast heart rate, and low blood pressure.

Why do epinephrine pens help?

Simply put, epinephrine can reverse the symptoms of anaphylaxis. It works by increasing blood pressure (it does this by causing the vessels to constrict) and decreasing swelling. Epinephrine also works to open up the airways.

Which pen should I use?

Just look at cost, and pick the one that is cheaper. The retail cash cost of the autoinjectors ranges from $450 to more than $700—but using a GoodRx discount, you could pay as little as $150 for generic epinephrine at some pharmacies.

If you have insurance, you could also pay a lot less using the generic. The epinephrine pen is covered as a Tier 1 generic under most plans, while EpiPen and Adrenaclick are more likely to be Tier 2 with a higher co-pay.

Is there any reason I should use brand name EpiPen or Adrenaclick?

All of the autoinjectors (Adrenaclick, EpiPen, and the epinephrine pen) are great choices for you, and work equally well. Find the most affordable one.

If you do switch though, keep in mind that the different pens work in slightly different ways. Plan ahead, and know how to use your autoinjector. You can find training videos on the Adrenaclick website here, and the epinephrine autoinjector website here.

What if I want to keep using EpiPen?

Mylan, the manufacturer of EpiPen is responding to complaints about the pricing by offering a few ways to keep your costs down. They currently offer a co-pay card that will let you save $100 off your out of pocket costs, and will soon be increasing the savings to $300 per fill.

Mylan will also introduce the option to order EpiPen directly from them, which could help you save some more.

If you’re still having trouble affording EpiPen, Mylan is also increasing the number of patients they will accept for their financial assistance program.

Are there any other discounts out there?

Yes. Epinephrine (the Adrenaclick authorized generic) already offers a co-pay card that will let you save up to $300 per fill.

Avoid the Sun If You Take These Drugs

by The GoodRx Pharmacist on August 24, 2016 at 2:55 pm

If you’re enjoying the sunshine one last time as summer comes to an end, it is important to know that some of your medications could cause you an unexpected problem. You may not be aware, but some prescriptions can increase your sensitivity to sunlight—causing your skin to burn more easily.

What type of reaction can occur?

If your medication has a warning to avoid sunlight, don’t ignore it. That usually means that you could be more sensitive to sunlight (photosensitive), which would cause you to sunburn more easily. You may also end up with a worse sunburn than usual—even a little exposure could mean a severe burn.

What is photosensitivity?

Photosensitivity is an abnormally high sensitivity to ultraviolet (UV) rays from the sun. You could also be affected by other light sources, including indoor fluorescent lights. The reaction to UV or fluorescent lights can cause itchy spots or areas of redness and swelling on patches of sun-exposed skin.

What are some medications that can cause skin problems if you are exposed to the sun?

There are a few basic types of medications that could cause sensitivity to the sun:

How can I minimize my exposure to the sun?

There are a few things you can do to cut down on your sun exposure. First, and this may be obvious—avoid direct exposure to the sun. You’ll also want to stay away from tanning beds—this is as bad or worse than direct sun exposure.

If you do need to (or want to) spend time outside, wear sunscreen! Protective clothing like long sleeves, pants, hats, and sunglasses can also help.

What can I do if I’ve been more sensitive to the sun because of a medication I’m taking?

This is pretty similar to regular sunburn treatments—try cool compresses, and topical corticosteroids like hydrocortisone to relive irritation.

As EpiPen Prices Soar, What Are Your Options?

by Elizabeth Davis on August 23, 2016 at 5:16 pm

This is an update to our 2012 Get to Know the EpiPen article.

For 1 – 2% of Americans, a bee sting or food allergy can cause anaphylaxis, a potentially fatal allergic reaction. Fortunately, these symptoms are easily treatable. Since the 1970s, epinephrine auto-injectors (EpiPen being the most common) have provided a life-saving treatment for anaphylaxis.

Unfortunately, patients (and parents) can’t predict where and when a reaction can begin, so they need to purchase EpiPen for home, work, school, car and anywhere else one might be needed in an emergency. Plus, EpiPen has a limited shelf life and need to be replaced frequently, creating more expense.

Why are we telling you all this? Because Epipen prices have increased over 400% from 2011 to 2016. The cash cost of a 2-pack has risen from about $150 to over $600. Not only have prices increased, but you’re paying a larger share of the cost as more and more plans shift to high deductibles.

Why have EpiPen prices increased?

There used to be other alternatives to EpiPen, but they are no longer available. Twinject, with two doses per injector, was discontinued in 2012. Auvi-Q hasn’t been discontinued, but all lots were recalled in 2015, and it isn’t back in pharmacies yet. With so many competitors no longer available, Mylan has been free to raise the cost of EpiPen without decreasing demand.

4 ways to save on EpiPen

  1. EpiPen, Adrenaclick, and epinephrine are all sold with two injectors per package. Epinephrine is an authorized generic for Adrenaclick (meaning the manufacturer allowed a generic to be made), and is by far your least expensive option, whether you have insurance or not.
  2. EpiPen manufacturer Mylan does offer a co-pay card to offset the cost. It’s a $0 co-pay card—there’s no minimum you have to pay—but has a savings limit of $100 per fill. This can be a huge help if you have insurance with a typical co-pay. However, if you have a high deductible or pay cash, there are better ways to save.
  3. Mylan also offers a patient assistance program for uninsured and lower-income patients. It’s worth a look if you’re still having trouble affording EpiPen.
  4. There are no manufacturer discounts for Adrenaclick, but generic epinephrine is the most affordable pen out there. With a GoodRx discount, you can find it at Walmart for under $150, Walgreens for under $200, and at Rite Aid for just over $200.

Here are some key things to keep in mind about Epipen and the other epinephrine auto-injectors:

  1. Ask your primary care doctor or pediatrician which auto-injector is best for you—but here are your choices:
  2. 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.
  3. Side effects of epinephrine are minor and pass quickly. You may experience tremor, dizziness, palpitations, anxiety, restlessness, and headache, but they should pass quickly.
  4. 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).
  5. 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.
  6. 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. A second dose may be needed 5 to 15 minutes after the first.
  7. Why is it so important that epinephrine pens stay readily available? Anyone who has experienced anaphylaxis should have access to epinephrine for self-treatment as it is the best treatment available.

Which Medications Work the Best to Help Me Stop Drinking?

by Dr. Sharon Orrange on August 18, 2016 at 12:40 pm

While interventions like group or individual therapy are effective for alcohol abuse, 70 percent of people relapse after psychosocial treatment alone. There are several medications that can be used to treat alcohol use disorder, leading to reduced heavy drinking and increased days of abstinence. So here are the fab five to get to know:

1. Naltrexone (Vivitrol)

Naltrexone is one of the first line treatments, and you may start it while you are still drinking without the need for a detox program first.

How does it work? Naltrexone works to suppress alcohol cravings by blocking the mu-opioid receptor. Blocking the effects of naturally occurring opioids will help block the reinforcing effects of alcohol.

How is it taken? In two ways: a tablet daily, or a once monthly injection. Vivitrol (the brand name of the injection) and naltrexone pills have never been compared in head to head studies so we don’t know which one works better, or if they are the same. Naltrexone cannot be used by people taking opioid medications.

Does naltrexone work? Sort of. Studies show that naltrexone reduced the risk of heavy drinking to 83 percent of the risk in the placebo group (those taking no medications), and decreased drinking days by about 4 percent. It does cause some nausea and headache—though the longer you take it, the fewer symptoms you will have. It is a first line treatment (meaning it is tried before other medications), though as you will see below, it works the same compared to topiramate.

2. Disulfiram (Antabuse)

Disulfiram cannot be started while you are still drinking. In fact, it will make you quite sick if you take it with alcohol, which is sort of the point of it.

How does it work? Disulfiram inhibits aldehyde dehydrogenase so it prevents the metabolism of alcohol’s primary metabolite, acetaldehyde. Nausea, vomiting headache and flushing will occur if you drink alcohol while taking this medication.

How is it taken? Disulfiram is a pill taken at a dose of 500 mg per day for one to two weeks, then lowered to 125 mg a day.

Does it work? Not so well. A 2014 meta-analysis did not find that it was any better than placebo. It may work in a small subset of people who are given it under supervised conditions.

3. Acamprosate (Campral)

Acamprosate should also be used once you’ve stopped drinking.

How does it work? Acamprosate works to dampen desire for alcohol by modulation of glutamate receptors in the brain.

How is it taken? Acamprosate is a pill, and you’ll take two pills, three times a day.

Does it work? Acamprosate has had mixed results and does not appear to have a significant effect on heavy drinking. Some studies show it does work in others. In those cases, it reduces the rate of return to any drinking, and increases abstinence rates by 11 percent. It is generally well tolerated, though diarrhea is the most common side effect reported.

4. Topiramate (Topamax)

Topiramate is used for migraine prevention, seizure disorder, and to suppress appetite—and now for alcohol dependence. It can be used if you are still drinking.

How does it work? Topiramate works by altering the balance of chemicals in the brain, which reduces the “rewarding” effect of consuming alcohol.

How is it taken? You’ll increase your dose of topiramate gradually over several weeks, starting at 25 mg per day and increasing to a maximum of 75 mg a day.

Does it work? Yes, a review of several studies found that topiramate reduced the percentage of heavy drinking days compared to placebo when taken over 14 weeks. Three trials comparing naltrexone to topiramate found no difference in outcome, so both appear to work the same.

5. Baclofen (Lioresal)

Baclofen is a muscle relaxant that has been found in small studies to be effective in the treatment of alcohol dependence.

How does it work? Baclofen also reduces the “reward” you feel from consuming alcohol.

How is it taken? Baclofen is available as 10 mg tablets, and in studies the effective dose was 10 mg three times daily (30 mg).

Does it work? People taking baclofen for 12 weeks were more likely to be abstinent from alcohol (71% vs 29%). Taken at a day it may be effective for alcohol dependence. Baclofen is well tolerated and has been around forever, so it is a tempting option.

How long will you take any of these medications?

Most research suggests two to six months, with at least six months being the preference of most experts.

Can I just stop the meds or do I need to taper?

Only topiramate (Topamax) requires a tapering to discontinue it over a few weeks.

Dr O.

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