We have good news for your health wallet! Humira (adalimumab), a popular specialty medication used to treat rheumatoid and psoriatic arthritis, will soon have a less expensive alternative, Amjevita (adalimumab-atto).
Amjevita is a “biosimilar” to Humira (because biologic drugs like Humira can’t have traditional generic alternatives), and will be offered at a reduced cost. Amjevita is now the 1st FDA approved biosimilar for Humira, the 2nd biggest selling drug of 2015.
If you are not sure what a biosimilar is (don’t worry, you’re not alone) check out one of our previous blog posts about biosimilars here.
Can Amjevita be used for all the same indications as Humira?
Unfortunately, no. Humira has been approved for 10 conditions, whereas Amjevita has only been approved for 7 conditions, listed below:
- Pediatric patients 4 years of age and older with moderate to severe active polyarticular juvenile idiopathic arthritis.
- Moderate to severe active rheumatoid arthritis.
- Moderate to severe active Crohn’s disease (adult).
- Moderate to severe active ulcerative colitis.
- Adults with chronic moderate to severe plaque psoriasis.
- Active ankylosing spondylitis (arthritis of the spine).
- Active psoriatic arthritis.
What are the other 3 indications that Humira was approved for?
Amjevita is not approved for the following conditions:
- Hidradenitis Suppurativa
- Pediatric Crohn’s disease
What type of cost-savings will Amjevita offer?
Amgen, the manufacturer of Amjevita, did not discuss the price of the drug in its recent press release. However, based on previous biosimilar cost savings, you can expect a discount of around 15%-30% of the cost of Humira.
What dosage forms and strengths will Amjevita be available as?
Amjevita comes in a single use pre-filled syringe in both 20mg/0.4ml and 40mg/0.8ml strengths, and a single-use pre-filled sureclick autoinjector in a 40mg/0.8ml strength.
How will Amjevita be administered?
Amjevita should administered by subcutaneous injection every week, or every other week. The dosing will be different for each individual based on the diagnosis.
If the doctor writes for Humira, can the pharmacy fill Amjevita instead?
Unfortunately, no. This is where biosimilars differ from regular generics. Amjevita is a biosimilar, not an interchangeable product. Interchangeable products are usually generic medications that can be substituted for a brand name medication without needing to consult the prescriber.
When was Amjevita approved by the FDA?
Amjevita was approved by the FDA on September 23rd, 2016. There is currently no estimate for when it will be available in pharmacies.
What are the common side effects of Amjevita?
The most common side effects include infections, and redness, swelling, or itching at the injection site.
Want to read more about Amjevita?
Take a look at the FDA announcement for Amjevita’s approval here.
You can also check out the manufacturer website here.
Omeprazole (Prilosec) is a cheap, generic medication available both over the counter, or with a prescription. Used for the treatment of reflux disease, ulcers, and stomach protection from NSAIDS (non-steroidal anti-inflammatory drugs), it is one of the most common medications used by adults. Omeprazole is a proton pump inhibitor (PPI), a class of drugs that are used to treat GERD, ulcers and heartburn.
Even if you’ve been taking omeprazole for a while, there may be some things you aren’t aware of:
- Omeprazole can prevent illnesses? Studies have shown that people treated with omeprazole have different communities of bacteria than untreated patients. Specifically, people taking omeprazole have higher counts of bacteria (not a good thing) like enterococcus, streptococcus, staphylococcus and some species of escherichia coli. The significance of this is not fully known, but the gut bacteria play an important role in our defense against pathogens, so disrupting the gut flora may be a downside of omeprazole. Disrupting the gut flora—which allows some “bad” bacteria to overcome the “good” bacteria—may be why people taking omeprazole are at higher risk of clostridium difficile infections. We may learn that omeprazole, and other proton pump inhibitors, have more prominent effects on the gut bacteria than antibiotics.
- Is it the best medication for stomach issues? Studies show omeprazole works better than rabeprazole (Aciphex) for more stomach issues, but it does not work as well for GERD as esomeprazole (Nexium).
- Omeprazole and risk of heart attack?! A study released in August 2016 found that taking PPIs, like omeprazole, could be a risk factor for cardiovascular adverse events. The full impact of this has not been fully explored, but in this study, the sustained use of PPIs was associated with a 70% increased cardiovascular risk–and that was higher in those taking omeprazole for an extended period of time.
- What about acupuncture? Acupuncture worked better than Omeprazole in a recent study out of China in 2016. The researchers compared the outcomes of GERD in patients taking omeprazole versus those undergoing acupuncture treatments. After 8 weeks, both groups had improved symptoms but the effect of acupuncture was significantly superior to that of omeprazole for improving symptoms. Worth a try!
- Can I take omeprazole “as needed” when I have symptoms? Unfortunately, it doesn’t work that way! Taking omeprazole once a day will only inhibit the acid in your stomach after five days. So, taking it on an “as needed” basis will not provide enough acid suppression and symptom relief. However, some histamine-2 antagonists, like Tagamet, Ranitidine or Zantac, are better for that.
With all of the attention on EpiPen prices recently, you may not be surprised to find that other drugs have seen similar price increases.
In the case of Aloquin, though, the rising cost is even more puzzling. Over the past year, Aloquin has increased from around $250 per tube of gel to over $9000—a price hike of more than 3500%.
Is Aloquin a one-of-a-kind drug?
Sort of. Aloquin is the only combination of just iodoquinol, an anti-fungal treatment, and aloe. BUT you can get generic iodoquinol combined with hydrocortisone for $40 – $50 per tube . . . and buy aloe over-the-counter at your local store.
Is the price justified?
In this case, it’s a pretty clear no. As an example—Caremark, one of the largest providers of prescription insurance will no longer cover Aloquin. Why? Aloquin falls under their new “hyperinflationary drugs policy.” It’s considered a product “with egregious cost inflation that [has] readily-available, clinically-appropriate and more cost-effective alternatives.”
What does that mean? Basically, a drug that has seen a drastic, unjustified increase in price can be excluded if there are reasonable alternatives on the market.
Why the huge price hike then?
Manufacturer Novum immediately increased the price by more than 10x in 2015 within a month of purchasing Aloquin from Primus Pharmaceuticals—from that initial $250 to over $2500 per tube. Since then Novum has continued to raise prices.
Novum also purchased a couple of other skin meds at the same time—including Alcortin A and Novacort—which have seen similar drastic price increases. After the purchase in mid-2015, Alcortin A jumped from around $200 to $2500, and Novacort from around $130 to $2500.
What are my options?
Fortunately, unlike with EpiPen, there are lots of options out there to help acne, eczema, and the fungal infections Aloquin is used to treat. If your doctor has prescribed you Aloquin, ask about generic hydrocortisone/iodoquinol. Some people are prescribed Aloquin because they may not be able to use hydrocortisone. In that case, ask whether another medication altogether might work for you.
There are discounts out there for Aloquin, but they may not do you much good. If you’re paying out of pocket, a GoodRx discount can save you almost $6000 . . . but would still leave you with a $3500 price tag.
Novum also offers a patient savings card that claims most insured patients will pay $0, and cash patients could pay as low as $35. However, as with most manufacturer offers, you should be aware that if your plan doesn’t cover Aloquin—or if you’re paying cash—your costs could be higher.
Skin abscesses are more common than you might think, and are usually caused by bacteria that live on the skin or adjacent mucous membranes (like in the nose). More often than not, the staphylococcus aureus bacteria is the most common culprit. In many cases, the cause of abscess is a staph aureus bacteria called MRSA that has become resistant to some antibiotics.
What’s in a name? A skin abscess is a collection of pus that develops under the skin. A common skin abscess that you might have heard of is a boil. A boil (also known as a furuncle) is an infection of the hair follicle that causes a painful pus-filled bump on your skin. I know, I know, these sound gross, but they are actually very common!
How do I treat it? There is good news! For most of the small boils and abscesses, a warm towel compress may be all you need for the pus to drain on its own. In some cases, if a compress doesn’t work, you might need to visit your doctor. During this visit, your doctor might numb the abscess and drain it, a procedure known as “incision and drainage” or “I and D.” This drainage, or pus, may be cultured in the lab to help guide potential antibiotic use.
After drainage, do I need antibiotics? Antibiotics are recommended for abscesses larger than at the time they were drained. In fact, people treated with Bactrim (sulfamethoxazole/trimethoprim 160 mg/800 mg) twice daily for 7 days had a higher cure rate than those who didn’t take antibiotics after incision and drainage.
Wait, but what if I have a sulfa allergy? If you have a sulfa allergy, you most likely won’t be able to take Bactrim, but there are alternatives. Other good options are clindamycin, and minocycline. An expensive brand name medication, Zyvox, is available now as generic linezolid but it’s still pricey. Taking linezolid twice daily is also an option.
For many, back to school also means back to sports—football, soccer, swimming, wrestling, and cheerleading, among others.
With so many kids coming through the same locker rooms, and sometimes sharing equipment, your child’s favorite sport can mean they’re more susceptible to fungal infections like athlete’s foot.
The good news: there are many non-prescription options out there that can help.
Are antifungals available over-the-counter?
Yes. If your child has come into contact with ringworm from the wrestling mat or athlete’s foot from a gym shower, you can find treatments in the aisles of your local pharmacy or grocery store.
The most common OTC antifungals include clotrimazole, miconazole, tolnaftate, and terbinafine. They can also be found under a variety of brand names including Lamisil, Lotrimin, Tinactin, and Zeasorb to name a few. They come in several forms, including creams, ointments, gels, sprays, and powders.
What you may not know: most of these products can be found in the foot care aisle of your local store—even though they can be used for other areas of the body.
What symptoms do these OTC antifungals treat?
OTC antifungals can treat itching, burning, cracking, scaling, and chafing.
Are there any limitations?
Yes. Non-prescriptino antifungals don’t treat fungal infections of the scalp or nails.
How can my child avoid getting a fungal infection when playing sports?
There are a few ways your kids can play it smart:
- Keep skin dry and clean
- Keep nails short and clean
- Keep all sports gear and equipment clean
- Change socks and underwear at least once a day
- Don’t share any personal items like towels, clothes, combs, sports equipment
- Don’t walk bare foot in public areas such as the locker room or shower
- Don’t share any personal items like towels, clothes, combs, sports equipment
How do I know when my child needs to see a doctor for a fungal infection?
If you think your child may have a more serious fungal infection (or an infection on the scalp or affecting their nails), contact your doctor for an appointment.
You should also consider contacting your doctor if your child has used an OTC antifungal treatment for 2 weeks but continues to have symptoms.
Your doctor can confirm and give an diagnosis a resistant or more serious fungal infection, and provide prescription treatment if necessary.
What prescription treatments are available to treat fungal infections?
Common prescription treatments for fungal infection include:
- Ketoconazole (Brand: Nizoral)
- Itraconazole (Brand: Sporanox)
- Fluconazole (Brand: Diflucan)
- Griseofulvin (Brand: Gris-Peg)
- Terbinafine (Brand: Lamisil)
Your child’s doctor will be able to tell you if one of these prescription treatments is needed.