As we exit 2016, we can only be certain about one fact regarding the future of health care coverage in America: big changes are ahead. Our healthcare was one of the biggest issues in a bitter Presidential campaign, and President-elect Trump has repeatedly said that he plans to replace Obamacare with something else. We’ll see what that something else is soon.
As politicians fought about the best ways to solve America’s health care challenges, we all suffered. Insurance premiums went up and also provided less coverage. Prices for many brand drugs continued their steady march upwards. There was some good news—exciting new treatments, and a bunch of expensive drugs became available as generics—but in general, 2016 was a painful year, and the prognosis for 2017 isn’t much better.
Here’s a recap.
1. More drugs lost insurance coverage.
The two largest prescription insurance companies, Express Scripts and Caremark, dropped coverage for 40 popular drugs in 2016. Most notably, medications like the popular insulin Lantus, and venlafaxine ER (Effexor XR) for depression have been dropped by Caremark. Express Scripts dropped Taltz for psoriasis, and Orencia for rheumatoid arthritis, among others, and Viekira Pak now has only limited coverage. Insurers are also restricting coverage for many of the expensive (but effective) hepatitis C drugs like Zepatier and Olysio, leaving only Sovaldi and Harvoni as options.
Overall, Caremark will be far more restrictive this year, with a total of 130 drugs excluded from coverage. In contrast, Express Scripts will only have 85 drugs excluded in 2017.
New for 2017—Caremark is dropping coverage based on excluding what they call “hyperinflationary drugs” or drugs that have seen a massive increase in cost. Think EpiPen, Alcortin A, and others you may have seen in the news this year.
2. Even more drugs went generic in 2016. Yay!
There is good news! A number of drugs went generic this year, meaning that more expensive brand name medications now have cheaper alternatives. In some instances, filling a generic instead of a brand can mean a difference of hundreds of dollars, whether you’re insured or paying cash. So this is good news for your healthcare wallet!
Here some of the major drugs that got generic alternatives in 2016:
- Gleevec (imatinib), an expensive specialty medication used to treat multiple types of cancer, went generic in February. Although the generic, imatinib, is still expensive, it does offer savings over the brand. This is a big deal—Gleevec has been very effective, and a lower cost generic will make it more accessible.
- Glumetza (metformin ER) is a popular drug used to treat type II diabetes that went generic in February. Glumetza is similar to the other type II diabetes drug Fortamet (also metformin ER), but they differ slightly in how they deliver the drug. You can read more about their similarities and differences here. Also—keep in mind that Glucophage XR has had a less-expensive generic for a few years now, and is still significantly cheaper than Glumetza or Fortamet.
- Enablex (darifenacin ER), for overactive bladder, went generic in March 2016. Although the generic, darifenacin ER, is on the pricey side, it will save consumers hundreds over the brand name.
- Nasonex (mometasone) is a popular corticosteroid used to decrease inflammation in the nose and treat the symptoms of allergies. Nasonex’s generic, mometasone, was approved in March.
- Crestor (rosuvastatin) is a major brand that got a generic alternative in April 2016. Crestor had been dropped by many insurance plans, but with the introduction of a generic alternative, consumers have been able to save big at the pharmacies for this popular statin.
- Epzicom (abacavir/lamivudine) is an antiretroviral used to treat HIV. Its generic, abacavir/lamivudine became available in October, offering huge savings.
- Benicar (olmesartan) is another major brand that became available as a generic drug this year. Benicar is a popular medication used to treat high blood pressure, and its generic, olmesartan (available only in tablet form) offers consumers a pretty substantial discount.
3. Insurance costs are going up.
You may have heard that Obamacare (Affordable Care Act or ACA) plan premiums are expected to climb by about 25% in 2017. Because so many insurance companies dropped out of the exchange markets this year, you can expect to pay an average monthly premium of $302, up from $242. Some companies are also raising rates because the premiums they charged initially were too low to cover the costs they faced. Many of these plans also offer limited coverage, especially for prescription drugs.
You can find more information on changes to ACA plans in 2017 here.
You can also expect to see some price increases and changes in coverage if you have a Medicare plan. More plans that ever (up to 85% in 2017) will have a preferred pharmacy network, meaning they will offer the maximum savings only at certain pharmacies. There is some good news here though—the donut hole is shrinking. You’ll owe a smaller percentage of both brand and generic drug costs while in the donut hole.
You can find more specifics on 2017 Medicare plan changes here, and on GoodRx! In May, Goodrx completed a multi-year effort to analyze Medicare drug pricing and help seniors take control of their prescriptions. Read more about it here, or compare Medicare, cash, and coupon prices on GoodRx here.
Of course, many elements the ACA will likely change in 2017 when President-elect Trump takes office . . .
4. 2016 was the year of outrageous drug prices.
The EpiPen drama exploded in the fall of 2016 as outraged parents encountered insane prices for a life-saving prescription. As you may have heard, Mylan, the makers of EpiPen, have raised prices for the lifesaving drug from about $150 to $600 since 2011. There is good news on the horizon though: Mylan has discussed creating a generic alternative to Epipen, and a less expensive epinephrine auto-injector, Auvi-Q, which should return to the market soon.
Insulin prices also continue to increase, with popular options like Lantus, Humalog, and Novolog increasing by around $150 per carton since 2013. This may hit some of you especially hard with Caremark’s decision not to cover Lantus next year.
Some other sky high drug prices continue to include Daraprim, Sovaldi and other hepatitis C drugs, and treatments for very rare conditions like hereditary angioedema (HAE).
What’s in store for 2017?
As you know, Donald Trump is our new president-elect. There are almost definitely changes in prescription and health care costs, and the future of ACA plans is in question. Stay tuned!
There will be more generics released- especially near the end of the 2017. Though none of these are guaranteed, popular drugs like Viagra (sildenafil) for erectile dysfunction, Truvada (emtricitaboine/tenofovir) for HIV treatment, and the expensive epinephrine auto-injector EpiPen (epinephrine) may see more generic alternatives in 2017.
One thing we can all be sure of—it’ll be more important than ever for Americans to be smart healthcare consumers, and GoodRx will be there to help!
Happy holidays and have a happy, healthy new year!
After months of waiting, we finally have some good news for EpiPen users! On December 16th, Mylan announced that epinephrine, the generic for the expensive EpiPen auto-injector, will be available in pharmacies this week.
As you may have heard, over the past couple of months, Mylan Pharmaceuticals, the manufacturer of EpiPen, has been criticized for increasing the price of the epinephrine auto-injector by 400% since 2007, to about $600. In response to the criticism, Mylan announced in September 2016 that they would be releasing a generic—and it is finally here!
You can read more about the EpiPen pricing drama here.
What is epinephrine for?
Epinephrine is used for the emergency treatment of anaphylaxis, or severe allergic reactions. People experiencing anaphylaxis may have symptoms like hives, shortness of breath, nausea, fainting, dizziness or low blood pressure.
Epinephrine treats anaphylaxis by increasing the blood pressure, decreasing swelling, and opening up the airways.
How much will the new generic cost?
Mylan released a statement last week that the authorized generic for Epipen would cost around $300 for a two-pack.
How will epinephrine be available?
Same as EpiPen and EpiPen Jr, epinephrine will be available in 0.15 mg and 0.3 mg strengths.
What are the upsides to the EpiPen generic?
There are several!
- First off is cost. With more options available, we expect that prices may become more affordable! Mylan will also be offering a $25 discount card on the new generic for insured patients. Hopefully this will mean less sticker shock at the pharmacy!
- This is also good news for coverage. We expect that the new generic will likely be covered under your lowest insurance tier, which means lower out-of-pocket costs for you!
- It will also be easy to use! For those of you who are used to using EpiPen, the generic auto-injector works the same way. This means that you won’t need to learn how to use a new type of injector.
Can I still save on brand name EpiPen?
Yes. If you decide that you would rather use brand name EpiPen, the manufacturer has some options to help consumers save. However, keep in mind that you have to qualify for these savings.
First, Mylan has a co-pay card for EpiPen that can reduce co-pays to as little as $0 for eligible patients. This card is for commercially insured patients only, and patients paying out of pocket are not eligible.
Mylan also offers a need-based patient assistance program for EpiPen users. Most people without insurance and with limited incomes will qualify. You will need a valid prescription and proof of household income.
If the generic still offer the best price for you, keep in mind that it is an authorized generic which means that it is essentially the same medication as the brand.
What other epinephrine auto-injector products are available?
- Adrenaclick. Similar to EpiPen, Adrenaclick contains 0.3 mg per dose, and has a smaller 0.15 mg per dose pen for younger kids. Adrenaclick also has an authorized generic, like EpiPen.
- Epinephrine. This is the authorized generic for Adrenaclick (check out this article for more information on what an authorized generic is). It also has both 0.3 mg and 0.15 mg dose pens.
- Auvi-Q. Last year Auvi-Q was taken off the market. However, in 2017, Auvi-Q will be re-released by its manufacturer, Kaloe. Kaloe has hinted at huge cost savings, so keep an eye out for it in 2017! You can read more about Auvi-Q here.
It’s tough enough to have pain severe enough to be treated with opioid pain medications like Vicodin or Oxycontin—but the side effects can make things even more difficult. Constipation from taking opioid medications can be debilitating and is estimated to affect 40 – 86% of patients using these drugs.
Why do opioids cause constipation?
Constipation from opioid pain meds occurs because of how these medications work. Opioids relieve pain due to direct effects on µ-opioid receptors, which is how they can relieve pain—but these receptors are also plentiful throughout the GI tract (your digestive system). This means a slower transit time through the gut, increased fluid absorption (harder stools) and increased sphincter tone.
What should I do first on my own, before I ask my doctor for help?
Start with dietary measures like more water and fiber, increased physical activity, and over-the-counter laxatives. Laxatives recommended as first-line therapy for opioid induced constipation include stimulant laxatives like Senna, Dulcolax (bisacodyl), or Cascara. There is insufficient evidence from clinical trials to recommend one over another, so pick one to see if it will work for you.
What won’t work?
For opioid induced constipation, bulk forming agents won’t work and may cause more discomfort. Bulk forming agents include psyllium, Metamucil, Citrucel, or Fibercon. These act to increase stool bulk and stimulate peristalsis—movements that push stuff through the colon. Not only will these options not help with opioid induced constipation (because opioids prevent peristalsis) but they may result in worse abdominal pain.
Over the counter options didn’t work, now what?
At this point, see your doctor. Constipation that doesn’t respond to the OTC options above needs the help of your physician. Your doctor may prescribe osmotic agents (eg, polyethylene glycol, lactulose), or newer prescription medications.
What are the “big guns”—the newer prescriptions?
- Amitiza (lubiprostone). Amitiza is a prokinetic, meaning it stimulates motility. It is a prescription medication for constipation that stimulates chloride channels and promotes intestinal fluid secretion. This adds fluid to stool and speeds up travel time through the gut, improving symptoms of constipation.
- Movantik (naloxegol). The newest kid on the block, Movantik, blocks the effects of opioids on the gut and works well in folks who have not responded to laxatives.
- Relistor (methylnaltrexone). Though effective and approved for opioid induced constipation, Relistor is an injection. Given newer pill options, Relistor may be phased out. Relistor is a subcutaneous injection given once every other day or every third day.
Hope this helps.
“Can I just stop my medication?” This question, frequently asked of primary care doctors, has a complicated answer. For starters, if you are taking a medication that is controlling an ongoing medical problem like high blood pressure, diabetes, or high cholesterol you should never stop it on your own—or your problem will return. Many patients do come clean though, and report that they just plain stopped their meds.
So when is stopping your medication dangerous? Abruptly stopping these 10 medications may make you sick, and lead to dangerous problems. The higher the dose and the longer you’ve been taking them, the worse the problem.
- Catapres (clonidine). This is no joke. Catapres tablets and Catapres-TTS patches are used to treat high blood pressure. Stopping them abruptly may result in a surge of catecholamine release. Rebound very high blood pressures can occur so Clonidine should be weaned slowly. If you’ve been on higher doses of Clonidine this is more likely to occur. Don’t stop this on your own.
- Inderal (propranolol). Beta blockers like propranolol are used to treat high blood pressure and palpitations, and are even prescribed for anxiety symptoms. While all beta blockers may have a mild effect, Inderal is a short-acting beta blocker, and stopping it abruptly may lead to a withdrawal syndrome. In addition to a rise in blood pressure, beta blocker withdrawal in patients with heart disease can lead to chest pain, heart attack, and even sudden death. Crazy thing is this can occur even in patients who have no previous history of heart issues.
- Topamax (topiramate). Taken for epilepsy, migraine headache prevention, weight loss (as one of the active ingredients in Qsymia), and alcohol abuse disorder, this is a medication you should not abruptly discontinue. Instead, taper your dosage gradually over 2 to 8 weeks to prevent rebound effects. Why? Stopping it suddenly increases seizure frequency. This happens, I’ve seen it.
- Effexor XR (venlafaxine ER). Used for depression, generalized anxiety disorder, and menopause symptoms, Effexor carries the nickname “Side-Effexor” partly for this reason: due to its short half-life (how long it takes for the medication to leave your system), stopping and not weaning venlafaxine may lead to horrible withdrawal symptoms. Instead, taper the dose by 37.5 mg to 75 mg per day each week, over four weeks. Abrupt discontinuation of venlafaxine may cause agitation, sweating, dizziness, fatigue, nausea, restlessness, and tremor. Not fun.
- Paxil (paroxetine). A widely used medication prescribed for depression and anxiety, paroxetine is the most likely of the SSRI antidepressants to cause withdrawal symptoms, again due to its short half-life. Paroxetine needs to be tapered down over two to four weeks prior to stopping. If you just stop taking it, symptoms may include nausea, vomiting, diarrhea, headaches, lightheadedness, dizziness, sweating, tremors, and sleep disturbances (vivid dreams, insomnia). Wean it down.
- Benzodiazepines. Used for anxiety symptoms, this whole class of medications including alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium) cannot be stopped abruptly IF you’ve been using them for more than a few weeks. Rebound or withdrawal symptoms, including seizures, may occur following abrupt discontinuation or even large decreases in dose. This is more common if you’ve been taking a high dose, or if you’ve been taking it for a long time The risk of seizures is greatest 24 to 72 hours after you stop, so instead, decrease your doses slowly and monitor for withdrawal symptoms.
- Neurontin (gabapentin). Don’t just stop taking gabapentin, commonly used for neuropathic pain and seizures. Withdrawal symptoms may begin between 12 hours to 7 days after stopping, but most start between 24 and 48 hours. Agitation is the most common and is reported by half of those experiencing symptoms of withdrawal. Confusion and disorientation have also been reported along with sweating, stomach complaints, and insomnia.
- Prednisone and other steroids. Prednisone is prescribed as a potent anti-inflammatory for a variety of conditions including asthma, allergies, hives, inflammatory arthritis, gout, and more. If you’ve been taking prednisone for more than 1-2 weeks and just stop it, you may get into trouble. Why? When you are taking prednisone tablets your own adrenal gland production of cortisol declines. When you abruptly stop taking prednisone the result may be low cortisol, causing weakness, nausea, vomiting, diarrhea and abdominal pain. It’s not fun and can be very serious. Wean it off.
- Opioid pain medications. Opioids are prescription analgesics like codeine, morphine, and hydrocodone (an active ingredient in Vicodin) and if you’ve been taking them long term, abruptly stopping causes symptoms like diarrhea, generalized pain, restlessness and anxiety. Withdrawing from opioids is no joke, wean them down.
- Baclofen. Baclofen is prescribed to decrease muscle cramps, spasms, and rigidity (including in folks with spinal cord injury and multiple sclerosis). Withdrawal is more common when it has been given as an injection directly into the spinal canal, but can also occur with tablets. Withdrawal symptoms include restlessness, insomnia, confusion, hallucinations, seizures, psychotic manic or paranoid states. Interestingly, Baclofen is also used to treat alcohol withdrawal.
Recently, the FDA approved phase 3 clinical trials using MDMA for the treatment of Post-Traumatic Stress Disorder (PTSD).
The first three phases of the clinical trials using MDMA for PTSD treatment began in 2004, and phase 3 is this final phase in the rigorous approval process. This means that MDMA is one step closer to becoming a legal therapeutic for PTSD! You can read more about the clinical trial process here.
What is PTSD?
Post Traumatic Stress Disorder (or PTSD) is a disorder that develops after a traumatic life-event. Events like war, abuse, car accidents, natural disasters, or a shooting are some of the many traumatic events that could cause some people to develop PTSD.
Typically, the symptoms of PTSD include hyperarousal, negative changes in beliefs or feelings, re-experiencing the traumatic event, and avoidance.
What is MDMA?
The chemical name 3,4-Methylenedioxy-methamphetamine, also known as MDMA, is a synthetic drug that alters a person’s mood, and their awareness.
You might be thinking that MDMA is just “Molly” or “Ecstasy.” However, they aren’t quite the same. Typically the illegal street drugs have MDMA in them, but they usually contain many other unknown and harmful substances.
How would MDMA be used?
The FDA has approved the phase three clinical trial for MDMA-assisted psychotherapy specifically. In this treatment, patients are given MDMA three times in total during therapy sessions, supplemented with weekly therapy without the drug.
Researchers have seen that MDMA has effects on the brain that make therapy more effective in treating PTSD. Essentially, the drug is allowing patients to comfortably process their pain.
The Multidisciplinary Association for Psychedelic Studies or MAPS is supporting these clinical trials. You can read more about their efforts here.
How soon could MDMA be available for PTSD treatment?
If phase 3 clinical trials go as planned, MDMA could be available for the treatment of PTSD with psychotherapy as soon as 2021.
You can read more about the previous phases here.