Osteoarthritis, also known as degenerative joint disease or OA, is the most common form of arthritis. It can cause severe and debilitating pain as the cartilage begins to wear away.
OA can be treated with over-the-counter oral medications like Tylenol (acetaminophen) or Motrin (ibuprofen). It can also be treated with prescription pain medications, and we have a new one to add to the list—Zilretta.
What is Zilretta indicated for?
Zilretta is an extended-release synthetic corticosteroid injection for the management of osteoarthritis pain of the knee.
Who is at risk for osteoarthritis?
Anyone can be at risk for OA, but females, individuals with joint injuries or bone deformities, older adults, or those with a genetic predisposition may have a higher chance of developing OA.
How does Zilretta work?
You will receive Ziretta as a single intra-articular injection into the knee by your healthcare provider. Zilretta works by slowly releasing the medicine over a period of 12 weeks. It is not intended for repeated administration.
Zilretta is the first and only extended-release, intra-articular injection for osteoarthritis knee pain. Using an injection like Zilretta for osteoarthritis knee pain offers an innovative non-opioid therapy, proven to deliver pain relief over 12 weeks.
What are the most common side effects associated with Zilretta?
The most common side effects include sinusitis, cough, and bruised skin.
Are there any other similar injections?
COPD, also known as chronic obstructive pulmonary disease, is a progressive lung disease that can cause persistent cough, wheezing, shortness of breath, excess mucus production, and frequent upper respiratory infections.
Treatment is often comprised of a variety of medications, and we have a new one to add to the list—Trelegy Ellipta—a once-daily single inhaler.
What is Trelegy Ellipta indicated for?
Trelegy Ellipta is a once-daily combination inhaler indicated for long-term treatment of patients with COPD, including chronic bronchitis and/or emphysema.
Who is at risk for COPD?
Former and current tobacco users, people with a family history of COPD, and those who have had long-term exposure to lung irritants (air pollutants, chemical fumes, dust, and secondhand smoke) are at a higher risk for COPD.
How is Trelegy Ellipta to be used?
Trelegy Ellipta is a triple combination inhaler containing 100 mcg of fluticasone furoate, 62.5 mcg of umeclidinium, and 25 mcg of vilanterol. It is a combination of the following 2 inhalers: Breo Ellipta (fluticasone furoate/vilanterol) and Incruse Ellipta (umeclidinium).
The recommended dose of Trelegy Ellipta is one inhalation by mouth once daily. You should rinse your mouth out with water and spit after using Trelegy Ellipta in order to prevent thrush, a fungal infection in the mouth.
What are the common side effects associated with Trelegy Ellipta?
Common side effects include headache, back pain, altered taste, diarrhea, cough, mouth pain and the stomach flu.
We are in the thick of Medicare open enrollment, meaning that seniors 65 and over now have the chance to enroll in—or switch to—a new healthcare plan that could save hundreds or even thousands of dollars in out-of-pocket costs.
Yet surprisingly, only 1 in 10 seniors voluntarily switch their plan each year, with most members staying put, even if their premiums have increased or their medications are dropped from their formulary. This can leave older patients on the hook for hefty out-of-pocket costs. Needless to say, enrollment can be a confusing process, but GoodRx is here to help.
When is open enrollment?
Medicare plans offer open enrollment from October 15th to December 7th. Keep in mind that this is different from the Affordable Care Act (ACA/Obamacare) open enrollment that lasts from November 1st to December 15th. (More to come on ACA enrollment soon.)
There is one exception. In 2017, seniors who live in hurricane-affected areas have until the end of December to enroll. This includes seniors in Alabama, Florida, Georgia, Mississippi, Louisiana, Texas, South Carolina, Texas, Puerto Rico, and the U.S. Virgin Islands. For more information, read here, or call 1-800-633-4227.
What’s changing in 2018?
- Most plans will have a preferred pharmacy network—99% to be exact, up from 85% last year and 7% in 2011. This means that your plan will offer greater savings on medications at certain pharmacies. In most cases, you will still have the option to go elsewhere, but you’ll pay more.
- Medicare Part D premiums are rising. According to The Kaiser Family Foundation, prices on standalone Part D drug plans have risen 9% from last year, with monthly premiums now averaging around $43.48. While 9% may not seem like much, keep in mind that premiums have risen a whopping 68% from 2006.
- But Medicare Advantage premiums are going down. Average monthly Medicare Advantage premiums will be around $30, down $2 from last year. Also, this year, most Medicare Advantage plans include drug coverage. Unfortunately, this drug coverage can be limited – with fewer drugs covered than in standard Medicare – so make sure you read the fine print before you commit!
- Good news for the donut hole. The coverage gap between the initial coverage limit and the out-of-pocket maximum is commonly known as the “donut hole.” During this coverage gap, you are responsible for a percentage of your drug costs. The good news? This percentage has been slowly declining. For brand name drugs you’ll pay 35% of a prescription price (down from 40% in 2017), and for generics, you’ll pay 44% of the price (down from 51% in 2017).
Traditional Medicare or Medicare Advantage?
Medicare Advantage, also referred to as Medicare Part C, has increased in popularity over the past couple of years. But how does it differ from original Medicare, and is it better?
Medicare Advantage plans are run by private insurance companies that wrap Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) into one plan. Some will even include prescription drug coverage (Medicare Part D). Advantage plans have a lot of benefits like coverage for outpatient services, and the ability to include dental, hearing, and vision coverage into your plan.
The trade off? Most Medicare Advantage plans limit you to certain doctors and hospitals, whereas people on original Medicare can visit any provider who accepts Medicare. If you’re comfortable with the network, though, these plans can be great ways to get great care.
Read here for more information on Medicare Advantage plans.
What plans are available?
Most seniors have around 20 Medicare plans to choose from, depending on where you live. If you live in a rural community, it may be harder to find a plan that suits you.
Overall, eight insurers dominate the marketplace. These include United Healthcare, Humana, Anthem, Blue Cross/Blue Shield, Aetna, Kaiser Permanente, Cigna, and WellCare. The plan finder from Medicare.gov is a great way to find the best insurer.
5 tips to help you save
- Watch your mail. If you are already enrolled, be sure to read over any mail you get from your insurer. Most insurers will send out an “annual notice of change” or “evidence of benefits” letter that details the changes you will see on your plan in the next year. If you see that your premiums are increasing, or a maintenance drug you take is being removed from the formulary, it might be time to think about switching.
- Use the Medicare.gov “Plan Finder.” This tool can help you find the best plan, and estimate your annual costs on each plan, based on your location and the medications you take.
- Don’t forget about the penalties. Prescription drug coverage, also known as Medicare Part D, is optional. Keep in mind that lofty penalties may apply if you fail to enroll when you are eligible. For more information on these penalties, and how to avoid them, read here.
- Check your plan’s network. This is especially important if you are enrolled in a Medicare Advantage plan. Contact your doctors, hospitals and other providers you may frequent to ensure that they are covered under your plan. This step can ensure that you won’t have to find a new provider, or pay out of pocket.
- Use GoodRx. Whether you’re choosing a plan, or enrolling in a new one, shopping around can still help you save. In fact, for the top 20 Medicare plans in America, 66% of prescriptions can be purchased for less than your typical Medicare co-pay using discounts found on GoodRx. Moral of the story? It pays to use GoodRx!
For any additional questions, be sure to read through this FAQ from The Kaiser Family Foundation.
If you have depression that hasn’t responded to a single antidepressant, switching to another one or adding a second medication is your next step. New evidence is guiding what to do next if you aren’t much better after 6 – 12 weeks of treatment.
When your antidepressant isn’t working to improve or relieve your depressive symptoms, what’s your next step?
- Don’t stop and switch. In adults with mild to moderate depression, augment (add to) your initial antidepressant with a second drug and/or psychotherapy rather than stopping and switching antidepressants. Adding a second med is where the benefit appears to be the strongest.
- Don’t stop and try therapy alone. It is also recommended you add a second medication to your first medication instead of stopping meds altogether and trying therapy alone.
- What’s the new info? In a recent study with 1500 patients with treatment-resistant depression, adding Abilify (aripiprazole) to their antidepressant led to more remission of symptoms than switching antidepressants. In this case, the original antidepressant was Wellbutrin (bupropion). It’s also important to know that most patients in this study were also receiving psychotherapy.
- Which one should you add as a second medication? Ok, here’s where it gets fuzzy. For patients with treatment-resistant depression, there has been little comparative evidence to guide the choice for add-on therapy with a second medication. Basically, there isn’t yet good evidence to support one option over another.
- Choices of second medications to add to your first antidepressant: Response (reduction of depression symptoms by 50 percent or more) or remission occurred more often with these 6 add-on medications, compared with placebo: Abilify (aripiprazole), lithium, Zyprexa (olanzapine), Seroquel (quetiapine), Risperdal (risperidone), or thyroid hormone (Cytomel, Synthroid, or levothyroxine). The benefits of each of these medications as a second choice were the same, so one has not been proven to be superior.
- Downsides: Side effects are more common with two medications for depression instead of one: akathisia (crawling out of your skin feeling), sleepiness and weight gain were more commonly reported.
- Take home message: Recent studies have shown that for patients who do not respond to a single antidepressant, add-on therapy may be modestly superior to switching antidepressants.
What has your experience been?
Let’s start with the bad news. Vyvanse—a stimulant typically taken to treat attention-deficit hyperactivity disorder (ADHD)—is really expensive. Many similar (but not exactly the same) drugs are available as inexpensive generics, but Vyvanse isn’t expected to be available as a generic for some time. If your doctor thinks Vyvanse is right for you, how can you make it affordable?
Here’s some information about Vyanvse and how you can save.
How popular is Vyvanse?
Vyvanse is the third most popular central nervous system stimulant, a class of medications that also includes Adderall (amphetamine salt combo) and Ritalin (methylphenidate). Drugs in this class are prescribed to help you focus and stay alert but can also be prescribed to treat narcolepsy and aid in weight loss.
For more information on Vyvanse, read our previous blog here.
When will generic Vyvanse be available?
As of October 2017, there is no generic available for Vyvanse. However, it may become available as generic lisdexamfetamine after 2023, when the brand name patent expires. While a generic alternative is still many years out, there are other ways to save on Vyvanse.
Are there any cheaper medications I can try for ADHD?
Finding a stimulant that works best for you and your pocketbook can be tricky. While Vyvanse doesn’t have a generic, there are a couple other options to speak with your doctor about.
- Other similar stimulants, including Concerta (methylphenidate er), and Adderall (amphetamine salt combo) have cheap generic alternatives. (See this Iodine comparison of Vyvanse vs Adderall for more information.) Keep in mind that switching stimulants may not always be easy, so it is always recommended that you consult your doctor.
- If you have insurance, check your coverage. While Vyvanse is not usually covered, plans tend to offer coverage for other brands.
- For more information on how Vyvanse compares to other stimulants, check out Iodine’s Vyvanse alternatives. As always, you’ll want to speak with your doctor if you think another medication might work better for you.
Vyvanse works best for me—can I still save?
- Filling a 90-day supply can help shave a little more off your out-of-pocket cost. Note that you may need a new prescription from your doctor, or approval from your insurance to fill a higher quantity, so check with your doctor, pharmacist, and/or insurance.
- Splitting a higher dosage pill can help decrease costs, especially if two strengths are priced similarly. You will want to ask your doctor to make sure this is a safe option for you.
- Use a Vyvanse coupon from GoodRx. GoodRx offers discounts for Vyvanse online. A GoodRx Vyvanse coupon can usually save at least 15% of the full retail price. Keep in mind that Vyvanse is a controlled substance, which means that some pharmacies may not honor the prices listed.
- Use a Vyvanse manufacturer coupon or patient assistance. Shire, the manufacturer of Vyvanse, offers both a manufacturer coupon and a patient assistant program. The manufacturer coupon can help reduce your out-of-pocket costs to $30 (for insured patients only), while the patient assistance program can help qualified patients get medication for free. For more detailed information on each program see the Vyvanse manufacturer coupon at GoodRx or visit Shire’s website directly.
- Try again to get it covered. If you have insurance and your plan doesn’t cover Vyvanse, ask your doctor about submitting an appeal. Some plans require prior authorizations—meaning you need permission from your insurance plan before you can fill your prescription—and then they will provide coverage. If you have insurance, call your provider and ask.
Learn more about Vyvanse at GoodRx’s Vyvanse page.