By now, you’ve probably heard that this year’s flu season is getting pretty bad (or “moderately severe”, as the CDC puts it), with widespread flu activity all across the U.S. We believe prevention is the best medicine, but certain strains, like this year’s H3N2 virus, are more resistant to the flu shot.
So if you find yourself feeling feverish and with chills, congestion, runny nose, or body aches (among other common cold and flu symptoms), you might be tempted to head to your local drugstore. But with over 300 products on the shelf in the typical cold and flu aisle (we counted), it’s easy to feel pretty overwhelmed – especially if you’re not feeling quite like yourself. Luckily, we’re here to help you sort through the confusion and pick the best over-the-counter cold and flu meds for you.
1. You’re getting duped by marketing
There are over 300 cold and flu products in the average drugstore, but what you probably don’t know is that they’re really just a handful of combinations of four basic types of ingredients: decongestants, pain and fever reducers, cough suppressants, and expectorants (mucus thinners). There are so many options because each brand (like Robitussin or Vicks) has its own version of almost every combination, plus many combinations come in more than one form (like liquid, dissolving tablets, and ‘liquicaps’). Some of this is good – for example, it’s nice to have a liquid option if you don’t like taking pills – but a lot of it is simply driven by marketing.
2. You’re spending too much on brand names
According to a 2014 study published by the National Bureau of Economic Research, drugstore shoppers spend an extra $44 billion a year on brand-name products, including over-the-counter medications and other health items. Pharmacists, on the other hand, are 90% more likely to buy generics, probably because they know how to hunt them down on store shelves and know that they’re just as effective. But it’s hard for most people to distinguish between pseudoephedrine and phenylephrine or dextromethorphan and doxylamine in order to pick a generic or store brand with the active ingredients they need.
3. You’re probably taking more medicine than necessary
People often take combination-ingredient cold and flu medicines like NyQuil or Tylenol Cold Multi-Symptom. You’ve probably seen TV commercials for these brands so they’re easy to recognize on the shelf, and you know they’ll probably cover whatever your symptoms are. But these combo products often have more ingredients than you need to treat the symptoms you actually have, which puts you at greater risk for side effects, drug interactions, and overdose. Overdose is especially risky with products that contain acetaminophen because going even just a little bit over the daily limit of acetaminophen can put your liver at risk and even cause death. Read our previous post on how to avoid taking too much acetaminophen or Tylenol.
So how do I find what’s right for me?
If you’re looking to treat the symptoms of a developing cold and flu early without having to visit the doctor’s office, our friends at Iodine have just the thing. Their cold & flu tool can help you save time, money, and extra stress on your body. Just select your symptoms, and it’ll narrow down all the options to products that treat the symptoms you actually have. You can compare them side by side and take the list with you to the pharmacy. Get in, get out, go home and rest.
A recent report published by the Centers for Disease Control and Prevention (CDC) confirmed what we already knew: this year’s flu is bad. Since October, widespread influenza activity has been reported in 49 states, resulting in 20 pediatric deaths and more than 6,000 influenza-related hospitalizations thus far. These rates surpass last year’s total numbers – and it’s only January.
One more way to see how bad the flu is this season: prescriptions for Tamiflu (oseltamivir), the most popular antiviral medication for treating the flu, are way up. According to a GoodRx analysis based on a significant sample of US pharmacy fills, Tamiflu fills are 640% above this time last year.
What’s more, it’s only January. As you can see below, fills for Tamiflu peaked in February of last year, indicating that the flu was the most widespread during that time. It’s possible that there is still more to come this year.
This is a stunning illustration of how bad the flu is – and how much worse it may still get.
If taken within the first 28 hours of getting the flu, Tamiflu can work to block the actions of influenza in your body, and shorten the duration of the virus. You can also take Tamiflu for up to six weeks to prevent you from getting the flu. Not surprisingly, Tamiflu is prescribed more often between the months of October and March, during flu season. Despite the surge of prescriptions, there are some doubts about whether Tamiflu is even effective for treatment or prevention – more on that below.
A shortage in Tamiflu
The high volume of Tamiflu prescriptions at this point in the season has resulted in a shortage of the medication. While the FDA has not yet confirmed this shortage, doctors and pharmacists in both urban and rural areas are reporting difficulty in accessing Tamiflu for their patients.
Those unable to access Tamiflu this year do have other options. Besides Tamiflu, there are two other influenza medications: Relenza and Rapivab. Both are considered just as effective as Tamiflu and may be easier to access this year. For more information on these medications, see our post here.
Over the counter medications can also help ease symptoms. Read here for more details on over the counter flu medications.
Is it effective?
Tamiflu is sometimes treated as a cure for all cases of the flu, but recent studies call this reputation into question. According to a study-of-studies, or meta-analysis, performed by Cochrane Research of 46 studies involving more than 24,000 people, Tamiflu may provide a much smaller benefit than expected. At best, the analysis found that Tamiflu may only help patients recover one day faster, and may not reduce the number of flu-related complications, like pneumonia. Additionally, it may only reduce the risk of getting sick by 55%. At over $50 per prescription for generic oseltamivir, for some, the benefits may not outweigh the cost.
While these findings don’t negate the use of Tamiflu, they may indicate that it is less protective than we had previously thought.
Tamiflu side effects
There has been recent concern about Tamiflu’s side effects, especially in younger children. Recently, a 6-year-old girl reportedly attempted to jump out of her bedroom window during a hallucination while taking Tamiflu. The FDA has warned of similar side effects previously, noting that:
“Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Tamiflu of may happen in people when the flu is not treated. These serious side effects are not common but may result in accidental injury to the patient. People who take Tamiflu should be watched for sins of unusual behavior and a healthcare provider should be contacted right away if the patient shows any unusual behavior while taking Tamiflu.”
More common side effects include nausea, vomiting, headache, and pain. Be sure to speak with your doctor if you or a loved one experience any of these side effects for a prolonged period of time.
Why is the flu so bad this year?
This year’s flu is different from past year’s. The reason? Around 80% of flu cases this year involved H3N2, a strain of the influenza A virus that is more dangerous and results in more complications. H3N2 is generally also harder to prevent with the flu vaccine, and this seems to be true this year. Experts say that this year’s flu vaccine may be only 10% effective.
How can you protect yourself?
- You can still get your flu vaccine. Even though the flu shot may only 10% effective against this year’s flu, you may still want to consider getting it. Even if you get sick, a flu vaccine can also help ease the severity and duration of the virus.
- Visit your doctor immediately. When true flu symptoms hit, go to the doctor. The sooner you visit, the sooner you can get your prescription for an antiviral medication.
- Wash your hands. This may go without saying, but washing your hands is your best weapon against the flu virus.
- Exercising may help. While heavy exercise may predispose you to the flu, a moderate amount may be protective.
On January 11th, the FDA issued a drug safety communication for certain prescription cough and cold medications that contain codeine or hydrocodone.
Many prescription medications are to blame for our current opioid epidemic, especially in our adolescents and teens. Therefore, limiting the prescribing of unnecessary medications to children under 18 years of age is particularly important.
What is the significance of this safety communication?
The significance of this safety communication is that the benefit of a prescription cough and cold medications containing codeine or hydrocodone no longer outweigh the serious risks associated with their use. Especially in children less than 18 years of age.
See the FDA Drug Safety Communication for a list of cough and cold medicines that contain codeine or hydrocodone.
Are there alternatives for those under 18 years of age?
Yes. Most coughs from the common cold will actually go away on their own and do not require treatment. However, if treatment is required, several over-the-counter medications that contain dextromethorphan can be used for symptom management.
There are also other non-opioid prescription medications that may be used if your doctor feels as though treatment is necessary.
What is being done to warn people about these serious side effects?
The FDA is requiring safety labeling changes for all prescription cough and cold medications that contain codeine or hydrocodone.
The FDA is also requiring the addition of safety information about the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing to the boxed warning the strictest warning given to a medication by the FDA.
Humalog (insulin lispro) is a fast-acting insulin used to treat diabetes type one and two. Doctors report low levels of adherence to insulins like Humalog because of its cost. Cash prices for Humalog average around $549 for five kwikpens, and there is no generic alternative for any insulin brand. Humalog generated billions of dollars in global sales for Eli Lilly in 2016.
Here is some information on Humalog, and how you can save.
When will Humalog see a generic?
Typically, when a manufacturer releases a brand name drug, it is protected by a patent. This means that the manufacturer holds market exclusivity for that drug, preventing other manufacturers from creating an alternative. The idea is to incentivize companies to innovate (such as spending money researching new drugs) with a period when they can reap the rewards for their work. Eventually, though, the patent expires, allowing competitors to create their own versions with the same active ingredient. These are known as generics.
In the case of Humalog, the patent expired in 2015, but no generic is on the market yet, and we may never see one. The reason has to do with the difference between drugs made of chemical formulations (think of any ordinary pill), and those treatments made from living, biologic organisms – such as insulin.
Humalog’s biosimilar ‘follow-on,’ Admelog, was approved last year but is not yet available in pharmacies. Stay tuned, we will keep you updated.
Why are there no generic insulins?
The cash price for insulins can range anywhere from $120 to $600 a month. At the moment, there are no generic insulins on the market, but we do have what are called biosimilars. Without getting too technical, biosimilars are close – but not identical – versions of a biologic. Since insulin medications are made out of living cells, they are slightly different and aren’t deemed therapeutically equivalent, or interchangeable, by the FDA. Where the FDA allows a generic manufacturer to move a chemical drug to market without additional research, biosimilars must go through deeper regulatory scrutiny before approval. They are also harder and more expensive to manufacture. For more information about biosimilars, see our previous blog post here.
Unfortunately, biosimilars, unlike generic drugs, they rarely provide any savings to consumers. You may remember the first insulin biosimilar that was approved in 2015 – Basaglar. Basaglar is manufactured as the ‘follow on’ to Sanofi’s Lantus, with the same active ingredient – insulin glargine. When Basaglar was first approved, many were hopeful that it would help to bring down insulin prices and reshape insulin insurance coverage. However, prices for Basaglar remain high; current prices are around $234, and few changes have been made to insulin coverage by insurers.
So how can I save on Humalog?
Bottom line: without insurance, Humalog is expensive. Cash paying patients will have to shell out as much as $549 for a carton of 5 kwikpens. Here’s how you can save.
- Try Manufacturer Eli Lilly’s savings programs. Manufacturer Eli Lilly has a manufacture card and patient assistance program to help patients save. The Humalog U-200 KwikPen Savings Card can reduce your co-pay to as little as $25, while the Lilly Tru Assist program can help you receive your medication at no cost. Be sure to contact Eli Lilly to see which program you qualify for.
- Use a GoodRx Humalog coupon. GoodRx offers discounts for Humalog online. A discount may only save you 10% to 15%, which won’t make it affordable for everyone, but every bit helps.
- Try to appeal your coverage. If you have insurance and your plan doesn’t cover Humalog, ask your doctor about submitting an appeal, Some plans require prior authorizations—meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.
Are there any alternatives to Humalog?
There are options to Humalog. While the cash prices of these may not significantly less expensive, depending on your insurance coverage, some alternative insulins might be more affordable.
Lantus (insulin glargine), and its biosimilar Basaglar are another type of insulin that has been found to be just as safe and effective as Humalog. Lantus and Basaglar are slightly more affordable, with cash prices averaging at $274 and $234 respectively, but they may be more affordable for you if your insurance covers it. You can read more on how to save on Lantus and Basaglar here.
Novolog (insulin aspart) is another fast-acting insulin that provides all-day blood sugar control, and it can be used by children as young as two years old who have type 1 or type 2 diabetes. The downside with Novolog is that it may cause weight gain, which could require you to adjust your dose.
If you’ve ever been afraid to show up at your doctor’s office because you’ve been “bad” then this post is for YOU! You may think your doctor is “pushing medications on you” especially if you aren’t experiencing any symptoms of the condition they are treating you for. However, their reasoning is not without sound medical and professional judgment.
One of the many reasons you might receive a lecture about the importance of taking your medications is due to the progressive nature of many diseases if not properly treated. The following are common disease states that are often “silent” and can be deadly if not properly managed.
Diabetes is a disease that occurs when your blood sugar is too high. Blood sugar is your main source of energy and comes from the food you eat. There are several different types of diabetes, with the most common being type 1 and type 2 diabetes.
Signs and symptoms of uncontrolled high blood sugar can oftentimes be overlooked, as you may not be able to tell. Some signs that are associated with low blood sugar include increased thirst and urination, blurry vision, lethargy, and frequent headaches.
Some people will stop taking their medication or take them inconsistently due to not “feeling” any different whether they take them or not. This is a more common occurrence with type 2 diabetics but has happened in type 1 diabetics who forgo their insulin.
Diabetes is one of many diseases that is often referred to as a “silent killer” as it can lead to amputations, vision loss, heart attack, stroke, sexual dysfunction, bladder problems, and kidney disease if poorly controlled.
Patients with diabetes may control their diabetes with injectable medications like Humalog, Novolog, Humulin, Lantus, and Tresiba, or oral medications like metformin, glipizide, glimepiride, and invokana.
High blood pressure
High blood pressure occurs when the force of your blood pushing against the walls of your blood vessels is consistently too high and can damage or weaken your blood vessels. However, it can’t physically be felt, as there are no obvious symptoms indicating something is wrong. You will need to visit your doctor to determine if you have high blood pressure.
Also referred to as a ‘silent killer,’ consequences of poorly controlled high blood pressure may include heart attack, stroke, vision loss, heart or kidney failure, and sexual dysfunction.
Cholesterol is a substance your body needs to build cells. However, there is bad cholesterol (LDL, and triglycerides) and good cholesterol (HDL).
Too much of the bad kind and not enough of the good kind increases the chances that cholesterol will begin to build up in the inner walls of arteries. Over time, this buildup can narrow or completely block the arteries leading to a variety of serious, life-threatening problems.
You can’t physically feel if you have high cholesterol and usually don’t know unless something bad happens or through routine blood work called a lipid panel. If not treated properly, high cholesterol can lead to heart attack, stroke, and chest pain.
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall, or, in serious cases, from sneezing or minor bumps. Osteoporosis affects both men and women, and as our bodies age the likelihood of developing osteoporosis increases.
Breaking a bone is often one of the first indications that you may have osteoporosis. People with osteoporosis most often break bones in the hip, spine, and wrist. You may also notice that you are getting shorter, or your upper back is beginning to curve forward. These symptoms may also indicate that you may have osteoporosis.
Consequences of untreated osteoporosis include one fracture, broken bones, pain, and limited mobility.