Advair (fluticasone/salmeterol) is one of the most commonly prescribed inhalers for asthma and COPD—more popular than any similar combination inhaler. It’s also very expensive if you don’t have insurance, Medicare, or a discount: over $300 per inhaler for some dosages, and up to $600 for others.
There is good news on the horizon though—in June of 2017, the FDA accepted an application from manufacturer Sandoz to make a generic version of one form of Advair. The application has been accepted, but not yet approved, so there are no guarantees—but an Advair generic may become available in 2018. Keep an eye out for a less-expensive version in the months ahead.
You do have a few options to keep your costs down in the meantime. Here’s what you need to know:
When will generic Advair be available?
It’s complicated, but likely sometime in 2018. Previously, two applications to make a generic available were denied approval. The FDA rejected an application from generic manufacturer Mylan in March 2017, and another from Hikma in May 2017. It is possible that those two manufacturers could reapply, but they will need to make major changes in order to get approval.
In June 2017, the FDA accepted another application from generic manufacturer Sandoz. However, it hasn’t yet been approved, so it’s not certain when (or whether) Sandoz will be able to make a generic available.
There is was another, less-expensive drug with the same active ingredients that did become available in 2017: AirDuo. More on that below.
How popular is Advair?
On GoodRx, Advair is currently the most popular beta agonist / corticosteroid combination drug. This class of medications also includes, Breo Ellipta, and AirDuo (the other fluticasone/salmeterol inhaler).
Have Advair prices changed recently?
Over the past few years, Advair prices have risen slightly—but steadily, increasing about 35% from January 2013 to January 2o17.
Are there any other inhalers I can try that may be less expensive?
There are several other inhalers with similar active ingredients to Advair, but unfortunately, they all cost about the same. They also can’t all be prescribed for both asthma and COPD.
AirDuo and its authorized generic fluticasone/salmeterol are the closest things to generic Advair in pharmacies right now. AirDuo has the same active ingredients as Advair, but there are a few key differences that mean your pharmacist can’t substitute it automatically.
AirDuo comes in slightly different strengths than Advair, and it uses a different type of inhaler. While Advair has two types of inhaler, HFA and Diskus, AirDuo uses a Respiclick device.
The good news: AirDuo and fluticasone/salmeterol are much less expensive, available at under $100 per inhaler (with a GoodRx discount) at most pharmacies. If you’re interested in AirDuo though, you’ll need to talk to your doctor to see if it will work for you, and to get a new prescription.
Advair works best for me—how can I save until there is a generic alternative?
- Use a manufacturer discount (co-pay card). GlaxoSmithKline, Advair’s manufacturer, offers a discount that can reduce your cost to as low as $10 per inhaler—if you have insurance. If you don’t, they will still knock up to $50 off the cash price. You can find more details here.
- Filling a 90-day supply at once can often help shave a little more off your out-of-pocket costs. You may also 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.
- Use an Advair coupon. GoodRx offers discounts for Advair online. A discount may only save you 10% – 15%, which won’t make it affordable for everyone, but every bit helps.
- Double check your coverage. If you have prescription insurance or Medicare, odds are good that your plan covers Advair. The majority of plans do offer preferred coverage for Advair HFA, Diskus, or both. If for some reason your plan doesn’t cover Advair, talk to your doctor about submitting an appeal.
- Find an assistance program. If you’re still having trouble affording your prescription even with insurance, there are some programs that can help. GlaxoSmithKline offers an assistance program for Medicare Part D patients that can reduce your out-of-pocket cost to $0. Another program from the PAN foundation can help you reduce your costs, but you must have insurance to qualify.
Cialis, approved to treat both ED and benign prostatic hyperplasia (BPH), has about a year left on the countdown to its generic. Generic Viagra (sildenafil) hit the market in Dember 2017, bringing prices down by as much as 50% per tablet.
Here’s all you need to know about the upcoming generic launch and how to keep your costs down while you wait.
When will generic Cialis be available?
After a patent dispute was resolved in the summer of 2017, Cialis is expected to be available as generic tadalafil as early as September of 2018. Previously, Cialis was expected to remain brand-only until 2020.
How popular is Cialis?
On GoodRx, Cialis is currently the second most popular PDE5 inhibitor, the class of medications that also includes Viagra and Levitra. It’s the most popular of the medications specifically used to treat ED (sildenafil / Revatio is the most popular in the class, but it is only approved for pulmonary arterial hypertension).
Have Cialis prices changed recently?
Cialis prices have moderately increased. Cialis is already expensive, and as a brand with no generic, there isn’t much competition. Like many brand-only drugs, Cialis prices have crept up slowly. Over the past 6 months, cash prices for Cialis have increased from about $370 to over $400—based on actual pharmacy claims for fills of thirty 5 mg tablets.
What will generic Cialis cost?
Generally, generic drugs first appear on the market at about a 15% discount to the brand. Unlike the brand, however, generic drug prices typically decrease very quickly. Within a year of release, many generics versions of prescriptions can become very affordable, especially if multiple companies are making the generic.
Cash prices for Cialis—thirty 5 mg tablets, the most common dosage—are currently about $400.
The latest GoodRx estimate is that generic Cialis will initially cost between $300 – 350. While this is still not affordable for most people, keep in mind:
- Discount prices will also decrease, probably by a similar amount. That could mean GoodRx prices at less than $275 for the same prescription, a savings of almost $100.
- Generics are more likely to be covered by insurance, so you may end up with a far lower out-of-pocket cost if you’re insured.
- Again, generic prices tend to go down quickly. Many generics drop to about 50% of the brand price after more than one manufacturer enters the market—increasing competition.
Are there any cheaper medications I can try for ED?
While Cialis doesn’t have a generic yet, there are other options to consider.
- First and possibly most important—Viagra has gone generic, and it is much more affordable. Prices with a GoodRx coupon are as little as $25 per pill, depending on which pharmacy you choose. For more information on Viagra’s generic, sildenafil, see our blog post here.
- Compare prices (whether you have insurance or not). Look at Cialis vs Viagra (sildenafil) or Levitra (vardenafil)—other common choices in the same class—along with Stendra (avanafil) and Staxyn (vardenafil). They may or may not be cheaper now—but both do offer manufacturer coupons and patient assistance programs, which Cialis does not. See manufacturer offers for Viagra here and Levitra here.
- If you have insurance, check your coverage. Many plans don’t cover ED drugs, but some will offer coverage for one or two preferred brands. You may be able to pay less at the pharmacy for Viagra or Levitra.
- For more information on Cialis side effects, and how Cialis compares to other ED medications, check out Iodine’s comparisons with Viagra here and Levitra here. As always, you’ll want to discuss with your doctor if you think another medication might work better for you.
Cialis still works best for me—how can I save before the generic is released?
- Filling a 90-day supply at once can often help shave a little more off your out-of-pocket costs. You may also 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 also help decrease costs, especially if two strengths are priced similarly. You’ll want to ask your doctor to make sure this is safe and a good option for you.
- Use a Cialis coupon. GoodRx does offer discounts for Cialis online. While this may not make it affordable for everyone, a coupon can still knock at least 15% off the full retail price.
- Try again to get it covered. If you have insurance and your plan doesn’t cover Cialis, ask your doctor about submitting an appeal. For conditions like ED this may not always work, but could still be worth a try.
Find out more about what GoodRx is doing to help here.
By the time Hurricane Harvey is finished, millions of Americans will be affected. More than 30,000 people are expected to need emergency shelter, and many more will face property damage and financial challenges. Those affected will need help long after the storm is over.
What can you do to help? Whether you’re able donate money, blood, or volunteer manpower, these organizations are a good place to start.
Keep in mind:
- Many places will be overwhelmed with donations of food, clothing, and other goods, while others may be asking for them. Check with the organization of your choice before sending physical items, to be sure they go someplace they can be used, and they don’t take up volunteer time that could be used for other efforts. In the end though, you may want to consider donating money instead of food or clothing—it lets the organization use your donation most effectively.
- Some donation web pages may be experiencing high traffic, and may load slowly—don’t give up, keep checking back!
- As always, before you donate, do some research! Site like Charity Navigator or Charity Watch can be a good place to start, and Consumer Reports has some good tips on how to check out a charity.
- Are you affected by the storm and looking for help? Most of the organizations below offer resources and ways to request help. FEMA has a Hurricane Harvey resource page, with emergency phone numbers, how to apply for assistance, and more. They are also fact checking rumors about shelters, insurance, immigration, and other topics. The United Way Storm Recovery page is another good example, with an After the Storm guide and phone numbers to call for assistance with cleanup.
The national organizations (the charities you’ve heard of)
- The American Red Cross is also accepting donations online, and via phone (1-800-HELP-NOW). If you’d also like to donate blood, you don’t need to wait for a drive to come to you—the Red Cross website has a tool that can help you find a place to donate.
- AABB (formerly the American Association of Blood Banks) is also calling for blood donations, and lists several resources for you to find a local blood drive. The most-needed is type O-positive.
- The Salvation Army is providing help to survivors and relief workers. They’re accepting donations online, by mail, and via phone (1-800-SAL-ARMY). You can find more info on their website, or donate from your phone.
- The United Way of Greater Houston lets you choose to send your donation to help a particular area, or to let them use it wherever it will do the most good.
- The Hurricane Harvey Relief Fund was established by Houston Mayor Sylvester Turner and administered by the Greater Houston Community Foundation, the fund will coordinate donations with relief services.
- The Houston Food Bank is asking for donations, along with the Food Bank of Corpus Christi. Remember that monetary donations are likely more useful—even though these are food banks.
- There are also several local organizations coordinating blood donations, including the South Texas Blood and Tissue Center and Carter Blood Care. If you’re located nearby, consider donating to help get blood to those who need it quickly.
- Try contacting local shelters or food banks directly, or checking their websites for ways you can help or donate.
Help for pets
- The San Antonio Humane Society has a page set up with information on what you can do to help, including donations of money and supplies.
- The Houston SPCA has a disaster response hotline for animal emergencies, questions, or reports (713-861-3010). You can find more information or donate on their website.
- You can also donate to the Houston Humane Society, or the SPCA of Texas—they don’t have special pages set up for Harvey-related donations, but they will be able to use any help you can give. If you’ve been affected by the storm, the SPCA of Texas also has a great list of resources to help you find a safe place to stay with your pet.
Want to volunteer?
If you are in Texas or Louisiana and want to donate your time, consider these organizations:
- American Red Cross has a special application for Harvey volunteers
- Volunteer Houston is coordinating volunteer requests from around the city
- National Voluntary Organizations Active in Disaster (VOAD) is coordinating volunteer efforts, but they are also suggesting that financial donations will be most helpful for the time being.
There are so many ways you can help right now—these are just a few of the great people and organizations working to help Texas and Louisiana in the wake of Hurricane Harvey. For more resources, we highly recommend starting with these great lists from the New York Times and NPR.
Remember way back in 2016 when we were outraged by the rising cost of EpiPen? How kids and schools couldn’t afford a simple, life-saving treatment? How the company’s CEO was grilled by the government and reporters and they pledged to do something about it?
Well, so much for public outrage. The cost of EpiPen has gone up yet again—by as much as 25%. No, we’re not kidding.
The EpiPen outrage of 2016
It’s been almost exactly year since news broke that EpiPen prices had increased by over 400% since 2007. At that time, Americans paying cash for their EpiPen would pay about $600 for a two-pack. While insurance often covers some of the cost, parents typically buy multiple two-packs to ensure that this life-saving treatment is available at home, school, in the car, or anywhere else they could be needed in an emergency. Those additional pens would not be covered, and the pens also have a limited shelf life, so they have to be repurchased every few years.
Thus, the typical American family would have to spend $1,000 or more to ensure that they had quick access to this life-saving medicine.
The outrage was swift and loud. It seemed like the American public had had enough with high drug prices, and finally something was going to be done. Or was it?
2017: Epipen prices increase by up to 25%
By August 2017, the price Americans are paying for brand-name EpiPen has increased yet again—this time by up to $150. That’s an increase of up to 25% since 2016. Yes, really.
Not all bad news
While all of the epinephrine pens out there are still expensive, there is some good news—you have more ways to save than ever.
- EpiPen and EpiPen Jr now have a less-expensive generic alternative, and a better manufacturer offer.
- CVS has introduced a lower cash price for the Adrenaclick generic.
- Auvi-Q, another epinephrine auto-injector, has been re-approved and is in pharmacies now.
- Another alternative, Symjepi, has also been approved and is expected to be available by the end of 2017.
Read on to find out how to save on each type of pen.
What are my options now?
First, know that all of the currently available epinephrine injectors come in two doses, 0.3 mg for adults and 0.15 mg for children, and come in a package containing two syringes or auto-injectors.
EpiPen and EpiPen Jr are still the most commonly used and prescribed epinephrine auto-injector pens. Mylan made an authorized generic available following the concerns over pricing, and made changes to the discounts they offer. However, we’re still seeing generic cash prices over $300 per two-pack, and brand-name EpiPen prices over $650 per two-pack—up to $750 at some pharmacies. Both generic and brand-name EpiPen have manufacturer discounts available, but they aren’t really going to cut it if you don’t have prescription insurance. The generic offer is for insured patients only. It’ll shave $25 off your insurance co-pay, but you’re still left with a $300+ cash price if you don’t have coverage (a GoodRx discount can drop this to around $150). The situation is about the same for brand-name EpiPen. Again, there’s a manufacturer offer that can drop your cost to $0—but only if you have prescription coverage. Bottom line: if you’re uninsured, or have high deductible prescription coverage, EpiPen (brand and generic) remains just about as costly as in 2016.
Adrenaclick and its generic have been the primary lower-cost alternative to EpiPen through the pricing concerns over the past year. The generic is available for just over $100 from CVS pharmacies, and has a manufacturer offer available that could reduce your co-pay to $0 if you have insurance. Like EpiPen, Adrenaclick is a pen-shaped auto-injector that’s designed to be easy to use.
Auvi-Q was pulled from the market in 2016, and re-released earlier this year. It’s very expensive, over $4500 even with a GoodRx discount, but the manufacturer has a mail order program that should reduce co-pays or out of pocket costs for many people to $0. Auvi-Q has a few unique features as well, like voice instructions to guide you through giving the injection, an auto-retractable needle, and a square shape that’s intended to be easy to carry.
Symjepi has been approved by the FDA, but isn’t in pharmacies yet. Expect to see it in pharmacies by the end of 2017. It’s intended to be a less-expensive alternative to EpiPen, and comes as a two-pack of regular pre-filled syringes, rather than auto-injectors. It won’t be quite as simple to use, and is the only option that will not have a lower 0.15 mg dose available—so this one may not be not a good alternative if your child carries an epinephrine pen. However, it could mean greater savings for some adults and medical professionals.
What can I do to save?
Your savings will depend on your insurance coverage, the pharmacy where you choose to fill, and which option you’ve been prescribed.
First—especially if you have prescription insurance—check for manufacturer discounts:
- The manufacturer offer for generic Adrenaclick can reduce your co-pay to as little as $0, and also offers up to a $300 discount per two-pack for cash-paying patients. Cash prices range from $110 to well over $500, but if you shop around, this can be a huge help whether you have insurance or not.
- EpiPen and EpiPen Jr have similar offers—if you have insurance, your co-pay can be reduced to $0, and cash-paying patients can save up to $300 per two-pack. Keep in mind though, this offer is for brand-name EpiPen, which still costs upwards of $650 if you’re paying out of pocket.
- The EpiPen generic also has a discount available . . . but it only offers $25 savings per fill, and is only available for insured patients. You can still use it if you have insurance that doesn’t cover the EpiPen generic—but without coverage, your cost per fill will likely still be over $300.
- Auvi-Q also offers a mail order program that can reduce your cost to $0. It’s available for all insured patients, and for uninsured patients with a household income below $100,000. If your annual income is higher, you can still receive it at $360 per fill. For comparison, Auvi-Q costs over $4500 per fill.
If you don’t have insurance, a low cash price or a GoodRx discount are the way to go.
CVS pharmacies (including locations inside Target stores) now offer the generic version of Adrenaclick at $109.99 for a two-pack. Walgreens also has a relatively low cash price, at $147.59. CVS and Walgreens are also your lowest-cost pharmacies for the EpiPen generic—discounts for a two-pack at both stores come in under $150.
Is there anything else I should know?
With generic alternatives now available for EpiPen and Adrenaclick, some insurance plans may not cover the brands, or may only cover one or the other. For example, starting in 2018, Express Scripts (which provides prescription benefits for millions of insured Americans) will only offer coverage for EpiPen and its generic. Adrenaclick, generic Adrenaclick, and Auvi-Q are being added to the exclusion list on their national preferred formulary.
If you’re having trouble with the cost of your epinephrine pen, talk to your doctor to see if any of the other options will work for you. Trying a generic alternative or switching to a different brand may save you hundreds per fill.
If you’ve got health insurance, now’s a good time to be paying attention. Each year, prescription coverage changes, and yours will likely be changing in 2018.
Express Scripts and Caremark, companies that handle pharmacy benefits for more than 200 million Americans, are removing more than 80 prescription medications from their formularies at the end of 2017. There is a silver lining for some of you though—almost 20 currently excluded drugs will be covered in 2018.
Find out below how your coverage may be changing next year.
What are Express Scripts and Caremark?
Express Scripts and Caremark are companies that administer prescription drug benefits for many health insurance companies and Tricare. While you may have health insurance from Anthem, Aetna or another insurer, your pharmacy benefits are usually handled by these companies or their competitors. They also set the formulary for everyone under their prescription drug benefit.
What do formulary changes mean for you?
Listed below are brand name drugs for which there may be a less expensive brand or generic alternative available. If your benefits are provided by Express Scripts or Caremark and you are filling one of these prescriptions, you’ll pay the full cash price at the pharmacy in 2018. (You can see estimated cash prices on GoodRx by clicking on a pharmacy name after you look up a drug.)
If your coverage is changing, talk to your doctor to see if a covered alternative might work for you. If you can’t switch, you may be able to use GoodRx or find patient assistance programs to help cover the cost.
Which drugs are affected?
⇒ Express Scripts: 64 new drugs have been added to the Express Scripts national formulary exclusion list.
The biggest change for many folks will be the exclusion of epinephrine pen Auvi-Q and epinephrine (generic Adrenaclick)—the main competitors to EpiPen. This isn’t great, but how it affects you will depend on which version you use, and how much you’re paying now. The Adrenaclick generic has less-expensive cash prices, starting at $110, but EpiPen (and its generic alternative) are still more popular overall.
If you use a long-acting powerful pain medication, you may want to check your coverage—Express Scripts will also be excluding Opana ER and generic oxycodone ER, along with Lazanda (fentanyl). Abstral and Fentora (also fentanyl pain medications) are already excluded. Your covered options will be mostly generics like hydromorphone ER, morphine sulfate ER, oxymorphone ER, and fentanyl citrate lozenges.
To be fair, 46 of 64 newly excluded drugs are simply brand-name drugs that now have a generic alternative—and several of the others are brand-only drugs with similar generics available in the same class.
⇒ Caremark: 19 new drugs have been added to the Caremark national formulary exclusion list. Similar to Express Scripts, 5 of these are brands with generic alternatives available, and several others have similar options in the same class.
On the other hand, Caremark is adding 19 drugs back to their covered formulary, some as preferred medications and other non-preferred (meaning you may need a prior authorization or step therapy to get coverage). This is great news, as there are some commonly used medications on this list that don’t have generics or close alternatives. These include asthma and COPD inhalers Symbicort, Dulera, and Incruse Ellipta; Levitra for erectile dysfunction; and Invokana and Invokamet for diabetes.
2018 Excluded Drugs
You can see all of the excluded medications below. For a full list of excluded drugs and covered alternatives, see the Express Scripts list here and the Caremark list here. If you’re not sure which company provides your pharmacy benefit, contact your plan administrator.
Aciphex (sprinkle) (Express Scripts)
Adderall (Express Scripts)
Androgel (1%) (Express Scripts)
Anusol HC (Express Scripts)
Atacand (Express Scripts)
Atacand HCT (Express Scripts)
Auvi-Q (Express Scripts)
Azor (Express Scripts)
Benicar HCT (both)
Bupap (Express Scripts)
Cymbalta (Express Scripts)
Cytomel (Express Scripts)
Effexor XR (both)
epinephrine (generic Adrenaclick) (Express Scripts)
Femring (Express Scripts)
Forteo (Express Scripts)
Fosrenol (Express Scripts)
Imitrex (Express Scripts)
Inderal LA (Express Scripts)
Intuniv (Express Scripts)
Lazanda (Express Scripts)
Lexapro (Express Scripts)
Librax (Express Scripts)
Lidoderm (Express Scripts)
Lovenox (Express Scripts)
Lunesta (Express Scripts)
Minastrin 24 Fe (Express Scripts)
Nasonex (Express Scripts)
Neupogen (Express Scripts)
Nevanac (Express Scripts)
oxycodone ER (Express Scripts)
Plaquenil (Express Scripts)
Plavix (Express Scripts)
Prevacid (Express Scripts)
Prilosec (suspension) (Express Scripts)
Pristiq (Express Scripts)
Protonix (Express Scripts)
Provigil (Express Scripts)
Prozac (Express Scripts)
Pulmicort Respules (Express Scripts)
Renagel (Express Scripts)
Sandostatin LAR Depot (Express Scripts)
Seroquel (Express Scripts)
Seroquel XR (both)
Signifor LAR (Express Scripts)
Singulair (Express Scripts)
Strattera (Express Scripts)
Sumavel Dosepro (Caremark)
Synjardy XR (Caremark)
Synvisc One (Caremark)
Tikosyn (Express Scripts)
Timoptic Ocudose (Express Scripts)
Tobi (solution) (Express Scripts)
Tribenzor (Express Scripts)
Trulance (Express Scripts)
Valium (Express Scripts)
Valtrex (Express Scripts)
Vytorin (Express Scripts)
Wellbutrin SR (Express Scripts)
Xanax (Express Scripts)
Xanax XR (Express Scripts)
Xenazine (Express Scripts)
Zegerid (Express Scripts)
Zoloft (Express Scripts)
Zyflo CR (Express Script
An important note about Medicare and individual plans:
These changes DO NOT apply to Medicare plans; if your Medicare benefit is managed by Express Scripts, you should check your coverage with your pharmacist or online through the Medicare.gov portal.
Some individual private insurance plans managed by Express Scripts or Caremark may also have different coverage. This means different drugs may be covered or excluded on your plan if you have coverage through work, for example. Please get in touch with your insurance provider if you have any questions about your coverage.