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.
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.
The first thing to understand about testosterone replacement is that oral testosterone (pills taken by mouth) doesn’t really work because it is broken down so quickly by the liver. The solution to this problem involves patches, gels, shots, and even nasal sprays. Here are your options, with some new players in the game.
Androderm patches are meant to be worn on the arm or torso. Androderm patches deliver approximately 5 mg of testosterone per 24 hours and result in normal testosterone levels in the majority of hypogonadal men. These have been around for a while.
Show me the gels!
- AndroGel is supplied in both 1% and 1.62% concentrations. The 1 percent concentration was the first to become available. This will be your cheapest option for a testosterone gel.
- Testim (1 percent testosterone gel) is supplied in tubes and applied once daily. Anecdotal reports suggest that this preparation gives off an odor.
- Axiron (2 percent testosterone solution) is a solution of testosterone that comes in a metered-dose pump with an applicator. This is a gel applied to the underarm and it is quite expensive so be prepared.
- Fortesta is a new 2 percent testosterone gel applied to the front and inner thighs. Also pricey.
The option of intramuscular injections is a good one, though it requires office visits. Injections are usually given one shot of 100 mg, once a week for 12 weeks. Regimens of 300 mg every three weeks and 400 mg every four weeks can also be used. An advantage of the shots for men is the freedom from daily administration of a gel or patch, while the disadvantages are the need for a shot of an oily solution every one to three weeks.
Natesto is the first nasal testosterone gel approved in the United States for the treatment of male hypogonadism and testosterone deficiency. Natesto is a metered-dose pump applicator that places the gel into the nostrils.
The good thing? Because this gel is applied inside of the nostril, there is little chance of transferring testosterone to women or children who come into close physical contact with the person using the intranasal gel. That can occur with the gels and patches used on the skin.
There are some disadvantages. Some men won’t like that it needs to be used three times daily. People with allergies or underlying nasal or sinus problems also may not like Natesto as a runny nose, sore throat and sinusitis are among the most common side effects.
Most options for testosterone replacement are considered Tier 2 drugs by many insurance plans, though they may fall under higher copays or may not be covered with some plans. Androderm patches and all gel options run about $550-$600 per month or per prescription (for 30 patches or one container of gel). Testosterone shots are significantly less expensive, with generic versions sometimes available for as little as $20 per dose.
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.
Epipens. Sovaldi. Tysabri. Acthar. Harvoni. Every month, it seems, there’s fresh outrage–from president Trump, the Congress, in the media, and among the public–over the soaring cost of prescription drugs.
With good reason: The cash price for the average brand-name prescription drug has increased 48% since 2013. These increases put desperately needed treatments out of reach for many, and cost taxpayers (via Medicare and Medicaid) billions of dollars more every year.
But as expensive as they are, the brand name drugs in the headlines actually treat relatively few people.
Much less attention has been paid to the price of prescription drugs that tens of millions of Americans take every day–that is, the 85% of prescriptions that treat common chronic conditions such as high blood pressure, high cholesterol, chronic pain, diabetes, and depression–and are usually generic medications, not brand-name drugs. Generics are the versions of drugs that get released after a manufacturer’s patent expires, allowing other makers to sell the same compound for less money–well, that’s how it’s supposed to work, at least. More than 3 billion prescriptions are written for generics every year. And the story of generic drug pricing is even weirder than brands.
We should start with the good news: generic drugs are, on average, getting cheaper. Patents on many blockbuster drugs–Crestor, Abilify, Nexium–have expired in recent years, and in some drug categories–statins or anti-depressants, for example–most treatments are now available as generics.
In theory, that should mean cheaper prices. In practice, not so much. Here’s why.
Until the last few years, insurance covered the cost of most generics; patients would chip in an average co-pay of about $10 and never think twice about the cost of their medications. Over the last decade, however, the $10 copay has slowly begun to disappear, and patients are exposed to prices that can vary wildly.
Part of this is driven by Obamacare. The ACA included prescriptions as an Essential Health Benefit, but it also allowed for very limited formularies, (the lists of drugs covered by insurers), extensive use of prior authorizations, (requiring extra approvals from doctor and insurer), and startlingly high deductibles–as high as $6,500 a year for entry-level Bronze plans–before those old-fashioned $10 co-pays kicked in.
At the same time, employee-provided insurance also changed dramatically. Plans that used to provide just one or two tiers of drug coverage now have as many as six, with patient costs ratcheting up with every tier. Meanwhile, copays are being replaced with “coinsurance”, where the consumer’s financial exposure is far greater–a percentage of the total cost, rather than a flat fee.
All this means that the average American has been quickly exposed to what’s called “usual and customary” (U&C) prices, which are the staggeringly high list prices for prescriptions that were never really intended for consumers to actually pay. Think of these prices like the sticker price on a car–most buyers know that the MSRP is a fool’s price, and the real, lower price is hashed out directly with the dealer. Same with the U&C price on drugs, except there’s no back office for consumers to negotiate with.
Take atorvastatin, which came on the market as Lipitor but has been available as a generic since 2011; the cash price for the most common dosage is $120 or more per prescription. Gabapentin, an oft-prescribed pain reliever, has a cash price of $75. Nexium, which went generic in 2015, has a cash price at $250 per fill. The story is even worse with diabetes drugs, including insulin, which are often not covered on insurance formularies altogether, (same with medications for erectile dysfunction and many dermatological conditions).
These prices aren’t just what people without insurance–which still numbers 30 million Americans and could rise substantially if current laws change–will pay. Add up the people in high deductible plans, on Obamacare, and more than 50% of Americans are at risk of paying the full cash price for generic medications.
Fortunately, there are now ways for consumers to comparison shop and access tools to make prescriptions more affordable, even when insurance can’t help. Some pharmacies have created programs to discount limited lists of prescriptions. Manufacturers are beginning to provide discounts and assistance programs to help reduce costs for cash-paying patients. And, over the past decade, pharmacy benefit managers–the companies that actually negotiate prices between manufacturers, insurers, and pharmacies–have launched discount cards that offer lower prices. Together, all of these discounts can provide significant savings; up to 75% off more expensive generics. The company I co-founded, GoodRx, has brought the same technology used to compare prices for plane tickets and TV’s to healthcare. We built a comprehensive database of all available discounts that shows consumers to the best available discount based on pharmacy and location, free of charge. It’s just one solution among many that are needed.
Every year, more Americans are diagnosed with chronic conditions, adding to the 50% of Americans currently coping with such diseases. These are conditions where medicine can’t promise a quick cure, but more typically offers years of coping through one or more medication. For these Americans–which sooner or later will include most of us–it’s essential that any solution coming out of Washington, or out of the drug industry, look beyond the headlines about expensive brand-name drugs, and include the vast number of drugs taken by the vast majority of Americans. If we’re really going to address the high cost of drugs in America, we need to understand the real problem.
This piece first appeared on Quartz