These price increases, among others, have shed necessary light on price hiking and transparency, and have caused many states to take this matter into their own hands. At the moment, 23 states are stepping up their efforts on drug pricing by proposing bills that take on the rising cost of drug pricing.
What is drug pricing transparency?
First off, it’s great for your pocketbook. Drug pricing transparency would require pharmaceutical companies and middlemen (like pharmacy benefit managers) to be less secretive about the actual costs of their medications.
Who would benefit?
Essentially everyone, minus those with a hidden agenda. Providing drug pricing will ensure affordable and accessible prescription drugs for consumers.
What’s going on in California?
Exciting things! Governor Jerry Brown just signed the SB-17 drug transparency bill. This bill requires that pharmaceutical companies give the state of California 60 days notice anytime they plan to raise the price of a drug by 16% or more over 2 years. The companies would also have to explain why the increases are necessary. In addition, health insurers would have to report what percentage of premium increases are caused by drug spending.
California also has another bill, AB-265, which would prohibit drug companies from offering coupons and other discounts to brand-name drugs that have an alternative cheaper generic available. This bill has yet to get to the governor but has passed in the Senate.
Vermont passed a bill in 2016 that requires pharmaceutical companies to provide justification for drug price hikes.
Each year the Green Mountain Care Board in collaboration with the Department of Vermont Health Access identifies drugs that have experienced price hikes by 50% or more over the past five years, or by 15% more over the past 12 months. For drugs that have experienced increases, the state can fine the pharmaceutical companies.
What about Nevada?
In June, Nevada passed a bill that focuses solely on the cost of diabetes medications. However, it is currently facing lawsuits from pharmaceutical lobbying groups, as they claim that it is unconstitutional and possibly violates patient rights. More to come on this!
What’s going on with the bill in Ohio?
The Ohio Drug Price Act is an initiative that aims to cut pricing. Or does it?
This act would mandate that the state agencies pay no more for prescription drugs than the U.S Department of Veterans Affairs, which typically gets a 24% discount on the price of drugs from pharmaceutical companies.
However, this bill does not apply to those with private health insurance; therefore, if passed Ohioans insured through their employers could actually see drug prices go up in order for the drug companies to regain the money lost from selling to certain buyers at a lower rate. A similar bill in California flopped just last year!
It seems like more bills are being proposed every day. Stay tuned, we will keep you in the loop.
The importance of getting a flu shot can’t be overstated, especially for those who are at a higher risk like young children, pregnant women, older adults, and the immunocompromised or disabled. (If you’re living or traveling outside the US, you’re also at higher risk.)
Before the various types of flu shot we have now—quadrivalent, nasal spray, high-dose, and more—there was only one option when it came to protecting yourself from the yearly flu. Now, you have options, and there are ways to get vaccinated even if you’re allergic to eggs, worried about preservatives, or just don’t like needles.
If you’re worried about cost, know that flu shots can range from $0 (yes, free) to $50 or more, depending on where you get your shot and what kind of vaccine you receive. Whether you’re insured or not, there are ways to make your family’s vaccines affordable.
For this year’s flu season, the experts have some new recommendations. We’ll also show you how to save no matter where you’re getting your shot.
ACIP recommends nasal spray flu vaccine should not be used (again)
The CDC’s panel of experts known as the Advisory Committee on Immunization Practices (ACIP) voted again this year that the nasal spray flu vaccine known as FluMist should not be used for the 2017-2018 flu season.
For the first time last year, the ACIP recommended against the use of the nasal flu vaccine. There are concerns about how effective it was against flu viruses in the US in previous years.
Scared of needles? Intradermal flu vaccines are your best bet
With the nasal spray option off the table, consider an intradermal flu shot. The intradermal shot uses a small, ultra-thin needle that’s 90% smaller than the ones used for other flu shots. The intradermal vaccine is given through your skin (intradermal) where the regular shot is given into the muscle (intramuscular).
Currently, Fluzone Intradermal is the only small-needle flu shot available.
Keep in mind—you can get your flu shot and a shingles vaccine together
The FDA now has substantial data showing that getting a flu shot and shingles vaccine at the same time is perfectly fine. The shingles vaccine, also known as Zostavax, is used for the prevention of shingles in adults 50 years of age and older.
Make sure to get your flu shot early
It can take up to 2 full weeks before you’re fully protected after you get your shot. It’s always best to get vaccinated and make sure you’re protected as early in the flu season as possible, before you may be exposed to others who have the flu. However, this is especially important if you plan to travel this fall—make sure to plan ahead and get your shot more than 2 weeks ahead of time so you’re protected once you hit the road (or the air).
If you’re pregnant, or thinking about becoming pregnant, get the flu vaccine
The flu vaccine is recommended if you will be pregnant during flu season (as early as October through as late as May). A flu shot can be given at any time during pregnancy, before and during flu season.
Your child may need 2 doses of the flu vaccine
If your child is 6 months to 8 years old, evidence from several studies shows that they require 2 doses of the flu shot (given at least 4 weeks apart) during their first season of vaccination for optimal protection.
Children 6 months through 8 years who have previously received 2 or more total doses of flu vaccination (trivalent or quadrivalent, it doesn’t matter) before July 1, 2017 will need only 1 dose this year.
You must be a certain age to receive a high-dose flu shot
You may not have to go to your doctor—or even your pharmacy
Flu vaccine accessibility continues to get better. You can still get a flu shot (and other vaccines) from your doctor, or your pharmacy—but many people are getting vaccinated at clinics, health departments, at school or a community center, and even through employers.
If you do prefer to get your flu shot from your doctor, check with the office first to see if they have the current flu vaccinations available for the 2017-2018 flu season, and ask if you’ll need an appointment.
Use these resources help you figure out where to get your shot
First, check GoodRx for discounts at flu shot prices at pharmacies in your area!
The HealthMap vaccine finder is also great tool for finding where to get vaccinated. Their site allows you to search by location, and to see a list of places near you that have the shot available. Make sure to call ahead whether you see your pharmacy on the list or not. And if you don’t see your local pharmacy, don’t be discouraged, they may still offer flu shots.
Flu shots can be expensive . . .
Flu vaccines start at about $20, and can cost more than $50 per shot, if you’re paying out of pocket with no discount or insurance. You’ll pay more if you’re getting one of the less common varieties like the high-dose shot or the nasal spray.
Medicare Part B completely covers flu shots—if you have Part B, your shot should be free. Commercial insurance plans often cover flu shots at no cost to you, because they are considered preventive care. One exception: if you get a shot from your doctor, you may still have to pay for the office visit.
. . . But there are lots of ways to save
Around this time of year, there are an abundance of free clinics and events offering low-cost or free flu shots across the US. Watch for announcements on your local news station, or in the local newspaper—or search online for free flu shots in your area. These are often very specific to your area, so keep an eye out.
Many pharmacies also have a flat rate for flu shots, or offer discounts or other perks if you get vaccinated at their stores. There are fewer offers out there than in previous years, but a few examples include:
- CVS offers a coupon for $5 off a $25 purchase when you get a flu shot. CVS doesn’t offer discounts on the vaccination itself, but they do note that your shot will most likely be free if you have any kind of insurance.
- Costco has shots starting at $19.99 (and a great list of tips on how to prepare for your shot.)
- Walgreens doesn’t offer a discount, but they do have a “give a shot, get a shot” program. When you get vaccinated at Walgreens, they will provide a vaccine to a child in need.
- Walmart also offers flu shots starting at $39.84.
Most pharmacies started receiving their shipments for the 2017-2018 flu shots in August, so go get vaccinated!
Cialis, approved to treat both ED and benign prostatic hyperplasia (BPH), has about a year left on the countdown to its generic. Viagra will likely be available as a generic before Cialis.
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 will get a generic alternative before Cialis, by the end of 2017.
- 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.
- Generic sildenafil (Revatio) is much less expensive, and is used by some patients to treat erection problems. However, take note that it is only approved by the FDA for the treatment of pulmonary arterial hypertension. Your doctor will be able to give you advice on whether sildenafil could be an option for you.
- For more information on how Cialis, 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.
What is a biosimilar?
Without getting too technical, biosimilars are basically the generic product of a biologic (a medication made from a living organism). However, because these medications are made out of living cells they are slightly different. The good news about biosimilars is that they are typically 15%-30% less expensive than their reference drug.
For more information about biologics and biosimilars, read our blog here.
What is Cyltezo indicated for?
Cyltezo is approved for the following 7 conditions:
- Pediatric patients 4 years of age and older with moderate to severe active polyarticular juvenile idiopathic arthritis
- Moderate to severe active rheumatoid arthritis
- Moderate to severe active adult Crohn’s disease
- Moderate to severe active ulcerative colitis
- Moderate to severe plaque psoriasis
- Active ankylosing spondylitis (arthritis of the spine)
- Active psoriatic arthritis
Keep in mind that Cyltezo is only approved for 7 indications whereas Humira has 10 indications. These three indications that Humira also treats include uveitis, hidradenitis suppurativa, and pediatric Crohn’s disease.
How will Cyltezo be sold?
Cyltezo will be available in a single-use prefilled glass syringe in the dosage of 40 mg/0.8 ml. The manufacturer, Boehringer Ingelheim, will also seek approval for an auto-injector in the future.
What are the most common side effects of Cyltezo?
The most common side effects include infections, injection site reactions, headache or rash.
Although these two are both biosimilars for Humira, they are different. Amjevita will be available additionally in a single-use prefilled glass syringe in the 20 mg/0.4 mL strength as well as a SureClick autoinjector in the 40 mg/0.8 mL strength.
Is Amjevita currently available?
How much will Cyltezo cost?
No. Although Cyltezo is a biosimilar, it is not interchangeable.
Interchangeable products are usually known as generic medications and can be substituted for a brand name medication if available and without needing to consult the prescriber. Your doctor must write your prescription for Cyltezo if this is the medication that is intended for you to use.
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.