Amid an already devastating flu season, the story of a Texas teacher who, sick with the flu, skipped her prescription for Tamiflu (oseltamivir) because of a $116 copay, and subsequently died of the illness, has struck many as a tragedy that could have been avoided. It’s especially mystifying because of the high price of such an essential drug. How is it that such a life-saving medicine can be out of reach for so many people?
Heather Holland, a second-grade teacher in Fort Worth, Texas, decided not to fill her prescription for Tamiflu when she saw it would be $116. Her husband says they could have afforded the medication, but she refused to pay out of principle. Three days later, she died from flu-related complications.
It’s impossible to say whether Tamiflu would have saved her life – but the story has provoked alarm and outrage across the country.
It is indeed an outrage – and it only gets worse when you start digging into the pricing behind the story. In fact, prices for Tamiflu – and its equally effective generic form, oseltamivir, are all over the place, depending on where you pay and how you pay. People across the U.S. are reporting paying $90, $25, $106, $10, $200, or $9 – and that is with insurance. Without insurance, paying cash prices people are paying as much as $250 for a prescription for Tamiflu, or $135 for the generic version.
“I just paid $220 for my children’s flu medication (Tamiflu) – they are 6 and 4, not taking them isn’t optional, my daughter got Strain A, more serious one. And this is AFTER insurance coverage AND their state supp. insurance wouldn’t pay because it copay exceeded $100.”
— Johanna (@JohannaMarcia01) January 14, 2018
“The copay for my 7 year old to get tamiflu was $370 dollars. I’m fortunate to have the resources. Others don’t.”
— ♀️♀️ (@abirdabeeaplane) February 10, 2018
What is going on? Here are some facts that can help explain the chaos behind the tragedy.
Tamiflu comes in a generic version
Tamiflu is the brand-name for the drug oseltamivir and is manufactured by Roche pharmaceutical company. Roche sells its version of the drug for a premium price – typically for around $175 cash. But most people who are prescribed the drug will actually get a bottle of generic oseltamivir, which is made by several generic manufacturers. This version of the drug is much cheaper, about $135 for a 10 dose prescription. Whether you are paying with cash or your insurance, be sure you are getting this cheaper generic form of Tamiflu – it is exactly the same medicine and works just as well as the brand version.
Tamiflu comes in 2 forms
Oseltamivir is typically prescribed to adults and most people 13 years or older in 75 mg capsules. But the drug also comes in a liquid form: Children under 13 can be prescribed the oral suspension, which is usually much more expensive than the capsule form – up to $350 for the brand version and around $250 for the generic version. The medicine also comes in a 30 mg and 40 mg capsule, which is sometimes prescribed to children instead of the liquid. Even though the dose is smaller for these smaller capsules, the prices are about the same as the 75 mg form.
Insurance often doesn’t give the lowest price
Even though oseltamivir is the medicine most people take when they are diagnosed with the flu, it is not always covered by health insurance plans. Often, it is put on a “low tier” formulary, meaning that the insurer will cover some – but not all – of the cost. Since there are hundreds of health plans and formularies in the U.S., this means that prices are all over the place. Often times people with insurance find that they are being asked to pay the full cash price of the drug (or even more baffling, sometimes even a higher price).
This is especially true when you factor in available discounts on the drug, such as those featured at GoodRx. Using a discount, prices drop to around $50 in many locations, with average discount prices nationwide at around $60. For many people, this is a lot less than what they would pay with insurance. There’s no catch, but to get the price you must 1) have the coupon and 2) tell your pharmacist you are not using your insurance.
GoodRx also has discounted prices for the brand version of Tamiflu – instead of $175, we have a price of around $140.
As to why prices vary so much from location to location? That’s because pharmacies and PBMs (the companies that actually supply the drug from the manufacturer) are constantly shifting prices around based on supply and demand. It can be terribly confusing but suffice to say that by using GoodRx you can be confident you are getting the lowest prices we can find.
Tamiflu is not the vaccine – and not a cure
Once somebody is diagnosed with the flu, there are very few medicines that actually work to fight the virus. Tamiflu is the most used of these – but even Tamiflu isn’t perfect. In fact, the research has been rather spotty in just how effective the drug is in reducing symptoms and speeding up recovery. Research does show, however, that the drug is most effective when it’s taken as early as possible (it also has some preventive properties, which is why it’s often prescribed to siblings when one child gets the flu).
And no, oseltamivir is not the flu vaccine and not a replacement for getting vaccinated. Even though there’s been doubt about how effective this year’s flu vaccine is, experts agree that it is the best available defense against illness, and reduces your chance of getting the flu by about ⅓. That should be reason alone to get vaccinated.
For a large portion of Americans, a simple bee sting or a peanut can cause a fatal allergic reaction called anaphylaxis. Fortunately, in most cases, these symptoms can be treated by a shot to the leg with an epinephrine auto-injector. Unfortunately, one of the most popular autoinjectors EpiPen costs around $630 and it’s generic version epinephrine costs around $320 for a pack of two autoinjectors, making them unaffordable for many people in need. But there are other alternatives. GoodRx is here to help explain them.
First off, why EpiPen is so expensive?
You may remember the EpiPen pricing controversy from about a year back, but here’s a refresher.
In August 2016 many patients ordering an EpiPen or EpiPen Jr, the autoinjector for children weighing 33 to 66 pounds, experienced sticker shock at the pharmacy. Those paying cash for EpiPen were hit with a bill for a whopping $600 or more for a pack of two auto-injectors. It soon came out that Mylan had increased prices for EpiPen and EpiPen Jr by 400% from 2011 to 2016.
Why was Mylan able to do this? Because they had the market all to themselves. The main competing autoinjector was discontinued in 2012, leaving EpiPen the only autoinjector available to treat anaphylaxis. With competitors out of the game, Mylan was free to gradually raise the cost of EpiPen more than four-fold without decreasing the demand.
When news broke of the large price hike, the outcry was loud. Top news outlets picked up the story, and Mylan was eventually hit with some lawsuits—sparking a nationwide discussion about drug prices. Mylan attempted to ease the public outcry by releasing an authorized generic version of EpiPen—epinephrine. The outrage, it appeared, had worked, and manufacturers were starting to listen and respond. Or so it seemed.
How much does generic Epipen cost?
Unfortunately, prices are still sky high. Cash prices for a pack of two epinephrine auto-injectors currently average around $377. While this is about 50% off brand name EpiPen, it is still not affordable for many Americans. So how can you save?
Are there any cheaper medications I can try?
We have good news! You have three other choices for epinephrine pens in addition to EpiPen and its generic.
- Adrenaclick (epinephrine). There are a lot of benefits to using Adrenaclick and its generic version. Like EpiPen, Adrenaclick is a pen-shaped autoinjector designed to be easy to use. The main difference? Adrenaclick is affordable. The generic is available for around $100 at CVS and has a manufacturer savings program that can reduce your co-pay to as little as $0 per fill. You can read more about this program here.
- Auvi-Q. During the EpiPen pricing controversy, manufacturer Kaleo made it their mission to develop an affordable autoinjector and released Auvi-Q. The average cash price for Auvi-Q is expensive, but the manufacturer has made it easy for many patients to access it for free through the Auvi-Q Affordability program. You can read more about this program here.
- Symjepi. This one was approved by the FDA in June 2017 and isn’t on the market yet. We also aren’t sure how much it is going to cost, although it is intended to be less expensive than EpiPen. For more information about this approval, read our previous post here.
Is there a reason I should use the brand version of EpiPen?
Not really. All of the autoinjectors work equally well. While it’s might be best to find the most affordable one for you, you should always defer to your doctor.
Generic Epipen still works best for me—can I still save?
- Save with a manufacturer coupon or patient assistance program. Manufacturer Mylan offers a manufacturer program, though it only offers $25 each fill for insured patients. That isn’t much for a $300 medication. You can read more about this program here.
- Use a GoodRx coupon for Epinephrine. GoodRx offers discounts for epinephrine online, which can usually save at least $15 off the full retail price.
- Try to appeal your coverage. If you have insurance and your plan doesn’t cover epinephrine, EpiPen or EpiPen Jr, ask your doctor about submitting an appeal. Some plans require 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.
Symbicort (budesonide/formoterol) is a common maintenance inhaler, taken on a daily basis to treat asthma and COPD, but it’s not cheap. Cash prices average around $323 for one inhaler, and out of pocket costs for those who fill Symbicort regularly can be unmanageable.
Symbicort works well. Around 60% of people rate that Symbicort is ‘worth it’, according to our friends at Iodine. If Symbicort works well for you, or your doctor thinks it’s best for you, how can you make it more affordable? Here’s some information about Symbicort and how you can save.
How Popular is Symbicort?
When will generic Symbicort be available?
As of December 2017, there is no generic Symbicort available. In January of 2017, manufacturer AstraZeneca received an extension on their patent exclusivity, which will allow for them to continue to be the sole manufacturer until mid to late 2018.
At present, there have been few reports of manufacturers developing a generic alternative, and no applications have been approved by the FDA. But with increasing pressure from popular inhaler Advair, and AirDuo (AirDuo just got its first generic equivalent), AstraZeneca will need to keep their prices for Symbicort competitive. While this doesn’t necessarily mean we will see a generic soon, this competition could speed up the process.
Are there any cheaper alternatives?
Since few generic beta agonist/corticosteroid inhalers exist, cash prices for alternatives could be just as expensive as Symbicort. However, depending on your insurance coverage, some alternative inhalers might be more affordable.
- Breo Ellipta is another common inhaler used to treat asthma and COPD and is used to provide long-term control of symptoms. The downside? Breo Ellipta contains an ingredient that can cause a yeast build up in your mouth and throat, and should not be taken by those who are allergic to milk.
- Dulera is a combination inhaler used to improve lung function and can reduce the number of asthma flare-ups by 70%.
- AirDuo (fluticasone/salmeterol) is one of the only alternative inhalers that has a generic. In fact manufacturer, Teva released brand name AirDuo and a generic fluticasone/salmeterol at the same time – the move was aimed at increasing access to lower-cost inhalers and competing in the asthma inhaler marketplace. Cash prices for generic fluticasone/salmeterol average around $89. That’s definitely more affordable than $323 for Advair. As always, be sure to speak with your doctor to see if AirDuo is right for you.
Symbicort is also often compared to GlaxoSmithKline’s popular inhaler Advair, but how interchangeable are they?
Symbicort vs Advair
Advair and Symbicort are very similar in nature—and many patients wonder which is best for them. While both Symbicort and Advair are both used to treat Asthma and COPD, they have several noteworthy differences.
First off, Symbicort and Advair have different active ingredients. These active ingredients are especially important to pay attention to, especially if you are on other medications that could have a negative interaction.
Another difference? The price. Advair tends to be a little more expensive. The average cash price for Advair is $367, while Symbicort is $323.
One final note. Be sure you know that both Symbicort and Advair are not rescue inhalers – they cannot be used to treat acute symptoms like an asthma attack.
Symbicort still works best for me: How can I save?
- Save with Symbicort’s manufacturer coupon or patient assistance program. Manufacturer AstraZeneca offers a manufacturer coupon program and patient assistance program for patients with and without insurance coverage. The Symbicort $25 Guarantee Program can reduce your payment to as little as $25 per month for one year, while the Patient Assistance Program can help you receive your medication at no cost if you qualify. For more information on eligibility and enrolling, be sure to read through our Symbicort Savings Tips.
- Use a Symbicort coupon from GoodRx. GoodRx offers discounts for Symbicort online which can save at least 15% off the full retail price
- Try to appeal your coverage. If you have insurance and your plan doesn’t cover Symbicort, 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.
Viagra is one of the most popular drugs on the market today, earning manufacturer Pfizer over one billion dollars a year. Its popularity has led to thousands of bad jokes, hundreds of cheesy commercials, and put the phrase “erectile dysfunction” on the radar. But how much do you actually know about the infamous erectile dysfunction pill?
Here are 10 things you should know to get better acquainted with Viagra, and its generic sildenafil.
There are two manufacturers for generic sildenafil… and more on the way.
In 2013, generic manufacturer Teva Pharmaceuticals reached a settlement that allowed them to manufacture generic sildenafil starting on December 11th, 2017. As of last week, Teva was set up to be the sole manufacturer for generic Viagra until 2020, when the brand name patent expires.
However, on December 6th, Viagra manufacturer Pfizer announced that they would also be releasing generic sildenafil, at a significantly reduced price. Ultimately this move will enable Pfizer to share in the profits of generic sildenafil. Smart move on their part.
Viagra’s patent officially expires in 2020, and we expect to see more manufacturers come to the table then, driving prices down. Stay tuned.
It comes in multiple dosages
Just like brand name Viagra, generic sildenafil is sold in tablets of 25 mg, 50 mg, and 100 mg.
It costs about half as much as brand name Viagra
Yes, you read that right. Pfizer, the current manufacturer of brand-name Viagra has priced generic sildenafil at 50% off the current brand price. The average retail price of one tablet of Viagra is around $73, so prices of generic sildenafil come in around at $30-$40 per tablet.
That is still on the pricey side for one tablet, but there is one more way to save. Generic manufacturer Teva offers a savings program for eligible patients to pay as little as $0 on their prescription. For more information on this program, see their website here.
Sildenafil won’t be different from brand name Viagra.
We consistently see patients voice concern about the efficacy of generic drugs. But keep in mind the rigorous process that drugs must go through before they hit the market. These processes ensure that generic medications contain the same active ingredients as their brand name counterparts, so there’s very few differences between brands and their generic counterparts. You can read more from the FDA about this here.
The biggest difference we can see right now? The color. The ‘little blue pill’ will now be the ‘little white pill’
A generic sildenafil already exists.
Don’t let this confuse you. Sildenafil is the generic for two common drugs on the market right now, Revatio and Viagra, but these drugs are approved by the FDA for two different uses. Revatio is used to treat pulmonary arterial hypertension, while Viagra treats erectile dysfunction in men.
How can you distinguish between the two? Revatio-equivalent sildenafil is only sold as a 20 mg tablet, while Viagra’s generic sildenafil is sold in 25 mg, 50 mg, 100 mg tablets. For more on this, see our previous blog here.
It is the most counterfeited drug in the world.
The problem of counterfeit Viagra is so widespread that Pfizer has even created their own security force to help cut down on the amount of unregulated drugs on the market. This team, called Pfizer Global Security, works with law enforcement, pharmacies and wholesalers to monitor distribution, and improve surveillance on counterfeit Viagra.
Why is this so important? One study done by the Pfizer Global Security team found that nearly 80% of online sites that claimed to sell Viagra were actually selling a counterfeit. The team has even found dangerous additives like blue printer ink, amphetamines (or speed), rat poison, road paint, and floor wax hidden in counterfeit Viagra—things you definitely don’t want to put in your body.
For more information on spotting fake Viagra, see Pfizer’s video on how to buy safely here.
It does have side effects.
While you might have only heard of the good effects of Viagra, be aware that it does have some negative side effects. According to our friends at Iodine, people typically report side effects like headache, flushing, low blood pressure, abnormal vision, indigestion, and an erection lasting longer than five hours. Be sure to speak with your doctor or pharmacist if you experience any of these side-effects for a prolonged period of time.
It is available without a prescription in the UK.
The UK just became the first company where patients can buy Viagra over the counter, without a prescription. It is sold under the name Viagra Connect, and is available as a 50 mg tablet for around $25 US dollars for four tablets.
This decision by the Medicines and Healthcare Products Regulatory Agency is aimed at reducing the amount of black market, unregulated Viagra tablets sold.
It treats more than erectile dysfunction.
In fact, it was first intended to treat chest pain and angina. However, patients prescribed sildenafil for chest pain reported an interesting side effect, an increased amount of erections, and it was soon after approved to treat erectile dysfunction.
Since then, sildenafil’s indications have expanded to include high blood pressure and pulmonary arterial hypertension in addition to erectile dysfunction.
At GoodRx, we work everyday to bring you better prices and greater convenience with your prescription drugs.
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