Since the FDA created the Priority Review Program, aimed at fast tracking the development of drugs used to treat serious conditions, new hepatitis C medications are being approved at a faster rate.
Recently, the FDA approved Mavyret, a new combination medication for hepatitis C.
What is Mavyret prescribed for?
Mavyret is a combination medication indicated for the treatment of all major genotypes for chronic hepatitis C.
Mavyret will be available as a combination tablet in the strength of 100mg/40mg, supplied in a 4-week (monthly) dose wallet. The recommended dose is 3 tablets once daily, for 8 weeks, with food. You may need to take Mavyret for longer than 8 weeks if you have been previously treated with other medications, or have mild liver disease.
What are the most common side effects associated with Mavyret?
The most common side effects include headache and fatigue. Be sure to speak with your doctor if you experience any of these side effects for a prolonged period of time.
Is there anything unique about Mavyret?
Yes. Mavyret is the only 8-week treatment for patients with hepatitis C, without liver disease, who have not been treated before.
How much will Mavyret cost?
Abbvie has priced Mavyret at $13,200 per month, or $26,400 per treatment course, before discounts. Although this is still expensive, Macyret is priced significantly lower than other hepatitis C treatments. For instance, popular medications Epclusa, Sovaldi and Harvoni are priced at $74,760, $84,000, and $94,500 respectively.
There is good news, though! Abbie offers a co-pay assistance program for commercially insured patients. If you are eligible, you may pay as little as $5 per co-pay using their Abbvie HCV Co-Pay Card. Visit the website here, and call 1-877-628-9738 to learn more and find out if you are eligible.
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.
Low back pain is a part of life—common across sexes, age groups, and countries, it’s something that almost all people experience at some point. Treatment for low back pain often includes a combination of medication and non-medication options. What should you start with? What treatments have the best evidence? And more importantly . . . what’s coming our way for low back pain treatment?
To start #OldSchool—the best evidence exists for these three treatments:
- Non-steroidal anti-inflammatory drugs (NSAIDS). Which NSAID? Ibuprofen (Motrin, Advil), naproxen (Aleve), and celecoxib (Celebrex) are common examples. There does not appear to be a “best” NSAID for low back pain from the evidence. Start with low doses and go higher if needed, aiming for short term use. If you can’t take NSAIDS (stomach issues, kidney problems) take acetaminophen (Tylenol) instead.
- Muscle relaxants. Adding a muscle relaxant to an NSAID improves low back pain. Start with one that doesn’t make you tired like methocarbamol (Robaxin) or metaxalone (Skelaxin). See my previous blog here for full discussion on muscle relaxants for low back pain.
- Heat. Superficial heat for low back pain has been shown to help. There is moderate evidence from a small number of studies that heat wrap therapy provides short-term reduction in pain and disability in those with acute or sub-acute low-back pain (less than 12 weeks). When using heat wraps, use them only for 15-20 minutes at a time. Don’t fall asleep with them on.
Ok, then what’s next for back pain?
- Physical therapist or chiropractor. To sum up the evidence here: for low back pain, physical therapy and chiropractic manipulation have similar effects on symptoms, function, satisfaction with care, disability, recurrences of back pain, and subsequent visits for back pain. So think of them as being equally effective. I’d pick whichever one is more convenient and covered more by your insurance.
- Other exercise therapy. For example,yoga, tai chi or qigong. There is fair evidence that yoga and movement therapies will help for your back pain. Pursue them on your own and stick with one that interests you the most and is the most convenient.
- Other alternative therapies. Mindfulness stress reduction (meditation + yoga) and cognitive behavioral therapy outperformed NSAIDS in a recent study. Both are worth a try for sure if you are struggling with low back pain. Acupuncture, though—not so much. In the last two years a review of scientific evidence found the practice of acupuncture was no better than placebo in treating those living with low back pain and sciatica. Gua sha is another alternative therapy that may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.
What’s next for those with chronic, neuropathic (nerve-like) low back pain?
- Gabapentin (Neurontin) or duloxetine (Cymbalta) have the best evidence in addition to the above listed options for nerve-like pain in your low back that may radiate down your buttock or leg. Tramadol (Ultram) may also be added to your regimen at this point.
- The hot-button issue: Opioids for low back pain. Opioids are no more effective than NSAIDS for low back pain and have a high rate of adverse effects (the understatement of the year). Avoid opioids at all costs for low back pain.
Moving on—invasive procedures:
- Epidural steroid injections. Steroid injections in the lumbar spine are performed by pain management or interventional radiologists, and they do work. Epidural injections done with several approaches (interlaminar, caudal, or transforaminal) have been shown to reduce pain and disability short term (usually at 2 weeks) and help delay the need for surgical intervention. Epidural steroid injections may provide relief for a period of time and additional repeat injections are an option if pain recurs.
The future—and beyond:
- Radiofrequency denervation aka radiofrequency ablation (RFA) was the rising star, but a recent large study revealed disappointing results. RFA is a medical procedure where the nerve is ablated (the nerve endings are deadened) using high frequency alternating current. But does it work for chronic low back pain? Not so well. A recent study (JAMA July 4; 318(1):68-81) found radiofrequency denervation added to a standardized exercise program for chronic low back pain resulted in either no improvement or no clinically important improvement compared with a standardized exercise program alone. To sum it up: the findings do not support the use of radiofrequency denervation to treat chronic low back pain originating in the facet joints, sacroiliac joints, or intervertebral disks. Disappointing.
- Platelet rich plasma. Platelet rich plasma (PRP) has shown promising results when injected into the intervertebral disc and is currently being studied. PRP is high in growth factors, which is why it’s being studied, yet there are no active studies for low back pain being done. Will PRP help for low back pain? We don’t know yet, and won’t for a while.
- Stem cell therapy to regenerate cells and increase disc matrix production (the gel- like central part of the disc) is also currently being researched. This may be coming our way for low back pain, but no results yet.
- Cannabis. Studies on cannabis/medical marijuana are limited because it is still illegal under federal law, but several trials have evaluated the effectiveness of cannabis for patients with neuropathic pain. Patients with nerve pain from spinal stenosis or degenerative disc disease show a 30% improvement in chronic pain score following cannabis therapy. Pain relief provided by cannabis is dose-dependent, with higher THC content producing more pronounced pain relief. Know this: the strains of cannabis containing high levels of CBD (cannabidiol) generally make patients feel less high, since CBD acts as an antagonist to the psychoactive effect of THC. Consider starting with high-CBD, low-THC strains if you are concerned about feeling high.
What has helped for you?
Female Pattern Hair Loss (FPHL) is the most common cause of hair loss in women. While the cause is unknown, FPHL is more common in women with obesity, high blood pressure, and insulin resistance (pre-diabetes).
FPHL mainly affects the mid and frontal regions of the scalp, while preserving the frontal hairline. Your part gets wider, and hair near your temples may recede, but you will not lose all of your hair. Noticing that your part is widening, or your ponytail is thinning, may bring you to your doctor. Help! What works?
Common myths about hair loss in women
- Genetics do not appear to play a role in female pattern hair loss. No definitive familial inheritance has been identified in women, unlike in men with androgenic alopecia (“male pattern baldness”) where genetics play an important role from both mom and dad’s side.
- The majority of female hair loss is NOT tied to high levels of androgens (male hormones). Only 39% of women with FPHL have high androgen levels whereas male balding is a genetically determined androgen-dependent trait.
- Taking oral estrogen (hormone replacement therapy) has no clear effect on hair growth and in some studies showed an inhibitory effect.
Medical causes for hair loss in women
Before you make the diagnosis of Female Pattern Hair Loss (FPHL) which has no known causes, look for these:
- An under or overactive thyroid. Hypo or hyperthyroidism may cause hair loss, and is easy to rule out with a blood test called TSH (thyroid stimulating hormone).
- Iron deficiency anemia. A common complaint in iron-deficient women is hair loss, with increased loss reported in women with ferritins less than 100ng/dL. That’s an easy blood test.
- Psychological and emotional stress. A major illness, severe psychological trauma, significant weight loss and childbirth may precipitate an episode of hair loss that begins a few months after the episode. This is called telogen effluvium, and hair loss occurs in all areas of the scalp.
- Polycystic Ovarian Syndrome (PCOS). Sometimes this condition causes your body to produce too many androgens, which can decrease the growth of hair on your scalp.
- Medications. Some common culprits include beta blockers, antidepressants, anticoagulants, and chemotherapy drugs. Read more about this in our blog here.
Options for treating hair loss
Once your hair loss has been determined to be FPHL, and not related to one of the above-listed conditions, here are your options:
- Topical solutions of 2% minoxidil (Rogaine). Minoxidil, applied as 1 ml twice daily, is the only drug approved by the FDA for the treatment of female pattern hair loss. What is interesting is that minoxidil 2% and 5% have basically the same result.
- Oral finasteride (Propecia). While finasteride 1 mg tablets have not been shown to be helpful, a few studies have shown improvement with finasteride 5 mg daily.
- Zinc sulfate + calcium pantothenate. These are over the counter supplements. For those using daily topical minoxidil adding zinc sulfate capsules 220 mg + calcium pantothenate tablets 100 mg twice a week was better than with minoxidil alone. Worth a try!
- Spironolactone (Aldactone). There is some evidence that using Aldactone (spironolactone) at a dose of 100-200 mg a day benefits women who haven’t responded to the use of topical Minoxidil.
- Platlet rich plasma (PRP) scalp injections. Very recent studies have shown that PRP injected into the scalp can improve both hair density and thickness. The basic idea behind PRP injection is to deliver high concentrations of growth factors to the scalp, which the hope of stimulating hair regrowth.
Hope this helps!
Prescription narcotics have been essential to improving the quality of life for those living with pain, but sometimes at a high cost. Since the 1990s, deaths related to opioids have quadrupled, resulting in a serious public health epidemic and the deadliest drug crisis in US history.
In 2015, roughly 33,0000 deaths were related to opioids, averaging around 100 deaths a day. Sales of prescription opioids have quadrupled since 1991, even though studies have shown that reports of chronic and acute pain have remained steady. As bad as that sounds, it is getting worse—STAT News estimated that opiates could cause as many as 650,000 deaths over the next decade.
Opioids are still incredibly helpful for many Americans, but it’s important to keep yourself informed and know how to get help if you need it. With that in mind, we’ve compiled some resources that can help you and your loved ones stay safe.
First, what are opioids?
An opioid is a type of drug that helps treat pain. The majority of medications that fall under this category are available with a doctor’s prescription, but some—like heroin—are not prescribed by a doctor and are considered illegal street drugs.
Some of the most commonly prescribed opioids include Vicodin (hydrocodone/acetaminophen), Dilaudid (hydromorphone), OxyContin (oxycodone ER), and Duragesic (fentanyl) among many others. They can come in many forms, like a pill, liquid, wafer, or even a patch.
In the US, most are considered “schedule II” drugs by the DEA, which means there are restrictions on how they can be prescribed and filled at the pharmacy.
Opioids affect the brain and can increase pleasant feelings in addition to offering pain relief. It is this feeling of euphoria that leads to abuse, addiction or overdose.
How do you treat an overdose?
First, know what to look for. Symptoms of an overdose include respiratory failure, slow breathing, small pupils, and loss of consciousness or vomiting.
Someone experiencing an opioid overdose needs immediate medical attention. If you believe you or someone else is showing signs of an overdose, call 911 immediately.
I take an opioid prescription—how can I avoid an overdose?
First, follow the instructions for use—use your medication as prescribed, don’t mix with alcohol, and talk to your doctor about any other medications you may be taking. Overdoses are more likely if you mix your opioid prescription with alcohol or a sedative-hypnotic drug (Valium or Ativan are common examples). However, many overdoses are simply a result of taking too much, by accident or abuse.
If you take an opioid for severe, chronic pain, you may also be prescribed naloxone or Narcan, which can temporarily reverse the dangerous effects of opiates. These drugs are administered in two ways, intramuscularly—a shot into the thigh or buttock—or through a nasal spray device. With basic training, even non-medical professionals like family or concerned bystanders can give these life-saving drugs. For more information on safely administering naloxone or Narcan, read the opioid overdose toolkit here.
If you take Vicodin, Percocet, or other drugs that combine an opioid with acetaminophen (Tylenol), you should also be aware of the danger of an acetaminophen overdose. It’s especially important not to combine your prescription pain medication with over-the-counter Tylenol or cold medications—you can take a dangerous dose of acetaminophen quickly without knowing it.
How can I avoid abuse?
No one is recommending that doctors withhold pain medications from patients undergoing a medical procedure, or experiencing severe pain. You should know though that even when opioids are appropriately prescribed—and you take them as prescribed—it’s still possible to become dependent. In fact, as many as 1 in 4 people who are prescribed an opioid for pain struggle with addiction.
There are a couple steps you can take to help avoid the slippery slope:
- Follow the dosage directions on the label, and take your medication as prescribed by your doctor.
- Have a friend or family member track your medication and help you through the recovery process.
- Get rid of your leftover pills if they’re no longer needed. Be sure to follow the FDA’s guidelines on proper disposal of unused medications.
What are the warning signs of opioid addiction?
Becoming addicted to an opiate is not a conscious decision. Opiates are both physically and psychologically addictive—they stimulate parts of the brain tied with reward.
There are some warning signs you can watch out for:
- Taking the medication longer than prescribed.
- Taking opiates for the euphoric high. Be aware if you begin taking your opiate not to ease pain, but only for the euphoric feeling.
- Stealing drugs or supplies.
- Improper administration—for instance, grinding and snorting your medication rather than swallowing whole as prescribed.
- Developing a drug tolerance where you need more opioids to achieve the desired effect.
- Memory problems.
How is opioid addiction treated?
- Detoxification is the first step in treating opioid addiction, but be aware that withdrawal from opiates is dangerous and potentially life-threatening. Many people require a supervised detox to manage the symptoms from withdrawal.
- Rehabilitation centers (yes, rehab) are the most common way of treating opioid addiction. These centers typically guide patients through detox, create an environment that supports sobriety, and teach healthy behaviors. Some insurance plans cover drug rehabilitation, but coverage differs in each state, so be sure to check with your provider. Many states also offer substance abuse services, which is usually the most cost effective option. You can see the directory for state-funded facilities here.
- Medication-assisted therapy is another common way that specialists are treating dependency. Medications like methadone, naltrexone, and buprenorphine can help prevent relapse, and help people overcome an addiction without the symptoms of withdrawal. These medications work differently and have different side-effects, so your doctor will create a personalized plan for you. Keep in mind that medication-assisted treatment alone may not be enough to prevent relapse, and doctors typically recommend a combination of medication and behavioral therapy.
I think I (or a loved one) may need help—what can I do?
Remember, recovery is possible! Here are some resources to help you or your loved one:
- Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline. 1-800-662-HELP (4357) or 1-800-487-4889 (TDD — for hearing impaired). This hotline can provide free and confidential information for individuals and family members facing substance abuse and mental health issues. You can call 24 hours a day, 7 days a week.
- Opioid treatment program directory. A list of opioid treatment programs in each state.
- Behavioral health treatment locator. An anonymous source of information regarding behavioral health treatment facilities.
- Buprenorphine treatment practitioner locator. A source to locate physicians authorized to treat opioid dependence with buprenorphine.
- Overdose Prevention Toolkit. A guide to opioid use, overdose, recovery, and facts for community members.
- Partnership for drug-free kids. A non-profit supporting families struggling with a child’s substance use. You can call the helpline at 1-855-378-4373, live chat, or email them for more information, resources or help.
- Directory of Single State Agencies for Substance Abuse Services. A directory of state-funded drug treatment facilities.
The information on this website is not intended to be fully systematic or complete, nor does inclusion here imply any endorsement or recommendation by GoodRx. We make no warranties, express or implied, about the value or utility for any purpose of the information and resources contained herein.