I know what you’re thinking…your doctor has probably been wrong more than ten times. I agree, but there have been times when the standard of care across the country has changed on a dime, and physicians went from routinely prescribing a medication to learning it may not be helpful at all.
Here are ten notable “whoops” times.
- Hormone replacement therapy (HRT). For years, physicians were initiating HRT in postmenopausal women praising its protection against stroke and heart disease. Well, the data showed otherwise. Hormone replacement therapy is the best treatment for relief of hot flashes and night sweats, vaginal dryness, and may protect against bone loss early in menopause. The problem? Combined hormone therapy is also linked to a small increased risk of heart attack. Some research suggests that women who start combined therapy within 10 years of menopause and who are younger than 60 years, may get some protection, but HRT should not be used solely to protect against heart disease.
- Digoxin (Digitek or Lanoxin). The warnings here keep getting stronger, and this year we learned that in patients with atrial fibrillation without heart failure, Digoxin was significantly associated with sudden cardiac death. The association between Digoxin use and poor clinical outcomes highlights the need to examine its use, particularly when prescribed to control heart rate in patients with atrial fibrillation. There are newer safer options.
- Bisphosphonates. This class includes medications like alendronate (Fosamax) and ibandronate (Boniva), which are indicated for the treatment of osteoporosis. When they were first approved, physicians prescribed these medications to women who had early signs of bone loss or bone thinning to prevent osteoporosis. The problem? Bisphosphonates inhibit bone remodeling and reduce the bone repair process which can lead to fractures. While they are still used for the treatment of osteoporosis and help prevent hip and spine fractures, they are not indicated for those with just mild thinning or mild bone loss.
- NSAIDS. Naproxen, Motrin, and Advil were believed to be relatively safe and effective even when used long term. Now we know that anyone who is at risk for or who has cardiovascular disease (coronary artery disease) may have a further increase in the risk of heart attacks when taking an NSAID. Let me be clear though, short-term intermittent use is fine.
- Proton pump inhibitors (PPI). The long-term use of proton pump inhibitors is also gathering more worrisome data. Turns out, you should try not to take proton pump inhibitors long-term. Medications in this class include omeprazole, esomeprazole, and pantoprazole. While they work well for reflux, esophagitis, gastritis and ulcer disease, it now appears that PPI use can lead to a higher risk of stomach cancer. Additionally, long-term use can also lead to vitamin B12 deficiency, increased risk of c-diff diarrhea, and some bone loss.
- Steroids. Physicians used to prescribe oral steroids for everything from poison oak, itchy rashes, allergies and ear congestion. A Medrol dose pack or prednisone for less severe illnesses is not recommended. Studies suggest that even short courses of oral steroids are associated with adverse effects that should be considered before prescribing
- Niacin, Tricor and gemfibrozil. Up until last year, physicians were prescribing these in combination with the cholesterol-lowering meds “statins.” However this combination showed little benefit, and the two are not recommended by the FDA for co-administration. This move also affected Niacin, fenofibric acid, Advicor, and Simcor. The FDA determined that the benefits of these medications along with statins no longer outweigh the risks.
- Avastin (bevacizumab). This was another medication that had its FDA approval yanked. Used for metastatic breast cancer, FDA approval was revoked when it was not shown to provide a benefit in terms of delay in the growth of tumors. Nor is there evidence that use of Avastin helped women with breast cancer live longer or improve their quality of life. Depressing.
- Epogen (epoetin alpha). This injection is given to stimulate red cells. Up until 2011, we were using it for the treatment of anemia (low red blood cell count) in people with kidney disease. That was until a study showed that the use of Epogen in these patients was associated with a 30% increased risk of acute stroke. Ugh.
- Diet meds. There has not been a great track record for weight loss medications. Fen Phen many of you remember was pulled from the market in 1997 after contributing to pulmonary hypertension and heart valve disease. Much later came Meridia (Sibutramine) for weight loss which was pulled in 2010 due to increased risk of stroke and heart disease. So, there’s that.
As of Monday, Dec. 11, 2017, two generic versions of Viagra (sildenafil) will be available in pharmacies: one by generic manufacturer Teva, and the other by the original manufacturer, Pfizer. Prices for generic sildenafil should be about half what they are for the brand version, according to the AP.
Current prices for Viagra are around $70, which would put the generic versions between $30 and $35. That’s before any additional discounts – check back at GoodRx to see what additional discounts might be available.
Pfizer announced plans to release its own generic version days before Teva’s version arrives on the shelves (Teva has planned a generic version since 2013). This will allow Pfizer – which sold more than $1 billion of Viagra in the US in 2016 – to keep some of that cashflow coming in. Other generic versions are expected to arrive in pharmacies in the summer of 2018, which should drive prices even lower.
More than 60 million men worldwide have used Viagra since it hit the market in 1998. Those are the official numbers from Pfizer; many men are embarrassed to ask their doctors for a prescription, and the Internet has long been awash in dubious offers for the drug without a prescription.
This story has been updated to reflect current news. The original story is below.
Pfizer, the manufacturer of erectile dysfunction med Viagra, just reached a settlement with generic manufacturer Teva that will allow Teva to start selling generic Viagra (sildenafil) in December 2017—that’s more than two years earlier than the current patent expiration in April 2020.
The Teva generic will be the only one available for two-plus years, unless there are other settlements or the patent is contested successfully. This means that there won’t be a lot of competition to drive the generic price down once it hits the market.
There is also a chance that because the indication (the reason it’s prescribed) isn’t considered essential by many insurance plans, your odds of getting the generic covered may not be all that much better than the brand.
Some better news though: The patent expiration for Cialis also falls in that 2017 – 2020 window, in May 2018, so other generic options in the same class of drugs may help lower prices as well.
You may also be aware that generic sildenafil is already available, as a generic to pulmonary arterial hypertension drug Revatio. You can check out Dr. O’s article It’s Here! Finally a Viagra You Can Afford for more info.
Overall, don’t expect major changes for a little while longer yet, but they are coming.
Xarelto is a commonly prescribed drug that helps prevent blood clots, stroke, and atrial fibrillation (a so-called anticoagulant).
The bad news? It’s really expensive, and Xarelto isn’t expected to be available as a generic for some time. If your doctor thinks Xarelto right for you, how can you make it affordable?
Here’s some information about Xarelto and how you can save.
How popular is Xarelto?
Xarelto is the third most popular anticoagulant, a class of medications that also includes Coumadin (jantoven, warfarin), Praxada, and Eliquis. Commonly referred to as blood thinners, these drugs help to prevent blood clots that can cause deep vein thrombosis, pulmonary embolism, angina, stroke, and heart attack.
When will generic Xarelto be available?
As of December 2017, there is no generic available for Xarelto. However, it may become available as rivaroxaban in 2021, when the brand name patient expires. While you might have to wait three more years to save with the generic, there are other ways to cut costs on Xarelto.
Are there any cheaper anticoagulants I can try?
While Xarelto doesn’t have a generic, there are a couple of alternatives. Be sure you speak with your doctor to see if these alternatives will work for you.
- Coumadin (warfarin, jantoven). Coumadin is a popular anticoagulant that has two affordable generic alternatives, warfarin and jantoven, that can cost as little as $4 for a one month supply. Very affordable, but what is the downside? Well, Coumadin can raise your risk of bleeding and bruising, so it requires regular blood tests to ensure its effectiveness.
- Other anticoagulants. Pradaxa or Eliquis are both still only available in brand form – so they don’t have cheaper generic versions. Still, these alternatives may be more affordable, especially if they are covered by your prescription insurance.
- For more information on how Xarelto compares to other anticoagulants, check out Iodine’s page on Xarelto alternatives. As always you’ll want to speak with your doctor if you think other medications might work better for you.
Xarelto still works best for me—how can I save?
- Fill a 90-day supply. This can help shave a little more off of your out-of-pocket costs. Be aware that you will need a new prescription from your doctor, and approval from your insurance to fill for a higher quantity. Check in with your doctor, insurance, and/or pharmacist.
- Use a Xarelto coupon from GoodRx. GoodRx offers discounts for Xarelto online, which can usually save at least 15% off the full retail price.
- Save with Xarelto’s manufacturer coupon or patient assistance program. Two manufacturers, Janssen and Johnson & Johnson offer two ways to save. The Xarelto manufacturer coupon can reduce your costs to as little as $0 per month, while the patient assistance program can help you receive your medication at no cost if you qualify. For more information on these programs eligibility, and how to apply, be sure to read through our Xarelto Savings Tips page, or visit Xarelto’s website.
- Split a higher dosage pill. This can help reduce costs, especially if two strengths are priced similarly. You’ll want to check in with your doctor to see if this is a safe option for you.
- Try to appeal your coverage. If you have insurance, and your plan doesn’t cover Xarelto, 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.
These days, insomnia is pretty much part of the national condition. Every evening, millions of Americans use a prescription drug to help them get to sleep and stay asleep – usually a generic version of Ambien (sold under the generic name zolpidem), Sonata (zaleplon), or Lunesta (eszopiclone).
These three medications are all so-called “z-drugs”: Non-benzodiazepines that calm the brain and induce sleep by inducing a sort of hypnotic effect. They’re considered safer to use than the benzodiazepine drugs, which have a higher risk of dependence and overdose.
How effective are these sleep drugs, anyway, and who do they work for best? It’s a straightforward enough question. But answering it isn’t so simple.
One problem is that in clinical trials, sleep medications are usually tested in sleep laboratories. Sleep labs look something like a motel room — there’s a bed and a bedside table, but also a machine that has all sorts of wires connected to it. These wires are hooked up to the study subjects to monitor vital signs as they sleep (or try to sleep). But a sleep lab is a poor proxy for real life. At best the labs are unfamiliar and somewhat uncomfortable; at worst they can heighten the anxiety that can cause insomnia.
And then there’s the problem of sample size: Sleep lab studies are expensive, so many clinical trials include fewer than 1,000 people, and sometimes fewer than 100 people, sleeping in the lab for just one or two nights.
Data from the Real World
People rated these drugs in three respects: 1) how well did they think the drug worked, 2) how much of a hassle – in terms of side effects and other challenges – did the drug create, and 3) what was their overall satisfaction with the drug – a “worth it” score.
So what did people say? For one thing, younger people are less satisfied with sleep medications and find them to be more of a hassle, in terms of side effects – and older people find sleep drugs to work better with fewer side effects.
And then there’s the bottom line: which drug works best. Comparing the “worth it” scores for these three drugs, the Iodine data shows a clear preference for Ambien, in terms of overall satisfaction – the “worth it” score. People taking Ambien (zolpidem) say it’s worth it 67% of the time, while Lunesta (eszopiclone) gets a 55% worth it score, and just 42% of people say Sonata (Zaleplon) is worth it. That leaves a lot of people still unsatisfied with these sleep medications. And that means lots of people are still going to struggle with insomnia, even with medications.
These results are especially interesting compared to published research. A study in Japan that compared eszopiclone (Lunesta) versus zolpidem (Ambien), for instance, found that at doses of 2mg or higher, eszopiclone was comparably effective in helping people fall asleep and more effective in overall sleep efficiency (defined as the percentage of time people stayed asleep). But the effect depended entirely on dose: eszopiclone’s advantage disappeared when it was administered at 1 mg. That’s important because the FDA reduced the recommended dose for eszopiclone from 2 mg to 1 mg, following reports that people on higher doses were less alert in the morning and at a higher risk in activities such as driving a car. This followed an earlier FDA adjustment in the recommended dose for zolpidem in women from 10 mg to 5 mg. (We don’t know the dose for people in our survey).
And here’s where price matters: at GoodRx, prices for zolpidem are around $8 – that’s about half what they are for zaleplon, and 60% cheaper than a prescription for eszopiclone. Considering that people report better satisfaction with zolpidem than the others, it looks like the cheapest drug might also be the one people prefer most. In other words, Ambien (zolpidem) offers the best bang for the buck.
Prices shown are average GoodRx discounted prices as of Dec 6, 2017. Local results may vary.
Most Americans don’t need to read the headlines to know that prescription medicines cost too much. They feel it every day in their wallets, and in the struggle to pay for expensive drugs, month after month.
Since GoodRx started seven years ago, more and more Americans have learned that drug prices can vary widely, and they’ve come to realize that having health insurance doesn’t guarantee affordable prescriptions. Along the way, new websites and apps have popped up to promise Americans all sorts of saving on their healthcare.
So what’s the best way to find savings on a patient’s prescriptions?
Before we get to any conclusions, it’s worth highlighting a key difference between GoodRx and many other services. GoodRx gathers available prices and discounts for every prescription at every pharmacy in the US. Altogether, we have collected billions of prices and discounts – so we don’t just offer one price set by one partner. When a patient uses GoodRx, they tap into all of these ways to save, and they can then decide for themselves where they want to buy their medications, and at what cost, before they head to the pharmacy. That transparency means more choice and lower prices.
We’re excited to report that independent experts agree that GoodRx is the best way to save. In the latest issue of the Journal for American Academy of Dermatology, a leading academic journal for dermatologists, two Ohio researchers examined prices from 3 discount services, including GoodRx, for 21 commonly prescribed dermatologic medications (such as tetracyclines like doxycycline and minocycline, and topical meds like adapalene and triamcinolone).
The researchers compared our prices with two other discount programs, and the news was good for us, and for our customers. The researchers found that GoodRx offered the best prices by far – nearly three times cheaper than Blink Health prices and one-and-a-half times cheaper than SingleCare prices. (To be clear, this research was done completely independently. We learned of it after publication, and we have not spoken to the authors.)
In their letter, the researchers reached a strong and clear conclusion: “GoodRx is the superior application for finding the cheapest medication costs among the 3 applications studied,” they write. “GoodRx appears to offer the overall greatest savings among the most popular apps.”
This finding isn’t just good news for patients – the researchers also believe that GoodRx can help physicians deliver better care, and save time. In a note, Dr. Matthew Zirwas, the Ohio dermatologist who led the analysis, explained that, by using GoodRx and other services, “I estimate that my office has needed to hire one less office staff member and that I save about 1-2 hours of my time per week. Even better, there is no question that these companies improve primary adherence (defined as the patient actually getting the prescription from the pharmacy) while strengthening the patient-doctor relationship and saving patients money.”
At GoodRx, we try to stay humble, but it makes us proud when independent experts agree with us that GoodRx is both the best place for patients to save – and also helps doctors improve their practices. Many doctors don’t know about GoodRx, and the more they learn about us from their peers and colleagues, the more likely they’ll be to recommend us to their patients. That helps us, and it helps the patients.