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Medicare “Donut Hole” Changes Being Made and What It Means For You

by Marcus Harding
PharmD Candidate Class of 2019, University of Arizona

Mmmm…donut holes. You may be thinking of relaxing on a Saturday morning, sipping coffee and eating these tasty, sugary, fried treats. Unfortunately,  the type of donut hole we’re talking about is not so tasty.

What is the “Donut Hole?”

The Medicare coverage gap, better known as the “donut hole,” is a mystery to many, however there are thousands of people that it effects every year1. Simply put, it is a gap in coverage of medications after a certain amount has been contributed2. In other words, after you and your plan have spent a total of $3,750 on medications for the year (not including your deductible), the plan stops covering those medications and you are required to pay the entire cost of the medication out of pocket2. Once you enter the donut hole, and pay a total of $5,000 for the year (including your deductible) you enter what is called “critical coverage,” and you only pay 5% of the total cost for each medication3.

Medicare donut hole image - ScriptSave WellRx

Changes to the Donut Hole

The Affordable Care Act set in motion a plan to get rid of the donut hole completely1,2,4,7. The act set in place a “discount” that each plan member would get every year when they reached the donut hole. This discount would be paid by the manufacturers of the medications, and would increase each year until 2020, when the donut hole would be gone completely2.

  • In 2018, once a member enters the donut hole, they pay 35% of the total cost of the brand name drug, and the manufacturer pays a 50% discount2. This discount would be applied to the total cost spent by you, the plan member.
  • Example: you need a $100 medication, you pay $35, the manufacturer discounts you $50, so it looks as if you payed $85.
    • That $85 goes towards the $5,000 required spending to get out of the donut hole.
    • Once that $5,000 is spent, you reach critical coverage and only pay 5% of the brand name drug cost.

On Friday February 9th, the president signed a budget deal to “get rid” of the donut hole sooner4,5,6,7.

  • In 2019, once you reach the donut hole you will only pay 25% of a brand name drug cost, the insurance company will cover 5% of the cost and the manufacturer will cover the other 70%4,5,6,7.
  • You will receive credit for the 70% discount from the manufacturer, plus the 25% that you contributed for a total of 95% of the drug cost4,5,6,7.
    • This amount will go towards the $5000 threshold, after which you will be in “critical coverage” and pay only 5% of the total drug cost.
  • Example: If you need a $100 medication, you pay $25, the manufacturer discounts you $70, so it looks as if you payed $95.
    • The $95 goes towards the $5,000 to reach critical coverage where you will only pay 5% of the drug cost for the rest of the year.

So, the donut hole will still technically exist, but now instead of paying the full 100% of the cost of your medications, you will only pay 25%, and be credited with 95%.

What does this mean for you?

Healthcare in general can be complicated, especially as you factor insurance and coverage into the mix. There are a lot of numbers and percentages, so if you got lost in the numbers throughout this description, basically this means that if you typically reach the donut hole each year and are expected to pay for medications out of pocket, you will be saving a lot of money. Some people may not have enough medications or a high enough drug cost to even reach the donut hole, which is great, however as people get older they tend to have more health complications and need more medications. This can cost a lot of money. With these new laws and budget deals in place, if you have been reaching the donut hole previously, your total cost savings can increase quite a bit compared to previous years1.

How do you know if you will reach the donut hole?

Once again, the numbers above can be tricky to work through. Luckily there are easier ways to look at cost, spending and discounts.

  • It is estimated that if you pay more than $318 a month, you will enter the donut hole before the end of the year.
  • If you pay more than $743 a month, you will exit the donut hole before the end of the year and enter catastrophic coverage (based on a deductible of $415)4.

These numbers are just estimates based off common coverage and will differ depending on the deductible you have and the coverage you pay for. If you want to find out more about how much you spend compared to how much is covered, there are Medicare Part D donut hole calculators that break it down by each monthly payment4. Lastly, pharmacists are always a great source of knowledge as they deal with these plans on a daily basis, so never forget to ask a pharmacist or even your plan directly if you have any questions regarding the changes.

References:

  1. “2017-01-13.” CMS.gov Centers for Medicare & Medicaid Services, 23 May 2018, www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-13.html.
  2. “Costs in the Coverage Gap.” Medicare.gov – the Official U.S. Government Site for Medicare, www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html. https://www.medicare.gov/part-d/costs/coverage-gap/more-drug-savings-in-2020.html
  3. Bunis, Dena. “Medicare Part D ‘Donut Hole’ Will Close in 2019.” AARP, 9 Feb. 2018, aarp.org/health/medicare-insurance/info-2018/part-d-donut-hole-closes-fd.html.
  4. A Preview of 2019: CMS Releases the Proposed 2019 Medicare Part D Standard Drug Plan Coverage Parameters.” Q1Medicare.Com, 2 Feb. 2018, 1524, https://q1medicare.com/q1group/MedicareAdvantagePartD/Blog.php?blog=A-preview-of-2019–CMS-releases-the-proposed-2019-Medicare-Part-D-standard-drug-plan-coverage-parameters&blog_id=397&frompage=18.
  5. Cubanski, Juliette. “Summary of Recent and Proposed Changes to Medicare Prescription Drug Coverage and Reimbursement.” The Henry J. Kaiser Family Foundation, The Henry J. Kaiser Family Foundation, 15 Feb. 2018, kff.org/medicare/issue-brief/summary-of-recent-and-proposed-changes-to-medicare-prescription-drug-coverage-and-reimbursement/?utm_campaign=KFF-2018-Medicare&utm_content=67264845&utm_medium=social&utm_source=twitter.
  6. Larson, John. “H.R.1892 – 115th Congress (2017-2018): Bipartisan Budget Act of 2018.” Congress.gov, 9 Feb. 2018, congress.gov/bill/115th-congress/house-bill/1892?q=%7B%22search%22%3A%5B%22H.R.1892%22%5D%7D&r=1.
  7. “Prescription Drug Benefits.” Social Security History, Social Security Administration, 22 Feb. 2018, www.ssa.gov/OP_Home/ssact/title18/1860D-02.htm.

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash discount price at pharmacies near you.
You may find prices lower than your insurance co-pay!

 

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Prescription options for allergy meds - scriptsave wellrx

by Marcus Harding
PharmD Candidate Class of 2019, University of Arizona

Seasonal allergies affect anywhere between 10-30% of people worldwide.1 Allergies to one or more common allergens are reaching upwards of 40-50% in school children.1 Allergies occur due to an immune response to something the body considers “foreign,” in other words, strange or unfamiliar. When in contact with the “allergen,” the body produces antibodies which release a chemical called histamine. Histamine and some other chemicals are what cause allergic reactions.1,3

Symptoms of a seasonal allergic response include but are not limited to:3

  • Sneezing and a runny nose
  • Itchy nose and throat
  • Itchy, watery eyes

Symptoms of a more severe allergic response include:

  • Shortness of breath
  • Rash
  • Welts
  • Swelling of mucous membranes

What to Do

When seasonal allergic symptoms occur, you should talk to your primary healthcare provider for help. While your physician can prescribe medications to minimize these symptoms, it is rare that they would be covered by your insurance. This is because most of the medications used for allergies are “over-the-counter” (OTC) medications. This means these medications can be purchased without a prescription, and can be easily found at your local drug store. If you are expecting a medication to be covered by your insurance, but find that it is not, there are options for you. Despite these medications being OTC, they can still be rather expensive, and if you need the medication consistently, the cost can add up. So, what are your options when it comes to these medications if your insurance won’t cover them?

There are many resources available to help you find the best price for OTC medications. The ScriptSave® WellRx app is free and can help you find the best price based on your location. If your physician writes a prescription for an OTC medication, you can use the ScriptSave WellRx app or discount card to get savings on that drug. You can visit www.WellRx.com to download a free card and find the cheapest cash price at a nearby pharmacy.

Lastly, your local pharmacist is a great resource when it comes to cost savings. They are a wealth of knowledge as it pertains to medication information and cost, and if they do not know the answer, they will know where and how to find the answer.

Allergy Medication Options

So now that you have the resources to find the best price, how can you decide which medication to choose? There are so many different types of medications for seasonal allergies, it is hard to know which is the best for you.

Antihistamines are the most common type of medication used for seasonal allergies.1 These are divided into two types, which are the first and second-generation antihistamines. The first-generation antihistamines are more likely to cause drowsiness and sedation compared to the second generation.2 The OTC first-generation antihistamines include:

The OTC second-generation antihistamines include

Second-generation antihistamines are not only less sedating, but also last longer, and are most often only needed once a day, whereas first-generation anti-histamines may need to be taken multiple times a day. All of these examples can be found as tablets, capsules, or suspensions.2

Some common side effects to look out for are:2

  • Dizziness/drowsiness (more common in first-generation)
  • Dry mouth
  • Blurred vision
  • Nausea/vomiting
  • Confusion

Another type of medication that can be used for seasonal allergies is nasal decongestants.1 These medications help to shrink the blood vessels in your nose to reduce the amount of leaking from your nose. These medications result in rapid relief of nasal congestion; however, they are only recommended for 3-5 days of use. Using these medications any longer than the recommendation can cause “rebound congestion,” basically making your symptoms worse. There are several different forms of these medications including topical, oral tablets and nasal sprays.4

Some of the side effects of these medications include:4

  • Rapid and irregular heartbeat
  • irritability
  • nasal dryness
  • high blood pressure
  • difficulty sleeping
  • loss of appetite
  • urinary retention
  • dizziness

Keep in mind that there are daily and monthly limits to the amount of Sudafed you can purchase based on state laws. Although these medications can act rapidly and help with symptoms right away, they should not be used for more than 5 days at a time.4

One last common type of OTC medication used for seasonal allergies is nasal corticosteroids1. These medications act to slow down the body’s immune response to the allergen, reducing the amount of inflammation. Although there are corticosteroids that work for the whole body, these are nasal sprays that are directed to the nose to help with symptoms that occur locally or in the general area, therefore, there are very few of the normal side effects of steroids because the medication is specifically targeted to the nose. Most of the side effects that can happen are in the nose/throat area, although they are not very common.4

The current nasal corticosteroids include:

The side effects of these medications can include:4

  • Nausea
  • Headache
  • Cough
  • Nose bleeds
  • Congestion
  • Throat swelling/irritation
  • Upper respiratory infection.

There are many options for treating your allergies with over the counter medications, including medications that are not antihistamines. If your doctor prescribes a medication and it is not covered by insurance, talk to your pharmacist about OTC alternatives and use the resources available to you to find the best price. That way you can treat your symptoms, feel better, and keep more money in your pocket.

 

References

  1. American Academy of Allergy, Asthma & Immunology. (2018). AAAA. Retrieved from http://www.aaaai.org/. Accessed on 5/16/2018.
  2. Carson S, Lee N, Thakurta S. Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]. Portland (OR): Oregon Health & Science University; 2010 May. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK50554/
  3. Jeffrey L. Kishiyama, M. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e. Gary D. Hammer, MD, PhD, Stephen J. McPhee, MD.
  4. Platt, Michael. International Forum of Allergy & Rhinology. Sep2014 Supplement, Vol. 4, pS35-S40. https://www.ncbi.nlm.nih.gov/pubmed/25182353

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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Opioids and alternatives image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Opioids and Their Risks

Opioids are a class of medication used to manage short-term and long-term pain. This medication class is well known to healthcare providers, but also to anyone keeping up with local and national news. The current opioid crisis affects thousands of people every year. When taken inappropriately, opioids can result in inadequate pain relief, drug tolerance, addiction, overdose, and even death. A majority of opioid overdoses that result in death are accidental or unintentional.4 Due to the side effects and risks associated with opioids, healthcare providers are being urged to change opioid prescribing habits to meet new opioid regulations and to keep patients safe.

Changing Opioid Regulations

Prescribers are currently facing new opioid regulations at the state and federal levels. The Centers for Medicare and Medicaid Services (CMS) have implemented a maximum daily limit for opioids and some states are also cracking down by regulating the amount of days allowed on initial prescriptions. Arizona restricts initial opioid prescriptions to 5 days and sets an opioid dose limit per day.1 New laws and regulations are changing prescribing habits in hopes of reducing the thousands of opioid related overdoses every year. If you are starting or currently taking opioids, ask your healthcare providers if there are any new rules and regulations specific to your state.

Alternatives to Opioids

There are many alternative medications that can be used to manage acute and chronic pain. Medication selection is based on identifying the cause of the pain. A sprained ankle might be treated with a nonsteroidal anti-inflammatory drug (NSAID) to reduce swelling and inflammation, but the same NSAID would not have benefit for pain caused by nerve damage.

Potentially useful medications for pain include:

Nociceptive pain

  • Non-opioid analgesic agents (aspirin, acetaminophen, NSAIDs)
  • Tramadol
  • Topical analgesic agents
  • Muscle Relaxants

Neuropathic pain

  • Gabapentinoids
  • Antidepressants (venlafaxine, duloxetine, amitriptyline)
  • Topical analgesic agents

Opioid Non-responsive cancer pain

  • Alpha 2 adrenergic agonists

The listed medications and classes are a general list not intended to help in your personal medication selection. The ideal approach to pain management identifies the underlying cause of the pain and selects the appropriate treatment.4  Please consult your healthcare providers for pain identification and medication selection.

Questions for Healthcare Providers

All of the drugs and drug classes listed above can help in pain management depending on the underlying issue. Classification of the cause and level of pain is something that should be handled by healthcare providers. Asking for your pain classification will assist doctors and pharmacists in identifying the correct pain management therapy.

There are some steps you should take before making changes or starting a new medication. When starting or changing medications, please consult your doctor and pharmacist regarding what to expect. Changes should not be made without consulting a healthcare provider because of potential medication interactions and repercussions of abruptly starting or stopping medications. Your healthcare provider should review your medication dose, route, and time to take your medication. The potential side effects and expected outcomes should also be reviewed.3

If you have any concerns with taking opioid medications, talk to your doctor and pharmacist to help identify if opioids or alternative medications are appropriate.

References
1. Ducey, O. o. (2018). ArizonaOpioid Epidemic Act. azgovernor.gov
2. Rosenquist, E. W. (2017). Overview of the treatment of chronic non-cancer pain. UpToDate
3. Rosenquist, E. W. (2018). Evaluation of chronic pain in adults. UpToDate
4. SAMHSA. (2015). Behavioral Health Trends. Rockville, MD: RTI International


If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

 

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Walmart Announces New Opioid Rules - pill image WellRx

On May 7, 2018, Walmart issued a press release to announce the pending introduction (within 60 days) of new restrictions on how it will fill prescriptions for opioid medications. These new initiatives will apply to all Walmart and Sam’s Club pharmacies and pharmacists in the United States and Puerto Rico.

Walmart indicated that these changes are “an effort to continue to be part of the solution to our nation’s opioid epidemic,” and it reflects a further expansion of the company’s Opioid Stewardship Initiative. The move from Walmart follows a similar initiative by CVS that went into effect in February. Increasingly, retail pharmacies are stepping up efforts to stem the spread of opioid addiction, prevent overdoses and curb over-prescribing by doctors.

What Doctors Need to know, and What it Means for Patients with Legitimate Prescriptions

Walmart is the fourth-largest pharmacy chain in the US and these changes (being introduced over the course of a 60-day period) are likely to touch a number of patients. The retailer will move to restrict initial acute opioid prescriptions to no more than a seven-day supply, while also limiting a day’s total dose to no more than the equivalent of 50 morphine milligrams. Meanwhile, in states where the law for fills on new acute opioid prescriptions is less than seven days, Walmart and Sam’s Club will follow state law.

In addition to these immediate-term changes, by January 1, 2020, Walmart and Sam’s Club will require e-prescriptions for controlled substances.

In terms of patients needing acute or short-time pain management, in the event that the pain lasts longer than a seven-day supply (and still warrants treatment with these medications), the patient will have to consult his/her physician in order to obtain a new prescription.

Such restrictions have prompted concern that requiring patients to obtain a new prescription after seven, or sometimes only three days (depending on the state), can become too costly due to mandatory co-pays. Dr. Steven Stanos, former president of the American Academy of Pain Medicine explained that the organization applauds “any action that seeks to limit the over-prescription of opioids,” but added, “That needs to be balanced with the very real need of patients.”

For this reason, doctors and patients should be engaging in dialog about current and alternative medications and possible savings options, as they formulate a strategy for effective pain management.


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by Derek Matlock
Pharm.D. Candidate 2017
Washington State University

Nearly one-quarter of all U.S. deaths in 2016 we­­­re linked to heart disease, which refers to conditions involved in narrowing or blocking blood vessels, potentially leading to things like heart attack, chest pain, or stroke.

A Steady Decline in Stroke Deaths

Despite the continued and steady decline of deaths due to strokes, they continue account for 1 of every 20 deaths in the US. The decline of deaths due to strokes can be attributed to early identification of strokes, primary prevention, and secondary prevention.

Signs of a Stroke

FAST stroke acronym explained - image - ScriptSave WellRx

As a patient or caregiver, is it important to be able to identify the signs of a stroke as early as possible, as it can influence a positive outcome in patients at risk. The FAST acronym can be a simple and easy tool for identifying a stroke.

 

Face: Does the face look uneven? Ask them to smile.

Arm: Does one arm hang down? Ask them to raise both arms.

Speech: Does their speech sound strange? Ask them to repeat a phrase.

Time: Every second brain cells die. If any of these signs are observed, call 911.

Primary Prevention of a Stroke

Primary prevention refers to the management or treatment of patients who have no prior history of stroke. It involves addressing modifiable risk factors a patient may have, which may include: high blood pressure, diabetes, dyslipidemia, atrial fibrillation, sickle cell disease, post-menopausal hormone replacement therapy, oral contraceptives, diet, weight and body fat.

 

Additionally, your doctor or pharmacist may calculate your Atherosclerotic Cardiovascular Disease (ASCVD) risk score, which estimates a 10-year risk of heart attack or stroke and helps determine the appropriateness of using medications to lower your risk. Some medications that may be added include: statins for cholesterol; thiazide diuretics, ACE inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), or calcium-channel blockers (CCBs) for blood pressure; and aspirin to help prevent blood clot formation.

Secondary Prevention of a Stroke

Secondary prevention refers to the treatment of patients who have already had a stroke or “mini-stroke.” Interventions commonly prescribed for secondary prevention are summarized using the following ABCDE acronym:

Antiplatelets and Anticoagulants: Antiplatelet medications, like aspirin, clopidogrel, and dipyridamole, can prevent formation of clots. Anticoagulants like warfarin, apixaban, rivaroxaban, and dabigatran can also reduce the ability for the blood to clot and thus lower stroke risk.

Blood pressure-lowering medications: Thiazide diuretics, ACEIs/ARBs, and CCBs help patients control the number one risk factor for a recurrent stroke, high blood pressure.

Cessation of cigarette smoking and Cholesterol-lowering medications: Quitting smoking can significantly lower the risk of strokes, while cholesterol-lowering medications, like statins (e.g., simvastatin, rosuvastatin, atorvastatin), have been shown to lower bad cholesterol as well as decrease the risk of recurrent stroke and mortality.

Diet: In addition to helping weight loss, following a heart healthy diet, or a low-sodium “DASH diet”, may help lower cholesterol, triglycerides, or blood pressure, which decreases your risk of a stroke.

Exercise: For patients capable of exercising, it is recommended to exercise moderately to vigorously for 20 to 40 minutes 3-4 times per week. Be sure to stay within your limits. Good exercises can include walking or riding an exercise bike. Some community centers and gyms even host classes for older patients with physical limitations.

Strokes Still a Significant Cause of Death

Strokes continue to account for a significant amount of deaths in the United States. Your doctor or pharmacist may recommend lifestyle modifications and medications to help lower the possibility of experiencing a new or recurrent stroke. If you are being prescribed medications to lower your stroke risk, be sure to provide your doctor with a thorough medical history and medication list, as some conditions and medications may guide the recommendations your doctor makes. Your pharmacist can also be a valuable resource to any questions you may have.

 

References:

  1. American Heart Association: Heart Disease and Stroke Statistics 2017
  2. Mayo Clinic: Heart Disease
  3. MedicalNewsToday: Top 10 Causes of Death in the U.S.
  4. Medscape: Stroke Prevention
  5. UpToDate: Overview of Primary Prevention of Coronary Heart Disease and Stroke
  6. UpToDate: Overview of Secondary Prevention of Ischemic Stroke

If you’re struggling to afford your medications,
visit WellRx.com to find Rx discounts at pharmacies near you.
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Cystic Fibrosis breathing treatment - image - ScriptSave WellRx

What is Cystic Fibrosis (CF)?

Cystic fibrosis (CF) is a complex genetic disease that affects the lungs, digestive system, reproductive tract, and sweat glands. In the United States, roughly 30,000 people are living with cystic fibrosis, and another 1,000 are being diagnosed with the disease each year. Most CF patients are diagnosed by age two.

Cystic fibrosis is a progressive condition, involving body’s mucus glands1. Despite its widespread effects on the body, the majority of patients in United States suffer from lung complications with CF. These patients cannot removes excess mucus from their lungs which can lead to the accumulation of thick, viscous secretions1. Mucus accumulation is often a breeding ground for bacterial growth. Children and adolescents with CF often have decreased growth, which could be caused by a combination of malabsorption, decrease in appetite, and increase in energy expenditure due to this condition2. Some CF patients do not make adequate pancreatic enzymes, which are needed to help the body absorb the fat soluble vitamins A,D, E, and K. These vitamins are essential for body growth, immune function, and reproductive health.

Dietary Supplementation

It is important for CF patients to eat a proper diet. They often require a higher caloric intake than other people. Pancreatic enzymes should be replaced if the patient is diagnosed with pancreatic insufficiency. These are some examples of targeted nutrients and/or pharmacological agents that are used in practice:

Non-Pharmacological Nutrients in Cystic Fibrosis3,5

  • Omega 3 fatty acids to lower inflammation.
  • Probiotic supplement to improve digestion.
  • Anti-inflammatory foods, such as extra virgin olive oil, avocadoes, walnuts, and flaxseed oils.
  • Sodium – patients with CF are prone to sodium loss. However, they should carefully monitor their blood pressure if their doctor recommends a high sodium diet.
  • Fluoride – vitamins formulated for the CF patient do not contain fluoride. It is essential to feed them fluoride supplement.
  • Zinc – CF patients under the age of two, who have inadequate growth despite the proper nutrient support, should be evaluated for zinc deficiencies.

Treatments for Cystic Fibrosis

Cystic fibrosis treatment strives to help patients reach a better quality of life by improving breathing and lung capacity. Devices, like oscillatory positive pressure, remove the mucus and secretions of the lungs. Hypertonic saline can be used to increase air flow into the lungs and break up mucus. Breathing exercises and physical therapy can help dislodge the mucus in the chest and promote better breathing4.

Symptoms of Lung Complications in CF Patients

Force expiratory volume (FEV1) is a measure of how much air a person can exhale in a forced breath, and is a good indicator of lung function. It’s an easy, convenient method for monitoring lung function at home. FEV1 below individual goal is the indication of reduction in pulmonary function3. In young children, viruses are the cause of acute exacerbations leading to a decline in pulmonary functions. Diagnosis of pulmonary exacerbations is based on decline in individual health condition with pulmonary symptoms, as compared to recent baseline health status3. Symptoms that are commonly present include:

  • New or increased cough
  • Increase in sputum production or chest congestion
  • Increased fatigue
  • Decreased appetite
  • Changes in sputum appearances

Pharmacological Treatments

CF patient are at a severe risk for influenza infection. Prophylaxis or treatment with oseltamivir (Tamiflu) or zanamivir (Relenza) is often recommended under certain circumstances6. Annual vaccination against viral influenza is recommended to all patients with CF six months and older6.

Many patients with CF have chronic bacterial infection of lungs because of the thick viscus mucus accumulation. Systemic antibiotics are indicated to all patient with CF if they experience new or increased cough, and changes in the color of their mucus, which can indicate bacterial presence due to unnecessary mucus accumulation in the lungs. Antibiotic selection will depend on the results of a sputum culture.

Patients with the CF should focus on the type of food they consume to ensure they are getting proper nutrients. Daily use of the FEV1 is important, which helps to clear the mucus and prevent possible infections.

References:

  1. Cohen, T. S., & Prince, A. (2012). Cystic fibrosis: a mucosal immunodeficiency syndrome. Nature medicine, 18(4), 509-519.
  2. Borowitz D, Baker RD, Stallings V. Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 2002; 35:246.
  3. Reilly JJ, Edwards CA, Weaver LT. Malnutrition in children with cystic fibrosis: the energy-balance equation. J Pediatr Gastroenterol Nutr 1997; 25:127.
  4. Rosenfeld M, Emerson J, Williams-Warren J, et al. Defining a pulmonary exacerbation in cystic fibrosis. J Pediatr 2001; 139:359.
  5. Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H, Clinical Practice Guidelines on Growth and Nutrition Subcommittee, Ad Hoc Working Group J Am Diet Assoc. 2008;108(5):832.
  6. https://www.uptodate.com/contents/cystic-fibrosis-overview-of-the-treatment-of-lung-disease?sectionName=Influenza%20vaccine&anchor=H20&source=see_link#H20

If you’re struggling to afford your medications,
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Prevent shingles - ScriptSave WellRx image

by Alyssa Kasher
PharmD Candidate of 2018

It’s likely you’ve heard about shingles, or may even know someone who has had the painful rash, but what exactly is shingles, and how can you prevent it? The varicella-zoster virus (VSV) causes two distinct forms of infection, chickenpox and shingles. It’s important to recognize how you can contract this virus and what you can do to protect against it.

If You’ve Ever had Chickenpox, You Can Develop Shingles

A primary VSV infection occurs when you’re first exposed to the virus, referred to as varicella or chickenpox. Chickenpox is a highly contagious condition spread through direct person-to-person contact, sneezing, or coughing. Most people recognize it from the itchy blisters or “pox” that appear all over the body.  In healthy people, the condition is mild and resolves within 5-10 days1.  As chickenpox resolves, the varicella-zoster virus retreats into the nerve cells and goes into hiding. The virus’s ability to evade the immune system allows it to lay dormant until future reactivation1. Although anyone previously infected with chickenpox will carry VSV in their system, not everyone will experience the virus’s reactivation.

According to the CDC, 1 in 3 Americans will experience the reactivation of the VSV. When this occurs, it manifests as a secondary infection called herpes zoster or shingles1. The virus travels down a nerve and produces a patch of painful lesions on the skin that may permanently scar or discolor the skin.

Shingles is More Dangerous Than Chickenpox

As the infection moves down the nerve, it causes inflammation resulting in damage or cell death2. This causes the most painful and lasting effect of the infection, called peripheral neuropathy or nerve pain. Inflammation may also occur in the eyes and the brain causing serious and potentially fatal complications1. Shingles is more dangerous than chickenpox, especially because it usually occurs in older people who may have weaker immune systems with less ability to fight off the infection.

How Can You Prevent Shingles? Vaccination

The first vaccine to prevent the primary VSV infection, or chickenpox, was not developed until 1995. This means much of the older population has been exposed to chickenpox. Zostavax, the first vaccine to prevent the reactivation of the virus (shingles), did not come out until 20064.  Many people may have already received the Zostavax vaccine. However, a better vaccine has taken its place.

Shingrix: A Better Way to Prevent Shingles

In the fall of 2017, Zostavax was replaced by Shingrix as the CDC recommended vaccine to best prevent shingles and related complications. Shingrix, unlike Zostavax, is not a live vaccine and cannot cause shingles. Shingrix is given in two doses, and is over 90% effective at preventing shingles3. The CDC recommends that everyone over the age of 50 of receive Shingrix. You should get the Shingrix vaccine if you have already had shingles, previously received Zostavax or if you’re not sure you had chickenpox as a child. Studies show that 99% of Americans over 40 have been exposed to the chickenpox virus whether they realize it or not3.

Patient populations at the highest risk of shingles include:

  • those over 50
  • immunocompromised patients
  • females
  • anyone with underlying chronic lung and kidney disease.

Facts About Shingrix3

  • After your first dose of Shingrix, you should receive the second dose within 2-6 months.
  • You can receive the vaccine at your community pharmacy without a prescription.
  • Shingrix is covered by Medicare Part D. Ask your pharmacist to see if your plan covers it.
  • Shingrix can cause injection site soreness and pain. Using ibuprofen or Tylenol can help.
  • Talk to your pharmacist or doctor to see if Shingrix is right for you.
  • Always discuss all conditions/medications with a doctor or pharmacist before getting a vaccine.

References

  1. Albrecht, MA. Clinical manifestations of the varicella-zoster virus infection: Herpes zoster. In: Basow DS, ed., UpToDate. Waltham (MA).: UpToDate; 2016.
  2. Albrecht, MA. Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster. In: Basow DS, ed., UpToDate. Waltham (MA).: UpToDate; 2016.
  3. Centers for Disease Control and Prevention. Vaccines & Preventable Diseases. Vaccines by Disease. Shingles. Retrieved at https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html. Accessed 2018 Jan 22.
  4. Immunization Action Coalition. Chickenpox (Varicella): Questions and Answers. Retrieved at: https://www.immunize.org/catg.d/p4202.pdf. Accessed 2018 Jan 22.

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Medicine Chest Must Haves - image

Here are ten must-haves for every home medicine chest:

Plain soap

Good ol’ soap and water is still the best way to clean minor cuts and scrapes. It works just as well as antibacterial soap—and it’s less expensive!

A compression wrap

If you twist your ankle or wrist, remember the RICE treatment: Rest, Ice, Compression, Elevation. Elastic wraps, such as those made by ACE, are the compression component of the RICE equation. “These are excellent for giving support to a sprained joint,” says Jennifer Zimmer, MD, an internal medicine doctor at the Dallas Diagnostic Association and the Baylor Regional Medical Center in Plano, Texas.

Aspirin

Not only for headaches and hangovers, but if you’re at risk for something far more serious: “If you have chest pain, chew up 325 mg of uncoated aspirin,” advises Singh. “Heart attacks can happen any time and taking aspirin as soon as possible can help reduce the damage.” Aspirin can help break down the blood clot in your artery and limit the injury to your heart. Keep in mind, however, that there are many different types of chest pain and that aspirin is not the right treatment for many of them. Rare use is relatively safe but repeated aspirin use can cause harm. Talk to you doctor to learn about your heart-disease risk and what to do in an emergency.

Bandages (assorted sizes)

Not just for kids! You need these, as well, to keep your boo-boos and owies from becoming infected.

A thermometer

Experts recommend a digital thermometer over the mercury type (which are just as accurate but difficult to read). “A good thermometer can monitor for temperature elevation that could indicate infection in a wound or worsening of an illness,” says Zimmer.

Mild pain relievers

Stock acetaminophen or ibuprofen for minor pain and fever. “Remember to check doses, though, as children take a dose based on their weight,” advises Singh.

Antibacterial ointment

Apply after cleaning a wound to help reduce infection risk and increase healing time.

An antihistamine

Use to relieve minor allergy symptoms like sneezing, itching and swelling. Call 911 if you have a severe allergic reaction—such as difficulty breathing, or swelling of the tongue or lip—as an antihistamine won’t help.

Hydrocortisone cream

This is useful for taking itch out of rashes and insect bites.

Phone numbers

Inside the door of your medicine cabinet, adhere contact info for your family members, doctors, pharmacy, and your local poison control center. If there is an emergency, this cost-you-nothing strategy can prove to be priceless.

Remember to check the contents of your kit every 6 to 12 months to ensure that medicines haven’t expired, and that your contact numbers are still up-to-date.

Finally, it’s also handy to keep a first-aid kit in your car and your day-trip backpack. And think about other places a kit could be useful. Going on vacation? Remember to take one with you to the cabin, boat, or wherever else your road leads. Go well!

Nancy Gottesman, a health and nutrition writer in Santa Monica, CA, is stocking her first-aid kit now.

Copyright © 2018 Healthnotes, Inc. All rights reserved. www.healthnotes.com

Learn more about Healthnotes, the company.


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ScriptSave WellRx - personalized wellness KGUN 9 - image

TUCSON, Ariz. – A local Tucson company is developing an app to help you grocery shop in a healthier way. ScriptSave developed an app and web version of a service called “Personal Wellness” that gives you grocery purchase recommendations based on what health conditions you have.

They’ll partner with grocery stores, and you’ll visit the store’s website after you fill out your health profile on “Personal Wellness,” and it will recommend products. When you buy the products recommended from the app in store, you qualify for rewards like gift cards and free fitness products.

“Personal Wellness” will be completely free to use and will also pair with the prescriptions and non-prescription drugs people take.

The app will be available after pilot tests by the end of this year or early next year.

For the full story, visit KGUN 9.

3/28/2018


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Treating and preventing osteoporosis - image - wellrx

by Tek Neopaney, University of Arizona College of Pharmacy Student

Each year, millions of Americans, who may otherwise feel fine, are diagnosed with Osteoporosis. Developing osteoporosis puts people at higher risk for fractures, especially in the hips, spine, and wrists. Women are at much higher risk, with 10 percent of women age 50 and older affected by osteoporosis, compared with just two percent of men that age.

What is Osteoporosis?

Osteoporosis is defined by low bone mass that results in decreased bone density, and bones become more prone to fracture. Osteoporosis often has no symptoms until there is a bone fracture. Bone strength decreases with the loss of bone mass, which is related to many factors such as, a decrease in bone mineral density, rate of bone formation and turnover, and the shape of the bones.

Postmenopausal women often have low bone density due to estrogen deficiency. With early diagnosis of bone loss and fracture risk, available therapies can slow or even reverse the progression of osteoporosis and help prevent bone fracture1. Vertebrae and hip fracture is common in osteoporosis patients. About two-thirds of the bone fractures are asymptomatic2, meaning patients won’t even be aware they have a fracture. Many patients without symptoms assume they don’t have osteoporosis, so it’s important for all post-menopausal women to get an osteoporosis evaluation.

Calcium Vitamin Supplements

If you are unable to achieve adequate amounts of calcium and vitamin D from diet alone, you should take supplements for bone growth and development. Children ages 9 to 18 should consume approximately 1300 mg of calcium per day from calcium rich food sources, and 600 mg of vitamin D from vitamin D-fortified food. Children who have a wide variety of foods in their diet, and are growing well, should not need calcium and vitamin D supplementation3. Calcium and vitamin D supplementation likely only benefits children with inadequate calcium and vitamin D intake3.

Most postmenopausal women with osteoporosis, 1200 mg calcium (total dietary and supplement) and 800 international units of vitamin D are recommended. Although optimal intake of calcium (diet plus supplement) for pre-menopausal women and men with osteoporosis is not established, generally suggested doses are 1000 mg of calcium (diet and supplement) and 600 international units of vitamin D4.

Exercise – It’s Important!

Exercise is strongly associated with a reduction in hip fractures in older women5. Regular exercise has shown to have positive effect on bone mineral density (BMD). BMD is the measure of calcium in your bone. In studies, a variety of exercises such as, jogging, resistance training, swimming, and walking were effective. Women with osteoporosis should exercise for at least 30 minutes a day, three days a week, to build bone strength and help prevent fractures. Exercise helps to increase muscle strength, reducing the risk of fracture from fall.

Pharmacological Therapy

In addition to lifestyle measures and calcium and vitamin D supplementation, patients at high risk for fractures should also receive drug therapy. Patients with a history of fragility fracture or osteoporosis based on BMD, benefit from medication. All patients treated with medication should have a normal calcium and vitamin D level prior to starting drug therapy, and should also receive vitamin D and calcium supplements if their dietary source is inadequate6.

Oral bisphosphonates such as, alendronate (Fosamax), ibandronate (Boniva) are the first line of therapy for postmenopausal women. These agents decrease the rate of bone breakdown leading indirectly to an increased BMD. Bisphosphonates are effective, inexpensive, and have long-term safety data on preventing hip and vertebrate fracture6. These drugs are usually taken once a weekly.

Putting it All Together

With so many Americans developing osteoporosis, it’s important to realize it could happen to you, so talk to your doctor about your risks. To help prevent, and possibly reverse Osteoporosis:

  • Bond density screening is important to detect osteoporosis
  • Get enough calcium and Vitamin D in your diet or take supplements to help prevent osteoporois
  • Exercise helps build bone mass and strengthen your bones
  • There are available drugs to treat osteoporosis that are inexpensive and have proven safe to take over time.

References:

  1. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  2. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva 1994. https://whqlibdoc.who.int/trs/WHO_TRS_843.pdf  (Accessed on March 09, 2012).
  3. Winzenberg TM, Shaw K, Fryer J, Jones G. Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst Rev 2006; :CD005119.
  4. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25:2359.
  5. Gregg EW, Cauley JA, Seeley DG, et al. Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998; 129:81.
  6. Crandall CJ, Newberry SJ, Diamant A, et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161:711.

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what is this med for image - wellrx

by Seth Root
PharmD Candidate – Midwestern University

If you’re on a prescription medication, you probably know it’s important to make sure you take that medication as prescribed by your doctor. What many patients don’t know, however, is that it is also important to know why you’re taking that medication, or why your doctor prescribed that medication for you. There are many reasons why knowing the purpose of your medications are important, but we’re only covering a few of them in this blog post.

Purpose of the Medication

Medications are generally made for a specific purpose, like aspirin is made to be a pain reliever. However, knowing what a medication is generally used for isn’t enough, as doctors may prescribe medications for things other than what the medication was originally meant to treat. For example, even though aspirin is meant to be a pain reliever, your doctor may prescribe it as a blood thinner.

Sometimes medications are prescribed for other purposes than what the manufacturer intended. This is known as off-label use. But this can make it difficult to accurately research your medications online. Researching your medications on the internet might be quick  and convenient, but even if the information is accurate (which often it is not) it might not reflect the information you need, as you might be taking the medication for a purpose other than what the drug was initially designed for. Therefore, if you have questions about why you’re taking a medication, the best person to ask is the doctor that prescribed it to you, or your local pharmacists.

This might have you thinking why it’s important to know the purpose of your medication. There are many reasons for this, one of which has to do with side effects. All medications have side effects. Side effects are important to consider as they can seriously impact your quality of life. How many medications you’re on is one of the most important determining factors regarding what side effects you’ll experience.

This is where knowing what purpose your medications are for comes into play, as sometimes we are on multiple medications for the same disease, but because you’re on multiple medications you’re experiencing side effects that you wouldn’t experience if you were on just one of the medications. This is known as a drug-drug interaction. If you can identify which medications are treating the same disease, it’s possible you can reduce the number of medications you’re on, which will help cut down on the number and/or intensity of side effects.

Where to Start

If you’re wondering where to start learning about your medications, as mentioned before the best place to start is by asking the doctor that prescribed the medication to you. Even if everything is good, you may be surprised with what you learn, like helpful tips on how to maximize the medication effect or ways to reduce the side effect. Another good person to ask is your pharmacist, especially if you’re on multiple medications. They can help identify drug-drug interactions you might be experiencing, can recommend similar medicines that might have less side effects and/or are cheaper, and can also give helpful tips about managing your medications and their side effects.

The biggest thing to do when learning about medications is to make sure to take them as prescribed. If for whatever reason you don’t want to continue taking the medication, the worst thing you can do is not tell your doctor or pharmacist about it. They’re here to help you. Even if you don’t want to take your medications, they can work around that the best they can or possibly find a more suitable medication. If you don’t take your medications as prescribed, they may think that your disease is not responding to the medications and therefore prescribe more medications to try to control it. This can lead to unnecessary prescribing and more side effects, as well as being more expensive. So please, talk to your doctor and/or pharmacists about your medications and the reason why you were prescribed them. In the long run, it will be helpful for you.

 


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Serotonin Syndrome - WellRx blog image

by Bhargavi Jayaraman, PharmD Candidate

A Challenging Diagnosis, but What is Serotonin1?

The varying symptoms of Serotonin Syndrome can be difficult to diagnose. Early serotonin syndrome symptoms, including diarrhea, high blood pressure, anxiety and agitation, can be easily confused with less serious conditions. Serotonin is a chemical produced by the nerve cells that acts on almost every part of the body. It’s helps with sleeping, eating, digestion, and is considered to be a natural mood stabilizer. It also helps reduce depression and anxiety, heal wounds, stimulate nausea and maintain bone health. When your serotonin levels are normal, you should feel happier, more calm, emotionally stable, less anxious, and more focused. A deficiency of serotonin would make you experience anxiety and/or insomnia. Many people who experience depression, anxiety, or need mood stabilizers take medications that help to increase serotonin levels in the body.

Medications That Increase Your Serotonin Levels2

With the proliferation of antidepressant drugs on the market, there is an increasing number of medications that can raise your body’s serotonin levels. But it’s not just antidepressants that can have this impact. Medications that increase serotonin levels in the body include:

Too Much of Something is Never Good

If serotonin has so many benefits to the mood and can help everyone in their daily functioning, shouldn’t we all want to take as many serotonin increasing medications as possible? The answer is no. Too much of any chemical compound in our body is never a good thing. Serotonin syndrome occurs when medications cause an accumulation of a high level of serotonin in the body. Symptoms of too much serotonin in the body can range from mild to severe, and severe serotonin syndrome can be fatal if not treated1.

What are the Symptoms of Serotonin Syndrome2?

There are no tests to diagnose serotonin syndrome1. Instead, your doctor might perform a physical exam and ask you some questions to diagnose serotonin syndrome. Due to the lack of diagnostic criteria, the exact prevalence of serotonin syndrome is unknown, however, it is known to be an extremely rare condition. So if you are experiencing any of the symptoms listed below, it’s important that you don’t stop taking any of your medications, but rather, make an appointment to see your doctor to rule out serotonin syndrome.

Mild symptoms of serotonin syndrome may include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate
  • High blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goosebumps

More severe symptoms of serotonin syndrome may include:

  • High fever
  • Seizures
  • Irregular heartbeat
  • Loss of consciousness

Prevention is Key2

Taking more than one drug that increases serotonin levels, or increasing the dose of one of these medications, can increase the risk of serotonin syndrome. Make sure your doctor is aware of all the medications you are taking, and discuss any risks and concerns with your doctor or pharmacist to make sure you understand how the medications can interact.

How Can You Naturally Increase Your Serotonin Levels1?

Since serotonin offers so many benefits to your mood and health, you may want to consider ways to naturally increase your serotonin levels. Some ways to stimulate natural production of serotonin include:

  • Exposure to light: sunshine or bright light to treat seasonal depression can raise your serotonin levels.
  • Exercise: getting regular exercise can help to elevate your mood and offers other health benefits!
  • A healthy diet: including foods that can help to increase serotonin levels, like eggs, cheese, turkey, salmon, nuts, tofu, and pineapple, can elevate your natural serotonin supply.
  • Meditation: helps to relieve stress and promotes a positive outlook on life, thereby increasing your serotonin levels.

References:

  1. Scaccia A. Serotonin: What You Need to Know. Healthline Newsletter. https://www.healthline.com/health/mental-health/serotonin. Published May 18, 2017. Accessed February 10, 2018.
  2. Serotonin syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758. Published January 20, 2017. Accessed February 10, 2018.

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