ScriptSave WellRx and Sinfonia announce medication therapy management partnership

ScriptSave WellRx partners with SinfoniaRx to enhance patient experience with no-cost, convenient access to licensed medical professionals

New York, NY. February 06, 2018 – ScriptSave® WellRx, a prescription savings website and mobile app, and SinfoníaRx, a subsidiary of Tabula Rasa HealthCare (NASDAQ:THRC), a technology company optimizing medical safety through proprietary software solutions and decision support tools, have announced a partnership that will make Medication Therapy Management (MTM) available by phone at no cost to consumers who use the ScriptSave WellRx website or app.

Medication Therapy Management (MTM) programs allow pharmacists to interact directly with patients to optimize the effectiveness and safety of their medication regimens. MTM helps to ensure patients follow their prescription drug regimens through enhanced communications, leading to fewer adverse drug events (ADEs) and overall improved health outcomes.

“Rising costs for prescription medications, combined with the increasing number of health benefit designs that include higher out-of-pocket spend, have placed a bigger financial burden on the patient,” said Marcus Sredzinski, PharmD and Chief Operating Officer of ScriptSave WellRx. “This financial hardship can lead to poor medication adherence and compliance. We are excited to offer ScriptSave WellRx as a tool to help consumers stay on their medication therapy for better health outcomes.

“As one of the nation’s premier medication management companies, SinfoníaRx’s pharmacists bring an important component to ScriptSave WellRx, offering medication information to our members if they have a question about drug interaction, dosage or alternatives,” said Sredzinski.

The Need for Medication Therapy Management

Patients frequently leave their doctor’s office only to discover later they have questions about their prescribed medications. Questions about dosage, side effects, alternative options, and payment options are not uncommon. MTM connects patients with pharmacists to address these concerns and enhances a personalized approach to medication management. Under this partnership, SinfoníaRx will provide clinical pharmacists, while the ScriptSave WellRx technology will connect patients with these pharmacists via their free mobile app.

“By partnering with ScriptSave WellRx, we are helping patients use the latest technology to better understand their medication regimen,” said Kevin Boesen, PharmD, CEO of SinfoníaRx. “As pharmacists, we care about optimizing an individual’s medication therapy. This partnership will ultimately help ensure that patients take their medications correctly and stick to their regimen.”

The partnership will give more than half a million ScriptSave WellRx users access to this free customized care. By improving communication and providing important information, programs like the ScriptSave WellRx ‘Ask A Pharmacist’ MTM program with SinfoníaRx can help prevent deaths, needless hospitalization, unnecessary medical bills, and increased strain on America’s healthcare system.

“ScriptSave already offers patients important information and services regarding their prescriptions,” said Sredzinski. “By partnering with SinfoníaRx, our pharmacists will encourage patients to be proactive about their health and get answers about their medications after leaving the doctor’s office and pharmacy.”

About ScriptSave WellRx

ScriptSave WellRx, owned by parent company Medical Security Card Company, LLC (MSC) and a member of the MedImpact, Inc. family of companies, offers savings on prescription medicines at more than 62,000 local and chain pharmacies, nationwide. ScriptSave WellRx is an online resource that makes prescription medicines more affordable and easier to manage for people who are uninsured, underinsured, or insured with high deductible plans.

About TRHC and SinfoníaRx

TRHC (NASDAQ:TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable health care organizations to optimize medication regimens to improve patient outcomes, reduce hospitalizations, lower healthcare costs and manage risk. TRHC provides solutions for a range of payers, providers and other healthcare organizations. SinfoníaRx is a Tabula Rasa HealthCare company. For more information, visit TRHC.com.

Forward-Looking Statements

This press release includes forward-looking statements that we believe to be reasonable as of today’s date, including statements regarding Medication Risk Stratification and/or Medication Therapy Management under the new scope of work.  Such statements are identified by use of the words “anticipates,” “believes,” “estimates,” “expects,” “intends,” “plans,” “predicts,” “projects,” “should,” and similar expressions.  These forward-looking statements are based on management’s expectations and assumptions as of the date of this press release.  Actual results might differ materially from those explicit or implicit in the forward-looking statements. Important factors that could cause actual results to differ materially include: the need to innovate and provide useful products and services; risks related to changing healthcare and other applicable regulations; increasing consolidation in the healthcare industry; managing our growth effectively; our ability to adequately protect our intellectual property; and the other risk factors set forth from time to time in our filings with the SEC,  including those factors discussed under the caption “Risk Factors” in our most recent annual report on Form 10-K, filed with the SEC on March 14, 2017, and in subsequent reports filed with or furnished to the SEC, copies of which are available free of charge within the Investor Relations section of the TRHC website http://ir.trhc.com or upon request from our Investor Relations Department. Any forward-looking statement speaks only as of the date on which it was made. TRHC assumes no obligation and does not intend to update these forward-looking statements, except as required by law, to reflect events or circumstances occurring after today’s date.


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Medication for insomnia image

by Alyssa Kasher, PharmD Candidate 2018
University of Arizona College of Pharmacy

Sleep is a precious commodity that everyone needs to function. Individual sleep needs are different; some people need a few extra hours while others need less. Some people are light sleepers, while others “sleep like logs.” Sleep habits can also change temporarily, for example during college or after a baby is born. Despite varying needs, all people need adequate sleep to function. Sleep loss negatively affects work performance, mood and overall health. In light of this, it is important to identify factors that are causing you to lose sleep. It’s important to speak with your doctor to see if ongoing sleep problems are caused by clinical insomnia.

How do I know it’s clinical insomnia?

Clinical insomnia is diagnosed by having all of the following 3 conditions1:

  1.       Difficulty falling asleep, staying asleep, or waking up too early
  2.       The above difficulty occurs even with plenty of time to sleep in an ideal environment
  3.       Sleep loss causes decreased function during the daytime

What causes insomnia?

Historically, insomnia has been viewed as a condition that occurs secondary to another disease or condition. Recent studies show us that insomnia does occur by itself without any identifiable reasons1. You should still check with your doctor to see if another medication you take or condition you have is causing insomnia.

Treatment of insomnia

First line treatment for insomnia includes behavioral counseling and improving sleep hygiene. For information on non-drug therapies, check out our previous blog post written by Jenny Bingham, PharmDShould you and your doctor decide to use medication to treat insomnia, it is important to tell your doctor about other medication you are taking as well as any conditions you have.

Over the Counter Medications

  • Antihistamines purchased over the counter are commonly used to induce sleep as they can cause drowsiness1. While they are helpful, these medications should only be used short term. If your problems with sleep continue, you should consult with your doctor to ensure you get the appropriate treatment.

Prescription Medications

  • Non-benzodiazepines include other sleep drugs with varying mechanisms. They differ from benzodiazepines in that they usually have less anti-anxiety effects. Some of these drugs are approved only for short term use; while drugs formulated as extended release are better suited for long term use1.
  • Antidepressants can be used for sleep as many of them have a sedating effect. These are particularly useful in people who concurrently suffer from depression or anxiety, because the drug is also treating a potential cause of insomnia. The only antidepressant specifically FDA approved for insomnia is Silenor (doxepin) 1.
  • Other drugs are used for insomnia that have unique mechanisms
    • Rozerem (ramelteon) is a drug that encourages your body to release melatonin, which makes you sleepy. It has less side effects and less addiction potential than other drug types. It is also not a controlled substance.
    • Belsomra (suvorexant) is a first of its kind drug that blocks molecules in your brain that encourage wakefulness1. Because it has a long half-life, it can still cause day time drowsiness. It is a controlled substance due to abuse potential.

General Considerations

  • Sleep medications can make you drowsy, dizzy or experience day time sedation.
  • Many medications used to treat insomnia have a potential to be habit forming. They may also worsen insomnia if stopped suddenly. Use them exactly as directed by your doctor.
  • Sleep medications can impair your ability to perform tasks, so it is crucial to only take them once you are ready for bed. Do not use alcohol as impairment may be worsened.

Considerations in the Elderly

  • Since most sleep medications cause drowsiness to induce sleep, they can be especially dangerous when used in the elderly. This is true of both over the counter sleep medications (like diphenhydramine) as well as prescription drugs. This drowsiness can cause confusion, memory issues and serious falls. Consult your pharmacist or doctor before starting sleep medication.

 

References:

  1. Arand DL, Bonnet MH. Treatment of insomnia in adults. In: Basow DS, ed., UpToDate. Waltham (MA): UpToDate; 2016

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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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managing-insomnia

by Jenny Bingham, PharmD, BCACP
SinfoniaRx

What is insomnia?

The prevalence of insomnia increases with age, especially in women. Individuals can experience one of two different types: acute or chronic. Acute or transient insomnia lasts for days to weeks. Chronic insomnia lasts for more than one month. 1

A general consensus estimates that approximately one-third of adults experience insomnia. Characteristic symptoms include: difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and/or poor quality of sleep. 2

Why is it important to treat insomnia?

Untreated insomnia can have negative outcomes on an individual’s overall health. It is been associated with altered physical health, emotional health, mental health, social functioning, pain control, and overall health perception. 3

What can you do to treat insomnia?

There are two approaches to treating insomnia without medications. 4

Sleep hygiene

  • Keep a regular sleep schedule.
  • Do not exercise immediately before bedtime.
  • Avoid alcohol and stimulants (caffeine, nicotine) in the late afternoon and evening.
  • Maintain a comfortable sleeping environment that is dark, quiet, and free of distractions.
  • Avoid consuming large amounts of food or liquids immediately before bedtime.

Stimulus control

  • Go to bed only when you are sleepy.
  • Avoid daytime naps.
  • If unable to sleep, get out of bed and go to another room— only return to your bed when you feel the need to sleep.
  • Do not eat or watch TV in bed.
  • Wake up at the same time each day.

Individuals should also ask their provider about management of other underlying causes of insomnia, like psychiatric or other medical conditions. It’s important to limit prescription sleep aids to short-term use. After initiating any treatment for insomnia, whether behavioral or prescription, it’s important to reevaluate after a few weeks.

References:

  1. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4:487–504.
  2. Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999 May 1; 22 Suppl (2):S347-53.
  3. Katz DA, McHorney CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002 Mar; 51(3):229-35
  4. Dopp JM, Phillips BG, Chisholm-Burns M. Sleep Disorders. Pharmacotherapy Principles & Practice and. 3e; 41: 737-747.

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.
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!

Controlling Your Fibromyalgia

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Dull, aching pain throughout your entire body. Trouble sleeping. Irritable mood. What could possibly be going on? Is it just in your head? Does anyone else feel like this? Well, if you experience some of these symptoms, one potential cause could be fibromyalgia, which affects the lives of almost 4 million Americans.

Fibromyalgia is a chronic pain condition that, while common, is not entirely understood or easy to manage.  Because the exact cause of this condition is not known, effective treatments are difficult to come across, and it’s common for patients to find themselves spending a lot of money trying to find a cure. Often times the suggested treatment is a combination of both lifestyle changes and medications. Ideally, by following the recommendations of your health care team and putting effort into your treatment plan, you will be in a good position to prevent your fibromyalgia from controlling your life and emptying your wallet.

Lifestyle Changes Can Help Fibromyalgia Symptoms 

First and foremost, physical therapy as well as certain daily exercises may be the key to keeping your symptoms at bay.  Suggested exercises include yoga, tai chi, walking, swimming, biking, and other low impact activities. Exercise has the potential to increase quality of life and reduce severity of pain over time.

Another way to improve your symptoms is sleep hygiene, which involves evaluating and making changes to some of your day time habits that may keep you from getting a good night’s sleep.  Some things to try include avoiding caffeine too late in the day and removing screens (phones, computers, televisions) from the bedroom.  By getting more quality sleep at night, you have the potential to majorly improve your symptoms.

In addition to exercising and changing your sleep habits, certain types of therapy may also be beneficial for some patients. This could include both group sessions and one-on-one sessions to address any potential underlying problems that may be making your symptoms worse.

Medications for Fibromyalgia

When it comes to medications, there are multiple options available, and occasionally, combinations may be necessary.  Many of the medications used for fibromyalgia can also be used to treat other things, such as depression, seizures, muscle spasms, and more.  Your doctor may prescribe one or more of the following medications to help control your symptoms:

It is important to keep in mind that with fibromyalgia, there is no miracle cure.  Some people may wonder whether or not opiates or narcotics (such as oxycodone, morphine, etc,) can be used to help with their pain, but these do not have proven benefit with fibromyalgia and are generally not recommended. Trying medication after medication can become costly, especially if you need to start taking multiple medications.  By working on lifestyle changes and giving the medications a chance to work, you will be on the right track to saving money and energy as well as getting back to a normal life.

 

References

  1. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
  2. http://www.mayoclinic.org/diseases-conditions/fibromyalgia/home/ovc-20317786
  3. Goldenberg DL. Initial treatment of fibromyalgia in adults. In: UpToDate, Schur PH (Ed), UpToDate, Waltham, MA

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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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Don't forget your meds on vacation

by Hayde Blanco, 2018 PharmD Candidate

Whether you’re heading for the ski slopes or escaping the cold in a tropical destination, medications are likely the last thing on your mind as you pack for vacation. Between booking a flight, making sure you have your passport, or packing last minute luggage, medications can be easy to forget. However, if you take medications regularly, they should be one of the first things you should be thinking about. Whether you’re just going to the next state or to another country may determine what you need to do before packing your medications.

Things to remember before leaving

Check if you can fill your medications in a different state in case you are not able to receive a refill before leaving. You might also need additional travel insurance, in case something happens when on vacation.

Medications cannot be mailed in the U.S. except under certain circumstances, so if you forget to take them, you might have to pick some up when you arrive at your destination. ​​

A few days or even weeks before leaving, make sure you will have enough medications for a little longer than your planned vacation. In case there is a delay in getting home, you will be prepared without having to worry about getting more medicine.

If you will be traveling into a different time zone, you might need to adjust when you’re taking your medications. Talk to your physician or pharmacist, if there are any medications that need be taken at the same time daily, or to check if you should change how you are taking any of your medicines.

Planes, trains, or automobiles?

If traveling by plane, make sure to take medications in a carry-on bag, in case checked luggage gets lost and so they are easy to access. All medications are allowed on a plane including insulin, inhalers, and over the counter medication. If anything needs to be refrigerated, such as insulin, remember to pack it in an insulated medicine bag or container.

Taking prescription medications internationally

If you are going into another country, some of the medications you are taking might be illegal there. If you are traveling internationally, check that your medications are not on the country’s list of illegal medications. Additionally, take them in their original containers and bring a copy of the prescription, just to stay on the safe side.

Some countries are significantly more strict than others in what medications are allowed into the country. Narcotics or medications with a higher potential for addiction tend to have more restrictions in some countries. This is particularly important to look into ahead of time as it can lead to your medications being confiscated and serious drug related charges such as drug trafficking. Check the international narcotics board if you need to take any opioids to see if they are permitted in your destination country.  Always remember to check for any medication restrictions in the country you are traveling to especially if it is somewhere you have never been before.

If you need to take an EpiPen or other similar medication for an allergic reaction, make sure it is under your name. If you are likely you get a severe allergic reaction, such as anaphylaxis, consider wearing a medical identification bracelet that includes what to do in case of an unexpected reaction.

Do you need a vaccine?

Get informed on any vaccines you might need before traveling to a certain location. It’s important to get vaccinated before traveling, because in the rare instance you would catch something, you don’t want to bring it back to the U.S. and cause a possible outbreak. To read more about getting travel vaccines, check out this previous post.

Know your medications and diagnosis

If you are traveling for an extended time, ask your doctor about a list of possible generic alternatives, as well as a prescription, and diagnoses of what you are taking your medications for. Since some areas will only fill prescriptions written in that country, they might need to write a new prescription, and the medication you are currently taking might not be an option where you are staying.

Although forgetting to pack a vitamin is usually not something to worry about, not taking a chronic medication, such as a blood thinner or a blood pressure medication, for a few days or weeks can lead to more serious consequences and potentially even a trip to the emergency department. In the excitement of planning and packing, don’t forget to pack your medications for your next vacation.

 

References:

  1. https://www.cheapflights.com/news/traveling-with-medication/
  2. https://www.osac.gov/pages/ContentReportDetails.aspx?cid=17386
  3. http://www.miusa.org/resource/tipsheet/medications
  4. http://www.medicinenet.com/script/main/art.asp?articlekey=63470
  5. https://pe.usps.com/text/pub52/pub52c4_019.htm#ep290406

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Rhabdomyolisis can cause muscle cramps, particularly in the legs.

by Sapna S. Patel, PharmD (2017)

For many who have been diagnosed with hypercholesterolemia, commonly known as high cholesterol, changes in diet and exercise may not be enough. If your doctor has prescribed a statin medication to lower your cholesterol, you may have heard or read about the potential side effects of statin drugs and their impact on liver function.

Doctors will often prescribe statins to lower the total cholesterol and reduce the risk of a heart attack or stroke in people with high cholesterol levels. While statins are highly effective, they have been linked to muscle pain in some people, and in rare cases, even cause liver damage.

So what is rhabdomyolysis?Coca-Cola colored urine caused by rhabdomyolysis

Rhabdomyolysis is a severe, debilitating muscle pain (interferes with your ability to perform normal daily tasks) due to muscle damage and breakdown. This causes your damaged muscle to release their proteins into your bloodstream, become eliminated through your kidneys (ultimately leading to your kidney(s) shutting down), and appearing in your urine (which explains why the urine color of a patient experiencing rhabdomyolysis is referred to as “Coca-Cola” or “reddish-brown” color).

Some common statin medications are:

Statin medications can be very beneficial to your health. Statins can decrease the amount of “bad” cholesterol, which can clog your arteries, preventing oxygen-rich blood from reaching essential organs. Decreasing your “bad” cholesterol can lower your risk of having a heart attack or stroke. Ultimately, this leads to living a longer and healthier life.

The majority of Patients benefit from using statin medications if indicated by their physician. Less than 3% of patients on statins report muscle pain while less than 0.5% report rhabdomyolysis. So, don’t stop using your statin medication until your physician confirms this side effect.

Common Symptoms of Rhabdomyolysis are:

In the larger muscle groups, like your thighs, shoulders, lower back, and calves:

  • Muscle tenderness
  • Severe muscle pain
  • Muscle weakness/fatigue
  • Muscle Stiffness
  • Muscle Cramping

Other signs of rhabdomyolysis are:

  • “Coca-Cola” or “reddish-brown” urine
  • Skin changes (discoloration or blisters)

How do I know if a statin medication is causing my symptoms?

Ask your Physician for bloodwork to check for abnormal Creatinine Kinase (CK, CPK) levels, liver function, and kidney function tests. These labs are not routinely checked during bloodwork.

Symptoms of rhabdomyolysis usually occur 4-6 weeks after first starting on a statin medication. However, they can occur years after being on a statin medication, so it’s important to always be aware of the symptoms of rhabdomyolysis.

If your only symptom is muscle pain, think about other reasons why your muscles may be painful, sore, stiff, or crampy. Could it be due to unusual physical activity such as hiking up a new trail, shoveling the driveway after a massive snowstorm, or trying a vigorous exercise routine, like spin cycling or high intensity interval training?

What if I do have rhabdomyolysis?

If you do end up with a diagnosis of rhabdomyolysis, your physician will likely stop your statin medication. There are statins that have a lower risk for rhabdomyolisis, such as pravastatin (Pravachol) and fluvastatin (Lescol).

As a final note, if you’re taking a statin, you should also avoid eating grapefruit or drinking grapefruit juice. Grapefruit contains compounds called furanocoumarins that stop your body’s natural enzymes from doing their job. As a result, more of the statin drug is absorbed, making it more powerful than it would normally be.


Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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 copay!

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Pharmacogenomics pharmacogenetics image

by Leah Samera, PharmD Candidate, Class of 2018

As with most things, when it comes selecting a drug regimen for the treatment of chronic disease, one size does not fit all. If you take medications, you may have wondered why that is the case. One reason is because of pharmacogenomics.

Pharmacogenomics refers to “the entire spectrum of genes that interact to determine drug efficacy and safety.” In practice, many people may use the terms pharmacogenomics and pharmacogenetics interchangeably.

Pharmacogenetics, however, also refers to variants of one gene that affect drug response. The study of both pharmacogenomics and pharmacogenetics can help to optimize drug therapy and minimize drug toxicity based on an individual’s genetic profile.

What is a gene?

A gene is a series of codons that specify a particular protein. Genetic variation may result in altered protein sequence and function or in altered protein levels. This is significant, because these proteins can have an effect on how your body interacts with medications.

How do pharmacogenomic variations affect drug response?

The impact of pharmacogenomic variations on drug response have traditionally been divided into four categories:

  1. Those that affect drug pharmacokinetics. Pharmacokinetics refers to how a medication moves through a person’s body, i.e., how the drug is absorbed, distributed, metabolized, and eliminated.  An example of a genetic variation that affects pharmacokinetics is one in which drug metabolism is altered, subsequently affecting plasma concentration.
  2. Those that effect on pharmacodynamics. Pharmacodynamics refers to a person’s therapeutic response to a medication; this depends on a medication’s affinity and activity at its site of action. An example of a genetic variation that affects pharmacodynamics is one in which binding of a drug to its receptor is reduced, thereby decreasing therapeutic efficacy.
  3. Those that affect idiosyncratic reactions. An idiosyncratic reaction is an adverse reaction to a medication that is both rare and unpredictable. An example of a genetic variation that affects idiosyncratic reactions is one in which the likelihood of a hypersensitivity reaction to a certain drug is increased.
  4. Those that affect disease pathogenesis or severity and response to specific therapies. Pathogenesis refers to the origination and development of a disease. An example of a genetic variation that affects pathogenesis is a specific molecular defect related to the development of certain malignancies for which there are targeted therapies.

How can the study of pharmacogenomics help to optimize your drug therapy and minimize side effects?

Organizations like 23andMe allow people to “access, understand, and benefit” from the study of pharmacogenomics. With their simple home-based saliva collection kits, all you have to do is order their Health + Ancestry service; register, and spit into, the provided tube; and mail the kit back to their lab via the pre-paid package. Next, their lab extracts, processes, and analyzes the DNA from the cells in your saliva. Within 6 to 8 weeks, you get an email notifying you that you can view your results in your online account and discover what your DNA says about you. By sharing those results with your healthcare providers, they then can use that information to ensure that you get the most benefit from your medications while minimizing the risk of side effects.

References:

  1. Cavallari LH, Lam Y. Pharmacogenetics. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.ezproxy4.library.arizona.edu/content.aspx?bookid=1861&sectionid=146077703. Accessed September 12, 2017.
  2. Roden DM. Pharmacogenetics. In: Brunton LL, Knollmann BC, Hilal-Dandan R. eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.ezproxy4.library.arizona.edu/content.aspx?bookid=2189&sectionid=167889559. Accessed September 12, 2017.
  3. Tantisira K, Weiss ST. Overview of pharmacogenomics. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 13, 2017.
  4. Our Mission. 23andMe.com. https://mediacenter.23andme.com. Accessed September 13, 2017.
  5. How it works. 23andMe.com. https://www.23andme.com/howitworks. Accessed September 13, 2017.
  6. Our science. 23andMe.com. https://www.23andme.com/genetic-science. Accessed September 13, 2017.

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Anxiety medications and children photo

by Jenny Bingham, PharmD

Across the United States, the rate of antidepressant use in children is rising. It has led to prescription costs exceeding $100,000 in the four states with the highest antidepressant prescription rates for children: Colorado, Florida, Pennsylvania, and Texas.

As the number of antidepressant prescriptions rise, it’s only natural that parents will have a growing number of questions about those medications. Here’s a list of common questions other parents have had when starting pharmacotherapy for their child’s anxiety and/or depression:

How many pills will my child have to take?

The simplest answer is, it depends. Pharmacists are trained to know FDA approved indications for mental health medications. By incorporating pharmacists into the healthcare team, they can help find medications that have dual purposes and decrease the amount of pills in the regimen. Talk to your pharmacist about the medications and if there are alternatives.

How will pharmacotherapy affect my child?

Each patient responds differently to medications. Whereas some patients that are prescribed a common first-line antidepressant (fluoxetine) and tolerate it well, others may have an entirely different reaction. Certain medications can have negative side effects, including:

  • shaking
  • drowsiness
  • weight gain
  • insomnia
  • dizziness
  • dry mouth
  • blurred vision
  • bleeding, and,
  • constipation.

These side effects can be extremely detrimental to a child’s quality of life. It’s important to have open communication with your healthcare provider to ensure that side effects don’t get in the way of medication adherence, school performance, or self-esteem. Current literature provides clinicians a wide variety of information about which side effects are more prominently reported in individual cases. This database of knowledge helps further individualize therapy and avoid potential side effects.

What risks are associated with pharmacotherapy?

Parents should be aware of the potential for abuse, especially with commonly prescribed anxiety medications (ex. alprazolam) that are rated as controlled substances.

Adolescents are at an increased risk of suicidal ideation when initiating certain medications. Family members must be educated on how to monitor, identify, and report these to the provider.

One must also consider the risks of not seeking appropriate treatment, like self-medication with illicit drugs, tobacco, and alcohol. Self-medication can unfavorable effects on one’s mental and physical health.

Are there alternatives to pharmacotherapy?

If a parent decides against using medications, trained therapists can provide alternative options, if appropriate. Cognitive behavioral therapy is a common tool that incorporates education, relaxation exercises, coping skills, stress management, and assertiveness training.1

Other approaches include: interpersonal therapy, motivational interviewing, dialectical behavior therapy, supportive therapy, and family therapy. These tools can also be used in combination with medication to improve depression and anxiety. Parents should work closely with their physician to determine if this is a safe option as monotherapy.

Final Thoughts

Decisions about using medications to treat anxiety and/or depression in children must be catered specifically to the patient. It is imperative for health care providers to approach this sensitive topic as a group, including the patient and parents. Pharmacists are a great resource for optimizing medication effectiveness and reducing pill burden.

References:

  1. Beck JS. Cognitive Behavior Therapy: Basics and Beyond, 2nd ed, Guilford Press, New York 2011. p.391.

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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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noacs - warfarin alternatives

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Not so long ago, a diagnosis of atrial fibrillation (AFib), deep vein thrombosis (DVT), or pulmonary embolism (PE) meant that a prescription for the blood thinner, warfarin (Coumadin), was likely coming your way. In recent years, multiple other blood thinners have become available, and you may have wondered if any of them could be right for you.

What are NOACs?

The NOACs, or novel oral anticoagulants, are a new breed of blood thinner that have arrived on the market within the last ten years. This class of medications includes:

How are NOACs Different from Warfarin?

Multiple clinical trials comparing these alternative warfarin medications have all shown that the NOACs are just as effective as warfarin, and that they have a similar (or lower) risk of bleeding. Warfarin has been around for decades and has been proven to be both safe and effective at preventing blood clots, but it’s no secret that it has its problems. Here are some key differences to note when comparing the newer anticoagulants with warfarin and when deciding what is right for you:

  1. Warfarin requires frequent trips to the lab to have your INR (international normalized ratio) checked. Also referred to as PT time, Prothrombin time is a blood test that measures how long it takes blood to clot, or how well the medication is working. You may potentially need to change your dose to increase or decrease the clotting time. NOACs do not require lab monitoring or frequent dose changes.
  2. NOACs do not have the high potential to interact with food or other medications like warfarin does, meaning there are fewer restrictions. This means no more worrying about how much salad you can eat on a day-to-day basis, or if you are allowed to have that glass of grapefruit juice in the morning. It is still recommended, however, to check with your doctor or pharmacist before starting any new medications, as there are still some medications that may increase your risk of bleeding when taken with the NOACs.
  3. NOACs begin working quickly, while warfarin may take up to a week to start working. Because of this, patients with a DVT or PE starting warfarin may require “bridge” therapy with heparin or enoxaparin (other fast acting blood thinners) to prevent clots while waiting for the warfarin to take effect. This “bridge” therapy is not necessary with the NOACs.
  4. Unlike warfarin, not all of the NOACs have a reliable reversal agent if you were to begin bleeding. With warfarin, if your INR becomes too high or if you are having signs of bleeding, you may be given vitamin K, or phytonadione, to reverse its effects. Currently, Pradaxa is the only NOAC that has an approved reversal agent, called Praxbind (idarucizumab). While bleeding is rare while on the NOACs, the lack of reversal agent is something to keep in mind when deciding which medication may be right for you.
  5. NOACs may not be appropriate if you have decreased kidney and/or liver function. Your doctor will review your labs and information to determine if your kidneys/liver are functioning well enough for you to take one of these medications.

The recent approval of the NOACs has provided prescribers and patients with more options to choose from when a blood thinner is necessary. Because these medications are still relatively new, there is a lot left to learn about their use and limitations, so they may not be appropriate for everyone. It is always important to discuss any questions or concerns with your doctor when starting any of these medications or when switching from one to another.

 

References

Leung LLK, Direct oral anticoagulants and parenteral direct thrombin inhibitors: Dosing and adverse effects. In: UpToDate, Mannucci PM (Ed.), UpToDate, Waltham, MA.

Hanley CM, Kowey PR. Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? Journal of Thoracic Disease. 2015;7(2):165-171. doi:10.3978/j.issn.2072-1439.2015.01.23.


Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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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Always ask the cash price - you could save on your prescriptions

The “he said/she said” of Rx pricing tools

If you’ve ever used a prescription price-check tool for an Rx savings program (like ScriptSave WellRx), only to have been told a different price when the time came to collect & pay for the prescription at the pharmacy, then the next few paragraphs are for you.

Regardless of the product or service, it’s an infuriating thing to be quoted one price online, but to then be confronted with a different reality at the store (unless, of course, the price comes down – then we love it).

What can be done to avoid bad price-quotes?

For patients using prescription savings programs, there are a few steps that can be taken to help reduce the potential for errors with an Rx price-check tool.

In short, there are some very important things to keep in mind when doing a price look-up with a prescription discount card and overlooking any single one of them has the potential to make a mess of things.

In no particular order, at ScriptSave WellRx we always recommend that our members keep the following pointers in mind:

    • Potential Problem #1
      Prescription prices can be volatile and it’s not uncommon to find regular (even daily) price changes across pharmacies in any given zip code.
    • Recommendation
      When using a price-check tool or mobile app to review the lowest prescription prices in your zip code, be sure to perform one final look-up on the same day that you end up collecting & paying for your script. As frustrating as it might be to discover that prices changed for your medication overnight, it’s far less frustrating to realize this before you leave home. Especially if you also discover that the same medication actually came down in price at a different pharmacy nearby (perhaps even giving you the opportunity to make arrangements to transfer the prescription).

     

    • Potential Problem #2
      Prescription medications come in many different strengths, forms, quantities, etc. There’s also the matter of brands & generics. However, a price-check tool for a prescriptions savings card like ScriptSave WellRx has to start somewhere – and the default settings on the website will generally only return pricing results for one very specific version of each medication. For example, perhaps the price-check tool will show results for the most commonly filled strength, quantity, form and manufacturer of the medication that you’re searching for.
    • Recommendation
      When the results of your price-check are returned by the website or mobile app, ALWAYS take a few minutes to review the details against the details on your prescription … and make the necessary manual changes (if any are needed) using the drop-down menus that determine the drug’s Strength, Quantity, Form, Brand/Generic, etc. (see Fig.1)

     

    FIGURE 1
    ask cash price filter - results image

    • Potential Problem #3
      Your pharmacist does not recognize or is not familiar with your prescription savings card.
    • Recommendation
      If you’re using the ScriptSave WellRx card or mobile app, you can be confident that if your pharmacy showed up in our price-check tool, it’s more than likely that we have a contract with them to accept your savings card. We do our best to keep our database up-to-date so as not to send members on a wild goose chase. Perhaps the best way to approach using a ScriptSave WellRx card is to do so with confidence. Although this program is NOT insurance, an Rx savings card includes the same pharmacy processing information that pharmacists see & use every day on all the different insurance cards they deal with. That being case, simply hand your ScriptSave WellRx card to the pharmacist, point to where the card shows the Rx BIN, Rx PCN, etc. and ask,
    “Would you please process my prescription using these details and let me know what my out-of-pocket cost will be?”

     

    If you’re absolutely sure that you’ve taken care of these 3 common issues and yet you’re still facing prices at the pharmacy that are higher than the quotes being shown on the ScriptSave WellRx website/app, there’s one more thing to double-check…

     

    • Potential Problem #4
      Your pharmacist used a different discount card.
    • Recommendation
      There are a number of reasons why this might have happened – and it can certainly be the result of an easy & honest mistake. For example, the ScriptSave WellRx card includes a set of codes that the pharmacist must enter into the computer before being able to tell you the price of your medication. If you look at your ScriptSave WellRx savings card or coupon, you’ll see where it says “RxBIN: 006053” (together with RxPCN, Group # and ID #). Similar codes also appear on insurance cards and they work in the same way.
       
      As with insurance, if you visit the same pharmacy each time, your name, address, DoB, etc. are saved on file for speed & convenience. As part of your saved pharmacy record, the pharmacy also stores a record of any insurance card or Rx Savings program that has been used in the past. Therefore, if you’ve used a different savings card but have since discovered more favorable pricing with ScriptSave WellRx, it’s very possible that the pharmacist simply assumed that your stored details were the same as the details on the WellRx card that you just handed him/her. Also keep in mind that no pharmacist ever wants a patient not to be able to afford their physician-prescribed medications. As such, they’re often on the lookout for ways to help their patients afford their meds (even if the patient doesn’t realize it). Therefore, even if you think you’ve never used another prescription savings card in your life before, it’s certainly not unheard of for a pharmacist to have used one on your behalf because he or she knew that it would save you some money and help you out. If that’s the case, the details pertaining to the RxBIN, RxPCN, etc. from that other card may very well be saved to your profile. This would explain why you’re receiving a discount … but not at the level that was indicated on the ScriptSave WellRx website.
       
      Take a few minutes to familiarize yourself with your savings card and next time you think you might be in this situation, politely ask the pharmacist,
    “Is there any chance you can double-check the processing details, please? Can we just be sure that we’re using the ScriptSave WellRx details as shown here on this card/coupon/app, because I was quoted a slightly lower price earlier this morning, and I’m sure it was for the same strength & quantity that’s on this prescription?”

    U.S. Based Call Center Support

    Another useful hint to keep in mind is that all ScriptSave WellRx members are serviced by a toll-free customer support number (staffed by real people right here in the U.S.). If you ever have a problem, you can call the support line toll-free at 1-800-407-8156, Monday through Friday, from 9am to 8pm EST, and our friendly staff will be glad to help get to the bottom of any issues. Given the real-time need that many patients face with filling their prescriptions, if you’ve had issues at a particular pharmacy in the past, it might be helpful to call our support staff ahead of your next visit to fill your prescription. If necessary, our staff may be able to call your pharmacy on your behalf – ahead of your visit – so that everything is smoothed out before you arrive to pick-up and pay.

    Final Thought – Love your Pharmacist (and Always Ask the Cash Price)

    Please always keep in mind that pharmacists have a LOT going on and they can be incredibly busy. Although they can make it look simple at times, that’s generally a reflection of their professionalism & experience, and their role in a patient’s healthcare is not to be underestimated. Pharmacists are a truly valuable resource and they juggle a lot of different tasks. If you meet a pharmacist who looks at your prescription savings card and doesn’t immediately recognize it, don’t be surprised. We can’t expect every pharmacist, at every pharmacy, to recognize and remember every single savings card and insurance program that they have a contract with. More often than not, if you ask your pharmacist (politely) to try processing your prescription using the details on the card, they will be happy to give it a try. If that doesn’t work, and if you’re using a card from ScriptSave, you have a tollfree support number to call for assistance.

    As for “Always Ask the Cash Price” … that’s a must-do for patients who don’t want to over-pay (especially for those WITH prescription insurance). For more insights on this, read our blog post on why you should Always Ask the Cash Price.


    Download the free WellRx app from the iOS app store or the Google Play Store,
    and get registered to take advantage of our free medication adherence tools.

    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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