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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Beating high prescription costs - WJLA

by Lisa Fletcher, ABC7 News

Washington, DC (WJLA) – Millions of Americans with health insurance still pay out-of-pocket for medications. And the cost can reach hundreds or even thousands of dollars a year.

But what many drugmakers and pharmacies don’t want you to know is that you could lower your medication costs, sometimes by as much as ten-times, by simply walking across the street to a competing pharmacy.

On a recent fall morning, ABC7 News caught up with Poet Taylor, the host of a popular Washington, DC radio show. As she regaled her listeners with stories and witty banter, you wouldn’t have guessed she suffers from asthma. Her job and her well-being depend on her ability to control it.

“Asthma is a very serious, serious diagnosis,” said Taylor. “The wrong medication could result in me having an asthma attack and not being properly medicated.”

But Taylor, like millions of Americans, is in the center of a tug-of-war between insurance providers and drugmakers.

Big insurance companies threaten to take popular medications off their coverage list unless drugmakers reduce the price. It’s a multimillion dollar game of chicken and the drug companies don’t always flinch.

Taylor recalled a recent, surprising trip to her pharmacy. “I put in my normal refill. I’m feeling good. And I get a call from my pharmacy and the pharmacy is like, ‘nope, your insurance doesn’t cover that.’ Yes they do, I’ve been on it almost a year now. I know they do. They were like, ‘not anymore.’”

Taylor was forced to switch to another brand of inhaler that she and her doctor agree, doesn’t work as well for her asthma. Taylor says she feels like a pawn in the game of trying to force pharmaceutical companies to lower their costs.

“A company that would wager my life on, I don’t know what kind of extra money you get at the end of the year, it just reads loud and clear: We don’t really care about you. We care about the money that we make off of you,” said Taylor.

ABC7 News checked. If Taylor wanted the medication that works best for her she’d be out of pocket as much as $433.99 a month. We asked if that’s something she could afford.

“No,” said Taylor. “That would be the cost of my car insurance, my car payment and my phone bill.”

But what Taylor and millions of others like her didn’t know is that you can comparison shop for drugs just like you would a car, a bed, or the paper towels in your kitchen.

“The crazy thing we see every day is that same drug, same exact prescription, different pharmacy, much better price,” says Shawn Ohri. Ohri works for ScriptSave, a pharmacy benefits manager, or PBM.

There are about 30 PBM’s in the U.S. and they negotiate prices on prescriptions for their members.

Ohri says insured or not, everyone should comparison shop.

“Twenty-eight million people that we know are uninsured today, You’ve got 20 million people that are on high-deductible health plans in 2016 and that number’s growing year-over-year, and then you’ve got 10 to 20 percent of the people that have great coverage, but that particular drug that they’re using isn’t covered,” says Ohri.

One way to shop around is to call every pharmacy in your area. Another is to use an app.

Ohri’s company came up with an app called “WellRx.” There are a handful of others and each is likely to find different deals for you, depending on how they negotiate with the pharmaceutical companies.

Using the WellRx app, ABC7 News compiled the most popular prescriptions in DC, Maryland and Virginia and compared prices among the top 10 pharmacy retailers.

The antibiotic amoxicillin is the No. 1 most purchased drug in Maryland. It’s three and a half times more expensive at CVS than Walmart.

The high blood pressure medicine amlodipine besylate is one of the most popular prescriptions in Virginia. It’s nearly six-times more expensive at WalMart than it is at Kmart.

And in DC, the second most prescribed drug, sildenafil, used for high blood pressure in the lungs, or as a generic form of Viagra, is more than eleven-times more expensive at Walgreens than Costco…at $195.00 versus $17.60.

“It pays to shop around, even with these types of programs,” says Ohri.

And that’s something Taylor won’t soon forget as she tries to outmaneuver the insurance and drug companies.

“I’m a person who wants to live a healthy, happy life,” said Taylor. “I don’t know why you would want to stand in the way of that. And I would hope an extra thousand dollars, or extra million should not matter more than me living, me breathing, me being here.”

Remember that depending on what app you’re using, the prices can vary – sometimes by a lot.

See the original story on the WJLA website.


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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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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shop around to save on medications

For those who are new to the ScriptSave WellRx prescription savings program, you may not realize just how long our company has been in the business of saving patients money on their prescriptions. It’s actually well over 20 years – we date back to 1993.

As such, it’s certainly nothing new to us to encounter people ‘paying it forward’ and helping to spread the word. That said, in all that time, it had never occurred to us to open our website to guest bloggers – until now.

Shell Roush is a Saturday Soccer Mom who lives in North Carolina and author of the extremely popular “Things I Can’t Say” blogsite. To simply refer to her as a “Mommy Blogger” doesn’t quite do her justice but, as she states, “I’m a mommy and I blog.” However, as her audience of ~30,000 unique visitors every month will attest, you’ll find that she writes so much more than just posts about parenting … including the following, which she wrote about us…

“The Easiest Way to Shop Around for the Best Prices on Prescriptions
by Shell Roush

The pharmacy assistant was typing away at her monitor when she paused and looked up at me to ask “You are aware of the cost of this medication?” with a note of apology in her voice.

I sighed and responded that unfortunately, I was and that yes, I still needed the prescription filled.

She hesitated and very quietly told me that if I needed a prescription filled and I didn’t have insurance, I’d be better off going to the pharmacy across the street because it had better prices.

Until that moment, I had no idea different pharmacies charged different amounts for the same medication. I’m not sure why it was such a surprise since everything, from milk to gas, has a price that varies from place to place.

But there are so many pharmacies that it would be extremely time-consuming to check all of them, especially since the prices aren’t clearly listed in store. It would require me to either, call and inquire about a specific medication, or even show up in store to ask.

But by using the ScriptSave® WellRx website and mobile app, I can access their fast, easy, and free price-check tool. I put in my zip code here in Jacksonville, NC and I quickly see the specific prices for all of the pharmacies near me. It’s so much more convenient than having to make all of those phone calls.

Not only does the cost of the same medication vary from one pharmacy to the next, it can vary greatly. When I pay out of pocket for one of the medications for my son, it costs around $300. The ScriptSave WellRx app shows me the discounts available near me, making the current cost anywhere from $156.92 all the way up to $274.99.

That’s such a huge difference in price of the same medication, saving me over $100 every month. I like how easy ScriptSave WellRx makes the price check. With three growing boys, I can take those savings and apply them to the rest of the things they need, like soccer dues, 5k race registrations, and computer coding classes.

Because the ScriptSave WellRx card/app is free to download, requires no credit card information to be entered, and has no membership fee, it’s definitely worth trying. Maybe you’ll get a better deal by using your insurance or without ScriptSave WellRx, but it is so quick and easy to compare prices that I always check it before I call my son’s doctor for a refill on his prescription.”


For the best Rx price on
prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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organizing your medications photo

For those who are new to the ScriptSave WellRx prescription savings program, you may not realize just how long our company has been in the business of saving patients money on their prescriptions. It’s actually well over 20 years – we date back to 1993.

As such, it’s certainly nothing new to us to encounter people ‘paying it forward’ and helping to spread the word. That said, in all that time, it had never occurred to us to open our website to guest bloggers – until now.

After years of working 12 hour days and living on a diet of frozen pizzas, diet soda and coffee, Ellen Christian decided that she’d had enough of being sick, tired and fed-up with everything. Taking matters into her own hands, she turned the tides and now writes about healthy living for busy women while also being a loving caregiver to her disabled husband. She lives in Castleton, VT and authors the extremely popular “Confessions of an Overworked Mom” blogsite. She reaches ~25,000 unique readers every month and we’re delighted that she also uses the ScriptSave WellRx program and that she agreed to write the following blog post for us…

“Be Prepared. Planning Pharmacy Visits Can Save Time As Well As Money
by Ellen Christian

Now is the time to get organized for cold and flu season. Since my husband is disabled, he has a reduced immune system. Staying healthy during cold and flu season is even more important to us because of this reason. An illness that I can fight off or that lasts me only a day or two can last him a week or more or turn into something more serious.

How to Get Organized for Cold and Flu Season

Living in Vermont, it seems like our cold and flu season lasts quite a while. Winter is the time of year when we get sick most frequently. Unfortunately, it’s also the time of year when we have snow, sleet, and bad weather. Hazardous driving conditions are just another reason why we try to get organized for cold and flu season. I don’t want to have to run to the store to get tissues or fill a prescription in the middle of a snowstorm.

Right now, I’m stocking up on tissues, orange juice, cough drops, Vitamin C, elderberry syrup and, of course, Marty’s prescriptions. Since he’s disabled, he has several prescriptions he takes each month to manage his symptoms. It can be fairly time-consuming to check the prices for each one with several drug stores. Prescription prices can change regularly so I cannot just assume I’m going to find the best price for everything all in one place.

I’ve been using an app and website called ScriptSave WellRx to save money on Marty’s prescriptions. When I searched on pharmacies in the Castleton, Vermont area, I was surprised at the options. I didn’t realize that my insurance didn’t always have the lowest price for every prescription. Did you know that you may be able to save more money by paying cash and using ScriptSave WellRx? – (Learn more about paying cash for prescriptions here).

ScriptSave WellRx gives “Medicine Chest Pricing” that lets me enter the details of several of Marty’s prescriptions at the same time. Then, I can click the “Price-check” button to see EITHER, the one single pharmacy that gives me the lowest ‘one-stop price’ OR the specific combination of pharmacies that give the lowest individual price for every single prescription.

That means I can stop at one pharmacy with the lowest overall price when I’m pressed for time. Or, I can go from store to store to get each one at the most affordable price when I want to. I can even save all of Marty’s prescriptions in one secure place so I can price-check them each month instead of re-entering them. That’s a huge time saver when you have multiple prescriptions. I just don’t have time to call all the different pharmacies in my area every month for all his prescriptions.

The card is totally free to use and you can get the app in the iTunes store or on Google Pay for free. There’s nothing lost to give it a try and see what you can save. There are no fees and it doesn’t need your credit card information. Plus, there is no way you’ll pay more for your prescription than you do right now. You’ll either get a discount or you can use your insurance like you normally would. Just have the pharmacist check the price with the card and with your insurance.

Give it a try and download it today. On average, members save around 45%, but prescription prices change all the time so it’s always worth re-checking before each refill (…and, as mentioned previously, this is made so much easier by using the ScriptSave WellRx ‘Medicine Chest’).  It’s easy to find savings and every little bit helps. Plus, it has convenient reminders that help keep you on track when you’re busy.


For the best Rx price on
prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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Dry eye treatment eye drops

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

For many people, dry eyes may only be a minor inconvenience. But for those who experience chronic dry eye, it can be a major problem, causing extreme discomfort. Left untreated, dry eye can have long term effects on your vision as well as your quality of life.

What causes dry eyes?

Dry eye occurs when you do not produce enough tears or if you are not producing quality tears.  As a result, there is not enough lubrication for the eye, leading to the gritty, burning, and irritated feeling that is most often associated with this condition.  There are a variety of things that may cause dry eye, including:

  1. Dry climate
  2. Wind
  3. Exposure to smoke
  4. Age
  5. Gender
  6. Certain medications and medical conditions.

For some, dry eye may be unavoidable, which is when finding an effective treatment that is not too costly becomes very important. In fact, one study found that the average direct cost for a patient seeking medical care for dry eye was $738 per year, and the cost to society per patient per year was over $11,000. So, the question is, what are your options if you are one of the millions of people in the United States who suffer from this condition?

Over-the-counter treatment for dry eyes

The key to managing dry eye symptoms and avoiding spending a fortune on prescriptions is to take advantage of the various over-the-counter options available.

The most popular over-the-counter treatment for dry eye is artificial tears, which help to lubricate the eye when you do not have enough tears of your own. There are many different varieties of artificial tears in the pharmacy aisle, and the most important distinction between them is that some are preservative-free while others are not. The preservative-free options tend to be more costly, but they are better for those who have more chronic symptoms because they are less likely to irritate the eyes following frequent use.

Another option that is available without a prescription is an omega-3 fatty acid supplement, which helps to increase tear production. Depending on what your doctor determines to be the cause of your dry eyes, they may have other recommendations for you that do not require a prescription for dry eyes.

Home treatment for dry eyes

In addition to over-the-counter medications, there are a number of other things you can try to prevent and/or reduce the symptoms of dry eyes. Some suggestions include blinking regularly, wearing sunglasses outside to protect your eyes, and drinking more water. If eyelid inflammation contributes to your dry eye symptoms, you may consider gently washing your eyelids, which can be done using a mild soap. Applying a warm compress over your eyes may also provide relief.

When do you need a prescription for dry eyes?

If prescription treatment does become a necessity, your doctor will discuss the different options with you. The ones most commonly used are Restasis (cyclosporine), which reduces inflammation, and Xiidra (lifitegrast), which helps you make more, quality tears. Another option is Lacrisert (hydroxypropyl cellulose), which is inserted between the eyeball and lower eyelid and slowly dissolves to release a lubricating substance. For now, these are only available as brand name medications, therefore price may be a barrier depending on your insurance coverage.

Finding the right dry eye treatment

Whether you seldom experience dry eyes or if you have constant symptoms, finding the right treatment is crucial. Dry eye can be irritating, costly, and even life-altering if not controlled. By working with your doctor, your pharmacist, your insurance company, and even prescription savings companies like ScriptSave, you will be in a better position to control your symptoms and save some money in the process.

References:

  1. Yu J, Asche C, Fairchild C. The Economic Burden of Dry Eye Disease in the United States: A Decision Tree Analysis. 2011 April. 30(4):379-387.
  2. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye?sso=y
  3. http://www.mayoclinic.org/diseases-conditions/dry-eyes/basics/lifestyle-home-remedies/con-20024129
  4. Micromedex

 

 

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Pharmacist help manage epilepsy drugs

by Jenny Bingham, PharmD

Choosing the correct medication to treat epilepsy is a multifaceted process. Pharmacists can have a huge impact on the patient’s therapeutic response as a valued member of the healthcare team. 1

Medications used to treat seizures are called anti-epileptic drugs. Pharmacists review reams of information to ensure medication safety and suitability. The three primary concepts involved in this evaluation include:

  1. Pharmacogenetics – the role of genetic differences on an individual’s response to a drug.
  2. Pharmacokinetics – how a drug moves through the body.
  3. Pharmacodynamics – an individual’s therapeutic response to a drug.

It is important to assess for drug interactions

When medications interact with one another it is called a drug-drug interaction. Medications can enhance the effects of another drug (agonize). They can also block the effects of another drug (antagonize).

Monitoring for kidney or liver function

Medications are either metabolized in the liver or kidneys. If an individual has impaired organ function or damage, it changes how the body responds to that drug. Some medications, like Carbamazepine and Phenytoin may have more of an impact than Gabapentin.

Medications that are metabolized in the liver have an affinity for certain enzymes:

  • If a medication induces a particular enzyme, it can increase the body’s metabolism of it. The result is decreased serum concentration levels, or decreased effects.
  • If a medication inhibits, it can decrease the body’s metabolism of it. The result is an increased serum concentration level. Individuals might experience increased side effects when this happens.

What to expect for the duration of treatment

The goals of treating seizures are:

  1. Improve the patients quality of life; and,
  2. Decrease seizure frequency.

An individual’s type of seizure and previous medical history dictate how long they must take anti-epileptic drug. Patients should only make changes to their medication as directed by their provider.

In general, there is no one size fits all approach to treating seizures. However, pharmacists can prevent medication-related issues by performing a comprehensive safety evaluation as a member of the healthcare team.

References:

  1. Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract. 2012 Feb; 20 (1):65-8.
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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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Savings card vs. savings coupon image scriptsave wellrx

What’s in a name and why does it matter?

Although many patients tend to think of the ScriptSave WellRx program as a coupon for their meds, your free prescription savings card is actually a lot more powerful.

In addition to the obvious differences, like the fact that you would normally only get to use a regular coupon for one transaction (related to just one very specific product, as stated on the face of the coupon), there are some additional and very important features that make for big differences between an Rx discount card (like ScriptSave WellRx) and a coupon.

Here are a couple of important things to keep in mind. Understanding these differences will also help to explain why an insurance provider can’t allow you use the ScriptSave discount in addition to their own reduced rates, or why a pharmaceutical manufacturer won’t allow you to apply their copay savings program together with our low prices.

  • A regular coupon works by lowering the end-price of a product, cutting it by the exact amount shown on the coupon. The coupon has a fixed value, and the retailer will subtract that fixed value from the current sales price. For example, the regular coupon might say, “Take $5 off the price of XYZ.” When this happens, the savvy consumer might decide to shop around in order to find the store that sells this product for the very lowest price…THEN s/he will receive an additional $5 off that lowest price upon surrendering the coupon.
  • In contrast, what we do with the ScriptSave WellRx program is to negotiate lower final costs for each specific medication. We don’t negotiate a fixed coupon value. Instead, we negotiate a final discounted price. This is a subtle but important difference. With our program we’re saying, “We can get you a specific medication for a negotiated final price of $X.” This being the case, if the patient can find a pharmacy that will fill their prescription for a final out-of-pocket cost that’s lower than our negotiated price (perhaps as a result of the drug being on a low copay list with their insurer), they may not want to use their Rx discount card for that particular medication. Meanwhile, the same patient may have a second prescription that’s not covered by insurance and where the ScriptSave out-of-pocket cost is the lowest discounted price available…in which case one script gets filled with ScriptSave and the other does not.

Can it be used with insurance, Medicare, Medicaid, etc.?

Here’s another example to help illustrate. We’ll start by laying out three basic pricing options for filling a prescription at a given pharmacy…

  1. An insurance policy (including Medicare and Medicaid) includes a list of drugs (known as the Formulary) for which covered patients will pay a predetermined negotiated rate.
  2. Similar to the prescription drug formulary at an insurance company, the contracts that ScriptSave has negotiated with its pharmacy partners also result in pre-determined out-of-pocket costs. These rates are available to ANY patient who chooses to pay cash.
  3. At the same time, a generic drug list at a retail pharmacy shows the final prices for certain drugs at that pharmacy.

Of the three pricing options listed above, a patient is free to choose the price that makes the most sense for each of the prescriptions they are filling. However, this is a one-or-other choice. There’s simply no way to “stack/combine” the savings from an insurance payer together with the savings from a cash discount card, because the prices being offered under each option are contractually agreed and final.

Another way to put this is to say that, in the world of a regular coupon, the value of the coupon is always the same no matter which store it gets redeemed it at. Therefore, the final out-of-pocket cost for any product that has a coupon will vary based on how much the store is selling the product for in the first place. Meanwhile, an Rx savings card like the ScriptSave WellRx card will deliver a fixed final out-of-pocket cost (and so it’s the value of the discount that changes with every prescription being filled, relative to the original cash price for the drug in question).

In short, prescription savings programs are NOT coupons. While it might be easy to think of them in this way (and you may even hear us refer to them as such), it’s important to keep the differences in mind. Furthermore, you’ll want to choose your savings program based on its reputation and relationship with pharmacies … because it’s these relationships that matter when it comes time for the pharmacist to honor the savings card or mobile app.

As part of the Medical Security Card Company and ScriptSave suite of pharmacy programs, the ScriptSave WellRx program boasts well over 20 years (founded in 1994) of history and relationships with our pharmacy partners. We believe this helps make ScriptSave WellRx second-to-none.


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!

high medication prices image

by Leah Samera
University of Arizona College of Pharmacy
PharmD Candidate, Class of 2018

It’s one of the most common questions we hear at ScriptSave: “Why are prescription medications so expensive?” With insurance deductibles going up and insurance companies providing less reimbursement, drug prices are outpacing the inflation rate. So why do drug companies continue to charge exorbitant prices for medications? The simple answer is, because they can.

There are a number of factors that affect the cost of medications. In the United States, drug costs are vastly higher relative to other countries. What sets the U.S. apart is that drug manufacturing companies are permitted to set their own price for a given prescription drug. Conversely, in countries with national health insurance systems, a separate organization negotiates drug prices or rejects coverage if the manufacturer proposes what is felt to be an excessive cost.

Market Exclusivity

The reason why brand name drug manufacturers are able to set such high prices in the United States is because they are “protected” from competition, and they have a lot of negotiating power; this leads to those manufacturers having market exclusivity. Market exclusivity is when the FDA allows a manufacturer to market their drug without generic competition. According to Kesselheim, et al. the median length of post-approval market exclusivity is 12.5 years for widely used drugs and 14.5 years for highly innovative, first-in-class drugs.

New medications are automatically protected from generic competition for anywhere between 5 and 12 years. On top of that, manufacturers may also receive patents that can last 20+ years. These companies can even extend their patent period by testing in children through the pediatric exclusivity program. They can also apply for additional patents on nontherapeutic aspects of a drug, such as the method of administration, coating, and formulation. Manufacturers can thus periodically implement and patent small changes to a drug, thus prolonging their market exclusivity.

Pay for Delay

Aside from legal protection, some brand-name manufacturers have historically negotiated with and offered financial incentives to generic manufacturers to defer introduction of a generic product until a later time; this is referred to as pay for delay. Some brand-name manufacturers have even paid generic manufacturers to cancel introduction of their generic product altogether. Brand-name manufacturers have also offered rebates to third party administrators of prescription drug plans to promote their product versus others in its class.

What About Generic Drugs?

Generic products can become expensive as well because, for some drugs, there is lack of motivation to create additional generic competitors. The number of generic manufacturers for a given drug depends on factors such as the size of the target population for the drug, availability of ingredients, and mergers in the industry. Those generic manufacturers with little competition may then raise prices.

Dispense As Written

It is also important to note that there are several laws and people involved in the process of writing and distributing a prescription medication. Physicians write prescriptions, pharmacists fill and sell prescription medications, and patients and/or insurers pay for said medications. The separation in these roles can often lead to physicians being unaware of drug prices and therefore not taking this consideration into account in clinical decision making. Several states also may not require pharmacists to conduct generic substitution, and all states allow physicians to write dispense as written prescriptions that pharmacists cannot substitute with a generic product.

How to Save Money on Prescription Drugs

Fortunately, the ScriptSave WellRx prescription savings program offers instant prescription discounts at the register on both brand name and generic prescription medications. Over 62,000 pharmacies across the U.S. participate, and there’s no enrollment fee or usage limits. Although there are many forces in the market that increase drug costs, ScriptSave WellRx delivers prescription savings solutions that can help you and everyone in your household save money on medications — even pets!

Registered members have access to a free suite of personal wellness tools in the Medicine Chest, including:

  • Ask a Pharmacist
  • Pill Reminders
  • Refill Reminders
  • Medication Information (in both English and Spanish)
  • Medication Videos
  • Mood-tracking (to review side effects, etc.)
  • Price-check and Pharmacy Locator

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!

References:

  • Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins and prospects for reform. JAMA 2016; 316:858–871. https://www.ncbi.nlm.nih.gov/pubmed/27552619
  • https://www.wellrx.com/faq

For the best Rx price on
prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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