patient doctor communication image - scriptsave wellrx blog

by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

Have you ever left your doctor’s office feeling more confused than when you arrived? Maybe even felt like your doctor didn’t understand your concerns? You’re not alone. When over 300 patients were interviewed after being released from the emergency room, only 6 in 10 patients were able to correctly describe their doctor’s directions.1

Good healthcare begins with good communication. If the doctor doesn’t understand your concerns and you don’t understand the doctor’s directions, you may not be getting the best care possible.

There’s a growing awareness in the medical community regarding the need for effective doctor-patient communication. We have several simple recommendations to help you in that process.

Eight Things to Consider on Your Next Doctor Visit:

  1. Write down your concern(s). When thinking about your health concerns, write down when it started, what you think may have caused it, how often it happens, what it feels like, things that make it better, things that make it worse, in as much details as possible.

    Having written notes will help you organize your thoughts during the short time you have with the doctor. Additionally, they will help you better answer the questions your doctor will have. The more information you can give them, the better they will be able to help you.
  2. Consider bringing someone who can support you. A friend or family member can help catch things that might otherwise be missed, ask questions you may have not thought of, and help keep track of the information and instructions shared by the doctor.
  3. Be honest and straightforward about any concerns you have. Your doctor is required to protect your privacy and will only share your information with other healthcare professionals as required for your care. Even if it may be embarrassing, or you feel it may be irrelevant, it is important to share everything. Your doctor should be nonjudgmental and understanding. When you share openly, it will help the doctor see the full picture and catch things that may otherwise be missed.
  4. Don’t be afraid to ask questions! Doctors can sometimes use terms that are overly complex and hard to understand. It’s perfectly okay to ask for clarification in simpler terms or ask them to explain it again. Then, once you think you understand, repeat the information back to your doctor in your own words. This technique, called teach-back, can help you to internalize information and let the doctor know if anything was missed.
  5. Create and maintain a medication list. It can be frustrating for everyone (healthcare team and patients alike) when in response to the question “What do you take?” the answer is, “the little round white pill.” Hospitals can, and do, call pharmacies to find out what patients are taking, but having a list up front can save time and prevent potentially harmful prescribing.

    In not knowing what you are taking, your doctor may mistakenly prescribe medication that could interact with what you are already taking. This could lead to your medications being less effective or additional side effects, so it’s important to create and maintain an up-to-date medication list.

    When making your medication list be sure to include, at a minimum:
    – medication name
    – strength, dose, and frequency of dose
    – reason for taking, and any special instructions that medication may have.

    For example:
    – levothyroxine (name)
    – 125 mcg (strength)
    – One tablet (dose) every morning before breakfast (frequency)
    – For low thyroid hormone (reason for taking), take levothyroxine by itself ½ hour before any other food, medicine or drinks (special instructions).

    When making your list, make sure to include any medicated creams, patches, inhalers, implants, suppositories, or any other less conventional forms of medications, like medical marijuana (MMJ).

    Make sure to include any over the counter medications and supplements you take as well, as many of these may interact with other medications you are taking. 
  6. Consider any language barriers. There can often be language barriers between a doctor and their patient. This can lead to problems in receiving quality medical care.

    In the United States, you have a legal right to oral interpretation and written translation of any medical communication into your preferred language. This may take the form of written instructions or drug labels in your language or having an interpreter in the room or on the phone when you are with your doctor. These resources can help break the language barrier that could otherwise make it hard to get care.
  7. Include other members of your healthcare team. Questions about a medication? Talk with your pharmacist, especially when starting a new medication! Your pharmacist can advise you about side effects to watch out for, possible issues with other medications or supplements you may be taking and give you additional advice about how to improve your medication regimen.
  8. Work together with your doctor for the best outcome. If you have concerns with the treatment plan, ask about them! Work actively with your doctor to decide the plan that will work best for you.

Good medicine is not one size fits all, and as you voice your concerns and strive for better communication, you and your doctor can work as a team to make sure you get the best care possible.

References

  1. Crane, J. A., Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997 Jan-Feb;15(1):1-7. https://doi.org/10.1016/S0736-4679(96)00261-2 Accessed Sep 24 2019.
  2. Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43. Accessed Sep 24 2019.
  3. Clancy, C. M. How to Talk to — and Understand — Your Doctor. American Association of Retired Persons. https://www.aarp.org/health/doctors-hospitals/info-09-2010/finding_your_way_how_to_talk_to_8212_and_understand_8212_your_doctor.html Accessed Sep. 25 2019.
  4. Howley, E. How to Make Sure Your Doctor Understands Your Medical Condition. U.S. News. Jan. 16 2018. https://health.usnews.com/health-care/patient-advice/articles/2018-01-16/how-to-make-sure-your-doctor-understands-your-medical-condition Accessed Oct 1 2019.
  5. Don’t Be Shy: 4 Tips for Talking to Your Doctor. Johns Hopkins Medicine. N.d. https://www.hopkinsmedicine.org/health/wellness-and-prevention/dont-be-shy-4-tips-for-talking-to-your-doctor Accessed Sep 24 2019.
  6. Health Literacy | Understanding What Your Doctor Is Saying. American Heart Association. N.d. https://www.heart.org/en/health-topics/consumer-healthcare/doctor-appointments-questions-to-ask-your-doctor/health-literacy–understanding-what-your-doctor-is-saying Accessed Sept 25 2019.
  7. Executive Order 13166. Limited English Proficiency (LEP).gov. https://www.lep.gov/13166/eo13166.html Accessed Oct 2 2019.


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naproxen vs ibuprofen - scriptsave wellrx blog image

Naproxen (brand name Aleve) and ibuprofen (brand name Advil) are two common over-the-counter pain relievers. People often reach for one of these when they have common aches and pains such as headaches, muscle pain, menstrual cramps, and arthritis.

Perhaps you’re wondering which medication is best for your particular pain, or you’re concerned about negative effects. Here is what you should know about Aleve vs. Advil and which pain reliever you should choose.

Are Aleve and Ibuprofen the Same Thing?

Naproxen (Aleve) and ibuprofen (Advil) are both non-steroidal anti-inflammatory drugs (NSAIDs) and they work in the same way – by blocking COX-2 enzymes and COX-1 enzymes. However, they have different onset times and durations. Naproxen (Aleve) is a long-acting drug, meaning it takes longer to start relieving your pain, but it lasts longer too. Ibuprofen (Advil) is short-acting, so it starts working more quickly but needs to be taken more frequently.

Which Is More Effective at Relieving Pain?

Since naproxen and ibuprofen work in the same way, they are generally equally effective for relieving pain. However, the type of pain you’re experiencing may help you decide which to take.

On average, Aleve lasts eight to twelve hours, while Advil lasts just four to six hours. That means that if you have chronic, long-lasting pain, Aleve is probably a more effective option for you. Advil is better for short-term pain, and it’s also considered safer for children.

Prescription Strength vs. Over the Counter

You may have heard about prescription-strength versions of Aleve and Advil. Doctors may prescribe you a higher dose of either of these medications if you have severe pain. There are also a variety of other NSAIDs that are only available by prescription, such as meloxicam, diclofenac, and indomethacin.

What Are the Potential Side Effects of Aleve and Advil?

While COX-2 enzymes are related to pain and inflammation in the body, COX-1 is involved with the lining of your stomach. This means both Aleve and Advil can cause gastrointestinal issues such as ulcers and gastrointestinal bleeding. Aleve poses a slightly greater risk of gastrointestinal issues, so if you are concerned about this side effect, you may want to choose Advil, or a different type of pain reliever such as acetaminophen (Tylenol).

Additionally, these medications can increase the risk of cardiovascular events like heart attack and stroke. If you have a history of cardiovascular issues, talk to your doctor before using an NSAID.

Some other potential side effects include:

  • High blood pressure
  • Kidney or liver problems
  • Headaches
  • Dizziness
  • Leg swelling
  • Ringing in the ears
  • Rash, throat swelling, and other allergic reactions

Do NSAIDs Interact with Anything?

You should watch out for interactions with any drugs you’re taking. There are some substances that interact with NSAIDs. These include blood thinners such as warfarin or aspirin, as well as substances such as tobacco and alcohol. Be sure to tell your doctor and pharmacist about all the drugs you’re taking, including over-the-counter pain relievers like Aleve and Advil.

Can You Take Naproxen and Ibuprofen Together?

NSAIDs also interact with each other. If you are taking Aleve (naproxen), do not take Advil (ibuprofen) at the same time, and vice versa.

How Many Advil or Aleve Should I Take?

The usual dosage for Advil is one tablet every four to six hours. You can increase the dosage to two tablets if one is not effective, but make sure you don’t exceed six tablets in 24 hours. If you’re taking Aleve, the dosage is one tablet every eight to twelve hours. You can take a second Aleve in the first hour if the first pill doesn’t work, but do not exceed three in 24 hours.

Note that you should not take Aleve for longer than ten days if you’re treating pain, and no longer than three days for a fever. Always take the lowest effective dose, and do not exceed the maximum dosage. Serious adverse health effects could result.

Which Is Better – Aleve or Ibuprofen?

If you’re still wondering whether to take Aleve or ibuprofen, remember that Aleve is a long-acting drug, while ibuprofen is short-acting. Aleve will last longer and is more effective for chronic pain, but it also poses a greater risk for gastrointestinal issues. Ibuprofen needs to be taken more frequently but it is generally safer, especially for children.

If you’ve been prescribed either of these medications, save with our drug price lookup tool. Find the lowest price on pain relievers, or search for discounts on any prescriptions you take.

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Do you have GERD - blog image

by Misgana Gebreslassie, PharmD Candidate,
Class of 2020 University of Colorado

Roughly 18 to 26% of Americans have GERD, and the majority are adults between the ages of 30 to 60 years. GERD is a short for gastroesophageal reflux disease, a condition where stomach fluid (acid) backs up into the esophagus (the tube connecting the mouth and the stomach) and causes aggravating symptoms.

Other names that you may have heard for GERD are acid reflux or heartburn. Often acid reflux is caused by muscle weakness of the lower esophageal sphincter, a valve that lets food and drinks into the stomach. [1,2,6]

What are the symptoms of GERD?

Symptoms are typically present after eating and can be different from person to person. The most common ones are: [1,6]

  • Heartburn or burning in the chest
  • Sour taste or burning feeling in the throat
  • Stomach pain
  • Difficulty swallowing food or choking
  • Sore throat or hoarse voice
  • Cough that is not relived by anything
  • Spitting up
  • Frequent burping
  • Asthma

How is GERD treated?

Treatment of acid reflux include lifestyle changes, antacids such as Tums, or stronger stomach acid suppressants like histamine 2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). [2,3]

Changes to diet or lifestyle can help control symptoms of heartburn and the following changes can be helpful: [2,3,4]

  • Stay away from foods and beverages that can lead to acid reflux or heartburn. Foods and beverages like: coffee, alcohol, chocolate, fatty foods, spicy foods, and citrus fruits/juices
  • Raise the head of your bed 6 to 8 inches
  • Try eating smaller portions and avoid sleeping or lying down within 3 hours of eating a meal
  • Lose weight. Being overweight can contribute to GERD
  • Stop cigarette smoking
  • Wear loose fitting clothes

Do Antacids Treat GERD?

Antacids work by neutralizing or reducing the acidity of the stomach. They are used for milder symptoms and are taken as symptoms occur to relieve heartburn symptoms.  These drugs can affect the absorption of other drugs. Always ask your pharmacist to check for interactions with your current medications as well as how and when to take them.[4]

What Other Drugs Can Treat GERD?

Histamine 2 receptor antagonists (H2RAs) work by suppressing acid secretion in the stomach. They are stronger than antacids in controlling heartburn symptoms. Overall, they are very well tolerated.[3]

Proton pump inhibitors (PPIs) also work by suppressing acid secretion in the stomach. They are used when heartburn symptoms are not well controlled by H2Ras or when symptoms are troublesome affecting quality of life.

PPIs work best when taken on empty stomach half an hour before the first meal of the day. PPIs may alter the way some drugs work. Ask your pharmacist or doctor to check for interactions with your current medications before taking them.[5]

Medicine
Type
Generic
Name
Regulatory
Status
Brand
Name
AntacidsCalcium CarbonateOTCTums
Aluminum hydroxide, magnesium
oxide and simethicone
OTC Maalox
Histamine 2 receptor antagonistsCimetidine OTC Tagamet
Famotidine OTC Pepcid
Nizatidine OTC Axid
Ranitidine OTC Zantac
Proton Pump Inhibitors (PPIs)EsomeprazoleRxNexium
DexlansoprazoleRxDexilant
Lansoprazole15mg – OTC Prevacid
Omeprazole OTC Prilosec
Omeprazole + sodium bicarbonate OTC Zegerid
PantoprazoleRxProtonix
RabeprazoleRxAciphex
OTC = over the counter (without prescription); Rx = prescription only; * Regulatory status obtained from FDA website [7]

All antacids and H2RAs are available over the counter whereas this would only apply to some PPIs. Sometimes these medicines are cheaper without a prescription. If cost is a concern for you ask your pharmacist to help you find ways to reduce your medication cost.[7]

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References:

  1. Gastroesophageal Reflux Disease (GERD). In DynaMed Plus [database online]. EBSCO Information Services. http://www.dynamed.com.proxy.hsl.ucdenver.edu/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 26, 2019. Accessed on 8/8/10/2019
  2. Patient education: Acid reflux (Gastroesophageal Reflux Disease) in adults. The Basics. In: UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited date unknown). Available from  https://www-uptodate-com. Accessed on 8/10/2019
  3. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. In: Talley NJ & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 28, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  4. Vakil NB. Antiulcer medications: Mechanism of action, pharmacology, and side effects. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 22, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  5. Wolfe MM. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited Nov 29, 2017]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008 Oct;135(4):1383-1391
  7. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food & Drug Admiration. https://www.fda.gov/drugs/drug-information-consumers/over-counter-otc-heartburn-treatment. Published date unknown. Updated on March 5, 2018. Accessed 8/10/2019


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by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

If you follow recent news, you’ve probably heard about measles outbreaks cropping up in California1, Washington2, and New York.3 The Centers for Disease Control and Prevention (CDC) reports, as of September 2019 there have been 1,241 confirmed cases of measles in the United States this year, a number already higher than the previous four years combined.4 With so many cases, this year marks the largest outbreak of measles in the United States in 27 years.5

What is measles?

Measles, also known as rubeola, is a viral disease that can lead to fever, cough, runny nose, and red, watery eyes.4 These symptoms will usually appear about 7 to 14 days after being infected, before which a person may not even know they are sick.

In addition, a few days after these symptoms start to show, a measles rash will appear. This rash normally starts on the face and spreads down the body, starting with small red spots that will merge over time. The rash will usually remain for about five days before fading away.

Why should I be concerned?

The measles virus is spread when an infected person coughs or sneezes, releasing viruses into the surrounding area. Once in the air, the virus can remain there for up to 2 hours, with anyone passing through the area at risk of breathing in the virus and getting sick.3,4

This virus is very contagious, which means that if exposed people are not protected by a vaccine, they have a 9 out of 10 chance of catching the disease!2 While measles is technically considered eliminated in the US, recent cases come from unvaccinated people traveling outside of the country, catching measles abroad, and bringing it home with them.1,2,4

Measles symptoms generally are not very severe, but this disease can have very serious complications including:

  • permanent hearing loss
  • severe lung diseases
  • swelling of the brain
  • pregnancy complications
  • death.4

Before the vaccine for measles was developed, over 3 million people were infected annually, with 48,000 hospitalized and 400 dying from measles and related complications each year.

How can I protect myself?

The best protection for measles is the vaccination.1,2,3,4 The measles vaccination is available as a combination vaccination with mumps and rubella, together called the measles-mumps-rubella or MMR vaccine.4

This vaccine works by teaching your body’s immune cells what to watch out for and helps prepare the body’s defenses for the viral attack. The vaccine is very effective, and when used as recommended is 97% effective at preventing measles.4

For most adults, the CDC recommends getting one dose of the vaccine, with certain conditions requiring a second dose achieve full immunity.9 In small children, the recommendation is to get one dose at 1 year old, and a second dose between 4 to 6 years old.9 The vaccine can and should be given to children under 1 year of age if planning on traveling internationally.3,9

Is the vaccine safe?

Yes, the MMR vaccine has been shown in repeated studies and trials to be safe and effective.2,3,6 While there have been concerns expressed that vaccines may cause autism, dozens of studies over the last 25 years including tens of thousands of patients have found no link between vaccines and autism.7,8

Additionally, the vaccine component purported to cause harm, a preservative called thimerosal, has never been a part of the MMR vaccine.6 The most common side effect of vaccines is redness and soreness at the injection site, and in rare cases a mild fever or rash may arise.4

Where can I get the vaccine?

The MMR vaccine is available at your doctor’s office or your pharmacy and is free of charge with most insurance plans.  If you don’t have a regular doctor or pharmacy, you can use https://vaccinefinder.org/ to find a location near you.10

Pharmacies are especially convenient, with 9 in 10 Americans living within 5 miles of a pharmacy.  At most pharmacies, no appointment is required, and your pharmacist can have you vaccinated and on your way in mere minutes. So then, what are you waiting for?

References

  1. Disneyland, Universal Studios Hollywood Visitors Reportedly Exposed to Measles. TIME. Aug 24, 2019. https://time.com/5660904/new-zealand-teenager-measles-southern-california/ Accessed Sept 20, 2019.
  2. Measles Cases Mount in Pacific Northwest Outbreak. NPR News. Feb 8, 2019. https://www.npr.org/sections/health-shots/2019/02/08/692665531/measles-cases-mount-in-pacific-northwest-outbreak. Accessed Sept 23, 2019.
  3. US in danger of losing measles-free status, a ‘mortifying’ effect of anti-vax movement. USA Today. Sept 13, 2019. https://www.usatoday.com/story/news/nation/2019/09/13/us-could-lose-measles-free-status-if-outbreak-continues-new-york/2300281001/ Accessed Sept 19, 2019.
  4. Measles (Rubeola). Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/measles/index.html Accessed Sept 19, 2019.
  5. U.S. measles cases reach highest level in 27 years. NBC News. May 31, 2019. https://www.nbcnews.com/health/kids-health/u-s-measles-cases-reach-highest-level-27-years-n1012401 Accessed Sept 23, 2019.
  6. Vaccine Safety. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccinesafety/index.html Accessed Sept 20, 2019.
  7. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. Journal of the American Medical Association. April 21, 2015. https://jamanetwork.com/journals/jama/fullarticle/2275444 Accessed Sept 23, 2019.
  8. MMR Vaccine Does Not Cause Autism: Examine the evidence! Immunization Action Coalition. N.d. http://www.immunize.org/catg.d/p4026.pdf Accessed Sept 23, 2019.
  9. Immunization Schedules. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccines/schedules/index.html Accessed Sept 19, 2019.
  10. Vaccine Finder. HealthMap.  N.d.  https://vaccinefinder.org/


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dangers of vaping and e-cigarettes - blog image

by Marcos Puente, PharmD Candidate Class of 2020
University of Arizona

If you have transitioned from regular cigarettes to electronic cigarettes (e-cigarettes) or vaping products for a safer and healthier alternative, you may want to reevaluate your decision. Until recently, many people believed that e-cigarettes and vaping were considered a “better” option compared to cigarettes because they do not release tar as well as other toxic gases found in cigarette smoke.5

Although many individuals have found that transitioning to e-cigarettes or vaping has helped with reducing their use of traditional cigarettes, and in some cases have helped cigarette smokers quit overall, recent cases of lung illnesses have raised the question: are e-cigarettes and/or vaping truly a better, safer alternative to traditional cigarettes?

An Epidemic of Lung Ailments

Vomiting, coughing, shortness of breath, and fatigue have been the most common signs and symptoms most individuals have complained about after vaping/using e-cigarettes within the last 90 days4. As of September 7, 2019, there have been at least 450 cases of an unknown lung disease possibly related to vaping, which has already claimed the life of three people across the nation. The Food and Drug Administration (FDA) and Center for Disease Control and Prevention (CDC) are investigating extensively to pinpoint the exact cause of these lung disease outbreaks and if they are in anyway related to vaping and/or using e-cigarettes3.

What We Now Know

  • CDC and FDA are warning consumers about the vaping-linked lung disease
  • CDC is recommending avoiding e-cigarettes while the FDA is suggesting avoiding products that contain THC (marijuana compound that produces a high)3
  • It is still too early to pinpoint an exact cause or culprit for the outbreak of these lung illness cases3

Potential Cause of these Lung Illness Cases

Although an exact explanation has not been recognized as to what is causing these recent lung disease outbreaks, health investigators have linked vaping to the underlying cause of these lung ailment cases. A clinical psychologist from San Francisco, Dr. Danielle Ramo, suggests that certain additives in the vapor being released from these vaping products contain oils that can be highly dangerous and toxic if heated and inhaled.1 One of the oils being identified in many of these recent outbreak cases is vitamin E, which is commonly used as a supplement and topical moisturizer/cream. Although Vitamin E is safe when applied topically and consumed as a supplement, it can cause damaging effects when inhaled as smoke.3 Although not all vaping products and e-cigarettes contain these additives, it is sill highly recommended to avoid these products until further research and studies have been completed.1

What this Means to You

If you are currently using e-cigarettes or vaping as an alternative to traditional cigarettes, it is highly recommended to quit until a definitive cause is identified for the growing number of lung disease cases across the nation.4 It is too early to determine if a certain brand is responsible for these outbreaks or if the lung illness cases are related to a specific ingredient found in some products offered on the shelves, or possibly even a black-market product being sold which can potentially contain an unsafe chemical. Whatever the cause may be, quitting e-cigarettes and vaping overall can potentially decrease your risk of developing future lung disease (e.g. COPD, lung cancer).

Need Help Quitting?

There are services and support to help assist you in quitting vaping and/or using e-cigarettes. To get free, personalized support from an expert you can call 1.800-QUIT-NOW or 1.800.44U-QUIT to talk with a tobacco cessation counselor. There is also becomeanex.org, a website designed to help support and give you resources to help you quit smoking or vaping.2

Sources:

  1. Graff, Amy. “57 Cases of Lung Illness Linked to Vaping Reported in California, 1 Death.” SFGate, San Francisco Chronicle, 9 Sept. 2019, www.sfgate.com/bayarea/article/vaping-California-acute-lung-disease-death-14424730.php
  2. “Imagine Your Life without Tobacco. Looks Great, Right?” Become An EX Smoker, Learn to Quit Smoking, Stop Smoking Cigarettes, www.becomeanex.org/.
  3. Lavito, Angelica. “What Should People Avoid Inhaling during Mysterious Lung Disease Outbreak? Health Officials Disagree.” CNBC, CNBC, 7 Sept. 2019, www.cnbc.com/2019/09/07/cdc-fda-clash-on-warning-consumers-during-lung-disease-outbreak.html.
  4. Richtel, Matt, and Denise Grady. “What You Need to Know About Vaping-Related Lung Illness.” The New York Times, The New York Times, 7 Sept. 2019, www.nytimes.com/2019/09/07/health/vaping-lung-illness.html
  5. Ross, John. “E-Cigarettes: Good News, Bad News.” Harvard Health Blog, 5 Aug. 2019, www.health.harvard.edu/blog/electronic-cigarettes-good-news-bad-news-2016072510010


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doctor pricing medications with ScriptSave WellRx - image

by Nikki Buzzelli

Diagnoses, treatments, surgeries. At every stage of your health journey, finding a professional second opinion, gaining new perspectives or searching for different resources, in your community or online, is one of the best ways you can advocate for yourself as a patient.

While the medical community agrees second opinions aren’t necessary in every case–a cold is most likely a cold–most doctors recommend a second opinion in certain cases, and some insurance companies cover them. A good second opinion could save you time, money, even your life.

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Seeking a Second Opinion

A few reasons to seek a second opinion are, if:

  • Your doctor is not a specialist or familiar with your condition. Specialists are dedicated to their field and can ask questions and notice symptoms so subtle others may miss.
  • You feel your concerns aren’t taken seriously. Mental health is as important as physical health and that starts with medical teams that listen to you, the patient.
  • You’re not confident in your diagnosis or treatment plan. Doubt, gut feelings, or intuition can all be enough reason to seek another opinion. You know best what is working for your body, or how well a diagnosis “fits.”
  • You’ve completed treatment and haven’t improved. Studies show our brains follow the same train of thought over time, creating natural blind spots in the way we think. Doctors are no exception. A fresh perspective could find a misdiagnosis or bring new skills that could lead to the correct treatment.

If you feel you want or need a second opinion, it’s easier than most people think. The important thing is to find a medical professional you are confident in and comfortable with.

You can ask your doctor for their recommendation or do your own research with the help of your insurance company. Make sure to get copies of your medical records to share with your new doctor. You’ll also want to compile lists of all the prescriptions you are taking, any relevant test results, and your past and current treatment plans.

Whether it’s a new approach or a different way of thinking about treatment, second opinions give you information necessary for you to make the best decisions about your health.

It’s clear we benefit from second opinions on treatments; but when’s the last time you thought about getting a second opinion on medical costs, like prescriptions?

The Two-Second Second Opinion

The ScriptSave WellRx app is the free, two-second ‘second opinion’ in your pocket that brings you lower prescription drug costs by negotiating drug prices with independent and chain pharmacies in bulk. Sometimes for even lower than your insurance cost.

Now, instead of taking the number at the pharmacy register at face value, one simple search shows you the out-of-pocket price for your prescriptions with a variety of discounts, all available for you to choose from. And because you can access WellRx online or through the app, it’s easier than ever to find the second opinion on prescription costs you need in real-time.

Simply go to WellRx.com, type in your or your family’s prescription and dosage information, and WellRx will find the biggest savings from the closest of over 65,000 pharmacies. The only thing you have to do is save your discount and show it to the pharmacist at the register. No extra costs, no sign ups, just the everyday savings you and your family needs.

See for yourself the difference a second opinion can make.

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After you leave the doctor’s office, you may find that there is an issue with the drug you were prescribed. You may be wondering whether you have to make another trip to the doctor or if your pharmacist could just change your prescription. The answer to this question depends on what state you live in, but there are generally a few things pharmacists are allowed to modify.

A pharmacist can change your doctor’s prescription in these ways:

  • Therapeutic Substitution: Switching out a prescribed drug with another drug in the same class.
  • Generic Substitution: Giving out a cheaper generic version of a brand name drug.
  • Pharmaceutical Compounding: Changing the form or taste of the drug to make it easier for the patient to take.

We provide more details about each of these below.

What Is Therapeutic Substitution?

Therapeutic substitution occurs when a pharmacist switches a prescribed drug for a different drug from the same class that has the same clinical effect. This type of drug switching (also called therapeutic interchange) could save a patient money, avoid side effects, or provide medication more quickly in the case of a shortage.

Your pharmacist may or may not be required to get your doctor’s approval before conducting therapeutic substitution. It depends on the specific drug and what kind of switch is occurring, as well as the laws of your state.

Risks Associated with Therapeutic Substitution

There are some types of medications that are not good candidates for therapeutic substitution. For example, antidepressants, cardiovascular medications, and epileptic medications should not be changed since doctors work closely with patients to find the right type of drug and exact dosage required.

Pharmacists may substitute medications without notifying you beforehand. If you do not want your drug to be substituted at the pharmacy, ask your doctor to note that on the prescription by writing DAW (dispense as written), “medically necessary,” or “may not substitute.”

Can a Pharmacist Change a Prescription to Generic?

Your pharmacist can often change a brand-name to a generic drug to save you money. They may do this automatically, or they may call your doctor for you and get an updated Rx. If your doctor prescribes you a name-brand drug that you’re struggling to afford, ask your pharmacist for a generic version.

Could You Save Money by Switching to a Generic Drug?

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Can a Pharmacist Change My Dosage?

A pharmacist cannot change the dosage of your prescription without talking to your doctor and getting their approval. However, the pharmacist may decide how best to dispense medications. For example, if your doctor prescribes 50mg of a drug to be taken daily, your pharmacist could give you 25 mg tablets and instruct you to take two daily. Or, they could give you 100mg tablets and tell you to split the pills, if the medication is safe to split.

What is Pharmaceutical Compounding?

Pharmaceutical compounding refers to the process of changing a medication so that it is easier for a patient to take. This may include changing the form from liquid to tablet or vice versa, adding a flavoring, changing the method of administration, eliminating inactive ingredients (such as allergens), or adjusting strength or dosage.

In short, pharmaceutical compounding is a way of customizing a patient’s prescription to fit their unique needs. When compounding, a pharmacist will work with you and your doctor to find the best solution.

What If My Medication Isn’t Working?

If you find that a drug your doctor prescribed is not working for you, a pharmacist cannot override a doctor’s prescription. You should see your doctor and have a discussion about the medications you are taking. It’s important to understand why your doctor prescribed a particular type or brand of drug.

Here are a few scenarios where you might need to modify a prescription.

Potential Interactions

Your doctor may have missed a potential drug or supplement interaction that your pharmacist catches. This is why it’s important to always inform your doctor and pharmacist of all drugs and supplements you’re taking.

There are also technology tools (like the free virtual Medicine Chest available from ScriptSave WellRx) that can automatically alert patients to potential adverse interactions for the medications they have been prescribed.

Adverse Side Effects

If you start to develop uncomfortable or dangerous side effects, let your doctor know immediately. Some side effects can be life-threatening. Be sure to carefully read all the information about your prescribed medication and report side effects as soon as they occur.

Insurance Coverage

You may find that your insurance company doesn’t cover a certain brand name or type of drug. In some cases, pharmacists can automatically substitute a drug that is covered by your insurance formulary.

Always Check Your Medication at the Pharmacy Counter

The next time you get a prescription filled, carefully check the medication that’s dispensed to you. Make sure the name and dosage match what your doctor wrote on your prescription. If it doesn’t, ask your pharmacist what has changed and how it will affect you. In many cases, pharmacists will automatically switch to a generic drug to save you money.

If you must have an expensive brand-name drug, know that there are several ways to save on prescription costs. Manufacturer coupons and patient assistance programs are available to patients who qualify. ScriptSave WellRx also offers a discount drug card to anyone, free of charge.

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EpiPen is a brand of epinephrine auto-injector that is used to treat anaphylaxis, a serious allergic reaction. An EpiPen prescription is life-saving for people with severe food allergies, but it is also expensive. Despite the risk of death with anaphylaxis, some patients choose not to fill their prescription for an EpiPen because they can’t afford it.

Here are some things to consider as you look for ways you can save money on EpiPen, to help ensure you always have epinephrine handy in case of an anaphylactic reaction.

How Much Does EpiPen Cost?

The cash price for a 2-pack of EpiPens ranges from $600-$800, while the authorized generic version could be anywhere from $150-$350 for the same dose. This is expensive for many patients, especially if they need EpiPens for multiple family members. 

Most insurance plans will cover some form of epinephrine auto-injectors, but you may still find yourself responsible for a high co-pay. Luckily, there are other ways to save.

Related: EpiPen Savings Tool

Use Generic Auto-Injectors

There used to be no generic versions of EpiPen available, which contributed to the high cost of epinephrine auto-injectors. Now, consumers have several alternative options:

  • Adrenaclick
  • Auvi-Q
  • Symjepi
  • Teva’s Epinephrine Auto-Injector

Depending on your insurance coverage, these generics can still sometimes end up being just as expensive as EpiPen. That said, Auvi-Q does have a savings program that offers the auto-injector for $0 to commercially insured, qualifying patients. Also, Teva offers a co-pay savings card, and CVS pharmacies sell Adrenaclick at a cash price of $109.99 for a two-pack.

It’s important to also be aware that these generics may have different injection procedures. You should always talk to your doctor or pharmacist about how to use your epinephrine injector. Some auto-injectors come with instructions, while others require you to order a trainer separately. Most manufacturers also post instructions on their websites.

Use a Prescription Discount Card

Unlike manufacturer coupons and patient assistance programs, prescription discount cards are available to everyone, and there are no requirements to meet. One of the big differences is that you cannot use a discount card in combination with your insurance coverage; you must use one or the other (usually patients will choose whichever one provides the lowest out of pocket cost). 

To receive a discounted price on your EpiPen, simply show your Rx savings card or mobile app when picking up your medication at a participating pharmacy.

Get a free Rx discount card today

Look for Manufacturer Coupons or Savings Programs

Mylan, the manufacturer of EpiPen, offers co-pay cards for commercially insured patients who qualify. These cards, also known as manufacturer coupons, can save you $300 on an EpiPen 2-Pak or $25 on a two-pack of the Mylan generic version of EpiPen. Additionally, Mylan offers a Patient Assistance Program. 

Manufacturer coupons and savings programs can make EpiPens affordable, but keep in mind that you must qualify for assistance. Visit the official EpiPen website for full requirements.

Compare Pricing Between Pharmacies

When it comes to getting the best price for your medications, you should compare different pharmacies in your area. You might be surprised at how much of a difference you find. There are many online tools that compare pharmacy prices automatically. 

Always be sure to check the cash price against your insurance co-pay. You may find that the cash price is actually better, especially if you use a savings program or discount card.

Check Your Insurance Coverage

If your insurance plan has a high deductible or doesn’t cover EpiPen, you may find yourself paying most or all of the cost of your auto-injector. Be sure to check your insurance formulary to see if a generic version of epinephrine auto-injector is covered. You can ask your doctor to write you a prescription for the generic, which will be just as effective as the brand name.

You could also file an appeal for coverage. The appeals process can be somewhat complicated, so ask your doctor if you’re unsure how to proceed. If your insurance company still denies coverage after you appeal, you have the option of filing an external appeal where a third party will decide the coverage.

We hope to see lower pricing for EpiPens in the near future. Until then, use the above strategies to access the lowest price possible on your medication. We recommend downloading or printing a free prescription savings card to have on hand whenever you shop for your prescriptions.

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photographs for memories images for alzheimer's

by Cherokie Dyer, PharmD candidate class of 2020,
University of Florida

Alzheimer’s is an irreversible brain disease best known for the hallmark sign of dementia. It is believed that Alzheimer’s is caused by plaques that form in the brain and damage your memory, thinking skills, and ability to do simple tasks. Usually the disease shows up around 60 years of age, with rare exceptions.

Treatment for Alzheimer’s

Currently, there are a few treatments to help with the symptoms of Alzheimer’s disease including agitation, loss of appetite, mood, and paranoia but there is no cure for the disease itself. In the past, Alzheimer’s disease seemed to be a random occurrence in old age.  The good news is that we now have research to suggest that it can be prevented or delayed.

Five ways to Prevent Alzheimer’s

There is not one specific behavior that you can start to prevent or delay Alzheimer’s. Rather, the Rush study lends evidence to suggest that it is a combination of four or more of these lifestyle behaviors that can lower your chances of getting Alzheimer’s. These findings even apply to people with an increased risk of Alzheimer’s due to genetic factors and family history.

  • Not Smoking
  • Exercising for at least 150 minutes a week at a moderate or vigorous level
  • Eating a brain supporting diet
  • Very light to moderate alcohol consumption
  • Engaging in late-life cognitive activities

The Alzheimer’s study indicates that practicing two or three of these behaviors can reduce your risk by about 37%. Practicing four or five of these behaviors can reduce your risk by 60%.

What is a Brain Food?

While most of these Alzheimer’s preventing behaviors are self-explanatory, two may need further explanation: ‘Eating a brain supporting diet’ and ‘light to moderate alcohol consumption’.

The MIND diet was developed by the same researchers as the Rush Study and incorporates recommendations from two popular heart healthy diets. It stands for Mediterranean-DASH Intervention for Neurodegenerative Delay and it was adjusted based on foods that would be accessible for Americans to readily include in their diet.

The MIND diet emphasizes ten foods you should eat daily and five foods you should avoid.

Start Eating: Green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and one cup of red wine

Avoid Eating: Red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

Key Take Aways

  • Alzheimer’s is a progressive disease that can manifest as severe dementia.
  • There currently is no cure, but there is hope to prevent or delay it as you age.
  • Embracing at least four out of five lifestyle adjustments found in the Rush Study can lower your risk of developing Alzheimer’s disease by 60%.

References:

https://www.nia.nih.gov/health/what-alzheimers-disease

https://www.nbcnews.com/health/aging/can-alzheimer-s-be-stopped-five-lifestyle-behaviors-are-key-n1029441

http://www.nbcnews.com/id/57163245/ns/technology_and_science-science/t/mind-your-diet-protect-against-alzheimers/#.XS5OzehKiUl

Mind Diet – https://www.ncbi.nlm.nih.gov/pubmed/25681666

Findings from the Rush Memory and Aging project – https://www.ncbi.nlm.nih.gov/pubmed/22471867



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stress hurts your health image

by Cherokie Dyer, PharmD Candidate,
Class of 2020, University of Florida

When was the last time you felt stressed?

Stress is so common that there is an organization called, “The American Institute of Stress.” According to this group, there are 50 common signs and symptoms of stress. Many of the signs we think about when it comes to stress are difficulty making decisions, excessive anxiety, worry, guilt, and nervousness. Other common signs include increased frustration, irritability, and edginess. We can determine these signs based on our interactions with people. But… did you ever think about what stress is doing to your body on the inside?

How does Stress affect the body?

Stress can be a good thing in an emergency. It turns on your ‘fight or flight’ response. This gives you that ‘adrenaline rush’ feeling, which is the release of cortisol and epinephrine. Stress raises your blood pressure, makes your heart beat faster, and boosts sugar levels in your blood. It can also slow down your digestive tract, make your muscles tense up, and make your breathing become more rapid. All these bodily reactions are great to help you act during a crisis.

However, it’s not good when our bodies are constantly flooded with stress for a long period of time.

  • Heart racing and blood rushing may cause inflammation in arteries and lead to heart attacks or strokes.
  • Constant boosts in blood sugar can affect insulin and lead to pre-diabetes.
  • An impaired digestive tract can keep the body from getting valuable nutrients and lead to hard or loose stools.
  • Constantly tensed muscles can cause tension headaches and migraines.
  • Rapid breathing can cause hyperventilation and lead to panic attacks.
  • Increased cortisol may cause the body to hold on to belly fat.
  • These reactions can start to make the menstrual cycle irregular or lower sperm counts.
  • Stress can also affect eating patterns making us want to eat more or less than usual.

Believe it or not, constant stress can wreak havoc on our body in a multitude of other ways. Especially if you already have medical conditions like heart disease, diabetes, irritable bowel syndrome, or obesity. Your constant stress could very well be the thing that’s preventing your medications from helping you get better.

Two Key Strategies to Manage Stress

Try to prevent it and cope with it when it comes. Figure out the things that trigger your stress. Do your best to avoid them or work around them. For instance, if leaving on time for work stresses you out, invest in a new alarm or get up even earlier to give yourself more time.

There are other ways to prevent stress besides just avoiding your triggers.

  • Carve out some more alone time for yourself
  • Do more of the things that you bring you joy
  • Make the effort to get near 8 hours of sleep
  • Eat more fresh foods and whole foods
  • Avoid stimulants like caffeine.

If you are already feeling stressed out, then there are a ton of options that you can try:

  • Calming activities like prayer, yoga, massages, and/or deep breathing
  • Active movements like going for walks, jogs, lifting weights, or taking group classes like kickboxing
  • More of your favorite hobby, listen to music you like, play with your pet more often, or participate in volunteer work.

The options are endless and there is no correct answer!

Bottom Line

Stress can be negative for both our sanity and our bodies. There are a variety of ways to deal with stress. Identify when you feel the most stressed out. Do your best to avoid that trigger and/or cope with those feelings, and your body will thank you in return.

References

https://www.stress.org/stress-effects
https://www.stress.org/military/combat-stress/management
https://www.stress.org/daily-life



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by Emily Ross, PharmD Candidate,
Class of 2020

You can add it to your morning coffee or smoothie. It is available in drops, creams, gummy bears, face masks and so much more. Some say it can help with anxiety, depression, insomnia, arthritis pain and a variety of other issues. You have likely seen it in your local market, pharmacy or shop on the corner. That’s right, we are talking about the latest health trend – CBD.

With all these new products to hit the market it has people wondering: Is CBD safe? Does CBD work? Should I use CBD? We are going to discuss these concerns and more to see if CBD is worth all the hype.

What is CBD?

Let’s start off with basics – CBD stands for cannabidiol. This is a chemical component of the plant Cannabis sativa which has two primary species – hemp and marijuana. The hemp variety contains a higher percentage of CBD. The other major component in the cannabis plant is THC – which is the psychoactive agent responsible for producing the effects most people associate with marijuana. For the purposes of this article, we will be focusing on CBD.

What is CBD Used For?

From relieving pain to helping with insomnia, people are using CBD for a variety of reasons. Many of the problems CBD has the potential to relieve is based on its action in what is called the endocannabinoid  system (ECS.)

This is a special system in the human body that is involved in many life functions including sleep, appetite, pain and immune system. By acting on receptors in the ECS, it may help treat issues listed with the above systems. In addition, it may also have anti-inflammatory effects that would help with chronic conditions such as arthritis.

Another indication for using CBD for many people is to relieve anxiety and depression symptoms. There are studies that show CBD to have an antidepressant effect due to its interaction with serotonin. Serotonin is a molecule in the body that regulates mood and behavior.

In addition, there are unsupported claims that CBD can help to reduce cancer-related symptoms, decrease acne, benefit heart health and may even prevent diabetes. I have just listed a few of the many different reasons people are using this new product.

Does CBD Work?

CBD makes a lot of great promises; however, this only goes so far if there are not proven benefits and results. There have been many studies done in animals and humans with CBD on the possible benefits. CBD has show efficacy in small clinical trials in reducing stress and anxiety, but more research is needed.

The research as to whether it is effective for pain relief is very early and the results are uncertain. As of now, there may be benefits due to the anti-inflammatory properties. CBD works in a different way than traditional prescription pain relievers, such as opioids, so there may be use for combination therapy when recommended by your doctor.

Is CBD Safe?

As of now, there has not been serious or major adverse effects reported in these studies. Though, CBD has been reported to have some side effects and can interact with other medications. Common side effects include:

  • Fatigue
  • Irritability
  • GI upset (nausea, diarrhea)
  • Dry mouth
  • Changes in appetite

Another big consideration is that CBD products are like herbals and other dietary supplements: there is no standardization on products. Different companies have different additives, and those may contain trace amounts of THC.

As of now, there are no regulations (FDA) in place that guarantee the safety of all the ingredients in the product. The FDA has issued a warning statement that there are many unanswered questions about the science, safety and quality of products that contain CBD.

Should You Try CBD? The Bottom Line

CBD comes in many forms and is being used to treat a variety of issues. While there are many convincing reasons to try it, more studies need to be done in order to make a conclusion and treatment decision regarding CBD. Everyone is different and what works for one person may or may not work for another.

The most important thing to remember is to talk to your doctor or pharmacist before starting any new supplement or product to make sure that it is safe for you.

References:

Bemben, Nina M. “CBD Oil and Medical Marijuana: Pharmacists Need to Know the High Points.” Wolters Kluwer, 21 May 2019, www.wolterskluwercdi.com/blog/cbd-oil-and-medical-marijuana-pharmacists-need-know-high-points/.

FDA Office of the Commissioner. “What to Know About Products Containing Cannabis and CBD.” U.S. Food and Drug Administration, FDA, 17 July 2019, www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.

Grinspoon, Peter. “Cannabidiol (CBD) – What We Know and What We Don’t.” Harvard Health Blog, 5 June 2019, www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

Kubala, Jillian. “7 Benefits and Uses of CBD Oil (Plus Side Effects).” Healthline, Healthline Media, 26 Feb. 2018, www.healthline.com/nutrition/cbd-oil-benefits#section7.

Volkow, Nora D. “The Biology and Potential Therapeutic Effects of Cannabidiol.” NIDA, 24 June 2015, www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/biology-potential-therapeutic-effects-cannabidiol.

Williams, Reagan A. “CBD Oil: Leading Patients to Safe Use.” Pharmacy Today, Nov. 2018, www.pharmacytoday.org/article/S1042-0991(18)31505-6/fulltext.



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transfer a prescription

The internet is a convenient option for purchasing many necessities, but can you fill your prescriptions online? In many cases, yes. There are generally two ways to fill a prescription online:

  1. Use an online pharmacy or mail-order pharmacy to fill your prescription; the pharmacy then mails you the prescribed medications.
  2. Use the patient portal on your pharmacy’s website to request an Rx refill online, and then pick up your medicine in person.

How Online and Mail-Order Pharmacies Work

An online or mail-order pharmacy allows you to order your medications over the internet (or by phone) and have them mailed directly to you. This is a convenient option but there are some drawbacks. Your medications take longer to arrive so you want to be sure you keep up with your refills. Some, but not all, online pharmacies have automatic refills available.

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Is It Safe to Buy Medication Online?

There are legitimate online pharmacies, and it is generally safe to use them. However, there are also several safety risks with online pharmacies. You may come across unethical companies that operate in a risky or even illegal manner. They may sell you counterfeit medications, drugs that aren’t FDA-approved, or medication that is expired or defective.

Unreputable online pharmacies may even sell Rx meds to people who don’t have a prescription. Be especially careful with international pharmacies. There are strict federal laws against importing certain substances from a foreign country.

How to Protect Yourself When Using Online Pharmacies

To protect yourself, watch out for these red flags.

  • Lack of contact information. Always check the website for contact information and verify that there is a U.S. address and valid phone number listed. Try calling the number to see if it is legitimate.
  • Availability of drugs without a prescription. If the pharmacy does not require a prescription to complete your transaction, or it advertises that you can obtain drugs without a prescription, do not go through with your order.
  • Drugs that are not FDA-approved. If you see any drugs that haven’t been approved by the FDA, stay away from the pharmacy.
  • No pharmacist available to answer questions. A reputable pharmacy will employ one or more licensed pharmacists to answer your questions.
  • Lack of a valid U.S. license. The National Association of Boards of Pharmacy (NAPB) verifies online pharmacies that are properly licensed. Look for a VIPPS (Verified Internet Pharmacy Practice Sites) seal and a “.pharmacy” website domain.

Do Online Pharmacies Save You Money?

Many people turn to online pharmacies to save money. Some legitimate online pharmacies offer discounted prices on medications, but many cut corners to offer discounts. The drugs may not be properly manufactured and as a result, may be too strong or too weak.

Rather than focusing only on price, you should focus first on safety. Once you have a list of reputable online pharmacies, then you can compare pricing.

Some online or mail-order pharmacies allow you to use discount drug programs when ordering your medication. Call or chat with a customer support representative and see if they accept any savings programs. For example, PillPack and Health Warehouse accept the ScriptSave WellRx prescription discount card.

Online Patient Portals

Online patient portals are offered through a traditional brick-and-mortar pharmacy like Walmart or CVS. These online portals offer a convenient way to request Rx refills from your home, office, school, etc. Once your prescription is filled, you must go to the pharmacy in-person to pick up your medication.

Patients can still use a pharmacy discount card with these portals. Simply bring your card or mobile app with you to the pharmacy when picking up your medications.

Rx Savings On The Go

ScriptSave WellRx is dedicated to negotiating discounted prices on as many medications and at as many pharmacies as possible. If you’re struggling to afford your medication, try downloading our mobile app. It allows you to search and compare drug prices to find the best discount in your area.

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