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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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There are a variety of reasons to move your medications from one pharmacy to another. It could be that you found a better price, you’ve recently moved to a new area, or you’re looking for a location closer to your workplace. Regardless of the reason, transferring prescriptions between pharmacies is a straightforward process.

Here are the steps to transfer your prescription to a different pharmacy:

  1. Call or visit the new pharmacy to request an Rx transfer.
  2. Give the new pharmacy the names of all the medications you want to transfer, along with dosage and Rx numbers.
  3. Provide your current pharmacy’s contact information. The new pharmacy will contact your old pharmacy and take care of most of the process.
  4. Wait for the transfer to be completed, allowing at least 1-3 business days.

Information to Share with Your New Pharmacy

When you contact your new pharmacy, be sure you have your health and prescription information available. Specifically, you will need to tell the pharmacist:

  • Your full name and date of birth
  • Your address and phone number
  • All known allergies (food and medicines)
  • The names of all the prescriptions you’re transferring
  • The strength and dosage of your medications
  • Rx number for each medication (the 7-digit number on the top left of the label)
  • Phone number and address for your current pharmacy
  • Contact information for your prescribing physician

Allow the New Pharmacy to Handle the Transfer

After you let the new pharmacist know that you wish to move your medications, they will contact your current pharmacist and handle the transfer. If your prescription is out of refills, the pharmacist will also contact your doctor.

To expedite the process, you can check with your doctor and make sure you still have refills before reaching out to the new pharmacy.

Allow Enough Time for the Transfer

Although prescriptions can be moved to a different pharmacy quickly, you should still err on the side of caution and allow at least 1-3 business days for the switch to take effect. If you’re out of medicine and need a refill immediately, you might not be able to access it at the new pharmacy right away. It’s important to make sure you have a sufficient Rx pill supply before making the move.

Be Aware of Exceptions

There are certain prescriptions that cannot be transferred or have a limited number of transfers.

Schedule III, IV, and V medications are classified as controlled substances. You are only allowed one transfer with these types of medications, regardless of how many refills you have left. If you’ve run out of transfers, contact your doctor for a new prescription before attempting to switch pharmacies.

Some examples of Schedule III, IV, and V medications include Tylenol with Codeine, Xanax, and Robitussin AC or other cough suppressants with codeine.

Schedule II controlled substances are not able to be transferred at all due to the risk of substance abuse and dependency they pose. These medications also cannot be refilled, so your doctor will have to write you a new prescription whenever you run out. Examples of these substances include Adderall, Ritalin, and OxyContin.

Additionally, be aware that if any of your Rx medications have run out of refills, your doctor may require you to come in for an appointment before refilling the prescription.

Establish a Relationship with Your New Pharmacist

It’s important that you inform your new pharmacist of all medications and supplements you take, including over the counter medicines that may interact with your prescriptions. Your pharmacist is there to make sure you stay safe and manage your prescriptions effectively. You should establish a relationship with them so they can properly advise you on your medications.

Different Pharmacies Charge Different Prices

Did you know that patients commonly switch pharmacies because it allows them to save money? Many pharmacies charge different prices for the same prescription medication. Consider comparing your Rx prices at different pharmacies from time to time so you can be sure you’re getting the best deal possible.

Are your prescriptions cheaper at another pharmacy?


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by Jamie L. Voigtmann, PharmD Candidate 2019
Saint Louis College of Pharmacy

There are many aspects in life that can decrease prescription fill rates. This in turn causes medication non-adherence, where patients are unable to take their medications regularly as prescribed by a physician. It’s a common and costly problem across America.

What Prevents Patients from Filling Prescriptions?

Barriers to medication adherence include lifestyle preferences, fear or uncertainty about the effectiveness of new medications or adverse reactions, The complexity of instructions and or drug regimens, personal beliefs, and insufficient funds also come into play.1 Patients who have insufficient funds to pay for medications include, not only decreased socioeconomic status, but also all patients that qualify as low-income based on age, gender, race, location, and family size. Patients who have financial restrictions will commonly delay prescription refills, as well as subsequent copays, by splitting pills, taking pills every other day, or even discontinuing medications on their own. This is because many chronic conditions require multiple medications for treatment and many medications are expensive even with insurance.1

The Low-Income Populations Includes Elderly Patients

As mentioned previously, low-income patients not only include race, location, and family size, but also age. As patients become ≥ 65 years old they are most likely dependent on Medicare for health insurance coverage, since it is offered through the government. Elderly patients who experience decreased prescription fill rates have been associated with having increased out-of-pocket costs with prescription medication coverage, lower net worth, and lower household incomes.2 This is important to consider because as patients age their health often declines, indicating more need for medications. It is also imperative to think about this aspect as many Baby Boomers fall into this category, increasing the number of patients sharing Medicare benefits.

Which Types of Medications Do Low-Income Patients Struggle To Get?

A common misconception is that patients with low-income only have trouble affording newer novelty medications, such as HIV, Hepatitis C, and oncology medications. With these types of medications, many patients including the middle and upper economic classes struggle to pay for the medications due to the outstanding drug cost dictated by the manufacturers. Low-income patients also struggle with common health conditions such as asthma, diabetes, and high cholesterol. Patients who are in a lower socioeconomic class experience significantly less control over their asthma and commonly experience increased exacerbations compared to patients who belong to a higher economic class.3

When considering Type-2 Diabetes Mellitus, patients with high-incomes had increased compliance to treatment regimens including diet, exercise, and medications.4 The high-income patient’s also checked their A1c more often and were associated with higher self-care ability.4 Finally considering cholesterol medications, a recent study showed that low-income patients were willing to give up their cholesterol medications if a copay was present because the benefits are not commonly felt unlike insulin for diabetes or lisinopril for increased blood pressure.5

Low-Income vs. High-Income Prescriptions

It is interesting to realize what types of medications low-income patients are filling at the pharmacy, compared to high-income patients. According to The New York Times, high-income patients receive more cosmetic medications to treat baldness, erectile dysfunction, wrinkles, and eyelashes.6 These patients were also more likely to purchase medications to treat mental health.6 They also had more prescriptions for birth control pills due to a consistent prescription from a regular doctor.6 Medications that are more commonly received by low-income patients include HIV and Hepatitis C, most likely due to lack of education in transmission and poor access to healthcare.6

Lowering Overall Drug Costs

Overall, the relationship between income and prescription fill rates at the pharmacy is much more complicated than low-income patients having decreased prescription adherence.6 Different patients are more likely to develop certain diseases or illnesses that would increase healthcare costs. Patients also differ on when they seek medical attention, resulting in a significant cost even before a physician writes a prescription.6 Regardless of income, it’s important to treat patients with as few medications as possible while still treating chronic conditions to help lower overall drug costs for all patients.

References:

  1. Mishra SI, Gioia D, Childress S, Barnet B, Webster RL. Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions. Health Soc Work. 2011; 36(4): 249–258.
  2. Zivin K, Ratliff S, Heisler MM, Langa KM, Piette JD. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health. 2010; 13(4): 338-45.
  3. Bacon SL, Bouchard A, Loucks EB, Lavoie KL. Individual-level socioeconomic status is associated with worse asthma morbidity in patients with asthma. Respir Res. 2009; 10: 125.
  4. Habib F, Durrany AM. Effect of age and socio-economic status on compliance among type 2 diabetic patients. Curre Res Diabetes & Obes J. 2018; 7(3): 555714.
  5. Watanabe JH, Kazerooni R, Bounthavong M. Association of copayment with likelihood and level of adherence in new users of statins: a retrospective cohort study. J Manag Care Pharm. 2014; 20(1): 43–50.
  6. Quealy K, Sanger-Katz M. The prescription drugs that rich people buy. The New York Times. February 7, 2019. https://www.nytimes.com/2019/02/07/upshot/income-strong-predictor-drug-purchases-serious-diseases.html. Accessed March 9, 2019.

 


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

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

 

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by Katie Tam, PharmD Candidate,
University of Arizona College of Pharmacy

In October 2017, Acting Health and Human Services (HHS) Secretary Eric D. Hargan issued a statement declaring a nationwide public health emergency regarding the opioid crisis.1 The opioid epidemic in America has become a top priority in efforts to prevent opioid overuse.

Opioids are a drug class that includes heroin, oxycodone, hydrocodone, codeine, morphine, fentanyl, and many other prescription pain relievers. These medications can carry serious risks, like addiction, overdose, and even death.

The U.S. Department of Health and Human Services (HHS) reported that more than 42,000 people died from overdoses involving opioids and estimated 40% of opioid overdose deaths involved a prescription opioid.2

New Medicare Part D Opioid Overutilization Policies

To help you use prescription opioid pain medications more safely, the Centers for Medicare and Medicaid Services (CMS) has recently introduced new regulations in the Medicare part D prescription drug program. Using recommendations made by Centers for Disease Control and Prevention (CDC) on prescribing opioids for pain, CMS developed new safety measures. Here are some key points that are crucial to understand:

  1. New Opioid Users: Your Medicare drug plan and pharmacist will do safety reviews of your opioid pain medications when you fill a prescription. If you are a new opioid user, you may be limited to a 7 day supply or less. The hope is to reduce the risk of longer-term opioid misuse through closer management of opioid naïve patients.2 This policy will affect Medicare patients who have not filled an opioid prescription within the past 60 days and will prevent pharmacies from filling a new opioid prescription exceeding a 7 days supply.2
  2. Limited Opioid Amount: During the safety review, your pharmacist will also look for potentially unsafe opioid amounts and drug-drug interactions that may increase your risk of overdose. If your pharmacist decides that your total opioid prescription dose is not safe, the plan may limit your coverage of these drugs. This alert will identify patients that may benefit from closer monitoring and care coordination and encourage doctors to educate patients about opioid overdose risk and prevention.3
  3. High-Risk Opioid Users: This new regulation allows Medicare drug plans to implement a drug management program (DMP) that limits access to opioids and benzodiazepines (used for anxiety and sleep) for patients at high risk of opioid abuse.3 High risk patients will need to obtain their opioids from specified doctors or pharmacies. Before Medicare places you in a DMP, it will notify you by letter. The goal of this program is to identify potential at-risk patients and provide better care coordination for safer use of opioids and benzodiazepines.3

Opioid Policy Exclusions

The new opioid regulations do not apply to patients with cancer, those who get hospice, palliative, or end-of-life care, or who live in a long-term care facility. Also, patients who use the medication-assisted treatment (MAT) program will not be impacted by these new policy changes.2

About 115 patients die every day from an opioid overdose. Because opioid addiction is driving this epidemic, the hope is that these new regulations will reduce the negative impacts of the epidemic on Americans.4 If you suffer from severe or long-term pain, talk with your doctor about all your pain treatment options including whether taking an opioid is appropriate for you. There may be other ways to manage your pain with less risks.

Resources:

  1. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html
  2. A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Polices for 2019. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/RxUtilization.html. Accessed January 20, 2019.
  3. CY 2019 Final Call letter. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf. Accessed January 20, 2019.
  4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65:1-49, available at http://dx.doi.org/10.15585/mmwr.rr6501e1.

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by Katy Winkel, PharmD Candidate Class of 2019
University of Kansas School of Pharmacy

Many of us have had a relative, friend, or coworker who gets their medications from Canada. For many of us, this sparks a stream of questions: “Are Canadian medications legit? How are medications approved in Canada? Is it legal to buy prescription medications from Canada?” You may be surprised to discover that Canada and the United States (U.S.) are very similar in their drug approval process; some may even say they are near identical.

Similarities between the U.S. and Canadian drug approval process

Both Health Canada and the U.S. Food and Drug Administration (FDA) have processes which drug companies must follow in order to get medications approved. Both processes have three phases of clinical trials as well as a post-marketing phase.1 Even though the processes are so similar for prescription medication approval, it is still illegal to import drugs or devices into the U.S. for personal use.3 The FDA’s reasoning behind this is that they cannot ensure “safety and effectiveness” of the medications being imported. Many of you may then be asking, “What if it’s a medication like Lisinopril that is already approved in the U.S.?” This is a gray area and even the FDA is vague on the topic saying these are “circumstances in which the FDA may consider exercising enforcement discretion and refrain from taking legal action against illegally imported drugs.”4

Why are Canadian medications so much cheaper?

The Patented Medicine Prices Review Board (PMPRB) “protects and informs Canadians by ensuring that the prices of patented medicines sold in Canada are not excessive and by reporting on pharmaceutical trends.” Furthermore, Canada has a law that states the price of a new medication, first of its kind, cannot exceed the median price for the rest of the world.2 As discussed above, the Canadian drug approval process is just as rigorous as the U.S., therefore if you decide to purchase from a Canadian pharmacy, one way to verify that it is legit is to look for the pharmacy license number to be shown on the website.2 Unfortunately, the United States is the only industrialized country that doesn’t utilize price controls for pharmaceuticals resulting in astronomical drug prices. The U.S. federal government reported that in 2012, around 5 million Americans had purchased drugs outside the U.S.

Over-the-Counter Medications

Along with cheaper prescription medications, Canada also has cheaper over-the-counter (OTC) medications, too. However, unlike prescription medications, it is legal to buy OTC medications from Canada.5 To determine whether the product is legit, look for the product label to contain an 8-digit Drug Identification Number (DIN), which means it has met Canadian standards for safety, quality, and effectiveness.5

“The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices;”3 therefore the safest option is to obey the FDA regulations.

If you’re having trouble affording your medications, try the free ScriptSave WellRx price comparison tool to see if we can help you save. The ScriptSave WellRx program is freeto all patients, and the price-check tool is available 24/7, without the need for an account or any personal details. In other words, the program can be used risk-free and with nothing to lose. We even provide free medication management tools, refill reminders and an “Ask a Pharmacist” helpline. We’re doing our best every day to help patients get safe, hassle-free savings.

 

References:

  1. “Comparison: Canada and United States.” National Institute of Allergy and Infectious Diseases, U.S. Department of Health and Human Services, 8 Feb. 2018, clinregs.niaid.nih.gov/country/canada/united-states#_top.
  2. Kirschner, Chanie. “Why Are Pharmaceuticals Cheaper in Canada?” MNN – Mother Nature Network, Mother Nature Network, 5 June 2017, https://www.mnn.com/health/fitness-well-being/questions/why-are-pharmaceuticals-cheaper-in-canada
  3. Office of Regulatory Affairs. “Import Basics – Personal Importation.” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, 3 Aug. 2018, https://www.fda.gov/forindustry/importprogram/importbasics/ucm432661.htm
  4. Osterweil, Neil. “Buying or Importing Prescription Drugs: Laws and Regulations.” WebMD, WebMD, www.webmd.com/healthy-aging/features/letter-and-spirit-of-drug-import-laws.
  5. Canada, Health. “Regulation of Non-Prescription Drugs.” ca, Innovation, Science and Economic Development Canada, 21 Feb. 2018, https://www.canada.ca/en/health-canada/services/self-care-regulation-non-prescription-drugs.html

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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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by Terra Leon, PharmD Candidate 2019

Tamiflu (oseltamivir) is a prescription medication used in the treatment of influenza in patients 2 weeks and older. It can also be indicated as prophylaxis treatment from the flu and reduce the chances of getting the flu in patients 1 year and older1.

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How does Tamiflu work?

Tamiflu (oseltamivir) is a prodrug, meaning that the drug is metabolized into the active drug after it is administered. Prodrugs are beneficial when the active drug itself has low availability in circulation and is not absorbed well in the stomach. Prodrugs are designed to not only increase the amount active drug in circulation, improve elimination but they also can reduce adverse effects or unintended side effects. Once Tamiflu is metabolized into the active drug, the active drug blocks replication of the virus in the body3. Tamiflu stops the replication process of the influenza virus in your body, it does not cure you of the flu rather it shortens the duration of flu like symptoms in the body by about 1-2 days.

Can everyone use Tamiflu?

Tamiflu (oseltamivir) is recommended in patients for treatment of influenza who are 2 weeks and older and is to be initiated within 48 hours of influenza symptom onset2. Tamiflu may also be prescribed for patients who were exposed to a confirmed flu diagnosis within 48 hours of close contact with the infected individual2. Patients who use Tamiflu >48 hours of symptom onset or exposure may still benefit from the medication, specifically children4. A study was done in children indicating that if Tamiflu was administered within 5 days of symptom onset that overall flu symptoms were reduced by 1 day when compared to placebo4.

Tamiflu side effects

The main side effects patients experience while using Tamiflu are headache, nausea and vomiting3. Please seek medical attention if you have any serious skin and hypersensitivity reaction.

Misconceptions about Tamiflu

Tamiflu will cure me of the flu

Most patients have the misconception that Tamiflu will cure them of the flu, when in reality the medication works by reducing the number of days with flu like symptoms. There is not direct cure for the flu since it is a viral entity, like the common cold. All we can do is treat our symptoms to ease the burden of the virus on the body. The most effective way to protect yourself from the flu is to receive your flu vaccination annually.

Tamiflu is a replacement for the flu shot

Tamiflu or any antiviral medication is not a replacement treatment for the flu vaccine itself. Receiving the flu vaccine is the primary defense to protect yourself from the flu. Antiviral medications are second line when the flu vaccine is not available or contraindicated for the individual4. Most insurance companies will cover the flu vaccine at little to no cost at all where Tamiflu (oseltamivir) can cost anywhere from $50-$135 depending on insurance and quantity needed5. That being said, receiving the flu vaccine protects you from the unwanted flu symptoms as well as the unwanted cost of medication, doctor office visits, and valuable time off work and school.

When I take Tamiflu I cannot get sick

There is no evidence that Tamiflu has any effect on any other illness in the body that does not contain influenza viruses, including bacterial infections. Some bacterial infections can initially present as influenza, it is important to be tested for influenza before starting Tamiflu as the sole treatment2. Always follow up with your doctor if you suspect a secondary bacterial infection in order to be treated appropriately.

Resources:

  1. “Fever, aches, chills. Check your symptoms and learn more about a prescription flu treatment.” Tamiflu.havaswwsfdev.com. 2019. 15 Jan. 2019 <https://www.tamiflu.com/>.
  2. Tamiflu Prescribing Information. 2018. 15 Jan. 2019 <https://www.gene.com/download/pdf/tamiflu_prescribing.pdf>.
  3. “Tamiflu (oseltamivir).” Facts & Comparisons. 15 Jan. 2019 <https://fco.factsandcomparisons.com/lco/action/search?q=tamiflu&t=name&va=>.
  4. “Influenza (Flu).” Centers for Disease Control and Prevention. 22 Nov. 2013. Centers for Disease Control and Prevention. 15 Jan. 2019 <https://www.cdc.gov/flu/news/flu-antiviral-benefits.htm>.
  5. “Tamiflu (oseltamivir).” ScriptSave Wellrx.  Feb 2019 https://www.wellrx.com/prescriptions/tamiflu/

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In the world of prescription drug insurance, there are medications that are covered by a health plan and some medications that are not covered. The list of drugs that are covered is known as the Prescription Drug Formulary (or “Formulary” for short).

What is a Prescription Drug Formulary?

If you’ve ever visited a pharmacy with a prescription in one hand and your insurance card in the other, only to be told that your medication is not covered by your insurance … but if your doctor is willing to change the prescription to a similar drug used to treat the same condition … you have first-hand experience of a Prescription Drug Formulary.

The formulary is a list of approved medications for which an insurer has agreed to help cover the cost. However, there might be multiple manufacturers of numerous drugs designed to treat the same condition. This is an opportunity for the insurance company to trim costs by only agreeing to cover one drug for each health condition.

For pharmaceutical manufacturers, this can be a very big deal to be included or excluded from an insurer’s formulary list. Accordingly, each health plan generally reviews its coverage list on an annual basis. This helps ensure they continue to get the best possible price-points for the competing medications that are available to treat high-cost health conditions.

For patients, this can mean that, each year, they may discover the drug they had been taking is no longer covered. This may require them to switch to an alternative medication to continue receiving help paying for the medication from their insurance provider.

Prescription Formulary Changes for 2019

At the time of this write-up, the calendar is fast approaching year-end, and new insurance plan-years for 2019. Many formulary lists are likely to change. Two of the largest managers of prescription drug formularies in the U.S. are Express Scripts and CVS Caremark. Here are the details of the medications these two companies are REMOVING from their lists for 2019:

Acanya  Humatrope  Saizen 
Acticlate  Invokamet XR  Savaysa 
Alcortin A  Invokamet  Sorilux 
Alocril  Invokana  Sovaldi 
Alomide  Jentadueto XR  Synerderm 
Alprolix  Jentadueto  Targadox 
Altoprev  Lazanda  Tirosint 
Atripla  Levicyn  Topicort spray 
Avenova  Levorphanol  Tradjenta 
Benzaclin  Lupron Depot-Ped  Uroxatral 
Berinert  Mavyret  Vagifem 
Brisdelle  Maxidex  Vanatol LQ 
Brovana  Nalfon  Vanatol S 
Cambia  Namenda XR  Veltin 
Chorionic Gonadotropin Neupro patch  Verdeso foam 
Climara Pro  Norco  Viagra 
Contrave ER  Norditropin  Vivelle-Dot 
Cortifoam  Nutropin AQ Nuspin  Xadago 
Daklinza  Nuvigil  Xerese cream 
Duzallo  Olysio  Xyntha Solofuse 
Eloctate Omnitrope  Xyntha 
Emadine  Onexton  Yasmin 
Embeda  Oxycodone ER  Zemaira 
Extavia  Pradaxa  Ziana 
Fasenra  Praluent  Zolpimist 
Fenoprofen (capsule) Pred Mild  Zomacton 
Fenortho  Pregnyl  Zonegran 
Flarex  Prolastin-C  Zuplenz 
FML Forte  Qsymia  Zurampic 
FML S.O.P.  Recombinate  Zypitamag

If your medications are listed above (and if your insurer uses Express Scripts or CVS Caremark to manage their formulary) you can speak to your doctor or pharmacist about alternative medications designed to treat the same health condition. You can check these alternatives against your insurer’s new formulary list for 2019.

What If My Drugs Are Excluded?

It may also be worth double-checking the cash-price (i.e., the price without insurance) for your current medication. You can do this by clicking the drug name link in the list above. This can be a worthwhile effort, as the cash-price can often be lower than an insurance copay [Read more about Always Ask Cash Price]

What If I Can’t Switch to a Covered Alternative Drug?

If you’re unable to switch medications, you may be able to get some help from the FREE ScriptSave WellRx program. We negotiate savings on the cash-prices of medications at over 65,000 retail pharmacies across the United States. Patients can save up to 80% (relative to the cash price of their prescription).

Our price-check tool is available for free — no sign-up necessary. Go to www.wellrx.com or download the ScriptSave WellRx mobile app on iOS and Android to see how much you’ll save on your prescription costs!


Read public reviews of the ScriptSave WellRx program on Trustpilot. Today we are ranked:
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For years, contractual clauses have kept pharmacy employees from telling their customers when a better price was available than their insurance copay for prescription medications. Recent congressional legislation has made changes to how that works.

So, how much do you know about how the Know the Lowest Price Act of 2018 and Patient Right to Know Drug Prices Act? Learn more about the impacts to the pharmacy customer by taking the Practice Trends quiz at pharmacist.com.

For more in-depth information on the latest changes to the ‘Gag Clause’ laws, check out our latest blog post, Outlawing Pharmacy Gag Clauses.

 


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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by Mitchell Welton, PharmD Candidate 2019
University of Arizona

After the much anticipated release of the 2016 Gallup poll, which had Americans assign a rating of honesty and ethical standards in professions, Pharmacists found themselves in a top-three ranking for the 14th straight year.1 In last year’s poll however, it seems the general public’s opinion of pharmacists had shifted slightly. With increased news coverage and scrutiny over rising drug prices, it seemed harder for patients to be able to separate the practices of big pharmaceutical companies with the copay price that the pharmacists were asking for at the drug counter.

Pharmacy Gag Clauses

Although the community pharmacist was unable to control the inflating cost from the manufacturers, there was a more insidious practice taking place that kept their hands tied and mouths shut, even though patients might have been paying more for their prescription medications than they needed to. This was due to pharmacy gag clauses, written into the contracts between the pharmacy and pharmacy benefit managers (PBM). These clauses prevented a pharmacist from telling the patient at the point of sale if the cash price was lower than their insurance copay. To violate such a gag order would mean risking the pharmacy’s network contracts with its PBMs and facing other sanctions.2

An example of this practice will help explain why the opinion of pharmacy ethics and honesty were not found in the top-three ranking in last year’s poll: A patient’s spouse went to pick up her generic medication, telmisartan, from their local pharmacy. He paid $285 for a 90-day supply. Before the 90-day period he and his wife decided to go on a trip and would run out of her previous fill before returning home. He went to go purchase another 90-day refill out of pocket and found out the cash price was $40. While a spokesperson for the PBM involved in this event confirmed that the $285 copay was correct he was unable explain why that dollar amount was so much higher than the cash price of the medication.3 Overpayments like this, known as “clawbacks”, have unfortunately not been isolated events, and the occurrence was recently quantified by the University of Southern California’s Schaeffer Center for Health Policy and Economics.

[ Read more about PBM Pharmacy Clawback’s ]

The study which was completed in March of this year looked at available pharmacy claim data from 2013. The study analyzed over nine million claims in which they found close to a quarter of them to involve overpayment. The average amount patients overpaid was $7.69 and overpayments on a brand name medication were significantly higher although not as frequent. 4

States Take the Lead

Between 2016 and August 2018 at least 26 states have enacted laws prohibiting “gag clauses” in pharmacy contracts. The most recent action came from the White House on October 10, 2018, when President Donald Trump signed into law the “Know the Lowest Price Act” and the “Patient’s Right to Know Drug Prices Act” which banned gag clauses immediately upon signature. This has represented a major victory for pharmacists who have had to remain silent while they watched the patients they care about struggle to pay for their medications. 2

How Pharmacists Feel About Gag Clauses

Pharmacists and law makers alike are disturbed that such practices have been allowed to exist. Senator Susan Collins, Republican of Maine, said, “I can’t tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high co-pay.” Senator Martin M. Looney, Democrat of Connecticut said, “This is information that consumers should have, but that they were denied under the somewhat arbitrary and capricious contracts that pharmacists were required to abide by.” 5 Pharmacist Robert Iacobucci Jr., who owns White Cross Pharmacy in North Providence, Rhode Island expressed his frustration,” There’s no other profession in the world where you can’t tell your customer how to best utilize their money.”  When you see a 98-2 vote from the senate in such a divisive political climate to eliminate these gag clauses, it is telling that change was long overdue.

For more than a decade pharmacists have consistently been thought of as the pinnacle of honesty and ethical behavior when evaluating professions. The recent ban on these gag clauses will allow pharmacists to maintain that respected title and get back to what they do best; Improving the health and outcomes of their patients.

 

References

  1. Gallup, Inc, and Jim Norman. “Americans Rate Healthcare Providers High on Honesty, Ethics.” com, 19 Dec. 2016, news.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx.
  2. Snyder, Lynn S, and John S Linehan. “New Federal Laws Banning ‘Gag Clauses’ in the Pharmacy.” The National Law Review, 30 Oct. 2018, natlawreview.com/article/new-federal-laws-banning-gag-clauses-pharmacy.
  3. Thompson, Megan. “Why a Patient Paid a $285 Copay for a $40 Drug.” PBS, Public Broadcasting Service, 19 Aug. 2018, pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug.
  4. Van Nuys, Karen, et al. Overpaying for Prescription Drugs: The Copay Clawback Phenomenon. USC Schaeffer, Mar. 2018, http://healthpolicy.usc.edu/wp-content/uploads/2018/03/2018.03_Overpaying20for20Prescription20Drugs_White20Paper_v.1-2.pdf.
  5. Pear, Robert. “Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8.” The New York Times, The New York Times, 24 Feb. 2018, nytimes.com/2018/02/24/us/politics/pharmacy-benefit-managers-gag-clauses.html.
  6. Povich, Elaine S., and Tribune News Service. “The ‘Gag Clause’.” The Lewiston Tribune, 1 July 2018, lmtribune.com/business/the-gag-clause/article_8c269796-7d54-5116-86ca-f3e59da23fae.html.
  7. Cauchi, Richard. “Ncsl.org – Legislative News, Studies and Analysis.” Prohibiting PBM “Gag Clauses” That Restrict Pharmacists from Disclosing Price Options: Recent State Legislation 2016-2018, 22 Aug. 2018, pm, ncsl.org/.
  8. Gallup, Inc, and Megan Brenan. “Nurses Keep Healthy Lead as Most Honest, Ethical Profession.” com, 26 Dec. 2017, news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx.

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 prescription 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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Every day we receive phone calls, emails, and comments from patients about the staggering prices they pay for the prescription medications they need. People are struggling to afford their medical bills. We get it. That’s why we are providing tips to help you save money at the pharmacy counter.

Here’s how to receive discounts on your prescription drugs:

1. Compare Rx Drug Prices at Different Pharmacies

It may come as surprise, but medication prices vary from one pharmacy to another. This is because pharmacies negotiate rates with drug manufacturers for the various medications they carry. Each pharmacy negotiates different prices, which means you could be asked to pay $65 when filling your prescription at one pharmacy and only $45 when filling the same prescription at another pharmacy.

One of the easiest ways to save money on your medication is to do a quick price comparison online before heading to the pharmacy. At ScriptSave WellRx, we provide a free cost-checking tool so you can compare Rx drug prices in your area and find the best discount.

2. Use a Prescription Discount Card

Regardless of whether you have health insurance or not, you can save money at the pharmacy counter by using a prescription discount card. Rx savings programs work by negotiating discounted cash prices on both generic and brand name medications. Patients can then receive cheaper prescriptions by showing their Rx card at participating pharmacies. It’s really that simple.

Most savings cards, including ScriptSave WellRx, are totally free to use, and they are accepted at pharmacies nationwide. For some patients, using a prescription discount card to pay cash for their medication may be cheaper than their insurance co-pay!

get a free scriptsave wellrx discount card

3. Ask Your Doctor or Pharmacist About Other Options

Your healthcare provider is also a great resource when looking for alternative ways to save money on your prescriptions. If you’re having trouble affording your medications, remember to ask your doctor or pharmacist if there are cheaper generic versions available, or if any other cost-saving alternatives exist.

4. Redeem Drug Manufacturer Coupons

If you are taking a brand name medication, the drug company manufacturing it may offer a coupon which can be applied to the cash price of your prescription. The best way to find out if there are any manufacturer coupons available for your medication is to check the drug company’s website for valid discount offers.

5. Consider a Prescription Assistance Program

Depending on your situation and what medications you’ve been prescribed, you may be eligible to receive additional help through the Medicine Assistance Tool (MAT) provided by the pharmaceutical industry trade organization PhRMA—Pharmaceutical Research and Manufacturers of America. MAT is a program that connects patients with available medication assistance resources based on the information they provide.

How Much Will You Save?

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Medicare donut hole header image - ScriptSave WellRx

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

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

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

What is the “Donut Hole?”

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

Medicare donut hole image - ScriptSave WellRx

Changes to the Donut Hole

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

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

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

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

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

What does this mean for you?

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

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

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

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

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

References:

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

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

 

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