why do my drugs cost so much - blog image

By Joel Yambert, MS, Pharm.D. Candidate, Class of 2020,
University of Arizona College of Pharmacy

We’ve all seen it happen before. You’re in line at the pharmacy and next thing you hear, “No way. How do you expect anyone to afford that? I’m not paying for that!” Healthcare costs in the United States have continued to skyrocket. A recent poll from the Kaiser Family Foundation shows that nearly one-in-four (25%) people stated they have difficulty affording their medications and three-in-ten (30%) report not taking their medications as prescribed due to drug costs.

So why are all these medications so expensive?

The Main Players in Drug Costs

There are a number of players in the pharmaceutical pipeline who impact the price of medications.

Government/
lawmakers
Pharmaceutical Companies/
Manufacturers
Pharmacy Benefit Manager (PBM)/
”Insurance”
Pharmacy stores/hospitals Patient
Pass laws that affect pricing, taxing, and reimbursement of drug creation and distribution Base pricing on a variety of factors: cost to create the drug, number of people with potential to take the drug, and severity of need for the drug Acts as the middleman between health plans, drug manufacturer, and pharmacy Pharmacies pay a wholesaler to get drugs from the manufacturer and have contracts with PBMs to dispense the drugs There are a variety of places to get your drugs, private or government insurance, and other elements

Government Factors

According to a government survey from the National Health Expenditure Accounts Team, spending on prescription drugs increased 12.2% in 2014. There was a drug recently approved for a rare childhood disorder that costs $2.1 million for treatment. Policymakers and legislature are constantly working on ways to control drug costs to try to find a balance between those creating the drugs, those paying for them, and the companies that act in between them—such as PBMs. Government officials and lawmakers look to other countries’ policies to continuously evaluate the state of drug costs, and healthcare in general, in the United States.

High Costs of Drug Development

As discussed in my article “Antibiotic Overprescribing: Creating the Next Big Superbug?,” the manufacturing and development of new antibiotics has been halted by most drug companies due to the lack of profit from their investment in antibiotics.

Drug development costs for pharmaceutical companies continue to rise as well as the cost to the consumers. The median cost of drug development for a single drug was $648 million, according to a 2017 study. Another study stated the cost to be an average of $2.7 billion.

These costs have put more pressure on pharmaceutical companies to be profitable in their drug development processes. Some diseases, like Alzheimer’s, have had their drug development funding cut in order to tackle more profitable diseases like cancer.

Pharmacy Benefit Managers and Pharmacies

Pharmacy Benefit Managers (PBMs) act as middleman, so they negotiate drugs from the manufacturers at a discounted price for pharmacies. The pharmacy then purchases the drug from a wholesaler and the PBM charges the pharmacy a fee for getting the drug at a discounted cost. By doing this, the PBM retains the rebates on the medications instead of passing them down to pharmacies or consumers. Rebates are also gained by the PBM when they put the drug from the drug manufacturer on their PBM formulary. Due to this, the pharmacy is paying the wholesaler for the discounted cost and paying a fee to the PBM.

For pharmacies to gain money back from paying for the PBM service and for the medication itself, they pass the financial burden downstream to the patient (or buyer). You can see that there are many different processes occurring that result in the way drugs are priced and how much they end up costing the patient.

Advantages of a Free Market

This may seem like finding affordable medication is helpless. What can you do to combat high drug prices? Many pharmaceutical company (or drug) sites will have coupons for their drugs that patients can use. There are also apps available, like ScriptSave WellRx, that provide discount pricing, sometimes less than the amount your insurance is willing to provide, on certain medications. There are many more avenues patients can take in order to combat against the high price of their medications. Talk to your pharmacist or doctor about potential price burdens.

Your health is in your own hands. You have the ability to research these pathways in order to get the best deal you can for your mediation needs. Don’t be afraid to ask questions to your various healthcare providers in order to get the help you need. Sometimes pricier drugs have alternatives that may be more affordable to fit your budget!

References:

  1. https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/
  2. Martin AB, Hartman M, Benson J, Catlin A. National Health Expenditure Accounts Team. National health spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150–60.
  3. Prasad, V., & Mailankody, S. (2017). Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval. JAMA internal medicine177(11), 1569–1575. doi:10.1001/jamainternmed.2017.3601
  4. Ventola C. L. (2015). The antibiotic resistance crisis: part 1: causes and threats. P & T: a peer-reviewed journal for formulary management, 40(4), 277–283.
  5. https://www.rheumatology.org/Portals/0/Files/Issue-Brief-Pharmacy-Benefit-Manager-Transparency.pdf


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manufacturer drug coupons

For anyone who has read the ScriptSave WellRx Facebook comment-threads, you’ll know the topic of manufacturer drug coupons (and the Q&A that relates to them) is a popular one. So popular, in fact, we felt it deserved its own article on what drug coupons are and how they work.

What are Manufacturer Drug Coupons?

These coupons often go by a number of different names. Sometimes referred to as copay cards or copay coupons, also commonly called Copay Assistance Programs or just pharma coupons, the end result is often the same. A program, funded by the pharmaceutical manufacturer of a prescription drug, which helps to lower the out-of-pocket cost that the patient pays at the pharmacy.

Because these programs are funded directly by the pharmaceutical company that manufactured the drug, they are usually able to provide the patient with an extremely low cost. Some programs can even drop a patient’s out-of-pocket expense to zero dollars (i.e., FREE prescription medication to the patient).

Get lower rx prices with ScriptSave WellRx

How do Copay Assistance Programs work (and are the really FREE)?

So what’s the catch behind the copay card (…and, yes, there is a catch)? To answer this question, let’s look at why these programs were created by pharma manufacturers in the first place.

Just because the patient might end up paying zero dollars, it certainly doesn’t mean the drug manufacturer gave their product away and didn’t make any money. In fact, nothing could be further from the truth.

The clue is really in the name, “Copay Assistance” or “Copay Coupon” – i.e. these programs are designed to help lower a patient’s insurance copay. More about that to follow, a little further down the page.

It’s important to keep in mind that the pharmaceutical manufacturer collects payment for their drug not just from the patient, but also from the patient’s insurance plan. Furthermore, with traditional health plans, the lion’s share of the payment for the drug would generally be coming from the insurance company rather than from the patient. For example, consider a brand drug that might sell for $1,000 and its generic equivalent that’s available for $100. If the patient’s health plan has a flat copay of $20, then the patient would likely opt for the brand. After all, their personal expense would be the same twenty dollars out-of-pocket cost, regardless of which version of the drug they choose … so why not go for the brand-version. In such an example, the patient would pay $20 in the form of their copay, while the brand drug company would collect the remaining $980 from the insurance company.

With this in mind, let’s consider what might happen if patient’s health insurance plan changes its copay structure for the next plan year. If the patient finds themselves having to pay 20 percent of the cost of their medications (a practice commonly referred to as co-insurance), rather than the flat copay of $20, they would then face an out-of-pocket cost of $200 for the same brand drug (i.e. 20% of $1,000) or only $20 for the generic – same as their previous year’s copay (i.e. 20% of $100).

Under these circumstances, the patient’s choice between brand vs. generic has a direct and significant impact on their own out-of-pocket cost, and the potential impact to the brand manufacturer is most certainly a cause for concern. Not only do they lose the patient’s share of the payment for the medication, they also lose the majority share that would have been paid by the insurance provider. And so comes the case for the copay card, copay assistance program or manufacturer drug coupon.

What if the manufacturer pays, reimburses, or assists with the patient’s cost?

Keeping the math the same as the example above, what if the manufacturer creates a program that offers to kick-in $200 against the patient’s copay? The answer is simple. If the patient faces 20% of the cost of a $1000 brand drug vs. 20% of a $100 generic … but then the manufacturer of the brand offers to subsidize $200 back to the patient if the patient picks their drug, then the patient is left facing a choice between a zero-dollar burden for choosing the brand or a $20 burden for the generic.

Obviously, the patient will now tend to choose the brand. However, although the patient is able to use the coupon to escape paying anything whatsoever for the drug, the drug company is now able to collect $800 from the insurance plan, because the pharmacist dispensed the brand as opposed to the generic (thereby triggering a bill to the patient’s insurance for the brand). In other words, by giving a $200 discount or subsidy to the patient, the pharma manufacturer manages to collect $800 from the insurer, rather than collecting nothing if the patient had opted for the generic.

Pharma coupons – only for the insured

At this point, anyone still reading has probably already had their ‘a-ha moment’ in realizing why these programs (that can be so wonderfully generous to patients across the U.S.) are often only available to patients with insurance. Long story short, without the insurance company in the equation to continue footing their full share of the bill, these programs wouldn’t make any money at all for the pharma manufacturer.

To many folks this seems unfair. However, it doesn’t change the fact that, every single day, manufacturer coupons make a HUGE difference to many patients who can’t afford their medications.

For those without access to these programs, the ScriptSave WellRx prescription discount card might be able to help (although, clearly, we’re never going to be able to help as much as the manufacturers’ own programs – for those who qualify).

If you’re struggling to afford your prescription medications, check out the ScriptSave WellRx website or app to see how much you could be saving on the cost of your medications! Furthermore, if you’re still unsure why the WellRx card from ScriptSave is different to the copay assistance cards from the manufacturers, and how our discount program works, there’s a brief write-up to explain that here. You may also want to read our related article, “What Are Patient Assistance Programs?



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common food and drug interactions - scriptsave wellrx blog image

by Stephanie Forbes, PharmD

We’ve all gone to the pharmacy to pick up a new medication and been counseled on interactions with other drugs. But, what about foods that might interact with the new medication?

Oral medicines are absorbed into the bloodstream through our gastrointestinal tract (GI tract). For this reason, food or drinks can sometimes interact with the absorption of the medicines we take.  In some cases, food can actually help with absorption, but in other instances it can be a hinderance, and cause less of our medicine to be taken up into the bloodstream.

Some antibiotics, like amoxicillin/clavulanate extended release (Augmentin) and cefuroxime (Ceftin) are better absorbed when we take them with food. Lovastatin is another example of a medicine that has improved absorption when taken with food. In contrast, some medicines (bisphosphonates like alendronate, antibiotics like ampicillin) are absorbed less when taken with food, and should be taken on an empty stomach.

Foods That May Interact With Drugs

Below are some foods and environmental aspects that can interact with the frequently prescribed medications .

Calcium Rich Foods

When we think of calcium, we tend to think of dairy products. In addition to milk, cheese, and yogurt, calcium supplements and some antacids containing calcium can interact with some medicines. Most commonly interacting with calcium are antibiotics, like ciprofloxacin, tetracycline, and doxycycline. The calcium may bind to the antibiotics creating a substance that prevents them from being absorbed.

Grapefruit

Grapefruit and grapefruit juice an affect the metabolism of drugs through a pathway called CYP450, a metabolism pathway through the liver. The impact of grapefruit (and juice) on this can increase the effects of some drugs to a dangerous level.  Furanocoumarin chemicals, compounds found in grapefruit, can interact with enzymes in the liver and small intestine. Some examples of medicines that interact with grapefruit are simvastatin, felodipine, and ticagrelor.

Vitamin K Rich Foods

Patients who are prescribed the blood thinner warfarin are likely familiar with this drug-food interaction. Anticoagulants like warfarin inhibit vitamin K, which an essential component in the process that makes clotting factors, which help prevent bleeding. A frequent misconception with this interaction is that vitamin K rich foods should be avoided; however, that is not the case. Most important is to keep a consistent intake of vitamin K in your diet, and avoid adding in new foods like kale, spinach, or other leafy greens.

Key Takeaways

Keep in mind, this is not a comprehensive list and other foods and beverages may interact with medications (alcoholic beverages, pickled, cured, and fermented foods, etc.). Always check with your pharmacist or doctor for any dietary considerations when starting a new medication. For additional help between doctor & pharmacy visits, it may be possible to turn to technology. For example, by searching for a given prescription drug on the ScriptSave WellRx website (or mobile app), a patient can click through to the “Lifestyle Interactions” tab, where upon they will see details of known dietary interactions for that drug (the example linked to here is for Atorvastatin/Lipitor, and shows details of the aforementioned MAJOR interaction with grapefruit juice).

Technology tools like ScriptSave WellRx are not just able to flag dietary/lifestyle interactions. They can also highlight potential interactions between the different medications in a patient’s personal prescription regimen. Patients are able to create a free account either on the ScriptSave WellRx website or through the mobile app and, by unlocking the free virtual Medicine Chest, they are able to load details of their own medication to a secure account. The medicine chest is then able to flag not just the known food/dietary interactions with the patient’s own specific drug list, but also potential interactions between the different prescription medications themselves.

References:

  1. Gilchrist, Allison. 5 Dangerous Food-Drug Interactions. Pharmacy Times. September 17, 2015. https://www.pharmacytimes.com/news/5-dangerous-food-drug-interactions. Accessed November 25, 2019.
  2. Technician Tutorial, Drug Interactions 101. Pharmacist’s Letter/Pharmacy Technician’s Letter. October 2016.
  3. Avoid Food-Drug Interactions: A Guide from the National Consumers League and U.S. Food and Drug Administration. April 4, 2017. https://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/GeneralUseofMedicine/UCM229033.pdf. Accessed November 25, 2019.
  4. Bushra, R., Aslam, N., & Khan, A. Y. (2011). Food-drug interactions. Oman medical journal26(2), 77–83. doi:10.5001/omj.2011.21


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humalog blog image - scriptsave wellrx

by Ryan Lowe, PharmD Candidate,
The University of Arizona College of Pharmacy

For many patients with diabetes, insulin has become a mainstay of their therapy. Despite the addition of newer drugs on the market (like the exciting GLP-1 agonists such as Victoza (liraglutide), insulin remains a popular choice among physicians for its numerous benefits. The dose of insulin can be easily adjusted; if your blood sugars are running high then simply try taking two more units and reevaluate in a couple of days. Insulin is also a great drug when used in combination with other medications such as metformin; these combinations allow for greater control of a patient’s diabetes. According to a study from the CDC, the percent of patients taking both insulin and an oral medication increased between 1997 and 2011. This suggests the importance of both types of medication in diabetes management. 1

What are the different types of Insulin available?

Insulin can be divided up into two categories: long acting and short acting. Most patients start out with a long acting insulin before a short acting insulin is added. The most common long acting insulin is Insulin Glargine, or Lantus. Another long acting insulin you may see is Insulin Detemir, or Levemir. These insulins are normally dosed once a day, and they work to keep your fasting sugars (your blood sugar when you’re not eating any food) within normal limits.  The most common side effect of long acting insulin is hypoglycemia, or low blood sugar. When you take too much insulin your body eats up too much glucose, resulting in low blood sugar levels. If you are hypoglycemic then you may start shaking, feeling dizzy or faint, and feel confused or anxious. The quickest remedy for this is eating a high sugar snack or drink, such as a glass of orange juice. As noted earlier, one of the main benefits of long acting insulin is being able to adjust the dose more frequently to find the perfect dose for you. With a tablet medication it is harder to find the perfect middle ground; you either take one tablet or you take two. Insulin doesn’t work that way; since insulin is a liquid injection you can easily take a little more or a little less than you were previously to account for your blood sugar levels.

Short acting insulin works much quicker than the long acting insulins, hence the name. There are two common short acting insulins: Insulin Lispro, or Humalog and Insulin Aspart, or Novolog. These insulins are commonly taken after a meal. The idea behind this is that the insulin will counteract a large spike in blood sugar gained by eating a large meal. However, these insulins are rarely taken alone; rather they are normally used in combination with long acting insulin to combat both types of sugars: fasting and post-prandial, or post-eating sugars. Hypoglycemia is still a risk with these short acting insulins, but it isn’t as great a risk as with the long acting insulins. One consideration that has been on many patient’s mind, however, is the rising cost of insulin – and Humalog specifically has been in the news lately.

Why is Humalog making headlines?

Humalog is a short acting insulin manufactured by Eli Lilly, a drug company responsible for numerous popular medications. Eli Lilly released some pricing information about Humalog, and the numbers are raising some eyebrows among patients, healthcare providers, and even politicians. An insured patient will typically pay around $135 a month for Humalog (which is a decrease of 8.1% from 2014). When you don’t factor in the rebates typically covered by an insurance company, the monthly price of Humalog rises to $549.2 These differences have gotten a lot of people talking. Eli Lilly hopes that the information they released will help shed some light on the often-muddled issue of rising drug costs. Politicians on both sides seem to agree that drug costs need to come down in America, but the solution to this issue is not an easy one. Eli Lilly themselves hope to improve the situation by releasing a “half-price” Humalog under the generic name Insulin Lispro. The cost will be $137.35 per vial, which should significantly improve the annual cost for those uninsured patients with diabetes.3

In response to the Eli Lilly price drop for Humalog, Sanofi recently announced a program that they hope will make a difference in the cost of insulin.4 They unveiled a Netflix-like program that takes that model directly to patients, supplying insulin products for a flat monthly rate instead of the usual cost per prescription or refill. The drugmaker will use its Insulin Valyou Savings Program to deliver insulin products for $99 per month. For that monthly fixed price, Sanofi will offer up to 10 boxes of insulin pens and 10 mL vials per month, regardless of a patient’s income. The new $99-per-month price could be as little as one-tenth of the amount patients would have paid previously.

References:

  1. “Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997–2011.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Nov. 2012, www.cdc.gov/diabetes/statistics/meduse/fig2.htm.
  2. Lovelace Jr., Berkeley. “Eli Lilly Sheds Light on Confidential Pricing, Discloses Charges for Popular Diabetes Drug Humalog.” CNBC, CNBC, 25 Mar. 2019, cnbc.com/2019/03/25/eli-lilly-discloses-pricing-data-for-its-popular-insulin-humalog.html.
  3. “Lilly to Launch a Half-Price Version of Insulin.” CNBC, CNBC, 4 Mar. 2019, www.cnbc.com/2019/03/04/lilly-to-launch-a-half-price-version-of-insulin.html.
  4. “Sanofi provides unprecedented access to its insulins for one set monthly price” Sanofi, 10 Apr. 2019   http://www.news.sanofi.us/2019-04-10-Sanofi-provides-unprecedented-access-to-its-insulins-for-one-set-monthly-price 

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pneumonia vaccine image - scriptsave wellrx blog

by Cindy Cho, PharmD Candidate Class of 2019,
The University of Arizona College of Pharmacy

In short, no. You cannot get pneumonia from the pneumonia vaccine. With all of the news coverage about vaccines, it is important to equip yourself with the knowledge on what vaccines are, how they work, and why they don’t cause disease, so you can make an informed decision on your health.

What is a vaccine?

A vaccine is a substance that contains very small amounts of weakened or dead germs to stimulate your body to produce immunity against certain diseases. Before the invention of vaccinations, the only way a person’s body can gain immunity to certain diseases is to (hopefully) survive an infection from the germ that causes the disease. For example, if a person gets pneumonia, an infection of the lung, from a certain germ and survives, their body will remember that specific germ if it were to come across it again. By remembering the germ, the body can protect itself and fight off the infection more efficiently to prevent sickness in the future. Vaccines provide a similar immune system response to help the body create immune system cells to remember disease-causing germs to protect your body, but the best part is that vaccines don’t come with the risks of getting the actual disease or its associated complications. Some vaccines can provide protection against multiple types of germs that cause the same disease to better protect against epidemics.1

What are pneumonia vaccines?

Now that you understand how vaccines work, let’s talk about the pneumonia vaccines! There are two pneumonia vaccines intended for use in the United States by the Food and Drug Administration (FDA), which includes the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) and the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23).2 Both of these pneumonia vaccines contain inactivated, or dead, germs. Because these vaccines contain dead germs, they cannot replicate in the body or cause disease.1 The differences between the two pneumonia vaccines are shown below:

  • Prevnar 13: this is a conjugated vaccine, which means it contains a protein that is joined to a part of dead bacteria to improve the protection the vaccine provides. Doctors give this vaccine to children at 2, 4, 6, and 12 through 15 months old. Young children need multiple doses of this vaccine to boost their protection since their immune system is not yet mature. Adults who need this vaccine only get a single dose. The vaccine has 13 in its name because it helps protect against 13 types of pneumococcal bacteria that most commonly causes serious infections in children and adults.2
  • Pneumovax 23:  this is a polysaccharide vaccine, which means it is made to look like the surface of certain bacteria in order to help the body build protection against that germ. Doctors give a single dose of this vaccine to people who need it. CDC recommends one or two additional doses for people with certain chronic medical conditions. The vaccine has 23 in its name because it helps protect against serious infections caused by 23 types of pneumococcal bacteria.2

 So, who needs the pneumonia vaccines?

Great question! Pneumonia disproportionately affects the young, the elderly, and the immunocompromised, so the CDC recommends these vulnerable patient populations to receive the pneumonia vaccines.3 The CDC created an immunization schedule that outlines when the two pneumonia vaccines should be received.

CDC recommends vaccination with the pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) for:2

  • All children younger than 2 years old
  • All adults 65 years or older
  • People 2 through 64 years old with certain medical conditions*

CDC recommends vaccination with the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) for:2

  • All adults 65 years or older
  • People 2 through 64 years old with certain medical conditions*
  • Adults 19 through 64 years old who smoke cigarettes

*Certain medical conditions such as: chronic heart disease, lung disease, liver disease, diabetes, HIV, or certain cancers warrant some adults to receive the pneumonia vaccines before the age of 65.4

What are the side effects of the pneumonia vaccines?

Reactions to the pneumonia vaccine can occur, such as cold-like symptoms, but it is important to realize that those are adverse reactions to the vaccine and not pneumonia itself. Talk to your doctor if you have allergies to any ingredients in vaccines. Below are common adverse reactions to the pneumonia vaccines:

Mild side effects reported with Prevnar 13 can include:2

  • Reactions where the shot was given
    • Redness
    • Swelling
    • Pain or tenderness
  • Fever
  • Loss of appetite
  • Fussiness (irritability)
  • Feeling tired
  • Headache
  • Chills

Mild side effects reported with Pneumovax23 can include:2

  • Reactions where the shot was given
    • Redness
    • Pain
  • Fever
  • Muscle aches

Why are the pneumonia vaccines important?

Vaccines, like the pneumonia vaccines, can prevent or decrease the severity of diseases. Unfortunately, around 50,000 people die from pneumonia in the United States each year.3 It is passed along through airborne droplets, such as from a cough or sneeze, so it is a highly contagious infection.2 It is crucial to receive the pneumococcal vaccine to not only protect yourself but to protect your loved ones around you. Especially if you have a breathing condition like asthma or COPD, it is important to have the pneumonia vaccines to prevent respiratory infections that can potentially make your breathing worse. Talk to your provider or local pharmacy if you are due for your pneumonia vaccine today.

References:

  1. Principles of Vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html. Published September 8, 2015. Accessed February 14, 2019.
  2. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html. Published December 6, 2017. Accessed February 14, 2019.
  3. Top 20 Pneumonia Facts (2018). American Thoracic Society.  https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf. Accessed February 14, 2019.
  4. Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-pneumo. Published January 2019. Accessed February 14, 2019.

 


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searching online for health information - scriptsave wellrx - blog image

When it comes to health information on the internet, many patients are no longer sure what to believe. Just as important, patients often don’t know how to apply what they have read. Healthcare providers have the opportunity to help patients navigate through the vast variety of online health information.

Take the Practice Trends Today quiz (here) from the American Pharmacists Association (APhA) to learn more about helping patients understand the results of their online healthcare searches.

Click Here to take the quiz.


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and get registered to take advantage of our free medication adherence tools.

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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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best-statin-prices - scriptsave wellrx - blog image

by Jenny Bingham, PharmD, BCACP; Heather Lee, PharmD Candidate; Mitchell Welton, PharmD Candidate

In such a competitive cholesterol medication market, manufacturers have been forced to make drastic cuts to their medication costs. Amgen lowered its product by 60%, followed by a 45-70% reduction from Regeneron. The price reductions occurred in response to the national consumer’s options to trial a multitude of more affordable options for cholesterol management, based on their clinical goals.

To better understand each product, a comparison should be made between each medication’s indication, effectiveness, and price.

Praluent

Praluent is an adjunct for patients who have uncontrolled cholesterol levels despite the presence of high intensity statin therapy.1 It is indicated for patients with atherosclerosic cardiovascular disease (ASCVD) who would benefit from an additional reduction of low-density lipoprotein (LDL) cholesterol. Praluent has been reported to reduce cholesterol levels by >=40% of patients who taking a maximally tolerated dose of statin.2 It was also reported to be effective at reducing cardiovascular outcomes and all-cause death by 15% in patients who have acute coronary syndrome.3 The primary patient population that would obtain the most benefit from Praluent are patients who have high LDL cholesterol levels.3 A recent price reduction by Regeneron and Sanofi occurred in May 2018. The price decreased from $14,600/year to a range of $4,500 to $8,000/year via rebate.4

Repatha

Repatha is indicated for the treatment of hyperlipidemia and has been reported to reduce the risk of heart attack and stroke.6 Evidence demonstrates the potential for plaque reduction if used with statin therapy. Amgen recently followed suit with lowering the price of Repatha after competitors Regeneron and Sanofi lowered the price of their competing product as mentioned above. Prior to the lowered cost in October the annual price of Repatha was $14,100/year. Amgen initially offered a prescription savings card for eligible patients, however patients with federal, state, or government-funded healthcare insurance were excluded. The new cost is $5,850/year, a nearly 60% decrease in cost. Amgen recently announced new opportunities for Medicare patients to benefit from therapy as the result of the price cut. 7

What to Ask Your Provider and/or Pharmacist

With the new, more affordable prices, you might be curious if these medications are best for your cholesterol management and cardiovascular health. It’s important to maintain routine appointments with your provider to ensure your cholesterol levels are monitored appropriately. Based upon your lab results and medication history, your provider and/or pharmacist may deem it appropriate to trial one of the above noted medications. However, it’s also important to adhere to provider recommendations about lifestyle changes, like diet and exercise.

References:

  1. Accessdata.fda.gov: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/125559Orig1s000lbledt.pdf. Published 2018. (accessed 29 Nov 2018)
  2. Alirocumab (Praluent) to Lower LDL-Cholesterol. JAMA. 2015;314(12):1284. doi:10.1001/jama.2015.11372
  3. American College of Cardiology: https://www.acc.org/latest-in-cardiology/articles/2018/03/05/15/53/sat-9am-odyssey-outcomes-cv-outcomes-with-alirocumab-after-acs-acc-2018 (accessed 29 Nov 2018)
  4. CNBC. https://www.cnbc.com/2018/05/01/regeneron-sanofi-chop-cholesterol-drug-price-in-express-scripts-pact.html. Published 2018. (accessed 29 Nov 2018)
  5. Repatha (Evolocumab Injection, for Subcutaneous Injection): Side Effects, Interactions, Warning, Dosage & Uses. (n.d.): https://www.rxlist.com/repatha-drug.htm#indications.
  6. CBS News: https://www.cbsnews.com/news/drug-repatha-with-a-statin-could-help-reverse-heart-disease/ (accessed 4 Dec 2018)
  7. CNBC: https://www.cnbc.com/2018/10/24/amgen-cuts-price-of-cholesterol-drug-by-almost-60percent.html (accessed 4 Dec 2018).

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2019 drug formulary changes - scriptsave wellrx - blog image

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!


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pharmacy gag clause quiz - scriptsave wellrx - blog image

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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Pharmacy Gag Clause - pharmacist perspective - ScriptSave WellRx blog image

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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For most Americans, chances are good you’re spending too much on your prescription medications. The increasing cost is staggering. And with so many companies offering discounts on prescriptions, it can sound like a scam. As the saying goes, if it sounds too good to be true, it probably is.

ScriptSave® WellRx is part of Medical Security Card Company, LLC; bringing some of the most advanced technology, pharmacy expertise and customer service in the industry for more than 20 years.

Best Prescription Discounts

While we can tell you what we do and how we really can help you save on your prescription costs, we’d rather let you see what folks who have saved, some who were skeptics, have to say.

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And, yes. We even help with the cost of some pet medications!

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Get your free Rx discount card!

If you need assistance affording your prescriptions, sign up for a free ScriptSave WellRx card or download the free prescription savings app, and save on your medications next time you visit the pharmacy.

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rising insulin costs - scriptsave wellrx blog image

by Eli Kengerlinski, 2019 PharmD Candidate
University of Florida College of Pharmacy

Over the years, insulin prices have increased in accordance with newly developed insulins that have come to market. Traditional insulins, short and intermediate acting, as compared to newer rapid and long acting insulins, are less expensive in market value.1 Biosimilar traditional insulins with expired patents (some since 2000) may be a better option for some patients, as their market price has significantly dropped over the years. However, many patients are still having trouble affording their monthly Lantus or Humalog due to their high copays.

Why is insulin important?

Insulin plays an important role in managing patients with Diabetes Mellitus (DM). Patients with Type 1 DM have limited ability to produce endogenous insulin due to their pancreas’s inability to properly function. Patients with Type 2 DM can also have increased dependence on insulin therapy use as their disease state progresses. It is crucial for certain diabetic patient populations to have insulin at hand as they cannot control their sugar levels with just oral medications (eg. Metformin) that have no effect on insulin production. Type 1 DM population, there’s a greater need for basal (intermediate or long acting) as well as mealtime (rapid or short acting) insulin.

What options do you have?

Lifestyle modifications towards a healthier diet and exercise can be the most important changes any diabetic can make, and help ensure proper management of your condition. Monitoring your daily sugar levels, managing your weight via carb counting or following the plate method2, as well as exercising 30 minutes a day, five times a week, are all great habits to ensure effective DM management.

From January 2014 to July 2018, short and intermediate acting insulins have dropped in price equaling less than half of rapid and long acting insulins in the market today.1 Even if newer insulins offer better sugar control, their high prices make it difficult for patient access. For these specific patient populations, traditional insulins should be considered to ensure patient adherence to DM therapy and prevent patients using less of their insulin. If you’re having trouble paying for your insulin, then ask your provider if short and intermediate acting insulins would be right for you. Also contact your insurance company to see if you qualify for additional programs (eg. Medicare, Medicaid).

Furthermore, ask your provider if there are generic alternatives to your rapid or long acting insulin. For example, Admelog costs 12 to 15% less than Humalog while Basaglar costs about 15% less than Lantus on a per insulin unit basis.3 Therefore, it is important to ask for biosimilar generics that have the same active ingredient as they are usually cheaper.

Another affordable alternative to ensure access to insulin would be switching patients on high cost insulin pens to vials. Even though pens are more convenient and patient friendly, vials should be considered, especially if you’re having trouble affording your insulin. However, do ensure that you are instructed on how to properly inject your insulin.

If you’re still having trouble affording your insulin, ask your local pharmacist for a manufacturer savings card. If you need help with diabetic medications, visit www.wellrx.com for substantial prescription savings at pharmacies throughout the U.S. and Puerto Rico.

REFERENCES:

  1. Eisenberg Center at Oregon Health & Science University. Premixed Insulin Analogues: A Comparison With Other Treatments for Type 2 Diabetes. 2009 Mar 25. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. [Table], Price of Insulin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45287/table/clininsulin.tu1/
  2. Lara Hamilton. “How to Create Your Plate.” Diabetes Forecast, Nov. 2015, diabetesforecast.org/2015/adm/diabetes-plate-method/how-to-create-your-plate.html
  3. “Sanofi Launches Follow-On Insulin Lispro, Admelog.” The Center for Biosimilars Staff, 9 Apr. 2018, www.centerforbiosimilars.com/news/sanofi-launches-followon-insulin-lispro-admelog.

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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