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

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

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

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

Eight Things to Consider on Your Next Doctor Visit:

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

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

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

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

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

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

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

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

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

References

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


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by Nikki Buzzelli

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

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

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Seeking a Second Opinion

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

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

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

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

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

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

The Two-Second Second Opinion

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

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

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

See for yourself the difference a second opinion can make.

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

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

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

We provide more details about each of these below.

What Is Therapeutic Substitution?

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

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

Risks Associated with Therapeutic Substitution

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

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

Can a Pharmacist Change a Prescription to Generic?

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

Could You Save Money by Switching to a Generic Drug?

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Can a Pharmacist Change My Dosage?

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

What is Pharmaceutical Compounding?

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

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

What If My Medication Isn’t Working?

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

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

Potential Interactions

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

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

Adverse Side Effects

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

Insurance Coverage

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

Always Check Your Medication at the Pharmacy Counter

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

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

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

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

How Much Does EpiPen Cost?

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

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

Related: EpiPen Savings Tool

Use Generic Auto-Injectors

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

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

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

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

Use a Prescription Discount Card

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

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

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

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

How Online and Mail-Order Pharmacies Work

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

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Is It Safe to Buy Medication Online?

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

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

How to Protect Yourself When Using Online Pharmacies

To protect yourself, watch out for these red flags.

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

Do Online Pharmacies Save You Money?

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

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

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

Online Patient Portals

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

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

Rx Savings On The Go

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

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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.

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ScriptSave WellRx Marks Silver Anniversary –
25 Years of Prescription Savings, Totaling $10 Billion, and a Brand New Innovation to Help Patients Who View Food as Medicine

A new analysis from the prescription discount program, ScriptSave WellRx, has revealed the savings from the company’s pioneering efforts to lower out-of-pocket costs for millions of patients paying cash for their prescriptions. The results: more than $10 billion dollars of savings, as the company marks its Silver Anniversary with the release of a brand new module that can assist patients with their grocery choices.

Founded in 1994, ScriptSave has been a pioneer and innovator, leading the way in terms of creating tools and programs designed to help un- and under-insured patients better afford their medications. Working in close collaboration with many of the nation’s pharmacy and grocery chains, ScriptSave has created incredible savings opportunities for patients.

With the latest update to the ScriptSave WellRx mobile app, ScriptSave has announced a new wellness-focused tool that provides grocery guidance. Using the new tool, consumers can check:

  • ensure the foods they are eating are consistent with their goals for general wellness
  • choose foods better aligned for pregnancy
  • select appropriate foods for other health conditions, including heart health and diabetes.

Users of the app can even find similar food options that are better aligned with their needs. As with most other programs and offerings from ScriptSave, the ScriptSave WellRx app (and the new grocery guidance toolset) is available to users at no cost.

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ScriptSave Never Stops Innovating

scriptsave wellrx food index imageOther pioneering innovations that are also available (free) in the latest app release include:

  • geo-targeted price-drop alerts for prescriptions medications, allowing users to see when the prices for their own medications come down at nearby pharmacies;
  • medication refill and ‘take your pill NOW’ reminders, helping to ensure prescribed medication adherence, and;
  • medication interaction alerts, to flag possible life-threatening drug or lifestyle interactions.

The newest release of the ScriptSave WellRx app, can help guide shoppers while they browse the aisles at the grocery store or as they take stock of their pantry. It’s a clear expansion outside of ScriptSave’s traditional domain. Moving beyond just pharmacy and prescription medications, the grocery guidance module can guide users towards more health-conscious food selections. It’s designed to help users concerned with chronic conditions like diabetes or heart health, and can help identify appropriate food selections for pregnant women.

These latest innovations to the app’s features are the result of more than two years of ongoing product development. Along the way, the team even managed to pick up a few awards for prototype versions of the app (including as a category winner at the 2017 National Association of Chain Drug Stores’ Product Showcase). ScriptSave’s Vice President of Product & Technology, Shawn Ohri, noted that the timing of this release to coincide with ScriptSave’s Silver Anniversary could hardly seem more fitting or rewarding to the team.

$10 Billion Saved

Meanwhile, an in-depth analysis of the traditional prescription savings programs that ScriptSave has been evolving throughout the course of its 25 years of innovation, shows how the business has helped an estimated 85 million patients in the US save a total of $10 billion on their prescription medication costs. In 2018 alone, the prescription discount program saved consumers $450 million on medications.

ScriptSave WellRx’s free savings cards and prescription coupons—which can be found online or in the mobile app—can help save patients up to 80% on their medications, with average savings of around 60%. In terms of dollars and cents, the average cash saved by patients using ScriptSave WellRx in 2018 was $30.85 per prescription.

Ohri noted that with the ever-increasing prices of medication in the US, ScriptSave WellRx is helping patients pay for the medications they need to not only get over a cold or fever but, in some cases, survive.

“This is our 25th anniversary, and during those years we’ve helped patients save $10 billion on prescriptions they need to get and stay healthy,” said Ohri. “Our prescription discount programs help consumers save money they can use on other critical expenses, like keeping the roof over their heads, putting food on the table for the family and buying school supplies for their kids. We continue to operate with a start-up mentality, bringing new and innovative solutions to help people manage their health and wellness.”

WellRx Mobile App Helps Consumers Find Lowest Prices at the Pharmacysrciptsave wellrx price drop alerts - image

At its core, ScriptSave WellRx negotiates drug prices in bulk with pharmacies across the nation, giving it access to pricing information for most prescription drugs being sold at independent and chain pharmacies. Consumers can access this data at no cost with the free ScriptSave WellRx mobile app and website.

This provides a fast, easy, free way for patients (and physicians) to get a second opinion on what an out-of-pocket cost might be. Patients can price-check all their family’s medications at most pharmacies in any zip code with just one click.

The price-check tool is available for free—no sign-up necessary—and features savings on medications at over 65,000 retail pharmacies across the U.S. In 2018, the program delivered average savings of 60%, with potential savings of 80% or more (relative to the cash price of those prescriptions being filled).

Patients can download the free ScriptSave WellRx mobile app (for iPhone and Android) or visit the website for more information.


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by Haley Stenquist, PharmD Candidate Class of 2019
The University of Arizona College of Pharmacy

A new group of generic medications are hitting the prescription drug market in 2019. At ScriptSave, we get a lot of questions about generic medications vs. brand name prescription drugs. “A” rated generics meet the same quality standards as brand name prescription drugs and so they provide the same medical benefits. A drug that is “A” rated by the FDA as a generic equivalent contains identical active ingredients as the brand name drug, the same dosage as the brand name drug, and delivers the same concentrations of drug to the bloodstream within the same amount of time. So what are the differences and what’s coming to a pharmacy near you?

Are Generic Drugs the Same as Brand Name?

Yes, generic drugs are “copies” of the brand name medication that was developed by a company other than the one that originally brought the branded medication to market. Generic drugs are available for a fraction of the price of brand name medications, so consumers are naturally eager for the generics to hit the market. Per the FDA guidelines, a generic drug application must first display the following parameters:

  • The generic drug is “pharmaceutically equivalent” to the brand
  • The manufacturer is capable of making the drug correctly
  • The manufacturer is capable of making the drug consistently
  • The “active ingredient” is the same as that of the brand
  • The right amount of the active ingredient gets to the place in the body where it has effect
  • The “inactive” ingredients of the drug are safe
  • The drug does not break down over time
  • The container in which the drug will be shipped and sold is appropriate
  • The label is the same as the brand-name drug’s label
  • Relevant patents or legal exclusivities are expired2

How Long Does It Take for a Drug to Become Generic?

After an application for a patent of a new drug is filed with the United States, it is granted patent exclusivity for 20 years.  The path to generic drugs coming to market was made cheaper, easier, and faster after the introduction of the Drug Price Competition and Patent-Term Restoration Act of 1984 or known as the Hatch-Waxman Act. This allowed companies to submit an abbreviated new drug application (ANDA). About one year before the expiration of the patent drug, companies that are wanting to manufacture the generic drug will submit the ANDA to the FDA. Generally, after that patent has expired and the ANDA is approved, a generic counterpart can be introduced into the market.1

First Generic Drug Approvals for 2019

Currently, the FDA has approved 16 first-time generics in 2019 between different manufacturers (each manufacturer must submit their own ANDA). These include:

  • pyridostigmine bromide syrup—Mestinon Syrup
    • Improves muscle strengths in patients with myasthenia gravis
    • Novitium Pharma LLC—03/08/2019
  • levofloxacin ophthalmic solution, 1.5%—Iquix Ophthalmic Solution
    • Treatment of corneal ulcer caused by certain bacteria
    • Micro Labs Limited, India—02/27/2019
  • deferiprone tablets, 500mg—Ferriprox Tablets
    • Treatment of transfusional iron overload due to thalassemia syndromes
    • Taro Pharmaceuticals Industries Limited—02/08/2019
  • sevelamer hydrochloride tablets, 400mg, 800mg—Renagel Tablets
    • Control of serum phosphorus in patient with chronic kidney disease
    • Glenmark Pharmaceuticals Limited—02/08/2019
  • levomilnacipran extended-release capsules, 20mg, 40mg, 80mg, 120mg—Fetzima
    • Treatment of major depressive disorder (MDD)
    • Amneal Pharmaceuticals Company GmbH—02/04/2019
  • acyclovir cream, 5%—Zovirax Cream
    • Treatment of recurrent cold sores in immunocompetent patients over 12 years of age
    • Perrigo UK FINCO Limited Partnership—02/04/2019
  • Wixela Inhub (fluticasone propionate and salmeterol inhalation powder, USP) 100mcg/50mcg, 250mcg/50mcg, 500mcg/50mcg—Advair Diskus
    • Treatment of asthma in patient over 4 years of age and COPD maintenance (250mcg/50mcg)
    • Mylan Pharmaceuticals Inc.—01/30/2019
  • sirolimus oral solution, 1 mg/mL—Rapamune
    • Prophylaxis of kidney organ rejection in patient over 13 years of age
    • Novitium Pharma LLC—01/28/2019
  • vigabatrin tablets USP, 500mg—Sabril Tablets
    • Treatment of refractory complex partial seizures (CPS) in patients over 10 years of age that have failed multiple alternative treatments
    • Teva Pharmaceuticals USA, Inc.—01/14/2019
  • ingenol mebutate gel, 0.05%, 0.015%—Picato Gel
    • Treatment of topical acne
    • Perrigo UK PINCO Limited Partnership—01/07/2019 (0.015%) and 01/09/2019 (0.05%)
  • lurasidone hydrochloride tablets, 20mg, 40mg, 60mg, 80mg, 120mg—Latuda Tablets
    • Treatment of schizophrenia and depressive episodes associated with bipolar disorder in adults
    • Torrent Pharmaceuticals Limited, Accord Healthcare Inc., Lupin Limited, InvaGen Pharmaceuticals, Inc., Amneal Pharmaceuticals Company GmbH—01/03/20193

Newest Generics of 2019

  • As of 03/12/2019, the FDA approved a new generic of Diovan (valsartan) among the vast recalls from multiple manufacturers, this was granted to Alkem Laboratories Limited.4
  • Lannett announced FDA approval for aspirin and extended-release dipyridamole capsules, 25mg/200mg—Aggrenox Capsules for secondary prevention of stroke and transient ischemic attacks (TIA) on 03/27/2019.5

Forecasted Generics for the Remainder of 2019

The Impact of Generics

It is a long, grueling process for a brand name medication to finally be released to the market as a generic, taking in excess of 20 years. Generic medications are instrumental in helping alleviate the financial burden of prescription medication costs in patients. Each year, the effect continues to grow. In the first quarter 2019, there is already a large impact with new generic medications coming to market. This impact is forecast to continue throughout the year, especially with the possibility of heavy hitters such as Lyrica and Restasis.

References:

  1. “S.1538 – 98th Congress (1983-1984): An Act to Amend the Federal Food, Drug, and Cosmetic Act to Revise the Procedures for New Drug Applications, to Amend Title 35, United States Code, to Authorize the Extension of the Patents for Certain Regulated Products, and for Other Purposes.” gov, 24 Sept. 1984, www.congress.gov/bill/98th-congress/senate-bill/01538.
  2. Center for Drug Evaluation and Research. “Generic Drugs – What Is the Approval Process for Generic Drugs?” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/genericdrugs/ucm506040.htm .
  3. Center for Drug Evaluation and Research. “First Generic Drug Approvals.” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/DrugandBiologicApprovalReports/
    ANDAGenericDrugApprovals/default.htm
    .
  4. Office of the Commissioner. “Press Announcements – FDA Provides Update on Its Ongoing Investigation into ARB Drug Products; Reports on Finding of a New Nitrosamine Impurity in Certain Lots of Losartan and Product Recall.” U S Food and Drug Administration Home Page, Office of the Commissioner, fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632425.htm.
  5. “Generic Drug for Stroke Prevention Granted FDA Approval.” Pharmacy Times, pharmacytimes.com/news/genericdrug-granted-fda-approval.
  6. “Pipeline Report Generic Drugs .” Welldynerx. welldynerx.com/content/uploads/2019/02/Generic-Drugs-Feb-2019-2-12-19.pdf.
  7. “Upcoming Generic Drugs.” Corporate Pharmacy Services, corporatepharmacy.com/page/upcoming_generic_drugs.

 

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

In 2014, approximately 4 million people in the United States were infected with hepatitis C virus (HCV).1 According to the Centers for Disease Control and Prevention (CDC), acute HCV infections reported in the United States increased approximately 3.5 times from 2010-2016 (from 850 to 2,967 cases).2 The speculated reasons for this massive increase have been due to increased intravenous drug use (IVDU) as well as more specific & sensitive testing.

There are six genotypes of HCV that have been identified; but of these six, only three make up 97% of HCV infections in the United States.1 These three genotypes include Type 1 (both subtypes a & b), Type 2, and Type 3. HCV was initially discovered in 1989 and since then, a search for a cure has become imminent as HCV plays a major role in the development of chronic liver disease, cirrhosis, hepatocellular carcinoma, and commonly ends in the need for liver transplantation.3

Hepatitis Medications Today

Multiple medications have been proven to treat and/or cure of HCV. A cure is defined as a sustained virologic response (SVR) resulting in an undetectable HCV RNA, 12-24 weeks after treatment is completed.1 In the past, a medication called interferons were used to boost the immune system and attack HCV to defend the body; but in the 2017 AASLD/IDSA Guidelines, interferons are no longer recommended in the treatment of HCV.4 Ribavirin has also been used for acute HCV in the past, but now is only indicated for chronic cases of HCV.7 With both interferon and ribavirin, virological response did not often exceed 50%. Since 2014, four once daily HCV medications have been FDA approved for the treatment of acute HCV in naïve patients that exceed a virological response of 90% after 12 weeks of therapy.4

These more novel hepatitis medications consist of multiple drugs with differing modes of action. There are three classes of drugs that are used to treat HCV and they are called direct acting antivirals (DAA) because they directly attack the HCV genome and replication process.4 These three DAA classes include: NS3/4A Protease Inhibitors, NS5A Inhibitors, and NS5B Polymerase Inhibitors (Nucleoside & Non-Nucleoside).4 All of these medications inhibit replication of HCV in the host cell, stopping the life cycle and preventing its transmission to other host cells. Below is a picture that further explains the mechanism of action of each DAA along with each HCV drug and its corresponding DAA class.5

hepatitis c vaccinations - scriptsave wellrx blog imageDirect Acting Antiviral Classes5

  • NS3/4A Protease Inhibitors
    • Boceprevir
    • Telaprevir
    • Simeprevir
    • Asunaprevir
    • Paritaprevir
    • Grazoprevir
    • Glecaprevir
  • NS5A Inhibitors
    • Daclatasvir
    • Ledipasvir
    • Ombitasvir
    • Elbasvir
    • Velpatasvir
    • Pibrentasvir
  • NS5B Polymerase Inhibitors
    • Sofosbuvir
    • Dasabuvir

Comparing Four Novel HCV Medications6

As mentioned previously, there are four HCV medications approved by the FDA that are one pill taken once daily and can result in cure. These medications include Harvoni (ledipasvir/sofosbuvir), Zepatier (elbasvir/grazoprevir), Epclusa (velpatasvir/sofosbuvir), and Mavyret (glecaprevir/pibrentasvir). Harvoni was approved by the FDA in 2014, Zepatier and Epclusa in 2016, and finally Mavyret in 2017. This is relevant because the two more recent drugs, Epclusa and Mavyret, treat all 6 genotypes of HCV while Harvoni and Zepatier are both first line therapy for genotypes 1 and 4.7

Unlike their differing genotype coverage, side effects for all four of these medications are quite similar. The most common side effects include headache, fatigue, and nausea and the instances for these side effects are approximately 16%, 13%, and 9%, respectively. Other more severe side effects (anemia, diarrhea, insomnia, and irritability) have been reported with these medications but only in combination with interferon or ribavirin as well as with prolonged therapy between 16-24 weeks.5

Cost of Therapy

According to current HCV Guidelines, Harvoni, Zepatier, and Epclusa require 12 weeks (84 days) of therapy.7 Mavyret can be either 8 weeks (56 days) or 12 weeks of therapy depending on the patient’s baseline liver disease.7 Unfortunately, considering both the high cost of medication as well as the long duration of therapy does not allow all patient’s to receive treatment. Harvoni and Epclusa have generics available for patients, and the Brand Name options of Zepatier and Mavyret are thankfully in the same price range as the other generic options. The cost of one tablet for these medications is as follows:6

  • Harvoni:
    • Brand Name: $1,350
    • Generic: $500
  • Epclusa:
    • Brand Name: $1,050
    • Generic: $350
  • Zepatier:
    • Brand Name: $300
  • Mavyret:
    • Brand Name: $200

Because these medications are very costly, a 12-week drug treatment regimen of therapy ranges from $16,800 to $113,400. This is a problem. Many patient’s simply do not have this amount of money to spend on one prescription. This further leads to controversial discussions because as mentioned earlier, HCV plays a major role in the development of chronic liver disease, cirrhosis, hepatocellular carcinoma, and commonly ends in the need for liver transplantation.3

Fortunately, there are patient assistance programs and copay cards offered by the manufacturers of these medications which allow a minimum cost of $0 with patient assistance programs and a minimum cost of $5 for copay cards per 4-week supply. Harvoni and Epclusa are manufactured by Gilead Sciences, Zepatier is manufactured by Merck, and Mavyret is manufactured by AbbVie.

Patient assistance programs require paperwork completed by the patient as well as the prescribing physician. Copay cards only work for Brand Name medications and most commonly require private insurance as a primary payor (not government funded insurances such as Tricare, Medicare, or Medicaid). For more information, check out these websites:

If you need help affording other prescription medications, visit www.WellRx.com. Many prices are lower than insurance copay costs!

References

  1. Kohli A, Shaffer A, Sherman A, Kottilil S. Treatment of hepatitis C: a systematic review. JAMA. 2014;312(6):631-640.
  2. Centers for Disease Control and Prevention. Surveillance for viral hepatitis – united states, 2016. https://www.cdc.gov/hepatitis/statistics/2016surveillance/commentary.htm. Accessed on February 13, 2019.
  3. Chen SL, Morgan TR. The natural history of hepatitis c virus (hcv) infection. Int J Med Sci. 2006;3(2):47-52.
  4. Geddawy A, Ibrahim YF, Elbahie NM, Ibrahim MA. Direct acting anti-hepatitis c virus drugs: clinical pharmacology and future direction. J Transl Int Med. 2017;5(1): 8–17.
  5. Dugum M, O’Shea R. Hepatitis c virus: here comes all-oral treatment. Clev Clin J Med. 2014;81(3):159-172.
  6. HCV Treatments: Harvoni, Zepatier, Epclusa, & Mavyret. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. February 13, 2019.
  7. Recommendations for testing, managing, and treating hepatitis c. Joint panel from the American Association of the Study of Liver Disease and the Infectious Diseases Society of America. https://www.hcvguidelines.org. Accessed February 13, 2019.

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by Katie Tam, PharmD Candidate
Class of 2019, University of Arizona

Do you wake up in the middle of the night feeling as if your lower legs are paralyzed and cramped? Do your lower leg muscles feel as if they are hard to the touch and tight? If you experience these symptoms, you may have nocturnal leg cramps.

What are Nocturnal Leg Cramps?

Nocturnal leg cramps (leg cramps at night), also called Charley horses, are involuntary contractions or spasms of the muscles in the legs that usually occur during the night. These leg cramps often involve the posterior calf muscles, but can also involve the feet or thigh muscles. Because the muscles are tightened and knotted, nocturnal leg cramps are extremely painful sensation. Symptoms of straining, tightening, cramping, and knotting may last up to 10 minutes per episode.1 Since leg cramps can last for a while, the patient may experience muscle tenderness and soreness for up to a day after symptoms are gone. Nocturnal leg cramps are more common in women and in adults over the age of 50.1 Laboratory evaluation and specialized testing are usually not necessary to confirm diagnosis.

Are Nocturnal Leg Cramps the Same as Restless Leg Syndrome? 

In a word, no. Nocturnal leg cramps are not the same as RLS (Restless Leg Syndrome).

Nocturnal Leg Cramps Restless Leg Syndrome
Usually occurs at night or at rest Usually occurs at night or at rest
Cause pain and cramping Cause discomfort and crawling sensation
Stretching the muscle relieves pain Moving the legs relieves discomfort

Causes of Nocturnal Leg Cramps

The exact cause of nocturnal leg cramps is often unknown. However, there are several factors that may increase your risk of leg cramps:

  • Sedentary lifestyle
  • Over-exertion of the muscles from exercise
  • Standing for long periods of time
  • Improper sitting position, like crossing your legs1

The following medical conditions are also known to cause nocturnal leg cramps:

  • Pregnancy
  • Endocrine disorders (diabetes, hypothyroidism)
  • Structural issues (flat feet, spinal stenosis)
  • Neurodegenerative disorders (Parkinson’s disease)
  • Neuromuscular disorders (myopathy, peripheral neuropathy)
  • Medications (diuretics, intravenous iron sucrose, raloxifene, statins, naproxen, conjugated estrogens, beta agonists)
  • Dehydration/electrolyte imbalances2

Management and Treatment of Leg Cramps

  1. Stretch: The best method to relive pain and cramps is to stretch the affected muscle and hold the stretch for one minute.
  2. Exercise: Walking around sends a signal to the muscle that it needs to relax after contracting, which will help ease the leg muscle.
  3. Massage: Kneading, rubbing, and massaging the affected muscle can also relieve the cramps.
  4. Apply heat: Other methods that have shown some benefit include taking warm baths and showers, and applying a hot towel or pad to the affected area to relax the tight muscles.2
  5. Over the counter medications: No current medications have shown safe and effective results in patients with nocturnal leg cramps. However, calcium channel blockers (diltiazem), vitamin B12 complex, carisoprodol (Soma) have some good evidence and may be considered in some patients.3 Magnesium have some benefit in pregnant patients and mixed results in non-pregnant patients with leg cramps. No evidence supports the use of nonsteroidal anti-inflammatory drugs (naproxen), potassium, or calcium.3

Prevention and Self-Care Strategies:

  1. Hydration: Drink lots of water and fluids every day to keep your body hydrated and help your muscles contract and relax more. Men should drink 15.5 cups (3.7 liters) of fluids and women should drink 11.5 cups (2.7 liters) of fluids a day.
  2. Stretch before bed: If you experience nocturnal leg cramps, stretch your calf muscles for a few minutes before bed.
  3. Doing light exercise: Walking around your neighborhood or house before bedtime may help prevent leg cramps at night.
  4. Wearing comfortable shoes: Wearing shoes that support your feet can help prevent leg spasms.
  5. Untucking the covers: Loosening the bed covers at the foot of the bed will give your legs more space to move and prevent cramps.1

The next time you experience nocturnal leg cramps, identify the cause. Then, try one of the treatment methods to relieve your leg cramps. After resolving your leg cramps, use the self-care strategies to help prevent future leg cramps. However, if your leg cramps persist for long periods of time and occur every day, talk to your physician to determine whether or not you have leg cramps or other alternative medications that are appropriate.

Resources:

  1. Leg Cramps at Night. https://my.clevelandclinic.org/health/diseases/14170-leg-cramps-at-night. Accessed January 10, 2019.
  2. American Academy of Family Physicians. Nocturnal Leg Cramps. Accessed January 10, 2019.
  3. Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53(7):494–496.

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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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alternatives toSudafed for HBP patients - allergy image - scriptsave wellrx

by Katie Tam
PharmD Candidate Class of 2019, University of Arizona

It’s allergy season and you can’t breathe the fresh air because your nose is congested and stuffed. You visit the pharmacy and purchase a box of Sudafed. Your pharmacist asks if you have a history of high blood pressure, and you answer “yes.” The pharmacist replies that she does not recommend Sudafed for you, but why?

What you need to know about Pseudoephedrine:

Brands of common over-the counter decongestants that contain pseudoephedrine: Allegra-D, Alka Seltzer Plus Cold Medicine Liqui-Gels, Aleve Cold and Sinus Caplets, Benadryl Allergy and Sinus Tablets, Claritin-D Non-Drowsy 24 Hour Tablets, Robitussin Cold Severe Congestion Capsules, Sudafed 24 Hour Tablets, SudoGest, Wal-phed 12 hour, Suphedrine.2

Indications: nasal congestion, sinus congestion, and Eustachian tube congestion

Adverse side effects of pseudoephedrine:

  • Common: insomnia, nervousness, excitability, dizziness, and anxiety
  • Infrequent: tachycardia (rapid heart beat) or palpitations
  • Rare: dilated pupils, hallucinations, arrythmias (irregular heartbeat), high blood pressure, seizures, inflammation of the large intestine, and severe skin reactions

Contraindications for pseudoephedrine:

  • Diabetes mellitus
  • Cardiovascular disease
  • Severe or uncontrolled high blood pressure
  • Severe coronary artery disease
  • Prostatic hypertrophy
  • Hyperthyroidism
  • Closed angle glaucoma
  • Pregnant women

Pseudoephedrine and High Blood Pressure Interaction

In 2005, a study showed that pseudoephedrine increased systolic blood pressure and heart rate, but had no effect on diastolic blood pressure.1 They also found that higher doses and immediate-release formulations of pseudoephedrine were associated with higher blood pressures.1 In addition, the study revealed that patients with well controlled hypertension had higher systolic and diastolic blood pressures after taking immediate release pseudoephedrine formulations.1

What are safe alternatives to pseudoephedrine in patients with high blood pressure?

There are a few safe and effective alternatives to pseudoephedrine in patients with high blood pressure that can relieve nasal or sinus congestion symptoms. Placing a humidifier in the bedroom keeps moisture in the air, which helps prevent your nasal passages from drying out. Humidifiers can also help break up mucus and soothe inflamed nasal passageways.3 In addition, propping your head up on 2 pillows may help the mucus flow out of your nose and relieve some congestion. Saline sprays are also another safe option that can loosen congestion and improve drainage.3 If a patient with high blood pressure insists on taking a medication that includes pseudoephedrine, their pharmacist or physician will recommend the patient to monitor their blood pressure and take a sustained-release formulation to reduce the risk of increasing blood pressure.3

Next time you have sinus or nasal congestion, ask your physician before using pseudoephedrine if you have high blood pressure. Your local pharmacist can also help manage nasal congestion symptoms, provide valuable information regarding safer alternatives, and ensure optimal drug selection in patients with high blood pressure.

Resources:

  1. Salerno SM, Jackson JL, Berbano EP. Effect of Oral Pseudoephedrine on Blood Pressure and Heart Rate: A Meta-analysis. Arch Intern Med. 2005;165(15):1686–1694. doi:10.1001/archinte.165.15.1686.
  2. Radack  KDeck  CC Are oral decongestants safe in hypertension? an evaluation of the evidence and a framework for assessing clinical trials.  Ann Allergy 1986;56396- 401.
  3. High Blood Pressure and Cold Remedies: Which Are Safe? Mayo Clinic.  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/high-blood-pressure/faq-20058281. Published January 09, 2019. Accessed January 20, 2019.

 

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