food allergies and medicine -scriptsave wellrx blog image

by Samantha McKinnon, PharmD Candidate 2019
University of Arizona College of Pharmacy

Nearly 20% of Americans have self reported an allergy to a medication and roughly 4% of the nation suffers from some form of food allergy.1 While it would seem obvious to avoid something if you’re allergic to it, you’d first have to know you’re allergic. When it comes to medications this can be challenging.

There are different grades to an allergic reaction. It could be as mild as some pesky itching or a cough; a more serious fever, rash or painful blisters; or very serious blood irregularities, difficulty breathing or death.2,3 Allergic reactions can occur within many different classes of medications such as antibiotics, antidepressants, anesthetics, narcotics, nonsteroidal anti-inflammatory drugs (NSAIDs), among others.1

Excipients – Crucial for Drug Delivery

When you take medication, there is more than just an active drug inside the tablet, capsule, spray or syrup; these additional “inert” products are called excipients4. Excipients play a variety of roles in medications. They are used to stabilize the active drug, bind the active drug(s), increase the solubility, enhance or delay absorption (such as enteric coated tablets), and provide flavor or sweetness.4 Some excipients come from foods that people have an allergy to. The most common food allergies in the United States are milk, egg, peanut, soy, fish, and gluten.5 The Food Allergen Labeling and Consumer Protection Act (FALCPA) was enacted to inform patients if a major allergen was in their food, even in trace amounts. This carries over to medications, however, this information comes and stays with the original bottle, it will not be transferred to the prescription label. These food and drug allergies are why the pharmacy will ask for your allergy information when creating your profile and before dispensing any medications. Different manufacturers use different excipients in their preparations, so you may be allergic to one brand and okay to take a different brand. If you would like to know if an allergen is in your prescription, ask your pharmacist.

Milk: Milk allergy, sometimes called lactose intolerance causes discomfort in the digestive tract whenever dairy products are consumed. There are other enzymes in milk that people may be allergic to such as casein. Lactose is used as a stabilizer in some asthma inhalers and as a filler (excipient) in some tablets. Other milk products can be found in TUMS smoothies, as well as some vaccines, so be sure to ask your doctor or pharmacist to avoid an allergic reaction.5,6

Egg: Those with an egg allergy should be cautious of vaccines that use egg as a stabilizer and certain hospital drugs for intravenous use as some patients have had an anaphylactic reaction. The CDC has said that the Flu vaccine is safe, even in people with an egg allergy but there are egg-free versions of the vaccine available. IV Benadryl and the sedative propofol are two medications that contain egg. Again, make sure any health care professional that considers you a patient knows your allergy history as it is important for your safety.5,6

Peanut: Peanut is a well-recognized allergy alert and as such is not found in many medications. The package inserts for progesterone capsules and valproic acid capsules have peanut as an ingredient. Dimercaprol lists peanut oil and there is peanut oil in some asthma inhalers and the topical medication fluocinolone.6  There are alternatives to any of these medications for anyone with a peanut allergy that would also need one of these medicines.

Soy: Soy can be listed as soy or as one of its derivatives – lecithin. Again, it can be found in some inhalers and propofol5. Some over the counter products I’ve discovered that have soy are Advil liquid-gels, TUMS smoothies, and black cohosh (an herb sometimes used to treat perimenopause and menopause symptoms). Be sure to read the ingredient list when choosing an over the counter medication or ask your pharmacist if you are unsure if an allergen is in a product.

Fish: Fish products can be found in some (not all) multi-vitamins and supplements, which highlights the importance of reading labels. A reversal agent for the anti-coagulant heparin called protamine contains some derived fish products. NPH insulin also contains some fish oil, so diabetic patients with a fish allergy needing a short acting insulin could choose a different insulin.3,5 There are case reports of patients with a fish allergy trying fish oil and not experiencing a reaction, if you would like to try the fish oil test then ask your doctor.

Dyes: One final excipient that causes a reaction in some patients is medical dye. Most specifically FD&C Blue 1, Blue 2, Red 4, and FD&C Yellow 5. These colors can be used in many different medications, your doctor or pharmacist would need to check to ensure these dyes aren’t in any of your medications7.

This is not a complete list of possible allergens or medications that may contain allergens. If you have ever experienced a reaction to a food, medicine, or dye be sure to inform your primary care doctor, pharmacist, and any specialists that you see. Document your reaction so that you can remember what happened if a health professional asks you about your allergy. Questions about possible allergens can be answered by your prescriber, pharmacist, poison control center, or manufacturer of your medication so never hesitate to call and ask. Any patient that has ever experienced an anaphylactic reaction should wear a bracelet advertising the allergy.

 

References

  1. Macy E, Ho NJ. Multiple drug intolerance syndrome: Prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol2012; 108:88–93
  2. Stevenson, DD. Sanchez-Borges M. Szczeklik, A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunology 2001; 87:177
  3. Demoly P, Adkinson NR, Brockow K, et al. International Consensus on Drug Allergy. Allergy 69:420-437, 2014
  4. Lesney, Mark S. More than just the sugar in the pillToday’s Chemist at Work. 10(1): 30–6, 2001
  5. Kelso JM, Davis C. Food Allergy Management. Immunology and Allergy Clinics of North America 2018; 38:53-64
  6. Kelso JM. Potential food allergens in medications. Journal of Allergy and Clinical Immunology. Jun 2013; 133(6):1509-18
  7. Swerlick RA, Campbell CF. Medication dyes as a source of drug allergy. Journal of Drugs in Dermatology. Jan 2013; 12(1):99-102

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why children need to play - scriptsave wellrx blog image

by Pattiya Wattananimitgul

When you think of a child’s development, you might think of good education, nutritious food, and a caring family. Play is likely not on the top of your list if it’s on your list at all, but it should be. In this post, playing means active activities that would engage children’s bodies and minds in imaginative and creative ways and not passive activities, like sitting in front of the screen playing computer or video games. Some examples of healthy, active activities are pretend plays, hide-and-seek, and board games. In this day and age, fast-paced lifestyle, family structure changes, and increased focus on academics are contributing to less free time for children to play.1 Some parents might think playing is useless or a waste of time. However, scientific studies show that play is crucial in children’s development.2 Here are some reasons why children need to play:

Strengthen “cognitive, physical, and emotional well-being of children”

Play is crucial to the development of the brain because it lets children use their creativity and imagination. By playing, they are able to make decisions, solve problems, and think for themselves. It allows them to explore the world around them, overcome their fears, and develop skills to deal with future challenges.1  Play also helps release stress, which help fortify children’s emotional well-being and reduce the risk of developing behavioral health problems.2 All these combined also lead to better academic outcomes.

Improve teamwork and social skills

Play allows children to work in groups, share, negotiate, boost confidence, solve problems, and learn how to respond to people’s feelings.1 It helps them develop social interaction skills and get along better with others.

Reduce obesity

Research shows that there is a link between decline in active outdoor play and increase in childhood obesity.2 About 18.5% of children and adolescents in the United States are obese, which increased more than three times the percentage from the 1970s when plays was more common.3,4  Obesity leads to complications such as high blood pressure and diabetes. According to Alliance for Children, doctors are warning that children today may be the first generation in two centuries to have a shorter duration of life than their parents. Active play increase children’s physical activities and therefore decrease childhood obesity epidemic.2

Discover their interests

Play allows children to explore in many different areas and discover interests without giving them any unrealistic expectations or pressure to be outstanding in each area. This would ultimately lead them to find their own passions they would like to pursue in the future.1

Open up opportunities for parents to engage with their children

Play would help build stronger bond with your children and better relationship with them. This would also give you opportunities to learn how to communicate with your children more effectively and give them nurturing guidance.1

By letting your children play and letting them be kids, it would strongly benefit them in the long run and help them become happy, healthy, and successful adults. Lastly, your pharmacist is a great resource to any questions you might have or to learn more about your children’s health and well-being.

 

References

  1. Ginsburg, K. R. (2007). The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics, 119(1), 182-191. doi:10.1542/peds.2006-2697
  2. Miller, E., & Almon, J. (2009). Crisis in the Kindergarten: Why Children Need to Play in School. College Park, MD: Alliance for Childhood.
  3. Childhood Obesity Facts. (2018, June 13). Retrieved August 10, 2018, from https://www.cdc.gov/obesity/data/childhood.html
  4. Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963–1965 Through 2011–2012. (2014, September 19). Retrieved August 10, 2018, from https://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm

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immunization changes for 2018 - scriptsave wellrx blog image

by Samantha McKinnon, PharmD Candidate 2019
University of Arizona College of Pharmacy

With flu season right around the corner, what better time to talk about vaccines than right now?  We talk and hear about vaccines a lot, but what exactly is a vaccine, and which vaccine is right for you?

What is a vaccine?

In the simplest terms, a vaccine is medicine created from weakened or dead disease-causing germs given to you to help prevent you from getting sick or prepare your body in case you are infected.1 Vaccines can be created using different strategies, depending on who the vaccine is intended for and what disease is trying to be prevented.  There are live, inactivated, recombinant and toxoid vaccines; each serves a different purpose and treats a different germ.1 The way they work is to expose you to a small and safe amount of the germ so your body will recognize it in the future by creating antibodies.  Antibodies are what allow your body to fight off infections or you experience a much milder version of the illness.2   You may sometimes see terminology like “trivalent” or “quadrivalent” when you’re looking at different flu vaccines.3 Trivalent vaccines contain three different strains of virus whereas quadrivalent vaccines contain four different strains of virus.  There also “high-dose” flu vaccine formulations, these formulations contain extra amount of virus material to help people create more antibodies.1

Live vaccines

Live vaccines are also called sometimes called “attenuated” – which is a fancy term for “weakened”. Some examples of live vaccines you or children may have received would be measles, mumps, rubella (MMR), chickenpox or even smallpox.  Live vaccines take the entire virus and weaken it so that it can’t get you as sick as the regular beefed-up virus.  Imagine you have two runners getting ready to run a marathon, but one of the runners has 20-pound boots on, who will win the race?  It’s going to be much harder for the runner with boots to cross the finish line, this is essentially what attenuating viruses do.  Live vaccines do come with some risks, especially to people with weaker immune systems such as someone that had an organ transplant or someone with cancer.

Inactivated vaccines

Vaccines that inactivate the virus also use the entire virus but instead of being weakened like a live vaccine, it is completely dead.  Inactivated vaccines are the typical flu shots, polio and rabies.  Because these germs are completely dead you will not get sick, but this means you will also not be immune and need more frequent shots.3 This is one reason for an annual flu shot.

Recombinant vaccines

Recombinant is technical term that basically means mixed up, it would be like switching some letters around in the alphabet to be CBADEFG instead of ABCDEFG, it’s still the alphabet but not in the exact order it used to be.  These vaccines use only very specific pieces of the germ, a “target”, which will create a strong response in the person receiving the shot.  The bonus is that the vaccine does not have the entire germ, so you won’t get sick and they can be used on more people than live or inactivated vaccines – a big plus for patients with weaker immune systems.  Some recombinant vaccines currently used are for Hepatitis B, meningitis, shingles and whooping cough.

What changed for this year?

Now that you know about all the different kinds of vaccines we can talk about the new changes for this year.  Besides the World Health Organization (WHO) and the Centers for Disease Control (CDC) there is also another government body called The Advisory Committee on Immunization Practices (ACIP) that provides recommendations for what immunizations are needed and when.  Previous flu seasons did not have very good coverage against H1N1 so live viruses were not recommended for children.  That has changed this year, ACIP has recommended that eligible patients receive the FluMist intranasal spray, a live attenuated vaccine, this is good news for parents and kids as there is no needle and no shot.4 The recombinant flu shot called Flublok is recommended for pregnant women. For the older population there has been a change to the zoster vaccination recommendation.  ACIP recommends the recombinant Shingrix vaccine for prevention of shingles in adults over the age of 50.4 Shingrix is a two-dose vaccine just like the previous shingles vaccination Zostavax but has been found to be more effective than Zostavax, most especially in patients over the age of 80.5 The final changed recommendation is in regard to the live MMR vaccine.  Traditionally it has been a two-dose vaccine and that covered you for life.  With recent measles outbreaks, patients living in an area with an outbreak are recommended to receive a third dose of MMR.5

What vaccine is right for you?

The CDC releases an immunization schedule for all patient populations and revises it as new evidence comes to light.  The recommendations from ACIP have allowed the CDC to release a newly revised immunization schedule effective for 2018.  Based on your age and your health you may get different versions of vaccines or vaccinated at different times in your life than other people.  Your provider or pharmacist would be happy to let you know which vaccines are right for you and when, since some vaccines are age-specific.  It is especially important to let health professionals treating you know your health status and social history such as if you smoke tobacco or drink alcohol, if you’ve recently been sick or had a fever, what kind of environment you work in, if you’ll be around newborns or elderly people, your HIV status or if you have liver problems or blood factor issues as well as any allergies.  If you travel outside of the US, especially to an area that requires you to use antivirals, let your prescriber know as this may affect your vaccinations.  Some countries also require special immunizations before you may be allowed to enter, be sure to check these recommendations on the CDC website.

The importance of getting vaccinated

Diseases like polio, measles, whooping cough, flu can be prevented with vaccines.  Without vaccines people that caught these viruses could be paralyzed, blinded, lose their hearing, or even die.  In 2015 there were 710,000 people hospitalized for flu and over 56,000 of them died.  There are some patients that can not be vaccinated and depend on others to be vaccinated so they do not get sick.  This is called “herd immunity,” the more people that are vaccinated, the healthier everyone will be.  So don’t wait, get vaccinated today!

 

References

  1. www.vaccines.gov/basics
  2. www.newsinhealth.gov/nih/2016/07/safeguarding-our-health
  3. Felicilda-Reynaldo RF, “Types of flu vaccines for yearly immunization.” MedSurg Nursing, July-Aug. 2014, p. 256
  4. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices United States 2018-2019 influenza season. MMWR Morb Mortal Wkly Rep 2018.
  5. Kim DK, Riley LE, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older – United States, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:158.

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does sunscreen cause cancer - scriptsave wellrx blog image

by Pattiya Wattananimitgul

According to the Centers of Disease Control and Prevention (CDC), approximately 5 million Americans are treated with skin cancer each year.1 Overexposure of ultraviolet (UV) rays from the sun is proven to be a major cause of skin cancer.2 In fact, approximately 90% of all skin cancers are associated with exposure to the sun’s harmful rays.3 One way to protect your skin from the harmful UV rays is wearing a sunscreen. However, you may have heard that ingredients in sunscreens can cause cancer, and not just skin cancer but also breast, prostate, and other types of cancer.4 But is it true? Does sunscreen, which is supposed to protect us from skin cancer, actually lead to cancer and other health problems?

Oxybenzone

Oxybenzone is a common active ingredient in sunscreens that absorbs the UVA and UVB radiation and then dissipates it as heat.5 Oxybenzone penetrates through the skin, and then gets metabolized and excreted through urine and feces.6 Some studies suggest that oxybenzone may have an impact on the endocrine system, disrupting hormone levels and potentially causing hormone-related cancer. These studies were actually done on rats. A human study suggested that oxybenzone, even at a high concentration, does not cause hormone disruption. The conclusion is that oxybenzone is an FDA-approved chemical to protect your skin from the sun’s radiation, and currently there is not enough evidence to prove or suggest that oxybenzone causes hormone disruption and cancer in humans.3,7,8

Retinyl Palmitate

Retinyl palmitate is another ingredient commonly added to sunscreens as a skin conditioner. It is a form of vitamin A, known to help slow down premature skin aging. There is some concern, based on a small number of studies, that the free radicals generated from retinyl palmitate may cause changes to our cells and cause skin cancer. However, no studies suggested that these changes are cancerous or increase cancer risks.3,7,8 In fact, a form of vitamin A called retinoids has been used for decades to help protect people with high risk of developing skin cancers from getting skin cancer, according to the American Academy of Dermatology.9

Zinc Oxide and Titanium Dioxide

Zinc oxide and titanium dioxide are nanoparticles that physically protect your skin from UVA and UVB radiation. Some studies indicated that these active ingredients can be absorbed in the skin and cause cells damage. However, according to current studies, these nanoparticles stay on the skin’s surface and do not penetrate the skin when applied.3

Protect Yourself from UV Rays

The main takeaway is that you should always wear sunscreen when going outside, even when it’s cloudy. The known benefits of regular sunscreen use outweigh the unproven risks of potential toxicity. The type of sunscreen you use is up to you, whether it is chemical or physical. However, make sure the ingredient protects both UVA and UVB radiation (broad-spectrum) with SPF of at least 30. Below is a chart by the Skin Cancer Foundation of US Food and Drug Administration (FDA)-approved active ingredients that can be found in sunscreen and their UV action spectrum.3 When using sunscreen, make sure to cover all the exposed skin and reapply the sunscreen every two hours, or right after swimming or sweating. Other ways to protect yourself from the harmful UV rays are9:

  • Seeking shade between 10 a.m. to 2 p.m., when the sun’s rays are strongest
  • Wearing protective clothing such as lightweight long sleeve shirt, pants, broad-brimmed hat, and UV-protection sunglasses
  • Avoiding tanning beds

active ingredients in sunscreen - scriptsave wellrx blog image

Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective?
Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective

Resources

  1. Cancer Prevention and Control. (2015, September 03). Retrieved August 6, 2018, from https://www.cdc.gov/cancer/dcpc/research/articles/sunscreen-use.htm
  2. The Facts About Sunscreen. (2018, January 11). Retrieved August 6, 2018, from https://www.melanoma.org/understand-melanoma/preventing-melanoma/facts-about-sunscreen
  3. Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective? Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective
  4. Do Sunscreens Cause Cancer? (2018, June 12). Retrieved August 6, 2018, from https://sciencebasedmedicine.org/do-sunscreens-cause-cancer/
  5. How does sunscreen work? (2017, August 14). Retrieved August 6, 2018, from http://www.loc.gov/rr/scitech/mysteries/sunscreen.html
  6. Jiang, R., Roberts, M. S., Collins, D. M., & Benson, H. A. E. (1999). Absorption of sunscreens across human skin: an evaluation of commercial products for children and adults. British Journal of Clinical Pharmacology, 48(4), 635–637. http://doi.org/10.1046/j.1365-2125.1999.00056.x
  7. Janjua, N. R., Mogensen, B., Andersson, A., Petersen, J. H., Henriksen, M., Skakkebæk, N. E., & Wulf, H. C. (2004). Systemic Absorption of the Sunscreens Benzophenone-3, Octyl-Methoxycinnamate, and 3-(4-Methyl-Benzylidene) Camphor After Whole-Body Topical Application and Reproductive Hormone Levels in Humans. Journal of Investigative Dermatology,123(1), 57-61. doi:10.1111/j.0022-202x.2004.22725.x
  8. Can the chemicals in sunscreen cause cancer – Canadian Cancer Society. (n.d.). Retrieved August 6, 2018, from http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/be-sun-safe/can-the-chemicals-in-sunscreen-cause-cancer/?region=on
  9. Is sunscreen safe? (n.d.). Retrieved August 6, 2018, from https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent/is-sunsceen-safe

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medications can increase your fall risk - scriptsave wellrx blog image

by Roxanna Orsini
PharmD Candidate Class of 2019, University of Arizona

Falls Happen More Often Than You Think

Every year there are millions of falls occurring in the older population, aged 65 and older.2 About 1 out of 4 older people fall each year, with less than half reporting it to their doctor.2 Your chances of a recurrent fall doubles after your first fall. The emergency department (ED) treats about 3 million older individuals for fall injuries each year.2 The most common injuries seen in the ED after a fall includes fractures, superficial injuries, and head injuries.(2,3) Patients have reported a reduction in their quality of life up to 9 months after being admitted in the ED for a fall.3

After a fall you may develop a fear of falling. This can cause negative health effects including:3

  • Recurrent falls
  • Reduced physical activity
  • Restriction or avoidance of social activities
  • Depression/anxiety

Are You at Risk for a Fall?

Here are a few questions to help you determine if you are at risk of a fall:5

  • Do you rush to use the bathroom?
  • Do you take a medication to help you sleep or improve your mood?
  • Do you take a medication that sometimes makes you feel light-headed or more tired than usual?
  • Do you use or have been advised to use a cane or walker?
  • Have you lost some feeling in your feet?
  • Do you feel unsteady when walking at times?
  • Have you had a previous fall?

Answering yes to any of these questions should warrant a conversation with your doctor about getting screened for your risk of falling.

There are certain chronic medical conditions that can contribute to your chances of a fall such as arthritis, dementia, stroke, cataracts, Parkinson’s disease, and urinary incontinence.1 Some of the medications used for these health conditions can increase your risk of a fall. However, falls can be caused by almost any medication that effects your brain or blood circulation.

Some Medications Can Increase the Risk of a Fall

A few medications that can increase your risk of a fall include:3

Most of these medications can decrease your alertness, cause fatigue, dizziness, and drop your blood pressure when you stand up (also referred to as postural hypotension).1

Postural hypotension occurs in about 30% of older adults and may experience one of these symptoms within 1 minute to several minutes of standing up:4

  • Lightheadedness
  • Blurred vision
  • Headache
  • Fatigue
  • Weakness

If you are taking any of these medications, experiencing any of these symptoms or taking more than 6 medications, talk to your doctor about your risk for a fall.4 Your doctor may need to reduce or change your medication to help reduce your symptoms and fall risk, never make any changes to your medication without consulting your doctor first.

Balance, medications, and home safety should be addressed in everyone at high risk.4 To help maintain the highest level of mobility and reduce your chances of falling or risk of injury, follow up with your doctor. Your doctor can provide tips and recommend exercises designed to prevent falls and help avoid unnecessary trips to the Emergency Department.

 

References:

  1. Berg, R. and Cassells, J. (1992). Falls in Older Persons: Risk Factors and Prevention. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK235613/ [Accessed 18 Jul. 2018].
  2. gov. (2018). Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. [online] Available at: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html [Accessed 20 Jul. 2018].
  3. de Jong, M., Van der Elst, M. and Hartholt, K. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety, 4(4), pp.147-154.
  4. Phelan, E., Mahoney, J., Voit, J. and Stevens, J. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), pp.281-293.
  5. Sri‐on, J., Tirrell, G., Kamsom, A., Marill, K., Shankar, K. and Liu, S. (2018). A High‐yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Academic Emergency Medicine.

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Epidiolex: A new CBD epilepsy drug

by Roxanna Orsini,
PharmD Candidate Class of 2019, University of Arizona

Treatments are available that can successfully control seizures for most people with epilepsy. However, there’s a soon-to-be-released medication, recently approved by the FDA, called Epidiolex.

What is Epidiolex?

Epidiolex (cannabidiol) is a new FDA-approved epilepsy medication that is derived from Cannabis Sativa plant (marijuana). Cannabidiol (CBD) does not create feelings of euphoria or intoxication, the “high” that is often experienced with Cannabis, which comes mainly from the compound tetrahydrocannabinol (THC), which is also found in marijuana.

Which forms of epilepsy does Epidiolex treat?

The FDA approved Epidiolex for treatment of seizures associated with two rare and severe forms of epilepsy, in patients two (2) years and older.5

  • Lennox-Gastaut Syndrome
    • Begins in childhood and continues to adulthood with some changes in presentation with age.3
    • Often characterized by multiple types of seizures (particularly tonic and atonic) and an intellectual disability.
    • An EEG (electroencephalogram) can display a classic pattern of background slowing and spike-wave bursts with frequencies less than 2.5 per second. 2
    • Found in 2-5% of childhood epilepsies.2
  • Dravet Syndrome
    • Begins during the first year of life and is a lifelong disease.3
    • This is a rare genetic epileptic brain disease.
    • Infants will have normal development up until an increase in seizure frequency occurs after the first seizure which is often associated with a fever. 1
    • Most children develop some level of developmental disability.
    • Seizures can be triggered by various factors such as body temperature, emotional stress or excitement, and photosensitivity.1

Coming Soon!

While Epidiolex has been approved for release, the expected time to market is September 2018. A few things to know about the medication before it is released:

Effectiveness

The study for Epidiolex involved 3 randomized, double-blind, placebo controlled clinical trials which included 516 patients who had either Lennox-Gastaut Syndrome or Dravet Syndrome.3 Results showed that patients taking Epidiolex along with other anti-epileptic drugs (AEDs) showed a decrease in seizure frequency when compared to the placebo.3

Precautions

Side effects (3,5) are often something to be aware of before starting a new medication. A few reported side effects to Epidiolex include:

  • Elevated liver enzymes
  • Sedation
  • Lethargy
  • Sleep Disorders
  • Diarrhea
  • Rash
  • Increase in suicidal thoughts
  • Decrease in appetite
  • Abdominal discomfort
  • Abdominal pain

Cost

The company has not release any official information about cost for Epidiolex, however NY Times analysis estimates a cost of $2,500 to $5,000 a month.4 It is possible that this medication may be approved by insurances so make sure to discuss options with your provider.

Future Opportunities

Even though this medication is only currently approved for these two forms of seizures, it does open the door to future possibilities.  Always keep communication open with your healthcare provider so they can help guide you on therapy options as more clinical studies arise with new information.

 

References:

  1. Epilepsy Foundation. (2018). Dravet Syndrome. [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome [Accessed 11 Jul. 2018].
  2. Epilepsy Foundation. (2018). Lennox-Gastaut Syndrome (LGS). [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs [Accessed 11 Jul. 2018].
  3. FDA.gov. (2018). FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [online] Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm [Accessed 10 Jul. 2018].
  4. Kaplan, S. (2018). D.A. Panel Recommends Approval of Cannabis-Based Drug for Epilepsy. [online] Nytimes.com. Available at: https://www.nytimes.com/2018/04/19/health/epidiolex-fda-cannabis-marajuana.html [Accessed 5 Jul. 2018].
  5. Micromedexsolutions.com. (2018). Micromedex Products: Please Login. [online] Available at:
    http://www.micromedexsolutions.com/micromedex2/librarian/CS/B42F8E/ND_PR/evidencexpert/ [Accessed 5 Jul. 2018].

 


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Your child's medication during school hours - ScriptSave WellRx blog image

by Pattiya Wattananimitgul

How to Handle Your Child’s Medication During the School Year

In the United States, more than 263 million prescriptions are dispensed each year for pediatric patients.1 Chances are, your child may need to take their medications at school. If your child has a medication that they need to take during school hours, whether it is a long-term, short-term, or emergency medication, here are some helpful tips for parents and guardians:

Prior to the School Year1,2

  • Ask the pharmacist to put your child’s medications into two different bottles, each with its’ own label. One to be kept at home and one to be kept at school, if school policy allows.
  • Make sure all the prescription medications kept at school are in an original container (ie., no zip-top bags or foil) and labeled by a pharmacist.
  • Make sure all over-the-counter medications (including supplements) kept at school are in the original containers. Some states require a physician’s written consent and a parent written permission for over-the-counter medications. Be sure to check with your school.
  • It is also important for your child to play active roles in their medication. They should be educated about the effective and safe use of their medicine to help avoid improper administration, dosing errors, and non-adherence.

At the Beginning and During the School Year2,3

  • Provide the school with a full list of your child’s medications, including over-the-counter medicines and supplements. Be sure to update the school with any changes throughout the school year.
  • Talk to the school nurse or teacher ahead of time to make sure your child’s medication will be administered correctly (icorrect medication, dosage, route, frequency). Define who will administer the medication, and who will carry the medications during field trips.
  • School staff are not allowed to determine when to administer “as needed” medications. Be sure that your child’s medication includes specific instruction on when to administer and for what indication (ie., every 6 hours as needed for headache).
  • All medications should be transported by adults to adults. DO NOT let your child carry the medications unless they are capable and responsible to self-administer their medication to carry their own medications, especially for emergency medications that need immediate access, as deemed appropriate by the school.

Emergency Medications2

  • Be sure your child is able to get instantaneous access to emergency medications, like epinephrine injections for allergic reaction, glucagon for low blood sugar, or albuterol for an asthma attack.
  • Acetaminophen, ibuprofen, antihistamines are usually available at school in case your child experiences sudden pain or fever such as headaches, toothache, or menstrual cramps. It is important to sign a waiver granting the school permission to administer these medications in case your child experiences these symptoms.

Lastly, most schools and school districts have policies regarding student’s medication handling. It is important for you to check with your school for specific protocols that you need to follow to make sure that your child is getting the proper care.

 

References

  1. Abraham, O., Brothers, A., Alexander, D. S., & Carpenter, D. M. (2017). Pediatric medication use experiences and patient counseling in community pharmacies: Perspectives of children and parents. Journal of the American Pharmacists Association, 57(1), 38-46. doi:10.1016/j.japh.2016.08.019
  2. Administering Medication at School: Tips for Parents. (2016, December 19). Retrieved July 25, 2018, from https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Administering-Medication-at-Child-Care-or-School.aspx
  3. Guidelines for the Administration of Medication in School. (2003). American Academy of Pediatrics, 112(3), 697-699. doi:10.1542/peds.112.3.697

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Cost of not taking your medications image - ScriptSave WellRx

by Roxanna Orsini

It’s a fact. Medications don’t work if patients don’t take them. Taking your medications as prescribed by your physician can help improve the quality and length of your life.

Importance of taking your medications

According to the Centers for Disease Control and Prevention (CDC), nearly 50% of Americans have used at least one prescription with in the last 30 days. One recent study shows that patients who were compliant with taking their statin therapy medications for at least two years had a 30% reduction in the risk of hospitalization for acute myocardial infarctions (heart attacks).1

Even with all the benefits medications can have on a patient’s health, there is still an issue with adherence to medication therapy.

After a patient visits their doctor

  • 20% – 30% of new prescriptions never reach the pharmacy.2
  • Of those prescriptions that do get filled, 50% of the time they are not taken as prescribed by the doctor.2
  • After six months of treatment for a chronic condition, patients tend to reduce the amount of medication they are taking, or stop treatment altogether.

Annual results of medication nonadherence

  • 125,000 deaths and at least 10% of hospitalizations.2
  • Costs the United States health care system between $100 billion and $289 billion annually.2,3

Most common reasons medication treatments are adjusted

Patients often discontinue or alter how they are taking their medications due to a variety of factors. A patient may no longer be adherent to their prescription therapy due to:

  • Cost of the medication
  • Experiencing a potential side effect
  • The patient no longer felt they needed the medication, and,
  • The patient feeling they are currently taking too many medications.

If a medication is too costly, ask your provider if they have any samples to provide, or even ask about possible generic alternatives. Prescription discount services, like ScriptSave WellRx, can often help reduce the cost. You may be surprised to find our cash prices is even lower than your insurance copay! Visit our website to check your medication prices.

When you’re considering an adjustment to your medication therapy, it’s important to follow up and discuss the decision with your healthcare provider. Some medications, if discontinued suddenly, can cause more harm than good.

Ways to improve the way you take your medications

Complications from medication nonadherence are 100% preventable. Here are a few tips to help you remember to take your medications:

  • Using an alarm or calendar
  • Filling a weekly pillbox
  • Taking the medication at the same time every day, create a routine
  • Ask your pharmacy about getting a 90-day supply
  • Ask your insurance provider if mail order provides prescription benefits.

Make sure to keep open communication with your healthcare provider. There are times a patient does not report a side effect or concern with the medication until the next appointment. Try reaching out to your provider right away. They are there to help you find a medication that can help improve your health condition.

References:

  1. Lansberg, P., Lee, A., Lee, Z., Subramaniam, K. and Setia, S. (2018). Nonadherence to statins: individualized intervention strategies outside the pill box. Vascular Health and Risk Management, Volume 14, pp.91-102.
  2. Rosenbaum, L. and Shrank, W. (2013). Taking Our Medicine — Improving Adherence in the Accountability Era. New England Journal of Medicine, 369(8), pp.694-695.
  3. Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R., Coker-Schwimmer, E., Rosen, D., Sista, P. and Lohr, K. (2012). Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States. Annals of Internal Medicine, 157(11), p.785-95.

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Genomics impact on your medicine - ScriptSave WellRx blog image

by Sterling Harpst
2019 PharmD Candidate

Testing Your DNA May Actually Help Make Your Medicines Work Better

Many patients have heard of the personal genetic testing kits available for purchase from websites such as 23AndMe or AncestryDNA. There are currently over 250 Direct-to-Consumer (DTC) companies providing services to analyze saliva samples and create customized reports on what your genetic information says about you.1 Advertising for these companies often include claims that DNA testing can be used to determine an individual’s ancestry, risk for getting certain diseases, or even athletic ability.

What is of interest for many patients, however, is the claim that genetic information can be used to make their medicine more effective. With all of the information being presented, it can be easy for patients to become overwhelmed and unsure of how to make sense of it all. Here’s what consumers should know about the evolving field of Pharmacogenomics.

What are genes?

Inside your body there are millions of cells carrying chromosomes. Chromosomes makes up what is referred to as your “genetic blueprint.”  These are passed on to you from your parents and are made of unique information (genes) which code for specific traits. It is thought that there are nearly 30,000 genes in the human body which determine things like eye color, skin tone, height, and even the likelihood you may get a certain disease.2

What is Pharmacogenomics?

Pharmacogenomics is a relatively new field that looks at how a person’s unique genetic material affects their response to drugs. Imagine that three people get the same disease. Conventional medicine would often recommend they be prescribed the exact same medication. This may make one patient well again very quickly but have no impact on the other two. Essentially, pharmacogenomics aims to explain why changes in genetic information cause some drugs to work differently in different people. This new and exciting field hopes to make personalized medicine a reality, resulting in better diagnoses, earlier treatment decisions, more effective medication use, and customized therapy. By combining an understanding of drugs and genes, there is hope that one day all medicine can be personalized based on a patient’s DNA.

The Limitations of Genetic Tests

Although companies make a number of claims about what information their tests can provide, there are a few limitations to consider before completing any genetic test.

Interpretation

Perhaps the biggest limitation to pharmacogenomics is our ability to fully interpret what genetic information means. Modern technology allows us to analyze tens of thousands of genes, however truly understanding that information is another challenge entirely. Imagine a dictionary full of words, except only a few pages have a definition listed for each word. This dictionary could be used to describe where pharmacogenomics currently stands. Although we have advanced tremendously in recent years, we are still far from fully understanding of the meaning of every gene.

Ability to Make Changes

While there are certain therapies that require genetic testing before use, most do not. Many of the DTC genetic tests are designed to report only information related to drug metabolism. For example, if you do not make specific chemicals necessary to break down a drug, the drug may stay in your system longer and result in side effects. If you make those same chemicals in very high amounts, that drug may not reach the intended effect because your body removes it too quickly. For the purpose of making medication changes, this is often the only result tests can provide.

Minimal Regulation

Although there are many tests available today, there is little regulation when it comes to making sure companies are producing accurate results. Claims that you will know your chances for developing diseases such as Alzheimer’s are based on likelihood, not certainty. Many companies advertise tests that can be used to customize your diet and lifestyle as well. Without well documented clinical studies to provide evidence of these statements, the Centers for Disease Control and Intervention (CDC) and Food and Drug Administration (FDA) are often hesitant to agree.3

For some of the newer or less well-known companies, there are significant concerns with the privacy of your genetic information. The Genetic Information Nondiscrimination Act (GINA) was signed into law in 2008, preventing health insurances and employers from discriminating based on genetic information.4 However, with patient permission it is still legal to sell this data, making it very important to read the privacy policies on how they will use your information before taking a test.

If You’re Considering a DTC Genetic Test

It is important to know that the FDA and CDC do not approve genetic testing in place of traditional health care evaluation. The results may provide a likelihood regarding your chance to benefit from certain medications, but the tests are not final. Often the results may not be significant enough to change anything about your medicine. Here are a few points to keep in mind:

  • Talk with your doctor first before completing any genetic test. It is important to know what they would recommend based on your specific circumstance.
  • Ask your doctor if they would be able to interpret the test with you. Some reports can be complicated and very difficult for patients to understand. Genetic counselors are healthcare professionals that are specifically trained to help interpret the meaning of genetic testing results.
  • Before making any changes to medications or lifestyle, ask the opinion of your doctor. Since test results can be challenging to understand, changes could result in dangerous consequences if made incorrectly.
  • Understand your rights regarding privacy. Before sending your DNA to anyone, it is best to know what your information will be used for. Your genetic information is personal, and you may not want companies to share that information for personal gain.

References

  1. Phillips, Andelka M. “Only a Click Away – DTC Genetics for Ancestry, Health, Love and More: A View of the Business and Regulatory Landscape.” Applied & Translational Genomics, vol. 8, 2016, pp. 16–22., doi:10.1016/j.atg.2016.01.001.
  2. “Human Genome Project Completion: Frequently Asked Questions.” National Human Genome Research Institute (NHGRI), 30 Oct. 2010, genome.gov/11006943/human-genome-project-completion-frequently-asked-questions/.
  3. “Regulation of Genetic Tests.” National Human Genome Research Institute (NHGRI), 17 Jan. 2018, genome.gov/10002335/.
  4. Su P. Direct-to-Consumer Genetic Testing: A Comprehensive View. The Yale Journal of Biology and Medicine. 2013;86(3):359-365.

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health information technology - PHI - ScriptSave WellRx image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Changes in Health Information Technology (HIT)

Technology in our daily lives is increasing at an astounding pace. Each day, our lives are becoming more connected to technology, but more specifically, to information technology. Recent news events related to personal information have brought some concerns to light. Companies that provide technology services are storing user data and potentially using the data for their own purposes. Technology users are becoming savvier about the data they produce, which companies have access to the data, and how the data is being used. There are government regulations set in place for protecting your health information.

Let’s look at how healthcare providers are using health information and what you can do to protect and use your information effectively.

What are healthcare providers are doing?

The impact healthcare providers have on you is dependent on the amount of information available. Access to health information can help in patient care. Healthcare providers are trying to get connected and stay connected with patients. Consistent, scheduled care can allow healthcare providers to prevent problems or treat them before they take a toll on daily activities.2

Some ways pharmacists are using health information technology is through medication therapy management, clinical decision support, chronic care management, and annual wellness visits. Medication Therapy Management (MTM) utilizes prescription medication claims and information from the patient to find problems with medications, costs, and adherence. Clinical decision support connects patient health information to a knowledge base to guide therapy and reduce medication errors. Using standardized records systems, pharmacists can manage chronic conditions by using data from multiple sources such as pharmacies, hospitals, and clinics.

The progression of a chronic disease can be tracked through the records from multiple sources, thus allowing pharmacists to adjust medication therapy as needed. Access to health information through multiple sources also allows providers to have a better picture of patients’ health during annual wellness visits.1

How can I stay safe?

Healthcare providers are required to provide patients with a Health Insurance Portability and Accountability Act (HIPAA) consent form. Signing this form allows the healthcare facility to utilize your health information for therapy and billing. The healthcare facilities also follow the guidelines set by HIPAA to secure your information and to use it only when necessary. If you are concerned about health information practices you can ask if the facility follows HIPAA guidelines. Most facilities can provide a report on why your information was used and to whom it was shared. You can also request a copy of your health records and make corrections to them, if appropriate.3

What can you do to help your healthcare providers?

Healthcare providers can make more informed decisions when your health information is accurate and complete. The best way to help providers reach informed decisions is to ensure your health records are up to date. These are some categories that should be up to date in your own health records:

  • Allergies
  • Current Medication List
    • Name of the medication
    • Strength of the medication
    • Schedule for taking the medication
    • Route of administration
    • Length of time on each medication
  • Current and Past Health conditions
    • When you were diagnosed
    • Surgical history

Shared decision making is a way for patients and their providers to work together to determine what is right for the patient in order for you, as the patient, to make an informed decision about your health care. When selecting treatments, screening tests, and care plans, it’s important to talk to your provider about your preferences and to fully understand how your personal health information is being used. After all, it is yours!

References

  1. Abubakar, A., & Sinclair, J. (2018). Health infromation tehnology in practice. Pharmacy Today, 58-65.
  2. Dullabh , P., Sondheimer , N., Katsh, E., Young, J.-E., Washington, M., & Stromberg, S. (2014). Improving the Health Records Request Process for Patients Insights from User Experience Research. Chicago: NORC at the Univeristy of Chicago.
  3. S. Department of Health and Human Services. (2017, February 1). Your Rights Under HIPAA. Retrieved from U.S. Health and Human Services: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

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Opioids and alternatives image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Opioids and Their Risks

Opioids are a class of medication used to manage short-term and long-term pain. This medication class is well known to healthcare providers, but also to anyone keeping up with local and national news. The current opioid crisis affects thousands of people every year. When taken inappropriately, opioids can result in inadequate pain relief, drug tolerance, addiction, overdose, and even death. A majority of opioid overdoses that result in death are accidental or unintentional.4 Due to the side effects and risks associated with opioids, healthcare providers are being urged to change opioid prescribing habits to meet new opioid regulations and to keep patients safe.

Changing Opioid Regulations

Prescribers are currently facing new opioid regulations at the state and federal levels. The Centers for Medicare and Medicaid Services (CMS) have implemented a maximum daily limit for opioids and some states are also cracking down by regulating the amount of days allowed on initial prescriptions. Arizona restricts initial opioid prescriptions to 5 days and sets an opioid dose limit per day.1 New laws and regulations are changing prescribing habits in hopes of reducing the thousands of opioid related overdoses every year. If you are starting or currently taking opioids, ask your healthcare providers if there are any new rules and regulations specific to your state.

Alternatives to Opioids

There are many alternative medications that can be used to manage acute and chronic pain. Medication selection is based on identifying the cause of the pain. A sprained ankle might be treated with a nonsteroidal anti-inflammatory drug (NSAID) to reduce swelling and inflammation, but the same NSAID would not have benefit for pain caused by nerve damage.

Potentially useful medications for pain include:

Nociceptive pain

  • Non-opioid analgesic agents (aspirin, acetaminophen, NSAIDs)
  • Tramadol
  • Topical analgesic agents
  • Muscle Relaxants

Neuropathic pain

  • Gabapentinoids
  • Antidepressants (venlafaxine, duloxetine, amitriptyline)
  • Topical analgesic agents

Opioid Non-responsive cancer pain

  • Alpha 2 adrenergic agonists

The listed medications and classes are a general list not intended to help in your personal medication selection. The ideal approach to pain management identifies the underlying cause of the pain and selects the appropriate treatment.4  Please consult your healthcare providers for pain identification and medication selection.

Questions for Healthcare Providers

All of the drugs and drug classes listed above can help in pain management depending on the underlying issue. Classification of the cause and level of pain is something that should be handled by healthcare providers. Asking for your pain classification will assist doctors and pharmacists in identifying the correct pain management therapy.

There are some steps you should take before making changes or starting a new medication. When starting or changing medications, please consult your doctor and pharmacist regarding what to expect. Changes should not be made without consulting a healthcare provider because of potential medication interactions and repercussions of abruptly starting or stopping medications. Your healthcare provider should review your medication dose, route, and time to take your medication. The potential side effects and expected outcomes should also be reviewed.3

If you have any concerns with taking opioid medications, talk to your doctor and pharmacist to help identify if opioids or alternative medications are appropriate.

References
1. Ducey, O. o. (2018). ArizonaOpioid Epidemic Act. azgovernor.gov
2. Rosenquist, E. W. (2017). Overview of the treatment of chronic non-cancer pain. UpToDate
3. Rosenquist, E. W. (2018). Evaluation of chronic pain in adults. UpToDate
4. SAMHSA. (2015). Behavioral Health Trends. Rockville, MD: RTI International


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Walmart Announces New Opioid Rules - pill image WellRx

On May 7, 2018, Walmart issued a press release to announce the pending introduction (within 60 days) of new restrictions on how it will fill prescriptions for opioid medications. These new initiatives will apply to all Walmart and Sam’s Club pharmacies and pharmacists in the United States and Puerto Rico.

Walmart indicated that these changes are “an effort to continue to be part of the solution to our nation’s opioid epidemic,” and it reflects a further expansion of the company’s Opioid Stewardship Initiative. The move from Walmart follows a similar initiative by CVS that went into effect in February. Increasingly, retail pharmacies are stepping up efforts to stem the spread of opioid addiction, prevent overdoses and curb over-prescribing by doctors.

What Doctors Need to know, and What it Means for Patients with Legitimate Prescriptions

Walmart is the fourth-largest pharmacy chain in the US and these changes (being introduced over the course of a 60-day period) are likely to touch a number of patients. The retailer will move to restrict initial acute opioid prescriptions to no more than a seven-day supply, while also limiting a day’s total dose to no more than the equivalent of 50 morphine milligrams. Meanwhile, in states where the law for fills on new acute opioid prescriptions is less than seven days, Walmart and Sam’s Club will follow state law.

In addition to these immediate-term changes, by January 1, 2020, Walmart and Sam’s Club will require e-prescriptions for controlled substances.

In terms of patients needing acute or short-time pain management, in the event that the pain lasts longer than a seven-day supply (and still warrants treatment with these medications), the patient will have to consult his/her physician in order to obtain a new prescription.

Such restrictions have prompted concern that requiring patients to obtain a new prescription after seven, or sometimes only three days (depending on the state), can become too costly due to mandatory co-pays. Dr. Steven Stanos, former president of the American Academy of Pain Medicine explained that the organization applauds “any action that seeks to limit the over-prescription of opioids,” but added, “That needs to be balanced with the very real need of patients.”

For this reason, doctors and patients should be engaging in dialog about current and alternative medications and possible savings options, as they formulate a strategy for effective pain management.


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You may find prices lower than your insurance co-pay!

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