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Help! My Patient Doesn’t have Much Money: Is there a Generic for that? A look at OTCs and Generics

Help! My Patient Doesn’t have Much Money: Is there a Generic for that? A look at OTCs and Generics. Amelie Hollier, DNP, FNP-BC, FAANP President, APEA. Making the Most . 1. Not all lists are the same And the lists change periodically

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Help! My Patient Doesn’t have Much Money: Is there a Generic for that? A look at OTCs and Generics

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  1. Help! My Patient Doesn’t have Much Money:Is there a Generic for that?A look at OTCs and Generics Amelie Hollier, DNP, FNP-BC, FAANP President, APEA

  2. Making the Most 1. Not all lists are the same • And the lists change periodically • Example: Benazepril/HCTZ available at Walgreen’s but not Wal-mart of the $4 generics

  3. Making the Most of the $4 generics Keep $4 generic lists of local pharmacies in your exam room

  4. Making the Most 2. Not all generics are on the $4 list! • Example: amolodipine, fluticasone nasal spray, losartan, many more! of the $4 generics

  5. Making the Most 3. Some doses of generics are NOT on the list • Example: Pravastatin 10, 20, 40 mg of the $4 generics

  6. Making the Most • Pravastatin 80 mg (30 tabs) • Price range: $18.99- $119.99 of the $4 generics

  7. Making the Most • Pravastatin 80 mg (30 tabs) • Price range: $18.99- $119.99 (without shipping) of the $4 generics Can you take (two) 40 mg tabs = (one) 80 mg tab? ($8)

  8. 4. Order 90 Day supply instead of 30 Days • Larger quantities (90 day supply usually cheaper than 3-30 day supplies) Annualized savings: • 1 script: $8 (12 months: $48 vs. $40) • 5 scripts: $40 • 10 scripts: $80

  9. 5. Free Delivery is Free!!! Gasoline!

  10. $4 Plan may be cheaper than with ins co-pay 6. Always consider $4 plan

  11. Making the Most of the $4 generics 7. Look for ways to combine meds • Example: HCTZ 12.5 mg daily ($4/30 tabs) • Lisinopril 10 mg daily ($4/30 tabs)

  12. Rx Case 1: Patient takes lisinopril 10/HCTZ 12.5 • Lisinopril 10/HCTZ 12.5 mg tab • Lisinopril 20/HCTZ 25 mg tab Can you split a Lisinopril 20/HCTZ 25 mg tabto get two doses?

  13. Pill Splitting Don’t split if tablet contains more than ONE active ingredient • Lisinopril/HCTZ • Combo antihypertensive medications

  14. Pill Splitting Clues Don’t split if enteric coated, sublingual, or buccal, some extended release tablets

  15. Pill Splitting Clues Don’t split if medication is a narrow therapeutic agent • Warfarin • Levothyroxine • Anti-seizure medications • Others

  16. Narrow Therapeutic Agents Warfarin Digoxin Phenytoin Levothyroxine Lithium Theophylline (Toxic dose may be slightly above therapeutic dose)

  17. Therapeutic Index TOXIC .5 mg Therapeutic range .3-.4 mg 0-.2 mg No clinical effect

  18. Pill Splitting Price comparable despite tablet strength

  19. Pill Splitting Some OTHER Considerations • Sharp tablet cutter • Good dexterity • Cognitive ability • Visual acuity

  20. 8. Member Discount Plans Many Businesses offer discounted drugs if you are “a member” • Membership: Free • Membership: Fee

  21. Member Discount Plans Largest 8 Examples Nationwide: • Costco: Free for members ($50/yr) • CVS: $15/year • Kmart Prescription Savings Club: $10/yr • Kroger: Free • Rite-Aid Rx Savings Plan: Free • Target: Free • Walgreen’s Prescription Savings Club: $20 individual/$35 family • Wal-mart/Sam’s Club: Free

  22. Combos are Cheaper, Right? • More than 75% of hypertensive patients need two or more meds • Strategy: Use Combos???

  23. Generics Save you Money, Right?

  24. Watch out! Don’t get taken! At the same pharmacy… $32.75 vs. $12.00 Across the street…

  25. Amelie’s Favorite Site! • Free for iPhone, iPod Touch, and iPad • Online: www.goodrx.com • Finds lowest price drug in stores AND online • Taps into generic discount plans • Gives access to manuf coupons when there is no generic • Finds prices of generic “equivalents”

  26. 3 Other Sites • Lowest Med • Mobile Rx Card • Pocket Doctor

  27. Disease Specific Strategies to Save Money

  28. Do not underestimate the $$$ value of Education about patient’s disease, the medications

  29. Asthma If it comes in a canister….

  30. Asthma RESCUE MEDICATION!!! • Albuterol: generic product, but the propellants changed in 2008 • HFA more ozone friendly • Cost is about $45-$48

  31. Asthma Mild persistent asthma: Inhaled corticosteroids (ICS) Moderate persistent asthma: ICS plus LABA

  32. Asthma Moderate persistent asthma: ICS plus LABA Fluiticasone/salmeterol (Advair) Budesonide/formoterol (Symbicort) Mometasone/formoterol (Dulera) Cost: $185 - $285/30day supply (BID dosing)

  33. Price Comparison Inhaled Combo Medications • AdvairDiskus: $285.46 • Advair HFA: $285.46 • Dulera: $242.69 • Symbicort: $259.08

  34. Asthma Moderate persistent asthma: ICS plus LABA Fluiticasone/salmeterol (GSK) Budesonide/formoterol (AZ) Mometasone/formoterol (Merck) Cost: $185 - $285/30day supply (BID dosing)

  35. Asthma Fluiticasone/salmeterol (866-518-HELP orwww.gsk-access.com) Budesonide/formoterol (800-292-6363 orAZandMe.com) Mometasone/formoterol (800-727-5400 orwww.merck.com/ merckhelps/patientassistance/)

  36. Web-based Resources www.needymeds.com • Brand and generic meds available through patient assistance programs www.rxassist.org • Patient can search medication by company, brand or generic search; lists various options for patient assistance

  37. Web-based Resources www.pparx.com • Pharmaceutical Research and Manufacturers of America (PhRMA). Search by manufacturers; patient assistance programs available

  38. Anti-Histamines Cost 1st gens cheaper/dose

  39. Hypertension

  40. Lifestyle Modifications • Maximize Non-pharm Management • Institute lifestyle modifications (change in diet, increase physical activity, weight loss)

  41. Hypertension Life style Modifications • DASH eating plan (8-14mm Hg) • Weight loss (5-20 mm Hg/ 10kg) • Exercise: 30 min most days (4-9mm Hg) • Sodium restriction (2-8 mm Hg) • EtOH in moderation (<2 drinks/d): (2-4mm Hg) • Eliminate other CV risk factors

  42. Anti-HypertensivesHow do I pick one? Multiple $4 Generics Available • ACE inhibitors • Alpha blockers and BB • Thiazide diuretics • CCBs • Combos

  43. Anti-Hypertensives ARBs(not $4) • Consider transitioning to an ACE inhibitor • Losartan, irbesartan, valsartan, are generic (not $4) • Candesartan generic 2012

  44. Anti-Hypertensives Generics • Takes at least 6 months as a generic before price begins to decrease • Occurs as multiple manufacturers produce drugs

  45. Anti-Hypertensives Alpha Blockers • Doxazosin (Cardura): once daily • Prazosin (Minipress): 2-3 times daily • Terazosin (Hytrin): once or twice daily

  46. Anti-Hypertensives Beta Blockers • Metoprolol tartrate (twice daily): $4 med • Metoprolol succinate (once daily) • Not for uncomplicated HTN

  47. Anti-Hypertensives Alpha/Beta Blocker • Selective alpha, non-selective beta • Carvedilol (Coreg): twice daily • Dose: 3.125 mg – 25 mg BID

  48. Anti-Hypertensives Think Combos • Most patients need more than one drug anyway • ACE/HCTZ • Atenolol/chlorthalidone • Carvedilol • K+ sparing/HCTZ

  49. Anti-Hypertensives What about Samples? Free is better than cheap!!!! but…..

  50. Hyperlipidemia

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