1 / 87

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

kaiser
Télécharger la présentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related