I have several medical conditions which pretty much require scipt-only drugs.
I am on:
Opiates (not cheap)
This is the immediate problem.
I have puberty-onset insomnia and have been on a roller-coaster of benzodiazepines since 2000.
None of which work, so I have been playing games. Nothing illegal or unethical - same Doc, same pharmacy, same insurance.
Finally, along came Lunesta - a non-benzo AND it actually WORKED!
It was also $130/mo, which I couldn’t afford, and insurance refused my Docs written request…
I checked with Wal-Mart a few years ago, figuring they would have a better price. Nope. Now $150.
At Last! The patent expired and it is now a generic and my insurance now covers it!
That lasted about 3 months.
Due to some bizarre side-effects (found only in the insurance company’s literature - not on any of the online pharmacy DB’s), they will cover only 3 months/year - but hey! were now covering drug X! Use it (at a bit over 4x the price).
Drug X is a disaster - extreme dry mouth prevents anything resemblinf rest, let alone sleep.
Well, maybe the generic is cheap enough I can pay out of pocket. You kid, right? The generic is $343//mo.
I need to find this drug at a price I can afford - so what, exactly, are the rules about importing 'script from Canada (or anywhere else)?
I’m reasonably certain that my standing instructions to the pharmacy (walgreens) says to use brand or generic, whichever is cheaper.
Have you used GoodRx yourself? How do those coupons work in real life - is it a one-shot or a standing discount? Are new coupons required and/or available each 30 days?
One of the coupons purports to be valid at Walgreens for the $24 price. Don’t see how that works - how does GoodRx make its money?
I have not, simply because I don’t take any prescription medications. One of my patients told me about it, and I’ve spread the word, because they all seem delighted. I’m sorry I don’t know the answers to the rest of your questions, except the last one: they make their money by selling advertising space, same as the SDMB.
At work at the moment, so don’t have time to answer as fully as I’d like, but one thing springs to mind regarding the 3 months/year exclusion. This is the first year that the Z-drugs are a metric impacting some insurance plans’ STAR rating. If an insurance company has above a certain percentage (3%) of older patients on the Z-drugs for more than 3 months of the year, their STAR rating takes a hit, which impacts their marketing ability in some way and thus their bottom line. If you’re over 65, that may be the culprit responsible for the 3 month rule.
I was taught that this was usually a case of a brand name manufacturer making a deal directly with an insurance company to prefer their branded product over generics in exchange for manufacturer rebates on the drug cost. How true/common this is, of course, is probably shrouded in some degree of secrecy by both the manufacturers and the insurance companies.
Definitely via mail-order, and definitely based of the prescription of a US doctor, but you can actually get a prescription from a licensed canadian prescriber filled in Canada and bring it over the border with you, provided the quantities are small enough, and you aren’t doing it too frequently. See the FDA Travel advisory and Federal Register link I posted in another thread (Thread Link) awhile back.
I don’t think the FDA has enforcement jurisdiction anyways, unless they believe that a drug manufacturer is specifically promoting this (for which they might be able to sanction the drug manufacturer)1. I think enforcement probably falls onto US Customs and the DEA (the former for all drugs, the latter for controlled substances), though I’m not an expert in that area.
I am intrigued, however, as to what drug “Drug X” was.
On the advice of my counsel, I respectfully exercise my Fifth Amendment right and decline to discuss any drugs I may have ordered from a Canadian pharmacy. However, I will note that the cost savings for anti hypertensives can be unbelievable. For atenolol, norvasc, and losartan I am able to buy 200 tablets for less than my copay on 30. I’ve heard.
With it, I cannot keep my mouth shut without conscious effort - which kinda precludes sleep. It also creates extreme dry mouth. See below for effect of distractions such as dry mouth.
Actually, the first night, it worked - for 5 hours.
Second night I found that it had a VERY brief (5-10 minutes) window in which the hypnotic effect took place, and any distraction (such as osteoarthritis pain) during that window meant the pill was wasted.
At the same time, they are killing Ambien (finally! - that one is the only one which caused me problems). That may mean it is not just regulatory games.
You are being gouged on Atenolol? That is one of those which (yes, Blue Shield of CA Medicare Plus Drug plan) provides at $6.
Walgreens shows the full (theoretical) retail price on the wad of paper they stick in the bag with the bottle. I’m going to have to learn to keep those.
And now, after all this crap: Lunesta failed last night, and failed miserably. Ended up dragging out the last of the benzos.
Here’s a good one - I did find confirmation of the side-effects the insurance co. used as excuse to restrict Lunesta:
Melatonin receptor agonists, like Ramelteon (Rozerem) or, well, melatonin, as well as the z-drugs, really only seem to be useful for shortening both the objective (as measured by EEG changes or possibly actigraphic changes) and subjective time to sleep onset. None of them are all that useful in maintaining sleep, and all of those generally seem to only get you an extra 15-30 minutes of sleep over the placebo response. They are, in effect, only useful if your problem with insomnia is difficulty falling asleep. If, however, your difficulty lies in sleep maintenance, the data suggests they’re not really useful, with caveats: higher doses of the z-drugs would seem to keep you asleep longer, but at the risk of more side effects and next morning cognitive impairment, and zolpidem also has products available (albeit brand only, so not cheap) which can be administered if you wake up in the middle of the night (but still have 4 or more hours before you need to be awake) to help you go back to sleep.
Zopiclone (which here in the US, we only sell the S stereoisomer, thus S-zopiclone–eszopiclone, marketed as Lunesta), while not structurally being a benzodiazepine, functionally is one–it hits the same GABA-A receptors which are sensitive to classic benzodiazepines (Zolpidem, by contrast, has a relatively low binding affinity for all but alpha1-beta-gamma2 containing GABA-A receptors). It also has a longer half-life than the other z-drugs, which may explain, at least in part, why it works longer for some people. Even it, however, doesn’t show that much improvement in overall insomnia–the three largest trials found on average again a 15 minutes improvement over placebo in the time it takes to fall asleep and around 37 minutes over placebo of total sleep time.
It’s not just regulatory games, no. Particularly in the elderly, the z-drugs seem to display no safety benefit versus the benzodiazepines (as was once claimed/hoped), with both z-drugs and benzos increasing the risk of falls, fractures, motor vehicle accidents, and ER visits by about the same amount (roughly double versus those who aren’t on them), and both drug groups also display correlation with increased all-cause mortality and increased risk of development of Alzheimer’s.
If those are the side effects the insurance company is using, they’re really reaching further afield than they need to. Don’t get me wrong, the above mentioned parasomnias have resulted in death, but they aren’t actually unique to the Z-drugs (reduction in use in the elderly being a STAR rating target)–they can also occur with other sleep agents, including the classic benzodiazepines (which while also not recommended for use in the elderly, aren’t a STAR rating target…I’m still trying to grok the logic behind that). The increased risk of falls/fractures/MVA’s/ER visits in a population generally already at a higher risk of those would have been better justification for said policy, though I guess those sound less scary than sleep driving (which is rare).
As mentioned zolpidem has given me problems - like calling cops over hallucinations.
Not going to miss it.
And - while using zolpidem, I was also getting a classic benzo (insurance considered one a hypnotic, the other an anti-anxiety agent). When you need 1.5 pills to get an effective dose, you play games.
Every pharmacist insisted that I know to never, ever mix the 2 - what happens? Does the time-space continuum invert? Earthquakes, Massive solar flares? What is so scary?
OK, I’m 65 and falling apart, but my mind is sharp, I still my memories going back 60 years, can fall and get up without trouble.
When does all this scary stuff happen? Am I supposed to liv in mortal fear of a fall or accident?
JayRx1981 - Thanks for thee mention of Actigraphy - an absolutely wonderful development, if it actually works - a sleep monitor that can be worn on wrist - no more trying to sleep with 10 wires on you and a MD (or 2) watching. See Wiki.
Tried the GoodRx coupon at Walgreens - the fellow didn’t bat an eye and set it up as payment method for that drug. The coupon is good until the deal behind it expires. Who knows?
If the $24 price is or is not met, I’ll find out next month.
In the mean time - Folks - see GoodRx - the retail quoted was $343 - this coupon - there were coupons for Wal-Mart, CVS, a few more - about 8 different price levels - $24, $34, and $146 or so. Who knows why the difference?
If this lasts, it beats the Canadian price by 80% or so.
At worst, you waste an hour or so and maybe ink and paper (I’m old fashioned).