I’m sorry you had to go through all that, RivkahChaya. I wonder how long I have been infected. I was expecting gastritis from my chronic NSAID use (3 years) more than H. pylori.
I will be treating it, starting this evening. In fact, I need to go eat supper right now to allow the 2 hours after eating before taking the first dose. I’ve set up my phone to remind me of the different times to take the antibiotics (without food) 7 am, 1 pm, 7pm, 11 pm, and my regular, twice daily medications (with food) 9 am and 9 pm.
I’ve had a different medication that cost more than I thought so I looked around some more from drug discount cards. There are several.
Rxsaver from retailmenot was the cheapest for my new script. So plugged in tetracycline to see what it would cost using that card… $15.37 at CVS for same 500mg pills, qty 56 that is $94 through GoodRx. Worth a bit of comparison.
Criminal that anyone would face such a stark choice as medicine or mortgage payment.
especially for an old generic drug that used to be cheap.
There are some new, high falootin drugs that probably really do have high costs either per dose (immunotherapy, maybe?) or recent high research costs to pay off. But tetracycline? That was paid for ages ago.
Yeah - a friend got lucky and developed a case of pneumonia - the treatment for which made other symptoms (that had caused the doctors to tell her parents she wasn’t likely to live all that much longer) suddenly Go Away. This was right about the time they were beginning to discover h. pylori as the cause of most ulcers.
And 500 bucks??? Worth checking with the insurance to see if there’s another version. That is not a new drug, and I can’t imagine it’s orphaned. Hell, I have permanently-discolored teeth from having it in the early 1960s, so I’m pretty sure it’s out of patent!
Different formats of the same medication can be covered or not. I found that out with my metformin. Doc had me on 500 mg of extended release. A couple of bucks a month. She wanted to double that. The 1000 mg tablets required preapproval and would have been hundreds of dollars a month. I finally told the doc “Just write the scrip for TWO 500 mg tablets”.
There are MANY combination of antibiotics that can treat ulcer causing bacteria; at least eight are first-line. Get a different one. Doxycycline tastes bad. But there are many other good choices.
In addition to the fact that doctor’s can’t be expected to keep up with changing prices, IME the drug companies actively mislead doctors. On several occasions I’ve had a doctor helpfully give me a card or coupon that looked like it would make the drug affordable, but it didn’t work. Like, it paid the copay, but I don’t have a copay, I have a high deductible. Others, I couldn’t even figure out why they didn’t work. And maybe I could have called around and figured something out, but when it’s 6:00 and your kid needs a drug, you pretty much just buy it, unless it’s truly unaffordable.
I believe in the US one way people have found to make money is find a generic drug with a small market, and have one company monopolize production. The cost of entry for competitors is too high so that company can charge whatever they want.
Its how Pharmabro got away with charging $750 a pill for generic daraprim which is $0.25 a pill in Australia.
I’ve had problems with those kinds of coupons before, and it’s nearly always because their algorithm for determining eligibility disallows insurance benefits that are paid for by the federal government. My health insurance is obtained through the Federal Employee Health Benefits program offered by my employer, the USPS. This is NOT an insurance benefit paid for by the federal government, but try telling those algorithms that.
It hasn’t been an issue for me since February, though. The monthly copays for my three meds come to less than $15.00.
There are lots of reasons they use to disallow the coupon. But the drug rep tells the doctor that they should prescribe this particular drug because there is a coupon, so the doctor feels good about it (because doctors don’t want you to overpay, either). Even if you express concern about the cost, the doctor reassures you that there is a coupon. So unless you hang out in the examination room while you call your pharmacy and double check, you have to take his or her word for it. Then, you get to the pharmacy a couple hours before closing. You drop off the script and the coupon. They call you 20 minutes later and tell you that it’s be $350. You can tell them not to fill it, call the doctor, try to get something else. There probably is a cheaper alternative. But here you are with a sick kid and the very real chance you won’t get through to the doctor and the doctor through to the pharmacy before it closes, and you really want to start the treatment tonight (you went to the doctor, right?). You could try another pharmacy, but it might be the same, might be worse, and there’s all sorts of social reasons you don’t want to make the nice pharma tech take the drug back, go try somewhere else, and then come back here if if turns out to be the best of a bunch of bad deals. And you have the $350, it’s a just a lot more than you wanted to spend, so you spend it.
Can I just say that as a doctor I often have to give patients all the options. Here in the DC burbs we see a lot of federal employees and the companies are all over the place with whether they allow coupons. I often have to give patients a list (for example, you can take januvia, tradjenta onglyza if you want a DPP4 inhibitor) and tell them to check their formulary and get back to me.
FWIW, we definitely know about the extended release metformin 1000 mg tablets. The current problem is that there is a recall on the 500s so they are in short supply. Luckily, the regular metformin is cheap although you have to take it twice daily.
Pharmacists are now allowed to mention coupon cards so that does help.
I also don’t know about other electronic records, but mine will give you an estimated price if you enter a standard prescription, so I can see if the cost is crazy and if it’s something like a high copay for the entire class, I will usually sign them up for coupon cards or print out a good Rx coupon right then.
You also do get to know some of the prices. Kaiser has a very limited formulary for example. The military will pay for cimetidine but not famotidine.
Some of us do make it our business to save patients money. I just got a report from an endocrinologist that a patient was paying a lot for her medication and I was going to see if she could use a coupon.
Just to add, with my EMR I can also try different pharmacies so I can say for example, that a medication would be $50 at CVS but only $10 at Walmart. It’s not 100% but it’s one of the best new features they’ve added recently (along with automatic access to the prescription monitoring program and electronic prescribing of controlled substances).
Just to say it again more clearly, to treat gastric disease you need 7-14 days of PPI (such as Prevacid, etc.) and 2-3 antibiotics, which vary. There are MANY effective combos, only one of which uses tetracycline at all. Sometimes bismuth or probiotics are added.
The most common antibiotics are amoxicillin, clarithromycin and metronidazole. Tetracycline is not very commonly used. At those prices, it cannot be justified. Rather than find cheaper tetracycline or something similar like doxycycline, you are better off using something different for this indication.
I often use PPI plus amoxicillin 1g - both twice a day, for 5 days. Followed by PPI plus clarithromycin 500mg and metronidazole 500mg - all twice a day, for another 5 days. Add bismuth or probiotic if intolerance is likely. This has eradication rates around 94%, among the best, which may vary by local factors almost no one measures.
Substitute erythromycin for clarithromycin if cost is a concern - but this is almost as cheap as the treatment gets. Add levofloxacin to make it costlier and for rare treatment failures.
Personally, the part I find criminal is that we can have a dozen posters talking about the price of a standard generic drug and find a dozen different prices for it that can vary by over 30x.
Having competition to reduce the cost of health care shouldn’t be about searching the market for the right magic words to speak to the CVS pharmacist so they don’t screw you blind on the price.
This is a fair point. But it is still very hard to conclude tetracycline as being the only option, even if the circumstances make it more common. Amoxicillin, clarithromycin, levofloxacin and metronidazole are different classes. I don’t want to get into drug-drug interactions and allergies due to privacy issues.
Tetracycline costs pennies and that price is unreasonable. Because allergies and odd circumstances are not rare, Sandford’s is a guide that shows bacterial sensitivities to second and third line antibiotics too. I’ve used Septra before. In this case, there are other options. But the pricing is the point. That’s some crazy pricing.
Sure, but there is reason to believe the doctor did go through multiple strategies with the op and took the time to explain his thinking. He probably has no idea of the current price of tetracycline, or he would have taken that into account too. He sounds like a thoughtful practitioner.
In practical terms, the OPs greatest issue is whether it’s prudent to delay treatment over the weekend to wait till he can talk to his doctor. But your post sounds like you think this doctor is an idiot. I don’t think there’s evidence to support that.
Understandable. I would assume a tetracycline tablet cost a penny to make and sold for a quarter. The quoted prices seem usurious. I understand medical summaries on boards do not represent the full picture and so my practice is not to criticize a doctor or other provider without knowing all the facts.
