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Drug update and drug affordability advice

Posted May 26 2012 12:00am
There has been a burst of news.  Let's get started, including some comments by The Allergy Dude!
 1. The FDA approved a combination product of azelastine (Astelin or Astepro) and fluticasone (Flonase) named Dymista .  Both ingredients are available individually.  There is no data supporting synergy.  This product could be convenient.  The Allergy Dude predicts that Dymista's success will hinge on the same factor as most other products, which is its price.  This is not known yet.  The product is slated to be launched during August.
2.  Omnaris (AQ) production continues to be too low, resulting in shortages.  There is no end in sight.  So if you want to fill a prescription, be prepared with an alternative.
3.  A new eyedrop for eye allergies called Lastacaft is being marketed.  There is no comparative data showing it is superior to other available products.
4. TEVA has been sampling its "new" nasal steroid product: Qnasl .  The more things change, the more they remain the same.  This is just like the no-longer-available Beconase and Vancenase sprays, except for two important differences.  First, each spray produces 80 mcg, not 42, of beclomethasone dipropionate.  Hence the dosing is 2 puffs once per day, not twice per day.  Second, the propellent is the same HFA is in the inhalers for asthma.  The Allergy Dude predicts that this product will have a niche in those patients who do not like the current aqueous formulations of corticosteroid sprays.  The only problems are the potential cost and the competition below.
5.  Omnaris HFA (Zetonna) is ciclesonide nasal steroid spray using HFA propellent.  Interestingly, no information can be found on Sunovion's nor the FDA website about the approval date.  There have been ads in allergy journals for months.  No word on the launch date. 
6.  To the best of The Allergy Dude's research, Singulair will not be available OTC after 8/3/12, but will be going generic.
7.  When the diagnosis of asthma remains in question after a careful history, physical exam, labs and spirometry, then a mannitol (Aridol) challenge would the next and definitive test.
8.  Studies by Merck for its sublingual (under-the-tongue) immunotherapy are closing and will be submitted for approval soon.  This means it is not available now and will not be available for 1-3 years more depending on the FDA's review, approval, and product manufacture.  
9. Daliresp is a new oral medication that may reduce the number of exacerbations of COPD in patients with severe COPD.

Affordability advice:
1. Concerning medications, Insurance companies are slowly increasing copays for medications, requiring prior authorizations, and issuing denials.  Keep track of which medications you have tried already.
2. At your doctor's office, ask for any coupons or rebates.  Within my office, The Allergy Dude is also known as The Coupon King, because I distribute so many coupons to patients.  Don't forget to use them, or you may be leaving money on the table.  If your medication is tier 2 or 3, you should seriously be searching for a coupon.  They are available more than you think.
3. Here is one example: Xopenex HFA's out of pocket cost is $66 but with a coupon card worth $75, it can be free.  You can't file through insurance though, because it was out-of-pocket.   
4. Another slightly different example: Alvesco's out-of-pocket cost is $122 but with a coupon card worth $75, you still pay $47.  If Alvesco is tier 3 on your insurance formulary, for which you pay $50, then using the coupon card gets you the Alvesco for free.
5. Read the coupons carefully.  For example, a Veramyst coupon offers $25 off, which helps, but only once, as is stated on the coupon.
6. Consider doing a drug study.  Often the participants may get paid for their time and effort, medications, and medical care & tests during the period of the drug study. It's not a bad option for those with high deductible insurance, those trying to get a medication they can't afford, or those wanting to try a new medication.

That's the news and views from The Allergy Dude aka The Coupon King.
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