I went to the doctor today and got my doxycycline prescription extended for 12 more refills (one per month). Doxycycline is a member of the tetracycline family of antibiotics, and may truely be a wonder drug.
It's effective against all kinds of infections - STDs, acne, anthrax, even the plague and many others. A special use is oral infections, like the ones that cause dental problems. But in addition to being antibiotics and killing germs, tetracyclines also have anti-inflammatory properties. That makes them candidates for treating aortic aneurysms (my use - currently off-label or not FDA approved), multiple sclerosis, even osteoarthritis, and they seem to be effective against certain cancers, like colorectal and eye lymphomas.
The problem for drug manufacturers is that doxycycline's patents have expired, so anyone can make it. But that's where the pricing gets interesting. (All links that follow are to drugstore.com pricing).
I take 100mg doxycycline hyclate tabs twice daily. The brand name for these (Pfizer's) is Vibra-Tabs. 100 Vibra-Tabs cost $621 - that's not quite 2 months supply for me. But as everyone hopefully knows, generics are cheaper, and at drugstore.com, 100 generic doxycyline tabs costs $70 - 11% of the brand name cost. (I paid $57 today at Safeway for generics).
But it gets even better. There's interest in low-dose doxycycline for various purposes, and one drug company developed a product for oral/gum-disease applications. It's called Periostat. It's plain old doxycycline hyclate in a 20mg dose - one-fifth the amount of medicine above. It costs $337 per 100 tablets. For a long time no one made a 20 mg dose tablet except for Periostat, but now someone does. The generic 20mg dose costs $88 per 100. That's about 1/4 the cost of branded Periostat (for the same thing), but $18 more than the same number of tablets with 5 times the amount of active ingredient doxycycline (the 100mg tabs above).
Apparently in the world of pharmaceuticals, it costs more to put less medicine in (that sounds vaguely homeopathic). For the equivalent amount of actual doxycycline as the 100mg tabs, Periostat would cost $1685 per 100 and the generic would be $440. Less medicine costs a lot more than more medicine.
People taking doxycycline for periodontal (dental) use or other low dose use might want to consider that you can buy a pill splitter for about $8 that will divide a tablet into 4 pieces - from 100mg to 25mg chunks in this case. That would mean you could buy the 100mg tabs (if you can get them prescribed by your provider) for $70 per 100 and divide them into quarters, making your actual cost per 100 doses about $18 (instead of $337). Of course you should discuss this with your doctor, dentist or pharmacist first before trying it.
(If your doctor wants you to take low dose - 81mg - aspirin, those are 1/4 of a normal aspirin tablet. 81mg tablets cost the same or more by count than normal aspirin tablets. However, if you split the ones with an enteric coating - for less stomach irritation - you lose the coating on part of the tablet. At Safeway, the really expensive low-dose aspirin tabs are in the drug aisle, but the pharmacy has really cheap ones if you ask for them)
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Drug prices scare the crap out of me
Luckily, the last time I took doxycycline, it was a true generic at a low dose. My insurance has now changed for the meds most important to me on a daily basis. It's about to cost me $300/month. I just don't have it and don't know what to do. The pharmacy I sometimes order from in India doesn't carry the meds. Somehow, that's called a good insurance plan after paying $200/month for coverage (the company pays the other $200).
Fortunately
I only have to take one other med, and the Dr. switched me from one with minor side-effects that was $20/month to a different generic in the same family which is only $10/month. So my total for both is about $45/month.
Medical costs in general scare the crap out of me. We have only major medical (self-employed), which has worked out well for us and actually saved us money, but it doesn't cover office visits, blood tests or meds.
If you ask your doctor to go cheap
...they usually will. Otherwise, they will prescribe what comes to them at the top of their head which is usually drug rep pushed meds that even when they have generic versions are too expensive. We have a wonderful doctor who went through everything my SO was on to find the cheapest medications that would work and sometimes other name-brand meds can be cheaper than generics used for a particular brand. It takes some work but if you can get your doc to do it or ask your pharmacist (they know the equivalents too) you can save a lot of money.
That said, even with all of that work meds are WAY too expensive.
PB 2.0 - Supplement the wonk!
PB 2.0 - Supplement the wonk!
This is not advertising but
If you have a Walgreens in your area check out their savings card. $20/yr for an individual.
I looked up the doxycycline listed like this:
DOXYCYCLINE HYCLATE 50MG CAPS 90
DOXYCYCLINE HYCLATE 100MG CAPS 60
DOXYCYCLINE HYCLATE 100MG TABS 60
and the price is $12.95
Using the pill-cutter could you take a 25mg dose as opposed to 20?
I took the list from Walgreens and showed it to the dr. I'm currently seeing. He said there was a good supply of generics listed there and he's keep that in mind when prescribing for me. I only have one medication I take that's brand name and it does hit my wallet a good whack, but have no choice.
The nearest Walgreen's brick and mortar
is at least 40 miles for me, and I think it's actually about 180 (to either Seattle or Spokane). However, they may be as near as my keyboard, and I'll check that out.
I've seen some speculation that the reason Periostat is 20mg instead of 25mg is because it's hard to dived a pill accurately into five pieces. Periostat does say they've run trials with 20mg doses, but not 25mg.
On the other hand, my uninformed, non-doctor, practical side says that if most people can tolerate a 100mg dose, the 5mg difference probably isn't important and you probably lose a few mg splitting the pill too. However on my previous BP med, there was a big difference between 40mg and 10mg doses, so those little, tiny mgs can be significant some times. I'd ask a knowledgeable professional.
Drug pricing for Tropical Disease Rx's
is a maze of bureaucratic rules, regulations (local and international) and, just out right, game playing. One particular drug for treating Malaria is five times more expensive in Africa where it is endemic than in Norway. Norway! There's malaria in Norway? Well, yes. But, just like the US, only if you go there with it already. The "reason" that was given by the pharmaceutical company was the LABEL and INSTRUCTION INSERT. It had to be printed in multiple languages not common in the EU.
The only problem w/ pill cutters is it's difficult to cut pills
exactly in half, much less in quarters--especially if they're not already scored. I have several pill cutters and the cheapest one actually cuts the best of those I've tried.
Recommendations for a really precise pill cutter would be much appreciated!
If your medication is meant to be kept very, very close to the same every day, using a pill cutter might throw things off. I don't know if that affects how these antibiotics work.
Also, since drug stores/sellers buy the cheapest generic, the manufacturer may vary from refill to refill. For many this is no problem, but some fillers affect how the active ingredient is absorbed and may affect efficacy.
Heard on public radio this week that China and India now supply an incredible percentage of the US pharmaceuticals. The FDA just shut off off imports of one of India's biggest producers. So far, I don't know of any problems with Chinese mfrs.
Cannot recall which program, but it was a discussion of a book written by a former US Big Pharma employee who was whistle blowing about the pressure drug makers put on doctors to not report problems with new drugs.
O Canada?
By mail from Canada might be cheaper--not only is it legal but docs now write prescriptions explicitly for getting a 3 month supply or more from there.
Also, one can actually, say, bite pills in two anyway, right?
Badger, hope your health continues to be good.
badger, I can fix that aneurysm
I have a caulking gun (I can just give you some caulk for nothing) and some duct tape (happy to donate), and a piece of PEX (better than the landfill).
Now, hold very very still and open your mouth very very wide.
Amazingly, that's how they do it nowadays
except they go into the artery through an incision in your crotch (through the femoral or iliac artery), as access through the mouth is a little more difficult.
They basically push a dacron tube around a wire frame (stent) inside the artery until it's in the right spot, and then it pops open and hooks itself into place (kind of like toggle bolts). When I got checked for it 10 years ago and asked the doctor - a GP - about that procedure (which hadn't been FDA approved yet), he thought it would never work. Now, over 50% of repairs are done without splitting you wide open, and there's even a doctor (highly rated by my sister-in-law the nurse) in the boondocks where I live who's done the procedure multiple times.
Actually, it's a cool disease to have. There are no symptoms, no restrictions on activity - in fact most people never know they have it until it ruptures and they drop dead from it. I got checked because it runs (more like gallops) in my family.
If I can keep it from getting much bigger, which is the plan, I'll die of something else before I need surgery or repair. If I were a mouse and not a man, there's even a chemical treatment that will reverse the process and shrink it back to normal.
I notice this with allergy & asthma meds
Frequently, the prescriptions are more expensive than the office visit and that is just one month.
I have never seen a generic maintenance inhaler for asthma treatment.
The big drug companies have to make all the money before the patent runs out AND it has to cover R&D for new drugs that fail.
I agree - this and diagnostics are some of the BIG expenses in the health system. I think we would still have R&D even with a more socialized system, there can still be incentives for innovation.
Advertising drugs takes far more money
Than research does, especially since most real research is publicly funded in colleges. The drug companies mostly research "me too" formulas, so they can patent them and charge more to make more profit.
So, the reality is we are paying for all that advertising here in the US, the only country besides New Zealand that even ALLOWS drug advertising. All other countries have banned it.
That's one of the reasons it is often less expensive in other countries, not to mention the governments where there is universal health care bargain with the drug companies, something we can't do as patients.
"A little knowledge is a dangerous thing. So is a lot." - Albert Einstein
Re: splitting pills-I've noticed that some expensive cholesterol
drugs are sort narrow shield shaped--difficult to split and get any kind of real measure of amount.
Possibly do halves, but quarters almost impossible.
Think it's done deliberately??
It's possible
I've seen speculation that the people who sell Periostat (relabled doxycycline) at inflated prices used a 20mg dose in their FDA trials for approval for periodontal use because you can't easily split a 100mg or 50mg tablet into 20mg doses.
Once-a-day time release tablets or any kind of capsule can't be split either.
Badger
Think you could do the Walgreens thing by mail order?
If that price is a good one for you it might be worth checking into.