When you have your prescription filled at the pharmacy how do you know you're getting what your doctor ordered?

It's not easy to make sure you're getting what you pay for. You have to rely on the pharmacist, who's selling you the drugs, but you can also do some digging  on-line.

With hundreds of prescriptions filled everyday many of us have blind faith in our pharmacists and that the medicines we get are the real deal.  Most pharmacists buy their medications from wholesalers, who they trust are buying directly from the drug companies.

"We put trust in them buying direct from the manufacturer as they state they do. But there could be places out there that people are buying drugs from that aren't reputable and could possibly have some potential to be counterfeit," pharmacist Joe Wapelhorst said.

So how can you make sure your getting what the doctor ordered?
   
"Webmd.com," Wapelhorst said. "You type in the medicine, they'll give you a tablet image and a brief graph about what the drug is."

You can also look up medicines in the Physician's Desk Reference.

The state requires pharmacists to provide invoices as proof of where they brought their medications, so if you have doubts about whether you're getting the real thing that's another way to check it out.

Zach Koffenberger said when he gets a prescription filled he sticks with national chains and he's not alone.

"I have a two-year-old and a four-year-old and I'm highly concerned with the prescription drugs," Jennifer Pence said.

"It's basically like counterfeit money," Wapelhorst said. "They look pretty darn close but you have to take the word from the person that's supplying it that it's actually coming from the manufacturer."

Labels: No Prescription, Online Pharmacy, Prescription Drugs

When it comes to prescription drugs, it turns out buying generic doesn't always mean the most savings. A Consumer Reports investigation found you still have to shop carefully to get the best deals.

We all know generic drugs are a lot cheaper than their brand name versions.

Take prozac. A year's supply of the generic, Fluoxetine, averages $433. Prozac averages more than four times that -- $1,863.

But Consumer Reports says despite big savings for generics, you can easily pay more than you need to.

"We did price comparisons at 132 pharmacies across the country. Those included drugstore chains, independent pharmacies, mass merchants, supermarkets, as well as online pharmacies," said Dr. Marvin Lipman.

The price check covered five common generic prescription drugs; Lisinopril for blood pressure, Lovastatin for cholesterol,
Metformin for diabetes, Warfarin the blood thinner, and Fluoxetine.

Consumer Reports found big price differences for a 30-day supply of these drugs.

"The range of prices for these 5 generic drugs varied widely at independent pharmacies, anywhere from $82 to $295."

And at drugstore chains, there were significant price differences too.

The median price for the five drugs at CVS was $116. At Walgreens, $157. And at Rite Aid, $162.

Consumer Reports found buying the generic drugs online is often one of the best deals, but not always.

Ordering from Cigna Teldrug's web site turned out to be very pricey --- $228 for the five drugs.

Costco stores had the best prices -- just $48 for the same five generic drugs.

And although Costco usually requires a membership, you don't need to be a member to shop either at its online pharmacy or at the pharmacy located in its stores.

Consumer Reports found Walmart charged more than twice as much as Costco for the five generic drugs but that could change.

Walmart recently announced it will test market a program and sell generics for as little as $4 for a month's supply.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Most Medicare prescription drug plans in 2007 will not cover erectile dysfunction treatments such as Viagra, Cialis and Levitra, the St. Louis Post-Dispatch reports. Many plans covered the treatments this year. According to the Post-Dispatch, "[m]any beneficiaries are learning of the change this week as they receive materials explaining next year's benefits." Most plans will continue to cover ED drugs if they are prescribed to treat medical conditions such as pulmonary hypertension, rather than for ED. Many of the insurers who sponsor Medicare drug plans say they support the change, which comes after a similar policy was implemented last year by Medicaid. UnitedHealthcare will market one Medicare drug plan that covers ED drugs, but its other plans will not cover the treatments. Charles Willey -- CEO of Essence, which markets Medicare Advantage plans -- said paying for ED treatments might not be the best use of health care expenditures, adding, "We have to decide what our priorities are"

Labels: No Prescription, Online Pharmacy, Prescription Drugs

We've done many columns on the risks and dangers of new drugs, and here is another variation on that theme - off-label use of drugs. That refers to drugs approved for one reason, but used for another reason unapproved by the FDA. The off-label drugs may even be riskier than the new drugs, which at least have been approved by the FDA.
Off-label use is commonplace, but it is not based on scientific study and has not gone through the FDA-approval process involving clinical trials. But under the law, doctors can prescribe any drug for an unapproved use. That rule is based on the concept that the FDA does not regulate the practice of medicine, and can't tell doctors what to prescribe. In fact, at times, it seems no one regulates the practice of medicine.
The doctor may go to an off-label use based on his theories about the drug, based on his experience with the drug and also based on recommendations from those touting the drug, or on anything else.
Now, there's new proof that, whatever intuition or other powers doctors draw on when making off-label prescriptions, they sometimes miss the mark.
A common off-label use for three drugs in the class called atypical antipsychotics is to treat agitation and aggression of Alzheimer's patients. The new study finds that the drugs are no more effective than placebos, but in addition, they can cause serious and even fatal adverse effects. In other words, the three drugs are worse than nothing.
Here are the names of those three drugs: Zyprexa, Risperdal and Seroquel. Those drugs, for on-label and off-label uses, ring up about $2 billion in sales a year. This new study passed no judgment on these drugs when used for approved purposes.
According to one published report, the drugs are prescribed on this off-label basis because families are so desperate to try to help an Alzheimer's victim, because the drugs seem to help once in a while, because company-sponsored doctors are out pushing the off-label uses and perhaps because doctors often prescribe ineffective and/or unsafe drugs.
I found this great revelation from this study published in the New England Journal of Medicine so interesting because, for years, doctors have been indicating these drugs are of little value and, their benefits, if any, are so negligible as not to be worth the risk of adverse effects, which include increased risk of death (compared to a placebo), sedation and confusion causing increased risk of falls and, in the case of Zyprexa and Risperdal, tremors and other Parkinson-like symptoms.
Another interesting aspect of the study involves the sponsor. The sponsor that financed the study is the National Institute of Mental Health. If this agency did not finance the study, the virtually useless and sometimes dangerous use of these drugs would probably have continued for many years, if not decades. You can be sure the drug industry is not likely to finance any after-approval-of-the-drug study to see if one of its products works or doesn't work. Perhaps an outcome, like the one in question, would be too likely for its tastes.
Still another interesting aspect of the study relates to the prescribing information, which states that patients with Alzheimer's-related psychosis "are at increased risk of death compared to placebo." This suggests that doctors either don't read prescribing information or don't consider death such a big deal when dealing with Alzheimer's patients.
In a published report in The New York Times, Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, observed that the drugs produce improvement that is modest at best, but that environment and behavior are more important in managing the combative behaviors of the patients (which the drugs are used to control). But the health delivery system is so obsessed with drugs that managing environment, behavior and other variables is not high on the priority list, even if such action would produce better outcomes. Prescribing and testing take the place of many things, including managing environment and behavior and talking to patients. It's much easier to write a prescription, especially when the prescribing pen is pushed by the marketing and legalized bribery of the drug industry, than to explore other more promising approaches.
Another expert, Dr. Jason Karlawish of the University of Pennsylvania, says the three drugs may be of use for "a subgroup of patients who can tolerate them, and in facilities that have the expertise to manage side effects." It would be reassuring to think that all facilities would have expertise to manage the side effects of drugs they give their patients, but apparently that is not the case.
Still another point of interest is that the study in question is the third in a series that finds this class of drugs, the atypical antipsychotics, is not as safe as are usually portrayed. When it comes to drugs, what else is new?
Finally, some observers say this study proves we need more research on how to handle the behavioral problems of Alzheimer's. My guess is this conclusion could have been reached by anyone of modest intelligence without the benefit of this study.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

In terms of the number of available vaccinations, the upcoming flu season is expected to go more smoothly than years past.

"There is an ample supply (of the vaccine) in this area," said Guillermo Cole, spokesman for the Allegheny County Health Department.

Guillermo said more than 100 million doses were distributed nationwide, compared to 80 million one year ago.

"There's enough for everyone who wants a flu shot," Cole said.

While several local clinics and physicians have already started issuing flu shots, a number of health centers, including Med-Fast Pharmacy and the Allegheny County Health Department, will begin offering the vaccine this week.

Gino Cordisco, spokesman for Med-Fast Pharmacy, said each location received 240 doses of the vaccine, which will be available at various times and locations beginning today.

Most clinics charge between $15 and $25 for the vaccination and will accept a variety of insurance plans.


Advertisement
Take Care Health Systems, which recently opened a health clinic in the Rochester Eckerd drug store, starting distributing the shots Saturday. Their Web site advises people to get the vaccination in October or November, before the flu season peaks. It takes about two weeks for the vaccination to take effect.

And if you're thinking this winter's mild temperatures will protect you from getting the flu, think again.

There is no correlation between the flu and the weather, Cole said. "All I can say is we know we'll have influenza."

The health department said this year's vaccine will protect against three strains of the virus, including New Caledonia, Wisconsin and Malaysia. They also estimate that between 5 and 20 percent of the nation's population gets the flu virus every year, more than 200,000 are hospitalized and nearly 36,000 people die from complications.

Those who should be vaccinated:

People 65 and older.

People living in nursing homes.

Adults and children older than 6 months with chronic heart or lung conditions and who need regular medical care.

People between the ages of 50 and 64.

Pregnant women.

Health care personnel.

Those who should not be vaccinated:

People with a severe allergy to chicken eggs.

Children less than 6 months old.

People with an illness or fever should wait until their symptoms improve.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

A new state law is expected to make prescription drug labels user-friendly and reduce medical errors, its backers believe.

Assembly Bill 269, which took effect this month, requires doctors — when asked by a patient — to include on the label the symptom or purpose for which the drug is being prescribed.

State Rep. Steve Wieckert (R-Appleton), the bill's author, believes it will reduce medical injuries and potentially save lives.

"It's an exciting thing that we can all use, especially seniors," said Wieckert. "Seniors take an average of 12 different prescriptions in Wisconsin, so they can get confused."

Wieckert said he hopes his bill will remind patients to ask their doctors for the clear labeling.

"They just have to give a little note to the doctor and just say, 'I'd like you to put on the label, in layman's terms, what is this medication for," he said. "A lot of people never thought to even ask. Sometimes when you make the rule, people are now aware that they can even ask."

A pharmacist can only print on a label what a doctor or healthcare provider includes on the prescription order. Patients, unfortunately, usually realize this at the pharmacy counter, Wieckert added.

"I've had some pharmacists tell me that they would issue three or four prescriptions for seniors who would come back and say, 'could you write on the labels what these are for,' but by law, they cannot do that," Wieckert said.

The Coalition of Wisconsin Aging Groups, AARP, the Wisconsin Nurses Association and the Wisconsin Patient Safety Institute were among the bill's backers.

It took Wieckert more than three years to get the bill passed. His original version required that doctors always ask patients if they want the purpose of the medication listed on the label. Doctors objected, arguing it would create another mandate that would interfere with the doctor-patient relationship.

Some doctors, though, remain dissatisfied with the new bill.

"I have a problem with micromanagement legislation," said Dr. John Barkmeier, a family practice and geriatric medicine physician with ThedaCare Physicians – Menasha. "There is no question that medication safety is an issue."

But it has more to do with adverse drug interactions when people take multiple medications, he said.

"I don't see any evidence that this is the solution that will make the biggest difference. Other interventions have proven to be more effective and that is where we are putting our energy."

Wieckert, however, believes the bill will also make it easier for seniors to switch to generic drugs, which could save them money.

"We found that there is a great reluctance among seniors to go from some of the brand-name drugs to generics," he said. "And one of the reasons is the pills are shaped differently and they worry they are going to lose track. Seniors remember to take the small blue pill for this and the square pill for that."

But if the labels say, "take for cholesterol, migraine headaches or blood pressure," he added, they can take their prescriptions with confidence.

Labels: No Prescription, Online Pharmacy, Prescription Drugs

Two classes of drugs commonly used to treat osteoarthritis—non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (a newer generation of NSAIDs)—present similar, increased risks of heart attacks while offering about the same level of pain relief, according to a new report by the Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ).

The exception is the drug naproxen, commonly sold as Aleve or Naprosyn, a medication that scientific evidence suggests presents a lower risk of heart attack for some patients than other NSAIDs or COX-2 inhibitors, the study concluded. Researchers emphasized in their analysis, however, that all drugs pose potential harms along with benefits. Patients differ widely on how they react to drugs, how they prioritize risks, and whether risks are acceptable when compared to a drug's benefits. Patients should talk to their doctors before changing any medications.

The report, authored by AHRQ's Evidence-based Practice Center at Oregon Health & Science University, was based on a systematic review of 360 published studies and represents the most comprehensive analysis thus far of arthritis pain medications. Researchers compared the pain medications' effectiveness and health risks, including heart attack and gastric side effects, plus identified topics where more research is needed. While the review yielded important findings about the painkillers, it concluded more studies are needed about the drugs' comparative risks, the consequences of long-term use, and the impact of dosing variations. The authors also suggested that genetic research may one day predict which patients are most likely to develop cardiovascular problems when taking the analgesics.

"These findings represent a vital comparison of medications that are taken by millions of Americans," said AHRQ Director Carolyn M. Clancy, M.D. "The report also shines a bright light on questions that could further our knowledge and give patients research-based evidence to help them choose the best available treatment."

Osteoarthritis is a joint disease that causes erosion of cartilage and leads to friction between bones. Its precise cause is unknown, though it has been linked to aging, specific occupations, trauma, genetics and repetitive, small injuries over time. The rubbing causes pain, swelling, and loss of motion. Osteoarthritis is different from rheumatoid arthritis, an autoimmune disease that causes joint pain and other problems.

Osteoarthritis affects mostly older people, but younger people with joint injuries also may be afflicted. About 6 percent of U.S. adults 30 or older have osteoarthritis of the knee, and about 3 percent have osteoarthritis of the hip. In 2003, Americans spent about $36.6 billion on treatments for osteoarthritis and other non-traumatic joint disorders, including hospitalizations, surgeries, diagnostic tests, drugs, home care and other interventions, according to federal estimates. Of this amount, about $5.5 billion was spent on COX-2 inhibitors and $3 billion on other NSAIDs.

The AHRQ report, which was developed with ongoing input from experts and other members of the public, analyzed the risks and benefits of 26 medications. Among the conclusions:
All NSAIDs and COX-2 inhibitors can cause or worsen hypertension, congestive heart failure, swelling and impaired kidney function.
No clear difference has been shown in pain-relief effectiveness among NSAIDS and COX-2 inhibitors.
Most NSAIDs and COX-2 inhibitors pose similar increased risks of heart attack.
The NSAID naproxen carries a smaller risk of heart attack than other NSAIDs or COX-2 inhibitors.
The risks of serious adverse gastrointestinal events for users of Celebrex are similar to the risks for users of Motrin, Advil, Voltaren and other NSAIDs.
More scientific evidence is needed to compare the cardiac and gastrointestinal risks of aspirin at doses effective for pain relief versus other NSAIDs.
Acetaminophen (Tylenol) generally reduces pain less effectively than NSAIDs but carries a smaller risk of gastrointestinal problems. One study showed high doses posed heart attack risks similar to NSAIDs.

For years, NSAIDs were the primary treatment for osteoarthritis. This class of drugs includes prescription medications, such as sulindac (sold as Clinoril) and diclofenac (Voltaren, Cataflam), as well as over-the-counter medicines such as aspirin, and medications with both prescription and over-the counter versions, such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve).

Traditional NSAIDs work by inhibiting the action of two related enzymes. One of the enzymes reduces inflammation, eases pain and prevents blood clotting. But the intervention also limits the other enzyme's ability to protect the stomach lining from digestive chemicals and help maintain kidney function. Each year, an estimated 16,500 people die due to NSAID-induced gastrointestinal problems.

Many experts initially expected that COX-2s, which target only the enzyme that stimulates inflammation, would not cause the same stomach problems as traditional NSAIDs. Unexpectedly, the drugs were linked to serious cardiovascular problems. Two COX-2 inhibitors—rofecoxib (Vioxx) and valdecoxib (Bextra)—were voluntarily withdrawn from the market because of heart attack risks. Evidence on a third COX-2 inhibitor, celecoxib (Celebrex), suggests that it does reduce the risk of bleeding and other ulcer complications in patients using the drug for less than 6 months, but it is not clear if it is safer than other NSAIDs when used for longer periods of time.

The new report, Comparative Effectiveness and Safety of Analgesics for Osteoarthritis, is the newest in a series of Comparative Effectiveness Reviews, and it is available at http://effectivehealthcare.ahrq.gov/synthesize/reports/final.cfm. They are produced by AHRQ's Effective Health Care Program, the first federal program to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, health care providers, and others choose the most effective treatments. Information on the program and other comparative effectiveness reviews can be found at http://www.effectivehealthcare.ahrq.gov.

Labels: No Prescription, Online Pharmacy, Prescription Drugs