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Less Expensive Medication Alternatives

Bryan Hayes, PharmD and Mike Weinstock, MD
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18:01

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Bryan and Mike talk through different options to treat various conditions seen in urgent care while balancing the cost of the medication and the patients needs. 

 

Pearls:

  • Considering the cost of medications is an important determinant of medication adherence

  • Avoiding prescribing non-generic medications and reminding patients to request generic versions when filling their prescriptions can dramatically lower the cost of many medications.  

  • Antibiotic eye drops should be reserved for cases with reasonable probability for bacterial etiology of infection. 

  • In patients with a  history of contact lens use, tobramycin ($8/bottle at Wal-Mart) is generally the most affordable option. Fluoroquinolones are typically prohibitively expensive. 

  • Cefuroxime is an excellent and reasonably priced oral cephalosporin with excellent activity against the common organisms causing UTI, pneumonia, and cellulitis. 

  • GoodRx™ is a powerful resource which is free for patients and offers substantial discounts for most medications and is accepted at nearly all pharmacies. Patients may need to present/download a coupon. 

  • Wal-Mart continues to offer a “$4 prescription” list that covers many commonly prescribed medications, especially antibiotics. 

    • These prescriptions are offered at this price to all patients without any sort of membership and regardless of insurance status. 

  • Lidocaine 5% patches are a common prescription for acute pain, but the out-of-pocket cost is often ~$20/patch. 

    • 4% Lidocaine patches, however, are available over the counter and cost ~$2/patch and should produce a nearly equivalent clinical effect.

      • The lidocaine in these patches is minimally absorbed systemically;  the patches must be placed over the area of discomfort for maximal benefit. 

  • Antibiotic eye and ear drops can be particularly and surprisingly costly.

    • Prophylactic antibiotic coverage for corneal abrasions is of limited benefit and the expense of antibiotic eye drops is unlikely justifiable.

      • Antibiotic drops/ointments are rarely indicated in conjunctivitis unless there is a high likelihood of bacterial etiology (ie: unilateral and significant discharge)

    • In patients with ocular infections who are NOT contact lens wearers, erythromycin ointment or polymyxin-trimethoprim drops are the most cost effective options. 

    • In patients who do wear contact lenses, Pseudomonas coverage is mandatory; use a quinolone or aminoglycoside preparation

      • Tobramycin (an aminoglycoside antibiotic) drops are an excellent option in these cases and are available at Wal-Mart for ~$8/bottle. 

  • Inhalers for patients with asthma/COPD are another group of medications where cost considerations are important. 

    • The most affordable steroid inhaler currently is AirDuo™, which is available as a generic Fluticasone/long acting beta-agonist (salmeterol) combo, and is indicated in moderate-severe asthma.  

      • This still costs >$50 and is generally cheapest at Walgreens, however, other inhaled corticosteroids commonly cost ~$200 for a metered dose inhaler. 

    • For allergic rhinitis, over-the-counter steroid nasal sprays are generally the most cost effective option. 

    • Albuterol inhalers are a necessary medication for all asthmatics to have available, however, the cost of these has recently increased.

      • Wal-Mart currently has the most affordable albuterol HFA inhalers, which cost about $35. 

  • Third generation cephalosporins are excellent outpatient treatment options for many infections commonly seen in UC. 

    • Cefpodoxime is the closest oral equivalent to ceftriaxone, but can be quite costly (ie: >$100 for a short course). 

    • Among third generation cephalosporins, cefdinir (AKA Omnicef™) is the most affordable. 

    • Cefuroxime (aka Ceftin™), a second generation cephalosporin, is an excellent, cost effective oral option for treatment of UTI, cellulitis, and pneumonia.

      • For UTI, cefuroxime is typically dosed at 250 mg BID and for pneumonia and skin infections, a dose of 500mg BID is recommended. 5-7 days is an appropriate treatment course with cefuroxime for each of these infections.

  • Treatment of hypertension can be achieved without the use of inexpensive medications relatively easily because there are many different therapeutic options. 

    • Wal-Mart has a number of anti-hypertensive medications available on the $4 prescription list such as: amlodipine, lisinopril, HCTZ, furosemide.

  • GoodRx™ is a free, and universally valuable resource for patients. It is a coupon service that provides significant discounts on most medications and at most pharmacies.

    • Patients may require a discount code, which can be downloaded or accessed through the GoodRx™ app on their smartphones, to benefit from the discount.

References:

1. GoodRx, https://www.goodrx.com/.

Ian L., Dr -

Salmeterol is not as fast at bronchodilator relief as formoterol because in formoterol has lower lipophilicity (Wikepedia -) also Science Direct writing an onset of action of 10-30 minutes for salmeterol .
Global initiative asthma control -GINA -recommends Inhaled corticosteroid -formoterol on pg 18 2019 .

Mike W., MD -

Thx Ian!
M

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