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Issue 2014.9 Best Ways to Beat Cold Symptoms According to ProCare Rx’s analytics team, the drug inflation rates year-to-date are as follows: ALL DRUGS 7.61% BRANDS 9.71% GENERICS -1.57% SPECIALTY 11.15% Generic Releases There are no new generic updates for the month of August Drug Condition Baraclude Frova Protopic Hepatitis B Headache Immunosuppressant Date Aug 26 Aug 28 Sep 9 While we have done extensive research on these dates, there is a possibility that any given date may change based on legal issues or patent challenges. If we become aware of any changes, we will update this chart in the next issue. Formulary Changes There were no changes to the ProCare Rx National Formulary for the month of September. For a complete list of formulary changes, please visit our website at http://www.procarerx.com It’s that time again! You feel terrible. You’re coughing, you’ve got a stuffy nose, a sore throat – the full monty. But which products are worth the money and which should you skip? We chose the best over-the-counter drugs based on effectiveness and safety. Use our picks below to treat a run-of-the-mill cold. But keep in mind that certain symptoms, such as shortness of breath, chest pain, a high fever, or an illness that worsens after seven days, warrant a trip to a health care professional. All of the products noted are name brands, but generic versions are available at significant cost savings. For Nasal Congestion…take Afrin (generic oxymetazoline) nasal spray…skip Sudafed PE (generic phenylephrine) tablet. The nasal spray wins because its active ingredients work fast to shrink swollen nasal blood vessels, which will help you breathe easier. Sprays used short-term are also a better first choice because they cause fewer side effects than oral decongestants – if you stick to the recommended dose – since they’re usually not absorbed into your bloodstream in significant amounts like oral decongestants. The active ingredient in Afrin is also in Dristan and Vicks Sinex, which are two other good options for 12-hour congestion relief. Sprays containing phenylephrine, such as Neo-Synephrine, also work well but last only up to 4 hours. Be sure to limit over-the-counter nasal-spray use to no more than three days or you could end up with rebound congestion, leaving your nose even stuffier. If you’re still congested after three days, you can try an oral product containing pseudoephedrine (Sudafed and generic). You’ll have to ask for it since they’re kept behind the pharmacy counter; the less effected Sudafed PE is stocked on open store shelves. But if you have glaucoma, heart disease, high blood pressure, an enlarged prostate, or thyroid disease, check with your doctor or pharmacist before using any type of decongestant, including sprays, since they might worsen the condition. For a Runny Nose…take Chlor-Trimeton (generic chlorpheniramine…skip AlkaSeltzer Plus Cold & Cough The single-ingredient antihistamine Chlor-Trimeton beats out the multidrug-remedy AlkaSeltzer Plus Cold & Cough. The Alka-Seltzer product has an antihistamine, too. But it also contains a pain reliever, a cough suppressant, and a decongestant, which is overkill if you just have the sniffles. Taking all those extra medications puts you at risk for possible side effects. Besides, neither dextromethorphan (a cough suppressant) nor phenylephrine in pill form (a decongestant) work very well. The downside of using older antihistamines like Chlor-Trimeton are side effects that include drowsiness , dry eyes and mouth, and urinary retention. Newer antihistamines, such as Claritin (generic loratadine) and Zyrtec (generic Cetirizine), work better for allergies but not as well for colds. Before you reach into your medicine cabinet, your best bet might be to have a bowl of chicken soup, drink a cup of tea, and head for bed early. For a Cough…take Luden’s throat drops, skip Robitussin (dextromethorphan) cough syrup Previous issues of Newsflash can be viewed under “Publications” at: www.ProCareRx.com Fits of coughing and hacking can be upsetting, but Robitussin syrup or a whole slew of other OTC remedies than contain dextromethorphan won’t do much to stop them. You’re better off sucking on a lozenge, such as Luden’s throat drops. They contain pectin and honey, which coat your raw throat and soothe the tickle that often triggers a coughing fit. Even easier: Try a spoonful of honey, which worked better than a honey-flavored cough syrup in a published study. But don’t give honey to babies younger than 12 months old because it could contain botulism spores, which can be dangerous to them due to their immature immune systems. Issue 2014.9 Page 2 The following New Drugs were recently approved by the U.S. Food & Drug Administration and added to ProCare Rx’s National formulary. Each drug was reviewed at the ProCare Rx’s P&T Committee meeting on September 10, 2014. Dose Form Brand Name Acticlate (doxycycline) Arnuity Ellipta (fluticasone furoate) Beleodaq (belinostat) Belsomra (suvorexant) FDA Approved Indication Tier P/A Specialty Medical Treatment for bacterial infections Tier 3 Prior Auth: No Specialty: No Medical: No Inhaler Treatment to improve glycemic control with diabetes mellitus Tier 3 Prior Auth: No Specialty: No Medical: No Treatment for cancer called peripheral T-cell Lymphoma Tier 3 Intravenous Prior Auth: No Specialty: No Medical: No Tier 3 Prior Auth: Yes Specialty: No Medical: No Tier 3 Prior Auth: No Specialty: No Medical: No Oral Oral Treatment for insomnia Invokamet (canagliflozin and metformin hydrochloride) Oral Treatment for type 2 diabetes Jardiance (empagliflozing) Oral Treatment for type 2 diabetes Tier 3 Prior Auth: No Specialty: No Medical: No Kerydin (tavaborole) Topical Solution Treatment for onychomycosis of the toenails Tier 3 Prior Auth: Yes Specialty: No Medical: No Natesto (testosterone Oral Treatment of hypogonadism Tier 3 Nikki (drospirenone and ethynyl estradiol) Oral Oral contraceptive Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: Plegridy (peginterferon beta – 1a) Oral Treatment for relapsing forms of MS Tier 3 Rasuvo (methotrexate) Intravenous Treatment for RA Ryanodex (dantrolene) Intravenous Treatment for malignant hyperthermia Sivextro (tedizolid phosphate) Striverdi Respimat (olodaterol) Targiniq ER (oxycodone hydrochloride and naloxone hydrochloride) Triumeq (abacavir, dolutegravir and lamivudine) Vogelxo (testosterone Zydelig (idelalisib) Oral Inhaler Treatment for ABSSI Treatment for COPD Tier 3 Prior Auth: Yes Specialty: No Medical: No Tier 3 Prior Auth: Yes Specialty: No Medical: No Tier 3 Tier 3 Tier 3 Tier 3 Oral Oral Pump or Topical Oral Treatment for severe pain Treatment for HIV Treatment for testosterone Treatment for leukemia No No No No No No Tier 3 Tier 3 Tier 3 Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: No No Yes No No No Yes No No No No No Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: Prior Auth: Specialty: Medical: Yes No No Yes No No Yes No No Is it Really Strep Throat? Most sore throats stem from viral infections, such as the common cold. Yet three quarters of the people who mention the complaint to their doctor each year are prescribed antibiotics, which work only against bacterial infections Why? Partly because many doctors feel so rushed that they don’t spend the few minutes it takes to identify the true cause of the problem. Or they write a prescription just to satisfy an insistent patient. But the inappropriate use of an antibiotic is both useless and dangerous, since it can breed drug resistance. Here’s how to know whether your sore throat stems from a bacterial infection – notably the one that causes strep throat – or some other reason, and what to do about it. Look for telltale symptoms. Contact your doctor if you have a very sore throat that makes it painful to swallow and you have a fever, enlarged lymph nodes on the sides of the neck, or nausea. Those symptoms could indicate strep throat, especially if they begin abruptly or if you were exposed to strep throat in the previous two weeks. Sore throats accompanied by a runny nose or cough usually indicate a cold. Give yourself a week to see if the symptoms resolve on their own. Get tested. Many doctors prescribe antibiotics for people with those symptoms, especially if the exam reveals redness with whitish deposits on the back of the throat. But they should confirm the diagnosis by using a swab to take a sample. Results for the standard test, which involves growing the sample to identify the bacteria, take 24 to 48 hours. But recent research confirms that a 5- to 10-minute test that measures an antigen, or protein, produced by the bacteria usually suffices. Take the right drugs. A confirmed case of strep requires antibiotics to shorten the contagious period from about 14 days to 24 hours. Antibiotics can also ease symptoms and prevent complications. While some doctors limit treatment to a week, a 10-day course of generic penicillin (250 milligrams three times a day) is usually best. People allergic to that drug should try erythromycin. The Food and Drug Administration recently approved a once-a-day form of the penicillin-derived drug amoxicillin, called Moxatag. But it’s no more effective, and a 10-day course costs about $100 compared with the less than $10 for penicillin. Soothe yourself. Try cough drops, gargle with warm saltwater, humidify dry air, and take generic acetaminophen, ibuprofen, or naproxen to ease fevers and aches.