I’m not in the habit of wishing bad things to happen to anybody, but yesterday, when I was at the pharmacy counter, I was wishing every member of Congress would have to experience the same insanity I was experiencing. If they did, they just might do something to fix the growing crisis they helped create when they passed the so-called “Medicare Modernization Act” (MMA) in 2003.
Out of pocket thru Canada….THREE Serevent Diskus (salmeterol xinafoate) from Canada via Mauritius scheduled to arrive including shipping: $67.99. Generic Ventolin: THREE inhalers @ $56.74 inclusive shipping right from Vancouver, BC. Thank you 🇨🇦! I’m an old hand at this now. If you’re picking up inhalers in the US you’re overpaying.
You can fulminate about the MMA, PBMs, drug companies, etc., but you need to be responsible for understanding what medicine you've been prescribed, what the generic name is, etc. You're already confusing what's a generic and what isn't right here:
"It turns out that there is: fluticasone propionate-salmeteroL. It isn’t a generic version of Symbicort but of a similar inhaler called Wixela Inhub. She wrote me a script for the generic version of the inhaler and I took it to my local Rite Aid last night."
Fluticasone-salmeterol is a combo treatment consisting of two drugs: Fluticasone propionate and salmeterol xinfoate. These are the generic chemical names for the two drugs sold originally by GSK as Flovent and Serevent. Flovent is an inhaled corticosteroid and Serevent is a long-acting beta agonist (essentially, a long-acting version of what your albuterol rescue inhaler does).
GSK later combined these into a single treatment called Advair, specifically Advair Diskus. The Diskus part refers to the special rotary inhaler that punctures a sealed pouch with the medication in powdered form on a rotating disk within the mechanical assembly. This is different from the gas propellant inhalers used for albuterol and originally used for Flovent and Serevent.
They did this, of course, because the new inhaler could be patented such that GSK could keep the drugs protected from being offered as a generic even after the original fluticasone propionate (Flovent) and salmeterol xinafoate (Serevent) compounds lost patent protection.
Advair eventually came off-patent, but any drug company wanting to offer a generic would need to cook up its own inhaler mechanism because the Diskus inhaler is still patented.
This is what Wixela Inhub is. It's what's called a branded generic. In this case, the drug compounds are generic (fluticasone propionate and salmeterol xinafoate) but the Inhub inhaler is new and has its own patent protection.
So, this is where you are confused. There is no generic for Mylan's Wixhela Inhub. The drugs in the inhaler are generic, but Mylan's Inhub inhaler is new and proprietary.
The original Advair Diskus is now sold as an authorized generic (I'm presuming that means GSDK licensed it) by Prasco. I've actually had one of these, and it looks exactly the same as the original Advair Diskus, same purple/violet color scheme and all.
It is idiotic that our doctors can't simply prescribe generic fluticasone-salmeterol for us and have the pharmacy fill it with whichever generic inhaler they carry. You can add the FDA to your list of villains along with insurers, PBMs, drug companies, and drugstores. In the meantime, you need to research the drug you are taking to know exactly what it is and how it's delivered to figure out how you can get it for the best price.
Case in point: I went from paying $132 for the Prasco authorized Advair generic to $50 for the Wixela Inhub. GSK came to an agreement last year along with other players in the pulmonary space to limit the price of certain treatments (Advair and Symbicort are both on the list, IIRC) to $35. I now have a GSK discount card that ought to allow me to get Advair for $35 and one for Wixela that is supposed to let me get it for $10. Both are readily available online, and I intend to get new prescriptions from my doctor to see which of the two I can get for the lowest price.
1) Was the initial Symbicort filled at a CVS rather than a Rite Aid?
2) Was your 3 month supply of symbicort going to be $606 at refill, or did you not check?
I ask because $606 is $480 + $126 - you met your $480 deductible on that fill and then you paid the Wellcare "preferred pharmacy" copay of $126 for 3 months for a tier 3 branded medication (in a single transaction of $606, but still). CVS is a preferred pharmacy in Wellcare's network, Rite Aid is a standard pharmacy, resulting in an out of pocket cost difference of $5/month ($15/3 months).
I suspect that your symbicort would be $126 at refill time, not $606.
Also, had you not filled the symbicort earlier in the plan year, your Wixela would have been $621, not $141, because you wouldn't have met the $480 deductible yet.
Is this insanely complicated and stupid? Yes.
Today at the pharmacy, I was discussing options with a patient who had Wellcare Part D coverage. Based on the low acquisition costs of the 4 medications he was taking, I suspected that all 4 drugs would be tier 1 (at most 2) on his plan's formulary. To my surprise, one was tier 1, two were tier 2 and the fourth was tier 3. This meant that his copays, rather than being the expected $10/month for each, were in fact $10/month, $20/month, $20/month and $47/month (after meeting a $480 deductible). So the total copayments per month added up to $97/month, not $40-50 that I expected to see.
I'm so glad to see this post. I recently had a very similar experience. CVS in San Francisco informed me by automated call that Wixela would provide a generic alternative to my Advair. After confusing exchanges with CVS and my doctor, I learned that Wixela was not covered by my SilverScript Choice/Aetna Part D Plan, so I stayed with the Advair brand name. I've already paid most $900 for this year's "deductible." Meanwhile, I've seen my monthly "premium" jump by 50% in the past 5 years.
I wish it happened to them all the time. The only experience with the American healthcare system they created is how it feels to lose/gain lobbying money from the pharma/insurance cartel that straight-up writes the legislation. They write it and members of Congress insert it. And somehow they always seem to have the healthcare plans that the rest of us say we would like, but they tell us would not be possible in the marketplace.
Out of pocket thru Canada….THREE Serevent Diskus (salmeterol xinafoate) from Canada via Mauritius scheduled to arrive including shipping: $67.99. Generic Ventolin: THREE inhalers @ $56.74 inclusive shipping right from Vancouver, BC. Thank you 🇨🇦! I’m an old hand at this now. If you’re picking up inhalers in the US you’re overpaying.
You can fulminate about the MMA, PBMs, drug companies, etc., but you need to be responsible for understanding what medicine you've been prescribed, what the generic name is, etc. You're already confusing what's a generic and what isn't right here:
"It turns out that there is: fluticasone propionate-salmeteroL. It isn’t a generic version of Symbicort but of a similar inhaler called Wixela Inhub. She wrote me a script for the generic version of the inhaler and I took it to my local Rite Aid last night."
Fluticasone-salmeterol is a combo treatment consisting of two drugs: Fluticasone propionate and salmeterol xinfoate. These are the generic chemical names for the two drugs sold originally by GSK as Flovent and Serevent. Flovent is an inhaled corticosteroid and Serevent is a long-acting beta agonist (essentially, a long-acting version of what your albuterol rescue inhaler does).
GSK later combined these into a single treatment called Advair, specifically Advair Diskus. The Diskus part refers to the special rotary inhaler that punctures a sealed pouch with the medication in powdered form on a rotating disk within the mechanical assembly. This is different from the gas propellant inhalers used for albuterol and originally used for Flovent and Serevent.
They did this, of course, because the new inhaler could be patented such that GSK could keep the drugs protected from being offered as a generic even after the original fluticasone propionate (Flovent) and salmeterol xinafoate (Serevent) compounds lost patent protection.
Advair eventually came off-patent, but any drug company wanting to offer a generic would need to cook up its own inhaler mechanism because the Diskus inhaler is still patented.
This is what Wixela Inhub is. It's what's called a branded generic. In this case, the drug compounds are generic (fluticasone propionate and salmeterol xinafoate) but the Inhub inhaler is new and has its own patent protection.
So, this is where you are confused. There is no generic for Mylan's Wixhela Inhub. The drugs in the inhaler are generic, but Mylan's Inhub inhaler is new and proprietary.
The original Advair Diskus is now sold as an authorized generic (I'm presuming that means GSDK licensed it) by Prasco. I've actually had one of these, and it looks exactly the same as the original Advair Diskus, same purple/violet color scheme and all.
It is idiotic that our doctors can't simply prescribe generic fluticasone-salmeterol for us and have the pharmacy fill it with whichever generic inhaler they carry. You can add the FDA to your list of villains along with insurers, PBMs, drug companies, and drugstores. In the meantime, you need to research the drug you are taking to know exactly what it is and how it's delivered to figure out how you can get it for the best price.
Case in point: I went from paying $132 for the Prasco authorized Advair generic to $50 for the Wixela Inhub. GSK came to an agreement last year along with other players in the pulmonary space to limit the price of certain treatments (Advair and Symbicort are both on the list, IIRC) to $35. I now have a GSK discount card that ought to allow me to get Advair for $35 and one for Wixela that is supposed to let me get it for $10. Both are readily available online, and I intend to get new prescriptions from my doctor to see which of the two I can get for the lowest price.
A few questions:
1) Was the initial Symbicort filled at a CVS rather than a Rite Aid?
2) Was your 3 month supply of symbicort going to be $606 at refill, or did you not check?
I ask because $606 is $480 + $126 - you met your $480 deductible on that fill and then you paid the Wellcare "preferred pharmacy" copay of $126 for 3 months for a tier 3 branded medication (in a single transaction of $606, but still). CVS is a preferred pharmacy in Wellcare's network, Rite Aid is a standard pharmacy, resulting in an out of pocket cost difference of $5/month ($15/3 months).
I suspect that your symbicort would be $126 at refill time, not $606.
Also, had you not filled the symbicort earlier in the plan year, your Wixela would have been $621, not $141, because you wouldn't have met the $480 deductible yet.
Is this insanely complicated and stupid? Yes.
Today at the pharmacy, I was discussing options with a patient who had Wellcare Part D coverage. Based on the low acquisition costs of the 4 medications he was taking, I suspected that all 4 drugs would be tier 1 (at most 2) on his plan's formulary. To my surprise, one was tier 1, two were tier 2 and the fourth was tier 3. This meant that his copays, rather than being the expected $10/month for each, were in fact $10/month, $20/month, $20/month and $47/month (after meeting a $480 deductible). So the total copayments per month added up to $97/month, not $40-50 that I expected to see.
I'm so glad to see this post. I recently had a very similar experience. CVS in San Francisco informed me by automated call that Wixela would provide a generic alternative to my Advair. After confusing exchanges with CVS and my doctor, I learned that Wixela was not covered by my SilverScript Choice/Aetna Part D Plan, so I stayed with the Advair brand name. I've already paid most $900 for this year's "deductible." Meanwhile, I've seen my monthly "premium" jump by 50% in the past 5 years.
I wish it happened to them all the time. The only experience with the American healthcare system they created is how it feels to lose/gain lobbying money from the pharma/insurance cartel that straight-up writes the legislation. They write it and members of Congress insert it. And somehow they always seem to have the healthcare plans that the rest of us say we would like, but they tell us would not be possible in the marketplace.