Drug prices increase as inflation rate declines

You may want to be extra vigilant buying brand-name prescription drugs these days. Prices for some of the most widely prescribed brands shot up an average 9% this year–the highest rate in over a decade–even as the overall inflation rate actually declined by around 1 percent.

This assessment* comes from Stephen W. Scholdelmeyer, a professor of pharmaceutical economics at the University of Minnesota’s PRIME Institute. The analysis includes drugs such as Nexium for heartburn (up 7.2%), Plavix to prevent blood clots (up 8.2%), Singulair for asthma (up 12.5%), Flomax for enlarged prostate (up 19.7%), and Fosamax and Boniva for osteoporosis (up 6.9% and 18.6%, respectively).

The analysis was done for AARP, which has closely monitored wholesale prices for a group of 219 drugs since 2002. "The pharmaceutical industry should be embarrassed when it sees its own price increases put side-by-side with the general inflation rate," said John Rother, AARP executive Vice President. "Even as the cost of most good and services drops, a person taking just one brand name drug now pays $200 more per year than a year ago."

Q&A: Preventing shingles?

A friend recently had a painful outbreak of shingles. How can I avoid that condition? —F.J.S., Franklin, N.C.

If you’re age 60 or older, you can get the shingles vaccine. About one in four adults who’ve had chicken pox will eventually experience shingles, a painful, blistering rash that occurs when the herpes zoster virus—which lies dormant in the body after a case of the pox—is reactivated by weakened immunity from age, disease, or another factor. The vaccine cuts your risk of a first outbreak in half, and reduces discomfort by about two-thirds in the event you do get shingles. (The odds of a second outbreak are much smaller, only about 1 in 20.) Your doctor should be able to provide the shot, which costs about $150 and is partly covered by most forms of insurance.

FDA cracks down on Web sites illegally selling prescription drugs

It’s buyer beware when it comes to purchasing prescription drugs over the Internet, but the Food and Drug Administration is looking to weed out some of the bad apples. The agency said it sent warning letters to 136 off-shore web sites that are illegally selling drugs to U.S. consumers.

The concern is that drugs sold by these web sites could pose a danger to consumers. "Many U.S. consumers are being misled in the hopes of saving money by purchasing prescription drugs over the Internet from illegal pharmacies," FDA Commissioner Margaret A. Hamburg, M.D., said in a statement. "Unfortunately, these drugs are often counterfeit, contaminated, or unapproved products, or contain an inconsistent amount of the active ingredient."

The agency said it also notified Internet service providers and domain name registrars that the web sites were violating U.S. law. The providers and registrars could terminate the sites or suspend use of the domain names. The FDA did not identify the web sites, but said that they did not represent U.S. or Canadian pharmacies.

Q&A: Viagra and eye problems?

I take sildenafil (Viagra), which temporarily gives a blue tint to my vision. Recently I was also diagnosed with macular degeneration. Will taking sildenafil worsen that? —Name and address withheld

Probably not, but few studies have looked into it. Sildenafil affects vision by blocking an enzyme that helps the eyes process color. But the limited studies available, mostly funded by drug manufacturers, show that effect is transient and appears to have no long-term effect on eye function. A few small studies of patients with macular degeneration or glaucoma taking sildenafil have shown the drug doesn’t worsen either condition within up to five hours of taking it. 

The only eye condition that’s been associated with sildenafil use is a rare blockage of blood flow to the optic nerve that causes a sudden, permanent decrease in vision in one eye—though it’s not clear what role the drug plays, if any, in the condition. If you experience such an impairment, contact your eye doctor right away.

Read more on the side effects of sildenafil, find out if women should take Viagra, and see our Treatment Ratings for macular degeneration (subscribers only).

Avoid dangerous combination: Blood thinner Plavix with some heartburn drugs

The Food and Drug Administration warned today that people who take the blood thinner clopidogrel (Plavix) should not take the heartburn drugs omeprazole (Prilosec, Prilosec OTC, and generics) and esomeprazole (Nexium) because two new studies confirm that the combination could have dangerous consequences. The studies show that omeprazole and esomeprazole—both members of a class of stomach acid-reducing drugs called proton pump inhibitors, or PPIs—can lower the effectiveness of Plavix , putting people at risk of heart attacks or strokes.

Plavix is given to people after a heart attack to help reduce the risk of blood clots that can trigger another attack. The drug can be hard on the stomach and cause gastrointestinal bleeding, so people are often prescribed a PPI treatment, which reduces the amount of acid in the stomach and lowers the risk of stomach bleeding. But previous studies suggested this drug combination may actually increase the risk of having another heart attack. The FDA’s warning is based on two new studies from the makers of Plavix that show that both omeprazole and esomeprazole reduce the drug’s effectiveness because they block an enzyme in the body called CYP 2C19.

The agency said it does not have enough information to draw a conclusion about whether any other PPIs can be safely used with Plavix, but studies into this issue are being conducted. However, a different type of acid-reducing drug called cimetidine (Tagamet, Tagamet HB, and generics) also inhibits the CYP 2C19 enzyme and should not be taken with Plavix.

Q&A: What causes easy bruising?

I’m a 75-year-old woman who bruises easily. What could cause that? —J.B., Irvington, N.Y.

Several things. Bruises form when tiny blood vessels near the surface break, causing bleeding that discolors skin. Anything that affects those vessels or the blood’s ability to clot can lead to increased bleeding and bruising. The most likely cause is the natural thinning of the skin with age, which leaves the vessels less protected. Other causes include various drugs, notably the steroid prednisone; the blood thinners aspirin, clopidogrel (Plavix), and warfarin (Coumadin); and diseases of the blood cells, bone marrow, immune system, or certain organs. So be sure to talk with your doctor if you’ve started to bruise easily.

People with depression get strong painkillers, but do they work?

If you have chronic pain, such as back or neck aches, and also suffer from depression, you may want to think twice about the treatment your doctor has prescribed.

A new study shows that people with chronic aches who are also depressed are more likely than others to get a potent painkiller, such as morphine or codeine, but there’s no evidence these drugs are effective or safe for those who suffer from depression. The medicines also pose a risk of addiction and serious side effects.

In the study, which appears in the November-December issue of General Hospital Psychiatry, researchers examined medical records of more than 14,000 people who were prescribed opioids for three months or longer between 1997 and 2005 for chronic pain. The result: people with a history of depression were three times more likely to have been prescribed the potent painkillers. They were also more likely to receive a higher dose, and to be put on opioids that carry a higher potential for abuse or addiction, such as morphine and oxycodone (OxyContin, Percocet, and others, including generics).

Patient beware: Contamination found in Genzyme drugs for rare disorders

According to a Food and Drug Administration report out today, five drugs made by Genzyme that are used for treating rare disorders were contaminated with metal and rubber particles that could pose serious risks to people who take them. The five drugs are:

• Aldurazyme (laronidase)
• Cerezyme (imiglucerase)
• Fabrazyme (agalsidase beta)
• Myozyme (alglucosidase alpha)
• Thyrogen (thyrotropin alpha)

These drugs are all used for treating mucopolysaccharidosis Type I, Gaucher disease, Fabry disease, Pompe disease, and thyroid cancer, respectively.

Potential side effects from these contaminated products include pain, swelling, and inflammation at the injection site, if they were given as shots. Intravenous administration could pose more serious adverse reactions, including blood clots, damage to blood vessels, and sudden, severe allergic reactions involving the whole body.

The FDA advised people who use these drugs to check their injection sites for redness, pain, discoloration, and hardness. Any breathing difficulties, rash, chest tightness, or unusual symptoms during or after treatment should be reported to your doctor. 

The FDA said it is allowing the products to remain on the market because people with the rare disorders they are used to treat have a critical need for them and there are no alternatives for four of the drugs.

The agency added that it is investigating how the products became contaminated with stainless steel fragments, rubber particles, and fiber-like material, as well as ways to prevent it from re-occurring.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

New heartburn drug available without a prescription. But beware—you may not need it

If you haven’t seen the new ads for the latest heartburn drug, Prevacid 24HR, chances are you probably will soon. According to a story in the Wall Street Journal, the drug’s manufacturer, Novartis AG, announced an enormous $200 million advertising campaign, just in time for the belt-busting holidays.

For consumers, this may actually be good news. This new drug in the class of medications known as proton-pump inhibitors, or PPIs, further expands the choice of low-cost drugs available without a prescription to treat frequent heartburn and GERD, or gastroesophgeal reflux disorder, also sometimes known as acid reflux.

Indeed, the suggested price of Prevacid 24HR, according to the WSJ, is similar to the price of another over-the-counter drug of the same type, Prilosec OTC (about $24 or less for a month’s supply). The two drugs are also nearly identical in terms of how well they work and their overall safety profile. Even more cost-conscious consumers could save bigger bucks if they turn to the generic version of Prilosec OTC, called omeprazole. Many pharmacies offer it as a store brand for even less.

Prilosec OTC, omeprazole, and Prevacid 24HR were recently named Consumer Reports Best Buy Drugs for how well they worked, because they are as safe as other drugs in the PPI class and are significantly less expensive. For more detail about heartburn, GERD, and understanding these drugs, see our latest Consumer Reports Best Buy Drugs report.

Consumers who took Zetia or Vytorin may get refund

If you took the cholesterol-lowering drugs Zetia or Vytorin in recent years, you may be able to get some of your money back. The manufacturers Merck and Schering-Plough have agreed to a proposed $41.5 million class action settlement over charges they violated consumer protection laws by marketing the drugs as being superior to other cholesterol drugs and selling them at higher prices when, in fact, they are not more effective. Merck and Schering-Plough deny any wrongdoing.

Vytorin has been under fire since last year, when two studies cast doubt on the benefits of the drug, which is a combination of Schering-Plough’s Zetia and Merck’s Zocor. The first was a 2-year study that showed Vytorin was no better than Zocor alone in reducing plaque build-up in arteries. The second was a five year study that showed Vytorin did not reduce strokes or heart attacks compared to placebo, and more alarmingly was associated with a higher incidence of cancer and death from cancer. Earlier this year, the Food and Drug Administration said in a controversial decision that people should continue to take Vytorin because it lowers LDL or "bad" cholesterol more than Zocor alone.

Study: Anemia drugs increase risk of blood clots

Medications frequently given to cancer patients to reduce their risk of anemia are associated with an increased risk of blood clots, according to a study published this week in the Journal of the National Cancer Institute. Anemia drugs, known as erythropoiesis-stimulating agents (ESAs), such as epoetin alfa (Epogen) and darbepoetin alfa (Aranesp), stimulate red blood cell production and are intended to reduce the number of blood transfusions required during chemotherapy.

Researchers at Columbia University Medical Center in New York analyzed the association between ESA use and the formation of blood clots (deep vein thrombosis or pulmonary embolism) and overall survival in patients who were 65 years or older and who received chemotherapy for colon, non-small cell lung, or breast cancer or diffuse large B-cell lymphoma from 1991 to 2002. Patients who took an ESA drug had an increased risk of deep vein thrombosis or pulmonary embolism compared to patients who did not take an ESA, though overall survival was similar in both groups.

Swine flu: Wherefore art thou vaccine?

With the swine (H1N1) vaccine production and distribution slower than expected, many Americans are having trouble finding vaccine, according to a new poll. And the trickle of vaccine has caused problems for mandatory vaccination programs for health care workers, as well as some public health officials when it was reported that Wall Street firms were delivered vaccines while hospitals continue to struggle with a shortage of supply.

Public having difficulty finding vaccine

A poll from the Harvard School of Public Health conducted October 30th through November 1st found that 21 percent of high-priority adults, and 41 percent of all parents tried to get the H1N1 vaccine, but 66 percent of both populations were unsuccessful. In response to the Harvard poll, the Centers for Disease Control and Prevention’s Anne Schuchat, M.D., said, "I’m very mindful of the frustration people have had, whether from information gaps or just the basic availability of the vaccine. I think it should be getting better over the weeks ahead." According to the CDC, the number of vaccine doses available has doubled over the past two weeks, and the supply is expected to continue to grow.

Backlash against Wall Street

The lack of H1N1 vaccine availability also caused a black eye for health officials in New York City, and several Wall Street firms including Citigroup, Morgan Stanley and Goldman Sacks, when it was reported that they were being shipped substantial doses of the vaccine, perhaps ahead of some hospitals. A Wall Street Journal blog summed up reaction to the news:

"It is official: Goldman Sachs is more important than you are…At least that is the way that the public may perceive a WSJ story today that Goldman was one of several Wall Street firms that received large dosages of swine flu vaccines, while some New York City hospitals and clinics are running out of the vaccine."

Q&A: Is there any way to treat or prevent cold sores?

Several steps might help. Cold sores are caused by the virus herpes simplex type 1. Like the related genital-herpes (simplex type 2) and chicken pox viruses, the bug stays in your body permanently, emerging when your immune system is weakened. Avoiding the triggers might reduce the frequency of outbreaks. Common ones include excessive sun exposure, stress, respiratory illness, and oral or facial wounds, even from shaving or dental work.

Several medications can shorten the duration of outbreaks. Prescription valacyclovir (Valtrex) may be the best choice for treatment because it requires fewer doses and costs less than some other prescription remedies. An over-the-counter drug containing docosanol cream (Abreva) is slightly less effective but it’s cheaper and can help ease the pain. Contact your physician if the sores don’t heal within two weeks. And if you have more than six outbreaks a year, ask your doctor about taking acyclovir (Zovirax) for prevention, since it can reduce episodes by up to 80 percent.

Pregnant and getting the runaround: My search for a flu shot

Every time I see advice for pregnant women to get a seasonal flu vaccine, I have to laugh—and then rant and rave to anyone who will listen. We’ve all been reminded how important it is for pregnant women to get vaccinated for the H1N1 (swine) flu and the seasonal flu, but it’s not necessarily easy.

This is the second time I have been pregnant during a flu season it’s also the second time I have faced serious obstacles trying to get vaccinated. First, I tried my obstetrician only to find out that, at least where I live in Westchester County in New York, they don't give out the seasonal flu vaccine.

So I tried my internist next. This year, his office is out of flu vaccine altogether. But during my last pregnancy I showed my internist at the time the CDC alert recommending that pregnant women get vaccinated, and he nevertheless refused to give me the vaccine. Even my pulmonologist wouldn't provide the vaccine, even though I have asthma, which puts me at higher risk of complications and severe disease.

For the first pregnancy, my employer at the time hired a nurse to vaccinate the entire company, and she wouldn't give me the shot. I finally, got one from my boss at the time, who also happened to be an M.D.

FDA says diabetes drug Byetta poses kidney risks

People with diabetes may want to use extra caution with the drug exenatide (Byetta). The Food and Drug Administration Monday added a warning about the risk of potentially life-threatening kidney problems to the package insert of the injectable diabetes drug.

The FDA said that from April 2005 through October 2008 it received 78 reports of kidney function problems, including 62 cases of kidney failure and four deaths, in people taking Byetta. The drug can cause nausea, vomiting, and diarrhea, and these might have contributed to the kidney problems, the FDA said.