SAVE $$ ON THE MEDICINE YOU NEED
2013
Top choices for:
Allergies, Depression,
Diabetes, Heartburn, Headache
High Cholesterol, Insomnia,
Joint Pain, and more
Free!
PLUS: 12 Rx Tips to Keep You Safe
So many questions about prescriptions...
Learn about your drug choices
Contents
2 | Get the best medication
for what ails you
Why does it cost so much?
Is it effective?
What are the side effects?
Which generics beat
brand-name drugs?
14 | Spotlight on: Treating
heartburn
21 | 6
ways to save on
the drugs you need
Tips that are good for your
health and your wallet
25 | O
TC vs. Rx medications
When cheaper, over-the-counter
remedies may be your best bet
30 | S
potlight on: Treating
high blood pressure
4 steps to keeping it low
Go to CRBestBuyDrugs.org today.
Learn all the facts — free.
Start saving money now.
The best way to save
40 | G
enerics
When to treat it on your
own, and when to get help
Consumer Reports Best Buy Drugs has answers – free.
Save hundreds, even thousands, of dollars each year.
Talk to your doctor or pharmacist about your options.
36 | $
4 Generics
Medicine you need at
a price you can afford
46 | W
here high drug
costs hide
And what you can do to save
54 | P
ill splitting
Cut your prescription
drugs (and costs) in half
60 | S
tay safe, be smart
12 Rx drug tips you must know
62 | T
ime to talk
2 important conversations
to have with your doctor
64 | About this guide
Find important info on these drugs—and more:
Actos.............................................. 6, 48
Alavert (loratadine)......................... 4, 26
Allegra................................................ 26
Ambien............................................... 26
Astepro................................................. 4
Celebrex........................................ 12, 28
Clarinex................................................. 4
Claritin................................................ 26
Crestor (rosuvastatin)................8, 48, 58
Cymbalta........................................ 5, 48
Fluoxetine............................................. 5
Glipizide/Glipizide Sustained Release...... 6
Ibuprofen.................................12, 28, 29
Imitrex................................................ 29
Lipitor......................................48, 56, 58
Lunesta................................................. 9
Maxalt.......................................... 10, 29
Metformin/Metformin Sustained Release.6
Metoprolol (Toprol-XL)........................ 35
Naproxen............................................ 12
Nexium.......................................... 7 , 18
Nytol................................................... 26
Omeprazole.......................................... 7
Pepcid........................................... 15, 17
Plavix.................................................. 48
Prevacid.....................................7, 15, 18
Prilosec OTC...............................7, 15, 18
Simvastatin........................................... 8
Sominex.............................................. 26
Tolterodine (Detrol)............................. 11
Zantac........................................... 15, 17
Zolpidem............................................... 9
Zyrtec.................................................. 26
Buy Smart
Buy Smart
Get the best medication
for what ails you
Find Best Buys that are less expensive, as effective,
and as safe as some pricey, brand-name drugs
Y
ou’ve probably seen them dozens of times: Ads for drugs that promise new solutions to your health-related problems. But are those
drugs really the best choice for your condition?
Pharmaceutical companies spend billions to convince us they do—$3.9
billion in 2011 alone to reach consumers—on top of $6.8 billion the same
year to promote medications to doctors, according to figures from IMS
Health, an industry group that monitors drug sales and marketing.
And the promotions work. Our research shows that about one of
every five people who take a prescription medication said they’ve asked
their doctors to prescribe a drug they’ve seen advertised. And 70 percent
of doctors complied with the request, according to a recent survey by
Consumer Reports Best Buy Drugs.
The problem is that it’s hard for consumers to know if an advertised
drug works better than a less expensive generic. That’s where Consumer Reports Best Buy Drugs can help. Our “Best Buy” recommendations
are drugs that are as safe and effective as other medications in their
respective classes, and typically less expensive. Conversely, if research shows
that a brand-name drug is notably safer or works better than a lower-cost
medicine, it is deemed a CR Best Buy, regardless of its price.
We base our conclusions on research from the experts at the Drug Effectiveness Review Project (DERP), based at the Oregon Health & Science
University. DERP analyzes hundreds of studies on a given class of drugs to
treat a condition. Prices of drugs come from Wolters Kluwer Pharma Solutions, which is not involved in our analyses or recommendations.
Most of the CR Best Buy picks are generics. Surprised? If so, you’re
not alone. Our own survey recently found that 43 percent of people said
2 2013 Consumer Reports Best Buy Drugs
they had concerns about generic drugs—including that generics weren’t
as safe or effective as brand-name medications, had different side effects,
or were regulated differently by the Food and Drug Administration.
But there’s no reason to be suspicious of generics.To get approval from
the Food and Drug Administration, a generic-drug maker must prove
that its product contains the identical active ingredient as its brand-name
counterpart and that the drug is
“bioequivalent,” meaning that
levels of the active ingredient in
The truth is that many
the bloodstream are the same as
newer drugs are often no
its brand-name counterpart. Gesafer or more effective than
nerics that meet those criteria
older medications that cost
are expected to have the same
a fraction of the price.
therapeutic effect as brand-name
drugs. Also, the FDA regulates
generics just as it does brandname drugs and monitors them
once they’re on the market. (See page 40 for more details on what to
know about generic drugs.)
Smart money-saving swaps
A few examples that show how choosing a generic can meet your
health needs while reducing your cost. >>
2013 Consumer Reports Best Buy Drugs 3
Buy Smart
Buy Smart
allergies
depression
Newer antihistamines are less likely to cause drowsiness,
but they cost more than older drugs. Inexpensive generics
are the best option.
Brand-name or
top-selling drug
Clarinex
One 5-mg pill per day
$187/month
CR Best Buy
Recommendation
vs.
Loratadine (generic)
One 10-mg pill per day
$4/month
If you suffer from hay fever or other
allergy symptoms, such as congestion,
sneezing, and watery eyes, you’ve got
a variety of choices for relief. Pharmacy
shelves are packed with older antihistamines, such as Benadryl, and newer
formulations, such as Claritin. But which
ones are best?
Newer antihistamines aren’t any more
effective at relieving allergy symptoms
than older ones, but they are less likely
to cause drowsiness. They also offer
the convenience of one pill daily. But
those advantages come with a higher
price. Newer medicines, which include
loratadine (Claritin and generic), and
cetirizine (Zyrtec and generic), run from
about $4 to more than $100 per month
for prescription strength.
Although drowsiness is less of a problem
if you opt for one of the newer antihistamines, you’ll still have to watch out
for it and other side effects, particularly
with high doses. And don’t ignore a
rapid heartbeat or heart palpitations.
These are rare side effects, but if they
occur, see your doctor. If you take
allergy medications regularly, talk
with your doctor to make sure your
problems stem from allergies. Up to
one-third of people with allergy
symptoms don’t actually have allergies;
other conditions, such as a cold or even
4 2013 Consumer Reports Best Buy Drugs
Estimated
monthly savings
$183
reactions to certain drugs, can cause
the sneezing, congestion, or runny
nose typical of allergies.
CR Best Buys
• Generic loratadine
• Alavert (loratadine)
These inexpensive medications are
available without a prescription.
Less impressive
• Azelastine (Astelin, Astepro,
and generic)
• Olopatadine (Patanase)
These nasal sprays are linked to
smell and taste problems, and the
possibility of birth defects. Women
who are pregnant or breast-feeding
should avoid them.
Antidepressants can help some. If you need one, the five
inexpensive generics we recommend are good first options to try.
Brand-name or
top-selling drug
Cymbalta
One 60-mg pill per day
$228/month
CR Best Buy
Recommendation
vs.
Fluoxetine (generic)
One 20-mg pill per day
$4/month
An estimated 19.2 percent of Americans
will experience a serious bout of depression during their lifetime, according
to a recent World Health Organization
study. Contrary to ads from pharmaceutical companies that suggest medication is the only answer, the first step is
to see your doctor and then possibly a
therapist. Talk therapy might be all you
need to feel better. (It worked for our
readers: According to our 2009 Annual
Questionnaire, those who had at least
seven counseling sessions reported just
as much relief as those who only took
medication. Those who did both fared
even better.)
$224
have to try several before you find one
that works.
And even then, up to 45 percent of
people who try antidepressants will not
experience any relief. If you already
take an antidepressant and it is working
well for you, we do not recommend
switching to another one.
CR Best Buys
• Generic bupropion
• Generic citalopram
• Generic fluoxetine
• Generic paroxetine
If your doctor recommends an antidepressant, our Best Buy Drugs analysis
finds that all are equally effective at relieving depression, so your choice might
come down to safety, cost, and whether
you have other medical conditions.
• Generic sertraline
Our five CR Best Buy picks are inexpensive generic drugs with well-established
safety profiles that will save you over
brand-name drugs. Some are more likely
to cause certain side effects than others,
so make sure your doctor is aware of the
side effects you especially want to avoid.
Less impressive
For example, paroxetine is associated
with a higher risk of sexual problems;
sertraline is associated with a higher
rate of diarrhea. People respond differently to antidepressants, so you might
Estimated
monthly savings
These medicines are substantially less
expensive than brand-name antidepressants and are equally effective. They are
good options to try if cost is an issue.
• Desvenlafaxine (Pristiq). Available only
since 2008, it does not have the long
track record of other antidepressants,
some of which have been around for
more than two decades.
• Duloxetine (Cymbalta)
These are expensive, brand-name drugs
that are no more effective than the
generic Best Buys. >>
2013 Consumer Reports Best Buy Drugs 5
Buy Smart
Buy Smart
DIABETES
HEARTBURN
Older drugs work just as well as newer drugs and may be
safer in some cases. They could also save you a lot of money.
Brand-name or
top-selling drug
Actos
One 30-mg pill
per day $318/month
CR Best Buy
Recommendation
vs.
Metformin (generic)
One 500-mg pill three times
per day $4/month
If you’re one of the nearly 26 million
people in the U.S. with type 2 diabetes,
exercise, a healthful diet, and weight
loss (if needed) are essential to help
keep your blood-sugar levels in check.
For some people, these can sometimes
alleviate the need for medication all
together. If you need medication, three
older, inexpensive drugs are your best
first options. They’re just as effective as
newer medications, and, in some cases,
are better and safer.
The best first option for many people is
generic metformin. If that doesn’t drop
your blood-sugar levels enough, you
might need to add one or both of these
medications: glimepiride or glipizide.
(If you also have heart failure or kidney
disease, your doctor might start with
one of those drugs instead.)
Estimated
monthly savings
$314
CR Best Buys
• Metformin and Metformin
Sustained-Release
• Glimepiride
• Glipizide and Glipizide
Sustained-Release
All available as low-cost generics.
Less impressive
• Pioglitazone (Actos and generic).
Linked to higher risk of heart failure,
and also a small but increased risk of
bladder cancer for those who take it for
a year or longer. Only consider as a last
resort, and if other treatments have not
worked.
• Sitagliptin (Januvia). Expensive brandname drug that’s no more effective than
metformin and might induce hypoglycemia (low blood sugar) when used with
other drugs.
Make sure you really need a prescription medication;
many people don’t. If you do, consider the least expensive
option because no one drug is clearly better than another.
Brand-name or
top-selling drug
Nexium
One 20-mg pill per day
$236/month
CR Best Buy
Recommendation
vs.
Estimated
monthly savings
Omeprazole (generic)
One 20-mg pill per day
$15/month
When heartburn flares up, many people
turn too quickly to powerful drugs
called proton pump inhibitors (PPIs);
instead, try lifestyle changes or antacids
that might fix the problem. Studies
show that up to 69 percent of people
who are prescribed a PPI don’t actually
need it. Not only can that be a waste
of money, but it can also expose you to
potentially serious side effects, including an increased risk of pneumonia and
fractures of the hip and other bones.
For relief of mild or infrequent heartburn, cut back on alcohol and caffeine,
quit smoking, eat smaller meals, don’t
lie down for two hours after eating,
and lose weight (if needed). If those
changes don’t bring relief, try an inexpensive over-the-counter antacid, such
as Maalox, Mylanta, Rolaids, Tums, or
their generic equivalents, or other drugs
called H2 blockers, such as Pepcid AC,
Zantac 150, or their generic equivalents.
$221
CR Best Buys
• Generic omeprazole
• Prevacid 24HR
• Prilosec OTC
All are available without a prescription
for $15 to $24 for a month’s supply and
work as well as the more expensive
medications.
Less impressive
• Nexium (esomeprazole), Prilosec
(lansoprazole), AcipHex (rabeprazole).
These branded prescription medications
are much more expensive and not much
more effective than generics in this
class. AcipHex and Nexium are not available as generics. >>
If heartburn strikes twice a week or
more for several weeks, see a physician.
You might have a serious condition
called GERD (gastroesophageal reflux
disease), and you might need a PPI.
6 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 7
Buy Smart
Buy Smart
HIGH CHOLESTEROL
INSOMNIA
Not all cholesterol-lowering statins are the same.
Inexpensive generics are the best option.
Brand-name or
top-selling drug
Crestor
One 10-mg pill
per day $185/month
CR Best Buy
Recommendation
vs.
Simvastatin* (generic)
One 40-mg pill per day
$69/month
Prescription sleeping pills are not the best treatment for
short-term insomnia. Changes to your sleep habits, or even
an over-the-counter medication, may be better.
Estimated
monthly savings
$116
Brand-name or
top-selling drug
Lunesta
2-mg per day
$127/15 day supply
CR Best Buy
Recommendation
vs.
Estimated
monthly savings
Zolpidem (generic)
10-mg pill per day
$28/15 day supply
$99
*For people who need to reduce LDL by more than 30 percent.
If you have high cholesterol, a
healthful diet and exercise can help
to lower it and alleviate the need for
drugs. But for some people, that may
not lower it enough, and they might
also need a medication called a statin.
All statins can lower cholesterol, and
some do it more than others.
If you haven’t had a heart attack,
the first thing to do when considering
which cholesterol-lowering drug to
take is to determine with your doctor
how much your LDL (bad) cholesterol
needs to go down. If you have to lower
your cholesterol by more than 30 percent, you should choose a more potent
statin, such as simvastatin (Zocor and
generic). If you have diabetes or heart
disease or have suffered a heart attack,
that could also affect your decision.
For some statins there is stronger
evidence that they reduce the risk of
a heart attack, stroke, or death for
those people.
Statins can cost from a few dollars per
month to several hundred. Because
many people stay on them for years,
cost is important. If you experience
muscle aches, pain, or fatigue when
taking a statin, contact your doctor.
8 2013 Consumer Reports Best Buy Drugs
CR Best Buys
• Generic lovastatin or pravastatin.
To lower LDL cholesterol by less than
30 percent.
• Generic simvastatin. To lower LDL
cholesterol by 30 percent or more, for
those who have heart disease or diabetes, or for those whose LDL is not highly
elevated but who have had a heart attack or have acute coronary syndrome.
• Generic atorvastatin. For those
who’ve had a heart attack or have
acute coronary syndrome and
highly elevated LDL.
Less impressive
• Pitavastatin (Livalo). It was approved
in 2010, so its track record isn’t as established as that of other statins.
• Fluvastatin (Lescol, Lescol XL), rosuvastatin (Crestor). They’re available only as
expensive brand-name drugs and do not
offer advantages over the Best Buys.
If you can’t sleep once in a while,
we suggest trying an over-the-counter
drug that contains diphenhydramine,
like Benadryl or Unisom, but use it
carefully. If the problem continues over
several months and your doctor is ready
to prescribe a sedative, we suggest asking for the generic version of Ambien,
called zolpidem. Our analysis finds that
by some measures, it’s more effective
than the others.
But we recommend that both prescription and nonprescription sleeping pills
be used judiciously because research has
found that people with mild insomnia
sometimes unnecessarily take these
medications when they might be able
to resolve their sleep issues with nondrug measures, such as improving sleep
habits and cutting back on caffeine and
alcohol before bedtime.
An alternative treatment to consider is
cognitive behavioral therapy, a form
of psychotherapy. It helps 70 to 80
percent of people with chronic insomnia. In fact, several studies have found it
more effective than sleeping pills.
CR Best Buys
• Generic zolpidem (Ambien)
Fifteen pills cost $27 to $31, depending
on the dose and where you buy it.
Less Impressive
• Lunesta – Along with a cost of over
$120 for fifteen pills, evidence has
shown that Lunesta has a higher rate
of next-day drowsiness than nearly all
of the other drugs. >>
All insomnia medicines can cause side
effects and dependency, and even
worsen your sleeping problems when
abused, misused, or taken too often.
Possible side effects include daytime
sleepiness, dizziness, unsteadiness, and
rebound insomnia. Sleep-walking,
sleep-driving, sleep-eating, memory
lapses, and hallucinations have also
been reported.
2013 Consumer Reports Best Buy Drugs 9
Buy Smart
Buy Smart
OVERACTIVE BLADDER
MIGRAINES
For occasional migraines, an over-the-counter pain reliever
may be a good first choice. Otherwise, a generic triptan
works as well as other brand-name drugs in this class.
Brand-name or
top-selling drug
Maxalt
5-mg tablet per headache
$39/headache
CR Best Buy
Recommendation
vs.
Sumatriptan (generic)
50-mg tablet per headache
$15/headache
Almost everybody suffers from a headache once in a while, but if the pain is
excruciating and disabling, you could
have a migraine. Over-the-counter
pain relievers like ibuprofen (Advil and
generic) or combination products that
contain acetaminophen, aspirin, and caffeine (Excedrin and generics) are a good
first option for treating these severe
headaches, but if these don’t work, it
may be time to reach for a stronger type
of medicines called triptans.
Triptans are effective medicines. They
significantly reduce migraine pain within two hours for most people. Complete
relief is less common, but if you take a
triptan early during a migraine attack
you may have a better outcome.
We recommend generic sumatriptan
as our Best Buy. Our analysis shows that
sumatriptan (Imitrex and generic) works
as well as, or even better than, most
of the other drugs in its class. All of
them can cause mild to serious side
effects, including dizziness, numbness,
rare cases of heart attacks, strokes,
and even death.
10 2013 Consumer Reports Best Buy Drugs
Before taking a drug to relieve your symptoms, try certain exercises
to strengthen your bladder and cutting back on caffeine first. These
drugs are only moderately effective, and can cause side effects.
Estimated
monthly savings
Brand-name or
top-selling drug
$14
Toviaz
4-mg once daily
$196/month
CR Best Buys
• Generic sumatriptan tablets, nasal
spray, and injectable forms
Sumatriptan is available as a less
expensive generic, and studies have
found that it is as effective as or better
than most of the other triptans when it
comes to pain relief.
Less Impressive
• Axert, Frova, Relpax, Zomig - These are
no more effective than other triptans,
and they are only available as expensive,
brand name drugs.
CR Best Buy
Recommendation
vs.
Estimated
monthly savings
Try lifestyle changes first
If you’re going to the bathroom frequently, it doesn’t necessarily mean you
need a medication. Lifestyle changes,
such as cutting back on caffeinated beverages and bladder training exercises
can often provide relief without the
need for a drug, so you should try those
first. Also learn how to do Kegel exercises to strengthen the pelvic muscles,
which can help control urination. They
might relieve symptoms enough so that
a drug isn’t necessary.
Other medications you take, such as
those used to treat high blood pressure, could also cause urgency, incontinence, and urinary frequency issues.
So can having diabetes, heart disease,
urinary-tract infections, kidney stones,
and strokes. See your doctor to rule out
any of these causes before you turn to
medication.
However, if you and your doctor decide
you need a drug because symptoms are
severe enough, we recommend tolterodine, the generic version of Detrol. It
works as well as others in its class and
has fewer side effects. Common ones
include dry mouth, constipation, blurred
vision, and dizziness. Many people stop
taking these drugs within six months,
often because they find that fewer trips
to the bathroom aren’t worth experiencing the side effects.
$196
CR Best Buys
• Generic tolterodine
• Tolterodine extended-release
(Detrol LA)
Both Detrol and Detrol LA have a low
rate of side effects, and Detrol LA offers
the convenience of only having to take
it once a day.
Less Impressive
• All Overactive Bladder drugs - There
are six different overactive bladder
drugs that have been turned into at
least a dozen separate products—
darifenacin (Enablex), fesoterodine
(Toviaz), oxybutynin (generic, Ditropan,
Ditropan XL, a skin patch called Oxytrol,
and a topical gel called Gelnique),
solifenacin (Vesicare), tolterodine
(Detrol, Detrol LA), and trospium (Sanctura, Sanctura XR).
They are only moderately effective and
can cause serious side effects, including
blurred vision, confusion, constipation,
dizziness, and dry mouth. In addition to
the side effects, these drugs are expensive, with some costing more than $200
per month. >>
2013 Consumer Reports Best Buy Drugs 11
Buy Smart
PAIN
For moderate joint pain, generic drugs such as ibuprofen and
naproxen are your best bets. They could save you a bundle
over some brand-name prescription options.
Brand-name or
top-selling drug
Celebrex
One 200-mg pill
per day $179/month
vs.
CR Best Buy
Recommendation
Estimated
monthly savings
Ibuprofen (generic)
One 400-mg pill four times
per day $28/month
$151
When muscle aches, headaches, or joint
pain strikes, the best remedy might already be in your medicine cabinet. Common over-the-counter painkillers, such
as ibuprofen (Advil, Motrin IB, and generic) and naproxen (Aleve and generic),
are just as effective as prescription drugs
in this class but cost much less.
But those medications—known as
nonsteroidal anti-inflammatory drugs
(NSAIDs)—can carry serious risks and
aren’t for everyone. Prolonged use,
especially at high doses, can lead to a
heart attack or stroke. NSAIDs can also
be tough on your body, causing stomach
ulcers and gastrointestinal bleeding.
If you have had an ulcer or intestinal
bleeding, acetaminophen (Tylenol and
generic) is a good first choice for pain
relief. Acetaminophen is not an NSAID.
It is less likely to cause bleeding, but be
careful: High doses can damage the liver
and lead to liver failure. Even taking just
a little more than the recommended
daily dosage can be toxic.
For chronic pain sufferers whose only relief is routine use of an over-the-counter
NSAID, it’s time to see a doctor.
He or she can suggest other strategies to
help manage your pain. In some cases,
such as for patients with osteoarthritis,
a prescription-strength NSAID might be
necessary.
CR Best Buys
For joint pain (osteoarthritis):
• Ibuprofen
• Naproxen
Get Our
Reports
FREE
and save $$
on your prescription drugs
Visit CRBestBuyDrugs.org to find our free,
detailed reports, which cover 25 classes of
drugs for more than 35 conditions, including
allergies, diabetes, high blood pressure, high
cholesterol, and muscle pain.
These inexpensive generics are available
over-the-counter or by prescription.
Less impressive
• Celebrex (celecoxib)
This is an expensive prescription drug
that has not been shown to be more
effective than other NSAIDs. ■
Acetaminophen or aspirin are good
options to consider for those who have
had a heart attack or stroke, or who suffer from heart disease or uncontrolled
high blood pressure.
12 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 13
heartburn
heartburn
Spotlight on:
Treating
heartburn
When to treat heartburn on
your own and when to get help
N
early everyone has experienced heartburn after eating a sumptuous or
oversized meal. For many, the distress goes away within an hour or so—with
or without the help of Rolaids or Tums—
making it seem like nothing to worry about.
But the millions who suffer from frequent
heartburn might actually have a chronic
condition called gastroesophageal reflux
disease, or GERD. Left untreated, it can damage the esophagus and even lead to cancer.
Lifestyle changes and over-the-counter medication can provide relief for many
people, but it’s important to know if your
symptoms are serious enough to warrant a
trip to the doctor. And when should you turn
to potent medications called proton pump inhibitors (PPIs) to extinguish the flames?
More than 50 million people in the
U.S. experience heartburn every month,
and about 15 million have daily flare-ups,
14 2013 Consumer Reports Best Buy Drugs
according to the National Institute of Diabetes and Digestive and Kidney
Diseases. The cost of treating the condition can quickly add up. The average person with GERD spends an estimated $3,355 a year on medication
and other treatments to help keep symptoms under control. Obese people,
smokers, and pregnant women are more likely to suffer from GERD, but it
can strike otherwise healthy men and women at any age. >>
Choosing the right remedy
Type of heartburn medication
(Specific drug)
When appropriate
Antacids
(Maalox, Mylanta, Rolaids,
Tums, and generics)
For occasional heartburn—less
than twice a week. Also try lifestyle
changes: Avoid food that triggers
heartburn and eat smaller meals.
H2 blockers
(Pepcid, Zantac, and generics)
For occasional heartburn not
relieved by antacids and lifestyle
changes, or before eating a known
heartburn trigger.
Proton pump inhibitors
(Prevacid, Prilosec, and generics)
For frequent heartburn not relieved by lifestyle changes, antacids, or H2 blockers. After two
weeks of use, check with your doctor to determine if you have GERD.
2013 Consumer Reports Best Buy Drugs 15
heartburn
heartburn
How heartburn happens
When you swallow food, it travels down your throat to your esophagus
into your stomach, which produces acid to help break it down so that it
can be digested. Your lower esophageal sphincter, a muscle at the entrance
to your stomach, is supposed to close after the food passes through to keep
stomach acid from going into the esophagus. But if that muscle doesn’t
close, and acid reaches the esophagus, sometimes along with food, you’ll
feel a burning sensation. It usually starts just below your breastbone and
can radiate into your throat. You might also notice a sour or bitter taste.
Occasional heartburn is generally not worrisome or dangerous, and
can be relieved with diet and lifestyle changes and, if necessary, overthe-counter antacids or other medications. However, if you have
heartburn twice a week or more, and it recurs for weeks or months, or
if you frequently regurgitate food (with or without heartburn), consider
seeing your doctor to be checked for GERD.
In contrast to occasional heartburn, GERD can be dangerous. Over
time, the refluxed acid can inflame and erode the lining of the esophagus,
resulting in esophagitis. You may feel a chronic soreness in your lower
throat or chest.
Most cases of esophagitis are relatively mild, but when it is left
untreated, bleeding, scarring, and narrowing of the esophagus can occur,
making eating and swallowing painful and difficult. People who have uncontrolled GERD for years have a higher risk of developing cancer of the
esophagus, though it’s rare.
Fortunately, changes in your diet and lifestyle might be all you need to
alleviate the problem. Those measures include eating smaller meals, not
lying down for at least two to three hours after eating, losing weight if
needed, and avoiding alcohol.
Certain food and beverages can trigger heartburn in some people, such
as citrus fruit, chocolate, coffee or other caffeinated beverages, fried food,
garlic, onions, spicy or fatty food, and tomato-rich food, such as marinara
sauce, salsa, and pizza.
Drinking alcoholic beverages may increase GERD symptoms, which
over time can cause damage to the lining of the esophagus. Symptoms
may resolve after you stop drinking.
Smoking weakens the lower esophageal sphincter muscle and increases
the risk of GERD (and other diseases), so if you smoke, consider quitting.
16 2013 Consumer Reports Best Buy Drugs
To help reduce heartburn flare-ups while you’re asleep, try placing wood
blocks beneath your bedposts to raise the head of your bed 6 to 8 inches.
Avoid wearing tight clothing or belts that push on your abdomen, since
that kind of compression can contribute to reflux.
Medication
If diet and lifestyle changes don’t help, it might be time to try an
antacid, such as Maalox, Mylanta, Rolaids, or Tums. Some people might
need something stronger to relieve their symptoms. In that case, try
an acid-reducing H2 blocker such as famotidine (Pepcid AC and generic), nizatidine (Axid AR), or ranitidine (Zantac 75, Zantac 150, and
generic). Those drugs help about half of sufferers and can be bought
over-the-counter. You might also consider using an over-the-counter
PPI, such as lansoprazole (Prevacid 24HR), for up to two weeks to see if
it eases your symptoms.
If you’ve tried these options and still have heartburn at least twice
a week for several weeks, it’s time for a doctor to determine if you have
GERD and if it has damaged your esophagus. If you have the condition, he
or she will probably recommend that you have an upper endoscopy. >>
2013 Consumer Reports Best Buy Drugs 17
heartburn
This procedure, done under light anesthesia, involves the insertion of
a lighted, flexible endoscope tube into your throat and down into the
esophagus. The doctor can also use the endoscope to do a biopsy to test
for cancer or a condition called Barrett’s esophagus, which can lead to
cancer.
If you have GERD, your doctor will probably prescribe a PPI, such as
esomeprazole (Nexium), lansoprazole (Prevacid and generic), or omeprazole (Prilosec and generic). Those popular drugs substantially reduce the
amount of stomach acid produced, making the contents of your stomach
less erosive. If there’s already damage to your esophagus, reducing the
amount of acid can help it heal.
But many doctors also think that PPIs are overused, a problem that is
exacerbated by heavy advertising from pharmaceutical companies. The
federal Agency for Healthcare Research and Quality (AHRQ) also noted
a widespread overuse of PPIs (as well as other drugs used to treat GERD)
in a September 2011 report. Advertising has helped propel those drugs to
top-selling slots among all prescription medication.
One PPI, Nexium, racked up $6.2 billion in sales in 2011, making it the third highest-selling prescription drug in the U.S. that year,
according to IMS Health, an industry group that monitors drug sales. But
studies have found that up to 70 percent of people who take a PPI may
not have GERD and may not need such a potent, expensive medication.
All PPIs can also cause serious side effects, including an increased risk
of diarrhea associated with Clostridium difficile, an acute, sometimes
chronic ailment that can lead to severe intestinal problems and, in rare
cases, death. Long-term use can deplete magnesium levels, which can
trigger muscle spasms, an irregular heartbeat, and convulsions. Other potential side effects include a higher risk of pneumonia and certain bone
fractures, including breaks in the wrist, forearm, and spine.
PPIs can also interact with other medication, so before you take one,
make sure it’s compatible with other drugs you take. One of the most
serious interactions occurs with omeprazole (Prilosec and generic) and
clopidogrel (Plavix), a blood thinner used to reduce the risk of clots.
According to the U.S. Food and Drug Administration, omeprazole can
reduce the effectiveness of Plavix by about half, increasing the risk of a
heart attack or stroke. Nexium and the H2 blocker cimetidine (Tagamet
and generic) might also interact with Plavix in the same way as Prilosec.
18 2013 Consumer Reports Best Buy Drugs
heartburn
Is it heartburn or a heart attack?
It’s no surprise that people who have heartburn sometimes fear that
they’re having a heart attack because the symptoms can be very similar.
But delaying treatment for a heart attack can be a matter of life and death.
Some typical heart attack signs are listed below. Not all people experience
the same ones. If you’re in doubt, don’t take a chance. Chew and swallow
a 325-milligram aspirin tablet and call for emergency help. >>
Heart attack
Heartburn
Sensation
Pressure, squeezing, tightness, or pain in the center
of the chest. Might last
for several minutes or go
away and come back.
Burning in throat that
generally occurs after
eating. Can be accompanied by a bitter or sour
taste at the back of throat.
Location
Pain or discomfort
generally starts in the
center of your chest and
spreads to one or both
arms, your back, stomach,
neck, or jaw.
Pain is usually felt below
the breastbone or ribs. It
usually doesn’t radiate to
your shoulders, arms, or
neck, but can.
Quick tests
Pain often goes away
quickly after taking nitroglycerin, but not everyone
will have this medication
readily available.
Sensation often goes
away soon after taking
an antacid, such as
Rolaids or Tums.
Other clues
Breaking into a cold
sweat, fainting, lightheadedness, nausea,
rapid heartbeat,
shortness of breath.
Pain tends to increase
when bending over,
exercising, lifting heavy
objects, or lying down.
Action
Call for emergency help
if you suspect you’re
having a heart attack.
Also chew and swallow
a 325-milligram aspirin
tablet.
Make lifestyle changes
and, if necessary, take
heartburn medication.
2013 Consumer Reports Best Buy Drugs 19
>> High Blood Pressure
six ways to save
heartburn
If you need a PPI, Consumer Reports Best Buy Drugs recommends first
trying an over-the-counter option, such as generic omeprazole, Prilosec
OTC, or Prevacid 24HR. At less than $1 a day, they cost almost one-tenth
the price of several of the prescription alternatives. And for most people,
they are as effective as the prescription drugs. But check with your insurance provider to see if over-the-counter PPIs are covered. If not, it may
be less expensive to get a prescription PPI because it might only cost you
a $5 to $10 drug co-payment.
There’s no clear answer about when to consider stopping a PPI,
because that decision varies. For some people with GERD, symptoms
go away after drug treatment and lifestyle changes, or they recur only
periodically. Others appear to have a lifelong battle with GERD, so
they may need to continue taking a PPI daily to keep symptoms under
control. Some people might even need to consider surgery.
If you are diagnosed with GERD and are given a PPI prescription, ask
your doctor how long you should take the medicine. After a few weeks
or months, you may be able to slowly taper off the drug and eventually stop taking it without issue. If your symptoms return, you can often
resume taking the medicine.
Considering surgery
If lifestyle changes and medication haven’t helped, then surgery
may be an option. The standard procedure for GERD is laparoscopic
fundoplication, in which the upper part of the stomach is sewn around
the lower part of the esophagus. This is intended to help strengthen the
sphincter muscle. It often helps relieve reflux symptoms and decrease the
use of heartburn medication, according to the 2011 report from AHRQ.
But some people who have surgery may still need to take drugs.
Also, serious side effects can arise from the surgery, including infections,
hernia, and difficulty swallowing. So laparoscopic fundoplication should
be used only as a last resort. ■
20 2013 Consumer Reports Best Buy Drugs
6
ways to save on
the drugs you need
Tips that are good
for your health
and your wallet
B
eing able to afford medications
and medical bills is the No. 1
financial concern among
Americans, beating out things
like problems with missing
payments on big household
bills, including mortgages,
and problems with losing
a job or being laid off,
according to the
Consumer Reports
Index, a monthly
national telephone
poll of American adults.
Those who regularly
take a prescription
medication spend an
average of $59 a month
out of their own pockets for
prescription medicines, and 12
percent of the survey respondents
said they spend more than $100 a
month, or $1,200 a year.
To help you get the best value for your dollar, Consumer Reports Best Buy
Drugs recommends these six ways to cut the cost of your medications. >>
2013 Consumer Reports Best Buy Drugs 21
six ways to save
1
Ask your doctor for a
generic. Generic drugs
can save you as much as 95
percent off the brand-name price
tag, and nearly three-quarters of
all medications are available in a
generic version. The shape, color,
and size of the pills might look
different from the brand-name
version, but the active ingredients
are the same. The Food and Drug
Administration regulates generics
in the same way it does brandname drugs.
did you know?
You can find cost-cutting
advice for medications
prescribed for dozens of
chronic conditions by going
to CRBestBuyDrugs.org.
Doctors don’t always consider
a patient’s ability to pay for their
medications when they prescribe
them, according to our annual
surveys. So be sure to speak up
when your doctor is ready to prescribe a drug. Explain that cost is
important to you, especially if you
will have to take the medication
for an extended period of time or
indefinitely.
22 2013 Consumer Reports Best Buy Drugs
six ways to save
2
Check out discount
programs. Chain drugstores, supermarkets, big-box
retailers, and pharmacies at warehouse clubs all offer “$4 generic
drug” discount programs. Prices
can be as low as $10 for a threemonth supply of medicine.
Most chains offer added perks,
such as savings on flu shots.
Kmart’s Pharmacy Prescription
Savings Club gives discounts of
5 to 20 percent on brand-name
drugs. Walgreens’ Prescription
Savings Club members also get a
10 percent bonus back onto their
card for purchasing store-brand
products and photo-finishing
services.
Program details vary, so it’s
important to shop around. When
checking them out, ask the pharmacist on duty if your medications
are included, and if you qualify for
additional discounts.
on a medication for a long time,
or even if you just prefer to shop
at a local pharmacy.
In a recent Consumer Reports
subscriber survey, independent
pharmacies scored highest for providing faster service, making fewer
errors, and being more likely to
have medications ready for pickup
when promised. Readers also
liked mom-and-pop drugstores
for their personal service and the
accessibility of pharmacists.
Regardless of which type of
pharmacy you decide to use, you
should fill all your prescriptions
at one place rather than shopping
around for the best price on each
medication. Aside from the convenience, having a single pharmacy
that tracks all your prescriptions
can help make sure you don’t
experience drug interactions or
other safety problems.
4
Order online (in the
U.S. only). Recently,
Consumer Reports Secret
Shoppers searched for the best
prices on five widely prescribed
drugs: the generic versions of
Actos, Lipitor, Lexapro, Plavix,
and Singulair. Some of the lowest prices were found online, at
HealthWarehouse.com, and
Familymeds.com. (Costco was the
least expensive brick-and-mortar
store, as were a few independents.)
But be careful choosing an
online pharmacy. Those listed
above are fine. But a recent
analysis of 9,677 of them by the
National Association of Boards
of Pharmacy (NABP), which
accredits online drugstores in addition to representing state pharmacy boards across the U.S., found
that just over 3 percent appear to
be sound. It considers the rest to
be “rogue” operations. More than
3
Ask mom-and-pop
drugstores if they’ll
negotiate. Although
many neighborhood independent
pharmacies might not offer or
widely advertise a discount generic drug program like their national
competitors, store owners might
be willing to match the prices of
the big chain stores. It’s worth asking, especially if you expect to be
2013 Consumer Reports Best Buy Drugs 23
six ways to save
85 percent don’t require a valid
prescription from the customer’s
doctor; almost 50 percent offer
foreign drugs or ones not approved by the Food and Drug
Administration; almost a quarter
have a physical address outside the
U.S.; and about 35 percent have
computer servers in foreign
countries. The problem with
selling medications from other
countries is that there’s no way
to ensure their safety or legitimacy. The FDA doesn’t regulate
foreign versions of medicines
bought over the Internet.
Don’t assume a Canadian
website is safe. Most online
pharmacies claiming to be
Canadian aren’t. And even legitimate Canadian online pharmacies shipping to the U.S. don’t fall
under any government’s jurisdiction. In other words, no agency—
U.S. or Canadian—regulates them,
making it hard to know if drugs
shipped from any online
Canadian source are safe.
5
Follow your formulary.
Insurance companies that
cover prescription drugs
and Medicare Part D plans have
formularies that offer pricing
advantages when you fill prescrip-
24 2013 Consumer Reports Best Buy Drugs
otc vs. rx
tions from their “tier 1” list (usually generic drugs) and “preferred”
medications (branded and generic). On private plans, the average
co-pay for tier 1 drugs is $10, and
$29 for preferred, according to a
recent survey by the Kaiser Family
Foundation. Co-pays for drugs on
a plan’s “nonpreferred” list average
$49, and $91 for very high-priced
medications or so-called “lifestyle”
drugs, which are not medically
necessary.
Some insurance plans might
offer additional discounts if you
choose to get your prescriptions
through their mail-order service,
which can be especially helpful
for people with chronic conditions. Again, though, it’s best to
use a single source for all your
prescriptions if possible.
6
Buy a pill splitter.
Saving money can be as
easy as buying a $3 device.
See page 54 for tips on how to
use it correctly. ■
OTC vs. Rx
medications
When cheaper, over-the-counter
remedies may be your best bet
I
t can be tempting to run to a doctor for a prescription medication
when you’re miserable with symptoms like nonstop sneezing or nagging knee pain, or when you’ve had a few sleepless nights. But the best
relief might already be in your medicine cabinet. For common ailments
like allergies, pain, and insomnia, over-the-counter drugs may be the way
to go—they can save you money, and some work just as well or better, and
may cause fewer or less severe side effects than prescription medications.
To help you find the best treatments, we’ve recently reviewed hundreds
of studies and came up with the following advice. We also calculated the
potential savings of going OTC, though your actual savings may depend
on your insurance coverage. >>
2013 Consumer Reports Best Buy Drugs 25
otc vs. rx
Allergies
INSTEAD OF Allegra (fexofenadine), Clarinex (desloratadine), or Xyzal
(levocetirizine)
GO OTC Alavert, Claritin (or generic loratadine), or Zyrtec (cetirizine)
SAVE AS MUCH AS $148 a month* (All savings are based on retail
prices of brand-name OTC and prescription drugs)
WHY SWITCH? Antihistamines block the chemical messenger histamine, one of the body’s natural defense mechanisms and the main trigger of allergy symptoms in the nose, airways, and skin. Studies show that
“newer” antihistamines—both prescription and OTC, such as those listed
above—are similarly effective.
They all generally bring some relief in 1 to 3 hours and continue to
work for 12 to 24 hours for most people. But keep in mind that even if
you have just mild allergies, you might need to try a few before finding
one that works best for you. Some people respond well to one antihistamine while not finding relief with another.
WHEN TO SEE A DOCTOR He or she will be able to tell if your symptoms are caused by an allergy. Studies have found that some people who
take prescription meds don’t actually have the condition.You could have
a cold, a mild case of the flu, bronchitis, or sinusitis. But if any of those
symptoms persist or are accompanied by high fever, shortness of breath,
or wheezing, seek help. Also consult a doctor before taking these drugs
if you have high blood pressure, a heart condition, diabetes, closed-angle
glaucoma, or prostate disease.
PREVENT IT IN THE FIRST PLACE Stay inside during peak allergy days.
A Consumer Reports National Research Center survey showed that one
in five Americans were “highly satisfied” with symptom relief achieved by
avoiding allergy triggers. They said that—when it worked—this strategy
was even more effective than treating their allergies with OTC drugs.
Insomnia
INSTEAD OF Ambien (or generic zolpidem), Lunesta (eszopiclone), or
Rozerem (ramelteon)
GO OTC Benadryl, Nytol, Sominex (or generic diphenhydramine),
or Unisom SleepTabs (or generic doxylamine)
otc vs. rx
doxylamine can cause sedation and sleepiness as a side effect, temporarily helping to relieve mild insomnia. Although relatively inexpensive and
easy to buy, they can also cause unwanted side effects, including nextday drowsiness, confusion, constipation, dry mouth, and trouble urinating.
But keep in mind that prescription medications can come with their own
disturbing side effects.
WHEN TO SEE A DOCTOR If your insomnia lasts three or more nights
a week for at least a month, schedule an appointment with your physician.
PREVENT IT IN THE FIRST PLACE Cognitive behavioral therapy, a
form of psychotherapy where you work with a therapist to learn a new
set of behaviors regarding your sleep habits, can improve sleep. Also, try
exercising and avoid alcohol, caffeine, and smoking. And keep in mind
that certain prescription drugs can cause insomnia. So can using a computer or smart phone or watching TV right before bedtime. Other things
that can make you toss and turn at night include inconsistent sleep and
Drugstore remedies to avoid: Combination drugs
Taking combo drugs that treat multiple symptoms— such as
headaches, achiness, and fever—can lead to dangerous
overdoses. In 2011 the manufacturer of Extra Strength
Tylenol lowered the maximum daily dosage from eight
pills to six pills to help people avoid taking too much acetaminophen, which can lead to liver damage. The reason:
Acetaminophen is an active ingredient in hundreds of
OTC products, many of which are combo formulas for
colds, flu, allergies, and sinus problems. But laxatives,
pain relievers, sleep aids, and indigestion treatments
can also contain more than one active ingredient.
So before taking a second drug to treat an unrelated
symptom, such as a headache when you just have a
cough and sore throat, always check the active ingredients to make sure you’re not overdoing it.
SAVE AS MUCH AS $47 a week
WHY SWITCH? OTC antihistamines that contain diphenhydramine or
26 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 27
otc vs. rx
wake-up times (on weekends, for example) and late-day napping. Finally,
if you can’t sleep, get out of bed and do something relaxing, like reading,
until trying to catch your zzz’s again.
Joint Pain
INSTEAD OF Celebrex (celecoxib)
GO OTC The NSAIDs Advil or Motrin IB (or generic ibuprofen),
Aleve (or generic naproxen), or the non-NSAID Tylenol (or generic
acetaminophen)
SAVE AS MUCH AS $151 a month
WHY SWITCH? These anti-inflammatory drugs block the production
of substances in the body called prostaglandins, which play a role in aches
and pain, inflammation, fever, and muscle cramps. At low doses, NSAIDs
(nonsteroidal anti-inflammatory drugs) essentially work as pain relievers. At higher doses they can actually reduce the body’s inflammatory
response to tissue damage as well as relieve pain. Studies show the nonprescription NSAIDs are as effective as Celebrex.
WHEN TO SEE A DOCTOR If you take these drugs for longer than 10
days or the recommended doses on the label aren’t effective, make an appointment. Prolonged use of these drugs can cause side effects including
gastrointestinal bleeding, heart attack, kidney failure, stomach ulcers, and
stroke. So consider taking Tylenol first.
PREVENT IT IN THE FIRST PLACE Regular stretching, exercise, and
muscle strengthening can help prevent joint pain.
Lower Back Pain
INSTEAD OF Long-acting opioid pain medication, such as OxyContin
(or generic oxycodone)
GO OTC The NSAIDs Advil (or generic ibuprofen) and Aleve (or generic naproxen), or non-NSAID Tylenol (or generic acetaminophen)
SAVE AS MUCH AS $115 a month
WHY SWITCH? Unlike opioid painkillers, which block signals to the
brain, these NSAIDs reduce pain by inhibiting the release of a certain
enzyme that produces hormones that cause inflammation. For mild to
moderate chronic pain, studies show that NSAIDs work about as well
as opioid drugs and are less risky. Opioids are only moderately effective
and little is known about their long-term effects. Also, they don’t always
28 2013 Consumer Reports Best Buy Drugs
otc vs. rx
completely eliminate pain; can cause side effects like nausea, constipation,
sedation, and dizziness; and can cause your body to build up a tolerance
so that you need increasingly higher doses, raising the risk of side effects.
And they can actually increase your body’s sensitivity to pain and lead to
addiction. To treat lower back pain, try nondrug treatments like exercise,
physical therapy, and cognitive behavioral therapy. Acupuncture, massage,
or yoga may help, too.
WHEN TO SEE A DOCTOR If pain lasts longer than a week or two,
radiates down your leg, or is accompanied by leg weakness, call your physician. Also be aware that NSAIDs have been linked with gastrointestinal
bleeding, heart attack, kidney failure, stomach ulcers, and stroke. So you
may want to consider Tylenol, a non-NSAID, first. NSAIDs can also aggravate high blood pressure.
PREVENT IT IN THE FIRST PLACE Clinical studies have found that
exercise can help prevent non-acute back pain. Try water and walking
workouts as well as aerobic exercise, weight training, and muscle endurance and stretching exercises.
Migraine Headaches
INSTEAD OF Imitrex (or sumatriptan) or Maxalt (rizatriptan)
GO OTC Consider trying Advil or Motrin IB (or generic ibuprofen),
Aleve (or generic naproxen), or the combination products Excedrin Extra Strength, Excedrin Migraine (or generic acetaminophen, aspirin, and
caffeine) first.
SAVE AS MUCH AS $31 a week
WHY SWITCH? These OTCs have been shown in studies to help some
people who suffer from migraines.
WHEN TO SEE A DOCTOR Even if the OTC drugs ease your pain, you
should still see a physician for a diagnosis if your migraines are moderate
to severe in intensity, or they disrupt your life. Consider seeing a doctor
too if the meds listed above don’t provide relief. Also be aware that overusing these OTC painkillers can sometimes cause rebound headaches,
where the pain can persist and become more frequent over time, as well
as other side effects.
PREVENT IT IN THE FIRST PLACE Figure out what prompts your migraines. Culprits can include alcohol, caffeine, certain kinds of cheese,
dehydration, plane rides, skipping meals, or stress. ■
2013 Consumer Reports Best Buy Drugs 29
High Blood Pressure
High Blood Pressure
a healthful diet and regular exercise, often help. If your blood pressure
is still high, drugs can usually help. Ask your doctor about diuretics—a
class of low-cost medication that is at least as safe and effective as newer,
pricier drugs.
Spotlight on:
Treating
high blood
pressure
4 steps to
keeping
it low
H
igh blood pressure triggers more heart attacks and strokes in the
U.S. than any other cause, killing more people worldwide than
smoking, diabetes, or obesity. And yet, 20 percent of Americans
with high blood pressure don’t know they have it.
Here’s why: High blood pressure rarely causes obvious symptoms, and
doctors don’t always test patients who might be at risk. So it’s important
that you ask your health care provider to check your blood pressure at
every appointment.
If your doctor diagnoses you with high blood pressure (hypertension), learn how to get it under control. Simple lifestyle changes, such as
30 2013 Consumer Reports Best Buy Drugs
Step 1: Get screened.
Over time, excessive pressure in the heart can damage blood vessels
in the body, increasing the risk not only of heart attacks, but also strokes,
kidney damage, vision loss, arterial blockages in the legs, and sexual
impotency. Blood pressure increases for many reasons: advancing age,
a genetic predisposition, certain medications, and risk factors such as
inactivity, obesity, and smoking, for example.
It’s important to detect high
blood pressure early, before too
much damage is done. Have your
You’re not considered to
blood pressure checked at least
have high blood pressure
once every two years, and more
until your systolic pressure
often if you’re 50 or older or have
other risk factors. In fact, it’s a good
tops 140 mm Hg or your
idea to have it done during every
diastolic pressure exceeds
visit to a health care provider.
90 mm Hg. But even below
If your initial reading is high,
those levels, the risk of
don’t panic. A number of factors,
a heart attack or stroke
including pain and emotional stress,
increases as pressure rises.
can temporarily boost blood pressure. To improve accuracy:
• Don’t smoke, exercise, or consume anything caffeinated for at
least half an hour before your appointment.
• Go to the bathroom first, since a full bladder can affect the reading.
• Sit with your feet flat on the floor for five minutes before the
reading. Rest your arm on a table so it’s at heart level. Remain quiet
during the test.
If your systolic (upper) level is 140 millimeters of mercury (mm Hg)
or higher, or your diastolic (lower level) is 90 mm Hg or higher, your
doctor should retest at least twice over the next several weeks to confirm the results. >>
2013 Consumer Reports Best Buy Drugs 31
High Blood Pressure
High Blood Pressure
Step 2: Know what your blood
pressure numbers mean.
Blood pressure is measured as two numbers, one over the other—for
example, 120 over 80 mm Hg. The systolic, or higher, number reflects
the pressure in the arteries when the heart contracts; the diastolic, or
lower, number reflects the pressure between heartbeats, when the heart
rests. An elevation in either or both of those numbers constitutes hypertension, as shown here.
Systolic
measure
(mm Hg)
Diastolic
measure
(mm Hg)
Normal
Below 120
Below 80
Maintain a healthy lifestyle to avoid increases
in levels, which are
common as people age.
High-normal
(prehypertension)
120 to 139
80 to 89
Make lifestyle changes:
stop smoking, cut back
on sodium, lose excess
weight, exercise regularly, and drink moderately,
if at all.
What to do
Drugs are generally
needed only if you also
have diabetes, coronary
heart disease, or kidney
disease.
Stage 1
high blood
pressure
Stage 2
high blood
pressure
140 to 159
160 or
higher
90 to 99
100 or
higher
Consider drugs, usually
a low-dose diuretic, if a
few months of lifestyle
changes (above) don't
adequately lower levels.
Drug treatment should
usually start at the same
time as lifestyle changes
(above). A diuretic plus
one other medication
are often required.
Step 3: Change your lifestyle,
lower your blood pressure.
The table below shows how much you can lower your systolic
(upper) blood pressure level by making these recommended changes.
People who make multiple changes and stick with them can expect
even greater reductions. >>
Lifestyle change
Estimated reduction in
systolic blood pressure
Adopt a healthy diet
Consume a diet rich in fruits, grains,
vegetables, and low-fat dairy products
and low in saturated and total fat.
8 to 14 mm Hg
Be active
Engage in regular aerobic physical
activity, such as brisk walking (at least 30
minutes a day, most days of the week).
4 to 9 mm Hg
Cut back on salt
Reduce dietary sodium intake to
no more than 2,400 milligrams a
day, the amount in a teaspoon of salt.
2 to 8 mm Hg
2 to 4 mm Hg
Drink moderately, if at all
Limit consumption to no more than two
drinks (e.g., 24 oz. of regular beer, 10 oz.
wine, or 3 oz. of 80-proof whiskey) a day
for most men, and no more than one drink
a day for women and lighter-weight men.
Lose excess weight
Aim for a body mass index under 25.
2.5 to 10 mm Hg for
about every 11 pounds
Source: Adapted from “The seventh report of the Joint National Committee on prevention, detection,
evaluation and treatment of high blood pressure,” the National Heart, Lung, and Blood Institute.
32 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 33
>> High Blood Pressure
High Blood Pressure
High Blood Pressure
Which blood pressure drug is right for you?
Step 4: Get the right drugs.
If healthy lifestyle changes alone are not enough to lower your blood
pressure, or if your levels are very high, you should also consider medication. The first choice for many people is usually a diuretic, particularly
thiazide diuretics. They’re effective, safe, and available as low-cost generics. If your doctor recommends another type of drug instead, but you
have no other health problems, ask why.
Whether you take a diuretic alone or with other drugs, use these tips
to reduce the chance of side effects—and increase the likelihood that
you’ll stick with the therapy:
• Get your blood levels of magnesium and potassium checked periodically, since diuretics can deplete those minerals. Call your doctor if
you have cramps, begin vomiting, or your heart rate or pulse increases,
which can indicate low potassium levels.
• Watch for signs of gout (for example, an acutely inflamed big toe or
knee).
• If you also have diabetes, monitor your insulin level extra carefully
because drugs for high blood pressure can cause it to fluctuate.
• Follow dosing instructions carefully and read the product label for
possible side effects. ■
34 2013 Consumer Reports Best Buy Drugs
Drug
Good candidates
Common side effects
Thiazide diuretics
Chlorthalidone,
hydrochlorothiazide,
and others
First choice, alone or
Frequent urination, low
with other drugs, for
potassium levels, and
most otherwise healthy erectile dysfunction.
people.
Beta-blockers
Metoprolol (ToprolXL and generic),
nadolol (Corgard and
generic), propranolol
(Inderal and generic),
and others
People who also have
angina (chest pain);
certain heart-rhythm
and heart-muscle
abnormalities; or a history of heart attack or
heart failure.
Drowsiness, fatigue,
erectile dysfunction,
and slowed pulse rate.
ACE inhibitors
Benazepril, enalapril
(Vasotec and generic), lisinopril (Prinivil,
Zestril, and generic),
and others
People who also have
diabetes, heart failure,
kidney disease, or a
history of heart attack
or stroke.
Persistent dry cough,
high potassium levels,
reduced kidney function, and an uncommon
but potentially fatal
allergic reaction,
angioedema, especially
in African-Americans.
Angiotensin II
receptor blockers
(ARBs)
Losartan (Cozaar
and generic),
candesartan
(Atacand), and
others
People who would
Similar to ACE inhibitors
otherwise be candibut less likely to cause
dates for ACE inhibitors coughing.
but can’t take them
because of excessive
coughing (ARBs are
relatively expensive
compared with other
blood pressure drugs).
Calcium-channel
blockers
Amlodipine (Norvasc
and generic), diltiazem (Cardizem and
generic), and others
People who also have
angina (chest pain),
certain heart-rhythm
abnormalities, and
possibly migraines.
Dizziness, fast or slow
heartbeat, flushing,
headaches, swollen
gums, and, less often,
breathing problems.
2013 Consumer Reports Best Buy Drugs 35
$4 Generics
$4Buy
Generics
Smart
$4 Generics:
The best way to save
Nearly every chain drugstore and
big-box retailer offers these programs
F
or almost a decade chain pharmacies nationwide have been selling
select generic drugs for as little as $1 for a week’s supply. And you’ve
probably seen ads for similar drug programs at mass retailers and
even some supermarkets. Here’s what you need to know to maximize
your medication savings.
What’s included? Generic drug programs cover hundreds of medications to treat many common conditions, including high blood pressure,
high cholesterol, type 2 diabetes, depression, osteoarthritis, and allergies.
What’s not included? Newer brand-name drugs.
How do the plans work? Some pharmacies require you to sign up for
membership or pay an annual fee. Others require only a doctor’s prescription. Some memberships need to be renewed annually, while others are
open-ended. Find out all the details before you need to fill a prescription
in case the enrollment process takes longer than you anticipated.
Why can pharmacies sell drugs so cheaply? Some pharmacies say
it’s because they buy drugs in bulk. Others say that program membership
fees help to offset the costs. Some pharmacies may lose money on these
programs, but others, such as the “big box” stores, may make up the loss
through impulse sales or sales of other high-ticket items.
What does insurance cover? Generic medication included in these
36 2013 Consumer Reports Best Buy Drugs
programs can be even cheaper than your insurance co-payment. If you
have a $10 co-pay but the drug you need is offered by a pharmacy for
$4, you should be eligible for the cheaper price. Simply pay for the drug
out-of-pocket and, in many cases, the pharmacy won’t submit the claim
to your insurance company. Ask the pharmacist about any exclusions (also
see the chart) or how the program works with Medicaid, Medicare, or
another federal program you use.
Where to get good prices beyond the chains… If your preferred
pharmacy is a mom-and-pop shop, it pays to ask if they will match
the discount prices of the chain drugstores. In many cases the independents will try, and they may even offer a discount generic drug program
of their own. >>
2013 Consumer Reports Best Buy Drugs 37
$4 Generics
$4Buy
Generics
Smart
Select national discount-drug programs*
Many pharmacies at national chains, big-box retailers, and warehouse clubs
have programs that offer hundreds of discounted generic drugs for treating
Retailer
Drug costs
Number
included
Costco
As low as $6.99 for a 90-day
supply (but check your local
Costco, as drug prices can
vary by location)
$11.99 for 90-day supply
CVS
Kmart
Kroger
Rite Aid
Target
Walgreens
Walmart
such common conditions as type 2 diabetes, high cholesterol, heart disease,
and depression. Be aware that stores often change the medicines in their
programs, and not all strengths and forms are covered. ■
Enrollment
fee
Who can
participate
Other benefits
More than
200 generic
drugs
Free
Anyone. Costco membership
not required.
Costco members not using insurance
or who are uninsured can join the free
Member Prescription Program and save
2% to 40%.
More than
400 generic
drugs
$15 annually
per person
People not using insurance
or who are uninsured or
underinsured.
Health Savings Pass members save 10%
on their annual flu shot and on visits to
in-store health clinics.
As low as $5 for 30-day supply;
$10 for 90-day supply
More than
500 generic
drugs
$10 annually
per person or
household
People not using insurance
or drugs not covered by your
insurance.
Pharmacy Prescription Savings Club
members get discounts of 5% to 20%
on brand-name drugs, 5% to 35% on
all other generic drugs, and 20% on flu
shots. And get discounted pet medication delivered for free by enrolling in the
Kmart Pharmacy Pet K program.
$4 for 30-day supply; $10
for 90-day supply. For highercost drugs: $9 for 30-day
supply; $24 for 90-day supply
About 300
generic drugs
Free
Anyone.
You receive these same savings
on generic drugs for your pets.
$9.99 for 30-day supply;
$15.99 for 90-day supply
More than
500 generic
drugs
Free
People not using insurance
or who are uninsured or
underinsured.
Rx Savings Program members save 15%
or more on thousands of brand-name and
generic drugs.
$4 for 30-day supply; $10 for
90-day supply. For higher-cost
drugs: $9 for 30-day supply;
$24 for a 90-day supply
About 300
generic drugs
Free
Anyone.
Pharmacy Rewards members get 5% off
all Target purchases made on a single day
after filling 5 eligible prescriptions. Also,
you can get the same $4 generic savings
for your pet’s medication.
As low as $5 for a 30-day
supply; $10 for a 90-day supply
More than
700 generic
drugs
$20 annually
per person or
$35 per family
People not using insurance
or enrolled in public
health-care programs.
Prescription Savings Club members (which
includes pets) get discounts on thousands
of brand-name drugs. They also save 5%
to 20% off most immunizations, and 10%
on Take Care Clinic services.
$4 for 30-day supply, $10 for
90-day supply. Higher-cost
drugs: $9 for 30-day supply,
$24 for 90-day supply
About 300
generic drugs
Anyone.
Walmart Pharmacy Home Delivery participants get free shipping on $10, 90-day
prescriptions. Pets also qualify for $4
generics and the home delivery program.
Free
*Information current as of December 2012. Check with individual
retailers for the discount programs they offer. Details may vary.
38 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 39
generics
generics
Generics:
Medicine you need at
a price you can afford
What you should know
Even though about 75 percent of prescriptions today are written for
generic drugs, many consumers still worry about their safety and effectiveness, according to a recent survey by Consumer Reports Best Buy Drugs.
“When people hear the word ‘generic,’ they think of generic
plastic wrap or generic pasta, and associate that with inferior quality,” says
Aaron S. Kesselheim, M.D., an assistant professor of medicine at Brigham
and Women’s Hospital in Boston. “But for the vast majority of people,
generic drugs are as safe and effective as brand-name drugs.”
In fact, the active ingredients in generic drugs work the same as their
brand-name counterparts—and offer significant savings to you. Still not
sure? Get to know the truth about generics with the answers to these
common questions.
40 2013 Consumer Reports Best Buy Drugs
What, exactly, are generic drugs?
Generics use the exact same active ingredients as their brand-name
counterparts. By law, generic drug companies can legally manufacture the
branded drug once the patent has expired—usually 12 to 15 years from
the drug’s initial release. And because brand-name drugs are prescribed
for many years before they can be copied, their generic clones are considered, by extension, “tried and true.”
The Food and Drug Administration requires that over-the-counter
and prescription generic drugs have exactly the same active ingredients
in the same strength as the brands they copy. It also requires that they
have the same purity and stability, come in the same form—for example,
tablet, patch, or liquid—and be administered the same way (for example,
swallowed as a pill or given as an injection). In addition, manufacturers
of a generic must demonstrate that the drug is “bioequivalent” to its corresponding brand by showing that it delivers the same amount of active
ingredients into a person’s bloodstream in the same time as the original
brand. A 2009 analysis of 2,070 bioequivalence studies found that the average difference in absorption—using two measures—between a generic
and its branded prototype was about 4 percent, the same variation that is
found between two batches of the same brand-name drug.
That means that generic drugs maintain the same therapeutic effect—
and therefore the same benefits and risks—as their brand-name counterparts, all while saving you as much as 95 percent of the price. >>
2013 Consumer Reports Best Buy Drugs 41
generics
generics
How many generics are available on the market?
Generics are available for nearly 80 percent of all prescription medicines.
And when an exact generic is not available for a certain drug, as is the
case with many newer brand-name drugs, doctors or pharmacists can often substitute a generic version of an older drug in the same class of drugs
that has equivalent effectiveness (and often a longer safety record).
So what about over-the-counter generics?
To find information about
recalls and other medical
safety alerts for all drugs,
go to the FDA’s website,
www.FDA.gov. If you’re
concerned about a drug you
are taking or if you’re
experiencing problems that
might be related to your
medications, speak to your
physician, pharmacist, or
other health care provider.
They’re required by law to meet
the same manufacturing standards as the name brands with
which they compete. They have
the same benefits and risks as
their brand-name counterparts,
but at a lower cost to you.
What’s the difference
between generics and
brand-name drugs?
Aside from the contrast in cost,
the biggest differences are simply cosmetic and bear no influence on the quality of the drug.
Brand-name pills may have a
colored outer shell that contains
a sweetener. Generics, on the
other hand, are often plain white
pills that don’t appear to be as high quality. However, generic pills, by law,
cannot look the same as their branded version due to patent issues. The
shape, color, and taste of a pill make no biological or medical difference,
except in rare instances when someone might be allergic to an inactive
ingredient.
But I recognize the brand names.
Yes, because drug companies do a good job of advertising. But don’t pay
for brand names simply because you recognize them. Most drugs have a
brand name and a generic name. For example, the generic name for Lipitor is atorvastatin, which is the main ingredient in Lipitor.
42 2013 Consumer Reports Best Buy Drugs
Get to know the generic names
of drugs you take. You’ll have an
easier time getting information on
the drug from reference books or
on the Internet.
So why hasn’t my
doctor prescribed a
generic to me?
If you don’t have insurance
coverage for drugs, talk
to your doctor, as switching to a generic may mean
substantial cost savings.
In many cases, doctors will write
a prescription for a brand-name
medicine and leave it to the pharmacist to substitute a generic when applicable. Pharmacists in every state can legally switch you to an approved
generic version of the branded drug prescribed to you without your
doctor’s permission.
Talk with your doctor about your prescription as it is being written.
Ask whether the prescription is for a brand-name or generic drug and
why the doctor has prescribed one or the other. And if cost is a concern,
let the doctor know that you would prefer the less-expensive choice as
long as safety and effectiveness are the same.
Can I really save that
much by switching?
Even if you have insurance, the
Generics can cost up to 95 perco-pay for a generic drug is
cent less than their brand-name
often less than for the branded
versions and save consumers an
version. For example, you may
estimated $8 billion to $10 billion a year. They’re less expensive
only have to pay $4 to $10 for
because manufacturers don’t have
a generic versus $15 to $35 for
the expense of developing them
a brand-name. When you are
from scratch and rarely spend
taking several medicines, these
money on advertising. The lower
savings can add up.
price not only helps your wallet
but might also help your health.
Research suggests that people
who use generics are more likely
to keep taking their drugs as directed, compared with those who use
costlier brand-name drugs. >> 2013 Consumer Reports Best Buy Drugs 43
generics
Are generic drugs made overseas safe?
Yes, or at least as safe as brand-name drugs made overseas. Eighty percent
of the active ingredients in all U.S. drugs—generic and branded—are
now made in foreign countries. In fact, most brand-name drugs are produced in the same countries and often the same factories as their generic
counterparts. There have been concerns about generic drugs made overseas, but there have been reports of problems with brand-name drugs, too.
For example, in 2009 the FDA took action against a generic drugmaker
for falsifying data and test results at one of its facilities in India.The previous year, an FDA investigation found that the active ingredient in branded
versions of the blood thinner heparin, made in China, had been contaminated. The agency has not had sufficient resources or access to inspect
foreign facilities as often as it does domestic ones.
The FDA has recently taken steps to increase overseas inspections, and
some U.S. drugmakers inspect their foreign facilities. The Food and Drug
Administration Safety and Innovation Act of 2012, signed by President
Obama in July 2012, provides additional resources for inspections of
manufacturing facilities overseas.
generics
For NTI drugs, particularly those to treat epilepsy, our medical consultants recommend staying on a generic made by one manufacturer to
avoid slight variations that may occur with different manufacturers. Talk
with your pharmacist to ensure that he or she can provide that consistency month-to-month, or at least tell you if the pharmacy switches its
generic supplier. If you do switch to a different generic or from a brand to
a generic, your doctor may want to monitor your response more closely
during the transition period.
Where can I learn more?
Check out our free Best Buy Drug reports on more than 25 classes
of drugs to treat dozens of conditions and find out whether a low-cost
generic is available. See the back cover for a list of available reports
at www.CRBestBuyDrugs.org. For more on generic drugs go to
www.FDA.gov. ■
How do I switch?
When your doctor prescribes a drug, ask if there is a generic version that
would be just as safe and effective but less expensive. If one isn’t available,
as is the case with many newer brand-name drugs, ask if a generic version
of an older drug in the same class would work as well. Is there a time when generics aren’t a good choice?
Some experts think so, though that’s controversial. Articles in medical
journals and other media have debated the safety of using generics in
place of brand-name drugs that have a “narrow therapeutic index” (NTI)
because they are effective and safe only within a small dosing range. In
other words, too little active ingredient and the drug doesn’t work; too
much and it becomes toxic. NTI drugs include antiseizure medications
for treating epilepsy, blood-thinning drugs like warfarin, antiarrhythmics
for controlling irregular heartbeats, and drugs that help prevent the rejection of a transplanted organ. Several states have restricted generic substitutions of NTI drugs, and an FDA committee recently recommended that
the agency tighten bioequivalence standards for them.
44 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 45
where drug costs hide
generics
Where high
drug costs hide
And what you can do to save
H
igh drug prices affect everyone—those who pay
out-of-pocket, those with private insurance, and even
those on Medicare Part D. Some may skip filling
prescriptions because they can’t afford them, while others
who take expensive drugs may see their insurance premiums
rise as a result. The price of prescriptions can be hidden from
consumers with insurance because complex drug formularies and co-payments can make it difficult to understand
a medication’s true cost. Here are five instances in which
medication prices are likely to be especially high, based on
our analysis of drug-pricing data, and how you can avoid
overspending. >>
46 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 47
where drug costs hide
where drug costs hide
Five years before a brand-name drug loses its patent
Consumer Reports Best Buy Drugs analyzed retail prices for 10 wellknown drugs that have either recently become or will soon be available as generics. Using data from nearly 49 million prescriptions filled
over the past five years, we found that price increases in some cases were
staggering (see box). For example, the retail price of the bone-building drug Boniva (ibandronate) went up more than 100 percent during
the five years before it became available as a generic. In 2007 the drug
Provigil (modafinil), used to treat excessive sleepiness caused by narcolepsy,
shift-work disorder, and sleep apnea, averaged $272 for a one-month supply. By 2012 that price had increased 305 percent, to $1,101.
Why does this happen? One reason may be that drug companies are
producing fewer blockbuster treatments, says Stephen Schondelmeyer,
Pharm.D., Ph.D., a pharmaceutical economics professor at the University
of Minnesota. A result is that companies may be “milking the cash cow to
get as much out of a drug as they can before it goes generic,” he says. >>
Increase in drug prices over the past five years
Brand-name drug
(generic name)
Used to treat
Avg. retail cost per
prescription in 20071
Avg. retail cost per
prescription in 20121
% change in price
Generic available2
Actos
(pioglitazone)
Type 2 diabetes
$200
$377
89
Now
Boniva
(ibandronate)
Osteoporosis
119
240
102
Now
Crestor
(rosuvastatin)
High cholesterol
112
214
91
July 2016
Cymbalta
(duloxetine)
Depression, anxiety,
fibromyalgia
139
241
73
June 2013
Lipitor
(atorvastatin)
High cholesterol
127
237
87
Now
Lunesta
(eszopiclone)
Insomnia
115
203
77
May 2014
Plavix
(clopidogrel)
Heart disease
142
261
84
Now
Provigil (modafinil)
Excessive sleepiness
272
1,101
305
Now
Seroquel
(quetiapine)
Bipolar disorder,
treatment-resistant
depression, schizophrenia
203
381
88
Now
Singulair
(montelukast)
Asthma
115
205
78
Now
1. For all strengths of the medication. 2. Dates are subject to change.
48 2013 Consumer Reports Best Buy Drugs
2013 Consumer Reports Best Buy Drugs 49
where drug costs hide
where drug costs hide
of generic fluoxetine can be found on lists of discount generics offered
by retail pharmacies for as little as $4 a month or $10 for a three-month
supply. “The new formulation really isn’t a new discovery per se,” Schondelmeyer says, “but drug companies claim a new use or a little tweak,
receive some additional patent life, and continue to raise the price.”
What you can do to save: Consider avoiding fancy versions of
medication, even if they offer some conveniences. If you don’t mind
taking your medication once daily or several times a day instead of once a
week or even less frequently, you could save big bucks. The same goes for
sticking with traditional tablets when possible. Liquid forms, dissolvable
tablets, patches, or creams can also be more expensive, although for some
people a more convenient form of the medication may be worth the
higher price.
Unsuspecting pharmacies
What you can do: Ask whether a generic is available. Other less-costly
generics in the same class may often be just as effective and safe as a
brand-name medication. According to the Food and Drug Administration, 80 percent of all brand-name drugs now have a generic equivalent
available. And for many other medications without a generic, ask your
doctor if a therapeutic equivalent is available instead.
New formulations of the same drug
Extended-release, sustained-release, or dissolvable tablets, or even an
oral solution, can be convenient medicine—but it can also be expensive.
Sometimes the original drug may be available as a generic, as is the case
with the sleeping pill Ambien (zolpidem). A week’s worth of 5 mg tablets
of generic zolpidem costs an average of $12. But the same amount for
the 5 mg tablet of the dissolvable version will run you $55, for which no
generic is available.
In the case of the antidepressant Prozac (fluoxetine), the 90 mg tablet
taken once a week will cost you $211; the generic version is still pricey
at $143 per month. But all of the daily doses (10 mg, 20 mg, 40 mg)
50 2013 Consumer Reports Best Buy Drugs
When the blood clot-reducing drug Plavix (clopidogrel) became available as a generic, we contacted 30 pharmacies in the U.S. Our secret
shoppers found that retail prices for a month’s supply of 75 mg taken
daily ranged from $179 to $210 at the CVS, Target, and Walgreens stores
we contacted to less than $15 for the same strength and supply at Costco.
Walmart consistently quoted a price of less than $50, and two independent pharmacies offered it for between $19 and $49. The online drugstore
HealthWarehouse.com charged $15 for a 30-day supply.
Recently, Consumer Reports searched for the best prices for five
widely prescribed drugs (generic versions of Actos, Lipitor, Lexapro, Plavix and
Singulaire). The lowest prices were found at Costo, as well as Familymeds.
com, and HealthWarehouse.com. Some independents came in even lower. The most expensive: CVS, RiteAid, and Target.
What you can do: Shop around. Ask whether your pharmacy has a discount program for generics. Almost all have them, which offer excellent
prices, sometimes as little as $10 for a three-month supply. Also ask about
other discount programs the pharmacy may offer. Consumer Reports’
current and past secret shoppers have found that pharmacists rarely offer
cost-cutting information spontaneously. >>
2013 Consumer Reports Best Buy Drugs 51
where drug costs hide
where drug costs hide
Doctors who are not cost-conscious
When your doctor gives you a prescription, she is most likely to first
consider the effectiveness and safety of the medication—as she should.
But affordability is often not considered. Nearly half of respondents to
our recent Consumer Reports Best Buy Drugs Prescription Drug Tracking
Poll who regularly take a prescription medication said that doctors don’t
consider cost when prescribing a drug. And four in 10 said that doctors
tend to prescribe newer, more expensive medication.
What you can do: Ask about drug costs.This is particularly important
for medication taken for many years or for the rest of your life. Although
your doctor may not know immediately what your insurance will cover,
he can determine if a less-expensive and appropriate generic or therapeutic equivalent may be available. Doctors are also aware that most
brand-name medication is probably more expensive.
From drug maker discount coupons and “freebies”
To combat higher co-pays on brand-name medication, drug manufacturers have offered more discount coupons and programs in recent
years—and more consumers are using them. Our recent drug-tracking
poll found that among those regularly taking a medication, some 16
percent had used manufacturers’ coupons in the last year to save on
medication costs.
Many major name-brand drugs are offered in these discount programs,
including Abilify, Actos, Crestor, Cymbalta, Effexor, Lipitor, Nexium, and
Plavix. But the programs are often designed to capture interest and retain
or expand the companies’ market share with low initial costs. Once the
program ends or you’re no longer eligible, you’ll have to pay the original
price. The coupons also can increase costs for everyone covered under
your insurance plan, according to a recent report by the Pharmaceutical
Care Management Association, an insurance industry advocate.
For example, if a brand-name drug costs the insurance company $150
for a one-month supply, and the co-pay is $50, they still pay $100 for
your prescription regardless of whether you use a coupon that reduces
your co-pay. The same report estimated that coupons could increase
drug expenditures by $3 billion annually. Those costs could be passed on
to you as higher premiums.
52 2013 Consumer Reports Best Buy Drugs
What you can do: Skip the coupons and freebies. The offers can be
enticing, but they’re usually not for drugs that are the best first choice.
That’s also true for most free drug samples, because after the sample runs
out and it’s time to fill the prescription, you could be stuck taking an
expensive drug.
One example, according to a recent Consumer Reports Best Buy Drugs
analysis, is Actos (pioglitazone), a brand-name medication that’s used to
treat type 2 diabetes. (It has recently gone generic but it is still expensive.)
A month’s supply can cost as much as $380. But three other low-cost
generic medications actually work as well as or better than Actos: metformin, glimepiride, and glipizide, alone or in combination. A month’s
supply of each of those is less than $30, and they can be found on the
discount generic-drug lists of many chain pharmacies for as little as $4. ■
2013 Consumer Reports Best Buy Drugs 53
Pill Splitting
Pill splitting:
Cut your prescription
drugs (and costs) in half
P
ill splitting can be an easy way to save money. For certain medications, at certain strengths, you may be able to essentially buy
two doses of medicine for the price of one. Research shows that
a wide variety of drugs can be split safely, as long as it’s done carefully.
The following are some tips and best practices you should use if you’re
considering splitting your pills.
Ask your doctor or pharmacist whether your medication can
be safely split. The Food and Drug Administration has called pill
splitting a “risky practice” and does not encourage it unless the package insert specifically states it has been approved for splitting. However,
our medical advisers say pills can be split safely as long as your doctor
agrees that it’s appropriate for your health situation, you learn how to
do it properly, and you only split pills that can actually be split. As long
as you follow those guidelines, many common drugs—including aspirin,
cholesterol-lowering drugs, and many high blood pressure and depression
drugs—can be split safely.
54 2013 Consumer Reports Best Buy Drugs
Pill Splitting
Review reasons why you shouldn’t split your pills. If you have
trouble physically splitting pills due to poor eyesight, tremors, arthritis, or
dementia, or if your doctor says pill splitting is bad for your condition,
you should never attempt it.
Always use a pill splitter to ensure you’ve split the medication into equal halves. Pill splitters are widely available from pharmacies for as little as $3. Check with your insurance company, they might
provide one for free.
Don’t use a knife or scissors. Doing so can lead to unequal halves—
a dangerous outcome. Pills should only be split in half, not into smaller
portions, such as thirds or quarters.
Ask your doctor or pharmacist to show you how to split your
pills. Research has shown that patients who receive instructions from
medical professionals divide their pills more evenly.
Do not split your pills in
advance. Some pills may
The biggest savings come from
deteriorate when exposed
splitting brand-name drugs that
to air and moisture for long
periods after being split. So for
you take regularly for a chronic
medications taken on a regular
condition. You might be able
basis, only split your pill on the
to save more money by switching
day you take the first half, and
to a generic version of your
then take the other half whenprescription, if one is available.
ever you are scheduled to take
Talk to your doctor to see if this
your next dose.
is an option for you.
If your doctor has prescribed
half tablets, your pharmacy may
split the pills for you. So when
you pick up the prescription or a refill, ask if the pills have been split
so you don’t inadvertently halve them again. Also be aware that the
prescription label may refer to “one tablet” even though your doctor
has told you to split the pills. If you’re not sure about the label instructions or your doctor’s instructions, ask for clarification before splitting
or taking your medication.
Although there is no official or complete list of medicines that can
be split, the following lists can inform your conversation with your
doctor. >>
2013 Consumer Reports Best Buy Drugs 55
Pill Splitting
Pill Splitting
Which pills cAN be split?
These medications can be split
(but always check with your doctor
or pharmacist beforehand):
Which pills Cannot be split?
Common use
amlodipine (Norvasc)
High blood pressure;
heart disease
atorvastatin (Lipitor)
High cholesterol
citalopram (Celexa)
Depression
doxazosin (Cardura)
Enlarged prostate
finasteride (Proscar)
Enlarged prostate
Chemotherapy drugs
Anti-seizure medicines
Birth control pills
Blood thinners (Coumadin, warfarin)
Capsules of any kind that contain powders or gels
Pills with a hard outside coating
NOTE: Women should NOT handle crushed or broken
tablets if pregnant or possibly pregnant. Broken
tablets lose some of the protective outer coating,
thus allowing absorption of finasteride through
the skin. The drug may cause a male fetus to be
born with abnormalities of his sex organs.
Pills designed to release medication over time in
your body (i.e. long-acting, extended release, etc.)
Pills that are coated to protect your stomach
(enteric coating)
levothyroxine (Synthroid)
Under-active thyroid
lisinopril (Zestril)
High blood
pressure
lovastatin (Mevacor)
High cholesterol
paroxetine (Paxil)
Depression
quinapril (Accupril)
High blood
pressure
sertraline (Zoloft)
Depression
simvastatin (Zocor)
High cholesterol
tadalafil (Cialis)
Erectile
dysfunction
vardenafil (Levitra)
Erectile
dysfunction
56 2013 Consumer Reports Best Buy Drugs
It can be dangerous to split some drugs.
Generally, the following kinds of pills
should not be split:
Pills that crumble easily, irritate your mouth, taste
bitter, or contain strong dyes that could stain your
teeth and your mouth.
Combination tablets that contain two or more
medicines, in which the amount of one active
ingredient changes from one tablet size to the
next, but the amount of the other does not.
(You’ll have to ask your doctor or pharmacist.)
Here are some examples:
• amlodipine/atorvastatin (Caduet)
• amlodipine/olmesartan (Azor)
• amoxicillin/clavulanic acid (Augmentin and others)
• ezetemibe/simvastatin (Vytorin)
• irbesartan/hydrochlorothiazide (Avalide)
• oxycodone/acetaminophen (Percocet and others)
• sitagliptin/metformin (Janumet)
2013 Consumer Reports Best Buy Drugs 57
Pill Splitting
Pill Splitting
How much could you
save by splitting your pills?
Average
monthly
cost
Cost of
doubled
dose
Cost of
splitting
higher dose
Monthly
savings
Drug
What is it?
atorvastatin (Lipitor)
A statin prescribed along with lifestyle
changes to reduce LDL-cholesterol in
the blood and the related risk of heart
attack and stroke.
20 mg:
$201
40 mg:
$214
$107
$94
escitalopram (Lexapro)
An antidepressant prescribed to treat
generalized anxiety disorder (excessive
worry and tension that disrupts daily
life and lasts for 6 months or longer)
and depression.
10 mg:
$161
20 mg:
$170
$85
$76
A medication to control high blood pressure. It is also used to treat kidney disease caused by diabetes in patients with
type 2 diabetes and high blood pressure.
150 mg:
$115
300 mg:
$136
$68
$47
A statin prescribed along with lifestyle
changes to reduce LDL-cholesterol in
the blood and the related risk of heart
attack and stroke.
10 mg:
$185
20 mg:
$191
$96
$89
A medication to control high blood
pressure. It is also sometimes used to
treat heart failure in people who
cannot take angiotensin-converting
enzyme (ACE) inhibitors.
80 mg:
$118
160 mg:
$131
$65
$53
irbesartan (Avapro)
rosuvastatin (Crestor)
valsartan (Diovan)
Monthly cost reflects national average retail prices for August 2012, rounded to the
nearest dollar. Data provided by Wolters Kluwer Pharma Solutions, which was not
involved in our analysis or recommendations.
58 2013 Consumer Reports Best Buy Drugs
Your insurance plan might also
provide a list of drugs that can be split.
If so, review the list with your doctor or
pharmacist before ever splitting your pills.
2013 Consumer Reports Best Buy Drugs 59
12 tips you must know
12 tips you must know
12
Stay safe,
be smart:
Rx drug tips
you must know
1
Ignore drug ads. Sure, they can let you know when a new drug is
on the market, but an impressive ad doesn’t mean the drug is better
than older drugs. Often, it’s just more expensive.
2
3
Talk to your doctor about cost. Unless you bring it up, your
doctor might assume that prescription cost isn’t a factor for you.
Ask why. Find out why your doctor is prescribing a drug, and
ask if it’s FDA-approved for your condition. If not, it’s being
prescribed “off-label.” In other words, to treat a condition other than
those for which the FDA has approved it. Ask your doctor about the
scientific evidence that shows it will work in your case.
4
Don’t fall for free samples. Drug companies give them to
doctors primarily as marketing tools, but these freebies might not
be the best treatment for you.
5
Keep track of your medicines. According to a recent survey
conducted by Consumer Reports Best Buy Drugs, about half of the
United States adult population currently takes an average of four
medications, and 16 percent take seven or more. Because drugs can
interact in dangerous ways, schedule a “medicine review” with your
doctor. And each time you fill a new prescription, ask your doc and
the pharmacist how it will interact with your current medicines.
60 2013 Consumer Reports Best Buy Drugs
6
Watch out for supplements, too. They can interact with drugs
as well, so keep a single list of all drugs and supplements you take
and ask your doctor about dangerous interactions.
7
Ask about splitting pills. (That’s not the same as skimping on
your dose.) Often, you may be able to save money if you fill a
prescription for pills that are twice the dose you need and then cut them
in half with a pill splitter. (See page 54.)
8
Don’t dismiss older drugs. In many cases, and for many conditions, older drugs available as low-cost generics are just as good as—
or even better than—newer, pricier drugs.
9
Shop carefully online. Brand-name drugs appear less expensive
from websites that claim to be based in Canada or Europe, but don’t
be fooled: The majority of those foreign websites are illegitimate.You
may expose yourself to the risk of counterfeit medications.
10
Stick to one pharmacy. To lower your risk of potentially
dangerous drug interactions, fill all of your prescriptions at one
store. Also, be sure to tell the pharmacist about all of the vitamins,
minerals, supplements, and over-the-counter drugs you regularly take,
since they might interact with certain prescription drugs.
11
Consider a generic ‘therapeutic substitution.’ If a generic
drug is not available for the brand-name drug you’ve been
prescribed, consider asking your doctor for another generic in the
same “class” of drugs, instead. Drugs within a class or group aren’t
always that different. Drug makers claim that each drug is unique,
but in some classes of medicines, there are several drugs that achieve
similar results for most people.
12
Report harmful side effects immediately. If you have an
adverse reaction that you think is related to a medication,
tell your doctor right away.You can also notify the FDA’s MedWatch
Adverse Event Reporting System (www.fda.gov/medwatch). If you
have a negative reaction to a vaccine, notify the FDA at www.fda.gov/
cber/vaers/vaers.htm. ■
2013 Consumer Reports Best Buy Drugs 61
talking with your doctor
talking with your doctor
Time to talk:
Two important conversations
to have with your doctor
Y
ou’re used to talking with your doctor about your health conditions
and your lifestyle, but at your next visit, plan to chat about two
other important topics: the types of medicines you’re already taking
and the cost of your prescription drugs. Ask your doctor:
TIP:
The names of prescription
drugs can be hard to pronounce and remember. Write
down the generic and brandnames of the drug or drugs
you’re taking, how much you
take of them, and how often,
before you see your doctor.
1. Is it OK to keep
taking all these
medications together?
Instead of relying on memory,
make a list of the drugs, vitamins,
supplements, any other herbal
treatments, and even over-thecounter medications that you’re
currently taking, and then review
this information with your doctor. Because prescription drugs,
supplements, and nonprescription medications can interact in
ways that reduce their benefit
to you or cause harm to you, it’s important for your physician to know
everything you’re taking. If you see several doctors, each might not be
aware of medicines the others have prescribed.
Since people respond differently to medications, it’s common for doctors to prescribe several medicines before finding one that works well.
If your doctor changes your prescription, review your list of medications
with your doctor to ensure that the new prescription is safe for you.
62 2013 Consumer Reports Best Buy Drugs
Tip:
2. Is there a generic
drug available?
Pay attention. When your
doctor prescribes a new
medication, review the order
with him or her. Write down
the dosage and frequency.
When you fill the prescription, double-check to see that
the dosage and frequency
match what your doctor told
you. If it doesn’t, ask your
pharmacist why not.
If you’re reluctant to discuss
the cost of medicines with
your doctor, you’re hardly
alone. But if you don’t bring it
up, your doctor might not either. Studies show that doctors
do not routinely take price
into account when prescribing
medicines. So it’s up to you to
let your doctor know if cost is
a factor for you.
Start the conversation by asking if a generic drug is available to treat
your condition. A prescription drug “goes generic” when a company’s
patent on it lapses, usually after 12 to 15 years. At that point, other companies can make and sell the drug, making the drug less expensive than
newer, brand-name medicines.
Many people—including physicians—assume that newer drugs
are better, but that’s not necessarily true. More than 75 percent of all
medications in the U.S. are available as a generic, and studies consistently find that many older medications are as good as—or even better
than—newer ones. Older drugs have a long safety record too, while
unexpected problems with newer drugs can and do crop up once they
hit the market.
Of course, some newer prescription drugs are indeed safer and more
effective than their older counterparts. Talking with your doctor about
your options will help him or her prescribe a medicine that’s best for
your condition and your wallet. ■
2013 Consumer Reports Best Buy Drugs 63
about this guide
About this guide
Consumer Reports Best Buy Drugs is a public education project
administered by Consumer Reports. These materials are made
possible by a grant from the states Attorney General Consumer
and Prescriber Education Grant Program, which is funded by
the multistate settlement of consumer fraud claims regarding
the marketing of the prescription drug Neurontin.
The Engelberg Foundation provided a major grant to fund the
creation of the project from 2004 to 2007. Additional initial
funding came from the National Library of Medicine, part of
the National Institutes of Health. A more detailed explanation
of the project is available at www.CRBestBuyDrugs.org.
We followed a rigorous editorial process to ensure that the information contained herein and on the Consumer Reports Best
Buy Drugs Web site is accurate and describes generally accepted
clinical practices. If we find, or are alerted to, an error, we will
correct it as quickly as possible. But Consumer Reports and its
authors, editors, publishers, licensers, and any suppliers cannot
be responsible for medical errors or omissions, or any consequences from the use of the information here or on the site.
Please refer to our user agreement at www.CRBestBuyDrugs.
org for further information.
Consumer Reports Best Buy Drugs should not be viewed as a
substitute for a consultation with a medical or health professional. The information contained herein and the information
on www.CRBestBuyDrugs.org is provided to enhance your communication with your doctor rather than to replace it.
Get on top of all your medicines.
Consumer Reports Best Buy Drugs
has answers - FREE.
Learn about your drug choices!
Not all medicines are created equal. Some work better than others.
And some are safer than others. Find our advice and the answers you
need at CRBestBuyDrugs.org. And start feeling better about making
informed prescription drug choices.
You can save hundreds, even thousands, of dollars by choosing
effective but less expensive medicines. Talk to your doctor and
pharmacist about all your options.
CRBestBuyDrugs.org
64 2013 Consumer Reports Best Buy Drugs
FROM
Our drug reports combine an expert review
of the scientific evidence with pricing information, making them
excellent tools for starting a conversation with your doctor.
Visit www.CRBestBuyDrugs.org to find reports on
the following conditions (also available in Spanish):
• Allergies, Hay Fever,
and Hives
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• Depression
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and Stroke
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• Heart Failure
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Hyperactivity Disorder
• Heartburn, Acid Reflux Disease
• Bipolar Disorder, Nerve Pain,
and Fibromyalgia
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and Bipolar Disorder
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