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Preparing
for the Influenza Season
The
following is provided by RxAmerica.
This year's flu season perhaps will be the most challenging we have
seen in many years. One of the reasons for this is the introduction
of two new prescription drugs, Relenza and Tamiflu, which will compete
through extensive promotions and direct-to-consumer marketing campaigns.
Here
are some questions and answers about this year's flu season:
How widespread is the flu? Influenza affects between 25 million
to 50 million Americans per year. Published information also states
that influenza is responsible for more than 20,000 deaths and about
300,000 hospitalizations annually. The flu changes each year and
randomly hits some areas harder than others. You may also remember
that last year a very bad, new strain of flu hit Hong Kong, believed
to be carried by poultry. Government officials ordered the slaughter
of all chickens, resulting in a huge financial impact, beyond that
of the flu itself.
How do doctors and patients know when they are trating the flu?
There are key features of influenza that can be used to help determine
that a person has the flu and not a cold. Tehs include: sudden onset;
dry hacking cough; fever, chills, headache, fatigue and weakness.
Are there ways to prevent the flu? The most effective wat to prevent
the flu remains vaccination. Each year, the vaccine is updated to
be effective against specific strains of influenza A and influenza
Bthat are predicted to arrive. Flu shots are especially important
in the elderly, as well as anyone with health conditions such as
asthma or diabetes. A recent study also points out hat even healthy,
young people without risks can benefit- people who got a flu shot
lost 43% fewer days of work. The optimal time to get a flu shot
is mid-October to mid-November. And remember, the old wives tale
that flu shots can give you the flu is absolutely false.
What "old" drugs are used to treat the flu? A variety
of over the counter medications are used to treat the symptoms of
the flu include amantadine (Symmetrel) and rimantadine (Flumadine).
However, both of these treat influenza "A" only, not "A"
and "B". Symmetrel and Flumadine do have side effects
and reported cases of drug-resistance. Both are also FDA-approved
to help prevent the flu.
What are the "new" drugs and how are they different? Relenza
received FDA-approval recently. Tamiflu is expected to receive final
FDA approval the first week of November. Both of the new drugs,
and others in development, are in a new class of drugs called neuraminidase
inhibitors. They act ot disable an enzyme on the surface of the
influenza virus, both types A and B. Without the enzyme, the virus
can't spread.
Relenza
is administered by oral inhalation, via a special inhaler that delivers
the powdered drug into the lungs. The dose is 2 inhalations twice
a day for 5 days. Therapy must be started within 2 days of the onset
of symptoms.
Tamiflu
is an oral drug that, pending final FDA approval, should be available
in early November. It is also dosed twice a day and must be started
within 2 days of the onset of symptoms.
How effective are these new drugs? Neither drug is a miracle cure.
Neither will stop a case of the flu. If administered within 2 days
of the onset of symptoms, the drugs appear to be effective in preventing
the flu virus from reproducing, resulting in a decrease in the seriousness
of the flu, development of compications, and duration of symptoms.
Sound good? Yes, but studies do vary as to exactly how many days
faster the patient will get better. Studies report that the duration
of the flu may be decreased by 17 hours to one and one-half days.
Typically, it will shave a day off of the typical flu run. Should
the drug be started more than 2 days from onset of symptoms, it
will have no effect at all on the severity or symptoms of the flu.
Do
these new drugs prevent the flu or just help treat the symptoms?
Although not FDA-approved for prevention, both manufacturers continue
to conduct studies and publish results showing that the drugs may
prevent the flu from spreading. This may be helpful in retirement
homes, convalescent hospitals and college dormitories. But remeber,
vaccination is still the best way to prevent the flu, and at a fraction
of the cost.
If these drugs are used, will the use of other drugs go down? In
theary, many patients who receive unnecessary antibiotics for treating
the flu virus will stop receiving atibiotic prescriptions. Patients
may still seek additional medications to treat fever, cough and
other symptoms. This decreased cost of antibiotics may be offset
by the cost of the new flu medications.
What
do these new drugs cost? The average wholesale price (AWP) for Relenza
is $44.40 for one patient-course of treatment. This may be contrasted
to $4.62 for amantadine and $26.32 for Flumadine. The price of Tamiflu
has not been set, but is expected to be slightly higher thatn that
of Relenza. Should the drug be used to prevent the spread of influenza
in household contacts, the "family" cost could easily
be $130 to over $200 per flu season per family.
Should
these drugs be included in the pharmacy benefit for all of my members
or employees? At the present time, we feel there is insufficient
information to make a recommedndation to include either of these
medications as a covered benefit. Concerns include the potential
for misuse (use of the inhaler for Relenza requires training), over-prescribing
(can patients really self-diagnose early enough to see a physician
and get a prescription within 2 days from the firs onset of symptoms?),
stockpiling of drugs ("just in case" I get the flus, I
want to have this in my house") and the effectiveness of the
drug (a decrease in symptoms of only one day).
Neither
drug will be added to the RxAmerica Drug Formulary for the current
influenza season. Relenza, then Tamiflu will be a covered benefit
for RxAmerica clients with "open" formularie, unless we
are directed to exclude it from coverage. For clients utilizing
a three-tiered formulary, Relenza will be available at the highest
co-payment amount, unless we are directed to exclude it from coverage.
Clients utilizing our closed formularies will determine their coverage
level in the standard, manner in conjuction with our Clinical Pharmacists.
We hope this information will assist you in evaluating these new
products. Should you have any questions please contact ARA at 1-800-806-6160.
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