mytopeka Posted May 2, 2013 Author Share Posted May 2, 2013 I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course. Link to comment Share on other sites More sharing options...
mytopeka Posted May 2, 2013 Author Share Posted May 2, 2013 I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course. Link to comment Share on other sites More sharing options...
mytopeka Posted May 2, 2013 Share Posted May 2, 2013 I got a call from The Wal Mart pharmacy last week asking me to switch an rx from doxy to something else due to the price. I thought it was going to be the usual "just switch it from monohydrate to hyclate" but the pharmacist told me that doxy hyclate has been taken off of the $4 formulary. I looked at both WM and Target's $4 list and sure enough, doxy is nowhere to be found. Usually I wouldn't post for such a specific change like this, but I know that I give doxy for a lot of my uninsured folks with pneumonia/lung crud and certainly for MRSA. Now with no insurance a patient would be looking at $40-$60 for a course. Link to comment Share on other sites More sharing options...
Hemegroup Posted May 2, 2013 Share Posted May 2, 2013 Sad to hear but I'll still use it as one of my bigger guns in skin infections (I don't typically Rx it for respiratory, I'll go with cipro or cephalexin first, for the amox/augmentin resistant). Sucks, I see a bit of Bactrim resistance around where I am, for the skin infections. Ah well. Link to comment Share on other sites More sharing options...
Hemegroup Posted May 2, 2013 Share Posted May 2, 2013 Sad to hear but I'll still use it as one of my bigger guns in skin infections (I don't typically Rx it for respiratory, I'll go with cipro or cephalexin first, for the amox/augmentin resistant). Sucks, I see a bit of Bactrim resistance around where I am, for the skin infections. Ah well. Link to comment Share on other sites More sharing options...
Hemegroup Posted May 2, 2013 Share Posted May 2, 2013 Sad to hear but I'll still use it as one of my bigger guns in skin infections (I don't typically Rx it for respiratory, I'll go with cipro or cephalexin first, for the amox/augmentin resistant). Sucks, I see a bit of Bactrim resistance around where I am, for the skin infections. Ah well. Link to comment Share on other sites More sharing options...
kbarro1 Posted May 29, 2013 Share Posted May 29, 2013 I had same thing happen. And of told me it was $200 for 20 pills. Calls pharmacy and pharmacist said it is due to shortage so supplier jacked up price. Sad.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 29, 2013 Moderator Share Posted May 29, 2013 Yup, totally bummed. Doxy is among my favorite abx Link to comment Share on other sites More sharing options...
MariaB Posted May 29, 2013 Share Posted May 29, 2013 I moonlight at an urgent care and had the same experience this weekend. It's sad because it's a great medication for the uninsured. Link to comment Share on other sites More sharing options...
d2305 Posted May 29, 2013 Share Posted May 29, 2013 I tried to write for TCN, and no one has it. Link to comment Share on other sites More sharing options...
benm93 Posted May 31, 2013 Share Posted May 31, 2013 tetracycline manufacturing has halted due to a lack of raw materials, and this may cause it to never be back on the shelves :( we cant get it from our suppliers anymore, it is gone, and probably for good from what I have heard. As many have said doxy is getting very expensive, and some dosages and salt forms are starting to be harder to get, and all of their prices are jacked up. For now they are saying Doxy WILL be bouncing back at some point, but we aren't sure when, it could be a while. We're working hard to keep as many doxy options available as we can, but I am having trouble getting Doxy Rx's under 40 bucks even with my best discount cards. Link to comment Share on other sites More sharing options...
benm93 Posted May 31, 2013 Share Posted May 31, 2013 adoxa, monodox and Doryx,... they are available, and if the pt has insurance, we may get them to dispense it at a reduced copay due to the shortage/cost issue. Doryx also has a discount card, though annoying, it takes it to 25 bucks, and i can get it to work even for an uninsured pt.... not sure of how much use outside of derm it has seen though Link to comment Share on other sites More sharing options...
Guest Paula Posted May 31, 2013 Share Posted May 31, 2013 Makes me a bit nervous with tick season starting here in WI and MI. There are alternatives but doxy is still treatment of choice. Link to comment Share on other sites More sharing options...
rcdavis Posted May 31, 2013 Share Posted May 31, 2013 Makes me a bit nervous with tick season starting here in WI and MI. There are alternatives but doxy is still treatment of choice. Paula.. Chloramphenicol is a GREAT antibiotic, which has suffered much malignment for it's very rare, but fatal, side effects. Except that drug, what other alternatives do you have for rickettsial dz? Tetracycline? Not as efficacious. Fluorquinolones? Exceptin q-fever, pretty much do not work.. Sulfonamides? Inhibit expression of sx, but not rickettsialcidal... Macrolides? .. Used in Europe, but not as efficacious... You make a great point though.. Here come the ticks.. We ought to be thinking about cheap treatment regimens... And, I wonder, why Walmart dropped them off the list??? Link to comment Share on other sites More sharing options...
cbrsmurf Posted May 31, 2013 Share Posted May 31, 2013 Paula..Chloramphenicol is a GREAT antibiotic, which has suffered much malignment for it's very rare, but fatal, side effects. Except that drug, what other alternatives do you have for rickettsial dz? Tetracycline? Not as efficacious. Fluorquinolones? Exceptin q-fever, pretty much do not work.. Sulfonamides? Inhibit expression of sx, but not rickettsialcidal... Macrolides? .. Used in Europe, but not as efficacious... You make a great point though.. Here come the ticks.. We ought to be thinking about cheap treatment regimens... And, I wonder, why Walmart dropped them off the list??? never used chloramphenicol, but was taught about the possibility of aplastic anemia are there any studies/numbers needed to harm that show the prevalence of side effects for this drug? Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 31, 2013 Moderator Share Posted May 31, 2013 Paula..Chloramphenicol is a GREAT antibiotic, which has suffered much malignment for it's very rare, but fatal, side effects. Except that drug, what other alternatives do you have for rickettsial dz? Tetracycline? Not as efficacious. Fluorquinolones? Exceptin q-fever, pretty much do not work.. Sulfonamides? Inhibit expression of sx, but not rickettsialcidal... Macrolides? .. Used in Europe, but not as efficacious... You make a great point though.. Here come the ticks.. We ought to be thinking about cheap treatment regimens... And, I wonder, why Walmart dropped them off the list??? Doxy is not getting manufacutred as I think I heard the plant that made most of it burned down Thoughts on the above comments CIPRO really is not a resp FQ - it misses strep which is one of the big three resp pathogens.... try Avelox or levaquin Bactrim should really be your go to agent for MRSA soft tissue infections and can actually us DS 2 Tabs BID not just one tab Amox is also a GREAT choice for tic born illness and the last time I looked I think it actually was the choosen second line abx Problem I have is the AECB who I always use Doxy with...... stuck now going with macrolides or FQ, neither one of which I want to use but only other real choice is Augmentin which just tears up stomachs.... CAution with cardiac issues with both the Macrolides and FQ though.... Why did Walmart pull from $4? They are not in the business of selling things at a loss - the wholesale price went up a HUGE amount, hence dropped from $4 listing.... And last but not least by any measure - stop using ABX for simple colds, stop using ABX for simple furuncles which the treatment is I&D, stop using ABX because the patient thinks they might have been bitten by a tic...... wait for s/s of lyme disease..... or other tic borne illnesses... Link to comment Share on other sites More sharing options...
rcdavis Posted May 31, 2013 Share Posted May 31, 2013 Doxy is not getting manufacutred as I think I heard the plant that made most of it burned down Thoughts on the above comments CIPRO really is not a resp FQ - it misses strep which is one of the big three resp pathogens.... try Avelox or levaquin Bactrim should really be your go to agent for MRSA soft tissue infections and can actually us DS 2 Tabs BID not just one tab Amox is also a GREAT choice for tic born illness and the last time I looked I think it actually was the choosen second line abx Problem I have is the AECB who I always use Doxy with...... stuck now going with macrolides or FQ, neither one of which I want to use but only other real choice is Augmentin which just tears up stomachs.... CAution with cardiac issues with both the Macrolides and FQ though.... Why did Walmart pull from $4? They are not in the business of selling things at a loss - the wholesale price went up a HUGE amount, hence dropped from $4 listing.... And last but not least by any measure - stop using ABX for simple colds, stop using ABX for simple furuncles which the treatment is I&D, stop using ABX because the patient thinks they might have been bitten by a tic...... wait for s/s of lyme disease..... or other tic borne illnesses... Jeff, do you have any recognized reference stating amoxicillin is appropriate tx for any rickettsial illness? I must be missing a huge block of ID literature.. This is, sadly, news to me. I agree with your comments about AECB and respiratory abx.. But we are talking about rickettsia... I vaguely remember the aplastic anemia as 1:30,000... But I will research and get back to you.. Incidence was low, but disastrous.... Link to comment Share on other sites More sharing options...
rcdavis Posted May 31, 2013 Share Posted May 31, 2013 never used chloramphenicol, but was taught about the possibility of aplastic anemia are there any studies/numbers needed to harm that show the prevalence of side effects for this drug? JAMA. 1969 Jun 16;208(11):2045-50. Statewide study of chloramphenicol therapy and fatal aplastic anemia. Wallerstein RO, Condit PK, Kasper CK, Brown JW, Morrison FR. PMID: 5818983 [PubMed - indexed for MEDLINE] MeSH Terms, Substances LinkOut - more Incidence of aplastic anemia 1:35,000-1:50,000 or oral dosing.... Link to comment Share on other sites More sharing options...
Guest Paula Posted May 31, 2013 Share Posted May 31, 2013 Jeff, do you have any recognized reference stating amoxicillin is appropriate tx for any rickettsial illness? I must be missing a huge block of ID literature.. This is, sadly, news to me. I agree with your comments about AECB and respiratory abx.. But we are talking about rickettsia... I vaguely remember the aplastic anemia as 1:30,000... But I will research and get back to you.. Incidence was low, but disastrous.... Infectious Disease Society of America guidelines on Lyme Disease from 2006 recommend Doxycycline 100mg BID 10-21 days, or Amoxicillin 500mg TID or Cefuroxime axetil 500mg BID for 14-21 days for early Lyme disease with erythema migrans. You can find the info either on CDC under Lyme disease and it will link you to the article, or google it under IDSA. I tried to post the link but was unsuccessful. Paula Link to comment Share on other sites More sharing options...
Guest Paula Posted May 31, 2013 Share Posted May 31, 2013 P.S. I agree with Ventana: don't treat viruses with Abx's, wait for signs and sx of tic borne disease, do the appropriate workup, I&D the abscesses, and use the right Abx for the right conditions. If only we could get our physician partners to comply! LOL! Link to comment Share on other sites More sharing options...
rcdavis Posted June 1, 2013 Share Posted June 1, 2013 Paula, Thanks for the link.. Yes amox is ok for LYME ... But, again, the real bugger, at least in my world, is RMSF... and, again, I would maintain that Amox is Not Okay as a tx for that.. Link to comment Share on other sites More sharing options...
CornellSPA Posted June 1, 2013 Share Posted June 1, 2013 Minocin is also a great alternative, especially if they have arthritis! Doxy is essential if the patient has ehrlichia or anaplasma! Less generic drugs and rising prices on generics, celebrate health reform! Link to comment Share on other sites More sharing options...
Guest Paula Posted June 1, 2013 Share Posted June 1, 2013 Paula, Thanks for the link.. Yes amox is ok for LYME ... But, again, the real bugger, at least in my world, is RMSF... and, again, I would maintain that Amox is Not Okay as a tx for that.. Agree with you, rcdavis. I haven't looked the RMSF or Erlichiosis/Anaplasmosis guidelines up to see how they differ from Lyme treatment. I know doxy is first-line treatment for them, but I honestly don't know the alternatives! Gotta go get educated on that! Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 3, 2013 Moderator Share Posted June 3, 2013 Erlichiosis and Ana are a concern,,,, what is the Amox coverage for them Anyone read the little blurb about a totally new tick borne illness, I think New England area that is so new they don't even have a name for it? I remember reading about it in a lay journal and they thought doxy would work, but alas we are in a pickle.... Link to comment Share on other sites More sharing options...
rcdavis Posted June 3, 2013 Share Posted June 3, 2013 Erlichiosis and Ana are a concern,,,, what is the Amox coverage for them Anyone read the little blurb about a totally new tick borne illness, I think New England area that is so new they don't even have a name for it? I remember reading about it in a lay journal and they thought doxy would work, but alas we are in a pickle.... http://www.nejm.org/doi/full/10.1056/NEJMoa1209039 Borellia miyamoti.. A spirochete discovered in 1965 in Japan, reported in 2011 by Russians to cause Lyme like sx ( but not the target lesion), thought to be the possible cause of " chronic Lyme syndrome" ( disputed by CDC). As I understand it tx'd with doxy... Not sure about amox. Link to comment Share on other sites More sharing options...
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