copax every other day

[DizzyDean]

For those who change over from daily copaxone to every other day -

How do you handle it when the specialty pharmacy calls to arrange delivery? Are there any repercussions with just telling them you take it every other day and only need a box every other month?

[Redwings]

When you talk to the pharmacy, they should be able to tell you what their procedure is for changing the delivery schedule. It might be just as easy as asking them to change to every-other-month delivery.

But if your delivery is on an automatic refill schedule tied to the terms of your original prescription -- daily dosing, which necessitates a new box every month -- you might not be able to change it yourself. Your doctor might have to issue a new prescription with new dosing/refill (and thus delivery) instructions.

[DizzyDean]

Thanks for the reply. The kinds of scenarios I was thinking of are:

* most insurance companies only permit ordering a 30 day supply of meds. The pharmacy now has to send the patient 15 syringes each month, sending a box of 30 every two months isn't reimbursable. So the patient winds up with the same co-insurance payment that they did on once a month.

* Shared Solutions will eventually hear about it, from the doctor, pharmacy, or insurance. Do they then admonish the patient (or the doctor) for using copaxone outside of an FDA approved dosage, and require a special liability waiver, etc.?

[justacowgirl]

What is your reason for wanting to dose every other day?

justacowgirl

[DizzyDean]

What is your reason for wanting to dose every other day?

justacowgirl

It was a decision jointly made by my neurologist and I - balancing the good and bad.

The good - I've achieved clinical stability - have been on copaxone daily for 3 years, with no relapses or progression during that time. At present, I don't have any symptoms of the disease. I lead a very full life - I work full time, have several hobbies that I share with my family, and exercise vigorously (running, weight lifting, martial arts, hiking).

The bad - the side effects to my skin have gotten pretty bad and I'm losing injection sites due to the formation of hard lumps and permanent bruising. I have had issues with cellulitis requiring several rounds of antibiotics. I have been experiencing 2-3 IPIRs a year, a typical episode for me involves 20 minutes of flushing and palpitations followed by 2-3 hours of hot flashes, muscle aches, chills, rigors, nausea, vomiting, etc. For those who've been through this deluxe variety of IPIR, you know what I'm talking about - its not a fun house ride.

With that as background its become awfully tempting for me to switch to another med or even just go without. My neuro suggested that taking copaxone every other day is an option to consider. It has been tried in a couple of small studies. And he says several of his other patients are doing fine on every other day dosing. There are risks to doing it this way, particularly lessened efficacy, that I have to be willing to accept.

Obviously, every other day is not the dose that was FDA approved. And its not a widespread practice among the patient community, so it brings up questions about the insurance and pharmacy implications.

[Redwings]

Hi DizzyDean:

By virtue of their medical licenses, doctors have broad leeway in how they prescribe for and treat patients. The pharmacy and drug manufacturer have no legal or regulatory standing to interfere in the doctor-patient relationship, nor do they have any say in how a doctor legally uses a medication.

The FDA does have regulatory authority, but allows variations in how pharmaceuticals are used. That's how medications can be used off-label. Off-label use means not only using a drug to treat a condition for which it was not specifically approved, but also using a different dosage than was approved. So changing the dosing to every other day can be considered a valid, off-label use of Copaxone. Not even an issue.

Now that you bring it up, the 30-day supply drug benefit thing is a bit of an issue because you have to decide whether you want to continue to receive a 30-day supply and use only half of it (and decide what to do with the other half) or cut the delivery to 15 doses per month and not have to deal with an extra 15 kits. If the monthly co-pay is the same, then money isn't a factor in the decision and you're getting the meds you need either way.

You are not obligated to inform the pharmacy or Shared Solutions that you're changing to every-other-day dosing -- that's between you and your doctor. The pharmacy is required only to fill the prescription as written. Otherwise, it's none of their business.

Your insurance company might want or require that your doctor write a new Rx to reflect the new dosing so they don't send (and spend) more than what's needed, but that's not your problem. Indirectly, it might cause you some grief later, so it might be a good idea to have a couple of extra weeks' supply of Copaxone on hand.

If your doctor automatically issues a new Rx for 15 doses a month instead of 30, the issue solves itself. But if not, it looks like it could be up to you to decide how you want to handle the extra 15 kits per month. It will be interesting to hear if anyone else has been in the same situation and what they did.

[Chais Papa]

Here is one of the studies that I used to help me make the decision to every other day, that and my latest MRI report that stated "no active disease".

{URL}http://www.thisisms.com/downloads/Cop_Every_Other_Day.pdf{URL}

[DizzyDean]

Here is one of the studies that I used to help me make the decision to every other day, that and my latest MRI report that stated "no active disease".

{URL}http://www.thisisms.com/downloads/Cop_Every_Other_Day.pdf{URL}

Here's another, which studied twice per week.

http://www.peerviewpress.com/efficac...-presented-aan

[Grace]

They don't ask and I don't offer the information... They are usually hacking me off about one of their stupid rules or changes to their rules enought that we don't even get into why I am only ordering every other month. I am not a fan of Medco/Accredo...

[davmets1]

I do every other day. They (medco) had no problem with my neuro changing the script to every other day. I used to get an every day 3 month supply through my insurance, but am only able to get a 2 month supply now because they refuse to break open a 30 day supply box. No big deal, I pay a $20 copay every 2 months instead of every 3.

[DizzyDean]

I do every other day. They (medco) had no problem with my neuro changing the script to every other day. I used to get an every day 3 month supply through my insurance, but am only able to get a 2 month supply now because they refuse to break open a 30 day supply box. No big deal, I pay a $20 copay every 2 months instead of every 3.

OK - the pharmacy isn't willing to break apart a 30 day box to fulfill an every other day prescription. That means my insurance is likely to agree to pay for a full box every other month even though technically their mail order service only pays for 30 days at a time, and this is a now 60 day supply (or golly - it could be a 15 week supply if patient dosed twice a week like they did in one study).

I don't think Teva would ever have reason to package copaxone in smaller quantities unless they first went and got FDA to approve the reduced administration. All the industry momentum is for oral drugs, I'm sure this is a high priority - NOT!

Extremely helpful data point, thanks!

[Redwings]

... we don't even get into why I am only ordering every other month.

Grace brings up a good point -- how are your refills ordered? Do you call the pharmacy yourself to request a refill and the pharmacy ships only when requested? Or are you on autoship, where the pharmacy just sends you a 30-day supply every month that the prescription is valid?

If you can request a refill only when you need it, can you just order a full box every other month? Does your insurance allow you to pay your co-pay only when you order? In that case, it could be as easy as ordering a new box every other month and paying your copay for the 30-day supply in the month you place the order, with no copay in the month you don't.

I've never had a prescription that wasn't on a refill- and pay-as-needed basis. I can only imagine what it must be like trying to coordinate a 30-day-supply copay with an autoship program that doesn't run on a 30-day schedule. Geez!

[DizzyDean]

Grace brings up a good point -- how are your refills ordered? Do you call the pharmacy yourself to request a refill and the pharmacy ships only when requested? Or are you on autoship, where the pharmacy just sends you a 30-day supply every month that the prescription is valid?

Its autoship now - they call before sending it to confirm. I owe them a callback right now...

I've never had a prescription that wasn't on a refill- and pay-as-needed basis. I can only imagine what it must be like trying to coordinate a 30-day-supply copay with an autoship program that doesn't run on a 30-day schedule. Geez!

I'm going to try and switch my relationship with the pharmacy over to "patient led" ordering. They will probably/hopefully bill me the same copay I was paying with daily usage, but only half as often.

[BrendaG]

I do mine every other day, have been for the past 2 years. I had to because my insurance maxed out by July if I did the shot every day.
If I could afford it, I would do it daily, but so far I seem to be doing fine on the every other day.
The pharmacy never asks why I refill every other month.