Generic Levaquin...

[WVUPharm2007]

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...in the house.

Dr Reddy's. AWP brand, $1089...Doc R...$1004.

Them Indians are about to make some bank, now.

 

[xiphoid2010]

...in the house.

Dr Reddy's. AWP brand, $1089...Doc R...$1004.

Them Indians are about to make some bank, now.

Meh, it's not even on our formulary. You got the cipro for G-, got moxi if you needed some beta-hemolytic strep or anaerobic coverage. About the only time I consider levaquin is prophylaxis in cancer patients with lots of mucositis.

 

[MindOverMatter]

I thought it wasn't coming out until November.

 

[Its Z]

Meh, it's not even on our formulary. You got the cipro for G-, got moxi if you needed some beta-hemolytic strep or anaerobic coverage. About the only time I consider levaquin is prophylaxis in cancer patients with lots of mucositis.

Then it's time for the formulary consideration.
And you really think moxi when anaerobic coverage is needed?

 

[Tinkerbell22]

Meh, it's not even on our formulary. You got the cipro for G-, got moxi if you needed some beta-hemolytic strep or anaerobic coverage. About the only time I consider levaquin is prophylaxis in cancer patients with lots of mucositis.

I used to see Levaquin prescribed a lot where I used to work. Island has a huge S. aureus problem... lots of tourism, hot weather, water sports... I saw it written for nasty skin infections, boils, etc... I guess the physicians thought it was needed... some prescribe bactrim/septra, but quite a few people are allergic to sulfa apparently.

 

[Its Z]

I used to see Levaquin prescribed a lot where I used to work. Island has a huge S. aureus problem... lots of tourism, hot weather, water sports... I saw it written for nasty skin infections, boils, etc... I guess the physicians thought it was needed... some prescribe bactrim/septra, but quite a few people are allergic to sulfa apparently.

Let me give y'all a quinolone war history.

Oflox was slightly before my time.. and wasn't worth a damn.

Cipro in the early 90's was the big gun. Restricted antibiotic that covered everything but nosocomial MRSA. Bayer marketed the crap out of it. Even had a video of some famous person saying if there was 1 drug she would have out on a desert island, it would be cipro and how it's a life saving antibiotic. Expensive drug. Unfortunately anyone and everyone out in the community started it to use it like water for UTI.

Then came Levaquin in the mid 90's and the war broke out. Levaquin underpriced Cipro and every hospital had an auto sub of Cipro to Levaquin.. Ortho McNeil threw money at anyone who was a Levaquin proponent. They offered to fly me out to Veil for a week long "training and education" session to be a speaker for Levaquin.

Then Pfizer released Trovan. Quinolone that kills everything (except MRSA) including patients. Of course the "hepatic toxicity" was underplayed and Bayer and Ortho were truly concerned. Pfizer sent out good looking reps fully armed with Gold Trovan Pens (I still have one) while selling Zpak. This was truly an awesome Quinolone marketing war at best.. so much money was thrown at us... then of course Trovan got pulled from the market.

Then Strep Pneumo became resistant to Cipro and Levaquin became the major work horse quinolone.. soon after, Cipro went generic but by then Schering had picked up Cipro and brought forth Avelox (Moxi) and packaged dealed it.. Avelox/Cipro combo had better pricing than Levaquin...and better spectrum. That's where Xiphoid's facility is still caught on..and haven't proactively pursued Levaquin going generic.

That brings us to Today. I bet your ID professor doesn't give y'all this sort of history lesson.

 

[type b pharmD]

Let me give y'all a quinolone war history.

Oflox was slightly before my time.. and wasn't worth a damn.

Cipro in the early 90's was the big gun. Restricted antibiotic that covered everything but MRSA. Bayer marketed the crap out of it. Even had a video of some famous person saying if there was 1 drug she would have out on a desert island, it would be cipro and how it's a life saving antibiotic. Expensive drug. Unfortunately anyone and everyone out in the community started it to use it like water for UTI.

Then came Levaquin in the mid 90's and the war broke out. Levaquin underpriced Cipro and every hospital had an auto sub of Cipro to Levaquin.. Ortho McNeil threw money at anyone who was a Levaquin proponent. They offered to fly me out to Veil for a week long "training and education" session to be a speaker for Levaquin.

Then Pfizer released Trovan. Quinolone that kills everything (except MRSA) including patients. Of course the "hepatic toxicity" was underplayed and Bayer and Ortho were truly concerned. Pfizer sent out good looking reps fully armed with Gold Trovan Pens (I still have one) while selling Zpak. This was truly an awesome Quinolone marketing war at best.. so much money was thrown at us... then of course Trovan got pulled from the market.

Then Strep Pneumo became resistant to Cipro and Levaquin became the major work horse quinolone.. soon after, Cipro went generic but by then Schering had picked up Cipro and brought forth Avelox (Moxi) and packaged dealed it.. Avelox/Cipro combo had better pricing than Levaquin...and better spectrum. That's where Xiphoid's facility is still caught on..and haven't proactively pursued Levaquin going generic.

That brings us to Today. I bet your ID professor doesn't give y'all this sort of history lesson.

cool story 👍

 

[Tinkerbell22]

Let me give y'all a quinolone war history.

Oflox was slightly before my time.. and wasn't worth a damn.

Cipro in the early 90's was the big gun. Restricted antibiotic that covered everything but MRSA. Bayer marketed the crap out of it. Even had a video of some famous person saying if there was 1 drug she would have out on a desert island, it would be cipro and how it's a life saving antibiotic. Expensive drug. Unfortunately anyone and everyone out in the community started it to use it like water for UTI.

Then came Levaquin in the mid 90's and the war broke out. Levaquin underpriced Cipro and every hospital had an auto sub of Cipro to Levaquin.. Ortho McNeil threw money at anyone who was a Levaquin proponent. They offered to fly me out to Veil for a week long "training and education" session to be a speaker for Levaquin.

Then Pfizer released Trovan. Quinolone that kills everything (except MRSA) including patients. Of course the "hepatic toxicity" was underplayed and Bayer and Ortho were truly concerned. Pfizer sent out good looking reps fully armed with Gold Trovan Pens (I still have one) while selling Zpak. This was truly an awesome Quinolone marketing war at best.. so much money was thrown at us... then of course Trovan got pulled from the market.

Then Strep Pneumo became resistant to Cipro and Levaquin became the major work horse quinolone.. soon after, Cipro went generic but by then Schering had picked up Cipro and brought forth Avelox (Moxi) and packaged dealed it.. Avelox/Cipro combo had better pricing than Levaquin...and better spectrum. That's where Xiphoid's facility is still caught on..and haven't proactively pursued Levaquin going generic.

That brings us to Today. I bet your ID professor doesn't give y'all this sort of history lesson.

Probably not... lol but I won't find out until 3rd year when we take ID. Not sure if I'm excited because ID is not my top interest, but it's important.

Is it typical to mainly use Vanco for MRSA?

 

[Its Z]

Probably not... lol but I won't find out until 3rd year when we take ID. Not sure if I'm excited because ID is not my top interest, but it's important.

Is it typical to mainly use Vanco for MRSA?

There are at least 2 types of MRSA. Community acquired MRSA where you'll see quinolone/bactrim/clinida being used. Then hospital acquired MRSA where vanco is the DOC unless MIC > 1ug/ml.

CaMRSA and HaMRSA are different.

 

[Praziquantel86]

Let me give y'all a quinolone war history.

Oflox was slightly before my time.. and wasn't worth a damn.

Cipro in the early 90's was the big gun. Restricted antibiotic that covered everything but nosocomial MRSA. Bayer marketed the crap out of it. Even had a video of some famous person saying if there was 1 drug she would have out on a desert island, it would be cipro and how it's a life saving antibiotic. Expensive drug. Unfortunately anyone and everyone out in the community started it to use it like water for UTI.

Then came Levaquin in the mid 90's and the war broke out. Levaquin underpriced Cipro and every hospital had an auto sub of Cipro to Levaquin.. Ortho McNeil threw money at anyone who was a Levaquin proponent. They offered to fly me out to Veil for a week long "training and education" session to be a speaker for Levaquin.

Then Pfizer released Trovan. Quinolone that kills everything (except MRSA) including patients. Of course the "hepatic toxicity" was underplayed and Bayer and Ortho were truly concerned. Pfizer sent out good looking reps fully armed with Gold Trovan Pens (I still have one) while selling Zpak. This was truly an awesome Quinolone marketing war at best.. so much money was thrown at us... then of course Trovan got pulled from the market.

Then Strep Pneumo became resistant to Cipro and Levaquin became the major work horse quinolone.. soon after, Cipro went generic but by then Schering had picked up Cipro and brought forth Avelox (Moxi) and packaged dealed it.. Avelox/Cipro combo had better pricing than Levaquin...and better spectrum. That's where Xiphoid's facility is still caught on..and haven't proactively pursued Levaquin going generic.

That brings us to Today. I bet your ID professor doesn't give y'all this sort of history lesson.

We got a bit of that from the PK end...one of our professors was (and still is) a big name in antibiotic Phase II PK/PD stuff. I have "double to dose of the quinolone or it'll end up like Cipro!" running on repeat through my head.

Once the price of generic Levaquin goes down, I think it'll be a no-brainer to switch the formulary. One drug where you previously needed two.

 

[Its Z]

We got a bit of that from the PK end...one of our professors was (and still is) a big name in antibiotic Phase II PK/PD stuff. I have "double to dose of the quinolone or it'll end up like Cipro!" running on repeat through my head.

Once the price of generic Levaquin goes down, I think it'll be a no-brainer to switch the formulary. One drug where you previously needed two.

And you won't be doing much running with your tendon rupture on your achilles heel.

 

[Praziquantel86]

And you won't be doing much running with your tendon rupture on your achilles heel.

Side effects didn't exist to him. PK optimization is the only thing that matters.

 

[Its Z]

Side effects didn't exist to him. PK optimization is the only thing that matters.

Nice.

People like that are dangerous. He needs the race horse blinders taken off.

 

[Praziquantel86]

Nice.

People like that are dangerous. He needs the race horse blinders taken off.

He doesn't practice anymore (not sure if he ever did). Real smart guy, just not the most practical advice.

 

[Tinkerbell22]

There are at least 2 types of MRSA. Community acquired MRSA where you'll see quinolone/bactrim/clinida being used. Then hospital acquired MRSA where vanco is the DOC unless MIC > 1ug/ml.

CaMRSA and HaMRSA are different.

oops I meant to say mrsa w/ hospitalization... a friend of mine acquired it from our local hospital recently

 

[Its Z]

He doesn't practice anymore (not sure if he ever did). Real smart guy, just not the most practical advice.

See, to me that doens't spell "smart." It's expertise in one subject matter yet he can't piece it all together. He's incomplete. A subject matter should be taught with a degree of expertise with a twist of practicality. That's complete.

I once worked with a PK pharmacist like your prof. He lacked common sense and personal interaction skills. And he insisted on 1,148mg Vanco and/or 432.5ml of D70 in TPN etc... He was soon fired for some unrelated reasons.

 

[xiphoid2010]

Then it's time for the formulary consideration.
And you really think moxi when anaerobic coverage is needed?

I doubt they will add it to the formulary since cipro is basically free to us (VA). Moxi is the only FQ I know of that as anerobic coverage. Gati might have it too, but we don't carry it. Moxi's anaerobic activity is quite good, and levaquin has no significant activity there.

 

[Its Z]

I doubt they will add it to the formulary since cipro is basically free to us (VA). Moxi is the only FQ I know of that as anerobic coverage. Gati might have it too, but we don't carry it. Moxi's anaerobic activity is quite good, and levaquin has no significant activity there.

I wouldn't really say that. And it's site specific. Sure some studies have pitted moxi vs. Pip/tazo but B.fragilis resistance against moxi is around. Always think metronidazole when anaerobic coverage is needed.

For VA, the best thing to do with just add generic levaquin and use it in place of Moxi to save money since generic levo shouldn't affect the moxi marketshare pricing. And reserve moxi for non UTI mixed infections. What are you going to do when patient has UTI plus CAP... moxi plus ceftriaxone or Levaquin mono therapy?

 

[Its Z]

Oh... I just gave VA a mucho savings idea in $millions...

 

[PharmaTope]

There are at least 2 types of MRSA. Community acquired MRSA where you'll see quinolone/bactrim/clinida being used. Then hospital acquired MRSA where vanco is the DOC unless MIC > 1ug/ml.

CaMRSA and HaMRSA are different.

thats cute and all but nobody in right mind uses quinolone or clinda for CA-MRSA especially with inducible resistance

you also left out doxy

 

[Its Z]

thats cute and all but nobody in right mind uses quinolone or clinda for CA-MRSA especially with inducible resistance

you also left out doxy

i didn't realize it was suppose to be a lecture on CA-MRSA path and pharmacotherapy. and you left out minocycline and every other CA-MRSA covering abx including oral linezolid.

 

[LazyMooch]

i didn't realize it was suppose to be a lecture on CA-MRSA path and pharmacotherapy. and you left out minocycline and every other CA-MRSA covering abx including oral linezolid.

Shnap! It's like watching Secondhand Lions

 

[PharmaTope]

i didn't realize it was suppose to be a lecture on CA-MRSA path and pharmacotherapy. and you left out minocycline and every other CA-MRSA covering abx including oral linezolid.

you left out gasoline and a match

 

[pfaction]

Wait, doesn't Levaquin cover anaerobes? I thought it did.

 

[xiphoid2010]

Wait, doesn't Levaquin cover anaerobes? I thought it did.

No, levaquin has very little anaerobic activity. I think of it's coverage as (cipro + streps - anaerobes).

While Z's argument of monotherapy for CAP + UTI is sound, that's more of a niche area. Just like we use it sometimes levaquin for chemo patients with major mucositis, but that's just not enough to warrant it being on formulary. Especially when a day's worth of moxi + ceftriaxone only cost $3 total. Gotta love VA pricing. 🙂

 

[Its Z]

No, levaquin has very little anaerobic activity. I think of it's coverage as (cipro + streps - anaerobes).

While Z's argument of monotherapy for CAP + UTI is sound, that's more of a niche area. Just like we use it sometimes levaquin for chemo patients with major mucositis, but that's just not enough to warrant it being on formulary. Especially when a day's worth of moxi + ceftriaxone only cost $3 total. Gotta love VA pricing. 🙂

Broad spectrum quinolone + cephalosporin. Hello C. Diff.

I doubt $3 is your Moxi IV pricing. Now, PO pricing I understand which is about what 340B should cost.

 

[xiphoid2010]

Broad spectrum quinolone + cephalosporin. Hello C. Diff.

I doubt $3 is your Moxi IV pricing. Now, PO pricing I understand which is about what 340B should cost.

You could just as easily go ceftriaxone + azithro for my UTI + CAP coverage. That's $2/day IV, and a first line CAP treatment anyway. No need for moxi or levaquin. Moxi is $1.50 /day PO, $7.50/day IV. (Besides, moxi bioavailability is ~100%) Ceftriaxone IV = $1.50 a day. You are arguing for a nich use of levaquin, there is just not enough savings to justify making it formulary.

 

[Its Z]

You could just as easily go ceftriaxone + azithro for my UTI + CAP coverage. That's $2/day IV, and a first line CAP treatment anyway. No need for moxi or levaquin. Moxi is $1.50 /day PO, $7.50/day IV. (Besides, moxi bioavailability is ~100%) Ceftriaxone IV = $1.50 a day. You are arguing for a nich use of levaquin, there is just not enough savings to justify making it formulary.

And Levaquin 750mg IV monotherapy is also a 1st line therapy. How is that a niche use? When the generic IV comes out and costs $3 per day and saves $4.50 per dose compared to Moxi, how is that not enough savings for the VA system?

Also, the goal of antimicrobial therapy is to use the most narrow spectrum of coverage (you should know this as a PGY1 grad) yet you want to throw around Moxi which has anaerobic coverage on top of your typical quinolone coverage. Sounds like you're the one arguing for a niche use.

 

[xiphoid2010]

And Levaquin 750mg IV monotherapy is also a 1st line therapy. How is that a niche use? When the generic IV comes out and costs $3 per day and saves $4.50 per dose compared to Moxi, how is that not enough savings for the VA system?

Also, the goal of antimicrobial therapy is to use the most narrow spectrum of coverage (you should know this as a PGY1 grad) yet you want to throw around Moxi which has anaerobic coverage on top of your typical quinolone coverage. Sounds like you're the one arguing for a niche use.

How is ceftriaxone + azithro any broader than levaquin? And its' still cheaper, not to mention I doubt levaquin IV will be $3 any time soon. Not to mention FQ use is associated with increased multi-drug resistance. You are the one who is arguing the use of levaquin in patient with BOTH CAP and UTI at the same time. How is that not a niche use? How many patients presents with these 2 totally unrelated infections at the same time? You say adding anaerobic coverage is too broad, I would say adding antipseudomonal activity is over kill. The last thing we need more of is resistant pseduomonas around here.

 

[Its Z]

How is ceftriaxone + azithro any broader than levaquin?

I was referring to use of Moxi over Levaquin being more broad. Is it not?

And its' still cheaper, not to mention I doubt levaquin IV will be $3 any time soon.

Just as fast as Cipro IV went down to $2 per dose. And so your azithromycin 500mg IV is $1.50? I doubt it.. more like $3.80 per dose 340B pricing + $1.50 for rocephin... that's more than $3 per day. Also, you have to add the price of IV bag.

Not to mention FQ use is associated with increased multi-drug resistance.

And use of cephalosporin is associated with increasing VRE.

You're also recommending You are the one who is arguing the use of levaquin in patient with BOTH CAP and UTI at the same time. How is that not a niche use? How many patients presents with these 2 totally unrelated infections at the same time?

Evidently you haven't been around long enough to know there's quite a few nursing home patients coming in with CAP & UTI together. That's not a niche market.

You say adding anaerobic coverage is too broad, I would say adding antipseudomonal activity is over kill. The last thing we need more of is resistant pseduomonas around here.

Yeah? Then why use Cipro at all which tends to have better pseudomonal coverage than Moxi and levo often? It's in your formulary. And yes, use of moxi when there's no anaerobic infection is too broad.

The 2 real reasons many facilities converted to Avelox/Cipro in 2005 was because of lower pricing of Cipro and matching pricing of Avelox. Another major factor was the Medication Assistance program where indigent use of these drugs were stock replaced by the manufacturer but in 2005, ortho mcneil discontinued the program. Of course VA would not have participated in the program but many if not most of the rest of the US hospitals participate in the program. You can give me all your reasons of what you know from VA and the therapeutics of why you guys are Avelox/cipro. But the true reason the conversion was done wasn't due to therapeutics. It was financial.

And today, it makes sense to go back to Levo.

 

[pfaction]

I learned that Cipro was no G+, great G-, pseudomonas, no anaerobes, great atypical. Levaquin = G+, slightly worse G-, not really pseudomonas, greater atypical, great anaerobes. Moxifloxacin = same, same, greater anaerobes, same atypicals...?

 

[Its Z]

I learned that Cipro was no G+, great G-, pseudomonas, no anaerobes, great atypical. Levaquin = G+, slightly worse G-, not really pseudomonas, greater atypical, great anaerobes. Moxifloxacin = same, same, greater anaerobes, same atypicals...?

You learned wrong. Demand a refund.

 

[xiphoid2010]

I was referring to use of Moxi over Levaquin being more broad. Is it not?

No, moxi has pointless anaerobic coverage, but levaquin has wasted pseudomonas coverage. Of the 2, I take the former, as we have less of that resistance.

Just as fast as Cipro IV went down to $2 per dose. And so your azithromycin 500mg IV is $1.50? I doubt it.. more like $3.80 per dose 340B pricing + $1.50 for rocephin... that's more than $3 per day. Also, you have to add the price of IV bag.

You underestimate the price VA gets. Cipro is practically free. Azithro is less than a dollar if I remember correctly. And why PO for highly bioavailable abx such as avelox is perfectly fine. We always try to do IV to PO conversion.

Evidently you haven't been around long enough to know there's quite a few nursing home patients coming in with CAP & UTI together. That's not a niche market.

And how does what goes on in nursing home matters to my VA medical center? We are not a nursing home. So yes, it's a niche drug.

Yeah? Then why use Cipro at all which tends to have better pseudomonal coverage than Moxi and levo often?

Who uses cipro for CAP? What are you talking about?

And today, it makes sense to go back to Levo.

Glad you think that's right for your institution. I don't think so for mine.

 

[Its Z]

No, moxi has pointless anaerobic coverage, but levaquin has wasted pseudomonas coverage.

Pointless anaerobic coverage? LOL, Why not just add flagyl to every regimen then? And why use Cipro for anything...it has psuedomonal coverage. Just like cephamycins have pointless anaerobic coverage...

You underestimate the price VA gets. Cipro is practically free. Azithro is less than a dollar if I remember correctly.

Cipro is practically free for everyone else too. Go back and check Azithro IV pricing again.

And why PO for highly bioavailable abx such as avelox is perfectly fine. We always try to do IV to PO conversion.

Levo is very bioavailable also.

And how does what goes on in nursing home matters to my VA medical center? We are not a nursing home. So yes, it's a niche drug.

Again, you display your ignorance. Where do you think nursing home patients end up when they have pneumonia? Hospital. You going to be at VA forever? I thought you were considering a manager job and install EMR.

Who uses cipro for CAP? What are you talking about?

Hopefully no one. Who said anything about cipro for CAP. Do you not have cipro on the formulary? What do you use it for? Pseudomonas alone...or for other mundane e coli UTI? This is on the same topic as you not wanting to use levo due to pseudomonal coverage. So I'm asking where do you use Cipro that's already on your formulary?

Glad you think that's right for your institution. I don't think so for mine.

Except you have no say so at VA on what drugs get on the formulary. I can impact my facilities. And if you don't think Levo which will have no impact on Avelox pricing yet more cost effective isn't right for VA, you're definitely wrong in your thinking.

 

[xiphoid2010]

Pointless anaerobic coverage? Why not just add flagyl to every regimen then? And why use Cipro for anything...it has psuedomonal coverage.

Your argument if flawed. Same could be said, "why not always use an antibiotic with psedumonal coverage"? We could always use more pseudomonal resistance, right? P.S At least anaerobic coverage is useful if the CAP is due to aspiration; same can't be said for your psedomonas coverage.

Cipro is practically free for everyone else too. Go back and check Azithro IV pricing again.

Will do. But it's dirt cheap. I looked it up once before.

Levo is very bioavailable also.

So why are you only hung up on IV pricing?

Again, you display your ignorance. Where do you think nursing home patients end up when they have pneumonia? Hospital. You going to be at VA forever? I thought you were considering a manager job and install EMR.

I was talking about VA formulary, wasn't I? No ignorance there, just know my patient population. It's a niche drug for us. As for my new job, I'll base my recommendation on the patients when I see it for myself.

Do you not have cipro on the formulary? What do you use it for? Pseudomonas alone...or for other mundane e coli UTI?

Cipro is not allowed to be used for UTI per policy unless pt has sulfa allergy, exactly because it's promote resistance and bad ass pseudomonas. I don't know what you do at your institution, but sounds like you could use more antibiotic stewardship.

Except you have no say so at VA on what drugs get on the formulary. I can impact my facilities.

So it's time to unzip and compare sizes? You have no idea of the formulary process at the VA, and yet you presume to speak on for it. Hey, don't let me stop you. Please, I want to see if you can twist the government's arm into doing anything.

 

[MindOverMatter]

 

[Its Z]

Your argument if flawed. Same could be said, "why not always use an antibiotic with psedumonal coverage"? We could always use more pseudomonal resistance, right?

Exactly. The argument is flawed. And you started it by saying harmless anaerobic coverage. Thank you for proving your argument flawed. Hook line and sinker.

P.S At least anaerobic coverage is useful if the CAP is due to aspiration; same can't be said for your psedomonas coverage. Will do. But it's dirt cheap. I looked it up once before. So why are you only hung up on IV pricing? I was talking about VA formulary, wasn't I? No ignorance there, just know my patient population. It's a niche drug for us. As for my new job, I'll base my recommendation on the patients when I see it for myself. Cipro is not allowed to be used for UTI per policy unless pt has sulfa allergy, exactly because it's promote resistance and bad ass pseudomonas. I don't know what you do at your institution, but sounds like you could use more antibiotic stewardship. So it's time to unzip and compare sizes? You have no idea of the formulary process at the VA, and yet you presume to speak on for it. Hey, don't let me stop you. Please, I want to see if you can twist the government's arm into doing anything.

So here are your arguments.

1. Levaquin causes pseudomonal resistance, so use moxi.
2. Levaquin is a niche drug to treat CAP & UTI.


So..moxi doesn't cause pseudomonal resistance?


When's the last time you read the IDSA pneumonia guidelines and NHIQM documents and PN-6a Measure? What is the only quinolone designated as the both antipneumococcal & antipseudomonal agent and for patients admitted to ICU setting directly from ED admission with Pneumonia? You want to call it a niche? Ok, let's call it a niche... what antibiotic does not have a niche then?

You want to talk ABS? How many programs have you started? How many do you monitor and track and report on? How many weeks have you spent on ID rotation?

And, what methodology do you use to track and trend ABS?


As far as VA formulary process goes, I don't need to know how it works. I just know you're not involved. I also know Levo was once a formulary item. I do not know if it was taken off with Avelox/cipro initiative..

 

[WVUPharm2007]

Who gives a ****, you dorks.

Now in my neck of the woods, this is great news because my % generic will go up.

 

[owlegrad]

Who gives a ****, you dorks.

Now in my neck of the woods, this is great news because my % generic will go up.

Nope, it will go down.

Drugs that do not have generic equivalents do not count against you, but now people will demand the brand (I can't take "genetics") and every time you comply with there asinine demand for Levaquin, your % generic takes a hit.

 

[WVUPharm2007]

Nope, it will go down.

Drugs that do not have generic equivalents do not count against you, but now people will demand the brand (I can't take "genetics") and every time you comply with there asinine demand for Levaquin, your % generic takes a hit.

No, it will go up.

Why? Because there is something that no sane person can up with a reason to dispense brand for. It will fight the evils of Topamax and Synthroid. Even if by 0.001%.

 

[owlegrad]

No, it will go up.

Why? Because there is something that no sane person can up with a reason to dispense brand for. It will fight the evils of Topamax and Synthroid. Even if by 0.001%.

Well, good luck with that. I am skeptical at best.

 

[Praziquantel86]

No, it will go up.

Why? Because there is something that no sane person can up with a reason to dispense brand for. It will fight the evils of Topamax and Synthroid. Even if by 0.001%.

How do you figure? My old store had customers that insisted on brand Amoxil and Z-Pak. If there's a brand being manufactured, people will request it.

 

[PumpkinSmasher]

No, it will go up.

Why? Because there is something that no sane person can up with a reason to dispense brand for. It will fight the evils of Topamax and Synthroid. Even if by 0.001%.

I don't what your talking about, we used to dispense brand Ery-tab to folks

 

[WVUPharm2007]

How do you figure? My old store had customers that insisted on brand Amoxil and Z-Pak. If there's a brand being manufactured, people will request it.

I must have smarter patients. The only brands we use are narrow-TIs and controls. People need their brand Xanax and Vicodin. But other than that...we have no brand Zpaks or brand Amoxil anywhere. It's an antibiotic. If you just don't carry it, they can't wait for you to order it. Ha.

 

[PumpkinSmasher]

I must have smarter patients. The only brands we use are narrow-TIs and controls. People need their brand Xanax and Vicodin. But other than that...we have no brand Zpaks or brand Amoxil anywhere. It's an antibiotic. If you just don't carry it, they can't wait for you to order it. Ha.

"Genetic" allergy must only affect the slow witted...😉

 

[Tinkerbell22]

How do you figure? My old store had customers that insisted on brand Amoxil and Z-Pak. If there's a brand being manufactured, people will request it.

that's crazy. i've never had people request brand on stuff like that... i don't even think we stock that stuff in brand.

 

[Praziquantel86]

that's crazy. i've never had people request brand on stuff like that... i don't even think we stock that stuff in brand.

When people pay for everything with AMEX black cards and roll through the drive-thru in Bentleys, they tend to not care how much anything costs. Sucked for our GSR though.

 

[xiphoid2010]

z-man, really, you can see my point just as well as anyone, just don't want to admit it because it runs counter your argument. Both moxi and levaquin spectrum wise are cover things that don't need to be covered. I don't need to compare resume with you. So you are older but quite frankly nobody cares. VA isn't anything like what you deal with, so I'll just leave to think whatever you want.

 

[xiphoid2010]

When people pay for everything with AMEX black cards and roll through the drive-thru in Bentleys, they tend to not care how much anything costs. Sucked for our GSR though.

Also note, governments don't work like private sectors. Many government agencies got drug manufactures to live with prices that's basically free. For example, Ohio medicaid pays for brand name Adderal, not the generic. VA pay 5 cents for 1000 count of meformin 1 gm. It is insane, I look at the the bottle, and the plastic must cost more than 5 cents.

 

[xiphoid2010]

n/m, double post