If you can't find any Sertraline in your area--refer your patients to drugstore.com. Its an online pharmacy, that from my own experience is cheaper than several pharmacies in my area.
Unfortunately the price of generic Zolift isn't much cheaper than Zoloft. Further, because its gone generic--the drug rep in my area for Zoloft no longer gives samples.
We got lots of patients that need samples, but since we can't give them, and the only SSRI we got is Lexapro, some of the attendings are suggesting we treat their disorder with Lexapro even though Lexapro isn't FDA approved for their illness (e.g. OCD, PTSD). These are d/o's treated by Zoloft.
So in short, I am bugged by this. You figure if Zoloft went generic it'd make it more accessible, but at least in my own area it hasn't. The poor people can't get samples and the people that can buy Sertraline aren't saving much vs Zoloft.
So what I've been doing is prescribing fluoxetine for the OCD & PTSD or other patients who need an SSRI but can't afford sertraline. Fluoxetine goes for only about $20 a month. I still don't like it because fluoxetine is considered one of the dirtier, more primitive SSRIs.
Whopper - when it comes to prescription drugs, accessibility takes many forms & is not directed solely by acquisition price by the pharmacy. When I buy sertraline, I buy it at a lower price than Zoloft. But....the price that is charged to the pt is set by their insurer - not by the pharmacy they go to, unless it is a cash paying patient.
When a prescription drug becomes generic - it is usually "lowered" on the forumulary tier of insurance plans - Medicaid included. There are some which are not - a good example is the current Zocor/simvastatin controversy (which has gone to a judge for a ruling for a stay of approval last week...). Another example is Wellbutrin (not XL nor SR - just straight Wellbutrin). In my state Medicaid will pay for Wellbutrin brand only - not buproprion, which has been available for many, many years generically. Why? because of preferential pricing on other drugs within that manufacturers line of products.
The reasoning is governed by contractual agreements insurers have with drug manufacturers. The poor (I'm assuming you mean poor enough to qualify for Medicaid) are not the issue here. It is the "working" poor - those who work, altho they may have poor drug coverage (which means SSRIs are ALWAYS in the highest tier - they want you to use the older types of medications before the SSRIs, so they use economics to force that) or, what is occurring currently this Aug-Sept, are the Medicare Part D folks who are now falling into the "donut-hole" part of the plan. This means, their initial covered amount has been used up & they now pay full price out of pocket until they hit the $5000 mark, then their coverage begins again...probably about Dec 15.
So....it is very complicated when it comes to finding a drug which fits the diagnosis & the economics of the pt. Fluoxetine, I'd agree, has its issues. But...when you understand they really would rather you go back to the tricyclics...you can understand why giving fluoxetine another go would be worth a try.
No - you won't get samples from a generic company. There is no incentive for them. They don't need to market - the originator of the drug has already done that. There is no reason for the Zoloft rep to give you samples either. His company owns one of the companies which will be a generic manufacturer...so he doesn't need to "entice" you any further.
Insurance drug coverage has become a dirty business - very, very dirty! We hate it at the pharmacy level & usually try to work with the pt & prescriber to work out what will be best for that pt. But....what works this year won't necessarily be applicable next year (or for Medicare Part D folks - their forumularies can change monthly without notice!).
As for online pharmacies - yes...they will usually be able to provide a lower price for the cash paying pt by 30-45% depending on the drug. As long as you have a stable pt - a 90 day supply will be the least expensive. But...I would never, ever encourage anyone to go outside the country (with one and only one exception) to obtain medication - far, far too many instances of tampering & adulteration.
Good luck - its tough, I know!
