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Allergy sufferers who rejoiced
when Claritin went over-the-counter are now dealing with a new headache: At
nearly $1 a pill, nonprescription Claritin is more expensive for insured
patients who were used to a $10 copay for a whole bottle.
Many insurance companies are
also making it harder to get competing prescriptions, charging $35 to $50
for competitors Allegra or Zyrtec. Some demand proof that patients tried,
and failed, OTC Claritin for a few weeks before even allowing their doctors
to write a prescription for an alternative.
"It's a real hassle," says
Dr. Gordon Raphael, a Bethesda, Md., allergist who reports being inundated
with calls from patients desperate for him to certify that they need a new
medication.
Patients rethinking their
allergy choices because of cost could find that other medicines actually
control their symptoms better. Although Claritin once was the best-selling
prescription allergy medicine, specialists like Raphael cite research
showing there are more effective choices for the severely afflicted.
In fact, study after study
finds prescription steroid nasal sprays -- sold under such names as Flonase,
Nasacort and Nasonex -- are the overall most effective hay fever treatment.
Yet by far, most sufferers pop pills.
"That's the power of modern
advertising," said Dr. Brian Smart of Illinois' DuPage Medical Group, who
recently reviewed medication options for the American Academy of Allergy,
Asthma and Immunology. He said the sprays would be his first choice. But
"there's no one drug which is perfect for every single patient," Smart said.
The options:
-Most popular are
non-sedating antihistamine pills. They block histamine, the body chemical
that causes hay fever's itchy nose and eyes, runny nose and sneezing. They
don't help congestion unless combined with a decongestant.
If Claritin worked well for
you, stick with it, allergists say. The only non-sedating option available
without a prescription, it is most helpful for mild to moderate allergies.
While the well-insured may
fuss at the new OTC price, they won't have the time and expense of a
doctor's visit -- and the uninsured will pay far less than they had been.
Also, generic versions have just begun selling at 65 to 80 cents a pill;
look for Claritin's chemical name, loratadine. Still available by
prescription -- albeit harder to get through insurance -- are nonsedating
Allegra, Zyrtec and Clarinex, Claritin's successor. Some studies suggest
they're more potent than Claritin.
-Nasal steroids
directly target various inflammation-causing substances inside the nose to
treat all nasal allergy symptoms, runny nose as well as congestion. That
means no separate decongestant.
Some people, children
especially, find a nasal spray's sensations uncomfortable or irritating.
-The newest option is
Singulair, an anti-asthma tablet now found to also ease allergies' itching,
sneezing and congestion. It targets a different symptom-causing substance,
leukotrienes, and thus can be used together with steroid sprays or
antihistamines. Like the previous two categories, it has few side effects.
-A non-steroid
prescription nasal spray named Atrovent also can dry up a runny nose.
-There also is a
prescription antihistamine spray named Astelin; it can cause sedation.
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