What do you pay for your meds in the US? I checked commonly used med prices on @GoodRx. Prices vary a lot!

@Lisa_L_Gill did this analysis a few years ago.

I added @costplusdrugs @mcuban to the list. #CostVR
People may not realize that for some meds in the US, the money you pay as insurance copay/coinsurance may be higher than what you can get paying out of pocket without using insurance.

It's one of the mind boggling things about prescription drug prices.
Not even people in healthcare know.

A friend who works in healthcare commented that after I told him about the way meds are priced, he's now saving $1200 a year on just one medicine.
Why is there such a huge price variation?

It's the difference between list and net price and the effect of middlemen. With vertical integration there's also more monopoly. It's complicated.

Read more here: mayoclinicproceedings.org/article/S0025-…
Here is the original table as published by @Lisa_L_Gill in @ConsumerReports a few years ago.
Unfortunately, the most disadvantaged in society— including the ones paying out of pocket are the ones more likely to not be aware of the many ways to get meds at lower cost. They may be spending way more than they need to.

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More from @VincentRK

Feb 19
How many Covid vaccine doses to be adequately protected?

3 doses if not immunocompromised.

4 doses if immunocompromised.
Above applies also to those who got J&J as initial vaccine.
More details here. cdc.gov/vaccines/covid…
Read 5 tweets
Feb 18
I hate to say this. But even as cases and deaths fall, COVID is not over: Get boosted. It is critical. Thread.

1/ In August last year, Malta became one of the highest vaccinated countries in the world. As cases rose with omicron, we thought deaths will stay low. They didn't.
2/ What happened? Did vaccines not work? Did the protection fade with time?

Well, we now know that vaccine efficacy after first 2 doses does go down with time. Malta raced to get everyone vaccinated. But when omicron hit, the population was >6 months out from initial vaccination
3/ Malta did recognize the importance of boosters early and offered them. But not everyone came and got the booster. There was also the small group of people who remained fully unvaccinated.

This is where most of the deaths are coming from.
Read 10 tweets
Feb 17
Are vaccines needed if you already had COVID?

I wrote a thread a few months ago arguing: Yes. They are.

This study just out in @NEJM provides a lot of important data nejm.org/doi/full/10.10…

1) Vaccines do provide higher and longer protection than you get from infection alone
2) The incremental benefit of vaccines over prior infection alone is particularly obvious if you had COVID >1 year ago.

But it is also seen if Covid infection was less than a year ago.
3. Prior Covid infection has 80% efficacy in preventing Covid compared to no prior Covid infection. But this efficacy drops to 70% if the Covid infection was over a year ago.

Vaccines increase both numbers. They help both.
Read 11 tweets
Feb 17
The beauty of Twitter in academic medicine is you can give an online lecture that reaches many times more people than you may reach even at a huge Plenary session.

However, impact on whether you actually influence clinical practice depends a lot on credibility. #MedTwitter
Academics should view Twitter as essential as original research papers, reviews, editorials, and lectures in terms of disseminating information that they think can help others in the field.
#MedTwitter
If you make the time investment and interact with people in a friendly manner, you will reach people outside of your own circle. And ultimately help patients worldwide. #MedTwitter
Read 4 tweets
Feb 16
Paxlovid results out in @NEJM

89% reduction in risk of hospitalization or death. Oral therapy for 5 days in people at high risk of severe Covid. The graphs look impressive. nejm.org/doi/full/10.10…
I also like the succinct summary of competing treatments (molnupiravir, monoclonal antibodies, remdesivir) for the same patient population at the end of the discussion.

Puts the results of this trial in context.
Good discussion ins the editorial also about the trial, relative risk reduction vs absolute risk reduction. nejm.org/doi/full/10.10…
Read 6 tweets
Feb 15
How I Treat Myeloma: 2022 Update.

10 slides. Hope it's useful for oncologists and patients. @NorthTxMSG @MyelomaTeacher

1/ Risk stratification: This is important both for counseling patients and to decide on treatment options. The more high risk factors, the higher the risk.
2/ Initial therapy. The 3 main choices are VRd, DRd, and Dara-VRd.

I prefer VRd. But the other options are reasonable. Transplant eligible patients need 3-4 cycles, then stem cell collection.
3/ Initial Therapy. For patients not eligible for transplant, results with DRd are outstanding. But it is more expensive and requires prolonged use of a triplet.
Read 12 tweets

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