Increase in prescription cost can be a hardship

Dear Dr. Roach: I had a partial thyroidectomy over 40 years ago due to an enlarged thyroid, which was benign. I have been on varying amounts of thyroid hormone replacement ever since – initially Armour, then Synthroid, and now levothyroxine 88 mcg. Until recently, the cost of levothyroxine was less than $20 for 90 tablets; however, my last refill was $76.77. I have excellent prescription coverage, so I do not pay the cost, but I am curious how this medication’s price could increase so drastically. – B.N.

Answer: The price of generic medication recently has increased in the U.S., dramatically in some cases. The reasons for this are complex and found in the interacting realms of business practice and public policy. In my opinion, this is an issue that can significantly reduce many people’s ability to properly treat their medical condition, and I urge those affected by this pricing change to let their legislators know. I have.

In the meantime, Target and Walmart sell 100 levothyroxine tablets (at many strengths) for $10. This is great for consumers but puts unreasonable pressure on small pharmacies, which often provide superior service to their customers.

Dear Dr. Roach: My daughter, 61 years old, has a condition called oral lichen planus. We know it is an autoimmune condition, but nobody in the medical field knows how to cure it or ease the breakouts. They don’t actually say “Just live with it,” but that is what they imply.

She did go to a dentist, who discovered she had thrush, too. He took care of the thrush, but said it goes along with the OLP.

Several years ago, she had cancer, twice, and had both breasts removed. She has tried some natural ingredients, rinses, etc., but they do not last. This condition is very painful and irritating. Any kind of spicy or acidic food is especially annoying. Do you have any recommendations? – N.J.C.

Answer: Lichen planus is a chronic inflammatory skin condition that can affect the skin, mouth, genitals, nails or esophagus. Although many experts believe it is an autoimmune disease, possibly after trauma or infection, this is unproven.

Treatment of lichen planus is designed to reduce symptoms. There is no known cure, but we do know how to alleviate it in most people.

Your dentist is a good place to start. Good oral hygiene and frequent dental visits to make sure there are no dental causes of irritation are essential. Smoking cessation, unsurprisingly, is essential. Spicy, acidic, hot, salty and rough foods all may exacerbate symptoms and should be minimized (sorry).

If medications are needed, the usual first treatment is a topical steroid, such as fluocinonide, in an adhesive base. In one study, 20 percent of people with OLP had complete responses and 60 percent had good or partial responses when treated with fluocinonide, versus no complete responses and 30 percent partial responses in the placebo group. This powerful steroid can predispose to thrush. Other options include the very expensive creams pimecrolimus and tacrolimus (in addition to cost, these are suspected but unproven to increase cancer risk). Injection medication and systemic therapies are used for people who do not respond to topical treatments.

Readers: The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Roach – No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.