June 19, 2015

Rytary: It's New and Costlier. But Will It Work Better?

A few days ago I reported that my neurologist had just prescribed rytary, the new Parkinson's drug approved by the FDA earlier this year to improve the delivery of levodopa.

I was looking forward to starting rytary the next day, but it didn't happen.

My CVS pharmacist said they didn't have rytary in stock, but thought they'd get it today (Friday, June 19). The pharmacist called this afternoon. They received the rytary, but my insurance company wouldn't cover it. The tab without insurance? Over $900.

I left a phone message for my neurologist about these developments. I suspect my insurance provider hasn't yet reviewed the new med, but will cover it when they do.

I'm not too concerned. In fact, I've been wondering whether rytary was really right for me.

Ever since I switched from the regular levodopa pills to an older extended release version, I've felt good. Should I really mess with this success?

Then at today's meeting of my Parkinson's support group, a fellow member who had started taking rytary just last week said he'd already stopped taking the new med because it was causing distressing nausea.

Is a New Med Necessarily Better than the Old One?
I've seen reports from physicians that new versions of older drugs often don't work as well. For example, many doctors now prescribe antidepressant drugs called tricyclics (developed in the 1950s) instead of SSRIs (from the 1980s).

Similarly, some physicians prefer 1920s-era diuretics for high blood pressure to newer hypertensives.

"The way the drug regulatory system is set up, even if you have just a small advance, if you market it right it can be very profitable," said Harvard Medical School's Aaron Kesselheim.

The French journal Prescrire publishes an annual report on the effectiveness of new drugs in France. In 2011, it found that about one in six new products created more harm than benefit, while over half the new products had no advantage over pre-existing options. In 2012, it reported that only four of the 283 new products represented a significant advance.

The effectiveness of new drugs has plummeted since the 1970s, according to a 2013 report on U.S. pharmaceuticals.

"Older Often Is Better"
This can be said about pharmaceuticals... and this 86-year-old as well.

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