- The Washington Times - Tuesday, April 22, 2003

The first allergy season since Claritin went over the counter is in full swing, and many sufferers are finding an additional headache: At roughly $1 a pill, nonprescription Claritin costs more for insured patients who were used to a $10 co-payment for a month's supply last year.
Plus, many insurers are making it harder to obtain competing prescription antihistamines, charging $35 to $50 co-payments or requiring proof that patients don't respond to Claritin before allowing a prescription.
Dr. Gordon Raphael is inundated with calls from sneezing patients, desperate because their insurance company demands they try over-the-counter Claritin for a few weeks before they're allowed a prescription for a competing allergy pill because the Claritin's not working.
"It's a real hassle," especially for patients who know they respond better to competitors Allegra or Zyrtec, says Dr. Raphael, a Bethesda allergist.
Patients rethinking their choices because of cost could find that other medicines control their symptoms better. Although Claritin was once the best-selling prescription allergy medicine, specialists such as Dr. Raphael cite research showing that there are more effective choices for the severely afflicted.
Numerous studies have found that prescription steroid nasal sprays sold under such names as Flonase, Nasacort and Nasonex are the most effective hay fever treatment. Yet by far, most sufferers pop pills.
"That's the power of modern advertising," says Dr. Brian Smart of Illinois' DuPage Medical Group. Dr. Smart recently reviewed medication options for the American Academy of Allergy, Asthma and Immunology and calls the sprays his first choice.
But he stressed, "There's no one drug which is perfect for every single patient."
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 works well for patients, they should stick with it, allergists say. It is the only non-sedating option available without a prescription and is most helpful for mild to moderate allergies.
Although the well-insured might fuss at the new over-the-counter price, they won't have the time and expense of a doctor's visit, and the uninsured will pay far less than they were. Also, generic versions have just begun selling at 65 cents to 80 cents a pill under Claritin's chemical name, loratadine.
Still available by prescription, albeit harder to obtain through insurance, are non-sedating Allegra, Zyrtec and Clarinex, Claritin's successor. Some studies suggest that they're more potent than Claritin.
But all "are much more alike than advertisements might lead you to believe," says Dr. David Pearlman of the Colorado Allergy and Asthma Centers, who leads the academy's therapy committee. So finding the best one might require trial and error.
Nasal steroids target various inflammation-causing substances in the nose to treat all nasal allergy symptoms, and runny nose as well as congestion. That means no separate decongestant.
Some people, children especially, find a nasal spray's sensations uncomfortable or irritating.
But people should expect to see more ads for steroid sprays soon as manufacturers try to increase use among insured patients struggling with antihistamine costs. Insurers typically charge a $10 to $30 co-payment.
The newest option is Singulair, an antiasthmine tablet found also to ease allergies' itching, sneezing and congestion. It targets a different symptom-causing substance, leukotrienes, and thus can be used with steroid sprays or antihistamines. Like the previous two categories, it has few side effects.
A non-steroid prescription nasal spray named Atrovent can also dry up a runny nose.
There is also a prescription antihistamine spray named Astelin; it can cause sedation.
Decongestants ease nasal blockage but can cause insomnia and heart palpitations.
Be careful with nonprescription antihistamines other than loratadine, allergists say. Older varieties are sedating and can impair performance even if people don't feel sleepy.

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