Tier 2 alternatives to Protonix - which do you prefer, why?

[DreamDiver]

So now, looking at this Anthem plan, the local agent suggested that I look at the drugs I'm taking to see what's covered. When I talked to a to her, I was told that GERD was actually a worse threat than the Sleep Apnea. That I'm taking a 'Tier 3' drug seems to have pushed me into a higher rate bracket than Sleep Apnea does. The agent suggested that when I fill out the application, I should include information about how my sleep apnea is being successfully treated with cpap therapy and that I have the full data to prove it.

Since I've been diagnosed with GERD, I've been taking Protonix 40mg. Apparently, this is a Tier 3 drug - whatever that means - and it's been removed from the 'rxlist' for Anthem as of January 1, 2009. They suggest one of the following as a replacement: Prevacid, Nexium or Prilosec - all of which are Tier 2 drugs - again, whatever that means.

I'm curious what other peoples' comments are on Protonix and the other Proton Pump Inhibitors as a replacement. Protonix seems to have no side effects except that most of my chest pain is now gone - an effect we're hoping for. What's the best replacement for Protonix of the three? Are there any side effects for them that you just can't deal with? What's been your experience?

[ozij]

DreamDiver, before I tell you my experience, I'd like to suggest you try each - if the switch from Protonics is medically OK . The nature of side effects is such that some people have them, others don't - and there's no telling who will have what.

I use a generic version of Prilosec. 20Mgs a a day gave me headaches - and I believe they also affected my visual accomodattion. I am very short sighted, and with more Prilosec, my multifocals seemed to become less efficienat. I am doing fine with 10Mg's once a day which is all I need at this point.
Before going down to 10mgs the doc. suggested I try Prevacid (I think it was that). Stomach aches, bloating - not for me.
Like I said, there's no telling who will have what side effect.

O.

[sleepycarol]

A couple of years ago I was put on 20 mg. of Prilosec 2 times a day due to chest pain from GERD. Last spring I was hospitalized due to severe chest pains and after multiple tests on my heart that showed my heart was in good condition, they did an endoscopy and found that the Prilosec was not controlling the acid and I had an ulcer. At the time I had Anthem insurance and they did not cover Nexium. I tried Prevacid and it didn't help. The doctor appealed the denial of the Nexium and it was still denied. She then said ### them and gave me a three month supply of samples of the Nexium. Bingo it worked and I felt better than I had in a long time. After the three month trial I then tried Prevacid (which at the time Anthem covered but only one tablet a day instead of the 2 prescribed). It kept the symptoms at bay and I did fine on it at that point.

My employer changed insurance companies at the beginning of the year and this insurance does NOT cover any of the prescription meds. When we had a group meeting with the insurance rep he said even appealing the denial of these meds he didn't know of anyone that was approved for them. I am back to taking Prilosec 20 mg. 2 times a day. Symptoms are back and don't know what to do from this point.

[Violet]

When my insurance dropped Protonics, I got a prescription for Omeprazole cap 20 mg which works great. I wonder, is Omeprazole just Prilosec?

However, I do struggle with daily dizziness. And since reading Ozij's post, I wonder if the dizziness is caused by a visual side effect of the Omeprazole.

[DreamDiver]

ozij, sleepycarol,

Thanks for your replies. It really helps. I'm sorry to hear they seem not to be as effective as Protonix - or have undesireable side effects.
I have read some other interesting things about PPI's though.
Apparently they don't stop bile, which can cause some problems with GERD too.
I read here that using OTC drugs like cimetidine or ranitidine help with this, and that taking it before bed can help with chest pain symptoms when coordinated with a PPI. I hope this helps.

[DreamDiver]

When my insurance dropped Protonics, I got a prescription for Omeprazole cap 20 mg which works great.

However, I do struggle with daily dizziness. And since reading Ozij's post, I wonder if the dizziness is caused by a visual side effect of the Omeprazole.

Omeprazole is the same as Prilosec, so I should probably avoid this if headaches are likely. I've already got that problem since before using protonics. Thanks for your reply, Violet.

[The Texan]

This is interesting information as my insurance just dropped Protonix from their formulary and switched me to Nexium. I have not made the switch yet as I still had some Protonix left, but both my GP Dr and the Gastroenterologist said that as long as it was Nexium it was OK, but no other would do. Guess I will switch today and save some Protonix in case I need to return.

[Debjax]

I have taken all three, since the Naval base switches out every couple of years....I prefer the prevacid over all of them. It seemed to do a better job for me,and on the next round of scrips, I'm probably going to switch back to that and just get it from the mail order pharmacy.

[TheDreamer]

Many years ago I had upgraded to Prilosec (it was called Losec in Canada). But, then I moved to the US...and they wouldn't authorize it unless I went through 3 of the -tidines first. That was painful. Didn't matter that I had done 3 or 4 different ones before getting to Losec in Canada.

Eventually I landed with Prevacid. Prilosec wasn't available as a generic yet, and both were tier 2...and my insurance was co-pay only.

But, then I switched jobs....and insurance. So now I'm Omeprazole (Prilosec). I'm sure I even read somewhere on in the prescription drug list that Prilosec, Prevacid, Nexium and such are all the same, so Omeprazole should be dispensed unless special authorization is granted to use something else. Guess there's also the part where Omeprazole is available OTC now. But, I get it as a prescription...so I pay co-insurance on the fills.

There was a time where I contemplated asking to get switched back to Prevacid...but now with all the bills, and having blown my FSA in two months....I'm more into trying to get all my prescriptions to be cheap generics.....

New this year the insurance company won't pay for allergy medication anymore, since Claritan and Zyrtec are both available OTC.....which makes having blown through my FSA so quickly that much more painful.

The Dreamer.

[junie]

I take Omeprazole caps 20mg, twice a day it's ok but some nights I still have a attack, but then I can go for months and be fine

[debrodl]

ACIPHEX!!!

I've tried them all for many, many years. Last year my doctor gave me Aciphex and it's so much better than the others.

First of all, it acts much quicker than all of the others. Secondly, NO side effects.

My GERD has really subsided since I have been consistent with my CPAP and have lost 25 pounds. Exercise is helping too.

Good luck to all who suffer with GERD. It's just an awful thing.

[N6CRV]

I have been using Nexium. Have not had any trouble with it and it seems to work. I have noticed that sence starting Cpap the the reflux has not been anywhere near as bad. I think the air must be keeping everything down I have had times where I did not wake up fast enough and got some into the lungs. Talk about pain and trying to cough it back out was fun.
Don

[sleepyred]

I use the generic of Protonix (pantoprazole) which is covered under my plan in the bottom tier.

[Catnapper]

I don't need these drugs now, but I will give you my experience.

Nexium - the purple one - gave me hives because I am allergic to the blue and red food colors in that purple color. Then the Protonix gave me dreadfully dry eyes. I found something online that said that diabetics can get dry eyes from the proton pump inhibitors. My eyes felt like they had shampoo in them all day long. Very painful. The eye doctor was treating the dry eye problem until I found the online tip. Stopped the drug, the eyes improved the next day.

[CorgiGirl]

I have taken Prilosec, Nexium, Protonix, and Prevacid over the last decade or so. Prevacid works best for me, but not everyone is the same. I have friends for whom Protonix is best and some which do fine on Nexium and Aciphex.

Deb, unless they have changed yet again, the military has gone exclusively to Prilosec and Nexium, unless you "fail" on them. Which means you have to use them for about three weeks and still have symptoms or have unacceptable side effects. Your doc will have to fill out two different forms and send them in for pre-authorization. It wasn't clear to me in the beginning that there were two different forms...

Gotta love the military and their forms. One of my husband's favorite stories is about the time he said to sign for some equipment and then he had to initial his signature.