The Cheapest Option for Tenofovir (TDF/Viread) or Entecavir (ETV/Baraclude): Medicare Part D?

[choppedliver]

Anyone in the U.S. using Medicare Part D for Tenofovir (TDF, Viread) or Entecavir (ETV, Baraclude)?

Currently, my aunt is on Adefovir (ADV, Hepsera) and she has Medicare Part D.  After asking around this forum, I now realize that she should be on the above 2 medication only!  I'm in the process of getting a new doctor, but I wanna see how costly getting on those 2 drugs will be.

How much of a burden is Tenofovir or Entecavir, if you use Medicare Part D?  From PharmacyChecker.com, I see that branded Tenofovir Disoproxil Fumarate (Viread) costs $18.76 per pill for 300mg or about $570 per month if taking 30 pills.  Entecavir (Baraclude), on the other hand, is even more expensive at $21.63 per pill (for 1mg) or $650 per month.  Does Part D cover most of the cost for the two?  

Or are you better off getting the generic for Tenofovir (is this Tenvir?), which seems to be significantly cheaper at $3.18 per pill (for 300mg) or $95 per month.  I've been told there is a generic for Baraclude but I don't see that on PharmacyChecker.com.  Does anyone know how one can get a hold of the generic Entecavir (Baraclude)?  Through offshore pharmacies?

Also, is 300mg per day for Tenofovir Disoproxil Fumarate (Viread) and 1mg per day for Entecavir (Baraclude) the right dose for someone on antiviral therapy?  My aunt only weighs around 90 lbs. so she she usually takes less than usual.  But I'm assuming getting the largest pill available and perhaps using a pill splitter will save her money.

[stef2011]

Yes, her GFR got worse and she was told to take 1 ADV (10mg) every 3 days for I believe most of her 1.7Y

this is crazy adv is too weak better off drug, make resistance test muattions they can get mutations if hbvdna is 50iu/ml
consider that one bottle of adv has the same potency of 1 pill tenofovir without toxicity

Baraclude, Viread, or Nitazoxanide.  Do you think a combo therapy with all three is still the best option?
yes it is, ntz is very active on hbsag so she might get it negative with time.if you plan a monotherapy like etv be sure to have resistance test to detect at least 20% hbv population, the 5% test is better bt not widely available.

please check carefully for kidneys damage since she had already some from adv

[choppedliver]

Yes, her GFR got worse and she was told to take 1 ADV (10mg) every 3 days for I believe most of her 1.7Y.  She originally started at 1/day. More recently, she took 1 ADV every 5 days because of kidney trouble; that's when her virus count jumped back to 3,000 iu/mL, probably due to this weak dosage.  So it's probably due to this weak dosage rather than any resistance at this point, don't you think?  

Her GFR has gotten much better now, so now she was told to go back on 1/day, but I wanna get her off ADV right away and gete her on Baraclude, Viread, or Nitazoxanide.  Do you think a combo therapy with all three is still the best option?  For someone who's been taking 1mg ADV every 3 days for most of her antiviral treatment (if you can call that treatment)?  Thanks so much again, Stefano.

[stef2011]

adv makes also kidney damage, does she check for it regularly?

ntz is active on all mutants, it boosts immune response so active and preventing mutations

[stef2011]

Her count went down to 20 iu/ml until recently when it went back up to 3,000 iu/mL.

that's too high you can even make a test for resistance at that high number, do check her for resistance it is very possible.adv resistance lowers tenofovir response so she must combo tnf+etv as soon as possible and use ntz for the adv resistance


Should she be on a combination, not just Viread?
absolutely combo, she might have mutants already

Her ALT isi usually in the mid to high 40s, but several times was in the 50s and low 60s.  AST, if relevant, is about the same.  Constantly elevated is her Alkalline Phosphatase:  ~190.
adv was useless, it failed, alt must be loer than 19 for woman and hbvdna undetactable by pcr that can detect even 1-10iu/ml (pcr realtime most recent assays)

[choppedliver]

Hi Stefano, she started Adefovir Dipivoxil (Hepsera) in January 2009, so it's been about 1.7 years. She never took Lamivudine.  She's Asian and she found out in her 30s, and it seems carrying Hep B virus is rather common in her country.  She's now 70.  So for ~40 years, she was ok and then she started this antiviral therapy (w/Hepsera); she seems to have been hoodwinked.

Her viral count in early 2009 was 3,000 IU/ML or 6,000 copies/mL.  I don't know what the count was before she started her therapy I don't think it could not have been that much different. Did she even need to be on an antiviral therapy?  Her count went down to 20 iu/ml until recently when it went back up to 3,000 iu/mL.

Her ALT isi usually in the mid to high 40s, but several times was in the 50s and low 60s.  AST, if relevant, is about the same.  Constantly elevated is her Alkalline Phosphatase:  ~190.

Should she be on a combination, not just Viread?

[stef2011]

http://www.dancewithshadows.com/pillscribe/indian-court-allows-ranbaxy-to-sell-generic-entecavir-baraclude-for-hepatitis-b-for-now/

if she was not exposed to lam and she is hbvdna und (pcr to 1-10iu/ml sensitivity) and normal alt the combo with etv 0.5mg and tnf 300mg is good, etv at 1mg doens t add much potency.on the contrary i'd suggest etv+tnf+nitazoxanide since ntz has no sides, lowers hbsag and might make it negative and prevents resistance