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 Best substitute for Spiriva Inhaler?

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Jan-KS Posted - Dec 30 2017 : 01:40:51 AM
My insurance company just informed me that Spiriva (which I have been on for years) will no longer be covered at all - so unless I want to pay the $400 or so full-price cost of it, I will need to start taking another drug. They offered these examples of covered drugs:

Advair (tried twice and it NEVER helped)
Breo (heard of but never tried)
Incruse (never heard of)
Anoro (never heard of)

Any suggestion as to which would be the closest in action to Spiriva? I'm OK with adding another nebulized drug as well if that's what it takes to keep me breathing well. I meet with my new pulmonologist on January 2nd (my last one was wonderful but tragically died in a small engine plane crash) and I'll get his input of course, but I think I sometimes trust other's experiences with a drug than just what the Dr recommends.

26   L A T E S T    R E P L I E S    (Newest First)
Jan-KS Posted - Jan 24 2019 : 11:32:44 AM
Roxie - as a pulmo patient you especially may want to be on Medicare once you are eligible. All nebulized drugs are paid for by Medicare Part B rather than your insurance - as long as it's reasonable and necessary - it's considered a DME (durable medical equipment because it must be used with a nebulizer). I currently take 3 nebulized medications - saving hundreds of dollars a month. BUT not all pharmacies cover a DME but whoever provides you with a nebulizer or oxygen will likely be able to provide it- my mother used to get a 3 month supply of hers through the mail since her oxygen company ordered it. I currently use my regular pharmacy but occasionally they forget that it's a Medicare drug and just bill my part D so if there is ANY cost to the medication then remind them that it's to be refilled through medicare part B as a DME. It is unfortunate that Medicare doesn't pay for all your health care costs but you will also need to purchase a supplemental medical insurance policy (these policies pick up a lot of the cost that Medicare doesn't cover, although, like any regular health insurance most have co-pays and deductibles but it's still a better deal than paying 100% private medical insurance if you don't have an employer that pays part of the cost.
SEW4no Posted - Jan 24 2019 : 11:03:17 AM
Roxie - if you don't take Medicare at 65 you will be significantly penalized! A friend waited since she was still working and when she finally signed up, she was really angry that for staying healthy/not using Medicare, they severely dinged her. Check out the rules! As I remember, sign up but if you currently have insurance, they will use that first and Medicare becomes 'secondary.' I also signed in for social security early(64) too just so it would be in place.
Roxie-OH Posted - Jan 23 2019 : 4:24:18 PM
Well, I still have a few years left before medicare kicks in. I am retired, but husband is not so I'm still on his insurance. It would be nice if I could stay on his insurance and not get medicare when I hit 65. I don't think they will allow that sadly.
Jocopd Posted - Jan 18 2019 : 2:26:18 PM
Yes it makes sense. And you scored!!! I used the manufacture's coupons for years for both Advair and Spiriva when I was on regular insurance - loved that $10 co-pay.

But you loose the coupons when you go on medicare - can't use both. So what happened here is that since your insurance doesn't cover it then your not using medicare and you get the $10 co-pay! Or you have regular insurance and are getting that nice discount.
Roxie-OH Posted - Jan 18 2019 : 1:53:08 PM
I called my lung doctor. He gave me a sample of Incruse Ellipta. It seems to be working good. Than I took a coupon in to my pharmacy that I got off Incruse website and they said since my insurance doesn't cover Incruse, it will be $10. A lot better than $490.00 for the Spiriva that they do cover. Does that make sense? I'm hoping they didn't make any mistakes. They are out of Incruse, it is suppose to come in Monday. So, we'll see if it goes through at $10.
Jocopd Posted - Jan 10 2019 : 06:03:26 AM
You must be using the Spiriva Respimat - not the capsules? The respimat is available in two dosage strengths. Each actuation from the SPIRIVA RESPIMAT inhaler delivers 1.25 mcg or 2.5 mcg of tiotropium (equivalent to 1.562 mcg or 3.124 mcg, respectively, of tiotropium bromide monohydrate) from the mouthpiece. Two actuations equal one dose (2.5 mcg or 5 mcg).

So if yours is the 3.124 then you are dosing a total of 5 mcg daily in two actuations. The one from ADC is 9mcg which is more than the 5 you are now getting. Almost double - not being a doctor I would suggest you ask your dr how to convert this to beneficial use for your situation. Like if you do one dose which would be half of the 9mcg or 4.5 would that be enough?
Roxie-OH Posted - Jan 09 2019 : 2:21:19 PM
I just got on the ADC website and noticed their Tiova is 9 mcg. My Spiriva is 3.124 Will that have an adverse affect on me?
klm49 Posted - Feb 04 2018 : 07:55:49 AM
Originally posted by jmrommes

Spiriva Respimat won't be available through ADC, but the dry powder version, Tiova, is.

ADC has TIOVA in dry powder and MDI
Sandyspen Posted - Feb 03 2018 : 10:32:43 PM
When I first told my pulmo that I used Tiova, I also brought him a couple capsules and the little plastic thing. He was excited to learn of them and even used one capsule on the spot.

He thought they were A-OK.

Jan-KS Posted - Jan 24 2018 : 12:59:55 PM
Received my tiova yesterday - 90 day supply for 1/3 the cost of Spiriva in the US. Will have to see how it works out. Where ADC asks for a prescription number just skip it - they will fill it without a prescription from a US doctor. There are no other acceptable substitutes on the market right now. My insurance cost estimate is $150 for 30 day supply - when I can get a 90 day supply from ADC for $56 shipped (it takes about a month - so plan ahead). I pay by bank draft not credit card. There is also a space where you can list all the drugs you currently take - I don't know if they actually review it but I put my info in just in case. I don't care for the inhaler it comes with, so think I will try my Spiriva inhaler.

Told my pulmonologist what I was doing and why - he had concerns about the purity of the drug but admitted that when he visits his home country in Peru he stocks up on Asthma inhalers for himself - so he had no problem with me going through ADC. The only downside is that ADC does not carry barbituates or narcotics (probably with good reason - like they'd be seized by customs). I was just informed that Alprasalom will no longer be on their formulary this year and I need to find an acceptable substutue! When I searched ADC - I have reasearched the "substitues" and found them all unsatisfactory - none are the same drug as Xanax, So I don't know what I'm hoping,

At least full-priced Xanex will only run me about about $27 per month - so and a months supply actually seems to last me more like 2 months. Getting medications is certainly getting expensive, 'I am currently on 33 prescriptions and sublements.

I appreciate you all for sending me to ADC.
n/a Posted - Jan 18 2018 : 06:51:13 AM
But I didn't like the device that comes with it. I use my old spiriva device with the tiova from ADC. Works well.
Dave-OH Posted - Jan 17 2018 : 1:20:43 PM
Yes it does
lauri-l Posted - Jan 17 2018 : 12:59:53 PM
When ordering from ADC does the Tiova come with a device to inhale the cap lets such as Spiriva does? I found another online pharmacy where it was not included. TIA
lauri-l Posted - Jan 17 2018 : 12:52:01 PM
I am currently taking Breo with Spiriva. I really like the results of the Breo. Oddly I wonder why my doctor is giving me both of them? He also added Daliresp every other day. I have definitely seen an improvement!
Dave-OH Posted - Jan 15 2018 : 8:12:02 PM
No script necessary.
lauri-l Posted - Jan 15 2018 : 7:59:24 PM
I too will not be able to use Spiriva due to my insurance which I have used for 8 years. I really dislike change lol. I will order from ADC for the first time. Does the script need to be written for the generic name or for Spiriva. Incruse makes me nervous. There are a lot of common side effects. Thanks all
hamtol Posted - Jan 12 2018 : 05:14:06 AM
ADC has a pay by voucher option for those who want to pay by credit card. The option does not show up on the website. After you order, call their customer service number and tell them you want to pay for your order by voucher. They will set it up and send you a link to the website of the company that handles it. But before you do this, check with your credit card or debit card company to make sure they process international sales (some companies only accept domestic charges). I use this option and it's much faster than sending a money order.
Jocopd Posted - Jan 01 2018 : 09:19:49 AM
If needed your doctor can give you a written prescription which you would then fax or scan and email to the pharmacy. Some pharmacys - like in Canada - might require a script and that is how you do it. They do not work like CVS or Walgreens where everything is done electronically so it doesn't have to come electronically from the dr.

When I asked my doc for a written one she asked what for and I explained I was going to get meds thru Canada as they were cheaper. She had no problem with that and even responded "I don't see anything wrong with that as they seem a healthy lot up there"

The only call I get from ADC is after I order using the money order option they will call and ask if I want to use a credit card. For some reason I don't see the credit card option on my order screen but it works out.
jmrommes Posted - Dec 31 2017 : 8:49:49 PM
They won't ask! Don't worry about it.......
Jan-KS Posted - Dec 31 2017 : 5:31:24 PM
Just ordered it - it's so funny they ask for a dr's number or prescription but they seem to let the transaction go through without it - should I expect a call from them requiring a RX? I seriously doubt my pulmonologist would write an RX for a drug in India.
Jan-KS Posted - Dec 30 2017 : 11:36:04 PM
Good advice jmrommes!
jmrommes Posted - Dec 30 2017 : 9:11:37 PM
For myself, I'm of the firm belief that if it ain't broke, don't fix it. I just went back to the Advair and Combivent combination I used successfully for years, after about 18 months of using Spiriva respimat, which I discovered really didn't do anything for me. So if the dry powder version of Spiriva works for you, use it and don't mess with a good thing unless you have to. The Incruse is new, so it will be expensive; I don't know how expensive, but Tiova will definitely be less expensive from ADC. You can probably call your pharmacy and find out what your co-pay would be.
Jan-KS Posted - Dec 30 2017 : 7:47:41 PM
Thanks so much - I have ordered from All Day Chemist and if the Dr doesn't find a suitable substitute I will get my Spiriva/Tiova through them. So jmrommes - do you think I should talk to my doctor about switching to Incruse first and see if that helps (I also need to find out what tier level Incruse and the others are on) I paid a $94 co-pay with Spiriva and never thought about ordering it online - could have saved a LOT of money. I tried to stop taking it for about a week due to the cost and had serious congestion by the end of the week - once I got back on Spiriva I started feeling "normal" again. Thank you all for your help!
SEW4no Posted - Dec 30 2017 : 10:54:09 AM
ADC also has the Tiova (tiotropium/spiriva) in an MDI format - works great for those who can't tolerate drugs with a powder base. Check out their prices. It indeed may be a whole lot cheaper per month than your copay of any other drug thru your insurance. I use echeck.
jmrommes Posted - Dec 30 2017 : 10:01:08 AM
Spiriva Respimat won't be available through ADC, but the dry powder version, Tiova, is. It is the same as Spiriva, and has been available through ADC for many years. Of the meds you listed, only Incruse is in the same class of medication (anticholinergic) as Spiriva.

The insurance companies are required to carry one med in each class, so they're meeting the requirement. Of the meds you listed, Advair and Breo are in the same class (LABA and ICS) and Anoro is a combination of a LABA and a LAMA.
Jocopd Posted - Dec 30 2017 : 08:47:32 AM
ADC - All Day Chemist. I recently ordered 90 caps for $36.00. Plus $10 shipping. So $46 for 3 months. It is the generic version of Spiriva and is called Tiova. I prefer ADC since both the generic spiriva and the generic advair I get come in clear capsules so you can see your actually getting the drug. If you want to know how to maneuver through the order process just let me know and I will post it since I was very lost the first time. I doubt I will even use my insurance any more for these 2 since the co pay would be $45 for one month each till donut hole.

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