Monthly Archives: November 2017

Four Airport Tips for Disabled Flyers

Thanksgiving is just a few days away, so I thought it would be a good time to repeat a few of my airline travel tips and add a few new ones.

Get the wait-time app

Needless to say, you need to get to the airport early on busy travel days. TSA appHow early? In the United States, the Transportation Service Administration has an app, MyTSA, which will help you judge. It will tell you:

  • The approximate wait-times at security checkpoints.
  • How historically busy the airport will be on your specific day and time of travel.
  • The delays and current weather at airports nationwide.
  • Which items you can bring with you through the checkpoint.

Get some wheels

Airports, particularly those handling international flights, can be huge. Even if you can walk you really don’t want to walk from check-in to the plane.

I travel with a scooter that’s very light and also can be folded like a travelscoot_classicbaby stroller. I drive my TravelScoot right up to the aircraft door. Its battery is taken on board (FAA regulations require that it be stowed in the overhead) and the scooter is stowed with the baggage. When we arrive, the scooter is returned to the aircraft door and off I go. (There are several other light scooters that fold. You can find them on the internet.)

This works well with a lightweight scooter. If your scooter is larger and heavier, or if you’re in an electric wheelchair, you’ll need to check it at the gate before flying rather than at the plane door. The airline will use an onboard wheelchair, if it’s necessary, to move you from the gate to your seat.

If you’re not disabled enough to use a scooter, arrange for a wheelchair. The airline will provide this from check-in to the gate and in reverse when you arrive. (There is no charge, though tips are accepted.) Request the chair when you make your reservation either via the airline’s website or with an agent on the phone. If you’re buying your ticket through a travel agent or third-party website, it’s a good idea to phone the airline three days ahead of your flight to ensure they know you need a chair. This notification also should be done if you’re traveling with a scooter or an electric chair.

As an extra benefit, whether using my scooter or in a wheelchair, we’re usually moved through security using the (usually faster) TSA Pre-check line. (Once, changing planes at London Heathrow, my wife and I were taken to a completely empty screening area).

Pre-select your seat

Don’t wait until you get to the airport to select your seat. Most airlines allow you to choose your seat when you buy your ticket or when printing a boarding pass. Doing this may allow you to nab an aisle seat or one near a restroom.

Many airlines now have two classes of coach seats: regular and premium. Premium, of course, costs a little more, but the extra leg room is worth it to me, even though I’m only 5-foot-6 tall. Those few extra inches allow me to stretch my legs and even to stand. I also can squeeze past others in the row more easily if I wind up in a window seat. And things are a lot less uncomfortable if the passenger in front of me decides to put his or her seat back as far as it can go … right into my lap.

Premium coach seats are at the front of the coach section, which means there can also be a downside to sitting in one. These seats are sometimes located far from coach restrooms, which are only in the rear on some types of aircraft. I’ve found, however, that if I explain to a flight attendant when I first board the plane that I have difficulty walking in the aisle, they’re usually willing to allow me to use the higher-class restrooms up front on the other side of that blue “iron curtain.”

Medications

Your meds need to go in your carry-on when you’re flying. You really don’t want to be without them if your checked bags are lost.

I travel with about a half-dozen oral medications. I keep them in their original pharmacy containers and carry those in a see-through food freezer bag. Using that method, I’ve never had a problem with security, in any airport in any country.

In the United States, the TSA considers needles and syringes medically necessary items and you can carry them on after they’re screened, just like pills. The Transportation Security Agency has a lot of good information about traveling with medications and medical devices on its website.

From my family to yours, I hope you have a thankful Thanksgiving.

(Featured photo by Nick Fewings, under Creative Commons

(This first appeared as my column on Multiple Sclerosis News Today)

 

Advertisements

Specialty Drugs Mean Specialty Prices

If you have MS, you’ve probably used a specialty drug. My first was Avonex, which I began to use about 1998. Several others followed.
There’s no formal definition of a specialty drug, but these therapies have several things in common. First, they’re expensive. According to the vice president in charge of specialty drugs at CVS Pharmacy, the average monthly cost is $3,000. A CVS website article says that’s about 10 times the cost of a non-specialty medication. Many specialty drugs are hard to administer, requiring an injection or infusion. And it may require special handling. My Avonex, for example, had to be shipped with dry ice to keep it cool.
So, I’m not surprised that the cost of specialty drugs is so much higher than your average prescription med. What really does bother me, however, is how fast the cost of these specialty drugs has been climbing.

Let’s look at the numbers

A few weeks ago, AARP released a lengthy report that studied 101 specialty drugs. Here are the headlines:
  • The price of the most widely used specialty prescription drugs increased substantially more than the general inflation rate in every year from 2006 to 2015.
  • From 2014 to 2015, specialty drugs had their highest annual price increase in a decade: an average hike of 9.6 percent. Inflation, on the other hand, increased by only 0.1 percent.
  • Prices for 29 chronic-use specialty drugs that have been on the market since the beginning of the study (from January 2006 to December 2015) increased cumulatively by an average of 177.3 percent. In contrast, general inflation increased by only 19.4 percent during the same period.

MS drugs are best-sellers

Multiple sclerosis drugs made up 12 of the 101 specialty drugs studied. Their average price rose 10.8 percent between 2015 and 2016, a little higher than the group average. Seven of those dozen MS drugs made the study’s list of 30 best-selling specialty drugs. (You can see the full list on page 30 of the report.)

RANK BY SALES DRUG DOSE DAILY COST 2015-16 HIKE (%)
6 Copaxone 20mg $201 7.6
7 Tecfidera 240mg $194 10.8
11 Copaxone 40mg $179 7.0
16 Avonex Auto-inject $198 15.2
17 Avonex Pre-filled $200 16.2
21 Rebif 44mcg $207 10.8
27 Betaseron 0.3mg $202 11.1

The drug that jumps out at me from this list is Avonex. Why should the price of a drug that’s been in use for nearly 20 years jump 15-16 percent in a year? Copaxone and Tecfidera both lead Avonex in sales, yet their price hikes were lower. Color me confused.

What’s the solution?

Is there a way to limit these price increases? In the CVS article I mentioned earlier, Dr. Alan Lotvin makes several suggestions, most of which don’t work for me.

Lotvin: “… Prior authorization and step therapy can be highly effective in controlling costs.”

Me: Step therapy means reducing costs by prescribing older, possibly less-effective drugs first rather than aggressively attacking MS with newer, more potent drugs. Some insurance companies insist patients follow this path, but it’s not the way that I want my MS treated.

Lotvin: “Another approach is the use of tiered formularies that require higher patient cost-sharing for more expensive therapies.”

Me: Yes, they do. And this is why many MS patients can’t afford to pay for the therapy that could be the most effective for them (though there are drug company programs that help some patients pay for these drugs).

Lotvin: “Ensuring that the drugs are administered at the lowest-cost site of care is also important — in most instances the hospital outpatient center is the highest-cost site of drug administration, while patients’ homes and doctors’ offices are typically the lowest.”

Me: Here, we agree.

The AARP study concludes:

“If recent trends in specialty drug prices and related price increases continue, it will almost undoubtedly become more difficult for patients to access and afford necessary specialty medications. The pricing patterns (price levels and price increases) for specialty drugs will lead to serious problems with respect to access and affordability issues in the future.”

Since access and affordability are already a problem, it seems to me that the future is now.

Yet, AARP offers no solutions, ending its report this way:

“Policy makers interested in reducing the impact of prescription drug prices should focus on options that drive significant innovation while also protecting the health and financial security of consumers and taxpayer-funded programs like Medicare and Medicaid.”

Well, yeah. But how do we find those options? The FDA has now approved generics for Copaxone 20mg and 40mg. That’s not an innovation, but, hopefully, it will help stick a pin in at least one specialty price balloon.

(This post first appeared as my column on http://www.multiplesclerosisnewstoday.com)

%d bloggers like this: