Why It's Important to Get Rid of Unused Medication

The best time to dispose of old meds is Oct. 28: 

National Drug Take Back Day

Consumer Reports /  Ginger Skinner

Last updated: October 26, 2017

When it comes time to dispose of your leftover or expired medicines, you might be tempted to just toss unused pills into the trash—20 percent of people get rid of their meds this way, according to a recent Consumer Reports Best Buy Drugs nationally representative survey of more than 1,000 Americans.

But discarded drugs can contaminate landfill soil and the water supply, according to a study published in 2014 in the journal Environmental Science. And pills can be fished out of the garbage by kids and even pets.

A far better way to dispose of old and unused meds is to drop them off at National Prescription Drug Take Back Day, this Saturday, Oct. 28.

Throughout the U.S., from 10 a.m. to 2 p.m., you can drop off unused pills and liquid medications at designated police departments, fire stations, health clinics, and other facilities in your community for proper disposal. (This doesn’t include inhalers or syringes; see below for how to dispose of those.)

To find a collection site near you, visit TakeBackDay.DEA.gov or call 800-882-9539. Drop-off is free and anonymous.

A Safer Way to Clear Out Old Opioids

To help reduce prescription drug abuse, the Drug Enforcement Administration, in conjunction with the Secure and Responsible Drug Disposal Act of 2010, launched Take Back Day seven years ago. Since then, this twice-yearly event has collected more than 900,000 pounds of medications.

Take Back Day goes a long way toward “eliminating the possibility of a family member or stranger removing your drugs from a medicine cabinet with the intent to misuse or abuse them,” says DEA spokesman Melvin S. Patterson.Many people keep old or unused pills such as opioids in their cabinets because they don’t know how to dispose of them, Patterson says.

Recent research bears that out: According to a survey published last June in JAMA Internal Medicine, 60 percent of people who had been recently prescribed an opioid—Vicodin, Percocet, and others—reported holding on to the drugs for future use. Almost half said that they weren’t aware of how to properly store or dispose of the drugs.Meanwhile, deaths from the use of these drugs have reached epidemic levels—91 people die every day from an opioid overdose, according to the Centers for Disease Control and Prevention.

“Anyone participating in Take Back Day is a welcome part of the solution to a significant problem,” Patterson adds. “It gives everyone an opportunity to take part in ridding our communities of old, unwanted, and potentially harmful drugs.”

The drugs you turn in on Take Back Day are all incinerated—never redispensed or put into landfills, Patterson says.

Other Ways to Dispose

If you can’t participate in Take Back Day this Saturday but still have unused meds to get rid of, follow these steps:

Buy an envelope and mail back your meds. Costco, CVS, and Rite Aid pharmacies sell postage-paid envelopes for a few dollars that allow you to mail any prescription pills or liquids, including opioids and over-the-counter medications, to a disposal facility to be incinerated. (Do not send inhalers or syringes.)

Drop off at a free kiosk in CVS or Walgreens. As part of its initiative to address opioid misuse, CVS this week announced that it plans to offer free, anonymous, secure drug disposal kiosks at 750 pharmacy locations across the U.S. Walgreens already also offers safe drop-off at in-store kiosks. (Medications are incinerated.) To use one, remove your personal information from the bottle or packaging and drop your unwanted or expired medication, including controlled substances, in the slot.

Toss meds in the trash (only if you can’t purchase a mail-back envelope or get to a CVS or Walgreens kiosk). Doing so can contaminate the soil and water supply, so this is not an ideal solution. If you must throw drugs away, first conceal pills (from kids and pets) by mixing them in a bag or another container and mix them with an unappealing substance, like used coffee grounds or kitty litter. Then seal up the container and toss the item into the trash.

Last resort: flushing. This is not ideal because trace amounts of flushed meds can end up in drinking water and possibly harm aquatic life. Our survey found that 17 percent of people said this was their typical disposal method.

The Food and Drug Administration suggests flushing certain drugs, like dangerous opioids, when they are no longer needed, because they could be deadly if accidentally taken by someone else, particularly children.

Disposing of Syringes and Inhalers

You won’t be able to dispose of needles, syringes, or inhalers at National Take Back Day. And it’s not recommended that you throw these items into the trash.

For inhalers, contact your local trash and recycling facility for proper disposal instructions.

For needle disposal, go to safeneedledisposal.org or call 800-643-1643 to find drop-off locations near you. You’ll also find information on pharmaceutical company mail-back programs.

Do Expiration Dates Matter?

Drug manufacturers are required by law to stamp an expiration date on medication bottles, cartons, and tubes; it’s the date the manufacturer can guarantee maximum safety and potency based on testing.

Our medical experts say you can keep most prescription and over-the-counter drugs for about 12 months past the expiration date, with critical exceptions. The antibiotic tetracycline should never be taken after that date, because as tablets break down they can become toxic and cause kidney damage. It’s especially important to keep nitroglycerin and other liquid meds, like insulin and epinephrine (i.e., EpiPens) up-to-date. They lose potency after the expiration date, so they might not work as well or at all in an emergency.

Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

National Clean Out Your Medicine Cabinet Day

Easy Steps for Getting Rid of Unused Medication

The risks for misuse and abuse increase with every bottle of pills you keep. 

Here’s how to safely dispose them.

Consumer Reports / Ginger Skinner / March 20, 2017

Today is National Clean Out Your Medicine Cabinet Day, and chances are you haven't given much thought to the unused medications taking up space in your medicine cabinet.

A new Consumer Reports Best Buy Drugs nationally representative survey of 1,006 American adults found that about one-third of Americans haven't cleaned out their medicine cabinets in a year or more; and nearly a fifth (19 percent) haven't done so in three years.

But those leftover pills are far from harmless.

Taking a drug not intended for you (or one taken by your child accidentally) could mean a trip to the emergency room—and can even prove deadly. Of particular concern are leftover opioids—narcotic painkillers such as Oxycontin, Percocet, and Vicodin.

A survey last June published in JAMA Internal Medicine suggests that there are a lot of opioids in people's medicine cabinets: 60 percent of respondents who had been recently prescribed an opioid reported holding on to the drugs for future use. Almost half said that they weren’t aware of how to properly store or dispose of opioids.

Don’t Hang on to Your Meds

Dan Budnitz, M.D., M.P.H., director of the Centers for Disease Control and Prevention's Medication Safety Program, suggests doing a yearly inventory of what’s in your medicine cabinet and discarding unused meds. Doing so will cut down on the risk of someone misusing a medication in your home—and not just young children, but teenagers, too.

When it comes time to clean out the cabinet or drawer, you might be tempted to just toss pills or other drugs into the trash. But because pills can easily be fished out of the garbage by a kid, you’ll want to take safer precautions instead:

1. Return unused medication to your pharmacy. (Or you can return it to a hospital, clinic, long-term-care facility, or narcotic treatment program.) New rules in 2014 from the Drug Enforcement Administration allow pharmacies to voluntarily take back your medications. This is an especially good option for opioids, ADHD drugs, and benzodiazepines (think: Xanax). Places that accept your unused medications are usually part of take-back programs, such as DisposeMyMeds, that collect and destroy (usually by incineration) unused drugs.

If you’re not sure what pharmacies accept meds, you can search for an authorized collector near you at DisposeMyMeds.org or DEAdiversion.usdoj.gov and search for "drug disposal." Or call the DEA’s Registration Call Center at 800-882-9539. It can also point you to fire and police departments, community hospitals, independent pharmacies, and other collection sites.

2. Drop off unused meds during National Prescription Take-Back Day on Saturday, April 29. Twice a year, the Drug Enforcement Agency holds National Prescription Take-Back Day, where you can drop off all your leftover medications at designated police departments, fire stations, and other specially designated facilities in your community for proper disposal. Drop-off is completely free and anonymous. If you miss this one, the DEA hosts a second one in the Fall.

3. Mail medication to a collection site. Costco, CVS, and Rite-Aid pharmacies sell postage-paid envelopes for customers to mail any prescription, including opioids, and over-the-counter medications to a disposal facility.

4. Use a self-service disposal kiosk. Walgreens offers free, anonymous, and secure kiosks in almost all states, and you can drop off any medication. To use one, remove your personal information from the bottle or packaging and drop your unwanted or expired medication, including controlled substances, in the slot.

5. Be responsible if you put pills in the trash—hide them in coffee grounds, sawdust, or kitty litter, then seal both in a plastic bag. If your local pharmacy won't accept your medication and drop-off at an authorized location is not an option, you can toss most pills in your household trash—just be sure to mix them with a substance that makes them less recognizable. (Don’t do this with opioids or other dangerous meds—it’s too easy for kids to fish these out of the trash and ingest them.)

6. For dangerous drugs, the FDA says flushing is an option. But trace amounts of drugs can end up in the water supply and possibly harm aquatic life. Flush dangerous drugs such as opioids only if there is absolutely no other choice.

What About Needles?

Most collection sites won’t accept asthma inhalers, needles, insulin syringes or any other syringes, marijuana, mercury thermometers, and medications containing iodine.

In some areas you can put asthma inhalers in the trash or recycling, but in other municipalities they’re considered hazardous waste and can’t be tossed in the regular trash. Check with your local sanitation company, recycling facility, or the health department for the rules where you live.

For disposal information and drop-off locations for syringes, needles, and other injectables—for example, expired EpiPens—go to Safe Needle Disposal or call 800-643-1643.

When in doubt about how to safely dispose of a medication or medical device, check with your pharmacist.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Congress Passes Bill with Billions for Cancer Research

But some consumer groups say new standards for drug approvals could put patients at risk

Consumer Reports / Teresa Carr / December 7, 2016

Congress has passed the most expensive and far-reaching health reform bill since the Affordable Care Act in 2010.

The 21st Century Cures Act, which garnered widespread, bipartisan support in both the House and Senate, is expected to be signed into law by President Obama soon.

The bill signifies an investment of billions of dollars over the next decade to fight cancer, prevent and treat brain disorders, and harness enormous amounts of data to develop individualized treatments based on person’s environment, genes, and lifestyle.

But the bill also lowers the bar for the kind of scientific evidence companies must provide to gain the Food and Drug Administration’s (FDA) approval for their products. It would mean, for instance, that in some circumstances the FDA could rely in part on individual patient experiences with a drug or device, instead of evidence from large-scale, randomized controlled clinical trials.

Rep. Fred Upton, the Republican from Michigan who chairs the House Energy and Commerce Committee and co-sponsored the bill, says the Cures Act "expedites the approval of drugs and devices and includes literally billions of dollars in additional spending for health research so that we can find a cure and the answers to what patients are demanding today.”

Consumer groups, including Consumers Union, the policy and moblization arm of Consumer Reports, have deep concerns that this effort to speed medical innovation comes with a potentially harmful tradeoff for consumers.

“The unfortunate consequence of 21st Century Cures is that less thoroughly tested medications and medical devices will reach the market,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. “And that means that consumers will have less assurance that a new treatment will help and not harm them.”

More Research Dollars

The bill directs $4.8 billion over the next decade to research, in part, to fight cancer.

“Considering that one in two men and one in three women will be diagnosed with cancer in their lifetime, cancer research funding is an investment in yours, mine, and everyone’s health,” says David Pugach, vice president of federal relations at the American Cancer Society Cancer Action Network, the advocacy arm of the ACS.

Pugach says 21st Century Cures represents a “historic opportunity” to accelerate cancer research. “This includes devoting more resources to improve and use new treatments like immunotherapy,” he says, “where the body’s own defenses are used against cancer—as well as creating ways for researchers to more easily share data so they can see patterns across studies more quickly.”

The bill also allocates funds to treat brain disorders, combat opioid abuse, improve suicide prevention programs, and provide mental health care to children. It establishes a task force for research on women who are pregnant or breastfeeding because these women are typically excluded from medical studies.

Faster Drug Approvals, But Lower Standards

The Cures Act loosens requirements for how drugs are studied and approved that have been in place since 1962.

Here's how it usually works: A company submits evidence from studies done under controlled conditions, comparing patients who received the treatment with those who didn't. The studies typically have to show that people who were given the new drug lived longer or felt better than those who didn't get it.

This kind of research can be expensive and time-consuming for drug companies to collect, says Diana Zuckerman, Ph.D., president of the National Center for Health Research, a nonprofit think tank focused on health research. Cancer drugs, for example, can take several years to show that a drug improves survival.

The Cures Act calls on the FDA to approve some drugs more quickly, based on less thorough testing. The problem with this, says Zuckerman, is that “getting drugs to market faster doesn’t help consumers at all if they turn out not to work or causes them harm.”

What Consumers Should Know

Once the Cures Act takes effect, consumers must be especially careful when considering a new medication or medical device, says Orly Avitzur, M.D., Consumer Reports’ medical director.

"When you have a choice, you may want to consider treatments with a proven track record, as you'll have more assurance that they work and are safe," Avitzur says. "Always make sure someone has taken the time to thoroughly explain all the options to you, and the possible risks and benefits of each."

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

A Generic EpiPen Might Not Be Your Best Option

Consumer Reports / Teresa Carr / August 30, 2016

Mylan is introducing a generic version of its life-saving EpiPen, 

but Consumer Reports has found another low-cost option

Mylan's plan to introduce a generic version of its life-saving EpiPen will cut the price in half, to $300 for a two-pack. But Consumer Reports has found that another low-cost option already exists.

Mylan announced the generic version of EpiPen after members of Congress as well as Consumers Union, the policy and mobilization arm of Consumer Reports, called for the manufacturer to lower the $600 price.

The generic EpiPen will be released in the next several weeks. But that's not your only—or perhaps even the best—option for getting the medicine and auto-injector.

There's already a low-cost epinephrine auto-injector available, the generic version of Adrenaclick. This product delivers the same drug, in the same dosages, but the auto-injecting mechanism works slightly differently.

It lists for about $450 for a two-pack, but we found that you could get it for as low as $140 at Walmart with a coupon from GoodRx.com. Your insurance might also cover it with a lower co-pay than brand-name EpiPens, and you might qualifty for further discounts using coupons through the manufacturer.

Mylan says that their new generic will be identical to their brand-name EpiPen. The generic device for giving yourself an injection with the drug ephinephrine will work exactly the same way to quell severe allergic reactions that interfere with breathing. And, like the brand-name version, the generic will be available in two doses—a 0.3 mg adult strength and a 0.15 mg strength for children.

Mylan told us that generic EpiPen will be available from pharmacies and directly from the company by mail.

Generic EpiPen Might Not Be Cheaper For You

With little competition and many years left on the patent for the EpiPen injector, it's "highly unusual" for Mylan to come out with a generic product to essentially compete with itself, says Stephen W. Schondelmeyer, Ph.D., Pharm.D., a professor of pharmacy economics at the University of Minnesota. "I think the company realized that they overreached on price," he says. "They can cut the price in half and still make a profit."

Even so, the generic EpiPen is overpriced, he says. "We're talking about a lifesaving product that costs a few dollars to make," says Schondelmeyer. "It's hardly a consumer win that the company has now decided to charge only $300."

Mylan told Consumer Reports that it won't offer coupons for the generic EpiPen, so even after it hits the market, some people might find it cheaper to stick with the brand-name version, says Barbara Young, Pharm.D., of the American Society of Health-System Pharmacists. "It really depends on your individual situation and insurance coverage," she says.

Young advises enlisting your pharmacists' help in pricing the various options—if possible before your healthcare provider writes the prescription. "Your doctor will need to write the prescription specifically for the device you decide on," she says.

For an EpiPen or generic EpiPen, your healthcare provider can simply prescribe the brand-name product. The generic is exactly the same, so pharmacists should be able to substitute it for the brand if you request it. To help lower the consumer's out-of-pocket costs if they are insured, Mylan announced last week it would offer larger discounted co-pay coupons, up to $300, and it expanded its patient assistance programs for brand-name EpiPens. However, those discounts are not available to people with Medicare or other government health insurance programs.

For generic Adrenaclick, your provider should prescribe "generic Adrenaclick" or simply "epinephrine auto-injector." Because those auto-injectors are slightly different than EpiPens, laws in many states prohibit phamacists from substituting one device for the other. (In some states, however, including California, Colorado, Connecticut, Florida, Vermont, and Washington, pharmacists can fill an EpiPen prescription with generic Adrenaclick, according to the drug's manufacturer, Impax Laboratories.) Just make sure that you get trained on the device before leaving the pharmacy, Young says. EpiPens and Adrenaclick pens are very easy to use and have similar instructions, but you want to make sure that you understand exactly what to do in an emergency situation.

More Competition on the Way

One reason Mylan might be coming out with a generic now is to get ahead of the competition. Earlier this year, the Food and Drug Administration turned down an application by drugmaker Teva for a generic epinephrine auto-injector due to "major deficiencies," but the company told us that it might reapply and that its product could enter the market next year.

In addition, Mark Baum, the CEO of Imprimis, a company that compounds drugs, told us that Imprimis is investigating selling epinephrine auto-injectors directly to consumers for about $100 for a two-pack of pens. Baum noted the company plans on selling them by the end of the year.

In the short term, an array of different options could make it more confusing for consumers, Young says. "But in the long run, the competition is likely to help bring down costs."


Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

What You Need to Know About Expired EpiPens

Consumer Reports / Ginger Skinner / August 26, 2016

Are they safe? And will they be effective in an emergency?

Anne McMaster, a retired nurse in Seattle with a serious allergy to bees, used to buy a new EpiPen every year when her current one expired. That stopped about three years ago when her out-of-pocket costs for the potentially life-saving medication spiked and she couldn't afford the higher price. Instead, she just kept her old injector, figuring an expired EpiPen is better than no EpiPen at all.

"I would never tell anyone else to do it because of the risks of it not working," McMaster says. "But for me, it was a risk I had to take."

Although there are some lower-cost alternative injectors on the market, and Mylan, the maker of EpiPen, says it is introducing programs to make the device more affordable for consumers, many Americans are wondering whether it is indeed okay to use expired EpiPens.

It's important to replace your epinephrine injector before the expiration date stamped on the pen. That’s because epinephrine deteriorates over time and relying on an outdated one (past the standard 12- to 18-month expiration date) can leave you with an auto-injector that's less effective, or not effective at all, when you most need it.

But what should you do if you are having an allergic emergency and the only injector you have is an expired one? It's probably better to use it than not, some experts say.

"If a patient were to experience an allergic emergency that required use of epinephrine and the only injector available was an outdated one, I would use it," says Andrew Murphy, M.D., a board-certified allergist at the Asthma, Allergy and Sinus Center in West Chester, Pa. "The risk would be that the epinephrine would have degraded and you may not get an optimal dose."

An April 2015 study in the Annals of Allergy, Asthma & Immunology looked at 35 expired EpiPens and found that injectors that were up to two years past their expiration date could retain 90 percent or more of the initial dose listed on labeling.

Murphy stresses that you shouldn't use any injector, even if it's technically not expired, if the medicine is pink or brown (instead of colorless), cloudy, or contains solid particles. In that case, "the medicine clearly has decayed and the injector should not be used at all," Murphy says.

Murphy also says that anytime you use an auto-injector—expired or not—you should call 911 or go to the emergency room, even if the shot seems to be working. That's because severe allergic reactions can require more than just a shot of epinephrine.

Storing and Disposing EpiPens
Be sure to store epinephrine auto-injector properly. And that doesn't mean in the refrigerator: Extremes of heat or cold can degrade the medicine, as can exposure to light and humidity. So while you might need to carry one around with you, when you are at home or work store it at room temperature in a dry, dark place. And while it might be tempting to keep a spare in the glove compartment of your car, that's probably not a good idea because it can get too hot or cold, in there. If your child needs one while at school, ask the nurse to keep it. Many schools have special lockers for such medicines.

It's also important to properly dispose of expired EpiPens or used injectors, says Barbara Young, Pharm.D., of the American Society of Health-System Pharmacists.

Auto-injectors thrown into in your household trash could prick or injure people or pets in your home. Instead, if you've used the injector, give the device to the healthcare professional you saw afterward. Take expired EpiPens to a doctor’s office, hospital, or pharmacy for disposal, Young says.

You can find a drop-off location near you at SafeNeedleDisposal.org.

A final tip: When filling an EpiPen prescription, ask the pharmacist to give you auto-injectors with the latest expiration date.


Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Is there a cure for high drug prices?

Anyone who takes medication realizes how much the cost has risen. 
Bernie Sanders gave CR's article "A Must Read" designation on his website.

Consumer Reports / updated July 29, 2016

The cost of prescription drugs for tens of millions of Americans rose $2 billion last year, and all signs point to a continued rise. At stake is nothing less than the ability of Americans to afford the medicines they need. Can we stop the madness?

Last August, Martin Shkreli, then the CEO of Turing Pharmaceuticals, did something considered so reprehensible that he was dubbed “the most hated man in America.” What caused the outrage? He increased the price of a little-known but important drug called Daraprim from $13.50 to $750 per pill. Daraprim is the best treatment for toxoplasmosis, an infection to which those with HIV/AIDs or cancer are susceptible.

The story went viral, and calls came from around the country, including from U.S. Rep. Elijah Cummings, D-Md., to stop drug entrepreneurs from gouging consumers for pure profit. Overnight, Shkreli became the poster child of pharmaceutical greed. And yet raising the price of a drug by that much is 100 percent legal.

What makes the case of Daraprim so important is that it brought a serious—and growing—healthcare problem out into the open: America spends a tremendous amount of money for prescription drugs—$424 billion last year alone before discounts, according to a new report by IMS Institute for Healthcare Informatics, a firm that tracks the pharmaceutical industry. And that number is rising fast with no sign of slowing down. What’s more, there are few regulations that shield consumers from the Martin Shkrelis of the world, or from drug companies that decide to raise prices to astronomical levels.

The Rampant Rise of Drug Prices

The practice of raising drug prices on new—and old—medications is common and widespread. From a nationally representative telephone poll conducted by Consumer Reports Best Buy Drugs in March, we learned that three in 10 Americans (about 32 million people) were hit with price hikes within the previous 12 months, costing them an average of $63 more for a drug they routinely take—and a few paid $500 or more. We also found price increases on everything from longtime generics used to treat common conditions such as diabetes, high blood pressure, and high cholesterol to new treatments for diseases such as hepatitis C. Our poll shows that when people were hit with higher drug costs, they were more likely to take unhealthy measures such as skipping doctor appointments, tests, or procedures, or not filling their prescriptions or taking them as directed.T

Take the case of Marlene Condon, a nature writer living in Crozet, Va. Two years ago she paid about $32 for 180 tablets of hydroxychloroquine (a generic available for almost two decades) to treat her rheumatoid arthritis. When the drug’s price more than doubled to $75, Condon says she was annoyed but paid the bill anyway. Then, last September, the price of her drug skyrocketed, costing her $500 out of pocket. Condon panicked and did what thousands of Americans do under those circumstances: She stopped taking the drug. Her arthritis pain grew much worse. Walking and doing simple household chores such as washing the dishes became almost impossible.

The Forces of Profit

Our analysis suggests that high prices for generic and brand-name drugs stem in part from a battle over profit between mammoth industries—big pharma and insurance companies—with consumers caught in the middle. On the one hand, pharmaceutical companies blame insurance companies for passing along high costs to consumers. And insurance companies point to very high-priced drugs for which there are few or no alternatives, which ultimately affects how much insurance coverage people receive and how much they must pay out of their pockets.

“Even as more patients have health insurance coverage, many more are facing high pharmacy deductibles and rising out-of-pocket costs, and other barriers to care, putting their ability to stay on needed therapy at risk,” says Holly Campbell, a representative at PhRMA, an industry association that represents pharmaceutical manufacturers.

“If there’s one treatment and there’s no alternative and no competition, then that’s where the challenge is,” says Matt Eyles, executive vice president of policy and regulatory affairs at America’s Health Insurance Plans (AHIP), a national trade organization for the insurance industry.

Click for more info: http://www.consumerreports.org/drugs/cure-for-high-drug-prices/

• Reason 1: Drug Companies Can Charge Whatever Price They Want
• Reason 2: Insurance Companies Are Also Charging You More
Reason 3: Old Drugs Are Reformulated as Costly ‘New’ Drugs
• Reason 4: Generic Drug Shortages Can Trigger Massive Price Increases
• Reason 5: Specialty Drugs Are Costing All of Us

What the Government Can Do

Consumers are looking to the government to take action to control drug prices. In our CR Best Buy Drugs poll, 77 percent of people taking a medication said the government should allow more generics onto the market sooner; 74 percent want the government to pressure drug companies to charge less. Seventy-nine percent say insurers should pressure pharmaceutical companies to lower drug prices; 81 percent said consumers should do the same.

More specific steps that could help control costs include asking the government to:

• Set a limit on out-of-pocket costs. That would ensure that consumers have some protection against very high costs or sudden large spikes in prices. For example, last year California enacted a law so that a consumer won’t pay more than $250 for a single prescription drug per month, or $500 for certain high-deductible plans.
• Approve more generic versions of common drugs. Currently, 4,300 generic drug applications await an FDA decision. The agency says it’s working to review new applications within 15 months.
• Allow limited importation of drugs from legitimate Canadian and European sources, which currently is illegal under U.S. law. The ability to import drugs from countries that have a regulatory system similar to that of the U.S. could alleviate shortages or moderate prices.
• Use government’s existing “march-in” rights. It works like this: If there is a problem with the public’s access to a drug (a supply shortage or an exorbitant price), and if a drug was developed using taxpayer money, the Department of Health and Human Services has the right to force the company to allow another manufacturer to make generic versions that are cheaper for the consumer.

What Drug Companies Can Do

The most obvious help pharmaceutical makers can provide is to charge less—or at least slow the pace of price increases. There is a precedent: Rising drug prices in the 1990s led to public outcry and congressional hearings. And fearing price controls, nine drug companies, led by Merck, made a pledge to keep price increases at or below increases in inflation.

“Pharma has a right to make a profit,” says Riley of the ACP, but it also has a “moral obligation” to be transparent about its pricing because it benefits greatly from government-funded research. “The American taxpayer has been providing the venture capital to fund their products,” he says. “The public deserves to realize a return on that investment in the form of medications they can afford.” But pharmaceutical industry representatives think the focus on price alone is misguided and threatens “to squander our opportunity to usher in the next wave of medical progress,” says Campbell at PhRMA. States are starting to fight back. This past June, Vermont passed the first legislation in the U.S. that requires drug companies to justify high costs and price increases, and to calculate the financial effect on insurance premiums with a select set of drugs. California is currently considering a similar bill.

What Consumers Can Do

Although much of drug pricing is out of consumers’ hands, consider these tips to find the best deals at the pharmacy:

• Talk to your doctor about the cost of the drug she is prescribing. For less expensive alternatives,ask about generics, which can cost up to 90 percent less. Your doctor might consider “therapeutic substitution”—a different drug that works as well. If your insurance drops or reduces coverage of a drug, your doctor can also help by appealing to your insurance company for an exception to cover the drug anyway. The administrative process for filing the exception is different with each insurance company and can take a few weeks before a decision is made.
• Shop around and negotiate. Consumer Reports’ secret shoppers have found that retail drug prices can vary widely, even within the same ZIP code. Our shoppers also found that asking, “Is this your lowest price?” could get you further discounts.
• Check online. If you pay out of pocket, check GoodRx to learn a drug’s “fair price.” You can also fill a prescription with a low-cost online pharmacy based in the U.S., such as HealthWarehouse.com. Be careful of fraudulent websites: Use only an online retailer that operates within the U.S. and displays the VIPPS symbol to show that it’s a Verified Internet Pharmacy Practice Site.
• Choose a plan that covers the medications you need. Compare plans during your open-enrollment period because coverage may change from year to year. Keep in mind that high-deductible plans have lower premiums but require you to pay a larger chunk of your drug costs.

Consumer Reports Is Working to Lower Drug Costs

You are outraged by rising drug costs, and we’ve listened. Because we do not accept money from the pharmaceutical industry, we can call it like it is. If a drug is too risky or a poor value, we are not afraid to say so. We want your voice to be heard by industry and government. We are advocating for a range of evidence-based solutions for lowering consumers’ out-of-pocket costs, ensuring access to essential medicines, and getting better value for our country’s prescription-drug spending—without sacrificing safety or effectiveness. See ConsumerReports.org/drugprices for more.

Editor's Note: This article also appeared in the August 2016 issue of Consumer Reports magazine.

Funding for the preparation of this article was provided in part by the Atlantic Philanthropies and by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumerfraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

*Clarification, July 29, 2016: An earlier version of this article indicated that Woodard’s injection lasts about a week. He gives himself a daily injection from a pen that lasts about a week.

Click for full article and more info: http://www.consumerreports.org/drugs/cure-for-high-drug-prices/

Sleep aids carry an array of risks, including next-day hangover effects

Consumer Reports / April 22, 2016

Sleeplessness is complicated — but that hasn’t stopped millions from craving a simple chemical solution. Potions to ease the misery of insufficient sleep can be traced to the ancient Egyptians, who employed an extract of the opium poppy.

In a Consumer Reports survey, 37 percent of people who complained of sleep problems at least once per week said they had used an over-the-counter or prescription sleep drug in the previous year.

“But those benefits aren’t as great as many people assume, and the drugs have important harms,” says Dr. Lisa Schwartz, a drug-safety expert at Dartmouth’s Geisel School of Medicine in Hanover, N.H., who has worked with Consumer Reports Best Buy Drugs on investigating sleeping pills.

What’s more, the survey found that about half of people who take sleep aids use the drugs in potentially harmful ways — by, for example, taking them more often or longer than recommended or combining them with other medications or supplements.

Even taken as directed, sleeping pills pose risks, including next-day drowsiness. A study published online in June 2015 by the American Journal of Public Health found that people prescribed sleeping pills were around twice as likely to be in car crashes as other people. The researchers estimated that people taking sleep drugs were as likely to have a car crash as those driving with a blood alcohol level above the legal limit.

Several sleeping-pill instructions caution users to take the medications only if they can stay in bed for at least seven or eight hours.

And to address the dangers of next-day drowsiness, the Food and Drug Administration has cut in half the recommended doses for Ambien and Lunesta.


The labels for Ambien CR and Belsomra 20 milligrams, in fact, caution against driving at all the day after taking the pill. Yet Consumer Reports’ survey found that about a quarter of sleep-aid users drove with less than seven hours of sleep at least once in the previous year.

Sleeping pills can pose other dangers, too, including dizziness, falls, and fractures.

“These drugs are known to have a hangover effect that impairs coordination and balance into the next day, especially in older adults,” says Dr. Ariel Green, a geriatrician at the Johns Hopkins University School of Medicine in Baltimore.

Even over-the-counter sleep aids — such as Advil PM, Sominex, and ZzzQuil — pose risks, including daytime drowsiness, confusion, constipation, dry mouth, and problems urinating.

Consumer Reports’ medical experts recommend following these precautions, which apply to both prescription and over-the-counter sleep drugs:

■ Tell your doctor about all of the medications you take, including supplements. Many common drugs, such as certain antibiotics and antidepressants, can interact dangerously with sleep drugs.

■ Take the drugs only if you have time for at least seven or eight hours of sleep. Even if you’ve had that much sleep, don’t drive if you feel drowsy.

■ Do not take an extra dose if you wake up in the middle of the night.

■ Never mix sleeping pills with alcohol, recreational drugs, or other sleep drugs or supplements, including over-the-counter nighttime pain relievers and antihistamines, such as Benadryl Allergy, that contain the sedative diphenhydramine.

■ Start with the lowest recommended dose, especially until you know how the drug affects you.

■ Be cautious about frequent use. Taking sleep drugs regularly can breed dependence and raise the risk of adverse effects.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Why Where You Store Prescription Painkillers Is So Important

Consumer Reports / Lisa Gill/ December 2015

Deaths due to these powerful drugs are on the rise, 

but our poll finds most people don’t secure them

Americans have a lot of painkillers sitting around in their homes, and some of these unused drugs can pose dangers to children and others.

In fact, of those who take any kind of prescription medication, more than 80 percent of people in a recent Consumer Reports poll said that they don’t lock up their narcotic painkillers, such as Oxycontin, Percocet, and Vicodin—and nearly three-quarters said they had children living at home. That translates to more than 16 million households across the U.S. where powerful opioid painkillers sit unsecured in medicine cabinets, closets, and kitchen drawers. 

The Consumer Reports National Research Center conducted the telephone poll of a nationally representative sample of more than 2,000 U.S. adults in June 2015.

The results are concerning because too many of those potentially deadly drugs wind up in the wrong hands. Pain relievers are by far the most commonly abused prescription drugs, with more than half of people who abuse them reporting that they got the drugs for free from family and friends, according to the National Institute on Drug Abuse. 

The results can be tragic. More than 47,000 Americans died of a drug overdose in 2014—more than during any other year on record, according to a new report released last week from the Centers for Disease Control and Prevention.

The number one culprit? The same painkillers that some people don't keep locked up. In fact, the CDC report found that overdose deaths from prescription pain relievers, which have skyrocketed in the last decade, also reached record highs—up 9 percent in 2014 alone.

“Leaving narcotic drugs unsecured is like having a loaded gun lying around,” says Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser, noting that when it comes to prescription pain relievers, there’s little margin for error. Using someone else’s medication, taking too much, or combining it with the alcohol or certain other medications can be a fatal mistake. 

Safer Strategies for Dealing With Prescription Painkillers

“You may not think anyone would get into your medication, but you’d be surprised,” says Lipman. “It could be anyone from an inquisitive youngster to someone seeking the drugs to sell or for recreational use.”

Teens who have abused prescription medications, for example, cite friends and their parents' medicine cabinet as the most common sources for the drugs.

Lipman advises taking two steps for safer, more responsible handling of narcotic drugs at home.

Lock them up. Secure prescription pain relievers and all other medications up and out of sight of visitors and children in a locked cabinet or container. Don’t keep loose pills in bags or containers in your purse, luggage, or office drawer and, when you travel, keep medications in a locking case.

Discard unused pills properly. You can take unwanted medication to drop-off spots at pharmacies, hospitals, clinics, and long-term care centers any time of the year, with no appointment needed. Or you can mail it in to collection centers in special envelopes that are available from pharmacies and other designated locations. To find out where to drop off pills or pick up a mailer, call the DEA’s Registration Call Center at 800-882-9539 or go to deadiversion.usdoj.gov and search for “drug disposal.”

If there’s no drop-off spot in your area and you don’t want to use the mail-back option, the Food and Drug Administration recommends flushing them down the toilet. That’s usually a bad idea because of the possibility of contaminating the water supply and possibly harming aquatic life. But the danger of someone accidentally getting his or her hands on opioids make flushing an acceptable option if you have no other choice.

Taking leftover pills from an old prescription can be dangerous. Read more surprising facts about prescription pain relievers.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

4 Ways to Get Insurance to Cover Your Prescription Drugs

Reprinted from Consumer Reports / Ginger Skinner / February 12, 2016

If your medication costs have shot up, ask your doctor for help

If your medication prices seem higher than last year, one culprit might be changes to your insurance company’s “formulary”—the list of drugs covered by your health plan.

During the year, insurance plans may change which prescription treatments they cover, and that’s true especially when it’s time to re-enroll.

Formularies are often developed to encourage people to use the least expensive medications whenever possible. But that list can change if an insurer negotiates a better deal with a drug company, if new research shows the medication isn’t as safe or effective as thought, or a less expensive generic version of the drug hits the market.

Even if your drug is covered on an insurance company’s formulary, the full cost of it may not be. Where an insurance company places a drug on its formulary, the list of drugs is further divided into what is called a ”tier”—and it’s essentially a way to determine how much you’ll pay out of pocket for it, through your co-pay. The higher the tier the higher your share of the costs.

"Consumers need to be on guard because drugs can be taken off a formulary at any time, or moved to a higher tier, which could make a big difference in your share of the costs," says Betsy Imholz, Consumers Union's director of special projects.

Most plans have about four levels, or tiers, of coverage, but in the last few years, more insurers have added a fifth tier by splitting the "generics" tier into two: "preferred" and "nonpreferred." Insurance companies do this to encourage people to choose less expensive medications.

Your copay for a drug in the non-preferred generic tier, for example, may be $15, compared to a preferred generic in the lowest tier, where your copay could be $5 or less. 

Diligently checking your plan's formulary (you can find it on your insurer’s website) can help you avoid getting stuck with paying the full costs of your prescriptions. But if it turns out a drug you're taking is dropped or moved to a higher tier, you have several options:

1. Switch Drugs. Ask your doctor to prescribe a drug on your formulary that may be just as effective and safe for your condition. Most plans will offer one or more alternatives to a medication they no longer cover.

2. Ask for an Exception. "Many people don't realize that just because a drug is not on your plan's formulary does not mean it's unavailable for coverage," says Imholz, "Work with your doctor."

If a drug alternative is not possible, your doctor can file an exception, or "prior authorization," through your health plan, requesting that the drug be covered because it’s medically necessary. If that happens, your plan should approve or deny your request within a few days.

3. Try Step Therapy. Depending on what medication it is, after your doctor files an exception, some plans may require that you agree to “step therapy” first, which is a type of prior authorization. It means trying other lower-cost medications that are appropriate for your condition first. If the lower-cost drug doesn’t work for you, your doctor can ask your insurer to cover the more expensive drug. 

4. File an Appeal. If your insurer still denies your request to cover a drug you need, you can file an appeal. You and your doctor can either complete and file an appeals form provided by your insurer, or write a letter that includes the name of the drug, why you need it covered, and any other supporting documents from your doctor. Your insurer's website will provide more details on the appeals process.

If your plan denies your appeal, you can file for an external, or independent, review with your state’s insurance regulator, which will make the final decision.

If your state doesn’t have an external review mechanism, the Department of Health and Human Services (HHS) or an independent review organization will oversee the process. A decision can take up to 60 days and is free if handled by the HHS, but may cost you to $25 if it’s handled by your state or an independent review organization.


When All Else Fails, Shop Around
Filing an appeal can be a lengthy process, and there’s still no guarantee that your insurer will agree to cover your medication. If you end up having to pay more for your medications out-of-pocket, shop around.

Our secret shoppers have found that prescription prices can vary widely from one pharmacy to the next, even in the same zip code. Costco often offers low prices (you don’t have to be a member) and independent pharmacies may be able to negotiate. And ask your pharmacist if you can save more by not using your insurance; many chains and big-box stores, such as Target, Walgreens, and Walmart, offer hundreds of generics for as low as $4 for a 30-day supply and $10 for a 90-day supply.

When it's time to re-enroll or change insurance plans, before choosing coverage, Imholz recommends checking the formulary to make sure the drugs you need are covered and under which tier.


Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

6 ways to reduce the price you pay for prescription drugs

Reprinted from Consumer Reports February 1 at 3:15 PM

Are you paying more at the pharmacy counter? 

Consumer Reports’ Best Buy Drugs experts have ideas 

that can save you time and money.

Ask for a discount. When Consumer Reports had its secret shoppers contact a variety of pharmacies by phone to price a market basket of common medications, they found that asking for the best deal got them occasional discounts. For example, at a supermarket pharmacy outside Des Moines, a shopper was first quoted a price of $75 for generic Actos, a diabetes drug, but after asking whether there was a better deal, she was offered the drug for $21.

Other tactics: Be sure to ask what a medication will cost if you don’t use your insurance (a generic’s price may be less than your co-pay), and ask about any senior, student or other discounts for which you may be eligible.

Shop around. Retail drug prices can differ greatly from one drugstore to the next, even in the same Zip code. For example, in Denver, the grocery store Albertson’s Save-On said its price for generic Actos was $330, but nearby Cherry Creek Pharmacy said it would sell it for just $15.

What about online drugstores? Skip those that are based in other countries, no matter how good the discounts. It’s illegal to order drugs for import from outside the United States, and they may not be safe or effective. If you want to order online for convenience, do so only from big-box stores, chains and independents that you know and trust. And because it’s wise to fill all of your prescriptions at one store (so that the pharmacist can flag potential drug interactions), once you find lower prices on the medications you take regularly, make it your go-to pharmacy.

Consider Costco. In all states, you can fill prescriptions there without being a member. And if you pay for medication out of pocket, you may reap big savings. Consumer Reports’ shoppers found that Costco usually offered the lowest retail prices on drugs. For example, a month’s supply of the antidepressant duloxetine was $220 at a Kmart and a Walgreens in Raleigh, N.C., but only $43 at a nearby Costco.

If you’re a member, you can join the Costco Member Prescription Program for free. That can net you savings of up to 40 percent on brand-name and generic meds (but only if you don’t have drug coverage or if insurance doesn’t cover all of your prescription medications).

Call the independents. The secret shoppers found that independent pharmacies, which are often smaller, can offer extremely low prices on certain medications. You may also have better luck negotiating at independents, which may have more pricing autonomy than chains. To find out whether an independent near you has a better deal on the medications you take, call several to ask for their absolute lowest prices.

Think 90 days. If you take drugs long term, you may be wasting time and paying extra money by making a monthly trip to the pharmacy for refills. Ask your insurance company whether you can get three months’ worth of medicine at a time. If you can, have your doctor write a 90-day prescription.

Skip economy-size OTCs. You probably think you save the most money by buying the largest available containers of over-the-counter drugs. But the shoppers found that the savings on medium sizes were often comparable to the biggest bottles because drugs in economy sizes are more likely to expire before you get a chance to use them all. Small sizes of OTCs were the worst buy of all.

Copyright 2015. Consumers Union of United States Inc.

For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.

Are Pricey New Cholesterol Drugs Worth the Money?

Consumer Reports
Steve Mitchell
January 19, 2016

Praulent and Repatha can dramatically lower your cholesterol—but aren't proven to prevent heart attack or save lives

You may have heard about two expensive new cholesterol-­lowering drugs: alirocumab (Praluent) and evolocumab (Repatha). Both are injectables recently approved by the Food and Drug Administration and are expected to cost $1,100 to $1,200 per month. That compares with about $48 per year for commonly prescribed cholesterol-­lowering statin drugs such as generic lovastatin, pravastatin, and simvastatin.

Those new drugs, called PCSK9 inhibitors, can dramatically reduce LDL (bad) cholesterol—even in people who’ve been unable to sufficiently lower their LDL with the maximum dose of a statin. But it’s not yet known whether that translates into a reduced risk of heart attack, stroke, or premature death—and that question won’t be answered until ongoing studies have been completed.

In addition, because the medications are so new, their long-term safety is unknown. The most common side effects seen so far include pain at the injection site and symptoms similar to those of a cold or the flu. Serious allergic reactions have occurred as well.

So should you ask your doctor about adding one of the new cholesterol drugs to your regimen? For now, the drugs are approved only for people with a genetic condition that causes extremely high LDL levels, and those who have already had a heart attack or stroke and can’t get their LDL levels down despite high-dose statins and a serious effort to make lifestyle changes.

If you fall into one of those categories, ask your doctor whether you should wait until more is known about the drugs, or whether they make sense for you to try now. Other people should definitely wait.

Be aware that if you do start either of the new cholesterol drugs now, your health insurance may cover the costs only if you take it for one of the FDA’s approved uses. And it’s still unclear whether Medicare will cover the drugs.

Both Sanofi (the maker of Praluent) and Amgen (which makes Repatha) told us that they have programs that can lower out-of-pocket costs for some people. But there are eligibility restrictions—you can’t be on Medicare or Medicaid, for example. And depending on the program, you may have to give the pharmaceutical company information such as your medical history and doctor’s name.

For more on cholesterol medications, see our free Best Buy Drugs report on statins.

Editor's Note: This article also appeared in the February 2016 issue of Consumer Reports On Health.

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

New Blood Pressure Guidelines

Do the new blood pressure guidelines affect me?

Consumer Reports
Steve Mitchell
January 17, 2016





New research on the benefits of much lower levels--what it really means for you

Confused about how low your blood pressure should really be? That’s understandable, considering the many headlines that a major new study has generated.

The study, dubbed the Systolic Blood Pressure Intervention Trial, or SPRINT, suggests that a blood pressure level that is much lower than what is currently recommended for some people can significantly cut the risk of heart failure and death from heart problems. That's prompted some experts to suggest new blood pressure guidelines for who needs to take medication, and how low their levels should go.

But many experts, including our own at Consumer Reports Best Buy Drugs, say it’s unknown whether the SPRINT findings are relevant for most people with high blood pressure. That’s because the study looked only at a small, high-risk subset of hypertension sufferers.

Old Questions, New Answers

If you’ve received a hypertension diagnosis, it’s important to keep your blood pressure at a healthy level. Uncontrolled high blood pressure leads to more heart attacks and strokes in the U.S. than any other cause. But how low is low enough?

Under current guidelines, the ideal is a systolic pressure (top number) of 120 millimeters of mercury or less and a diastolic pressure (bottom number) of 80 mmHg or less. You’re considered to have high blood pressure if the systolic hits 140 or the diastolic goes to 90 or above. But experts have long debated whether those with high blood pressure need to get their levels all the way down to the ideal or whether somewhere below the cutoff for high blood pressure is fine.

The SPRINT study sought to end this debate, and at first glance, the results suggest that lower is healthier. Here’s why: The government-funded trial involved more than 9,300 people with elevated blood pressure and a high risk of heart attack. They were given medication to reduce their blood pressure. About half aimed to lower their systolic pressure to 120; the other half stuck with a goal of 140.

The study was slated to run for five years but was stopped after slightly more than three years because results were so dramatic. During that time, 65 people in the group aiming for a systolic pressure of 140 died and 100 developed heart failure. Of those trying to get down to a systolic of 120, only 37 died and 62 developed heart failure, researchers reported in the New England Journal of Medicine.

Gary Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), SPRINT’s primary sponsor, says the findings will prompt new blood pressure guidelines and save lives.

But the benefits came with significant downsides. To get their blood pressure to 120, people in the study had to take three blood pressure medications on average. That led to almost double the instances of serious side effects, including some that required emergency care at a hospital, such as kidney failure, dangerously low blood pressure, and imbalances in potassium or sodium blood levels.

Also, many people find it difficult to take their blood pressure medication consistently, and an additional pill may increase that challenge, notes Michael Pignone, M.D., chief of internal medicine at the University of North Carolina School of Medicine in Chapel Hill. In fact, because of side effects, the need to cut costs, and/or other factors, up to one-half of people stop taking their high blood pressure medication within one year. “Putting somebody on more medications if they’re not consistently taking their current regimen is not a helpful strategy,” Pignone says.

Who's Affected

SPRINT focused on a specific group of people with hypertension: those 50 and older with at least one other chronic condition, such as heart disease or kidney disease (both raise heart attack and stroke risks), and those 75 and older. Only about one in six people with high blood pressure is in such a high-risk group.

If you are, talk with your doctor about whether lowering your systolic blood pressure to 120 is worth the risk, says Harlan Krumholz, M.D., a cardiologist at Yale University. Otherwise, he adds, you may not need to lower your goal to 120, based on these new findings.

Talk with your doctor about making important lifestyle changes that can help reduce blood pressure (see “Make Lifestyle Changes First,” below). Those are especially important for people like those in the group studied in SPRINT.

For the Rest of Us

If you’re not in one of the previously mentioned high-risk categories, what should your blood pressure levels be? Our medical experts consider 150/90 a reasonable goal for most people 60 to 75 who don’t have other risk factors. They suggest a goal of 140/90 for people younger than 60, those with diabetes, and those younger than 50 with chronic kidney disease.

Those numbers are based on recommendations from an independent expert panel convened by the NHLBI. The panel notes that achieving levels below 140/90 can require additional blood pressure drugs or high doses. That increases the risk of previously mentioned side effects, and—depending on the drugs—problems such as persistent coughing, erectile dysfunction, and frequent urination.

But Be Sure of Your Numbers

Uncertain about your blood pressure level? Get it measured, even if you think it’s fine. The U.S. Preventive Services Task Force recommends that everyone 18 and older be screened for hypertension. Having high blood pressure generally causes no obvious symptoms, so an estimated one-fifth of American adults with the problem don’t know they have it.

Surprisingly, the most accurate way to measure your blood pressure is not at your doctor’s office. Up to 30 percent of people receive an incorrect diagnosis of high blood pressure, often because their blood pressure is normal at home but spikes in a doctor’s office—perhaps because of anxiety. Blood pressure can also fluctuate depending on factors such as sitting position, bladder fullness, and placement of the monitor’s cuff.

The gold standard method for measuring blood pressure—known as ambulatory monitoring—involves wearing a small, portable device that records your blood pressure at frequent intervals over 24 hours. But that monitoring, prescribed by your doctor, isn’t widely available, and insurance might not cover the cost. A good alternative, the task force says, is a home blood pressure monitor. Record levels once in the morning and once in the evening for a week.

Make Lifestyle Changes First

If your systolic level is moderately elevated (150 to 160 for people 60 and older, 140 to 150 for others) and you are otherwise at low risk for heart disease, try lifestyle changes before considering medication.

Losing weight, exercising more, cutting back on sodium, quitting smoking, and limiting alcohol to no more than two drinks (24 ounces of regular beer, 10 ounces of wine, or 3 ounces of 80-proof whiskey) per day for most men, and no more than one daily drink for women can lower your blood pressure and sometimes allow you to reduce your drug dosage or eliminate your need for it. Consider medication only if your blood pressure hasn’t dropped enough after six months of lifestyle changes.

And if you do end up needing medication, it’s important to continue those healthy habits.

Editor's Note: This article also appeared in the February 2016 issue of Consumer Reports On Health.

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).