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Medically reviewed by, Russell Braun RPH
Linzess also know by its chemical name Linaclotide is a medication used for treatment of irritable bowel syndrome (IBS) with constipation (IBS-C). It can also be used for constipation form an unknown source. That is called Chroni idopathic consipation (CIC)
At this time there is no generic available for Linzess and due to that fact, the medication is very expensive. Here are 9 tips for dealing with constipation and paying for Linzess if it is the medication for you.
#1 Remember Linzess is not a laxative
Linzess is not a laxative. It is in a new class of drugs called guanylate cyclase-C agonists. That is a fancy way for saying it increases the amount of fluid into the intestine which increases the mobility of the stool. This is also supposed to lower the sensation of pain that is triggered by constipation.
A laxative is something that loosens stools and increase bowel movements to promote emptying of the bowel. Linzess does not technically fit into this definition and is not considered a laxative.
However, both Linzess and laxatives work to relieve constipation and create the same effects.
Many laxatives exist both available by prescription and over the counter. In some cases people with chronic constipation will overuse laxatives, which can lead to some dangerous consequences.
With either Linzess or laxatives if the treatment ends up producing diarrhea, then you need to use caution.
Diarrhea may not seem like a big problem when you are having constipation issues, but if it persists long enough it can affect your body chemistry and put you at risk for several health problems such as heart arrhythmias which can be very serious.
#2 No generic in site
Linzess was approved by the FDA in 2012. Unfortunately, the patent life is not close to expiring at this time.
In fact there has already been court cases over this patent. The two manufacturers that have a joint venture to make Linzess, Allergan and Ironwood Pharmaceuticals came to terms with a generic manufacturer.
That generic drug maker, Aurobindo Pharma got approval to start making a generic version of the drug but not until 2030!
Make sure you review the rest of the post to see what you can do if you are stuck paying high prices for Linzess.
#3 OTC options
Laxatives can be a cost effective option when treating IBS or other constipation that is chronic and of an unkown reason.
This should only be your plan if managed with your doctor!
You should always discuss any OTC laxatives with your doctor and pharmacist so they know you are taking these in addition to any other medications you take as their could be dangerous drug interactions.
Using a medication list is always a good idea, see my free medication list that I have created that combines all the most important points you need to have with you at all times.
The types of laxatives available work in slightly different ways and if one type is not effective for your constipation, combining different types can provide relief for many patients. While the thought of taking more than one medication may seem overwhelming, it can save you a lot of money over newer brand name medications that can be quite expensive.
Different types of laxatives available are listed below with examples. For simplicity I listed brand names, you should use the generic versions ask your pharmacist to assist you in finding the generics:
- Bulk forming laxatives: Examples-Fibercon, Metamucil
- Stimulant laxative: Examples- Senna, Ducolax
- Osmotic laxative: Examples- Miralax, Milk of Magnesia
- Lubricant laxatives: Example – Mineral oil
Another important medication for patients who suffer from constipation are stool softeners. These do no actually work as laxatives do, though many will refer to them as a laxative. Instead they coat the intestines with a surfactanct that is like soap. Making the stool more slippery in the intestines and making it easier to evacuate the stool.
- Stool softeners: Examples – Colace
IBS often can have constipation and diarrhea
Since IBS can fluctuate back and forth between constipation and diarrhea, it is important that you have an action plan for when to use laxatives and when you should hold off.
After you discuss with your doctor which laxative you are going to use, they can write you a prescription. Take that to your pharmacy and have your pharmacist help you find the appropriate generic product to use.
Some laxatives might be able to be filled as a prescription by your insurance. You will want to confirm if that is a more economical route for you to take when talking to your pharmacist.
Constipation is a common problem. Constipation due to IBS or chronic constipation are more problematic and need to be dealt with in conjunction with your doctor and pharmacist.
However, no matter the type of constipation, there are some common lifestyle changes that can and should be implemented.
Exercise stimulates muscle movement in the intestines and is good for you for many, many other reason.
Drink at least 100 ounces of water per day. That comes out to 12-13 cups of water in an 8 ounce glass.
Soft drinks and sugary drinks do not count. These can actually make you build up gas which increase the pain when constipated.
Adjust your diet to eat foods that are less likely to cause constipation. Foods known to cause issues with IBS include nuts, especially peanuts, citrus fruit, corn, apple peels, things with seeds and pineapple. A high fiber diet is a very good idea. Bananas can increase constipation if eaten daily.
#5 Prescription medications
Your next option are prescription medications for constipation. You will likely need prescription strength medication at some point if you have IBS-C or constipation of some other origin.
Most of these drugs replicate what your body does naturally to try and overcome constipation. Food is broken down by chewing, stomach acid and in the intestines. Fluid in the intestines starts to create the stool from what is not absorbed from our food.
If not enough fluid is available constipation can occur. The following prescription medications either increase fluid in the intestines.
Make sure you discuss with your doctor any other laxatives you take if you start a prescription medication. More than likely you will not want to use them when you start these medications. However, if the constipation is still painful, your doctor may want you to take both.
What is on Formulary?
It is likely that one of these medications will be on your insurers Formulary. You need to find out which one is in the most preferred tier and then determine what the copay is for that tier. The non preferred option is likely to be a much more expensive copay.
Can be used for Chonic idiopathic constipation (CIC) at the 145mcg dose or Irritable bowel syndrome with contsipation (IBS-C) at the 290mcg dose.
This can be dosed once daily. You should see some effect in the first day and possibly within the first 30 minutes after taking. If you do not see an increase in the number of bowel movements per week, you might want to talk to your doctor about a higher dose.
Linaclotide should be taken on an empty stomach 30 minutes before the first meal of the day.
Can be used for Chonic idiopathic constipation (CIC) and Irritable bowel syndrome with contsipation (IBS-C) at the 3mg dose.
Trulance can be dosed once daily. You should see some effect in the first day and possibly within the first 30 minutes after taking. If you do not see an increase in the number of bowel movements per week, you might want to talk to your doctor about a higher dose.
You can take Trulance any time of the day, but you should try to take the medication at the same time each day. You can also take Trulance with or without food.
For a direct comparison of these drugs see Linzess vs Trulance.
Can be used for Chonic idiopathic constipation (CIC), Irritable bowel syndrome with contsipation (IBS-C) and Opiod induced constipation (OIC). CIC and OIC are usually 24mcg twice a day. OIC is recommended dose of 8mcg twice a day.
Twice daily dosing for Amitiza makes it less convenient than Linzess or Trulance, but it has been shown to work quickly. Over 50% will have a bowel movement in under 24 hours.
Amitiza should be taken with meals to make it easier to remember that you need to take this drug with food and water.
Opiod Induced Constipation (OIC)
Two other medications are available for Opiod induced constipation (OIC) only. These are not good options to use in place of Linzess as it does not currently have an indication for OIC.
- Relistor (Methylnaltrexone)
- Movantik (Naloxegol)
If you have to take an expensive prescription medication listed in #5, then you need to ask for samples. Typically I do not recommend people take samples, even though it seems like a no brainer.
Here is why… only expensive brand drugs have samples. Generics do not. Therefore, the manufacturer gets you and your doctor hooked in pricy new drugs that you eventually have to pay for… bigtime!
However, in this case we walked through the process to try other options. Now you want to get samples of the medication that is on your Formulary and therefore will have the best copay for you.
Ask your doctor what an appropriate trial period will be for you to see if this medication is working. Once that is established try to get enough samples to make it through that trial.
Tell your doctor you don’t want to pay huge amounts of money for pills you might not be able to use later. Click here to read how to journal on your medications to know if they are working for you.
Once the trial period is almost up and if the drug is working, call and ask the doctor to write you a prescription and ask for more samples until you receive the medication. These meds will probably need a prior authorization from the insurance company, so make sure to get at least two weeks supply of samples.
This will give you time to start on cost savings idea #7.
#7 Patient assistance
Most people do not realize that assistance is available for free through many foundations for medication. You do not have to be impoverished to qualify.
The worst thing that could happen is you apply and they say no. However, if you apply and they say yes, it could save you thousands of dollars on expensive medications such as Linzess.
I recommend you go through the Needymeds.org website. It is a wealth of information on assistance of all types. Search under patient assistance and put in the drug name Linzess.
The Allergan Patient assistance program will pop up. These are the highlights of the program:
- Must be a U.S. Citizen or legal entrant
- Medicare Part D only eligible if have been denied or ineligible for Low Income Subsidy
- Commercial insurance should contact program for details
- Doctor must sign form and fax
- Will ship the medication to the doctors office.
Another important point!
Make sure to check the Needymeds site for diagnosis related savings options also. You can find a wide variety of other items such as durable medical equipment and medical supplies and medical transportation.
#8 Manufacturer copay coupon
Once you try your other options and you still have a large copay to deal with you should look to the manufacturer coupon card.
Linzess costs around $456 cash price for a 30 day supply. The Linzess Savings program could get your copay down to $30. In fact, they also offer a 90 day supply for as little as $30 option also.
You have to register for a savings card like the one pictured above and if you are eligible you can get a new card right away.
Medicare, Medicaid or other federal or state health plan patients are not allowed to use copay coupon cards!
The coupon card will not allow you to get the drug at this price forever! They will have maximum amount it will pay and then you will be stuck with the high copay after that point. This is why I recommend trying other steps before the manufacturer coupon card.
If you have a high deductible health plan (HDHP) you may have another problem. While this copay card is paying if your insurance has a copay accumulator program then the amount paid by the coupon will not count toward your deductible.
A copay accumulator is a fancy way to say they do not count the coupon toward your deductible, see the example below.
Your deductable is $1500, the Linzess card pays $200 per month while you pay $50 for six months.
$200 x 6 month = $1200 from Linzess card
$50 x 6 months = $300 from you paying copay
$1200 + $300 = $1500
You might think your deductible has been met, however with a copay accumulator you would still owe $1200!
$1500 deductible minus $300 you actually paid, which is $1200.
#9 Deductible Timing
If you have a high deductible health plan (HDHP) you want to closely monitor how much you have paid toward the deductible. Usually this will include all your medical and medication spending.
Once the point in the year comes where you have maxed out the deductible, you will either not have to pay anything more, or pay a coinsurance amount. The coinsurance usually comes out to around 20%.
After the deductible is met is a great time to purchase medications like Linzess. You pay less or nothing and since the medication may not be used all the time you can stock up. This maximizes the amount your insurance pays and decreases your out of pocket expenses.
Get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, FREE Click here!
Share your story!
Have you tried Linzess? Did it help your constipation? Please chime in below with your comments and thoughts below