Get Ready for New Options to Treat Seasonal Allergies

Spring will bring a bloom of changes with seasonal allergy meds.

Ryaltris (olopatadine/mometasone) will be a new Rx nasal spray.

Think of it as similar to Rx Dymista (azelastine/fluticasone). Both are combo nasal sprays that contain an antihistamine and a steroid...and can cost about $200/month. Anticipate prior auths.

Enter days' supply correctly. One bottle of Ryaltris contains 240 sprays...and will last 30 days if the patient uses 2 sprays in each nostril bid (240 sprays/bottle x 1 day/8 sprays = 30 days/bottle).

Avoid covering up important patient info on the Ryaltris box. For instance, the packaging states that Ryaltris needs to be primed with 6 sprays before first use...and shaken well before EACH use.

Astepro, Lastacaft, and Nasonex will switch from Rx to OTC.

Lastacaft (alcaftadine) eye drops are on OTC shelves now.

Astepro Allergy (azelastine 0.15%) and Nasonex 24HR Allergy (mometasone) nasal sprays will join later this year. Keep an eye on Rx avoid having too much in stock when these OTCs arrive.

Treat these like other Rx-to-OTC switches. The new OTCs have the same ingredients, doses, and directions as their Rx versions.

Expect payer coverage to drop off for meds making the switch.

If payers reject the Rx, offer to fill the OTC as a cash Rx. Remind patients they can use an FSA/HSA card to pay for it.

Acuvue Theravision will be the first contact lenses for vision correction that also contain ketotifen...the same med that's in some allergy eye drops (Zaditor, etc).

These daily contacts treat itchy eyes for up to 12 hours.

Don't expect to dispense Rx Acuvue Theravision.

But get in the habit of asking patients whether they use a medicated contact avoid doubling up on allergy eye meds.

Dig into our resources, Managing Seasonal Allergies and Nasal Sprays for Allergic Rhinitis, for more on how options stack up.

Key References

  • J Allergy Clin Immunol. 2020 Oct;146(4):721-767
  • Allergy. 2000 Feb;55(2):116-34
  • Ocul Immunol Inflamm. 2019;27(4):622-631
  • Medication pricing by Elsevier, accessed Apr 2022
Pharmacy Technician's Letter. May 2022, No. 380502

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