National Family Caregivers Month: The Impact of OFF Time for People With Parkinson’s Disease and Their Care Partners

2022-11-07T07:01:00

(BPT) – This article was sponsored and developed by Neurocrine Biosciences, Inc.

Approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months. With November being National Family Caregivers Month, it’s a time to recognize care partners and celebrate the contributions that care partners make in supporting a loved one who may also be managing a health condition.

Jim and Hettie have been married for over 50 years and enjoy doing a variety of activities together, such as involvement in church activities, doing projects around the house, and Jim’s favorite hobby—bass fishing. When Jim, a veteran and retired accountant, began experiencing tremors in 2007 and noticed that his handwriting was getting progressively worse, he went to his doctor for help. Jim’s doctor told him that nothing could be done at the time. In 2012, Jim went to a neurologist for a second opinion and was diagnosed with Parkinson’s disease (PD).

PD, a chronic, progressive neurological and movement disorder, affects approximately 1 million people in the U.S. and 10 million people worldwide. Symptoms generally develop slowly over years. The progression of symptoms is unique to each individual. People with PD may experience tremors, slowness of movement, limb rigidity or stiffness, and gait or balance problems. While there is no cure for PD, medication can help improve daily symptoms.

After receiving his PD diagnosis, Hettie worked to help Jim adapt to his PD symptoms so that he could continue doing the things he loves. As Jim’s wife and care partner, Hettie keeps a log of Jim’s symptoms based on her observations, attends doctors’ appointments, and supports Jim in every way she can. Together, Jim and Hettie manage a PD support group and enjoy getting to know group members on a personal level. When Jim started to have challenges backing the couple’s boat down ramps to access the lake, putting his beloved pastime of fishing at risk, Hettie suggested they find a lake house to make Jim’s passion more accessible. The two found a small fixer-upper and have spent the past six years working side by side to improve the house and travel to it several times each week.

After Jim’s diagnosis, he began taking levodopa/carbidopa to treat his PD. Nearly nine years after being diagnosed in 2012, Jim began experiencing OFF time—a period of time between regular doses when medication “wears off” and symptoms return. He felt extremely sluggish in the mornings and noticed that his tremors would return after a long day, especially when he was overly fatigued. Like many people with PD and their care partners, Jim and Hettie weren’t familiar with OFF time—until they mentioned Jim’s symptoms to his doctor. A recent survey showed that 86 percent of people with PD experience OFF time, and most people with PD and their care partners say OFF time has a significant impact on their daily activities.

To help manage Jim’s OFF time symptoms, his doctor prescribed ONGENTYS® (opicapone) capsules, a prescription medicine used with levodopa/carbidopa in people with PD who are having OFF episodes. It is not known if ONGENTYS is safe and effective in children. The most common side effects of ONGENTYS include uncontrolled sudden movements (dyskinesia), constipation, increase in an enzyme called blood creatine kinase, low blood pressure, and weight loss.

Please see full Important Safety Information below and Prescribing Information.

Hettie saw improvements in Jim’s symptoms after taking ONGENTYS. “With less OFF time, the spark is back in the man I married 54 years ago,” said Hettie. Jim also notices improvement and gets up and moves at a quicker pace each morning since taking ONGENTYS.

By sharing their story during National Family Caregivers Month, Jim and Hettie hope their personal journey encourages people with PD to share their experiences or concerns regarding symptoms with their loved ones and to speak with a healthcare provider about treatment options. They also remind people that each person has a different PD experience, and treatment varies from one person to another, which is why it is important to speak with a healthcare professional to determine the appropriate treatment approach.

To learn more about ONGENTYS, talk to your doctor or visit ongentys.com for more safety information.

See Important Safety Information Below

IMPORTANT INFORMATION

Approved Use

ONGENTYS® (opicapone) capsules is a prescription medicine used with levodopa and carbidopa in people with Parkinson’s disease (PD) who are having “OFF” episodes.

It is not known if ONGENTYS is safe and effective in children.

IMPORTANT SAFETY INFORMATION

Do not take ONGENTYS if you:

  • take a type of medicine called a non-selective monoamine-oxidase (MAO) inhibitor.
  • have a tumor that secretes hormones known as catecholamines.

Before taking ONGENTYS, tell your healthcare provider about all of your medical conditions, including if you:

  • have daytime sleepiness from a sleep disorder, have unexpected periods of sleep or sleepiness, or take a medicine to help you sleep or that makes you feel sleepy.
  • have had intense urges or unusual behaviors, including gambling, increased sex drive, binge eating, or compulsive shopping.
  • have a history of uncontrolled sudden movements (dyskinesia).
  • have had hallucinations or psychosis.
  • have liver or kidney problems.
  • are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take nonselective MAO inhibitors (such as phenelzine, tranylcypromine, and isocarboxazid) or catecholamine medicines (such as isoproterenol, epinephrine, norepinephrine, dopamine, and dobutamine), regardless of how you take the medicine (by mouth, inhaled, or by injection).

ONGENTYS and other medicines may affect each other causing side effects. ONGENTYS may affect the way other medicines work, and other medicines may affect how ONGENTYS works.

What should I avoid while taking ONGENTYS?

  • Do not drive, operate machinery, or do other dangerous activities until you know how ONGENTYS affects you.

What are the possible side effects of ONGENTYS?

ONGENTYS may cause serious side effects, including:

  • Falling asleep during normal activities such as driving a car, talking or eating while taking ONGENTYS or other medicines used to treat Parkinson’s disease, without being drowsy or without warning. This may result in having accidents. Your chances of falling asleep while taking ONGENTYS are higher if you take other medicines that cause drowsiness.
  • Low blood pressure or dizziness, light headedness, or fainting.
  • Uncontrolled sudden movements (dyskinesia). ONGENTYS may cause uncontrolled sudden movements or make such movements worse or happen more often.
  • Seeing, hearing, or feeling things that are not real (hallucinations), believing things that are not real (delusions), or aggressive behavior.
  • Unusual urges (impulse control and compulsive disorders) such as urges to gamble, increased sexual urges, strong urges to spend money, binge eating, and the inability to control these urges.

Tell your healthcare provider if you experience any of these side effects or notice changes in your behavior.

The most common side effects of ONGENTYS include uncontrolled sudden movements (dyskinesia), constipation, increase in an enzyme called blood creatine kinase, low blood pressure, and weight loss.

These are not all of the possible side effects of ONGENTYS. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Please see ONGENTYS full Product Information.

This article was sponsored and developed by Neurocrine Biosciences, Inc. Jim and Hettie were compensated by Neurocrine Biosciences, Inc. to share their story.

©2022 Neurocrine Biosciences, Inc. All Rights Reserved. CP-OPC-US-0658 11/2022

Setting goals: How to manage a chronic inflammatory disease

2022-11-07T06:01:00

(BPT) – Content sponsored and provided by Pfizer. Ashley partnered with Pfizer to share her experience living with moderate to severe rheumatoid arthritis (RA).

Growing up, Ashley was active, played sports, and exercised regularly. So, when she began feeling joint pain, she attributed it to typical sports injuries or soreness. However, as time passed, she was concerned about the ongoing joint pain and swelling she was experiencing.

After discussing her symptoms with her aunt who was a nurse, Ashley sought help from a rheumatologist. Following multiple tests and exams, her rheumatologist diagnosed Ashley with moderate to severe rheumatoid arthritis (RA), a chronic inflammatory disease of the joints.

At first, it was difficult for Ashley to understand the permanence of her RA diagnosis and how it would impact her. “I don’t think I initially grasped the fact that I would be navigating this disease for the rest of my life,” says Ashley. As she processed her diagnosis, she continued with her usual activities, supplemented by physical therapy sessions when necessary.

However, as Ashley’s symptoms continued to progress she realized that she needed to re-prioritize her disease management and self-care. Working with her doctor, she became more aware of setting realistic exercise goals and finding activities that are more manageable with her RA.

When Ashley met Mike, her now-husband, she opened up to him about her RA on their first date. “I felt like it was important to be open about my RA with Mike because when you live with a chronic illness, it doesn’t just impact you. It impacts your significant other, your family members, and friends,” says Ashley.

“If you would have asked me what RA was before I met Ashley, I would have had no idea. Ashley was very upfront and honest about the challenges that she deals with, and over time I got to see firsthand how RA impacted her,” says Mike.

Throughout their marriage and Ashley’s journey with RA, Mike has been supportive of Ashley’s disease management goals and treatment plan. “He’s given me so much confidence to try different things that I would have never tried before, like traveling solo,” says Ashley. “He also has even given me the confidence to approach my doctor to find a treatment plan that works for me.”

During the course of her journey, Ashley has gone through a lot of trial and error with different types of prescription treatment plans for her RA. She tried multiple tumor necrosis factor (TNF) blockers, but these medicines did not work well enough for Ashley. As a result, she did some research online and read about XELJANZ® (tofacitinib), an oral medication for moderately to severely active rheumatoid arthritis when one or more medicines called TNF blockers have been used and did not work well or wasn’t tolerated. XELJANZ appealed to Ashley and she liked that it was an oral option. She brought it up with her rheumatologist after getting encouragement from her husband.

Ashley’s rheumatologist reviewed the benefits and possible serious side effects of XELJANZ with her. They also discussed the type of laboratory monitoring that would be needed before and during treatment. Her rheumatologist also explained that XELJANZ has a BOXED WARNING.

XELJANZ can cause serious side effects and can lower your ability to fight infections; don’t start XELJANZ if you have an infection. Before and during treatment, your doctor should check for infections like tuberculosis (TB), and do blood tests. Serious, sometimes fatal infections, cancers including lymphoma, and lung cancer, blood clots and serious heart-related events have happened. People 50 or older with heart disease risk factors had an increased risk of death. Tell your doctor if you had a heart attack, other heart problems, stroke, or a history of blood clots.

Read more Important Safety Information and Indication below.

After starting XELJANZ, Ashley noticed that she was experiencing less joint pain, swelling, and stiffness, and was feeling less fatigued. Ashley was also able to partake in some of the activities that she enjoyed before she was diagnosed with RA, such as hiking and bird watching.

What is Ashley’s advice for others living with RA?

“I always tell people to focus on what you can do instead of dwelling on what you can’t. Focus on the good things in your life because RA doesn’t define you. It’s a part of who you are, but it’s not all of who you are, and it doesn’t mean that you can’t have a productive, fulfilling, and happy life.”

To learn more about XELJANZ, visit XELJANZ.com/RA.

IMPORTANT SAFETY INFORMATION AND INDICATION

The safety information below applies to all marketed formulations of XELJANZ. Specific risks associated with certain dosing are noted.

Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Do not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay. Serious infections have happened in people taking XELJANZ. These serious infections include tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with XELJANZ. You should not start taking XELJANZ if you have any kind of infection unless your healthcare professional tells you it is okay.

Before and after starting XELJANZ, tell your doctor if you are being treated for an infection, have infections that keep coming back, or have symptoms of an infection, including:

  • fever, sweating, or chills
  • cough
  • blood in phlegm
  • warm, red, or painful skin or sores on your body
  • burning when you urinate
  • urinating more often than normal
  • muscle aches
  • shortness of breath
  • weight loss
  • diarrhea or stomach pain
  • feeling very tired

Increased risk of death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily.

Cancer. XELJANZ may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen. People taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily have a higher risk of certain cancers including lymphoma and lung cancer, especially if you are a current or past smoker. Tell your healthcare provider if you have ever had any type of cancer.

Higher dose. People with ulcerative colitis taking the higher dose of XELJANZ (10 mg twice daily) or XELJANZ XR (22 mg one time each day) have a higher risk of serious infections, shingles, or skin cancers.

Immune system problem. Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus–associated post-transplant lymphoproliferative disorder).

Increased risk of major cardiovascular events such as heart attack, stroke or death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily, especially if you are a current or past smoker.

Get emergency help right away if you have any symptoms of a heart attack or stroke while taking XELJANZ, including:

  • discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back
  • severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw
  • pain or discomfort in your arms, back, neck, jaw, or stomach
  • shortness of breath with or without chest discomfort
  • breaking out in a cold sweat
  • nausea or vomiting
  • feeling lightheaded
  • weakness in one part or on one side of your body
  • slurred speech

Blood clots in the lungs (pulmonary embolism, PE), veins of the legs (deep vein thrombosis, DVT), and arteries (arterial thrombosis) have happened more often in people who are 50 years of age and older and with at least 1 heart disease (cardiovascular) risk factor taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily. Blood clots in the lungs have also happened in people with ulcerative colitis. Some people have died from these blood clots.

  • Stop taking XELJANZ and tell your healthcare provider right away if you have any signs and symptoms of blood clots such as sudden shortness of breath, difficulty breathing, chest pain, swelling of a leg or arm, leg pain or tenderness, or red or discolored skin in the leg or arm.

Tears (perforation) in the stomach or intestines. Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking XELJANZ can get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your healthcare provider right away if you have fever, stomach-area pain that does not go away, and a change in your bowel habits.

Serious allergic reactions can occur. Stop using XELJANZ and call your healthcare provider right away if you have swelling of your lips, tongue, throat, or get hives.

Changes in certain lab test results. Your doctor should do blood tests to check your white and red blood cells before starting and while you are taking XELJANZ. Your doctor should also check certain liver tests. You should not take XELJANZ if your lymphocyte count, neutrophil count, or red blood cell count is too low or your liver function test levels are too high. Changes in lab test results may cause your healthcare provider to stop your XELJANZ treatment for a time. Your cholesterol levels should be checked 4 to 8 weeks after you start receiving XELJANZ.

Before you use XELJANZ, tell your healthcare provider if you:

  • Are being treated for an infection, have an infection that won’t go away or keeps coming back, or think you have symptoms of an infection
  • Have TB, or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
  • Have diabetes, chronic lung disease, HIV, or a weak immune system. People with these conditions have a higher chance for infections
  • Live or have lived in certain areas (such as Ohio and Mississippi River Valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections
  • Have or have had Hepatitis B or C
  • Are a current or past smoker
  • Have had any type of cancer
  • Have had a heart attack, other heart problems or stroke
  • Have had blood clots
  • Have liver or kidney problems
  • Have any stomach area (abdominal) pain or been diagnosed with diverticulitis or ulcers in your stomach or intestines
  • Have recently received or plan to receive a vaccine. People taking XELJANZ should not receive live vaccines but can receive non-live vaccines
  • Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. You should not take XELJANZ and breastfeed
  • Have had a reaction to tofacitinib or any of the ingredients
  • Are taking other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any of the following medicines while taking XELJANZ since this may increase your risk of infection:
    • tocilizumab (Actemra®)
    • etanercept (Enbrel®)
    • adalimumab (Humira®)
    • infliximab (Remicade®)
    • rituximab (Rituxan®)
    • abatacept (Orencia®)
    • anakinra (Kineret®)
    • certolizumab (Cimzia®)
    • golimumab (Simponi®)
    • ustekinumab (Stelara®)
    • secukinumab (Cosentyx®)
    • vedolizumab (Entyvio®)
    • ixekizumab (Taltz®)
    • sarilumab (Kevzara®)
    • azathioprine, cyclosporine, or other immunosuppressive drugs
  • Tell your healthcare provider if you are taking medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these.

What are other possible side effects of XELJANZ/XELJANZ XR?

If you are a carrier of the Hepatitis B or C virus (viruses that affect the liver), the virus may become active while you use XELJANZ. Your healthcare provider may do blood tests before starting and while using treatment with XELJANZ. Tell your healthcare provider if you have any signs of these symptoms: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.

Common side effects in people with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, runny nose (nasopharyngitis), and high blood pressure (hypertension).

Common side effects in people with ulcerative colitis include nasal congestion, sore throat, runny nose (nasopharyngitis), increased cholesterol levels, headache, upper respiratory tract infections (common cold, sinus infections), increased muscle enzyme levels, rash, diarrhea, and shingles (herpes zoster).

Common side effects in children (2 & older) with polyarticular course juvenile arthritis include upper respiratory tract infections (common cold, sinus infections), nasal congestion, sore throat, and runny nose (nasopharyngitis), headache, fever, nausea, and vomiting.

XELJANZ & Pregnancy

XELJANZ may affect the ability of females to get pregnant. It is not known if this will change after stopping XELJANZ. It is not known if XELJANZ will harm an unborn baby.

  • Pregnancy Registry: Pfizer has a registry for pregnant women who take XELJANZ. The purpose of this registry is to check the health of the pregnant mother and her baby. If you are pregnant or become pregnant while taking XELJANZ, talk to your healthcare provider about how you can join this pregnancy registry or you may contact the registry at 1-877-311-8972 to enroll.

You and your healthcare provider should decide if you will take XELJANZ or breastfeed. You should not do both. After you stop your treatment with XELJANZ do not start breastfeeding again until 18 hours after your last dose of XELJANZ or 36 hours after your last dose of XELJANZ XR.

What is XELJANZ/XELJANZ XR?

XELJANZ/XELJANZ XR (tofacitinib) is used to treat adults with:

  • Moderately to severely active rheumatoid arthritis when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or cannot be tolerated
  • Active psoriatic arthritis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated.
  • Moderately to severely active ulcerative colitis when 1 or more tumor necrosis factor (TNF) blocker medicines have used, and did not work well or cannot be tolerated
  • Active ankylosing spondylitis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated

It is not known if XELJANZ/XELJANZ XR is safe and effective in people with Hepatitis B or C.

XELJANZ/XELJANZ XR/XELJANZ Oral Solution is not recommended for people with severe liver problems.

It is not known if XELJANZ/XELJANZ Oral Solution is safe and effective in children for treatment other than active polyarticular course juvenile arthritis.

It is not known if XELJANZ XR is safe and effective in children.

Please see full Prescribing Information, including BOXED WARNING and Medication Guide.

August 2022; PP-XEL-USA-7762

Four safety tips to help prepare your home for storms

2022-11-04T16:25:07

(BPT) – Natural disasters such as hurricanes, tornadoes, floods and snowstorms can occur at any time, so preparing ahead is key. However, a study by the Federal Emergency Management Agency found that only 44% of Americans are prepared for an unexpected natural disaster.

“Unfortunately, severe weather can occur throughout the year, so it is important to always be prepared,” said Ashley Gocken, a home safety expert with First Alert residential fire safety company, now part of Resideo Technologies, Inc. “Implementing new safety measures or strengthening the ones that you and your family have in place can help save yourself from unnecessary stress should an emergency arise.”

Follow these home safety tips to help ensure your family is prepared during storm season:

1) Equip for emergencies. Being prepared for inclement weather includes having an emergency kit ready. In addition to necessities such as a first aid kit, flashlight, water and medical supplies, make sure your safety kit includes a multi-tool, portable phone charger, fire extinguisher, carbon monoxide (CO) alarm, batteries, blankets and non-perishable food.

2) Know about CO. An invisible and odorless gas, carbon monoxide (CO) is the leading cause of accidental poisoning in the U.S., leading to more than 430 deaths each year, according to the Centers for Disease Control and Prevention. CO incidents can spike during storm season, due to the misuse of portable generators, stoves or grills as alternative heating sources during power outages.

In the case of a power outage, run generators in a well-ventilated, outdoor area to avoid CO build up in your home. Don’t operate them in the garage, even if you intend to keep the garage door open and be sure to keep it at least 20 feet away from any door, window or vent opening for extra safety precautions.

3) Install home safety tools. Because CO is impossible to detect without an alarm — and its symptoms like headache, nausea, dizziness, weakness and vomiting can easily be confused with the common cold — proper alarm placement, regular maintenance and alarm replacement are essential parts of your home safety plan. According to guidelines from the National Fire Protection Association, carbon monoxide and smoke alarms should be installed in or near every sleeping area and on every level of the home, including the basement. Equip your home with 10-year alarms or alarms with battery backup for protection during power outages. The First Alert Carbon Monoxide Plug-In Alarm with Battery Backup alerts residents to dangerous CO levels and, thanks to its battery backup, allows for continuous monitoring during a power outage.

For ultimate protection against the threats of smoke, fire and CO, install combination alarms such as the First Alert 10-Year Sealed Battery Smoke and CO Alarm to eliminate the need to replace batteries for a decade. Make sure alarms are installed at least 15 feet away from CO sources to reduce the chance of false alarms, but if one does sound, leave the home immediately and call 911. Be sure to test all alarms regularly, and for those without a 10-year battery, replace batteries at least every six months.

4) Safely store valuables. In case of an emergency, make sure important documents such as birth certificates, passports and insurance papers are stored in waterproof or fire-resistant safes or security chests, and create password-protected digital copies for preservation. Move valuables, including family heirlooms and prized possessions, to higher levels of the home or to the same safes for maximum security.

“Putting the proper protections in place can better enable families to be well-prepared when a severe storm arises, and all year round,” said Gocken.

For more information, visit www.firstalert.com.

World champion skier Lindsey Vonn on insomnia and scoring better sleep

2022-11-04T12:01:00

(BPT) – Lindsey Vonn has been tackling challenges all her life as a professional skier. However, one of her biggest challenges didn’t happen on her skis, but rather, in her own bed. A knee injury took her off the slopes to recoup in 2013. Around this time, she began having trouble falling and staying sleep, also known as insomnia, and even after recovering, she couldn’t shake it off. When she officially retired from the sport in 2019, her sleep problems only intensified.

She is not alone. More than 25 million Americans suffer from insomnia every year and experience firsthand the toll that it can take on their nights and days.[i], [ii] For Lindsey, not sleeping at night meant that she couldn’t be her best self during the day as an entrepreneur, author, philanthropist and investor.

Lindsey’s journey with QUVIVIQ® (daridorexant) CIV

After years of trying out various sleep hygiene practices, common over-the-counter supplements and even prescription sleep medicines, Lindsey still struggled with her sleep. She decided to talk to her doctor about available treatment options, and to understand the benefits and risks of each. Based on her needs and preferences, once-nightly QUVIVIQ was the best option for her — because in clinical studies QUVIVIQ has been shown to help adults with insomnia fall asleep faster and stay asleep longer with improvements measured at one month and which continued over a period of three months.

QUVIVIQ is a prescription medicine for adults who have trouble falling asleep or staying asleep (insomnia).[iii] As an athlete, Lindsey is incredibly mindful of what she puts in her body, which is why she talked to her doctor about the risks and benefits of treatment options to find the best one for her. Lindsey’s doctor told her that QUVIVIQ may cause headache or sleepiness during the day and to be cautious about driving or doing other activities until she feels fully awake. She feels good about taking QUVIVIQ because of its safety profile and because clinical studies show a lack of withdrawal symptoms after stopping usage, which suggests no physical dependence. QUVIVIQ is a federally controlled substance because it can be abused or cause dependence.

“I didn’t just decide to be a championship skier. I worked at it, and that’s how I approach my sleep,” said Lindsey. “It’s a journey, which is why I talked to my doctor about QUVIVIQ.”

Taking QUVIVIQ helps her fall asleep faster and stay asleep longer and getting more sleep at night may mean feeling less tired during the day. This is Lindsey’s experience with QUVIVIQ and individual results may vary. Review the additional important safety information and talk with your healthcare provider to see if QUVIVIQ may be right for you.

Lindsey’s advice for others struggling with insomnia

  • 1. Talk about it. It’s common for sleep issues to isolate people or cause them to cope in silence, as problems sleeping can be misconstrued as a “personal” issue. Therefore, Lindsey’s biggest piece of advice for others struggling with sleep like her is to start a conversation with their doctor to discuss the sleep challenges they’re having and to find out what treatment options are out there.
  • 2. Be patient. Lindsey recognizes her issues with sleep didn’t happen overnight, so she knew improving her sleep would take some time to get right. She recommends others be consistent and patient when working through treatment solutions and give them time to work. “Insomnia can impact both my days and my nights. That’s why I take QUVIVIQ nightly, and I feel that my sleep has improved,” she said.
  • 3. Seek support. Paying for treatments can be a concern for many. Those interested in QUVIVIQ should check out QUVIVIQ.com to download or screen shot a QSavings Card. Eligible patients pay as little as $0* for the first month of treatment and receive refills for as little as $25*.

If you’re like Lindsey and struggle with falling asleep or staying asleep, start a conversation with your doctor today and see if QUVIVIQ is right for you. To learn more, visit QUVIVIQ.com.

*For eligible commercially insured patients. Terms and conditions apply. Please read the full terms and conditions.

Sponsored by Idorsia U.S.

What is QUVIVIQ?

QUVIVIQ (daridorexant) 25 mg, 50 mg tablets is a prescription medicine for adults who have trouble falling asleep or staying asleep (insomnia).

Important Safety Information
Do not take QUVIVIQ if you fall asleep often at unexpected times (narcolepsy).

QUVIVIQ may cause serious side effects, including:

  • Decreased awareness and alertness. The morning after you take QUVIVIQ, your ability to drive safely and think clearly may be decreased. You may also have sleepiness during the day.
    • Do not take more QUVIVIQ than prescribed.
    • Do not take QUVIVIQ unless you are able to stay in bed for at least 7 hours before you must be active again.
    • Take QUVIVIQ at night within 30 minutes before going to bed.

QUVIVIQ is a federally controlled substance because it can be abused or lead to dependence.
Before taking QUVIVIQ, tell your healthcare provider about all of your medical conditions, including if you:

  • have a history of depression, mental illness, or suicidal thoughts or actions; drug or alcohol abuse or addiction; a sudden onset of muscle weakness (cataplexy); daytime sleepiness
  • have lung or breathing problems, including sleep apnea
  • have liver problems
  • are pregnant or plan to become pregnant
  • are breastfeeding or plan to breastfeed

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

  • Taking QUVIVIQ with certain medicines can cause serious side effects. QUVIVIQ may affect the way other medicines work and other medicines may affect the way QUVIVIQ works.
  • Do not take QUVIVIQ with other medicines that can make you sleepy unless instructed by your healthcare provider.

What should I avoid while taking QUVIVIQ?

  • Do not drink alcohol while taking QUVIVIQ. It can increase the effects of alcohol, which can be dangerous.
  • Do not drive, operate heavy machinery, do anything dangerous, or do other activities that require clear thinking if you do not feel fully awake, or you have taken QUVIVIQ and have less than a full night of sleep (at least 7 hours), or if you have taken more QUVIVIQ than prescribed.

QUVIVIQ may cause other serious side effects, including:

  • Worsening depression and suicidal thoughts. Call your healthcare provider right away if you have any worsening depression or thoughts of suicide or dying.
  • Temporary inability to move or talk (sleep paralysis) for up to several minutes, or hallucinations while you are going to sleep or waking up.
  • Complex sleep behaviors such as sleep-walking, sleep-driving, preparing and eating food, making phone calls, having sex or doing other activities while not fully awake that you may not remember the next morning. Stop taking QUVIVIQ and call your healthcare provider right away if you experience a complex sleep behavior.

The most common side effects of QUVIVIQ are headache and sleepiness.

These are not all of the possible side effects of QUVIVIQ. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see the full Prescribing Information and Medication Guide.



[i] Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153.

[ii] Ogunwole S, Rabe M, Roberts A, et al. United States Census Bureau. Population under age 18 declined last decade. https://www.census.gov/library/stories/2021/08/united-states-adult-population-grew-faster-than-nations-total-population-from-2010-to-2020.html. Accessed May 12, 2022.

[iii] QUVIVIQ® (daridorexant) [prescribing information]. Radnor, PA: Idorsia Pharmaceuticals U.S. Inc; 2022.

Finding my routine: Managing my daily life while living with a chronic inflammatory disease

2022-11-04T06:01:00

(BPT) – Content sponsored and provided by Pfizer. Michael partnered with Pfizer to share his experience living with moderate to severe rheumatoid arthritis (RA).

Michael retired from being a professional figure skater to pursue his dream of becoming a fashion designer. He was enrolled as a student in design school when he started having signs of joint inflammation. He originally attributed his joint pain to figure skating.

After thorough testing by his rheumatologist, Michael was diagnosed with moderate to severe rheumatoid arthritis (RA), a chronic inflammatory disease of the joints. At the time, he thought only older people could get the disease, so he was surprised when his doctor told him that he had RA.

At first, it was difficult for Michael to come to terms that he’d be living with RA while he struggled with his ongoing joint pain. “At times, I was in so much pain from my RA that I didn’t want to get out of bed.”

Over time, Michael started to accept his diagnosis and began a daily routine. “I could see that getting into a routine helped me stay motivated and be more positive — I was walking, being as active as possible, eating well and drinking lots of water. Those simple tasks turned into a regular routine for me and is still part of what I do today.”

“You have to know to listen to your body. Doing this has been both the hardest thing and the best thing for me.”

Michael also learned that part of listening to your body is knowing when a treatment plan isn’t working well enough to help manage his symptoms. Michael tried multiple tumor necrosis factor (TNF) blockers, which did not work well enough for him and he continued to experience RA symptoms. As a result, Michael worked with his rheumatologist to find a treatment plan that was right for him.

Michael’s rheumatologist suggested XELJANZ® (tofacitinib), an oral medication for moderately to severely active rheumatoid arthritis when one or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or wasn’t tolerated.

His rheumatologist reviewed the benefits and possible serious side effects of XELJANZ, and discussed the type of laboratory monitoring that would be needed before and during treatment. His rheumatologist also explained that XELJANZ has a BOXED WARNING.

XELJANZ can cause serious side effects and can lower your ability to fight infections; don’t start XELJANZ if you have an infection. Before and during treatment, your doctor should check for infections like tuberculosis (TB), and do blood tests. Serious, sometimes fatal infections, cancers including lymphoma, and lung cancer, blood clots and serious heart-related events have happened. People 50 or older with heart disease risk factors had an increased risk of death. Tell your doctor if you had a heart attack, other heart problems, stroke, or a history of blood clots.

Read more Important Safety Information and Indication below.

Within a few months, Michael could see XELJANZ was a good fit for him. After starting the treatment, he began to notice that he was experiencing less joint pain and swelling.

Michael likes that XELJANZ is an oral option. Through careful discussions with his rheumatologist, Michael was able to find a treatment option that works for him, and now Michael looks forward to getting up and doing activities he enjoys, like spending time with his dog, traveling and designing clothes.

Today, Michael serves as a patient advocate in the community to help others on their RA journey.

Michael’s advice to those starting their own journey with managing RA is to make a list of questions about the symptoms they are experiencing, partner closely with their doctor, and seek resources that are available from the RA community, which includes patient advocacy groups and trusted rheumatological organizations.

“I try to stay positive as much as I can. When I was trying to navigate my RA journey at the beginning, I wanted to find someone in similar shoes as me who has a positive outlook that I could relate to, and now I want to be that person for someone else with RA,” says Michael.

To learn more about XELJANZ, visit XELJANZ.com/RA.

IMPORTANT SAFETY INFORMATION AND INDICATION

The safety information below applies to all marketed formulations of XELJANZ. Specific risks associated with certain dosing are noted.

Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Do not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay. Serious infections have happened in people taking XELJANZ. These serious infections include tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with XELJANZ. You should not start taking XELJANZ if you have any kind of infection unless your healthcare professional tells you it is okay.

Before and after starting XELJANZ, tell your doctor if you are being treated for an infection, have infections that keep coming back, or have symptoms of an infection, including:

  • fever, sweating, or chills
  • cough
  • blood in phlegm
  • warm, red, or painful skin or sores on your body
  • burning when you urinate
  • urinating more often than normal
  • muscle aches
  • shortness of breath
  • weight loss
  • diarrhea or stomach pain
  • feeling very tired

Increased risk of death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily.

Cancer. XELJANZ may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen. People taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily have a higher risk of certain cancers including lymphoma and lung cancer, especially if you are a current or past smoker. Tell your healthcare provider if you have ever had any type of cancer.

Higher dose. People with ulcerative colitis taking the higher dose of XELJANZ (10 mg twice daily) or XELJANZ XR (22 mg one time each day) have a higher risk of serious infections, shingles, or skin cancers.

Immune system problem. Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus–associated post-transplant lymphoproliferative disorder).

Increased risk of major cardiovascular events such as heart attack, stroke or death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily, especially if you are a current or past smoker.

Get emergency help right away if you have any symptoms of a heart attack or stroke while taking XELJANZ, including:

  • discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back
  • severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw
  • pain or discomfort in your arms, back, neck, jaw, or stomach
  • shortness of breath with or without chest discomfort
  • breaking out in a cold sweat
  • nausea or vomiting
  • feeling lightheaded
  • weakness in one part or on one side of your body
  • slurred speech

Blood clots in the lungs (pulmonary embolism, PE), veins of the legs (deep vein thrombosis, DVT), and arteries (arterial thrombosis) have happened more often in people who are 50 years of age and older and with at least 1 heart disease (cardiovascular) risk factor taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily. Blood clots in the lungs have also happened in people with ulcerative colitis. Some people have died from these blood clots.

  • Stop taking XELJANZ and tell your healthcare provider right away if you have any signs and symptoms of blood clots such as sudden shortness of breath, difficulty breathing, chest pain, swelling of a leg or arm, leg pain or tenderness, or red or discolored skin in the leg or arm.

Tears (perforation) in the stomach or intestines. Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking XELJANZ can get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your healthcare provider right away if you have fever, stomach-area pain that does not go away, and a change in your bowel habits.

Serious allergic reactions can occur. Stop using XELJANZ and call your healthcare provider right away if you have swelling of your lips, tongue, throat, or get hives.

Changes in certain lab test results. Your doctor should do blood tests to check your white and red blood cells before starting and while you are taking XELJANZ. Your doctor should also check certain liver tests. You should not take XELJANZ if your lymphocyte count, neutrophil count, or red blood cell count is too low or your liver function test levels are too high. Changes in lab test results may cause your healthcare provider to stop your XELJANZ treatment for a time. Your cholesterol levels should be checked 4 to 8 weeks after you start receiving XELJANZ.

Before you use XELJANZ, tell your healthcare provider if you:

  • Are being treated for an infection, have an infection that won’t go away or keeps coming back, or think you have symptoms of an infection
  • Have TB, or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
  • Have diabetes, chronic lung disease, HIV, or a weak immune system. People with these conditions have a higher chance for infections
  • Live or have lived in certain areas (such as Ohio and Mississippi River Valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections
  • Have or have had Hepatitis B or C
  • Are a current or past smoker
  • Have had any type of cancer
  • Have had a heart attack, other heart problems or stroke
  • Have had blood clots
  • Have liver or kidney problems
  • Have any stomach area (abdominal) pain or been diagnosed with diverticulitis or ulcers in your stomach or intestines
  • Have recently received or plan to receive a vaccine. People taking XELJANZ should not receive live vaccines but can receive non-live vaccines
  • Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. You should not take XELJANZ and breastfeed
  • Have had a reaction to tofacitinib or any of the ingredients
  • Are taking other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any of the following medicines while taking XELJANZ since this may increase your risk of infection:
    • tocilizumab (Actemra®)
    • etanercept (Enbrel®)
    • adalimumab (Humira®)
    • infliximab (Remicade®)
    • rituximab (Rituxan®)
    • abatacept (Orencia®)
    • anakinra (Kineret®)
    • certolizumab (Cimzia®)
    • golimumab (Simponi®)
    • ustekinumab (Stelara®)
    • secukinumab (Cosentyx®)
    • vedolizumab (Entyvio®)
    • ixekizumab (Taltz®)
    • sarilumab (Kevzara®)
    • azathioprine, cyclosporine, or other immunosuppressive drugs
  • Tell your healthcare provider if you are taking medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these.

What are other possible side effects of XELJANZ/XELJANZ XR?

If you are a carrier of the Hepatitis B or C virus (viruses that affect the liver), the virus may become active while you use XELJANZ. Your healthcare provider may do blood tests before starting and while using treatment with XELJANZ. Tell your healthcare provider if you have any signs of these symptoms: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.

Common side effects in adults with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, runny nose (nasopharyngitis), and high blood pressure (hypertension).

Common side effects in adults with ulcerative colitis include nasal congestion, sore throat, runny nose (nasopharyngitis), increased cholesterol levels, headache, upper respiratory tract infections (common cold, sinus infections), increased muscle enzyme levels, rash, diarrhea, and shingles (herpes zoster).

Common side effects in children (2 & older) with polyarticular course juvenile arthritis include upper respiratory tract infections (common cold, sinus infections), nasal congestion, sore throat, and runny nose (nasopharyngitis), headache, fever, nausea, and vomiting.

XELJANZ & Pregnancy

XELJANZ may affect the ability of females to get pregnant. It is not known if this will change after stopping XELJANZ. It is not known if XELJANZ will harm an unborn baby.

  • Pregnancy Registry: Pfizer has a registry for pregnant women who take XELJANZ. The purpose of this registry is to check the health of the pregnant mother and her baby. If you are pregnant or become pregnant while taking XELJANZ, talk to your healthcare provider about how you can join this pregnancy registry or you may contact the registry at 1-877-311-8972 to enroll.

You and your healthcare provider should decide if you will take XELJANZ or breastfeed. You should not do both. After you stop your treatment with XELJANZ do not start breastfeeding again until 18 hours after your last dose of XELJANZ or 36 hours after your last dose of XELJANZ XR.

What is XELJANZ/XELJANZ XR?

XELJANZ/XELJANZ XR (tofacitinib) is used to treat adults with:

  • Moderately to severely active rheumatoid arthritis when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or cannot be tolerated
  • Active psoriatic arthritis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
  • Moderately to severely active ulcerative colitis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
  • Active ankylosing spondylitis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated

It is not known if XELJANZ/XELJANZ XR is safe and effective in people with Hepatitis B or C.

XELJANZ/XELJANZ XR/XELJANZ Oral Solution is not recommended for people with severe liver problems.

It is not known if XELJANZ/XELJANZ Oral Solution is safe and effective in children for treatment other than active polyarticular course juvenile arthritis.

It is not known if XELJANZ XR is safe and effective in children.

Please see full Prescribing Information, including BOXED WARNING and Medication Guide.

August 2022; PP-XEL-USA-7763

How do you know blood donations are safe?

2022-11-03T11:01:00

(BPT) – Every two seconds, someone in the United States (U.S.) needs blood. A single donation can save lives. However, only 3% of eligible Americans give blood each year.

“When you give blood, you’re giving the gift of life,” said Simone Glynn, M.D., chief of the National Heart, Lung, and Blood Institute’s (NHLBI) Blood Epidemiology and Clinical Therapeutics Branch. “You aren’t just helping patients in critical care, but also those dealing with blood disorders.”

For the person doing the giving, you can be assured that you are doing a great thing, Glynn said. But if you’re the person receiving, can you trust that the blood you’re getting is safe?

Glynn said it’s a very important question. For 30 years, NHLBI has funded programs and research aimed at keeping the nation’s blood supply safe. One of these programs is NHLBI’s Recipient Epidemiology and Donor Evaluation Study, or REDS program. The REDS program conducts research to evaluate and improve the safety of the nation’s blood supply and the safety and effectiveness of transfusion therapies in children and adults. REDS is the largest research program of its kind in the U.S. It addresses potential emerging threats to the blood supply and serves as a resource for ongoing transfusion research. Because of programs like REDS, patients can have confidence that the blood they are receiving is safe.

Another major reason the blood supply is safe and trustworthy, Dr. Kamille West-Mitchell of the National Institute of Health Clinical Center Blood Bank noted, “are the donor screening requirements that blood donation sites have in place to ensure the safety of both donors and blood recipients.” On the day a person shows up to give blood, some of the requirements they must meet are to:

  • Be in good health — meaning that you feel well and can perform normal activities
  • Have a healthy pulse and blood pressure
  • Register a normal temperature — not a fever
  • Meet their state’s minimum age requirement
  • Not have a low hemoglobin level
  • Not have HIV, hepatitis, or risk factors for these infections and other blood transmissible infections
  • Not have donated blood in the last 56 days

Once the person’s blood leaves the donation site, it is carefully tested and screened for major known transfusion-transmissible agents such as HIV and hepatitis B and C to ensure it is safe, then stored at the right temperature before it is shipped where needed.

“Blood is always in demand because it’s perishable. But the good news is most people can donate blood,” West-Mitchell said. Finding a place to donate is simple, as there are blood donation sites in nearly every community. For more information about blood donation and safety, visit the NHLBI’s Blood Diseases & Disorders Education Program at www.nhlbi.nih.gov/education/blood/donation.

Can you save $3,000 in 2023? See what’s new for Medicare insurance plans

2022-11-02T16:01:00

(BPT) – The countdown is on! The Medicare Annual Enrollment Period ends Dec. 7, and it’s that time of year when you can change your Medicare plan (that is if you want to!). Now is the time to evaluate your current plan and see if it’s still a good fit.

This year, the top carriers have added several new benefits, making 2023 a good year to find a new Medicare Advantage plan. Here are just a few highlights from the nation’s top insurance carriers.

United HealthCare

  • National rollout of their UCard, which combines customers’ membership cards with their shopping benefit into one integrated card
  • Up to $3,600 to spend on over-the-counter items, groceries, even utilities
  • Enhanced dental benefits on 96% of their Medicare Advantage plans, which covers all non-cosmetic dental care including dentures and implants, and no out-of-pocket costs up to the annual coverage limit on most plans
  • $0 co-pays when visiting your primary care doctor

Cigna

  • Cigna Healthy Today flex card will be available to all plans. The card combines additional benefits and incentives to earn money, up to $200, for wellness activities
  • 25% more plans have the Part B premium rebate benefit, with up to $130 added back to a Medicare customer’s Social Security check every month
  • At least one $0 monthly premium Medicare Advantage plan in every market

Humana

  • Health Option Allowance of up to $3,300 per year will be available for most Dual Medicare Advantage members to spend on things like rent, groceries, utilities, over-the-counter items and more
  • 73% more plans that offer Part B premium giveback
  • Comprehensive dental benefits on some plans with a yearly allowance of $500 or more
  • 78% of new plans have $0 monthly premiums

WellCare

  • $0 monthly premiums, $0 or low co-pays for primary care physicians, and $0 lab and X-ray services on most MA plans
  • Up to $1,000 Flex spending cards are available on many plans for dental, vision, and hearing benefits on some MA plans
  • All Part D plans will include $0 tier 1 (most generic) drugs when filled at preferred pharmacies
  • Amazon is now a preferred pharmacy provider

Aetna

  • Aetna Medicare Extra Benefits Card is a prepaid debit card for over-the-counter items, groceries, utilities and transportation
  • 95% of MA plans will include dental benefits, which include preventive and comprehensive dental services and allows the member to choose any licensed dentist, in or out of network
  • Healthy Rewards Program encourages plan members to improve their health and well-being by rewarding them with $150 or more on personalized activities

With so many new benefits for 2023, it may be overwhelming to choose which plan is right for you. The caring, licensed agents at ClearMatchTM Medicare are patient and helpful, and will check to see if plans with these new benefits are available in your area. And, if they find you are already in a great plan, they’ll tell you so. If you’d like help, call 1-888-921-1286 (TTY:711) for a free Medicare review, Monday-Friday, 9 a.m.-9 p.m., Saturday, 9 a.m.-6 p.m. (ET) or visit ClearMatchMedicare.com, open 24-7.

Considering goals: Partnering with your doctor to help manage a chronic inflammatory disease

2022-11-02T06:01:00

(BPT) – Dr. Sharma and Ashley were compensated for their participation.

Content sponsored and provided by Pfizer. Ashley and Allegheny Health Network (AHN) rheumatologist Dr. Tarun Sharma partnered with Pfizer to share their different experiences with moderate to severe rheumatoid arthritis (RA).

Note: The image is not the actual patient and physician

Ashley grew up watching her grandmother struggle with rheumatoid arthritis (RA), a chronic inflammatory disease of the joints, and saw first-hand the effects RA could have on a person. When she was diagnosed with moderate to severe RA as an adult, managing her condition became a priority.

“I had concerns about the impacts of living with RA, and I knew that I needed to find a way to help manage my condition,” Ashley explains.

Ashley sought the opinion of several rheumatologists to help manage her RA before establishing an ongoing relationship with Tarun Sharma, MD, a rheumatologist at Pittsburgh-based Allegheny Health Network (AHN). When she met Dr. Sharma, she felt that his approach to care fit her needs and that he listened to her concerns and partnered with her to find a treatment that worked best for her.

Patients with RA, like Ashley, may find it difficult at first to establish a trusting relationship and discuss treatment goals with their rheumatologist. It can sometimes be challenging for patients to articulate the RA symptoms that they are experiencing to their doctor.

Dr. Sharma says he finds that patients may not initially share everything about their RA experiences with their physician but may open up once asked specific questions about how RA impacts their daily activities. “It is important for the patient to feel comfortable being honest about their condition, during an appointment,” says Dr. Sharma. “This helps physicians conduct a comprehensive evaluation and treat the patient’s RA.”

To that end, Dr. Sharma and Ashley work together to manage Ashley’s RA symptoms through ongoing communication. Ashley is now proactive about asking Dr. Sharma questions and is comfortable communicating clearly with him about her RA symptoms. She works closely with Dr. Sharma when making a treatment plan decision or change to her care with the goal of finding a plan suitable for her.

Throughout her disease management journey, Ashley has gone through a lot of trial and error with different treatments for her RA, including trying medicines called tumor necrosis factor (TNF) blockers, but none worked well enough for her. As a result, she did some research online and learned about XELJANZ® (tofacitinib), an oral medication for moderately to severely active rheumatoid arthritis when one or more TNF blockers have been used and did not work well or cannot be tolerated.

Ashley asked Dr. Sharma about XELJANZ. Dr. Sharma reviewed the potential serious side effects of the medication with her and discussed the type of laboratory monitoring that would be needed before and during treatment. Dr. Sharma also explained that XELJANZ has a BOXED WARNING.

XELJANZ can cause serious side effects and can lower your ability to fight infections; don’t start XELJANZ if you have an infection. Before and during treatment, your doctor should check for infections like tuberculosis (TB), and do blood tests. Serious, sometimes fatal infections, cancers including lymphoma, and lung cancer, blood clots and serious heart-related events have happened. People 50 or older with heart disease risk factors had an increased risk of death. Tell your doctor if you had a heart attack, other heart problems, stroke, or a history of blood clots.

Read more Important Safety Information and Indication below.

When Dr. Sharma and Ashley identified XELJANZ as a potential treatment option, they had an open conversation about Ashley’s treatment history and how her symptoms were impacting her at the time, which allowed Dr. Sharma to gather the appropriate data needed. According to Dr. Sharma, “It is important for rheumatologists to have a candid discussion about a patient’s disease management goals to help find a treatment plan that works best for them.”

From a patient perspective, Ashley’s advice to those navigating their own journey with RA is to focus on how you communicate with your doctor and look for ways to enhance active listening and two-way communication. For example, make a list of items you’d like to discuss with your rheumatologist in advance of your appointment and take notes during the conversation so you can refer to them in the future.

“You can’t be afraid to speak up when communicating with your doctor. Your rheumatologist is not going to know what’s going on with your RA symptoms or what your specific concerns are unless you address them directly. If something is on your mind related to your RA management, don’t be shy about addressing it with your doctor,” says Ashley.

Dr. Sharma agrees with Ashley’s tips and emphasizes the importance of proactively communicating developments related to your health and RA treatment plan. “If you have questions or concerns, it’s okay to reach out to your doctor in between visits. Your doctors are there for you, which sometimes requires an additional office visit or conversation,” says Dr. Sharma.

“In my experience, I’ve learned that managing my RA is about finding a balance — between me as an empowered patient and my doctor as the expert guiding me through my medical journey,” says Ashley. “My relationship with Dr. Sharma is an ongoing partnership, with the common goal of ensuring the best care for my RA.”

To learn more about XELJANZ, visit XELJANZ.com/RA.

IMPORTANT SAFETY INFORMATION AND INDICATION

The safety information below applies to all marketed formulations of XELJANZ. Specific risks associated with certain dosing are noted.

Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Do not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay. Serious infections have happened in people taking XELJANZ. These serious infections include tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with XELJANZ. You should not start taking XELJANZ if you have any kind of infection unless your healthcare professional tells you it is okay.

Before and after starting XELJANZ, tell your doctor if you are being treated for an infection,

have infections that keep coming back, or have symptoms of an infection, including:

  • fever, sweating, or chills
  • cough
  • blood in phlegm
  • warm, red, or painful skin or sores on your body
  • burning when you urinate
  • urinating more often than normal
  • muscle aches
  • shortness of breath
  • weight loss
  • diarrhea or stomach pain
  • feeling very tired

Increased risk of death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily.

Cancer. XELJANZ may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen. People taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily have a higher risk of certain cancers including lymphoma and lung cancer, especially if you are a current or past smoker. Tell your healthcare provider if you have ever had any type of cancer.

Higher dose. People with rheumatoid arthritis taking the higher dose of XELJANZ (10 mg twice daily) or XELJANZ XR (22 mg one time each day) have a higher risk of serious infections, shingles, or skin cancers.

Immune system problem. Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus–associated post-transplant lymphoproliferative disorder).

Increased risk of major cardiovascular events such as heart attack, stroke or death in people 50 years of age and older who have at least 1 heart disease (cardiovascular) risk factor and are taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily, especially if you are a current or past smoker.

Get emergency help right away if you have any symptoms of a heart attack or stroke while taking XELJANZ, including:

  • discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back
  • severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw
  • pain or discomfort in your arms, back, neck, jaw, or stomach
  • shortness of breath with or without chest discomfort
  • breaking out in a cold sweat
  • nausea or vomiting
  • feeling lightheaded
  • weakness in one part or on one side of your body
  • slurred speech

Blood clots in the lungs (pulmonary embolism, PE), veins of the legs (deep vein thrombosis, DVT), and arteries (arterial thrombosis) have happened more often in people who are 50 years of age and older and with at least 1 heart disease (cardiovascular) risk factor taking XELJANZ 5 mg twice daily or XELJANZ 10 mg twice daily. Blood clots in the lungs have also happened in people with rheumatoid arthritis. Some people have died from these blood clots.

  • Stop taking XELJANZ and tell your healthcare provider right away if you have any signs and symptoms of blood clots such as sudden shortness of breath, difficulty breathing, chest pain, swelling of a leg or arm, leg pain or tenderness, or red or discolored skin in the leg or arm.

Tears (perforation) in the stomach or intestines. Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking XELJANZ can get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate. Tell your healthcare provider right away if you have fever, stomach-area pain that does not go away, and a change in your bowel habits.

Serious allergic reactions can occur. Stop using XELJANZ and call your healthcare provider right away if you have swelling of your lips, tongue, throat, or get hives.

Changes in certain lab test results. Your doctor should do blood tests to check your white and red blood cells before starting and while you are taking XELJANZ. Your doctor should also check certain liver tests. You should not take XELJANZ if your lymphocyte count, neutrophil count, or red blood cell count is too low or your liver function test levels are too high. Changes in lab test results may cause your healthcare provider to stop your XELJANZ treatment for a time. Your cholesterol levels should be checked 4 to 8 weeks after you start receiving XELJANZ.

Before you use XELJANZ, tell your healthcare provider if you:

  • Are being treated for an infection, have an infection that won’t go away or keeps coming back, or think you have symptoms of an infection
  • Have TB, or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
  • Have diabetes, chronic lung disease, HIV, or a weak immune system. People with these conditions have a higher chance for infections
  • Live or have lived in certain areas (such as Ohio and Mississippi River Valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections
  • Have or have had Hepatitis B or C
  • Are a current or past smoker
  • Have had any type of cancer
  • Have had a heart attack, other heart problems or stroke
  • Have had blood clots
  • Have liver or kidney problems
  • Have any stomach area (abdominal) pain or been diagnosed with diverticulitis or ulcers in your stomach or intestines
  • Have recently received or plan to receive a vaccine. People taking XELJANZ should not receive live vaccines but can receive non-live vaccines
  • Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. You should not take XELJANZ and breastfeed
  • Have had a reaction to tofacitinib or any of the ingredients
  • Are taking other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take any of the following medicines while taking XELJANZ since this may increase your risk of infection:
    • tocilizumab (Actemra®)
    • etanercept (Enbrel®)
    • adalimumab (Humira®)
    • infliximab (Remicade®)
    • rituximab (Rituxan®)
    • abatacept (Orencia®)
    • anakinra (Kineret®)
    • certolizumab (Cimzia®)
    • golimumab (Simponi®)
    • ustekinumab (Stelara®)
    • secukinumab (Cosentyx®)
    • vedolizumab (Entyvio®)
    • ixekizumab (Taltz®)
    • sarilumab (Kevzara®)
    • azathioprine, cyclosporine, or other immunosuppressive drug
  • Tell your healthcare provider if you are taking medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these.

What are other possible side effects of XELJANZ/XELJANZ XR?

If you are a carrier of the Hepatitis B or C virus (viruses that affect the liver), the virus may become active while you use XELJANZ. Your healthcare provider may do blood tests before starting and while using treatment with XELJANZ. Tell your healthcare provider if you have any signs of these symptoms: feel very tired, little or no appetite, clay-colored bowel movements, chills, muscle aches, skin rash, skin or eyes look yellow, vomiting, fevers, stomach discomfort, or dark urine.

Common side effects in people with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis include upper respiratory tract infections (common cold, sinus infections), headache, diarrhea, nasal congestion, sore throat, runny nose (nasopharyngitis), and high blood pressure (hypertension).

Common side effects in people with ulcerative colitis include nasal congestion, sore throat, runny nose (nasopharyngitis), increased cholesterol levels, headache, upper respiratory tract infections (common cold, sinus infections), increased muscle enzyme levels, rash, diarrhea, and shingles (herpes zoster).

Common side effects in children (2 & older) with polyarticular course juvenile arthritis include upper respiratory tract infections (common cold, sinus infections), nasal congestion, sore throat, and runny nose (nasopharyngitis), headache, fever, nausea, and vomiting.

XELJANZ & Pregnancy

XELJANZ may affect the ability of females to get pregnant. It is not known if this will change after stopping XELJANZ. It is not known if XELJANZ will harm an unborn baby.

  • Pregnancy Registry: Pfizer has a registry for pregnant women who take XELJANZ. The purpose of this registry is to check the health of the pregnant mother and her baby. If you are pregnant or become pregnant while taking XELJANZ, talk to your healthcare provider about how you can join this pregnancy registry, or you may contact the registry at 1-877-311-8972 to enroll.

You and your healthcare provider should decide if you will take XELJANZ or breastfeed. You should not do both. After you stop your treatment with XELJANZ do not start breastfeeding again until 18 hours after your last dose of XELJANZ or 36 hours after your last dose of XELJANZ XR.

What is XELJANZ/XELJANZ XR?

XELJANZ/XELJANZ XR (tofacitinib) is used to treat adults with:

  • Moderately to severely active rheumatoid arthritis when 1 or more medicines called tumor necrosis factor (TNF) blockers have been used, and did not work well or cannot be tolerated
  • Active psoriatic arthritis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
  • Moderately to severely active ulcerative colitis when 1 or more tumor necrosis factor (TNF) blocker medicines have been used, and did not work well or cannot be tolerated
  • Active ankylosing spondylitis when 1 or more tumor necrosis factor (TNF) blocker medicines have bene used, and did not work well or cannot be tolerated

It is not known if XELJANZ/XELJANZ XR is safe and effective in people with Hepatitis B or C.

XELJANZ/XELJANZ XR/XELJANZ Oral Solution is not recommended for people with severe liver problems.

It is not known if XELJANZ/XELJANZ Oral Solution is safe and effective in children for treatment other than active polyarticular course juvenile arthritis.

It is not known if XELJANZ XR is safe and effective in children.

Please see full Prescribing Information, including BOXED WARNING and Medication Guide.

August 2022; PP-XEL-USA-7764

Supporting a Loved One Living with a Mental Health Condition and Tardive Dyskinesia

2022-11-01T08:01:00

(BPT) – This article was sponsored and developed by Neurocrine Biosciences, Inc. Amy and Kim were compensated by Neurocrine Biosciences, Inc. to share their story.

For the approximately 40 million people who care for loved ones, this November is a time to recognize their important role during National Family Caregivers Month. Caregiving can encompass a variety of activities and their support is a critical component in the lives of those who require it.

Amy grew up as an athlete and played sports throughout college, earning 10 varsity letters. After her collegiate sports career came to an end in 1981, a friend asked if she would be interested in joining a community-level slow pitch softball team. That’s where she met her partner Kim, whose parents were sponsoring the softball team.

In 1996, Amy was diagnosed with major depressive disorder and worked with her doctors to find the right treatment plan. The diagnosis came after several major life-changing events, including an internal conflict she experienced after learning that members of her own religious community had challenging views of her relationship with Kim. Overtime, Amy’s mental health became stable, but then in the early 2010s, after experiencing extreme job dissatisfaction and the death of both of her parents, she slipped back into a deep depressive state. In 2019, she worked with her doctors and therapists to find the most effective treatment and began taking antipsychotics, which again helped to stabilize her condition.

A few months later, Amy started to experience involuntary movements, including jaw swinging, chewing movements, grimacing, and movements while sitting. “It all began in kind of a blur,” said Amy. “When I first started having the movements, I just thought, why am I doing this?” Kim also noticed these symptoms. She pointed them out and suggested that Amy talk to her doctor about the movements.

About a year and a half after realizing she had involuntary movements, Amy was referred to a neurologist, who diagnosed her with tardive dyskinesia (TD). TD is a movement disorder characterized by abnormal, involuntary movements of the tongue, jaw, trunk, or extremities, which may be disruptive and negatively impact those living with the condition. TD is associated with prolonged use of certain kinds of mental health medicines (such as antipsychotics), which help control dopamine receptors in the brain. Approximately 600,000 people in the U.S. may be affected by this condition.

Once Kim knew of Amy’s diagnosis and realized Amy may be living with TD for the rest of their lives, she took a step back to determine what she could do for Amy. Kim learned to become more aware and understanding of Amy’s needs. “Amy and I have a strong relationship. We can talk to each other and say, ‘this is what I need from you,’” Kim said. “It’s a daily thing and we’re working through it together.”

To help manage Amy’s TD, her neurologist recommended INGREZZA® (valbenazine) capsules, the only once-daily treatment for adults with TD. INGREZZA is a prescription medicine used to treat adults with movements in the face, tongue, or other body parts that cannot be controlled. It is not known if INGREZZA is safe and effective in children. The most common side effect is sleepiness (somnolence).

After Amy worked with her neurologist to find the most effective dosage, her symptoms became less prevalent, and with that she felt more confident. Individual results may vary. Some taking INGREZZA begin to notice a reduction in movements at 2 weeks with clinical results at 6 weeks*.

Please see full Important Safety Information and Prescribing Information below.

Kim saw the improvements in Amy’s symptoms a few weeks after Amy started taking INGREZZA. “Her whole attitude is different. She seems more relaxed now, while before I could tell she would be trying to stop moving, or chewing a lot of gum to hide the symptoms,” said Kim. “We are not back to our everyday life quite yet, but it feels more comfortable.” Kim is proud of her progress and plans to be there every step of the way.

By sharing their story during National Family Caregivers Month, Amy and Kim hope to shed a light on the importance of supporting a loved one with a mental health condition and helping to recognize potential symptoms of TD. They encourage others to know what TD looks like, understand the cause and the impact, and encourage people to talk to their healthcare providers about TD or related disorders.

To learn more about TD and INGREZZA, talk to your doctor or visit INGREZZA.com for more safety information.

Important Information

Approved Use

INGREZZA® (valbenazine) capsules is a prescription medicine used to treat adults with movements in the face, tongue, or other body parts that cannot be controlled (tardive dyskinesia).

It is not known if INGREZZA is safe and effective in children.

IMPORTANT SAFETY INFORMATION

Do not take INGREZZA if you:

  • are allergic to valbenazine, or any of the ingredients in INGREZZA.

INGREZZA may cause serious side effects, including:

  • Sleepiness (somnolence). Do not drive, operate heavy machinery, or do other dangerous activities until you know how INGREZZA affects you.
  • Heart rhythm problems (QT prolongation). INGREZZA may cause a heart problem known as QT prolongation.

Symptoms of QT prolongation may include:

  • fast, slow, or irregular heartbeat
  • shortness of breath
  • dizziness or fainting

Tell your healthcare provider right away if you have a change in your heartbeat (a fast or irregular heartbeat), or if you faint.

  • Abnormal movements (Parkinson-like). Symptoms include: shaking, body stiffness, trouble moving or walking, or keeping your balance.

Before taking INGREZZA, tell your healthcare provider about all of your medical conditions including if you: have liver or heart problems, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effect of INGREZZA is sleepiness (somnolence). Other side effects include changes in balance (balance problems, dizziness) or an increased risk of falls, headache, feelings of restlessness, dry mouth, constipation, and blurred vision.

These are not all of the possible side effects of INGREZZA. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see accompanying INGREZZA full Product Information.

*INGREZZA was studied in a 6 week clinical trial. A total of 234 people participated in the study. Results were based on 79 people taking the recommended dose of 80 mg.

This article was sponsored and developed by Neurocrine Biosciences, Inc. Amy and Kim were compensated by Neurocrine Biosciences, Inc. to share their story.

©2022 Neurocrine Biosciences, Inc. All Rights Reserved. CP-VBZ-US-2151 11/2022

How to get health insurance coverage – and get help if you need it

2022-11-01T06:01:00

(BPT) – Health insurance can help protect you from unexpected costs if you or someone in your family gets injured or becomes ill. If you do not have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source, Individual and Family Plans available in the Health Insurance Marketplace can get you covered, and this is the time of year to find a plan that helps provide the best coverage for your and your family’s needs.

During the open enrollment period, there are options available that may include subsidies to help you save money out of pocket, if you’re eligible, and many people qualify for plans as low as $0 per month depending on their incomei. If you find comparing and choosing healthcare confusing, you can get help navigating your options so you can make a good decision to help safeguard your health, not just when you are sick or injured, but also through preventive care like health screenings, vaccinations, wellness visits and more — so you can stay as healthy as possible.

UnitedHealthcare Individual and Family Plans

For 2023, UnitedHealthcare is offering coverage options in the Marketplace in these 22 statesii, with enrollment beginning on November 1, 2022:

Alabama Arizona
Colorado Florida
Georgia Illinois
Kansas Louisiana
Maryland Massachusetts
Michigan Mississippi
Missouri Nevada
New York North Carolina
Ohio Oklahoma
Tennessee Texas
Virginia Washington

The 2023 Individual and Family Plans through UnitedHealthcare in these states provide a wide range of benefits, as well as a simple enrollment process and a quality service experience once you become a member.

Health benefits included on UnitedHealthcare Individual and Family Marketplace Plans

Besides being able to find competitively-priced health plans and access to healthcare providers in-network, these plans may includeiii:

  • $0 unlimited primary care
  • $0 unlimited virtual urgent careiv
  • Dental and vision coverage
  • Prescriptions as low as $3
  • Complimentary digital fitness classesv

Some plans also offer 24/7 virtual visits for urgent, primary, and specialty care in English and Spanish, at no additional costiv.

Additional highlights include:

  • An opportunity to earn a $100 gift cardvi
  • Health savings account options

How to enroll

To help you figure out the type of coverage that may be good for you, think back on your doctor visits, prescriptions and other medical care. This may give you an idea of what you may want to consider moving forward.

Then, go to UHCExchange.com (available in Spanish: UHCExchange.com/es) to learn more about your choices, and enroll in a plan. The 2023 open enrollment period goes from November 1, 2022 through January 15, 2023 in most states, and if you want your coverage active on January 1, 2023 you must enroll by December 15, 2022.

If you’d like assistance with finding the right plan for you and your family, you can also call 1-877-649-9797 and talk to a licensed insurance agent.

By enrolling now, you may be better prepared for whatever the next year may bring. Visit UHCExchange.com to get started todayvii.



i To qualify for a $0 monthly premium, you must meet household income requirements for Advanced Premium Tax Credits. Cost-sharing (like deductibles and coinsurance) may be higher.

ii Subject to regulatory approval.

iii The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. The policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review the plan coverage documents or contact UnitedHealthcare.

iv Virtual visits conducted by telephone or video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Data rates may apply. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members, and visit limits may apply. Check your benefit plan to determine if these services are available.

v The Peloton offering is available to members enrolled in applicable fully insured UnitedHealthcare plans and participants enrolled in UnitedHealthcare Level Funded NavigateNOW plans who are 18+ years of age and register for an account with Peloton. Offer is valid until June 30, 2023. UnitedHealthcare members and participants that own a Peloton Bike, Bike+ or Tread can redeem a 3-month All-Access Membership. Limit one code redemption per UnitedHealthcare member or participant. All services provided by Peloton directly to consumers are governed by Peloton’s Membership Terms, located at https://www.onepeloton.com/membershipterms. Discounts available on applicable purchases until June 30, 2023. Equipment offer void in Maryland, New York, New Jersey, Pennsylvania, or Washington D.C. To inquire about eligibility for a retroactive refund on applicable purchases, contact Peloton customer service. Peloton Bike, Bike+ or Tread purchase requires an All-Access Membership to access content. All prices are exclusive of applicable taxes. Offer applied at checkout. No substitutions. Peloton equipment discount is limited to a purchase of one unit of each equipment type per member or participant. Void where prohibited. Not transferable. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. UnitedHealthcare members and participants should consult with an appropriate health care professional before beginning any exercise program and/or to determine what may be right for them. The value of this offering may be taxable. Members and participants should consult with an appropriate tax professional to determine if they have any tax obligations from having access to this offering at no additional cost.

vi Enrollees are eligible to earn a $100 gift card for certain retail participants upon completion of a wellness visit with the enrollee’s primary care provider. Limited to one gift card per enrollee.

vii Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Administrative services provided by United HealthCare Services, Inc. or its affiliates.