How to save on acid reflux medicine: omeprazole, pantoprazole and famotidine

The main types of reflux medicine

NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes three main groups, many sold over the counter (NIDDK).

• Antacids relieve mild heartburn, but they aren’t meant for daily use or for treating most GERD symptoms (NIDDK).
• H2 blockers, such as famotidine (Pepcid), lower acid. NIDDK says they’re less effective than PPIs at healing the lining of the esophagus (NIDDK, MedlinePlus).
• Proton pump inhibitors (PPIs), such as omeprazole and pantoprazole, lower the amount of acid the stomach makes. NIDDK says PPIs are generally safe and effective (NIDDK, MedlinePlus).

NIDDK also lists steps that can help without medicine, such as losing weight if needed, raising the head of your bed 6 to 8 inches and quitting smoking (NIDDK).

Over the counter vs. prescription

• OTC omeprazole is for frequent heartburn, meaning two or more days a week. It’s taken as a 14-day course, no more than once every 4 months unless your doctor says otherwise, and it can take 1 to 4 days for the full effect (MedlinePlus).
• OTC famotidine shouldn’t be taken more than twice in 24 hours, or for longer than 2 weeks, unless your doctor tells you to (MedlinePlus).
• Prescription PPIs and H2 blockers are used to treat GERD and other conditions, and the dose and length of treatment depend on your diagnosis (MedlinePlus, MedlinePlus).

If you need a reflux medicine for more than the label allows, see your doctor. A prescription may also change what you pay. A discount card like RxGo is for prescriptions, and many plans cover prescription versions, but not always the OTC ones. Medicare Part D doesn’t cover nonprescription drugs (CMS).

When to see a doctor right away

NIDDK says to see a doctor if you have GERD symptoms along with trouble or pain swallowing, vomiting that won’t stop, vomit with blood or that looks like coffee grounds, black or tarry stools, or weight loss you can’t explain (NIDDK). MedlinePlus says chest or shoulder pain with shortness of breath, sweating, lightheadedness or pain spreading to the arms, neck or shoulders may be a sign of a more serious condition (MedlinePlus). Call 911 if you think you might be having a heart attack.

Long-term PPI use: talk with your doctor

MedlinePlus says people who take PPIs like omeprazole and pantoprazole may be more likely to break a wrist, hip or spine, with the highest risk at high doses or after a year or more of use. Long-term use can also raise the risk of fundic gland polyps (MedlinePlus, MedlinePlus). NIDDK says PPIs may raise the risk of C. diff infection (NIDDK).

What happened to Zantac?

On April 1, 2020, FDA asked companies to pull all prescription and OTC ranitidine (Zantac) from the market because of a contaminant called NDMA. FDA said its testing had not found NDMA in famotidine, cimetidine, esomeprazole, lansoprazole or omeprazole (FDA).

How to pay less

• Choose the generic. FDA says generic drugs usually cost less, and prices tend to drop as more companies make the same drug (FDA).
• Check your plan. Look up your drug on your plan’s drug list. If your doctor thinks a drug is medically necessary and it isn’t covered, you can ask for an exception (HealthCare.gov).
• Compare cash prices for prescriptions. Check a free discount card such as RxGo before you fill a prescription. Drugs bought with a discount card instead of your Medicare plan don’t count toward the plan’s out-of-pocket limit (Medicare.gov).
• No insurance? HRSA-funded health centers offer care on a sliding fee based on income. Find one near you.