Patients who start treatment for depression with generic drugs are as likely to keep taking their medication as those who start on brand-name medicines, and at considerably lower cost, says a new US study.
Researchers reporting their study last week in the US Journal of Managed Care Pharmacy (JMCP) said that patients starting generic selective serotonin reuptake inhibitors (SSRIs) and generic selective norepinephrine reuptake inhibitors (SNRIs) were found to have a discontinuation rate of 44.2%, compared to 46.8% among those on brand-name SSRIs and SNRIs. Moreover, drug costs for those starting on generics were almost 50% lower and their total health costs were about 20% less, averaging $3.660 in patients starting on a generic compared to $4.587 for those starting on a brand-name drug, report researchers Anna Vlahotis, Scott Devine et al.
These results "do not support the contention sometimes made by critics of pharmacy utilisation management tools that generic antidepressants are less effective or safe than brand drugs," they say.
The study is part of pharmacy benefit manager (PBM) Express Scripts' Consumerology programme, which applies the behavioural sciences to healthcare. Express Scripts notes that depression is a major cause of disability in the US, accounting for more than $83 billion in costs each year, and that the study provides "further proof that greater use of generics could significantly reduce wasteful healthcare spending while maintaining positive health outcomes."
The findings have "significant implications for plan sponsors looking to reduce costs while maintaining high levels of patient care," said Sharon Frazee, vice president of research and analytics for Express Scripts. "When patients use medications that cost more without offering a clinical advantage, it causes waste in the system," she added.
In a joint statement, campaign groups Mental Health America, the National Council for Community Behavioural Care and the National Alliance on Mental Illness say that the use of pharmacy utilisation management programmes can help ensure that patients are not being over- or under-medicated or treated with inappropriate medications. However, they add, if such programmes are designed solely to control pharmaceutical costs, they can result in "harmful consequences for vulnerable patients and higher overall health costs."
Concerns that health plans are using pharmaceutical utilisation management tools such as step therapy purely to control costs have led to number of US states to consider legislation to limit or ban their use. Step therapy is defined by Medicare - the US federal health insurance programme for the over-65s - as "a process whereby prescriptions are filled with an effective but more affordable prescription (Step 1). When appropriate, a more costly (Step 2) medication can be authorised if the Step 1 prescription is not effective in treating the condition."
However, ForGrace, a pressure group supporting bill AB 1826, which was introduced in the California legislature on February 14 this year to ban the use of step therapy (also known as "fail first") for pain patients, describes the practice as "unethical."
"Some plans require patients to try up to five different types of medications before they have access to the one their doctor determined was best for them," says the group, adding: "many plans are requiring patients to take medicine that the Food and Drug Administration [FDA] has not even approved for their condition before being allowed the FDA-approved medication."
"Only a doctor can write a prescription, but insurance companies are second-guessing their decisions. It is very difficult for physicians to override the health plan requirement for step therapy," says ForGrace.
New Jersey has already banned step therapy in pain treatment, while in Missouri, bills to prohibit the practice were introduced into the state House of Representatives (HB 458) in 2009 and Senate (SB 918) in April 2010.
Citizens Against Government Waste - "America's No 1 taxpayer watchdog" - which opposes the Missouri bills, point to a study by the American Association of Managed Care (AAMC) which found that implementing step therapy programmes for three major drug classes - for ulcers, depression and arthritis - reduced total costs by 38% during a two-year period. The proposed legislation would, on the other hand, "require a new, bureaucratic, government-regulated process of approval," which would "stifle plan sponsors from communicating with beneficiaries on a timely basis and would inevitably discourage the use of generic alternatives, raising costs for taxpayers and consumers," the group says.