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Psychiatric drugs like Eli Lilly’s Zyprexa could be next on the list for reimbursement restrictions based on comparative effectiveness data, experts in the field told Pharmawire.
The move would also spell trouble for AstraZeneca’s Seroquel and Pfizer’s Geodon, two commonly prescribed and costly antipsychotics. Cost pressures will be felt most acutely starting in June, when the patent expires on Johnson & Johnson’s competing product Risperdal.
Public and private payers have been fueling the growing interest in compiling data that allows them to compare different drugs within the same therapeutic category. The information then helps shape reimbursement programs - like step therapy, where patients are required to try a cheaper drug before a more expensive one will be covered.
Tanisha Carino, a director at research firm Avalere Health and former policy analyst at the Centers for Medicare and Medicaid Services, noted that mental health is a prime target for using comparative effectiveness data to make coverage decisions.
The National Institute of Mental Health is already sponsoring the large-scale Clinical Antipsychotics Trials of Intervention Effectiveness (also known as CATIE), which have shown that older, less expensive drugs can be as effective as newer ones. The data is rife with cost effectiveness comparisons.
”The momentum, politically, is there,” Carino said, adding that the Congress wants to allot USD 1bn to similar studies. ”The question is how we’re going to use the research in terms of reimbursement.”
A lobbyist similarly told this news service that comparative effectiveness legislation appears to be part of a wider Medicare bill expected to pass by the end of this year. About 71% of patients who are eligible for antipsychotics are enrolled in a Medicare Part D plan, according to IMS Health; these plans are under pressure to at once hold down costs while also offer broad formularies.
Physicians, however, have been resistant to changing treatment protocols, and have previously defended their use of newer antipsychotics to this news service - arguing that schizophrenia is a particularly difficult disease to treat. One physician noted that the CATIE trial changed prescribing habits only ”academically.”
”The practitioner community were not interested in the findings that older drugs were as effective as new drugs,” Carino said.
Yet while pieces of the CATIE data have been available since at least 2003, next year marks the first time that a newer drug, atypical antipsychotic Risperdal, will be available as a generic, potentially leading prescribers to choose that product.
Mark Gibson, deputy director at the Center for Evidence Based Policy at the Oregon Health & Science University, noted that physicians will use comparative effectiveness data if they trust the source that conducted the research.
”[Doctors] understand that so much of the information is coming from a buyer source,” he said. ”In general, CATIE was an important step forward. It gave us some very constructive information.”
Eli Lilly has a market cap of USD 61.28bn. Pfizer has a market cap of 169.83bn.
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