• Intro
• Commercial Market
• Medicare
• Prior Authorization
• Quantity Limits
• Strategic Implications

Featured article: Lack of Impact from Two Key Generics in the Anti-depressant Formulary Market

Executive Summary

Since June 2006 two key products - Zoloft and Effexor - each lost their patent exclusivity. We sought to examine the impact of the widespread availability of generic venlafaxine and sertraline in the anti-depressant marketplace. A previous edition of Fingertip Formulary Insights reviewed the negative impact of the widespread availability of simvastatin on the branded statin marketplace. Thus, in this issue of Fingertip Formulary Insights™, we examine the impact of two generic anti-depressants on the formulary status of key brand products.

Methods

We utilized the Fingertip Formulary Analytics^® platform to evaluate the formulary status of key products in the SSRI and SSNRI drug classes commencing in July 2006 through November 2007. We examined formulary access as measured by tier 1 and 2 coverage, as well as managed care restrictions such as prior authorization, quantity limits, and step therapy. All results were analyzed as a percentage of covered lives.

Findings

Despite the availability of two lower cost generic equivalents, there was surprisingly little downward pressure on formulary access for remaining single-source branded products. Single source brands generally maintained their tier 1 and 2 position in aggregate, and in certain cases, actually gained ground. As anticipated, the branded versions of Zoloft and Effexor rapidly lost formulary access as their generic equivalents entered the marketplace.

• Commercial Market – Effexor XR has consistently been the leader in tier 1/2 availability with no significant changes during the past 17 months. Lexapro also has held steady, despite the introduction of two generics and is currently number two, having displaced Paxil CR around 4Q'06. Cymbalta has gained the greatest access advantages and has increased approximately 15% in absolute terms since July 2006 and currently is on tier 1/2 for 34% of covered lives as of November 2007.
• Medicare Market – Directional movements in the Medicare market were similar to the commercial marketplace, except that Cymbalta's formulary access gains were significantly more prominent across Medicare plans. Cymbalta's access increased by over 35% during the prior year and is currently tier 1/2 for over 80% of Medicare lives, just behind Effexor XR.
• Managed Care Restrictions – Significant differences were present between the commercial and Medicare markets. On the commercial side, there are important increases in the prevalence of both prior authorization (PA) and quantity limits (QL) over the past 17 months, while these restrictions were more or less flat overall for Medicare.

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