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Brand-name medication cost increases, recent generic releases, and expected generic releases for 2020

March 3, 2020 · Optum Settlement Solutions

Medications comprise a large proportion of Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). And, as the population ages, more claimants will become eligible for Medicare coverage. So, it is important to stay up-to-date on medication costs and how they affect WCMSAs.

Brand-name medication manufacturers typically increase the cost of their products 10 percent per year. Increases are often announced in January and July. Fortunately, formularies implemented at the Pharmacy Benefits Management (PBM) level and a growing number of state formularies are working to decrease medication claim costs. Formularies are effective initial tools to help keep medication costs down. However, there are times when despite best practices, the cost of prescribed medications can result in a high MSA allocation, making settling claims unlikely. The Optum Settlement Solutions clinical team can often recommend cost-effective alternatives and opportunities to improve claimants’ clinical well-being.

January 2020 brand-name medication cost increases
Our most recent pricing review for brand-name medications commonly seen in WCMSA allocations revealed the usual biannual cost increases, averaging eight percent in January 2020. Typical WCMSA medications with their potential therapeutic uses, including off-label uses, are listed below.

All pricing information below is from RED BOOK. There are cost-effective alternatives for claims involving one or more of these medications. The Optum clinical team can likely recommend guideline-supported therapy alternatives to reduce the claim’s WCMSA allocation and improve clinical outcomes.

Brand name
(generic name)
Common therapeutic uses Dosages and
formulations
Current
price/unit
Percent
increase
Belsomra® (suvorexant) Insomnia 5 mg, 10 mg,
15 mg, 20 mg Tablets
$14.62 5%
Bunavail® (buprenorphine-naloxone) Opiate dependence 2.1-0.3 mg, 4.2-0.7 mg,
6.3-1 mg Buccal Films
$10.36 - $20.73 11%
Cambia®
(diclofenac)
Acute migraine 50 mg Powder for Solution $99.73 21%
Dexilant (dexlansoprazole)** Gastroesophageal reflux disease (GERD), esophagitis, heartburn 30 mg, 60 mg Capsules $11.63 3%
    20 mg, 60 mg, 80 mg,
100 mg, 120 mg
Extended-Release Tablets
$11.90 - $61.61 5%
Hysingla® ER (hydrocodone ER) Chronic pain 30 mg
Extended-Release Tablets
$17.37 27%
    40 mg
Extended-Release Tablets
$23.40 67%
Linzess®
(linaclotide)
Constipation 72 mcg, 90 mcg,
145 mcg Tablets
$17.80 5%
Lyrica®
(pregabalin)*
Neuropathic pain 25 mg, 50 mg, 75 mg,
100 mg, 150 mg, 200 mg, 225 mg, 300 mg Capsules
$9.82 - $10.80 5%
Nucynta®
(tapentadol)
Acute pain 50 mg, 75 mg,
100 mg Tablets
$8.39 -$13.69 10%
Nucynta® ER
(tapentadol ER)
Chronic pain 150 mg, 200 mg, 250 mg,
50 mg, 100 mg
Extended-Release Tablets
$8.22 - $24.90 10%
OxyContin®
(oxycodone ER)
Chronic pain 10 mg, 20 mg, 30 mg,
40 mg, 60 mg, 80 mg
Extended-Release Tablets
$4.82 - $26.91 5%
Relistor® (methylnaltrexone) Opiate-induced constipation 150 mg Tablets $23.10 8%
Suboxone® (buprenorphine-naloxone)* Opiate dependence 2-05 mg, 4-0.5 mg, 4-1 mg, 8-2 mg, 12-3 mg
Buccal Films
$6.01 - $21.55 5%
Xtampza® ER
(Oxycodone ER)
Chronic pain 9 mg, 13.5 mg, 18 mg,
27 mg, 36 mg
Extended-Release Capsules
$5.88 - $18.78 10%
Zorvolex® (diclofenac) Acute pain, osteoarthritis 18 mg, 36 mg
Capsules
$8.66 10%

*Generic now available
**Generic launch expected in 2020

Generics released in 2019
Several generic medications relevant to WCMSAs were released in 2019. Typically, new generics provide approximately a 20 percent cost reduction compared to their brand-name counterparts. But as more generic manufacturers enter the market, increases in supply and competition continue to drive down prices, over time. Keep in mind that some of these new generic medications continue to have very high prices per unit, and most have more cost-effective therapeutic alternatives.

Brand name
(generic name)
Common therapeutic uses February 2020 brand AWP Lowest generic AWP per unit Percent decrease
Advair Diskus®
(fluticasone-salmeterol)*
Asthma, chronic obstructive pulmonary disease (COPD) $380.46 - $621.72
per inhaler
$357.63 -
$584.42
6%
Amrix®
(cyclobenzaprine ER)
Muscle spasms $50.71
per capsule
$45.27 11%
Evzio® (naloxone
auto-injector)**
Opiate overdose $4,920
per 2-pack
$213.60 96%
Flector® (diclofenac epolamine 1.3% patch) Acute pain $14.92
per patch
$13.42 10%
ProAir® HFA
(albuterol sulfate HFA)
Asthma $80.26
per inhaler
$64.2
per inhaler
20%
Lyrica®
(pregabalin)
Neuropathic pain $9.82 - $10.80
per capsule
$0.90 - $2.05 81-91%
Rozerem®
(ramelteon)
Insomnia $15.56
per tablet
$13.99 10%
Silenor®
(doxepin)
Insomnia $19.96
per tablet
$16.30 18%
Suboxone
(buprenorphine-naloxone)
Opiate dependence $6.01 - $21.55 per film $4.90 -
$17.58 per film
18%
Vesicare®
(solifenacin)
Overactive bladder,
neurogenic bladder
15.42 per tablet $0.34 - $0.57 96-98%
Zohydro ER
(hydrocodone ER)
Chronic pain $12.00 - $14.65 per capsule $9.98 - $12.20 17%

*The generic launch of fluticasone-salmeterol inhaler was discussed in our February 2019 blog, FDA Approves First Generic of Advair Diskus® Inhaler for Asthma and COPD.
**The generic of Evzio® auto-injector was launched in December 2019. But at the time of this writing, it is currently on backorder and not yet available to wholesalers; however, generic pricing information has been published.
The generic launch of diclofenac epolamine patches was discussed in our March 2019 blog, New Generic Options Available for Flector® Patch.
Generic pricing of pregabalin, ramelteon and solifenacin were previously discussed in our September 2019 blog, Generic Lyrica® Price Drop and Other Updates – Significant MSA Savings. While solifenacin has shown a significant price decrease, this medication is not as common in WCMSA allocations as the others on this list.

Generic launches expected in 2020
A few other medications relevant to WCMSAs are expected to see generic launches in 2020. It is important to understand that prospective generic launch dates are subject to change depending on factors beyond our control. As with the newly available generics, most of these medications also have more cost-effective therapeutic alternatives available.

Brand name
(generic name)
Common therapeutic uses February 2020
brand AWP
Expected
generic launch
Daliresp®
(roflumilast)
COPD $14.44
per tablet
Early 2020
Dexilant
(dexlansoprazole)
GERD, esophagitis, heartburn $11.64
per capsule
June 2020
Dulera®
(mometasone-formoterol)
Asthma, COPD $373.62
per inhaler
Late 2020
Latuda®
(lurasidone)
Bipolar depression $51.34 - $76.63
per tablet
December 2020
Vimovo®
(naproxen-esomeprazole)
Arthritis $49.64 per tablet July 2020

 

Optum’s Settlement Solutions clinical team can help with claim cost mitigation
The Optum team can help reduce medication costs to facilitate claim settlement. We are constantly monitoring trends in the marketplace pertaining to generic availability of brand-name medications and average wholesale price (AWP) changes that may positively or negatively affect the WCMSA. The team is also well versed on clinical practice guidelines and has deep knowledge of therapeutic alternatives that are more cost-effective and/or clinically-effective to aid in moving claims to settlement.

Optum Settlement Solutions can provide clients a list of previously completed WCMSAs that include medications with price increases. We recommend that carriers, third-party administrators (TPAs) and claim handlers also review active claims to determine if any are affected by these price changes, and take advantage of Optum’s suite of clinical mitigation products to reduce claim costs, improve claimants’ clinical outcomes and move claims to settlement in a timely manner.

At Optum Settlement Solutions, we continue to follow industry trends involving medication pricing and other changes that may affect WCMSA arrangements. Follow our blog to stay informed on the latest industry trends.

For a more thorough list of expected generic launches, as well as forecasting for new medication approvals, see the latest edition of the OptumRx RxOutlook® publication.

Sources:

  1. Friedman, Yali. 29 Drugs Facing Patent Expirations and Generic Entry in 2020 - 2021. DrugPatentWatch.com, thinkBiotech, LLC. Updated 28 February, 2020. Available online at: www.drugpatentwatch.com/p/expiring-drug-patents-generic-entry

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