Brand-name medication cost increases, recent generic releases, expected generic releases for 2021
Over 800 brand-name medications increased in price in January 2021 ― below we list price boosts for 19 of these medications commonly seen in Workers’ Comp Medicare Set Aside Arrangements (WCMSAs), which average a 6% cost increase.
Brand-name medication manufacturers typically announce price increases in January and July that total about 10% annually. While formularies help keep medication costs down, the price of prescriptions can boost WCMSA costs, making claim settlements unlikely without claim cost mitigation efforts by a specialist, such as Optum.
Below find: January 2021 brand medication cost increases, 2020 first-time generic releases and 2021 expected generic launches
January 2021 brand medication cost increases
All average wholesale price (AWP) information in the table is from RED BOOK®. Although the medications listed below do not have FDA-approved generics, cost-effective therapeutic alternatives may be available.
| Therapeutic Category, Brand name (generic name) | Dosages and formulations | New AWP/unit | Percent increase |
| Opioid analgesics for pain | |||
| OxyContin® (oxycodone ER) | 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg Tablet | $5.32 - $29.68 | 5% |
| Xtampza ER® (oxycodone ER) | 9 mg, 13.5 mg, 18 mg, 27 mg, 36 mg Capsule | $6.46 - $20.64 | 10% |
| Hysingla® ER (hydrocodone ER) | 20 mg, 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg Tablet | $11.90 - $61.61 | 5% |
| Nucynta® (tapentadol) | 50 mg, 75 mg, 100 mg Tablet | $9.22 - $14.36 | 10% |
| Nucynta® ER (tapentadol ER) | 50 mg, 100 mg, 150 mg, 200 mg, 250 mg Tablet | $9.93 - $37.63 | 10% |
| Belbuca® (buprenorphine) | 75 mcg, 150 mcg, 300 mcg, 450 mcg, 600 mcg, 750 mcg, 900 mcg Sublingual Film | $7.33 - $18.06 | 5% |
| Migraine treatment agents | |||
| Cambia® (diclofenac potassium) | 50 mg Powder for Solution | $109.60 | 10% |
| Aimovig™ (erenumab-aoee) | 70 mg/mL, 140 mg/mL Solution for Injection | $766.52 | 6% |
| Emgality® (galcanezumab-gnlm) | 100 mg/mL, 120 mg/mL Solution for Injection | $627.60 - $753.12 | 4% |
| Ajovy® (fremanezumab-vfrm) | 225 mg/1.5 mL Solution for Injection | $506.90 | 5% |
| Ubrelvy™ (ubrogepant) | 50 mg, 100 mg Tablet | $107.10 | 5% |
| Constipation treatment agents | |||
| Relistor® (methylnaltrexone) | 150 mg Tablet | $26.90 | 8% |
| Relistor® (methylnaltrexone) | 8 mg/0.4 mL, 12 mg/0.6 mL Solution for Injection | $269.03 - $403.54 | 8% |
| Linzess® (linaclotide | 72 mcg, 145 mcg, 290 mcg Capsule | $18.69 | 5% |
| Movantik® (naloxegol) | 12.5 mg, 25 mg Tablet | $14.64 | 3% |
| Proton pump inhibitor for stomach protection | |||
| Dexilant® (dexlansoprazole) | 30 mg, 60 mg Capsule | $12.34 | 6% |
| Antidepressants | |||
| Trintellix® (vortioxetine) | 5 mg, 10 mg, 20 mg Tablet | $16.92 | 5% |
| Viibryd™ (vilazodone) | 10 mg, 20 mg, 40 mg Tablet | $12.01 | 5% |
| Sedative agent for insomnia | |||
| Belsomra® (suvorexant) | 5 mg, 10 mg, 20 mg Tablet | $15.36 | 5% |
| Topical anesthetic for localized pain | |||
| ZTlido® (lidocaine) | 1.8% Transdermal Patch | $11.94 | 5% |
First-time generics released in 2020
A few brand-name medications relevant to WCMSAs saw their first FDA-approved generics released in 2020 and early in 2021. Typically, new generics provide approximately 20% cost reduction compared to their brand-name counterparts, but as more generic manufacturers enter the market over time, increases in supply and competition work to drive down prices.
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 available.
| Brand Name (Generic Name) | Therapeutic Use | February 2021 Brand AWP | New Generic AWP | Percent Decrease |
| Vivlodex™ (meloxicam) | Osteoarthritis; Pain | $34.50 per Capsule | $31.05 per Capsule | 10% |
| Vimovo® (naproxen/esomeprazole) | Various types of arthritis; Pain | $49.64 per Tablet | $44.67 per Tablet | 10% |
| Zohydro™ ER (hydrocodone ER) | Chronic, severe pain | $12.00 - $14.65 per Capsule | $9.98 - $12.19 per Capsule | 10-17% |
| Zomig® Nasal Spray (zolmitriptan) | Acute migraine | $177.31 per Nasal Spray Device | $111.44 per Nasal Spray Device | 37% |
Also noteworthy, Amitiza® (lubiprostone), a medication for treatment of constipation, had a lower cost brand alternative released in January 2021, discussed in detail in this Medicare Insights blog post.
Generic launches expected in 2021
Several other medications relevant to WCMSAs are expected to see generic launches in 2021. Note that prospective generic launch dates are subject to change depending on factors beyond our control. As with the newly available generics, most of these products also have more cost-effective therapeutic alternatives available.
| Brand Name (Generic Name | Therapeutic use | February 2021 Brand AWP | Expected Generic Launch |
| Lyrica® CR (pregabalin) | Neuropathic pain | $17.70 per Tablet | April 2021 |
| Narcan® Nasal Spray (naloxone) | Opioid overdose | $75.00 per Nasal Spray Device | 2nd Half 2021 |
| Perforomist® (formoterol fumarate) | Chronic obstructive pulmonary disease (COPD) | $11.15 per Vial for Inhalation | June 2021 |
| Brovana® (arformoterol) | Chronic obstructive pulmonary disease (COPD) | $10.72 per Vial for Inhalation | November 2021 |
| Arnuity® Ellipta® (fluticasone furoate) | Asthma | $220.96 - $295.81 per Inhaler | August 2021 |
| Flovent® HFA (fluticasone propionate) | Asthma | $238.30 - $495.53 per Inhaler | 2nd Half 2021 |
The Optum Settlement Solutions clinical team is skilled in claim cost mitigation
Optum constantly monitors trends in the marketplace pertaining to generic availability of brand-name medications and AWP changes that may positively or negatively affect WCMSAs. Our team of clinicians is well versed on clinical practice guidelines and can often recommend cost effective and clinically effective therapeutic alternatives to reduce medication costs/WCMSA allocation, improve a claimant’s clinical outcomes and aid in moving claims to settlement.
Cost mitigation recommendations
Optum Settlement Solutions can provide clients a list of previously completed WCMSAs that included medications with price increases, if requested. We also recommend that carriers, third-party administrators (TPAs) and claims handlers review active claims to determine if any are affected by these price changes, and consider the Optum clinical mitigation products to potentially reduce claim costs, improve claimants’ clinical outcomes and move claims to settlement in a timely manner.
At Optum Settlement Solutions, we will continue to follow industry trends involving medication pricing and other changes that may affect WCMSA arrangements. Follow our Medicare Insights blog to stay informed on the latest industry trends.
For a more thorough list of expected generic launches, as well as forecasting for new drug approvals, see the latest edition of the OptumRx RxOutlook® publication.
Sources
1. RED BOOK® - https://www.ibm.com/products/micromedex-red-book (Subscription required)
2. First Generic Drug Approvals (FDA) https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/first-generic-drug-approvals
3. Friedman, Yali. 33 Drugs Facing Patent Expirations and Generic Entry in 2021 - 2022. DrugPatentWatch.com, thinkBiotech, LLC. Updated 10 February, 2021. Available online at: www.drugpatentwatch.com/p/expiring-drug-patents-generic-entry/
4. OptumRx® RxOutlook® 4th Quarter 2020 publication. Accessed 10 February, 2021. Available online at: https://professionals.optumrx.com/publications/library/rxoutlook-q4-2020.html
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