Lilly’s Zypreza, Pfizer’s Geodon could see reimbursement restrictions next year

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.

READ MORE @ FINANCIAL TIMES