Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that the willingness of neurologists to prescribe generic anti-epileptic drugs (AEDs) varies dramatically by indication, affording branded AEDs protection in the epilepsy market but not in other markets. Despite physicians' misgivings about the generic equivalence of AEDs, 89 percent of surveyed neurologists are willing to prescribe generic AEDs for painful diabetic neuropathy, and 84 percent are willing to prescribe AEDs for migraine prophylaxis. By contrast, only about one-third of neurologists are willing to prescribe generic AEDs for patients with partial onset epilepsy or refractory epilepsy.
The new Physician & Payer Forum report Will Prescribers and Payers Allow Branded AEDs to Stem the Tide of Generics in Epilepsy, Migraine, Neuropathic Pain or Bipolar Disorder? finds that while physicians' determination to resist generic substitution of branded AEDs at the pharmacy level varies hugely by indication, it does not vary as significantly by brand.
"Currently, 54 percent of the neurologists we surveyed specify 'no generic substitution' on prescriptions for GlaxoSmithKline's Lamictal and a similar proportion indicate they will specify the same on prescriptions for other AEDs when generic versions of these agents become available," said Kate Hohenberg, director at Decision Resources. "However, there is an exception, most significantly in epilepsy, for Abbott's Depakote ER. Our survey showed that 79 percent of neurologists will not agree to switch their epilepsy patients from the brand to the generic version of Depakote ER. Physicians' concerns are a result of this agent's narrower therapeutic index and its narrower margin for error in generic equivalence."
The report also finds that brands facing generic competition will be dropped or pushed to tier three of many managed care organizations' (MCO) formularies. After March 2009, when generic versions of UCB's Keppra, Ortho-McNeil's Topamax and Depakote ER have become available, more than half of 20 surveyed private plans will remove Keppra and Topamax from their formularies and another five plans will shift these brands to tier three. By contrast, Depakote ER will retain favorable placement in 50 percent of surveyed plans.
Will Prescribers and Payers Allow Branded AEDs to Stem the Tide of Generics in Epilepsy, Migraine, Neuropathic Pain or Bipolar Disorder? is based on a U.S. survey of 70 psychiatrists and 70 neurologists and 20 MCO pharmacy directors. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic and scientific factors.
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