On December 11th, 2013, the U.S. Food and Drug Administration (FDA) approved the first generic versions of Cymbalta® (duloxetine). Progressive Medical 2013 Drug Trends reported that Cymbalta® accounted for 4.2% of total spend in 2012, which places it in the number five of the top medications by total spend.
Cymbalta® is an antidepressant in the therapeutic class of selective norepinephrine reuptake inhibitor which is FDA approved for the following conditions: chronic musculoskeletal pain, diabetic peripheral neuropathic pain, fibromyalgia, generalized anxiety disorder, and major depressive disorder. It is often used off-label to treat neuropathic pain. The usual dosage is 60mg once daily, swallowed whole. There is no evidence that dosages greater than 60mg per day confer any additional benefits.
The generic drug manufacturers include: Aurobindo Pharma, Actavis Pharmaceuticals, Citron Pharmaceuticals, Dr Reddy’s Laboratories, Lupin Pharmaceuticals, Caraco Pharmaceuticals/Sun Pharma USA, Teva Pharmaceuticals and Torrent Pharmaceuticals.
The AWP per Redbook Online as of 1.6.2014 for Cymbalta® 20mg is $7.77 per capsule; whereas duloxetine 20mg ranges from $6.22 to $6.99 per capsule. Cymbalta® 30mg is $8.72 per capsule; duloxetine 30mg ranges from $6.97 to $7.85 per capsule. Cymbalta® 60mg is $8.72 per capsule; duloxetine 60mg ranges from $6.97 to $7.85 per capsule.
Savings will accrue for the Workers’ Compensation payers once claimants are switched from the brand name product to the generic agent.
Generic interchange regulations vary from state to state. Gould and Lamb’s ‘Stop the Pain’SM (STP) is an interventional and actionable product which can assist in switching from the brand name medications to the more cost-effective generic agent. STP can produce significant savings, assess appropriateness of current therapy, optimize drug therapy, assist clients in lower claims costs, and lower Medicare Set-Aside allocations.