Aripiprazole (Abilify®) Price Drop

Abilify® (aripiprazole), a second generation atypical antipsychotic, has been a high cost medication until a recent and dramatic reduction in price. Aripiprazole is FDA approved for schizophrenia and acute mania, and as an adjunct second-line therapy for bipolar maintenance and major depressive disorder. It also has non-FDA medically accepted uses of borderline personality disorder and drug-induced hyperprolactinemia caused by antipsychotics. While aripiprazole has been commercially available as a generic agent since 2015, the cost has still been high and provided an obstacle for settlement and closure of claims. Please refer to the table below outlining a significant difference in the lowest average wholesale price (AWP) between the previous and current AWP.

 

Aripiprazole Strength

Previous AWP

New AWP

% Change

2mg tablet

$30.50

$0.07

99.77%

5mg tablet

$0.45

$0.08

82.22%

10mg tablet

$10.04

$0.10

99.00%

15mg tablet

$30.50

$0.12

99.61%

20mg tablet

$32.00

$0.15

99.53%

30mg tablet

$36.66

$0.17

99.54%

If utilized for the aforementioned indications listed above, maintenance use of aripiprazole would be included by Center for Medicare and Medicaid Services (CMS) in a Workers Compensation Medicare Set-Aside Arrangement (WCMSA). The dramatic reduction in cost would markedly reduce the Part D allocation of the updated WCMSA and potentially facilitate settlement.

The Official Disability Guidelines (ODG) on antipsychotics

The ODG recommends providers use caution concerning the use of antipsychotics for patients who do not have a diagnosis of psychosis, since the drugs are associated with serious adverse effects. The second-generation agents [such as aripiprazole, quetiapine (Seroquel®), olanzapine (Zyprexa®), and risperidone (Risperdal®)] cause weight gain and lipid/glucose dysregulation, while the first-generation antipsychotics have an increased risk of extrapyramidal symptoms with first-generation antipsychotic. Moreover, antipsychotics may be linked to increased rates of stroke and all-cause mortality in patients with dementia.

 

The FDA required a boxed warning on the aripiprazole product label for the various formulations, signifying the drug carries a significant risk of serious or even life-threatening adverse effects. For the oral formulation, the black box warning states elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Aripiprazole is not approved for the treatment of patients with dementia-related psychosis. Furthermore, there is an increased mortality in elderly patients with dementia-related psychosis and suicidal thoughts and behaviors with antidepressant drugs.

 

As part of best practices, ExamWorks Compliance Solutions continually monitor CMS’ recognized proprietary source, Red Book, for real-time changes for newly generic agents and for average wholesale price (AWP) for medications used to treat the injured worker, as well as PharmD review of all Part D medications for the indication for use for potential exclusion from the WCMSA.

 

ExamWorks Compliance Solutions strives to provide the most accurate and defensible MSA by utilizing technology and compendia databases which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace. 

Nahla Rizkallah, PharmD, MSCC

Nahla Rizkallah, PharmD, MSCC

Nahla D. Rizkallah, PharmD, MSCC, serves as the Senior Clinical Pharmacist at ExamWorks Compliance Solutions. In this capacity, she performs prescription analysis to optimize drug therapy using evidence-based guidelines and national guidelines, and participates in physician outreaches to implement the recommendations. She has 29 years of experience in various area of pharmacy practice including: review of Part D medications on Medicare Set-Aside Allocations, prior authorization reviews for the Florida Medicaid program as Senior Clinical Pharmacist, development of drug utilization criteria, academic detailing, Pharmacy and Therapeutics Committee, Pharmacy Manager for a closed mental health facility, Pharmacy Manager for the indigent, staff/clinical pharmacist for assisted- living facilities (ALFs), medication audits for ALFs, drug information center, clinical pathways, staff education, and surgical/medical pharmacy satellite at All Children’s Hospital. Dr. Rizkallah has the following certifications: Medicare Set-Aside Certified Consultant, Hypertension and Dyslipidemias, and Diabetes. Dr. Rizkallah received her Doctorate from the University of Florida in Gainesville followed by a one year American Society of Health-System Pharmacists accredited residency.

For questions about medications or the ExamWorks Compliance Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or nahla.rizkallah@examworkscompliance.com

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