Sertraline (Zoloft®) Price Cut

With the start of a new year, we typically see price hikes but that is not the case with sertraline (Zoloft®) where we have seen a significant price cut. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is FDA approved for major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder and social phobia. It also has a multitude of non-FDA medically accepted uses, some of which include: aggressive behavior, anorexia nervosa, binge eating disorder, adjunct treatment of bipolar depressed phase, adjunct to severe major depression with psychotic features, fibromyalgia, and generalized anxiety disorder. All sertraline formulations were previously the same price; please refer to the table below outlining a significant difference in the lowest average wholesale price (AWP) between the previous and current AWP.

Strength

Previous AWP

New AWP

% Change

25mg tablet

$2.70

$0.41

~85%

50mg tablet

$2.70

$0.48

~82%

100mg tablet

$2.70

$0.54

80%

If utilized for the aforementioned indications listed above and the other non-listed medically accepted indications, maintenance use of sertraline 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 sertraline

In the pain chapter, the ODG does not recommend sertraline for the treatment of chronic pain. SSRIs have not been shown to be effective for low back pain.  In the mental illness and stress chapter, the ODG recommends sertraline as a first-line treatment option for MDD and PTSD.

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 AWP changes 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. 

For questions about medications, please contact Nahla D. Rizkallah, PharmD, MSCC, at 678.256.5086 or nahla.rizkallah@examworkscompliance.com.

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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