sernyak MJ (VISN 1 MIRECC)
rosenheck R (VISN 1 MIRECC)
Prozac® (fluoxetine, Lilly), one of the more commonly prescribed antidepressants, has recently become available as a generic at less than a tenth of its previous cost. We examined what changes, if any, accompanied this generic availability. We also describe the potential savings that could be realized from the VA pursuing a “fluoxetine first” policy for new antidepressant prescriptions.
New prescriptions for antidepressants for selected patients during FY2001 and FY2003 were identified. The prescription records of patients who met the following criteria in either FY01 or FY03 were reviewed: 1) six outpatient visits or one hospitalization in a psychiatry stop code, and 2) in the first 4 months of the fiscal year no record of an antidepressant prescription. Antidepressant prescription in the subsequent 8 months of the year was counted as a “new antidepressant start.” VA clinical and pharmacy databases were merged to examine medical center-level changes in antidepressant prescriptions.
In FY01 54,510 patients fulfilled criteria for a new antidepressant start; 4527 (8.3%) received fluoxetine and the average cost per day of treatment was $1.49. In FY03 46,629 patients met antidepressant start inclusion criteria and (9.3%) were prescribed fluoxetine. Now generic, the average cost per day of fluoxetine treatment was $0.10, a fifteen-fold decrease. While overall medical center prescribing rates did not change, at four medical centers, fluoxetine accounted for 25% or more of new antidepressant prescriptions in FY03. Constructing a model that posits the exclusive use of fluoxetine for new antidepressant treatment reveals potential savings, depending on the length of time patients continue to take the antidepressant, from $1.9 million (30 days of treatment) to $11.5 million (180 days of treatment).
Despite the potential for millions of dollars of savings, there was not a concerted effort to take advantage of the generic availability of fluoxetine.
This study demonstrates the potential savings for the VA when the first of a commonly used class of medications becomes available as a generic. It suggests that the VA both: 1)investigate ways to still realize savings from the availability of generic fluoxetine, and 2) prospectively identify upcoming opportunities in other classes of medications.