2005 HSR&D National Meeting Abstract

1045 — Impact of Generic Fluoxetine Availability

Author List:
sernyak MJ (VISN 1 MIRECC)
rosenheck R (VISN 1 MIRECC)

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
Despite the potential for millions of dollars of savings, there was not a concerted effort to take advantage of the generic availability of fluoxetine.

Impacts:
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.