Antipsychotic Discounts To Medicare Cards Are 15%-30% Off AWP; Abilify Is Outlier

Bristol-Myers Squibb's antipsychotic Abilify (aripiprazole) is being offered at less than half of list price under the National Community Pharmacists Association's Medicare-endorsed discount card brands.

Abilify is being offered at $222.33 for a 30-count supply of 30 mg tabs under either the Community Care Rx or Criterion Advantage card plans, data from the Centers for Medicare & Medicaid Services web site indicate. That price is 52% below the published AWP of $465.60.

The Community Care Rx and Criterion Advantage cards are being offered via a partnership between NCPA, the Senior Care Pharmacy Alliance and Member Health, Inc. The cards are administered by Computer Sciences Corp.(¹ (Also see "NCPA Plans Medicare Rx Card Partnership" - Pink Sheet, 30 Jan, 2004.)).

The NCPA cards have a huge price advantage over other card programs; Caremark/AdvancePCS' RxSavings card, for example, lists Abilify for $379.39, or about 19% off of AWP as of May 10.

Community Care Rx and Criterion Advantage do not provide mail order options, but the price for Abilify is still significantly cheaper than the lowest available mail price on the CMS website. EnvisionRx is offering a 90-day supply for $1,002.20, or 28% of off AWP.

The pricing breakdown among card plans for Abilify is an outlier both within the antipsychotic category and across categories on the CMS website. For most brands, there are a number of card plans clustered within a few dollars of the lowest price.

For example, prices for Lilly's market-leading antipsychotic Zyprexa range from a low of 16.3% off of AWP to a high of 10% off of AWP.

The deep discount on Abilify also makes the brand an outlier for the NCPA cards; for most brands, Community Care Rx and Criterion Advantage offer some of the higher prices within the discount ranges (for example, 11% off AWP for Zyprexa).

The antipsychotic category offers an interesting test case for the discount card market. The class is primarily paid for by Medicaid (upwards of 70% in the case of Zyprexa) and so will not be as heavily represented in the discount card program as some other categories.

It is also a category in which therapeutic interchanges are rarely pursued.

However, antipsychotics will be a significant line item under the full Medicare Part D benefit in 2006 since the new program will become the primary payor for seniors and the disabled.

AstraZeneca's Seroquel has the deepest across-the-board discounts among atypical antipsychotics, with NationsHealth Prescription Drug Discount Card (Option A) offering 30 300 mg tabs for $157, 27% below AWP. Several other cards have prices in the $165 range.

Janssen's Risperdal is available at 20% off AWP, with Rx Savings among those offering the best price ($222.14 for 30 4 mg tabs).

Pfizer's Geodon has the smallest discount off of AWP, with Argus offering the lowest price ($135.40 for 30 80 mg capsules), or 15% below AWP. Pfizer's long standing no-discount policy means that its published AWPs tend to be closer to actual market prices than most manufacturers'.

The antipsychotic market is also showing nascent signs of price competition among card plans.

CVS' myPharmaCare card offers the best price for Zyprexa as of May 10; the card plan lowered its posted price for Zyprexa by almost $50 from $562.25 as of May 3 to $513.20 for 30 20 mg tablets.

MyPharmaCare also cut its price on Risperdal (by about $16), Abilify (about $10), Geodon ($9) and Seroquel ($6).

Walgreens Health Initiatives cut its prices significantly on Zyprexa and Seroquel to move up from the bottom of the rankings. On Risperdal, Walgreens had one of the best prices as of May 3 ($247.14); the company did not cut that price for the May 10 list and so dropped from the number six slot for the brand to number 23, after several cards posted prices for the first time and others lowered prices.

- Michael McCaughan