Private Payers Aren’t Yet Sold on Vraylar for Bipolar Disorder

by Bronwyn Mixter

TA recently approved brand drug for bipolar disorder will have little impact on how health plans cover these medications, experts say. Health plans will continue to encourage the use of less expensive generic bipolar drugs.

The brand drug, Allergan plc's Vraylar (cariprazine), was approved by the FDA to treat depressive episodes associated with bipolar 1 disorder in adults. It is an oral, once-daily atypical antipsychotic.

There are other medications approved to treat the same conditions as Vraylar, including generic drugs, Mesfin Tegenu, R.Ph., president of PerformRx, tells AIS Health. Vraylar is typically not a preferred option since it is a newer, branded and more expensive agent, and more cost-effective alternatives are available, he says.

However, non-formulary drugs are available to those who have a demonstrated medical need. "There can be adherence issues with this disease and at times there is a need for longer acting agents to improve adherence," Tegenu says.

Health plans employ several utilization management techniques for bipolar drugs, according to Tegenu. Some examples include prior authorization, duplicate therapy edits, age restrictions and step therapy.

For Vraylar, health plans will use prior authorization or steps to encourage the use of a generic bipolar drug first, Michael Schneider, a principal at Avalere Health, tells AIS Health. There also could be some higher out-of-pocket costs for Vraylar even when compared to some of the other branded antipsychotic drugs.

Vraylar is in a protected drug class on the Medicare side, Schneider says. Because it is the first brand drug of a particular chemical entity, plans have to cover it. In some Medicare plans, Vraylar is disadvantaged because even through it is in a protected class, there are still utilization management techniques placed on the product, as well as higher cost sharing, he says.

In Medicaid, many states require all the antipsychotic bipolar drugs to be on the formulary with no utilization management, Schneider adds.

From RADAR on Drug Benefits