New Vyvanse Generic: A Break for Employers?
Posted on September 21, 2023
Self-funded employer groups face an overwhelming number of challenges in 2023 and beyond when tasked with controlling pharmacy costs, including an emerging anti-obesity pipeline, increased specialty utilization, and decisions on how to cover gene therapies. The recent approval of several generic equivalents of Vyvanse (or Lisdexamfetamine) is much welcomed good news, as the event is expected to be a major boon for employers and patients, offering the potential for significant savings. Increasing Generic Fill Rate is one metric that all health plans and consultants focus on to control cost trend, and the August 28th approval of generic Vyvanse should contribute in a positive way.
Generic Vyvanse Overview
Vyvanse, which generated 4.3 billion dollars in sales during 2022, is indicated for ADHD in both pediatric and adult populations, as well as Binge Eating Disorder. Vyvanse is the number 1 medication by plan cost per Artemetrx Book of Business for Mental Health treatment and in the Top 10 for overall spend for non-specialty drugs. A one-month supply averages over $350 for 30 capsules or tablets, and this cost is a burden to employers and to the increasing number of patients who are obligated to meet a deductible or co-insurance.
What makes this generic release different and so impactful?
Typically, the first generic manufacturer to market is granted a 6-month window of exclusivity, which decreases discount competition and allows the brand to retain a portion of the market share via rebates. Following the exclusivity period, other generics can enter the market, thus driving down the price due to competition. Upon patent expiration for Vyvanse, the FDA granted approval to 13 generic equivalents of the capsule formulation and 3 generic equivalents of the tablet (chewable, pediatric) formulation. This immediate competition from multiple manufacturers should lead to significant savings for employers and patients, with the generic discount off brand likely topping 75% by the end of 2024 or sooner. CVS Health has announced that Vyvanse will move from preferred to non-preferred status effective October 1 on its primary formularies, which may be a hint of how the major PBMs will initially encourage generic conversion. Expect more PBMs and health plans to announce their strategy for conversion, with the majority targeting January 2024 for a formulary or utilization management change.
Increased competition is also welcome news for clinicians and patients. DEA controlled substance restrictions, manufacturing delays, and increased demand due to the expansion of telehealth services during the COVID-19 pandemic have caused short supply and access to care issues for those needing Vyvanse or other amphetamine treatments used for the treatment of ADHD over the last year. More supply will lead to better prices and decrease barriers to treatment.
Employer Strategies to Maximize Cost Savings
With generic Vyvanse (Lisdexamfetamine) scheduled to hit the pharmacy shelves any day, now is the time to ensure your PBM is supporting your plan in maximizing cost savings and access for members. The following are best practices to consider to optimize this new opportunity:
- Confirm the PBM’s formulary strategy will make generic Vyvanse available to your members and steps will be taken to transition patients to this generic equivalent.
- Consider proactive member communications to educate on the member savings available through the new generic option.
- Proactively monitor the adoption of lower cost generics within your member population. Tools like Artemetrx, PSG’s proprietary data and analytics tool, can track the switch rate each month and measure financial savings.
