What's the deal with generic Concerta?
March 3, 2012 10:49 PM Subscribe
What's the deal with Generic Concerta?
As of 2011 Concerta is now available as a generic drug (Methylphenidate ER OSM). My insurance company didn't recognize the generic during 2011 so it actually cost me less to stick with the name brand. The generic and name brand versions are both made by the same manufacturer, to my knowledge.
As of this year my copay for either "formulation," generic or name brand, has increased by $20. Whereas last year the name brand cost me $30, I'm paying $50 this year, even if I go with the generic, which my formulary claims is "tier 1" while the "copay calculator" on my website confirms that either way I'm expected to pay $20 more.
This doesn't make much sense to me, but Concerta uses a complex osmotic delivery system and the generic drug is almost as costly to my insurer as the name brand. "Almost" is the effective word: before I knew that the generic was supposedly "tier 1" as of 2012 I filled a name-brand script for $50 and saw that it cost my insurance company $322 back in January. Once I switched to the generic, I saw that it cost them $271 in February.
I think there's a very interesting story here. Clearly the drug is expensive but there is no copay incentive or cost savings passed to me as a consumer. It would be petty of me to stick with the name brand at this point because I'd be essentially increasing my burden on my insurer by $50 a month for no tangible benefit (other than petty satisfaction since my employee monthly premium is around $500). I realize that in some cases there can be differences in quality / binders / etc between name-brand and generic, but in this case the drug is identical. Or is it? I've heard different things (they are identical and made in the lab facility [both pills bear an "ALZA" label] or they both share identical osmotic delivery systems patented by "ALZA" and the rest of the pill is handled independently).
From a free market perspective this seems all very silly but it also makes perfect sense: beyond switching to a different medication entirely, it would be highly impractical for me to attempt to change my situation by finding another insurance policy (aka finding a new job or buying coverage out of pocket at an exorbitant rate) so why bother passing the savings on to me?
So I guess my questions would be:
1) Does anyone know the "full story" on how this generic/name-brand agreement came into being, and why an insurer could expect to save $50 on a generic drug manufactured by the same company as the name brand (assuming the generic and name brand truly are identical)?
2)If you take Concerta yourself, does your insurance company provide you any incentive for choosing the generic drug? If so, I'd be curious to know more about your plan. Obviously it's extremely unlikely that I would switch to a different insurance carrier, but this could be useful knowledge if I were to raise this issue with my carrier (over the phone all they can do is run test claims through and say "yep, it costs you $50 either way," so I am awaiting a reply on an email I sent via their website). I would imagine that if I took the "petty" route my carrier could decide to suddenly cover 0% of the name brand drug, which would be caught by my pharmacist when they ran the claim through. (Seriously though, I won't take the petty route, I promise!)
3)Is it possible to enroll for mail-order Concerta? My carrier claims I would save $25 every three months using mail-order. This is based on an automated web-based quote system, so it's possible that I'm being told I'd be saving money when it may not be legal to provide the drug through mail-order.
Concerta is a schedule II drug with no refills allowed - I typically get a month's supply at a time, and occasionally get two scripts, with one marked "do not fill until [today's date+30 days]." My carrier specifically quoted $125 for a 90-day supply but I'm curious how the logistics would work here: it sounds like I'd need to arrange for getting three scripts at a time, and would need to mail them in.
What would happen if the scripts get lost in the mail and my doctor has a "zero tolerance" policy on re-writing scripts due to the high potential for abuse with this medication? To put it another way, would there by any recourse? I'm assuming I'd have to take the same tack as I do with rebates though I don't know how effective the approach would be: scan in the original before sending it off.
I have sent an email to my carrier so I may have a clear answer on item #3 shortly, but questions 1 and 2 are more intriguing :)