Prime Therapeutics Updates Medicare Formularies

Prime Therapeutics has removed several drugs from its Medicare formularies, including five that now have generics available and one drug that has been discontinued by the manufacturer.

One of these is the epilepsy drug Vimpat (lacosamide) solution 10 mg/ml from UCB. In March 2022 Alembic, Amneal, and Glenmark launched generic versions of Vimpat. Vimpat has been removed in favor of the generics on some formularies, including Ideal, Value, Value Plus & Essential, and Center of Excellence Formularies. On the Expanded, Complete Formulary, Vimpat will increase in tier. These moves were effective June 8, 2022.

The list price of Vimpat is $1,098.23 per month, according to UCB. The average retail price of generic lacosamide, according to GoodRx, is $878.38 for 60 tablets, but is offered at some locations for as low as $36.22.

Other drugs removed from Prime’s Medicare formularies in favor of generics include:

• Takeda’s ulcerative colitis drug Pentasa (mesalamine) 500 mg extended release capsules has been removed from the following formularies: Ideal, Value, Value Plus & Essential, and Center of Excellence Formularies effective June 9, 2022. Sun Pharmaceutical’s generic mesalamine was approved in May 2022. The retail price of 240 capsules of Pentasa is about $1,442.47, and the average retail price of the generic is $473.86 with prices as low as $107.02, according to GoodRx.
• Lilly’s chemotherapy Alimta (pemetrexed) for IV solution has been removed from Prime’s Ideal, Value, Value Plus & Essential, and Center of Excellence Formularies because of the availability of generics effective June 22, 2022. It is used to treat patients with non-small cell lung cancer and mesothelioma. The list price of Alimta is $10,781.33 per month, according to Lilly.
• AbbVie’s antidepressant Viibryd (vilazodone) tablets has been removed from Prime’s Ideal, Value, Value Plus & Essential, and Center of Excellence Formularies effective June 23, 2022. Generics of vilazodone are offered by Accord Healthcare, Alembic Pharmaceuticals, Apotex and InvaGen Pharmaceuticals. It is available in 10 mg, 20 mg and 40 mg tablets. Generics of Viibryd have an average retail price of $288.61 and are offered as low a $43.73 for 30 tablets, according to GoodRx.
• Ortho Dermatologics’ Targretin (bexarotene) gel 1% has been removed from Prime’s Ideal, Value, Value Plus & Essential, and Center of Excellence Formularies because of the availability of generics effective June 28, 2022. It is used to treat patients with cutaneous lesions in patients with cutaneous T-cell lymphoma.

Additionally, TG Therapeutics’ Ukoniq (umbralisib) has been removed from Prime’s formularies because the drug has been discontinued.

Related: FDA Withdraws Approval of Ukoniq

In June 2022, the FDA withdrew its approval for the cancer medicine Ukoniq, which was approved to treat two specific types of lymphoma: marginal zone lymphoma and follicular lymphoma. Updated findings from the UNITY-CLL clinical trial continued to show a possible increased risk of death in patients receiving Ukoniq for the treatment of patients with chronic lymphocytic leukemia. As a result, regulators determined the risks of treatment with Ukoniq outweigh its benefits.