A Healthesystems publication

Fall 2011

Medications to Watch

Every year, new medications are approved and introduced into the marketplace with the potential to impact costs for workers’ compensation payers

In 2010 alone the Food and Drug Administration (FDA) approved four new generics formulations and 13 new drugs that are likely to be seen as players in workers’ compensation drug spend. Notably, there were three new opioid products including Exalgo™ (hydromorphone extended-release), the reformulated, abuse-deterrent Oxycontin® (oxycodone extended-release), and a generic version of Opana IR® (oxymorphone immediate-release) that warrant close monitoring.

In the first three months of 2011, five new medications were approved that will likely be used for treating workers’ compensation patients. Three of these, Gralise™ (gabapentin extended-release), Viibryd™ (vilazodone), and Abstral® (fentanyl sublingual tablet) are certainly drugs to watch as they emerge in the marketplace.

Healthesystems clinical professionals actively monitor the pharmaceutical pipeline and alert clients to the potential impact of newly released medications. One such product, slated for a release in fall 2011, is LAZANDA.

LAZANDA (fentanyl nasal spray)

Lazanda is the next in the line of rapid-release fentanyl products, similar to Actiq®, Fentora®, and Onsolis™. Like these other products, Lazanda is indicated only for the management of breakthrough pain in adult cancer patients who are already receiving, and are tolerant to opioid therapy. It is not indicated for the treatment of acute pain, or for chronic, non-cancer pain.

Unlike other orally-administered fentanyl products, Lazanda is a nasal spray, and can reach maximum blood concentration in as little as 15 minutes. The maximum dose is two sprays (1 spray in each nostril) up to 4 times in 24 hours. Patients must wait at least 2 hours before treating another breakthrough pain episode. Lazanda should not be substituted for other fentanyl products, as they are not equivalent.

Because of the risk of abuse, addiction, and overdose, Lazanda is available only through a restricted Risk Evaluation and Mitigation Strategy (REMS) program and can only be dispensed from a pharmacy that is enrolled in the REMS program.

While pricing information is currently unavailable, the off-label use of Lazanda in treating chronic pain conditions will have likely but unknown cost implications in the workers’ compensation patient population. This impact, however, may be mitigated by the presence of similar rapid-release fentanyl products on the market.

Healthesystems strongly discourages expensive off-label use of rapid-acting oral fentanyl products, including Lazanda. Proactive drug plan management of our clients’ drug plans avoids potentially inappropriate use of these extremely potent opioids in the workers’ compensation patient population.

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