Navigating Access to Generic Therapy

The Pulmonary Hypertension Association (PHA) reported Aug. 17 that generic tadalafil was approved by the Food and Drug Administration (FDA) and suggested that pulmonary hypertension (PH) patients taking Adcirca® discuss the implications with their care teams. Since then, generic tadalafil has become available through many health insurance plans. In addition, PHA has been advised that two other medications could soon have generic options, Letairis® (ambrisentan) and Tracleer® (bosentan).

If you are a PH patient taking Adcirca®, how you are affected by the availability of generic tadalafil depends on several factors, including:

Your state of residence
The law in some states allows pharmacies to transition a prescription to generic without notifying the person who takes the medication or their physician. In other states, notification is required or required in some circumstances but not others. Since the law differs by state, ask your pharmacist or physician if you would like more information.

Your health insurance plan
Some health insurance plans update their formularies more quickly than others. For example, many commercial plans already make generic tadalafil available while Medicaid plans may take several months to begin offering coverage. Medicare currently must provide 60 days’ notice before transitioning someone to a generic drug. However, in 2019, no notice to Medicare beneficiaries will be required.

In addition, generic specialty drugs are a relatively new phenomenon and health insurance plans are still sorting out how to pay for them. Some plans may have placed generic tadalafil in the same branded tier as Adcirca®, rather than the generic tier. Patients’ out-of-pocket responsibilities could shift as these plans’ administrators begin to better understand the price difference between the two drugs and adjust which tier into which they categorize generics.

Your PH care team, specialty pharmacy or drug manufacturer may be able to help you advocate for yourself with your insurance plan for appropriate coverage of the drug you need.

Cost and financial assistance considerations
What you pay for Adcirca® or generic tadalafil over the next few months will depend on: whether you are receiving the brand or generic drug, whether your plan covers both the brand and generic drug, and how your drug is covered; in other words, what your out-of-pocket responsibility is based on the coverage tier in which your drug is placed (see above).

Some eligible patients may pay as little as $10 a month with a copay card. For information about the Adcirca® copay card, contact the ASSIST program at 877-864-8437. For information about the generic tadalafil copay card, visit https://www.activatethecard.com/tadalafil/.

For patients receiving grants from non-profit financial assistance organizations such as the Patient Advocate Foundation and PAN Foundation, these grants will cover both Adcirca® and generic tadalafil.

If you have questions about generic therapy, you may wish to contact your PH physician, your specialty pharmacy, the company that manufactures your medication and/or the nonprofit organization that provides your financial assistance grant. PHA provides contact information for many of these companies at www.PHAssociation.org/Help.

For more information, contact PHA at 301-565-3004 x749 or Insurance@PHAssociation.org.

2018-09-14T20:44:07+00:00 September 14th, 2018|