title: The introduction of generic risperidone in Medicare Part D.
abstract: OBJECTIVE
  The introduction of generic second-generation antipsychotics (SGAs), starting with risperidone in July 2008, could reduce antipsychotic spending and cost-related use barriers. This study examines associations between generic risperidone use and spending and adherence after introduction among Medicare Advantage (MA) beneficiaries.
  
  
  METHODS
  Historic cohort study.
  
  
  METHODS
  The study included MA beneficiaries receiving SGA treatment prior to July 2008. We examined antipsychotic spending using linear models, adherence (proportion of days covered ≥ 80%) using logistic models, and nonpersistence (time to first gap in antipsychotic use > 30 days) in 2009 using Cox proportional hazard models, comparing beneficiaries with versus without generic use, adjusting for individual and plan characteristics.
  
  
  RESULTS
  Between July 2008 and December 2009, 22.8% of beneficiaries had ≥ 1 fill of generic risperidone: 73% of those previously using branded risperidone and 6.7% of those previously using other SGAs. Beneficiaries in private fee-for-service (FFS) versus health maintenance organization (HMO) plans had lower rates of generic use (hazard ratio [HR], 0.73 [95% CI, 0.56-0.96]); however, cost-sharing levels were not associated with generic use. Compared with beneficiaries who continued using other SGAs, those who switched from other SGAs to generic risperidone in 2008 had lower out-of-pocket spending (-$214; 95% CI, -$314 to -$115), higher adherence (odds ratio, 2.34; 95% CI, 1.62-3.40) and lower rates of nonpersistence (HR, 0.56; 95% CI, 0.46-0.69) in 2009.
  
  
  CONCLUSIONS
  Generic use was concentrated among patients previously using branded risperidone. HMO plans appeared to be more effective at encouraging generic use than unmanaged private FFS plans; however, patient financial incentives had limited influence on switching. Additional opportunity remains to encourage greater generic SGA use, reduce spending, and potentially improve treatment adherence and outcomes.
authors.affiliation: 50 Staniford St, 9th Fl, Boston, MA 02114. E-mail: vfung@mgh.harvard.edu.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.forename: Mary
authors.initials: M
authors.lastname: Price
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Busch
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D016568:Drugs, Generic / Q000191:economics / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D008297:Male; D020398:Medicare Part C; D054524:Medicare Part D; D018967:Risperidone / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D016568:Drugs, Generic; D018967:Risperidone