On January 25th, 2024, the first available generic for Gralise® was released as Gabapentin once daily tablets. Gabapentin is one of the most common medications prescribed to injured workers. It is mainly prescribed for nerve pain treatment rather than seizure treatment for these patients. Many practitioners utilize long-acting formulations such as Gralise® to provide optimal pain relief.
Gralise® (Gabapentin) is an anticonvulsant, or anti-seizure medication, and Gralise® is an extended-release version of Gabapentin that is taken once daily. This is in comparison to other immediate-release formulations taken multiple times a day. Gralise® is FDA-approved to treat Postherpetic Neuralgia (shingles pain), but it is not FDA-approved to treat seizures like the immediate-release versions. Gralise® is commonly prescribed for many off-label uses, including many types of neuropathic (nerve) pain.
CorVel Clinical Team Input
This new generic formulation is a welcome release for use with relevant injury claims. It will offer cost savings while providing a chemically identical treatment to the pre-existing brand formulation of Gralise®. Because generic medications contain the same strength and active ingredient as their brand counterparts, they exert the same therapeutic effect on the body and carry all of the same dosing recommendations and safety and use precautions. The main difference between brand components and their generic counterparts is their different inactive ingredients. Allergies should always be noted, as a patient may be allergic to inactive ingredients in a generic formulation not present in the brand product.
Availability
As the generic was just launched, it can be expected that they will soon be available (if not already) for pharmacies to purchase and stock for use. However, as with any new generic launch, sometimes it can take weeks to months for some pharmacies to be able to get a supply of the new product. At the beginning of the generic launch, our clinical team will consult with the dispensing pharmacies regarding stocking.
Cost Comparison
New generics are less expensive than their brand counterparts. Cost estimates are based on medications’ Average Wholesale Price (AWP), which is fluid and based upon many factors. Generally, generic medications do not rapidly drop in price to yield significant cost savings until enough time (months or years) have passed to allow multiple generic manufacturers to enter the market with their approved products. This process increases competition and, therefore, decreases the price.
Estimated cost savings (AWP as of 02/09/2024): The below estimates are based on example quantities that could be dispensed as a thirty-day supply for this medication:
- Brand Gralise® 300 mg capsules have an AWP of $12.76 per tablet.
- Generic Gabapentin once daily 300 mg tablets have an AWP of $11.49 per tablet.
Potential cost savings example: Substituting a 30-day dispense quantity of # 60 tablets with the generic would result in a cost savings of approximately $1.27 per tablet (or $76.20 for 60 tablets). While this does result in cost savings, note that the overall cost is still high as the generic would cost $689 total versus $765 total for the brand product.
CorVel Action Plan
If a prescription for the brand Gralise® presents on a pharmacy card, CorVel’s clinical team will enforce generic dispensing. When processed at the pharmacy, pharmacy systems automatically substitute generic formulations for brand medication orders. A brand product would only be dispensed if a physician ordered the prescription to be dispensed as written (DAW), meaning the pharmacy cannot legally substitute it as a generic. In that case, our team would enforce our brand with available generic DAW workflow, which involves Letters of Medical Necessity Requests and provider and pharmacy outreach. As the generic product still carries a high price point compared to immediate release formulations, we will still attempt to convert these prescriptions to the more cost-effective Gabapentin products. Gabapentin immediate release formulations remain the preferred formulary medications.
CorVel’s proactive approach to pharmacy benefit management ensures patients receive appropriate treatment and that prescriptions are optimized to avoid unnecessary costs. Our experienced clinical team remains up-to-date on the latest pharmacy updates and provides high-quality healthcare solutions. For more information on CorVel’s pharmacy benefit management services, click here.
