US Pharm.

States struggling with increasing Medicaid costs may save more than $100 million over the next several years by changing generic substitution laws to permit easier and faster substitutions of generics for brand medications, according to a new CVS Caremark study.

The study, published in the July edition of Health Affairs, looked at the generic substitution of simvastatin for cholesterol brand drug Zocor beginning in 2006, when Zocor's patent expired. The review looked at how quickly Medicaid recipients moved to the generic equivalent medications under three different state statutes: mandatory versus permissive substitution, with and without prior authorization, and with and without requiring patient approval for substitution. “Requiring patients to provide consent prior to generic substitution led to an approximately 25% reduction in generic substitution,” said William H. Shrank, MD, the study's lead author, an assistant professor of medicine at Harvard Medical School in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston. The study determined that states could have saved almost $20 million if the substitution from Zocor to simvatstatin were made more quickly for that one medication alone.