HMOs will not be impressed with TRIs seen more effective than SSRIs

Even if clinical trials demonstrate that the new class of triple reuptake inhibitors (TRIs) launching in 2009 are more effective than selective serotonin reuptake inhibitors (SSRIs), Health Maintenance Organization will not be impressed, according to a study by research and advisory firm Decision Resources. A large portion of HMO pharmacy directors are planning on granting TRIs only a tier 3 placement on their formularies.

According to DC's new PhysicianForum report, entitled Acceptance of Next-Generation Antidepressants, even though TRIs were found in Phase II clinical trials to be tolerable, safe, and equally as effective as the SSRI citalopram, half of surveyed pharmacy directors desire more data before coming to a conclusion, and the rest are divided between tiers 2 (15%) and 3 (35%).

"If new data emerge that prove TRIs to be more effective than the generically-available SSRIs, more pharmacy directors say they would grant the agents a tier 2 placement, and 35% still maintain that tier 3 placement would be appropriate," said Natalie Taylor, an analyst at Decision Resources. "Wellbutrin XL (bupropion) and Cymbalta (duloxetine) are two examples of current therapies that are commonly placed in tier 3. If the data show no comparative advantage to the SSRIs, half of surveyed pharmacy directors declare that TRIs would not be covered on their formularies at all, she added.