Check OC options: Readers share views
Where do generic oral contraceptives fit in your facility's formulary? About 70% of participants in the 2008 Contraceptive Technology Update Contraception Survey say their facilities have increased the use of generic oral contraceptives due to budget constraints, up 5% from 2007's statistic.
While the Casper Natrona County Health Department in Casper, WY, has increased its use of generic oral contraceptives, Tia Hansuld, nurse practitioner and clinic director, says it has not significantly impacted clinicians' practice. Carol Morgan, RN, nurse manager at the Portales (NM) Public Health Office, agrees that the switch to generic pills has not impacted clinical practice at her facility.
"We do provide the generic or the brand name contraceptive, depending on availability and cost," states Hansuld. "The generics work well for most clients. There are a few that have a problem, and we will switch to another brand."
A woman should be able to request and obtain the oral contraceptive that she and her provider decide best addresses her individual needs, according to a 2007 committee opinion released by the American College of Obstetricians and Gynecologists.1 If a provider or pharmacist switches a patient's OC prescription for cost, insurance coverage, compliance, or any other reason, the patient always should be notified, the opinion states. The opinion supports patient or clinician requests' for branded OCs or continuation of the same generic or branded pill "if the request is based on clinical experience or concerns regarding packaging or compliance, or if the branded product is considered a better choice for that individual patient."1
Most family planning providers are familiar with generic oral contraceptives from Barr Pharmaceuticals of Pomona, NY, and Watson Pharmaceuticals of Corona, CA. However, look for changes in the generic landscape: Barr has struck a deal with German pharmaceutical firm Bayer to produce generic versions of the company's Yasmin and Yaz birth control pills in the United States prior to their patent expiration. Barr now is marketing the generic equivalent of Yasmin as Ocella; Barr's generic form of Yaz is set to debut in 2011.
In July 2008, Barr's board of directors agreed to sell the company to Jerusalem, Israel-based Teva Pharmaceutical Industries, the world's largest generic drug maker and biggest pharmaceutical supplier to discount giant Wal-Mart.2 Another manufacturer is set to enter the generic OC marketplace. Pittsburgh-based Mylan announced in August 2008 that it has completed an agreement with Famy Care Ltd., a global, India-based manufacturing leader of women's health care products, to develop and supply 22 OCs to U.S. customers.3
Which pill do you pick?
The young woman sitting in front of you tells you she is interested in using oral contraceptives (OCs). She's 21, a nonsmoker, and is in good health. If formulary issues are not in play, which pill would you prescribe?
When bound by formulary, about 30% of 2008 survey participants say they write prescriptions for Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) for young nonsmoking women, similar to 2007's statistic. About 13% named Ortho Tri-Cyclen, another triphasic pill, as a formulary OC. Yaz (Bayer HealthCare Pharmaceuticals), Alesse (Wyeth Pharmaceuticals; Collegeville, PA), and Loestrin (Barr Pharmaceuticals) each represented about 10% of the total response for the category.
Ortho Tri-Cyclen Lo reclaimed its top spot in the 2008 Contraception Survey as the leading nonformulary pick for young women, followed closely by 2007's leader, Yasmin, a monophasic pill containing 3 mg drospirenone and 0.030 mg ethinyl estradiol from Bayer HealthCare Pharmaceuticals, Wayne, NJ. Ortho Tri-Cyclen Lo, a triphasic pill that contains 25 mcg estrogen for 21 days and three different doses of the progestin norgestimate (180 mcg daily/days 1-7; 215 mcg daily/days 8-14; 250 mcg daily/days 15-21), had led the category for two years beginning in 2004. Yasmin moved ahead in 2006. (See chart, below, of top nonformulary pills.)
- Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 375: Brand vs. generic oral contraceptives. Obstet Gynecol 2007; 110(2 Pt 1):447-448.
- Todd S. Barr deal seen as a boon for Teva. Star Ledger, July 19, 2008: Accessed at www.nj.com/business.
- Mylan. Mylan creates new women's health care franchise; signs agreement with Famy Care to develop and supply 22 oral contraceptive products. Press release. Accessed at investor.mylan.com.