What is changing?
Effective September 1, 2004, the Wisconsin Medicaid
program will require Prior Authorization (PA) for all brand
drugs for which federal Food and Drug Administration (FDA) approved
generic drugs are available. This includes Clozaril®. The
Medicaid pharmacy budget is one of the fastest growing parts of the
State budget. The substitution of generic clozapine for Clozaril®
has been shown to be a clinically appropriate way to lower drug costs.
Many other states, private health plans, hospitals, and
health maintenance organizations (HMOs) began requiring generic
substitution for Clozaril® some time ago. In Wisconsin,
approximately 70% of Medicaid recipients taking clozapine are already
using a generic. It is anticipated that the majority of the remaining
30% can be switched without difficulty.
This change applies to you if you are taking Clozaril®.
If you are already taking generic clozapine, no change is necessary.
If your prescriber can show that you should not use
generic clozapine, he/she will work with your pharmacist to obtain PA
What is generic substitution?
When a drug company develops a new medication, it
obtains a patent for the new product. The patent prevents others from
making the new medication without the original company’s permission for
approximately 15 years. Since only the original company is allowed to
make the medication, it can name any price it wants. This medication is
called the brand name medication. Novartis held the patent for
clozapine, which is sold under the brand name Clozaril®.
After the patent runs out, it is legal for other
companies to also make the same medication. When made by other
companies, the medication, which has the identical active ingredient as
the brand name, is called the generic medication. Generic
medications are sold for about one-third the cost of brand medications.
Several companies currently make generic clozapine.
How is a generic medication different from a brand
For both a brand name medication and a generic
The rest of the materials in pills consist of:
binders that keep the pills stuck together
coatings that make the pill easy to swallow and
determine how fast the pill dissolves
dyes that make the pills different colors.
The binders, coatings and dyes are different for each
generic and brand name pill.
The active ingredient is identical.
Getting ready to switch to a generic medication
Your prescriber will need to write a new prescription
for you for generic clozapine. Your pharmacist will need this new
prescription to dispense generic clozapine for you on or after September
If you or your prescriber (or your family or case
manager, if desired) are concerned about the change to generic clozapine,
you should review the pattern of your symptoms while taking Clozaril®.
Some people have very few symptoms or side effects while taking
medications. Other people experience changes in their symptoms even when
taking the same dose of the same drug over time. It is important that
you and your prescriber have a clear idea of what your symptom pattern
is before you make the switch.
Your prescriber might also wish to see if your
body absorbs generic clozapine at a different rate than it absorbed
Clozaril®. To do this, he/she would test your blood while on
Clozaril® and then test it again after the switch to generic
clozapine was made. The results of these two tests would help your
prescriber decide if a different amount of clozapine was getting to your
nerve cells and help him/her decide if the dose needs to be adjusted.
"What if I just don’t feel the same?"
Only a small portion of persons switched to generic
clozapine have needed to be switched back to brand Clozaril®.
Similar changes in Medicaid and private insurance have already happened
in many other states. In those states, almost all patients were able to
do just as well on generic clozapine as on Clozaril® and most
didn’t need any dose change.
Wisconsin Medicaid has provided a way to change back to
Clozaril® in certain situations. They are:
You have an allergic reaction to a something in the
binding agent, coating or dye in a generic formulation.
You experience adverse reactions not experienced on
You experience therapeutic failure on a generic
If any of these three situations apply to you, your
prescriber will work with your pharmacist to obtain PA for you.
If you have questions, you can contact Medicaid
Recipient Services (Voice/TTD) at 800-362-3002.
Department of Health and Family Services
Division of Health Care Financing
Division of Disability and Elder Services
PDE 3192 (07/04)