Among patients reporting at least some type of pain within the last year, it’s estimated that up to 15 percent likely have some neuropathic component contributing to their pain. Identifying and effectively treating neuropathic pain can be a challenge. It is associated with significant impairments in health-related quality of life as well as a substantial economic burden.
Gabapentin is one option to consider that may help your patients achieve neuropathic pain control while also helping to lower their medication costs. Gabapentin tablets and capsules are available on the lowest/preferred tiers for most all Medicare and Commercial plans, meaning less out-of-pocket costs for your patients. Selecting gabapentin over other expensive therapies will also help your Medicare patients during the initial coverage phase since they may not progress to the coverage gap as quickly as they would otherwise. Also, patients may not have to stop treatment once in the coverage gap since alternative therapies such as Lyrica can cost up to 25 times more per script compared to gabapentin. The average out of pocket cost for a 30-day supply of Lyrica is $55 as compared to $5 for gabapentin.
It is important to recognize that some of the failures reported on gabapentin therapy may have resulted from inadequate titration. The lowest dose of gabapentin that is typically effective for neuropathic pain is 1,800mg per day, however starting a patient at that dose will likely cause intolerable drowsiness, disequilibrium, and confusion which could lead to treatment discontinuation. Initiating gabapentin with a slow taper up in dosing can help avoid these intolerable side effects. A typical starting regimen would be to begin gabapentin 100-300mg either at bedtime or three times daily and then gradually increase the dosage by 100-300mg every three to seven days to a target dosage of 600mg three times daily (up to a maximum of 3,600mg daily). Increasing the dose faster will almost guarantee that your patient will end up stopping therapy due to intolerable side effects requiring a change in therapy.
Contact KHP Pharmacist Carrie Schanen with questions about generics or therapeutic alternatives at CarrieSchanen@KentuckyOneHealth.org.