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An Update on Gilenya Generics

By February 1, 2023February 3rd, 2023eMS News

There are now several generic versions of the common MS drug Gilenya approved for use in the United States. Patients currently taking Gilenya should be aware that this could impact them financially, as insurers may soon make changes to their approval guidelines now that these generic versions of the drug are available.

If you’ve been receiving Gilenya at an affordable price, either through insurance coverage or through a financial assistance program, an insurance-required switch to generic fingolimod might mean your monthly copay could change and/or you might no longer qualify to use the financial assistance program for the brand name product.

The generic medications are expected to work in the same way and have the same side effects. With the availability of the generic form (fingolimod) many insurances may prefer to cover the generic capsules instead of the brand capsules as generic tend to be a less expensive version.

Gilenya (fingolimod) is a disease-modifying therapy used to treat Multiple Sclerosis. It’s the first of now four similar molecules in the class of MS drugs referred to as the S1P1 modulators.  It’s an oral capsule that is taken by mouth once daily. The newly-approved generic medications are expected to work in the same way and have the same side effects. With the availability of the generic form (fingolimod) many insurances may prefer to cover the generic capsules instead of the brand capsules as generic tend to be a less expensive version.

What this means for patients:

If a patient has been receiving Gilenya at an affordable price either through insurance coverage or through a financial assistance program, an insurance-required switch to generic fingolimod can mean their monthly copay could change and/or they no longer qualify to use the financial assistance program for the brand product. As of March 31, the Gilenya patient assistance program (Gilenya Go Program) will end completely. And, as of now, they are not able to assist with emergency medication or provide the 14 day bridge supply of Gilenya. Co-pay assistance programs for Gilenya will still be available via McKesson Co-Pay Assistance at 855-823-2886 and Novartis Patient Assistance Foundation at 800-277-2254 or www.pap.novartis.com.

Although generic medications tend to be less expensive than brand name medications, insurance companies are the ones that decide on how much your copay amount will be (i.e. what you pay for a medication out-of-pocket, after insurance covers a portion). For some patients, they may continue to have a copay amount of as low as $0. However, there are many insurance plans that will have substantial co-pays and/or deductibles. As a result, with the disappearance of assistance programs, patients may, indeed, face higher costs for the generic version of the drug.

What patients can do:

Call your insurance company and ask if they will continue to cover the brand Gilenya or if they will require you to switch to the generic. If they require you to switch, ask them what to expect for a copay amount each month. You may also find out this information from the pharmacy when you go to refill your prescription. If the new copay amount is unaffordable, please reach out to your neurologist ASAP to discuss your options. We recommend doing this as soon as possible to try to prevent patients from running out of their medication before an alternative plan can be determined. It is extremely important to not go more than two weeks without medication due to potential rebound of disease activity.

If running low, one option may be to take the medication every 2-3 days to maintain some coverage and avoid rebound MS activity while you switch to an alternative medication as quickly as possible.

Please note: Any potential medication changes or timing adjustments should be discussed with your own medical team.

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