Novartis's Exelon Patch For Treatment Of Alzheimer's Disease Not Yet Widely Used

Armen Hareyan's picture

Novartis's Exelon patch, applied once daily for the treatment of mild to moderate Alzheimer's disease, is not yet widely used by primary care physicians.

According to the new Physician and Payer Forum report entitled Alzheimer's Disease, Early-Stage Parkinson's Disease, and Restless Legs Syndrome: Will Agents That Offer Improvements in Compliance Achieve Reimbursement and Usage?, 65 percent of neurologists prescribe the patch for Alzheimer's disease, while only 36 percent of primary care physicians do so.


Formulary hurdles are a key obstacle to prescribers' use of new agents like the Exelon patch. Only 60 percent of managed care organizations cover the patch, although it is covered by 70 percent of surveyed Medicare prescription drug plans and has a slight edge in Medicare plans versus private plans. However, the Exelon patch still has strong potential to increase its prescription share by developing a new weekly formulation.

"Neurologists, primary care physicians and managed care organization pharmacy directors all favor weekly patches for moderate to severe Alzheimer's disease," said Kate Hohenberg, principal director at Decision Resources. "The reformulations to which managed care organizations are most likely to say they will grant favorable formulary status are weekly patch and rapid melt formations.

In the context of primary care physicians' high level of concern about the impact of cost on compliance, the cost of a weekly patch would need to be less than seven times that of the daily patch if it is to achieve widespread use among primary care physicians."

Alzheimer's Disease, Early-Stage Parkinson's Disease, and Restless Legs Syndrome: Will Agents That Offer Improvements in Compliance Achieve Reimbursement and Usage? is based on a U.S. survey of 70 primary care physicians, 72 neurologists and 20 managed care pharmacy directors. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic, and scientific factors.



As a behavioral neurologist treating Alzheimer disease, I have never prescribed the Exelon patch at all, and am pretty unlikely to do so. There are at least a couple of reasons for this: The Exelon patch is far less convenient than pills. Swallow the pill, you're done. With the patch, you have to put it on, leave it on all day, then take it off the next day and put the next one on, being careful to avoid spots where you've recently had a patch. Second issue, is that in the only controlled trial so far published, the "Patch 10" appeared to have about half the typical efficacy of cholinesterase inhibitors in their pivotal trials (exception being one of the Exelon trials that had similarly low cognitive efficacy for the capsules). "Patch 20" had better cognitive efficacy, but more adverse effects, ergo the company wants to promote the one with less adverse effects (better chance the patient will stay on it and keep paying for it) rather than the one with better efficacy. I'll just stick with oral Aricept or Razadyne, in that order, with equivalent efficacy but less adverse effects. Reps say that the patch is good for those patients who won't swallow a pill. If the patient is so far gone with Alzheimer disease that they can't swallow, then they're too far gone for use of a cholinesterase inhibitor. If they won't swallow because they're obstinate and refuse meds, I highly doubt they'll leave the patch on (if they let you put it on in the first place). If they can't swallow for mechanical reasons, they can use the ODT formulation of Aricept. The number of patients I follow with Alzheimer disease who can't swallow a pill, or won't, is exactly 1. Out of a few hundred. She uses Aricept ODT with no problems. Finally, in our market the patch costs around $30-40 a month more than either Aricept or Razadyne (not Razadyne ER, which may be less efficacious, but the immediate-release form). So, it's more expensive, fills no need, doesn't work as well, is less convenient... Why would anyone want to use it, other than to have the rep bring bigger, nicer lunches? Mark Pippenger, M.D.
I have seen your post against the Exelon Patch on many sites. I think you need to mention on all sites that you are a speaker for Aricept. With only three drugs on the market, (by the way Namenda is not in that class), you should not make claims without your personal experience. My father is on the Exelon Patch and is doing much better than he ever has on other drugs. It is easier to know if my father takes his meds, es. since I do not live with him.
Dr. Pippenger, M.D. I have to wonder how much Aricept is paying you for your opinion.