Abilify: Is It Worth Paying For?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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What’s the deal with the best selling mood medicine of the year?

Abilify. This tiny little pill, an atypical antipsychotic, made the drug company over 6 billion dollars this past year. It’s an expensive drug and there are many patient assistance programs out there for Abilify but the question you should ask first: is it worth paying for? Let’s find out.

1. Schizophrenia.
Abilify (aripiprazole) is indicated for the treatment of schizophrenia. Abilify was found to be less effective than Zyprexa (olanzapine) in a head to head study but did have fewer “sedative adverse effects”. Abilify was also compared to Risperdal (risperidone) and there was no difference in effectiveness, and Abilify-treated folks had more tremor. There are many atypical antipsychotics to choose from now including Risperdal, Zyprexa, Seroquel (quetiapine) and Geodon (still a brand name and expensive). All of these medications are cheaper than Abilify. Just know this.

2. Mania from Bipolar Disorder.

Several atypical antipsychotics are indicated for the treatment of mania associated with bipolar disorder. Abilify has been studied for mania and compared to placebo (folks taking nothing) both alone and added to lithium or Depakote (valproate). It does work for mania but whether it work better than the others, we don’t know.

3. Depression.

I saw many folks last year coming to see me on this medication, added to their SSRI antidepressant (escitalopram, paroxetine, fluoxetine, citalopram, etc). This may surprise you but it doesn’t really work very well as a second medication for depression, even in the drug company sponsored studies. When Abilify is added to an SSRI or SNRI (venlafaxine, Cymbalta, etc) it does not significantly improve depression in patients.

In the next couple years when most atypical antipsychotics will be available as generics you’d better think long and hard before you spend tons of money on an expensive brand name like Abilify. The company spent twice as much money on advertising as the others in their class so you will hear about Abilify as will your doctor. Worth it?

Dr O.

Depending on the strength, 30 tablets of Abilify can cost from $700 to $1000 out of pocket, even with a discount. If covered by your insurance, it’s likely to fall under your highest co-pay. In contrast, generic atypical antipsychotics like olanzapine (Zyprexa) and risperidone (Risperdal) can be found for under $20 out of pocket with a discount. They are also covered under most insurance plans as Tier 1 drugs, meaning you’ll pay only your lowest co-pay.

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