DEVAL L. PATRICK Governor
TIMOTHY P. MURRAY Lieutenant Governor

The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
One Ashburton Place
Boston, MA 02108

JUDYANN BIGBY, M.D. Secretary
TERENCE G. DOUGHERTY Interim Medicaid Director

Dear Prescriber,

November 2009

MassHealth and the Massachusetts Department of Mental Health are writing to you about the prescribing of paliperidone (Invega®) for some of your MassHealth patients. We hope that this information is useful to you and your patient(s).
Comparison Table	
	risperidone	paliperidone	
Chemical structure	Parent drug of paliperidone 1,2,3	Active metabolite of
risperidone1,2,3	
Side effect profile	No demonstrated difference from
paliperidone*1,2,3	No demonstrated difference from
risperidone*1,2,3	
Clinical efficacy	No demonstrated difference from paliperidone*	No demonstrated difference from risperidone*	
Cost of 30-day prescription 4mg risperdone vs. 9mg paliperidone	$36	$274	
Projected yearly cost (MassHealth)	$3.5 million for 98,600 prescriptions	$2.2 million for 8,000 prescriptions	

*The dose of risperidone is adjusted as needed for patient-specific metabolizing rate.
An extensive review of the literature does not support any clinically significant differences between paliperidone and risperidone. The two medications share a very similar pharmacological structure and profile. Typically, when medications are so structurally similar, a “head-to-head” trial is considered the “gold standard” for identifying differences between them. In this instance, no such studies have been conducted.
We have attached a list of your MassHealth patients who are currently prescribed paliperidone. Please review your cases carefully, and as clinically appropriate, reconsider continuing treatment with paliperidone, a much more costly product than risperidone.
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Thank you for joining us in this important and focused effort to help ensure that our members receive medically necessary prescriptions that are safe and effective, and result in high quality and cost-effective care.
Sincerely,

Mary Ellen Foti, MD	Paul L. Jeffrey, PharmD
Deputy Commissioner	Senior Director
Clinical and Professional Services	Office of Clinical Affairs
Massachusetts Department of Mental Health       Director of Pharmacy
MassHealth

1.	The Carlat Psychiatry Report. March 2007;5(3)
http://www.thecarlatreport.com/index.asp?page=wp3152007185348 (accessed June 2009)
2.	Dolder C, Nelson M, Deyo Z. Paliperidone for schizophrenia. Am J Health-Syst
Pharm. 2008;65:403-413.
3.	Marino J, Caballero J. Paliperidone extended-release for the treatment of
schizophrenia. Pharmacotherapy 2008;28:1283-1298.