Deval L. Patrick governor timothy p. Murray lieutenant Governor

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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


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



Chemical structure

Parent drug of paliperidone 1,2,3

Active metabolite of


Side effect profile

No demonstrated difference from


No demonstrated difference from


Clinical efficacy

No demonstrated difference from paliperidone*

No demonstrated difference from risperidone*

Cost of 30-day prescription 4mg risperdone vs. 9mg paliperidone



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.


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.


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


1. The Carlat Psychiatry Report. March 2007;5(3) (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.

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