{"id":517,"date":"2012-01-22T13:59:29","date_gmt":"2012-01-22T17:59:29","guid":{"rendered":"http:\/\/www.khpi.org\/blog\/?p=517"},"modified":"2012-01-28T12:16:32","modified_gmt":"2012-01-28T16:16:32","slug":"not-one-public-penny-more-for-lipitor","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/not-one-public-penny-more-for-lipitor\/","title":{"rendered":"Not One Public Penny More for Lipitor\u00ae"},"content":{"rendered":"

It is often said facetiously that the true measure of the success of an advertising campaign is that it compels its target to buy something that is not needed.\u00a0 By this measure, the pharmaceutical industry is the true master of the craft.\u00a0 What else explains the high proportion of the industry\u2019s budget that goes to advertising and marketing spending more for ads than research!\u00a0 But that is a subject for some future blog or comment below.\u00a0 What I will highlight today is the stunningly successful campaign of the industry to induce us to pay $billions for overpriced brand-name drugs when the exact same drug (or one that is as or more safe and effective) is available for a small fraction of the price as a generic product.<\/p>\n

What got me going today is the latest of a long series of full page ads in my local newspaper urging me to apply for Pfizer\u2019s $4-CoPay Card that allows me to begin or continue to take brand-name Lipitor\u00ae to lower my cholesterol.\u00a0 The CoPay Card promises an out-of-pocket cost to me of from $4 to $50 per month for perhaps one year.\u00a0 The savings depends on whether or not I have prescription drug coverage as part of my health insurance, and how low my co-pays are.\u00a0 As usual, those without any health insurance pay the highest prices.\u00a0 Those of our neighbors do not have anyone negotiating discounts for them are stuck being billed for the full amount of whatever the healthcare industry thinks it can get away with.<\/p>\n

Lipitor\u00ae may be the most successful pharmaceutical product ever, at least from the industry\u2019s perspective, earning billions-and-billions of dollars for its maker.\u00a0 Some experts speculate that this success stems more from the effectiveness of marketing than any clinical superiority of the drug over available alternatives.\u00a0 It certainly seems that way to me.\u00a0 Unfortunately for Pfizer (the company that enjoyed this bonanza) the patent giving it a monopoly on this drug ran out last summer.\u00a0 I would have expected that the expiration of their patent would have opened the door for multiple generic manufacturers to jump into the market, but that did not happen.\u00a0 What did happen, as best as I can understand, is that Pfizer made a business deal with one of the big generic manufacturers that allowed it to extend its patent protection for another 6 months. Perhaps someone can explain to us as a comment how this can happen and not be an anti-trust issue.\u00a0 In any event,\u00a0 atorvastatin, the generic version of\u00a0 Lipitor\u00ae, finally became available on November 30, 2011.\u00a0 As expected this took a big bite out of Pfizer\u2019s fortune.<\/p>\n

Despite the new alternatives, Lipitor\u00ae continued to own a third of the market share for atorvastatin at the end of December.\u00a0 How can that be?\u00a0 Why would a rational person pay several times more for the same drug?\u00a0 A variety of\u00a0 hypotheses are offered: lazy or uninformed physicians and patients; people who are addicted to the shape and color of the pill; a continuing campaign of mis-information against the safety of generic drugs; the drug rebate system; and other non-rational explanations.\u00a0 Perhaps there are some valid reasons unknown to me that justify the continued prescription of Lipitor\u00ae.\u00a0 Indeed, Pfizer has told us in one of their ads that \u201cyour physician must have had some good reason to prescribe Lipitor to you.\u201d\u00a0 Presumably this reason is other than the free lunches provided to the physician\u2019s office.<\/p>\n

To continue to keep its cash-cow alive, Pfizer arranged a combination of discounts and rebates [Please explain to me below how these are different than bribes or kick-backs.] to medical insurance companies and pharmacy benefit managers to induce them to continue to pay for Lipitor\u00ae and making it profitable for Pfizer to offer their $4-CoPay Card. \u00a0 The business deals outlined above are said to be legal and probably yielded Pfizer another $5 billion from the still-standing cow.\u00a0 In my view this result is a measure of the magnificent power of the pharmaceutical industry\u2019s lobbying and the influence of its political cash contributions on our lawmakers.\u00a0 How great for the industry and how sad for the rest of us!\u00a0 I am prompted to ask, \u201cIs anybody on the side of the drug-taker?\u201d<\/p>\n

Full disclosure: Up to two years ago, I took Lipitor personally.\u00a0 My physician prescribed it for me several years ago as my first-ever cholesterol-lowering drug.\u00a0 It worked well for me.\u00a0 I had a monthly copay of some $25 to $35, but my insurer (my former employer and co-workers in a self-insured plan) was paying a lot more than that on my behalf\u2013 much more than $120 monthly.\u00a0 I was lazy.\u00a0 What brought me to my senses was the $4 Prescription Program of Walmart.\u00a0 Walmart and a few other large pharmacies offer a list of generic drugs available for a monthly price of $4, or a three-month supply for $10.\u00a0 The long list contains tried and true drugs for most categories of disease.\u00a0 As a physician I had a long experience with most of them and it seems to me that the vast majority of patients can be well treated, at the very least initially, with the listed drugs.\u00a0 I asked my doctor to change my prescription of Lipitor\u00ae to pravastatin, the generic version of Pravachol\u00ae.\u00a0 My doctor had absolutely no problem with changing Lipitor\u00ae and another of my regular medicines to the generic ones on Walmart\u2019s list.\u00a0 I now get a whole year\u2019s worth of my cholesterol-lowering medicine for $40.\u00a0 That\u2019s barely more than the previous copay for a single month.\u00a0 As it happens, my regular neighborhood chain drugstore was willing to match Walmart\u2019s price to keep the rest of my family\u2019s business.\u00a0 It was much less expensive for me to pay cash for two of my drugs outside of the structure of my regular health insurance coverage than to submit a claim.\u00a0 My insurer did not have to pay even one cent of the otherwise inflated costs!\u00a0 Of course as a result, I do not get credit for these expenses against my out-of-pocket maximum yearly deductible.\u00a0 How do we allow such craziness to continue?\u00a0 Is there any better reason not to embrace comprehensive healthcare reform?\u00a0 Why do we tolerate our legislators\u2019 rejection of the ability of Medicare and Medicaid to negotiate drug prices on our behalf when other health insurers and the drug companies themselves are willing to engage in such contractual gymnastics?<\/p>\n

In 2010, Consumer Reports prepared a rational and eminently medically justifiable analysis of cholesterol-lowering drugs<\/a> including Lipitor\u00ae and others of the\u00a0 most frequently used \u201cstatin\u201d group.\u00a0 As of today, at least 4 of this group of 8\u00a0 drugs are available in a generic form.\u00a0 There is no meaningful medical reason apparent to me why these generic drugs cannot serve all the needs of patients for whom drug therapy of hypercholesterolemia is necessary. \u00a0 Believe me, I would not have switched personally if I thought for an instant that I would\u00a0 have been hurting myself medically!\u00a0 Although most of us who are lucky enough to still have health insurance may appear to benefit from having to pay out-of-pocket for only a part of our drug bills, all of the rest of the otherwise inflated cost of the prescriptions is nonetheless still being paid for by our private or government health insurance\u2013 our own personal premium and tax dollars!\u00a0 This is no free lunch! \u00a0 What a gigantic waste!\u00a0 Think of all the other things that could be done with the money.<\/p>\n

Therefore, instead of just complaining about the high cost and poor quality of American medicine, I offer a rational, defendable, and simplifying partial solution.\u00a0 I address specifically the category of cholesterol-lowering statin drugs, but I see no reason why the framework should not be extended to every other category of drugs in which generic versions are available.\u00a0 Here it is.\u00a0 Not one single dollar of taxpayer money, nor of the premium paid by or on behalf of the beneficiary of a private or public health insurance program may go towards the purchase of Lipitor\u00ae, Mevacor\u00ae (lovastatin), Pravachol\u00ae (pravastatin), Zocor\u00ae (simvastatin), or any other brand-name drug in this group.\u00a0 If there are still people who insist they \u201cneed\u201d the brand name, they are free to pay for the drug themselves outside of their insurance plan.\u00a0 There is absolutely no reason for the rest of us to subsidize their folly. \u00a0 If there are doctors who, for whatever reason, insist on continuing to prescribe the expensive brand names, they are free to defend their actions to their medical payers or state medical licensure boards.\u00a0 Perhaps these prescribers know something that the rest of us physicians should know, but do not.\u00a0 Any potential exceptions for medical necessity that might justify the continued prescription of a brand name instead of the generic will be rare enough that they can be handled by existing avenues of individual medical review.<\/p>\n

The savings from the the above will be enormous if not stupendous.\u00a0 No one will lose a thing except the pharmaceutical companies, and that will not be a true loss.\u00a0 They and our insurers will be forced to develop more rational and fair business models.\u00a0 These companies need our help to move in that direction and in the end, we will all be better off.\u00a0 If you disagree, tell us why below.\u00a0 If you agree, lets do something about it instead of just complaining or allowing ourselves to be distracted.\u00a0 I will start by writing to my insurers (currently Medicare and Humana) and legislators asking them to stop the waste of my money or to justify current practices.\u00a0 Will you join me? \u00a0 I will post a sample letter later and you can sign-on or write your own letters that will give our insurers, regulators, and legislators the cover they need to change the status quo.<\/p>\n

Peter Hasselbacher. MD<\/p>\n

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