Lipitor Goes Generic: Business as Usual or More Big Business?
Authors: Lisa Gill, John Santa, Doris L. Peter, Joel Keehn
Journal: Annals of Internal Medicine (2012)

Ideas and Opinions19 June 2012Lipitor Goes Generic: Business as Usual or More Big Business?FREELisa Gill, John Santa, MD, MPH, Doris L. Peter, PhD, and Joel Keehn, MSLisa GillFrom Consumer Reports, Yonkers, New York.Search for more papers by this author, John Santa, MD, MPHFrom Consumer Reports, Yonkers, New York.Search for more papers by this author, Doris L. Peter, PhDFrom Consumer Reports, Yonkers, New York.Search for more papers by this author, and Joel Keehn, MSFrom Consumer Reports, Yonkers, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-12-201206190-00420 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When physicians prescribe atorvastatin—at least until May 2012—patients might receive Lipitor, the branded pill. Certain insurers have reportedly instructed some pharmacies to fill prescriptions with Lipitor, even if patients present with a prescription for generic atorvastatin (1–4).How is this happening? Lipitor became available as a generic on 30 November 2011. Pfizer, the maker of Lipitor, has reportedly negotiated deals with several large insurance companies (such as UnitedHealth), pharmacy benefit managers (such as Medco), and Medicare Part D plans that have resulted in some patients paying lower prices for the branded drug than for generic atorvastatin through May 2012. During this same time, only 2 drug manufacturers are authorized to produce generic atorvastatin, and they have temporarily set prices relatively high. Meanwhile, Pfizer continues to actively promote Lipitor. So, in a strange twist, some patients may have discovered that, for now, their co-pay for Lipitor is less than their co-pay for generic atorvastatin. After May 2012, when the exclusivity deals with the 2 generic-drug companies reportedly expire, more manufacturers will be able to produce atorvastatin, and we expect that the price will slowly, but surely, drop.This unusual pricing situation could well repeat itself as other major medications are anticipated to become available as generics in the coming months, including Actos, Lexapro, and Plavix, among others. For many patients, high drug prices are a significant financial burden and that, in turn, can lead to poor medication adherence and poor health outcomes. Traditionally, expensive, highly marketed drugs like Lipitor can exacerbate those issues.Not surprisingly, medical bills and the cost of medications are consistently a top financial concern for U.S. adults, according to Consumer Reports' monthly nationally representative survey, the Consumer Reports Index (5–7). Another survey, conducted in June 2011 by the Consumer Reports National Research Center, found that nearly half of consumers who take at least 1 prescription medication have taken some potentially dangerous measures to save money, including putting off physician visits (21%), delaying medical procedures (17%), or declining medical tests (14%). Respondents also reported that, when faced with dwindling funds, they have skipped filling a prescription (16%), taken expired medications (13%), skipped a scheduled dose without checking with their physician or pharmacist (12%), split pills without consent of their physician or pharmacist (8%), or shared a prescription with someone else (4%) (8).Moreover, physicians rarely talk with patients about drug costs. Just 5% of survey respondents said they found out about the cost of a prescribed drug at the physician's office, and 64% discovered it at the pharmacy when picking up the prescription. In addition, although generics can cost a fraction of the cost of brand-name drugs, 41% of people said their physician only sometimes or never recommends a generic medication, and yet 93% said they'd be willing to switch (9). Compounding this issue is that nearly 1 in 5 patients (18%) who currently take a medicine also said that in the past 12 months, they asked their physician to prescribe a drug they saw or had heard advertised; in 70% of such cases, patients said their physicians complied (10). While effectiveness and safety are the most important factors to consider when prescribing a drug, cost is far too often a forgotten component of good patient health care—especially when there are comparable alternatives that are less expensive.In the case of Lipitor, there are safe and effective alternatives for many patients. Consumer Reports analyzed results from a systematic review of more than 347 studies of statin drugs to treat high cholesterol, published by the Drug Effectiveness Review Project at Oregon Health and Science University in November 2009. On the basis of those findings, if lipid-lowering therapy is needed, Consumer Reports suggests that consumers discuss with their physicians the use of generic lovastatin, pravastatin, or simvastatin for primary prevention and simvastatin and Lipitor—and now generic atorvastatin—for secondary prevention (11).The evidence we have evaluated indicates that the drugs listed above are as safe and effective as Lipitor and generic atorvastatin and are often cheaper (12). Indeed, a 30-day supply of lovastatin (10 mg or 20 mg) and pravastatin (10 mg, 20 mg, or 40 mg) can be found for as little as $4 through various discount generic drug programs at such stores as Target and Walmart. Generic simvastatin is less than $9 a month though Rite Aid's discount generic program. Purchasing a 90-day supply can substantially increase the savings. Offers may vary by store, state, or insurance status, so we recommend that consumers read the fine print.However, if patients require Lipitor, here's our advice: First, those with private drug coverage from such companies as UnitedHealth or Medco might save money by sticking with Lipitor. They will probably have a lower co-pay for Lipitor than for generic atorvastatin until May 2012. Patients might be able to reduce their co-pay further by using the manufacturer discount program for Lipitor, which runs until December 2012. However, the program is not available for residents of Massachusetts; those who have Medicare, Medicaid, or another federal or state health plan; or those with private insurance that covers drug costs in full. Also, not all pharmacies accept the coupons. Consumers should shop around, and they might otherwise have to order the drug directly from Pfizer.Second, patients with drug coverage through Medicare Part D face a complex situation. Our analysis suggests that some carriers reduced co-pay prices for Lipitor after generics became available. For example, Cigna RX1 reduced its co-pay from $31 in 2011 to $3 in 2012, CVS Caremark Value went from $42 to $8, and WellCare Classic went from $41 to $6. But this pricing comes with a caveat: The total price of the drug (the cost to the patient and the plan) is applied to a patient's total amount spent on medications and puts them closer to the “doughnut hole.” For example, although a patient is charged a $3 co-pay with Cigna RX1, the total cost of the drug is actually $167 per month. Multiply that by 12 months, and a patient would have “spent” $2004 toward the $2930 that puts them in the doughnut hole. Patients can find out their plans' coverage details and compare with other plans by going to Medicare.gov and clicking on “Compare Drug and Health Plans.” (At the time of this writing, the Medicare.gov Web site does not allow users to enter “atorvastatin” as part of a medication regimen, nor does it disclose that Lipitor has a generic available, so it's nearly impossible to determine from the Web site if any of the plans actually covered it. We had to visit the specific plan's formularies listed on their Web sites to make the determination. A Medicare spokesman told us that this would be corrected at the next upgrade of the site by mid-March.) Alternatively, patients can contact the State Health Insurance Assistance Program (www.shiptalk.org), which offers free information and counseling about Medicare.Third, patients who pay for drugs out-of-pocket should explore whether they are eligible for one of Pfizer's discount programs that include Lipitor. They can visit www.PfizerHelpfulAnswers.com for more information. Details and qualification rules vary, so it is essential to read the fine print.Physicians can help by prescribing generics whenever possible—and specifically atorvastatin if it is warranted—or by offering patients alternatives if appropriate. We urge physicians to recognize that patients may have difficulty paying for their medications. Ask your patients if filling their prescriptions will cause them financial burden; if so, look for alternatives. And don't hesitate to bring up drug cost with your patients, even if your patient remains silent on the subject.Note added in proof: Since this article first appeared on Annals.org in March 2012, new developments have occurred. In May 2012, Pfizer reported that it stopped making deals with health plans to offer Lipitor at the lowest-price co-pay tiers. Pfizer also made 2 changes to their $4 Lipitor co-pay program: It will now pay up to $75 of the cost of a patient's co-pay for Lipitor (up from the $50 previously offered), and the program will expire in December 2014 instead of at the end of 2012. In addition, Medicare.gov has added atorvastatin to the list of medications that patients can add to their search of Part D plans.References1. Wilson D. Plan would delay sales of generic for Lipitor. New York Times. 11 November 2011:B1. Accessed at www.nytimes.com/2011/11/12/health/plan-would-delay-sales-of-generic-for-lipitor.html on 10 February 2012. Google Scholar2. Armstrong D, Peterson M. Pfizer strikes pharmacy deals to hold Lipitor sales. Bloomberg News. 16 November 2011. Accessed at www.bloomberg.com/news/2011-11-14/pfizer-strikes-pharmacy-deals-to-hold-on-to-lipitor-market-share.html on 10 February 2012. Google Scholar3. Armstrong D. UnitedHealth chooses Lipitor over generics. Bloomberg News. 18 November 2011. Accessed at www.bloomberg.com/news/2011-11-18/unitedhealth-chooses-pfizer-s-lipitor-over-generic-versions.html on 10 February 2012. Google Scholar4. Wang M. Pfizer's latest twist on “pay for delay.” ProPublica. 14 November 2011. Accessed at www.propublica.org/article/pfizers-latest-twist-on-pay-for-delay on 10 February 2012. Google Scholar5. Consumer Reports National Research Center. The Consumer Reports Index. Consumer Reports; February 2012:5. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/CR-Index-February-2012.pdf on 10 February 2012. Google Scholar6. Consumer Reports National Research Center. The Consumer Reports Index. Consumer Reports; January 2012:6. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/CR-Index-January-2012.pdf on 10 February 2012. Google Scholar7. Consumer Reports National Research Center. The Consumer Reports Index. Consumer Reports; December 2011:5. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/CR-Index-December-2011.pdf on 10 February 2012. Google Scholar8. Consumer Reports National Research Center. Best Buy Drugs Prescription Tracking Poll 3. Appendix: Questionnaire. Consumer Reports; August 2011:18. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/2011-BBD-Rx-poll-public-release.pdf on 10 February 2012. Google Scholar9. Consumer Reports National Research Center. Best Buy Drugs Prescription Tracking Poll 3. Appendix: Questionnaire. Consumer Reports; August 2011:27. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/2011-BBD-Rx-poll-public-release.pdf on 10 February 2012. Google Scholar10. Consumer Reports National Research Center. Best Buy Drugs Prescription Tracking Poll 3. Appendix: Questionnaire. Consumer Reports; August 2011:30-31. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/2011-BBD-Rx-poll-public-release.pdf on 10 February 2012. Google Scholar11. Consumer Reports Health Best Buy Drugs. Evaluating Statin Drugs to Treat High Cholesterol and Heart Disease: Comparing Effectiveness, Safety, and Price. Consumer Reports; June 2010:10-16. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/StatinsUpdate-FINAL.pdf on 10 February 2012. Google Scholar12. Consumer Reports Health Best Buy Drugs. Evaluating Statin Drugs to Treat High Cholesterol and Heart Disease: Comparing Effectiveness, Safety, and Price. Consumer Reports; June 2010:21. Accessed at www.consumerreports.org/health/resources/pdf/best-buy-drugs/StatinsUpdate-FINAL.pdf on 10 February 2012. Google Scholar Comments0 CommentsSign In to Submit A Comment Lisa, Gill, Editor, John Santa, MD, Doris Peter, PhD, Joel Keehn, MSConsumer Reports15 May 2012 Updates to Lipitor pricing and availability Since this article first appeared on annals.org in March 2012, new developments have occurred. In May 2012, Pfizer reported that they stopped making deals with health plans to offer Lipitor at the lowest-price copay tiers. Pfizer also made two changes to their $4 Lipitor co-pay program: It will now pay up to $75 of the cost of a patient's copay for Lipitor (up from the $50 previously offered) and the program will expire in December 2014 instead of at the end of 2012. In addition, Medicare.gov has added atorvastatin to the list of medications that patients can add to their search of Part D plans. Conflict of Interest:None declared Author, Article, and Disclosure InformationAuthors: Lisa Gill; John Santa, MD, MPH; Doris L. Peter, PhD; Joel Keehn, MSAffiliations: From Consumer Reports, Yonkers, New York.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0361.Corresponding Author: John Santa, MD, MPH, Consumer Reports, 101 Truman Avenue, Yonkers, NY 10703; e-mail, HealthImpact@cr.consumer.org.Current Author Addresses: Ms. Gill, Drs. Santa and Peter, and Mr. Keehn: Consumer Reports, 101 Truman Avenue, Yonkers, NY 10703.Author Contributions: Conception and design: L. Gill, J. Santa, J. Keehn.Analysis and interpretation of the data: L. Gill, J. Santa, J. Keehn.Drafting of the article: L. Gill, J. Santa, J. Keehn.Critical revision of the article for important intellectual content: L. Gill, J. Santa, D.L. Peter, J. Keehn.Final approval of the article: L. Gill, J. Santa, D.L. Peter.Obtaining of funding: J. Santa, D.L. Peter.Administrative, technical, or logistic support: L. Gill, J. Santa.Collection and assembly of data: L. Gill, J. Santa. 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