Questions raised about prescribing atorvastatin, 180-day period costs

Pfizer, Medco, and pharmacy groups are all battling to get their voices heard after a November article in The New York Times raised questions about prescribing Lipitor versus atorvastatin (the new generic form of Lipitor).

Pfizer loses its patent protection for Lipitor on November 30. The Times’ article claimed that Medco Health Solutions and other pharmacy benefit managers (PBMs) were instructing drug stores to block prescriptions for atorvastatin beginning December 1.

Pfizer executives acknowledged to Drug Topics that the manufacturer is offering Lipitor at or below generic cost during the first 180 days of the generic introduction, when the generic medication is typically priced higher at about 15% to 20% less than the brand. After 6 months, when other generic forms of Lipitor will be allowed on the market, the generic price is expected to decrease.

However, Pfizer said in a statement to Drug Topics, “Our programs, which are designed to offer Lipitor at or below generic cost during the 180-day period, will not increase costs for the significant number of payers participating in our programs. In this 180-day period, typically payers do not receive a significant cost-savings by utilizing a generic.”

Through innovative contracts with health plans and PBMs, total costs to payers are typically less than a generic option and patients receive Lipitor at co-pays comparable to generics, the Pfizer statement added.

However, Pharmacists United for Truth and Transparency (PUTT), a national coalition of around 500 pharmacists and pharmacy owners, believes that employers are getting the short end of the stick. “Our whole reason for bringing this story to light is to act as the self-insured [employers] advocate, to make sure they are getting every dollar [they should],” said David Marley, RPh, spokesperson for PUTT.

Marley estimates that plan sponsors will pay $35 more per prescription for Lipitor than they would for atorvastatin. “Roughly 70 million Lipitor prescriptions were filled last year. Plan sponsors need to evaluate their contracts to see how much, if any, of the Lipitor rebate money they will receive. It is unlikely that they will receive any of it,” Marley said.

Meanwhile, executives with Medco said that the PBMs always encourage the use of generics above brands. However, some of its health plan sponsors – representing less than 20% of Medco’s client base – have opted to take Pfizer’s rebate for prescribing Lipitor for the first 180 days. “They cut their own rebate deal [with Pfizer]. They made a decision to favor a brand for a certain period of time. I imagine that it is neutral for employers in terms of co-pays,” Tim Wentworth, group president for employer and key accounts at Medco, told Drug Topics.

Pfizer executives likely made a smart business move for the company, according to Wentworth. “Pfizer was willing to discount in order to keep their factories running longer. I expect that Wall Street believed the supply would fall off the table the first day. If Pfizer can sell more than expected, it is a bit of everyone winning,” Wentworth said.

Meanwhile, Medco patients are aware that generic Lipitor is on the market and “are very excited about the savings they are going to get,” Wentworth said. “We have sent 50,000 faxes to physicians and will send another 100,000, reminding them that their patients can save money by switching to generic [Lipitor],” Wentworth said.