...instead of focusing on innovation. I've written about Pfizer and Lipitor a few times in the last year. Now, Pfizer has found a way to extend its patent on Lipitor, a very profitable drug used in the management of heart disease and high cholesterol.
Lipitor's a great drug. It treats high cholesterol very effectively, and is effective as both primary and secondary prevention for cardiovascular disease (there is much more to the story, but that's it in a nutshell). It's also costs about $120.00 for a month of therapy, and therapy is usually life-long.
In contrast, simvastatin, a generic drug, is also effective for primary and secondary prevention (once again, it's a bit more complicated than that) but is generic and costs between $2.00 and $20.00 per month of therapy.
Not all statins are created equal. Some have better data in primary or secondary prevention, in coronary artery plaque regression, in reduction of mortality, stroke prevention, side-effect profile...you get the idea.
What we do know is that statins save lives, and cheap statins probably save lives just as well as expensive ones.
Pfizer suffered a big setback last year. A trial of a new type of cholesterol medication failed badly (link to my old blog above). Drug development is risky business. But clinging to an old drug by squeezing more time out of a patent is doomed to fail. Insurance companies put a lot of pressure on doctors and patients to prescribe generic alternatives where appropriate, and in the era of high deductibles, patients want the cheaper drug.
Hopefully, companies like Pfizer will invest more resources in drug discovery and development, and let the market do away with it's enormous Lipitor profits. After all, if you can keep a patent forever, what use is looking for new drugs?
Primary prevention: preventing a first incident (first heart attack, stroke, etc.)
Secondary prevention: preventing further events in established disease (subsequent heart attacks, strokes, etc.)
Just wondering what you think of Wal-Mart and their $4 prescription plan. On one hand, it's Wal-Mart, but on the other hand they've really done a service to force a lot of other places to make the generics available pretty cheaply. And they even have the Pill (or at least one variety thereof, not available in all states). I know that I and a lot of the attendings I've worked with have definitely tailored prescription regimens for less-affluent patients with an eye towards the inexpensive (and probably just as effective, as you've pointed out) generics.
Wal-Mart, Target, Kroger, and others are following. While I love my local independent pharmacy (OK, he got bought out) I send all my patients to the cheapest place for their drugs. I can almost always find a $4 Rx for someone. There are a few exceptions (plavix, for instance), but let's say I have someone with established coronary artery disease with moderately decreased LV systolic function. Monthly meds:
1) aspirin a few bucks
2) metoprolol four bucks
3) pravastatin four bucks
4) lisinopril four bucks
5) quitting smoking positive ~150 bucks
Really, treating serious diseases in an effective and evidence-based manner has never been cheaper.
I just heard (on the radio, so no link) the other day that Pfizer and other drug companies are now pushing to have statins cleared for over-the-counter sale. This, of course, would increase the cost to consumers because they'd no longer be covered under any drug insurance plans, especially by Medicare.
Of course, this would also allow the drug companies to advertise much more directly to the public. Whether this would apply to any current generic statins was not mentioned.
Dammit, Bill, we already went through this a few years ago. Friggin' drug companies!
IT IS NOT A GOOD IDEA TO SELL STATINS OVER THE COUNTER!!
You know when you need a tylenol...your head hurts, knee hurts, etc.
You don't know when you need a statin. Indications differ for different people, and these drugs requires a certain amount of monitoring. It's a monumentally bad idea. It's just another way to raise the price.
Dammit, Pal, I agree. ;-)
I just thought the link was relevant.
"He doesn't have to shoot me now..."
As usual, I have nothing to contribute here...
Couldn't help but crack a smile at the very noticeable typo in the title : )
I and a lot of the attendings I've worked with have definitely tailored prescription regimens for less-affluent patients with an eye towards the inexpensive (and probably just as effective, as you've pointed out) generics.
Bless you and all docs who do that, including my primary! He first prescribed one of the fancy brand-name combinations for my widely fluctuating BP, and I nearly dropped my teeth when I found out that the combo cost $90-something/month but one of the ingredients had been available as a generic for years and the other had just come out of patent. So he wrote separate scripts for the two meds, and then I found out that yes, the other had just come off patent, but only one company was making it so far, so it was still $55 or something like that!
OK, so here I am with no income and no insurance, and this just wasn't gonna work. I called him back and not only did he put me on something else that went generic who-knows-how-long-ago, he loaded me up with freebies.
The stuff works just fine. I'm now running a pretty steady 125/80 (not bad for a lazy overweight middle-aged broad, I'd say =grin=), where before I was bouncing between 130/80 and 160+/110. (Been through the stress test and everything and there's no obvious cause, so everyone's happy so far. But DAMN, I hate that ****ing treadmill! I thought I was gonna die from that.)
More kudos to my other doc for getting me hooked up with a prescription assistance plan so I can get my $500+/month of meds free for my chronic depression.
To hell with manufacturers trying to eke out just one more year (or seven, or 20) of charging $5 or $10 a pill for daily maintenance meds that cost a few cents to make. And Ceiling Cat bless all docs who put their patients first and refuse to go all starry-eyed whenever anything new, shiny, and Ã¼berexpensive comes down the pike.
Oops, sorry about the umlaut-that-wasn't. BTW, the stuff I'm taking for my BP is Lisinopril. (I'd take aspirin too if I could, but even a low dose can make my ears buzz.)
Pfizer is using several tactics to fight for their financial life. The first is for the hearts and minds of physicians. They have been pushing a study that supposedly shows Lipitor to be more effective than simva, but it looks like this will turn out to be bunk.
Wasn't atorvastatin significantly more effective than simvastatin in at least one trial?
I have to say, I would be strongly opposed to Wal-Mart selling prescriptions. I can see it going exactly the same way as every other sector supermarkets move into and monopolize - the price goes down as they use their superior financial weight to destroy any competition, and then once they have a stranglehold over the market they're free to ratchet up the prices.
Assuming PalMD is correct that you can get drugs as cheaply as Wal-Mart are offering anyway (I'm not American so I can only go by what he says), then there is little advantage to patients from Wal-Mart's $4 prescriptions, and every chance they'll screw the market over in a few years time.
Just my tuppenceworth anyway.
You admit that discovering new medications is a hugh risk. Most thought that raising HDL was the answer to CHD so that is where Pfizer "focused" with trocetrapib and in the end lost 1 BILLION dollars on that project alone. Now you denegrate the company for trying to ring every last drop from the few drugs that make it to market! Typical attitude for someone ,on the side lines, who's only investment is the time it takes it take to pick up a pen and write an Rx after the fact!!!!
As someone who takes cholesterol meds (heredity and a long history as a chef who will eat anything....) I read about Pfizer's money grab and it infuriates me. While the current med I am taking is not a Pfizer product, I just can't wait until they follow suit. Monthly cost for meds is ridiculous as it is. I can afford them but I just think about those people that have to make the choice between food and controlling their health issues.
Now you denegrate the company for trying to ring every last drop from the few drugs that make it to market! Typical attitude for someone ,on the side lines, who's only investment is the time it takes it take to pick up a pen and write an Rx after the fact!!!!
Yeah Pfizer sure is struggling to make ends meet as a Fortune 500 (39th) company (only behind Johnson and Johnson in Pharm ranking) with nearly 20 billion in profits last year.
I have no problem with companies making profits from their products. That's what capitalism is about. But please don;t try to pass off some attempt to make them looks like they have to squeeze it to make things work for them. They are doing just fine. This is a pure grab.
Preview button for the win.
"Don't" and "look"
Personally, when I discovered I would need to be placed on a daily medication for the rest of my life, I was literally checking daily for news that my (relatively new) drug was being produced as a generic. When it did go generic, it saved me almost $50 per month.
I am exceedingly grateful to the drug company which first developed the medicine which has allowed me to lead a much better life. But my aching wallet has gotten more relief from the generic.