How to prescribe when brand names are seemingly bargains

Odd as it may seem, patients prescribed atorvastatin may face lower co-pays for the brand name Lipitor (Pfizer) than for the generic. In an Ideas and Opinions article published March 12 in the Annals of Internal Medicine, Lisa Gill and colleagues from Consumer Reports explored the causes of this topsy-turvy pricing and provided guidance for physicians whose patients require the drugs.

Pfizer’s patent on its statin Lipitor expired at the end of November 2011. In a strategy that has been criticized for keeping prices high, Pfizer rolled out a number of deals, incentives and marketing initiatives to maintain market share. Those moves included agreements with insurers and pharmacy benefits managers to provide Lipitor at below generic costs, a $4 copayment card for direct sales and an agreement with Watson Pharmaceuticals to sell the drug at entry-level generic prices for a cut of sales.

As a consequence, some insurers are instructing pharmacies to fill prescriptions for atorvastatin with Lipitor. “So, in a strange twist, some patients may have discovered that, for now, their co-pay for Lipitor is less than their copay for generic atorvastatin,” Gill and colleagues wrote. “After May 2012, when the exclusivity deals with the two generic drug companies reportedly expire, more manufacturers will be able to produce atorvastatin, and we expect that the price will slowly, but surely, drop.”

In the meantime, the authors recommended that physicians first consider other low-cost statin options for their patients; but if atorvastatin is the preferred option, to then consider the financial scenarios.

• Patients with private insurance may have lower copays with Lipitor and may qualify for a manufacturer discount. The manufacturer discount program extends through December 2012.
• Some Medicare Part D beneficiaries may have lower co-pays with Lipitor under some carriers, but the total cost of the drug will be applied to their health plan. That may put them at risk of falling in the gap known as the “donut hole,” at which point they may be required to pay full cost of prescriptions out of pocket.
• Uninsured patients who otherwise would pay all out-of-pocket expenses may qualify for Pfizer’s discount program.

“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 [pioglitazone, Takeda Pharmaceuticals], Lexapro, and Plavix [clopidogrel, Bristol-Myers Squibb/Sanofi-Aventis], and others,” the authors warned. They detailed findings on the burden of high medication costs to patients and the subsequent risk of poor adherence and adverse outcomes, and concluded by encouraging physicians to discuss drug costs with patients.