Lipitor: better than the rest of the statins? Not so fast.

Medpundit’s got a good post on the marketing of Lipitor. It stands alone so I won’t quote anything here, except to re-post the comment that I left there:

Interesting post. Thanks for the analysis. It mirrors what I had suspected recently with regards to the “80mg Lipitor” reduces the risk of stroke. Emphasis on the 80mg part.

AstraZeneca did something similar with their marketing of Nexium, btw. You’ll recall that Prilosec is typically prescribed as 20mg QD. Nexium is most common as 40mg QD. A drug rep (no longer with AZ) told me that they compared the two together — only Nexium was at 40mg and Prilosec was at 20mg. Naturally that part wasn’t emphasized, and a lot of doctors were snowed by it. Hence Nexium’s evergreened, un-deserved, excessively-costly popularity.

In the case of Lipitor, I think marketing will only work for so long. It’s in the government’s interest to conduct head-to-head studies comparing the generic statins to Lipitor because it can save them money. It’s only a matter of time before this is done — and I think the results are not going to be in Pfizer’s favor, which is why I think Lipitor will largely be irrelevant by the time it loses protection in 2010.

And another comment I left on PharmaGossip about a week or so ago:

It seems likely, to me, that this study was conducted with an eye toward generic competition in the form of simvastatin. Pfizer knew Merck was their largest competitor in the statin market, and conducted this study in the hopes of finding this correlation at around this time.

Why?

In the last month, I’ve seen Express Scripts (one of the largest pharmacy PBMs) move toward making Lipitor available only with a Prior Authorization where before it was the preferred statin of choice. Several other PBMs have done the same thing.

The only exception in the case of Express? 80mg Lipitor. I think that’s why Pfizer is emphasizing the “80mg” part as much as the “Lipitor” part: the strength is just as significant (for them) as the drug itself.

My experience is anecdotal in this case — and should be taken as such — but there it is nonetheless.

I should add an addendum that I have since seen Express Scripts cover lower doses of Lipitor, and that different plans probably have different formularies. (Or doctors simply bothered to call in a PA before the patient filled the script which is equally possible.)

Yay marketing!

[tags]Medicine, pharmacy, marketing, Pfizer, Lipitor, cholesterol, statins[/tags]

3 thoughts on “Lipitor: better than the rest of the statins? Not so fast.

  1. I do wish regulatory authorities would require head to head studies, against current standards of care and not just accept studies against placebo. Speaking to some Australian pharmacists I think this is required down under, the result being that they only have a few ACE inhibitors on the market as compared to the 10 or more available in the UK.

    I take it that QD is an abbreviation fir once daily? In the UK od is once daily and QDS or QID is four times daily.

  2. QD = Quaque Die (daily)
    OD = oculus dexter (Latin for right eye)
    QID = quater in die (4x/day)
    TID = ter in die (3x/day)

    q by itself means every.

    So for instance, on a prescription:

    2 gtts od q4 x7d

    would translate to “Instill 2 drops into right eye every 4 hours for 7 days”

    AFAIK, pharmacy abbreviations are the same in the UK, but I could be wrong.

    And I agree with you on the head-to-head studies. Because big pharmaceutical companies are the ones that typically fund clinical studies, they have no incentive to do this because it could jeopardize a product’s saleability. The result is “me-too” drugs — which only makes sense from a business standpoint — and formularies with preferred drugs.

    I don’t know how the Aussie system works (are you all socialized down there?), but up here limiting drug approvals would never fly because of our free-wheeling system. It would be nice to have an index of sorts to see how well one drug compares to another of the same class. But again, that will never happen.

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