Should Consumers Be Forced To Switch Meds When They Go Generic?

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  • 11/15/2011
Apparently the NYT's Duff Wilson thinks so: 

Plan Would Delay Sales of Generic for Lipitor

"The biggest introduction of a generic drug in pharmaceutical history is being met with tough business strategies by Pfizer and pharmacy benefit companies, according to recent letters to pharmacists.

Many drugstores are being asked to block prescriptions for a generic version of Pfizer’s Lipitor starting Dec. 1, when the company loses its patent for the blockbuster cholesterol drug and generic competition begins.

Medco Health Solutions, among the nation’s largest pharmacy benefit managers, is one of the companies issuing instructions, seeking to have pharmacists keep filling prescriptions with the more expensive Lipitor for six months."

Except that it won't be more expensive to consumers...

"Pfizer has agreed to large discounts for benefit managers that block the use of generic versions of Lipitor, according to a letter from Catalyst Rx, a benefit manager for 18 million people in the United States. The letters have not previously been made public.

A pharmacy group and an independent expert say the tactic will benefit Pfizer and benefit managers at the expense of employers and taxpayers, who may end up paying more than they should for the drug.

Pharmacy benefit managers are middlemen between drug companies (the sellers) and insurers and employers that sponsor insurance plans (the buyers). "

Let's presume Wilson's unsupported assertion that employers and taxpayers will pay more is correct even though it isn't since PBMs benefit whether the price drops due to discounts or generic drug introduction.  Should patients who are on Lipitor be forced to instantly switch to a generic version?  Did Duff consider the impact of drug switching to save money in the short term on the ability to reach optimal lipid levels?

No.  And he should have.  An across the board switch can and does affect compliance.  And in the short term at least a percentage of patients (of all ages) saw their bad cholesterol levels increase.   Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients. Tunceli K, Sajjan SG, Ramey DR, Neff DR, Tershakovec AM, Hu XH, Tomassini JE, Foody JM. J Clin Lipidol. 2010 Nov-Dec;4(6):491-500

How many strokes and heart attacks occured as a result?  Duff doesn't care.

I am not making a case against using generic drugs or even switching.  Rather, I am asking why the NY Times and every other major media outlet never considers the impact on price-driven changes on the total health or cost of care.  Switching has to be done carefully and has to be explained to patients that equivalent generic drugs are generally as safe and as effective as the innovator product.  So a six month transition process, paid for by Pfizer and PBMs is not sticking it the taxpayer.  It could be smart and patient-centered medicine.

Does Duff understand that?


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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