Lipitor(R): Jarvik's Folly & Your Money
Lipitor is one of many statin drugs, designed to lower "bad" cholesterol, which it does. Pfizer spends heavily on promoting the product, as you've probably seen in the ubiquitous television ads featuring Dr. Robert Jarvik, primary inventor of the Jarvik artificial heart.
What Jarvik does by touting Lipitor is unconscionable. His actions violate the Hippocratic Oath, which first requires doctors to "do no harm." In fact, he does plenty of it.
He's advocating the use of a high-priced drug and, in so doing, is helping increase the cost of health care, raising health insurance premiums, and thus making health insurance unaffordable for a growing number of people.
A dollar misspent on health care is a dollar unavailable for other pressing needs. The big pile of money Jarvik is receiving from Pfizer should be going to important social needs, including health care, not to increasing his already substantial net worth.
Here's how www.Druginfonet.com describes Liptior: "[It] is an HMG Co A Reductase Inhibitor. This class of drugs inhibits an enzyme in the liver, which is responsible for cholesterol metabolism in the body. Lipitor currently is the most potent per mg of the class. Side effects are usually pretty minimal, but serial testing of liver enzymes is necessary and occasional patients will have marked muscle inflammation, which necessitates stopping the drug. There is a long list of other minor problems."
Pfizer claims Lipitor is a superior medication when it comes to reducing cholesterol. One of its representatives emphasized to me that Lipitor is compatible with cyclosporine, a drug given to people who've had organ transplants, not exactly a huge group.
At Costco, the full retail price of 20 mg. Lipitor (generic name: atorvastatin) is approximately $110.00 for a 30-day supply -- about three-and-half-dollars per pill. Pfizer fought hard to preserve its patent on the drug until 2010, so the price probably will rise in the future. (Note: if you have drug insurance, the cost would be somewhat lower because of discounts given to insurers.)
However, even with insurer discounts, Lipitor costs several times as much as alternative medications. Of course, if you have good insurance, that won't be obvious when you make your relatively small co-pay. But the premiums you or your employer lay will reflect the drug's high cost.
For example, the price of 20 mg. Mevacor (in its generic name of Lovastatin) is $9.00 per month at Wal-Mart, the same price as Pravachol (in its generic name of Pravastatin). The price per pill for these statin drugs is about one-tenth that mentioned earlier for Lipitor.
Are these drugs as good for MOST people as Lipitor? Essentially, the answer is yes. They occasionally may have some relatively minor side effects not found with Lipitor, but that would happen will a small minority of users, who could then switch to another statin.
Would that switch be to Lipitor? Not necessarily. Another popular statin is Zocor, now sold mainly under its generic name of Simvastatin.
At Costco, the retail price for a 30-day supply of Simvastatin is 37.14. (For reasons specific to the drug industry, the cost of a 60-day supply is the same price, achieving through splitting the 40 mg. tablets!)
Using my Medicare Plan D, where the insurer has negotiated a discount for Simvastatin, I recently paid $18.76 for a 60-day supply. The price is a tiny fraction of the daily cost for Lipitor.
At www.Druginfonet.com, you'll see the following Q&A, with a doctor knowledgeable about cholesterol providing the answer as to how Zocor matches up to Lipitor. (The answer was given before Zocor "went generic.")
Question: "What are the pros and cons on Lipitor vs. Zocor? Is one preferred over the other?"
Answer: "They're pretty similar. Lipitor is somewhat more potent mg for mg, but they have similar side effects and lowering of cholesterol. I use them interchangeably."
(You can read a long list of Q & As about Lipitor at the following site: http://www.druginfonet.com/index.php?pageID=faq/faqlipit.htm.)
Why do doctors continue to prescribe drugs like Lipitor when alternatives would serve patients equally well -- and cost them far less money? Apparently, they do so because branded drugs like Lipitor get heavily promoted, while generic versions don't.
There's no real parallel to the situation with medications. Can you imagine going out and paying $20.00 for a loaf of bread that MIGHT be marginally superior to a $2.00 loaf? It's mind-boggling.
Frankly, if U.S. sales of Lipitor are roughly $8 billion now, they probably should be about $2-$ billion, if that much. Even if, say, they should be $4 billion -- and I seriously doubt that -- then the savings to American health care costs would be approximately $3.5 billion.
Added to the $400 million "saved" on Avandia in the previous column, the U.S. health care bill should drop by $4 billion overall. However, don't hold your breath.
Millions of patients take drugs like Avandia and Lipitor -- and I've taken both -- but very, very few consumers of those meds are aware of any of the issues I've discussed. Doctors prescribe them, insurers (generally) pay for them, and patients take them. Those who pay anything like retail price get badly hosed -- and American health care suffers.
The application of common sense -- among doctors and patients -- would save tens of billions in health care (and possibly hundreds of billions). However, common sense --and a dose of real capitalism -- is exactly what's lacking in this area. More (a lot more) to come, including the next piece.
Note: Stephen R. Maloney has worked in the past as a consultant (writer) for Merck, Eli Lilly, and the Pharmaceutical Manufacturers Association (PMA), now known as PhRMA. He is now an independent writer and researcher, with no connection to the pharmaceutical industry.