One More Thought About Lipitor 3

With all the discussion about generic Lipitor this week here’s one thought that deserves some consideration: the saga of Lipitor is the best case yet for the defense of the pharmaceutical industry.

I’ve been as critical as anyone of big pharma over the years, and there’s little doubt that the pharmaceutical industry deserves much of the criticism it has received. But, for once, let’s focus on the positive side of pharma.

Don’t take this to mean that the Lipitor story is a pure and shining example of pharma virtue. It’s not. As with all successful drugs, Pfizer has used every trick in the book, and even written a few new books to add to the library, in its efforts to wring every last dollar out of the Lipitor patent. Most recently, Pfizer’s efforts to blunt the impact of the drug’s patent expiration are a masterful example of corporate ingenuity (or deviousness).

But I’m ok with that. The reason: starting this week, people will pay about half of what they used to pay for the drug, and in six months the cost will drop to pennies a day. We can argue about the relative benefits of Lipitor compared to other blockbuster drugs, but there’s little question that after delivering well over $100 billion to Pfizer (and its predecessors, which the Pfizer leviathan swallowed like so many small fish) for branded atorvastatin over the last dozen years or so, the world will now enjoy the yields of its investment. In the end, the dividend will make even $100 billion seem cheap.

This might provoke howls of protest from some, but isn’t this how capitalism is supposed to work? I suppose we can all imagine more idealistic economic and political systems, in which research would be unsullied by commercial considerations and the pharmaceutical industry would be motivated solely by the desire to help people, but I haven’t seen any evidence that any system radically different from our current one could produce an atorvastatin.

And let’s remember: atorvastatin is not an anomaly. I’ve been covering cardiovascular medicine since the 1980s, and the parade of major blockbuster drugs that have appeared on the scene, raked in billions and billions of dollars, and then gone generic, is breathtaking. When I started out writing about cardiovascular medicine the beta-blocker Inderal (propranolol) was still one of the best-selling drugs in the world, and since then we’ve had more beta-blockers, followed by calcium channel blockers, ACE inhibitors, ARBs, and many others. All of these drugs have come and gone generic. Next year Plavix (clopidogrel) will lose its patent protection, which will mean that the vast majority of people will be able to take cheap generic drugs for nearly every major cardiovascular illness. That’s what I call progress.

Next week I’ll continue my regular coverage of the cardiovascular arena. I have little doubt that new examples of industry excess and malfeasance will turn up as a recurring theme. But it’s good to remember, especially at the end of the week when Lipitor went generic, that there’s another side to the story.

 

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3 comments

  1. I appreciate these comments, but I should add at least this cautionary tale, which I think moves us beyong “ingenuity.”

    I am myself a Lipitorian and stuck with it even against the sirens of generic simva, shelling out an enormous co-pay to do so. During the past year, when Pfizer was offering “special deals,” I went with one of those because my pay-out was less than co-pay with insurance.

    Now it turns out that my rx plan is one of those that has been “bought” not to provide generic atora. And I am also told that, in order to qualify for coverage of Lipitor the brand, I have to be “reauthorized” since I had not used the insurance for Lipitor (thanks to Pfizer’s “blue light specials”) over the prior year. (“Authorization” only lasts one year, so i am now told.) This means going through the whole trip with generic simva trials, etc., Or else pay full freight, with no insurance coverage whatsoever.

    Is that how capitalism is supposed to work? Or is that, well, a kind of scam?

  2. Follow-up. The story as described above was further confirmed when my cardiologist’s office tried to obtain authorization for me. They were also told that, since I’d been off benefits coverage for Lip. for a year (taking advantage of Pfizer’s own better deals), I would have to be reauthorized–meaning generic simva trials, etc.–in order to qualify for any coverage at all for brand. That office was also told that plan was not covering generic atora.

    Let’s just say noise was made. some hours later I learned that I would be covered for the generic. I don’t know if this was a purely systemic series of glitches that got unsnagged or anything else impacted the result.

    So that’s fine for me. I hope that others, who may have found themselves in a similar situation, will persist in making inquires, perhaps even noise, as relevant.

  3. This is all gaming y’all. Come on!! I am a cardiologist with a very busy practice. I have been using simvastatin since the 4S study came out, never used Rosouvastatin (Crestor), had a smidgin of brand name atorvastatin (Lipitor) only because I hate changing meds if patients are already on it, but mostly lovastatin and simvastatin. So enough of this, “what will we do now BS”.

    BTW the problem is the way we think like we all start with the billions of Dollars that Pfizer/Lipitor is worth etc.
    So please lets not put generic lipitor in the water instead take the trouble to tell people to lose weight, eat less, exercise and take the cheapest statin that works. Stop with the adulation.

    Big PhRMA is as evil as ever.

    Wilbur Larch MD FACC

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