News March 2007

State To Push For Use Of Generic Cholesterol Drug

Generic cholesterol drugs are getting a boost from health insurers hoping to avoid the significantly greater cost of Lipitor, the nation's No. 1 prescription drug, in Washington state.

Next month the state government and Regence BlueShield, the second-largest health insurer in the state, plan to begin requiring new patients to try the generics before being reimbursed for Lipitor.

Insurance experts say the moves reflect a growing use of "step therapy," a procedure in which patients are required to try generics or cheaper brand-name drugs before they can be reimbursed for expensive brands - if they are reimbursed at all.

Much of the demand for the more expensive branded drugs reflects aggressive advertising, said SuAnn Stone, Regence director of pharmacy services.

"Effective marketing doesn't necessarily mean better," Stone said. "It just means new and more expensive."

Step therapy for statins, the class of medication that includes Lipitor, takes effect April 1 for state employees covered by the Uniform Medical Plan and in Washington's Medicaid program and two days later for 1.1 million Regence members.

In most cases, new patients will have to show they have tried at least two less expensive statins before they can seek coverage for Lipitor. Two generics, pravastatin and simvastatin, offer savings as high as 80 percent compared with Lipitor.

Regence's new policy specifies that if generics prove inadequate, doctors must submit a patient's cholesterol levels and a target goal to get approval to try two brand-name statins, Crestor or Vytorin, with reimbursement available for Lipitor only as a last resort.

Regence adopted a similar change previously for members in Oregon, Idaho and Utah.

Patients already on Lipitor are exempt from the generics-first requirements, but for some state workers and retirees the copays for Lipitor could double.

Nationwide, prescriptions for Lipitor in 2005 totaled $8.4 billion, about twice as much as for Zocor, its closest competitor.

In Washington, Lipitor is the biggest drug expense in the Uniform Medical Plan, which covers half of the 322,000 state and public-school employees, and the fifth-largest drug expense for Medicaid.

In January, the Uniform Medical Plan began step therapy in 10 classes of medication for conditions such as arthritis, asthma, herpes and insomnia.

Pharmaceutical companies and some doctors and patients say the move unfairly restricts their choices.

"Physicians should have the autonomy to treat their patients," said Jennifer Van Meter, director of clinical medical policy for Pharmaceutical Research and Manufacturers of America.

Jeff Sutton, 42, vice president of an aviation insurance firm in Seattle, opted for higher copays to receive Lipitor under his Regence coverage after going on statins three years ago. Since then his cholesterol level has fallen by nearly 40 percent.

If Regence made it difficult for him to stay on Lipitor at any price, Sutton said, he would be concerned about potential side effects and the more-frequent blood checks that are required when switching statins.

Stone said the vast majority of those who take statins have cholesterol levels respond well to treatment with generics.

Source http://www.theolympian.com/