Indianapolis-based WellPoint Inc. is in a tussle with the nation's largest drug maker over the nation's top-selling drug.
New York-based Pfizer Inc., facing the loss of billions in sales of its Lipitor cholesterol-fighting drug, sent letters last month to doctors, encouraging them to protest the attempts of health benefits firms to switch patients to generic cholesterol drugs.
The letter, which says the change is being pushed "for cost reasons alone," reached doctors several days after Well-Point expanded a promotion to get patients to switch their cholesterol-lowering medications, also known as statins, from brand names to generics. The promotion began in January.
Lipitor racked up $8.6 billion in U.S. sales last year, more than any other drug, according to IMS Health, a health care information company. WellPoint estimates it saves $70 to $80 each month for every patient who uses a generic statin instead of a branded one.
Pfizer has a patent on Lipitor until 2010. But its blockbuster is under a new threat from a generic version of Merck & Co.'s drug Zocor (simvastatin), which became available in June 2006 and was produced widely at the start of this year.
Brian Sweet, WellPoint's chief clinical pharmacy officer, didn't deny that cost was a big reason for promoting simvastatin, but he emphasized WellPoint has not mandated that any patients switch drugs. It is merely encouraging them to discuss their options with their doctors.
"The simvastatin decision was made based upon some analysis that we'd done on the pricing of simvastatin, and when we knew there were enough manufacturers making it," he said, adding, "I'm sure Pfizer is interested in protecting their brand."
Health benefits firms are eager to find cheaper versions of cholesterol drugs, which as a class rang up $22 billion in U.S. sales last year, according to IMS Health.
St. Louis-based Express Scripts, a pharmacy benefits manager, is hawking generic Zocor for just $20 for a 90-day supply. At drugstore.com, an online pharmacy, a supply of 90 pills of 80 mg Lipitor costs $326.
Patients started embracing the generics even before WellPoint began promoting them. Since June 2006, WellPoint's members have more than doubled their use of generic statins. Sales of Zocor plunged 30 percent last year, to $3.1 billion.
WellPoint's promotion, which started in six states, offers patients a free, four-month supply of generic Zocor if they switch off any brand-name statin, including Lipitor. On March 19, the company announced that patients in seven more states, including Indiana, could get the same deal.
WellPoint runs that promotion for every drug it adds to its GenericSelect program, which includes drugs to fight such chronic conditions as high blood pressure, depression, diabetes and arthritis.
Pfizer's notice to doctors is in a form letter they can forward on to health benefits companies. Sam Nussbaum, Well-Point's chief medical officer, said he thought Pfizer's letter was in response to WellPoint's changes.
Pfizer declined to make one of its officials available for comment, but did release a written statement.
"To categorically switch patients' medications interferes with physicians' ability to make clinical decisions on behalf of their patients," the statement read. "Pfizer believes that physicians should be able to make clinical decisions based on their medical expertise and that patients should have access to the best treatment options available or information about those options."
Indianapolis primary care physician Robert Mouser agrees.
"To me, that's not ethical," Mouser said of WellPoint's promotion. "That's purely over money. That has nothing to do with the health of the patient."
The big difference between Lipitor and generic Zocor is potency. Lipitor is roughly twice as powerful at reducing levels of LDL cholesterol-commonly called "bad" cholesterol.
For that reason, Mouser has favored Lipitor over Zocor. He now most often prescribes a newer statin called Crestor, made by AstraZeneca, for which he participated in clinical trials.
"There are 400 studies that show [Zocor] is not as good [as Lipitor]," Mouser said.
Pfizer would not say to how many doctors it has sent letters. Mouser received one.
So did William Gill, a cardiologist at the Clarian Cardiovascular Center in Indianapolis.
But he didn't read much of it. Gill appreciates WellPoint's pitch and said he thinks Pfizer is quibbling over the difference between a Mercedes and a Honda. Just as both cars will get their drivers to their destinations, so can both medications be used to effectively reduce patients' cholesterol levels.
"A lot of patients might want to go with the generic," Gill said, noting that he gets questions from patients every day about which drugs cost the least. "It's better than not taking the drug."