Hundreds of thousands of people who now take the best-selling cholesterol-lowering drug Lipitor may soon find themselves holding a new prescription. In a cost-cutting measure, Express Scripts, which administers drug benefits for one in six Americans, will remove Pfizer's Lipitor from its approved list of drugs in January and replace it with Merck's Zocor. When Zocor (simvastatin) goes off patent in June, Express Scripts will then move to a generic form of the drug. (Generic versions of drugs often cost 50 percent less than name-brand formulations, and consumers with drug insurance often have a lower co-payments for generics.) "This is not a huge clinical issue for the vast majority of patients," said Michael P. Cecil, an Atlanta cardiologist and author of "Drugs for Less" (Hatherleigh Press, 2005). But a small fraction of patients may be less well-served.
Different Strokes Lipitor is twice as potent as Zocor, so patients getting 10 or 20 milligrams of Lipitor daily "can reasonably be switched to a double dose of Zocor," said Stuart F. Seides, associate director of cardiology at Washington Hospital Center. But at its highest dose of 80 milligrams, he said, Zocor has more potentially dangerous side effects, including muscle pain and liver toxicity. So for the approximately one in five Lipitor users taking a dose of 40 or 80 milligrams, Seides said, "switching to Zocor may not be as satisfactory or as safe." Another statin option on the Express Scripts formulary offers a potent alternative: Crestor. But that drug has also raised safety concerns, Seides said.
Special Cases Protest your insurance plan's switch to Zocor and you may be able to retain coverage for Lipitor: Some insurers and employers grant exceptions for patients who appeal. Some do not. One way or another, Lipitor loyalists will likely pay a penalty: by having to switch drugs or pay more.
-- Ben Harder
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