Cost-conscious Medco pits Plavix against Effient

Congress might be leery of comparative-effectiveness research that actually guides treatment decisions, but pharmacy benefits managers aren't so squeamish. Medco Health Solutions, in fact, is launching its own head-to-head study comparing the blockbuster clot-buster Plavix to its new rival Effient.

You'll recall that Plavix is nearing the patent cliff; Bristol-Myers Squibb and Sanofi-Aventis will face generic competition for their big moneymaker by late 2011. Eli Lilly's Effient, however, is brand-spanking new. So by the time Medco's proposed 14,000-patient study is unveiled--in early 2012--low-cost Plavix copycats will likely be on the market. Effient will still carry the premium price of a branded drug.

Getting the drift? Medco wants to know whether Effient's performance justifies the higher price tag--and to know whether pre-treatment genetic screening might be cost-effective. Already we know that about one-quarter of Plavix patients have a gene mutation that makes the drug much less effective, but those patients will be excluded from the study, so Medco will be looking specifically at the patients in whom Plavix works best.

Presumably the PBM also will slice and dice the data to not only determine overall differences in treatment effects, but any differences within subsets of patients. Women, men, over-65s, patients with heart failure, patents with diabetes? We'll have to wait and see.

- see Medco's release
- read the Associated Press story

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