Insurers could bring the axe down hard on Vytorin and Zetia. In light of the anti-ezetimibe recommendations from an American College of Cardiology panel and the New England Journal of Medicine, among others, several big drug-benefits plans are considering changing their reimbursement policies on the meds. So far, only Cigna has actually changed its policy; the health insurer suspended a program that notified members using certain other cholesterol meds that Vytorin was an effective alternative.
Several other plans and PBMs--including UnitedHealth, Medco, and Express Scripts--say they will review the data on Vytorin and Zetia soon. Cigna also plans to sift through the data to see if further changes are needed. They might all decide to keep Vytorin and Zetia where they are. But they might not. One thing that might affect those decisions: The ACC plans to issue treatment advice in the next few months, to account for the new data. Another thing: Merck and Schering-Plough plan a big promo push among insurers and PBMs, so sales reps can argue aggressively for Vytorin.
Whatever insurers decide, analysts and doctors are expecting a big slide in sales. Moody's Investors Service cut Schering's outlook to "negative" from "stable," citing negative scrip trends.Â BusinessWeek called the Vytorin flap an object lesson in the dangers of over-aggressive drug marketing, saying that promos got way ahead of scientific proof. And a New York Times editorial castigated Merck and Schering for flogging Vytorin and Zetia even though they had "slim supporting data."
ALSO: One side of an email conversation doesn't tell the whole story--so Schering-Plough released the entire exchange of messages between a visibly irate lead investigator John Kasteltein and various Schering officials. Whether the other side will help Schering's case is unclear; one email from a Schering VP and joint venture manager said, "The bottom line however is we all aspire to have quality and credible data, and results that we can stand behind--whatever the 'truth.' "Â ReportÂ | Emails
Congress: M/S-P sat on bad news. Report
ACC panel unleashes Vytorin whirlwind. Report
Companies saw Vytorin threat in 2005. Report
Congress: Were Enhance results secret? Report
Congress promises Vytorin hearings. Report
Merck, Schering defend embattled Vytorin. Report
Merck, Schering's Vytorin fails trial. Report