Lipitor just got shot down by a healthcare plan. As The Wall Street Journal reports, WellPoint ($WLP) is planning to stop covering Pfizer's ($PFE) brand-name cholesterol drug April 1, favoring its generic rivals instead. The change applies to millions of its members in 12 of the 14 states it serves; in the other two states, WellPoint members can have access to branded Lipitor, but only if they try a generic first.
It's the latest blow to Pfizer's aggressive Lipitor battle plan. The company decided not to take immediate generic erosion as a given, and made several moves designed to keep Lipitor patients on the brand-name version. The company not only offered discount cards to blunt the effects of higher co-pays on branded drugs, but negotiated cut-rate deals with pharmacy-benefits managers and set up an arrangement to sell Lipitor by mail order through a specialty pharmacy.
The cholesterol pill fell off patent Nov. 30, and Pfizer's aim was to keep up to 40% of market share, at least until multiple generic rivals hit the market in May. The brand held its own in the high thirties for several weeks in December, but its share appears to have fallen to around 34% since then. Still, as the WSJ points out, that's a bigger share than many other big-selling drugs have commanded after losing their exclusive hold on the market.
In WellPoint's case, it appears as if Pfizer's co-pay discount card worked against the branded drug. The company offers Lipitor patients a card that sets their co-pays at $4 per month, with Pfizer paying the rest. So, if Lipitor sat on a higher-priced tier than its generic counterparts, that would make no difference to a patient's out-of-pocket cost. Good for patients who want to stay on Lipitor, but not so good for insurers trying to control costs, WellPoint said.
That's not to say that Pfizer's efforts are doomed. As the WSJ reports, UnitedHealth continues to offer co-pays on Lipitor that favor the brand over the generic versions. "In this environment, health plans and [benefit managers] will act in the best interest of their business, and as such, will determine how to cover Lipitor within their pharmacy benefits structure," Pfizer spokesman MacKay Jimeson told the Journal.
- read the WSJ piece
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