With Plavix gone generic, payers aim to cut Effient, Brilinta

Look out, Brilinta and Effient. Payers are targeting your patients. Now that rival bloodthinner Plavix is off patent, health plans will be fielding new programs to encourage switching to the cheaper generic. Worries about the one-third of patients known to respond poorly to Plavix nothwithstanding.

As The Wall Street Journal reports, Eli Lilly's ($LLY) Effient and AstraZeneca's ($AZN) Brilinta boast much smaller shares of the bloodthinner market than Plavix does. The companies have marketed these drugs as alternatives to Plavix, particularly for patients who have the genetic variation thought to dampen Plavix response.

Neither Effient nor Brilinta appear to be affected by the genetic quirk. But they are far more expensive now that Plavix copies are on the market. Generic versions are expected to cost about $1 a day at first, compared with $7.68 per day for Brilinta and $6.38 for Effient. Brand-name Plavix runs $6.44 per day, the WSJ says.

"We have switching programs to help get patients to the lowest cost agent," Express Scripts CMO Steve Miller told the WSJ. And some new research suggests that moving patients to Plavix from Effient may not make a difference in outcomes. In one study, screening patients for the genetic variant, then switching the patients at risk for poor Plavix response to Effient, didn't affect the number of heart attacks. (The patients studied were stable, however, so the results may not apply to higher-risk patients.)

Others say caution is still in order. Doctors at Brigham and Women's Hospital in Boston are making Brilinta their preferred drug, WSJ says. A Long Island cardiologist uses Effient for most patients to avoid the Plavix-response risk, turning to Brilinta for higher-risk patients. Now that Plavix has gone generic, he's using a daignostic test that measures Plavix response, expecting payers to demand backup for his prescribing the more expensive drugs.

- read the WSJ piece