March 2008
Cholesterol drugs
Lipitor battles generics
"Did you know there's no generic form of Lipitor?" asks an online advertisement for the cholesterol-lowering drug. Lipitor
(atorvastatin) is the world's top-selling prescription drug. The Web ad is part of a campaign that also includes TV and radio
spots, all featuring Robert Jarvik, M.D., as spokesman. Jarvik is renowned for inventing the Jarvik artificial heart, first
used in 1982. The ads seem designed to convince consumers that Lipitor is a better choice than less expensive generic options.
Lipitor is one of a class of cholesterol-lowering drugs known as statins. Of six existing statins, three--lovastatin, pravastatin, and simvastatin--are now available as generics. About 20 million Americans take a statin.
It's true that atorvastatin is a highly effective drug, and for a select group of high-risk patients, it remains a good choice. But the vast majority of people who need to take a statin can get the same protection from the less expensive generic options, and for less than half the cost. The Lipitor ad also contributes to general misconceptions about generics.
New ad, old battle
Simply, a generic drug is a chemical twin of a brand-name drug whose patent has expired. To get approval from the Food and Drug Administration, a generic must contain the same active ingredient as the brand-name version, though it can have different inactive ingredients, such as color or flavoring agents. The manufacturer also has to show that the generic drug is bioequivalent by demonstrating, among other things, that the active ingredient enters and leaves the bloodstream as rapidly and completely as its brand-named drug. Generic drugs that do this should have the same therapeutic effect. Each year, consumers save as much as $10 billion at retail pharmacies by buying generics.
Pharmaceutical companies have long tried to discourage consumers from buying generics by implying that they are of lesser quality. Even when ads don't mention generics, "they serve to reinforce the trade names for drugs, so that people develop an affinity for a certain brand name," says Gerald McEvoy, assistant vice president for drug information of the American Society of Health System Pharmacists.
Lipitor has much to gain from implanting that brand loyalty now. The patent on the active ingredient in Lipitor, atorvastatin calcium, will expire in 2010, opening the market to competitors who are expected to offer the drug as a generic at a lower price. That could cause a loss in market share for Pfizer, Lipitor's manufacturer. In 2006, when generic simvastatin became available, sales of Zocor, Lipitor's chief competitor, plummeted 30 percent as doctors switched patients to the generic.
Strong messages
Our own research suggests the messages in drug ads still resonate, even as the use of generics rises. Generics now account for just over 60 percent of all prescriptions filled. When Consumer Reports in December 2007 showed a television ad for Lipitor to 978 people who had been advised by a doctor to lower their cholesterol, we found the following:
What you can do
If you need to lower your cholesterol, and you and your doctor have determined that you need a statin, our medical experts recommend the following:
In addition, lifestyle changes that can help lower cholesterol include avoiding trans fats and partially hydrogenated oils, eating more fiber, limiting dietary cholesterol, and aiming for two servings a week of fish high in omega-3 fatty acids.
Lipitor is one of a class of cholesterol-lowering drugs known as statins. Of six existing statins, three--lovastatin, pravastatin, and simvastatin--are now available as generics. About 20 million Americans take a statin.
It's true that atorvastatin is a highly effective drug, and for a select group of high-risk patients, it remains a good choice. But the vast majority of people who need to take a statin can get the same protection from the less expensive generic options, and for less than half the cost. The Lipitor ad also contributes to general misconceptions about generics.
New ad, old battle
Simply, a generic drug is a chemical twin of a brand-name drug whose patent has expired. To get approval from the Food and Drug Administration, a generic must contain the same active ingredient as the brand-name version, though it can have different inactive ingredients, such as color or flavoring agents. The manufacturer also has to show that the generic drug is bioequivalent by demonstrating, among other things, that the active ingredient enters and leaves the bloodstream as rapidly and completely as its brand-named drug. Generic drugs that do this should have the same therapeutic effect. Each year, consumers save as much as $10 billion at retail pharmacies by buying generics.
Pharmaceutical companies have long tried to discourage consumers from buying generics by implying that they are of lesser quality. Even when ads don't mention generics, "they serve to reinforce the trade names for drugs, so that people develop an affinity for a certain brand name," says Gerald McEvoy, assistant vice president for drug information of the American Society of Health System Pharmacists.
Lipitor has much to gain from implanting that brand loyalty now. The patent on the active ingredient in Lipitor, atorvastatin calcium, will expire in 2010, opening the market to competitors who are expected to offer the drug as a generic at a lower price. That could cause a loss in market share for Pfizer, Lipitor's manufacturer. In 2006, when generic simvastatin became available, sales of Zocor, Lipitor's chief competitor, plummeted 30 percent as doctors switched patients to the generic.
Strong messages
Our own research suggests the messages in drug ads still resonate, even as the use of generics rises. Generics now account for just over 60 percent of all prescriptions filled. When Consumer Reports in December 2007 showed a television ad for Lipitor to 978 people who had been advised by a doctor to lower their cholesterol, we found the following:
- Forty-one percent said the ad conveyed that Lipitor is better than the generics.
- Sixty-five percent said the ad conveyed that leading doctors prefer Lipitor.
- More than two-thirds (67 percent) of respondents taking Lipitor said they were inclined to stay with it after seeing the ad.
- Forty-eight percent said Jarvik's endorsement made them more confident about Lipitor. A Jarvik Heart representative declined
our request to interview Jarvik about the ad.
What you can do
If you need to lower your cholesterol, and you and your doctor have determined that you need a statin, our medical experts recommend the following:
- Ask a doctor about generic lovastatin or pravastatin if you need to lower LDL (bad) cholesterol by less than 30 percent.
- Consider generic simvastatin if you need 30 percent or greater LDL reduction or have heart disease or diabetes, or if you
have had a heart attack or have acute coronary syndrome and your LDL level is not high.
- Ask about atorvastatin (Lipitor) if you have had a heart attack or have acute coronary syndrome or your LDL is high.
In addition, lifestyle changes that can help lower cholesterol include avoiding trans fats and partially hydrogenated oils, eating more fiber, limiting dietary cholesterol, and aiming for two servings a week of fish high in omega-3 fatty acids.
