 PhysicianForum --
May 2006
 In This Issue...
In 2005, sales of HMG-CoA reductase inhibitors (or
"statins") generated $12.8 billion in sales. Use of these antidyslipidemic
agents is supported by a robust body of clinical research demonstrating their
ability to reduce morbidity and mortality. The statin class is dominated by
Pfizer’s Lipitor (atorvastatin), which generated U.S. sales of $7.4 billion in
2005. Several factors have driven Lipitor’s success: Lipitor was the first
statin to be markedly more effective in reducing low-density lipoprotein (LDL)
than other agents in the same class; in addition, it has been promoted in the
United States for nearly a decade by Pfizer’s enormous sales force and
marketing resources. More recently, an even more potent statin, AstraZeneca’s
Crestor (rosuvastatin), was launched. Crestor’s sales gains have been slower
than first expected, largely due to concerns about a rare but potentially
lethal side effect (rhabdomyolysis) and also because Crestor’s greater potency
was not targeted to a clear unmet need--existing agents are effective for most
patients.
The high prevalence of dyslipidemia in the United States and
high levels of lipid screening have led to very wide use of statins and, more
recently, use of single-pill combinations of statins with other antidyslipidemic
agents. In 2006, this market will undergo major upheaval when two formerly
leading statins, Bristol-Myers Squibb’s Pravachol (pravastatin) and Merck’s
Zocor (simvastatin), lose market exclusivity. Still widely prescribed, these
agents are the first generic statins viewed as legitimate alternatives to Lipitor
and Crestor.
Decision Resources’ Physician Forum survey entitled "Changing
Dynamics in the Dyslipidemia Market: The Intrusion of Major Generic Statins"
explores the current treatment of dyslipidemia, and examines the
effect that the advent of major generic statin competition will have on future
prescribing patterns and reimbursement policies. We surveyed 70
primary care physicians, 72 cardiologists and 20 HMO pharmacy directors and
compared their responses to assess similarities and differences. This survey
enabled Decision Resources to:
- Determine the magnitude of the impact of generic statins
on the first- and second-line usage of branded statins and single pill
combinations.
- Uncover alignments and dis-alignments in the
attitudes and behaviors of clinicians versus HMO directors in factors that will
influence the use of specific statins.
- Determine the secondary effects that patent expiry will
have on prescribing behaviour, for example by gauging clinicians' impression of
the role that the high cost of statins has on patient compliance.
- Describe the effect that Medicare reforms (including
payment for lipid screening beginning in 2005 and the introduction of drug
coverage in 2006) are having on the level of screening and price dynamics in
the statin market.
- Analyze the current and future tier assignments of
various antidyslipidemic agents, including the level of copayments associated
with each tier, and the expectation of HMO PDs concerning generic substitution
and therapeutic interchange.
- Compare various stepped-care approaches that HMOs expect
to introduce following the availability of generic statins, and explore how
patient level of risk will impact clinicians’ plans to switch patients to generics.
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