Dear Doctor: A Union Shills For Pfizer And Lipitor
7 CommentsBy Ed Silverman // March 24th, 2008 // 9:18 am
File this under creative marketing. A union that represents about 50,000 emergency medical technicians and paramedics recently mailed a letter to its “approved physician network” endorsing the use of Pfizer’s Lipitor cholesterol pill. The letter isn’t dated, but does a carry a Pfizer trademark for 2007.
“When appropriate, we ask that you please consider an agent like Lipitor for our members with high cholesterol or without clinically evidence CHD,” or coronary heart disease, read the letter, which was signed by Matthew Levy of the IAEP, or International Association of EMTs and Paramedics. “IAEP leadership stands behind Lipitor as the lipid-lowering agent of choice when it is prescribed by a physician. This confidence in Lipitor is based on its proven efficacy and is supported by its vast clinical experience of more than 15 years.” This is the letter.
One doctor who recently received the letter - and shared it with us - says the effort raises questions about the union’s motives and qualifications to involve itself in medical decisions. “I’ve never had an experience where a union says one drug is better than another,” Alicia Fernandez, an associate professor of clinical medicine at UCSF/San Francisco General Hospital, tells Pharmalot. “I don’t think unions necessarily have the medical expertise to make such a suggestion. And I think it’s unusual for a union to appear to be working on behalf of a particular drug.”
We left messages for Levy, but he hasn’t responded. An IAEP spokeswoman tells us that “a division head sent it out without prior approval of the national president. It was inappropriate. It was not approved and a policy was put in place to ensure it never happens again. A division head sent it out without prior approval of the national president. We don’t endorse any particular drug.”
But why was the letter sent out in the first place? And was any further action taken? She wouldn’t say. She did say that IAEP members obtain their prescription-drug coverage through their local employers. But she declined to comment on whether there was any arrangement - financial or otherwise - between the IAEP and Pfizer. She also described Levy as a division head, although he’s generally referred to as a national organizer on the IAEP web site and works out of the union’s Quincy, Massachusetts, headquarters.
It appears, however, that IAEP may have instituted its new policy in response to questions. This episode was first reported late last week by the Health Beat Blog last week and Fernandez received the letter earlier this month, suggesting the letter may have been mailed to an untold number of doctors for several weeks. Of course, this is a plus for Pfizer, which needs to generate as much revenue as possible from Lipitor, a best-selling pill that is under pressure. We have written a Pfizer spokesman and will update you with any reply.
Jack2
It’s a plus for Pfizer and the patients.
Lipitor is the best. It’s proven to lower cholesterol more than other statins that went generic. The same generics that insurance companies will pay doctors to switch pts from Lipitor to.
…and no I don’t work for Pfizer. Maybe I’m just buying the hype, but I think Lipitor’s the greatest recent achievement of the pharmaceutical industry, and I think Pfizer deserves to make a bundle off of Lipitor.
Justice in Michigan
40 mg. starting dose? How typical is that? (Anyone have the actual numbers re: proportion of Lipitor rx’s at that level?)
Atlex
JiM,
As the letter states, the 40mg starting dose is appropriate for patients who need an LDL-C reduction of >45%. That would be a minority of the patients with high LDL.
My guess that there are two purposes to this letter: 1)assuming that Lipitor is the preferred branded agent on the formulary, this letter would lead more physicians to prescribe Lipitor instead of Crestor or Vytorin; 2) Since simvastatin is not as potent as Lipitor, this letter will subtedly remind prescribers that patients who need >45% LDL reduction probably won’t benefit from simva but will benefit from Lipitor. In the first instance, Lipitor may cost the union less than the branded alternatives due to a contract. In the second case, the union may believe that Lipitor’s ability to impact very high LDL as opposed to simva, makes it a better value for the targeted segment of patients.
Health plans (as opposed to unions) send these type letters out all of the time when they are at risk.
Atlex
M Helm, MD
Jack2, you may be buying the hype. No question atorvastatin is a good drug, but it is hard to argue that aside from being half as potent, simvastatin does not have the same advantages.
A 40mg “starting” dose is very high. Some of the data I had laying around showed that more than 80% received 10mg or 20mg atorvastatin prior to simvastatin being selected as the preferred agent.
It is unlikely that the union can get atorvastatin for less than simvastatin. More likely some “rebate” money is involved.
Pfizer has developed some good outcomes data on the 80mg dose, but hardly anyone prescribes it. I don’t know if there just aren’t that many people whose physicians feel they need >50% reduction, or if there is just healthy caution about playing at the higher end of the dose range of a potent statin. On a certain level, the research focus on 80mg atorvastatin seems to imply that Pfizer knows they can’t really compete with simvastatin 20mg or 40mg for the former 10mg and 20mg atorvastatin patients.
The only thing certain: the letter was NOT a public service announcement.
Bingo
Here is some approximate market share data for Lipitor doses
10mg:42%
20mg:35%
40mg:18%
80mg: 5%
Make of that what you will…
Justice in Michigan
Many thanks to all for providing info and reflections. This is beside the point, but I had a _60%_ reduction in LDL on 2.5 mg! Obviously, the folks behind all of this don’t want anyone to “miss out.”
Atlex
JiM,
Call me skeptical, but are you sure it was a 2.5mg dose? Were you really taking just 1/4 of a 10mg pill? Must of been a hell of an effort to split the pills!
M Helm,
I think you miss the point regarding price. Lipitor, even with a rebate or discount, is unlikely to approach the price of simvastatin. However, for patients needing reduction of LDL >45%, a level that simvastin rarely achieves without a significant increase in side effects, Lipitor, if contracted for by the union’s PBM, might be a lower cost alternative to Crestor and Vytorin.
Atlex