Wondering just what managed care and pharmacy benefit managers may be thinking about Vytorin and Zetia? A survey of 71 execs taken during the week immediately following the American College of Cardiology meeting finds that 67 percent felt there would be “no immediate change” to their coverage plans, according to Cognet-X, a healthcare research firm.

The reason? The marketplace will make changes for them. About 84 percent expected prescribing to shift dramatically from Vytorin to generic versions of Zocor, or simvastatin. And roughly 53 percent expect more Crestor scrips to be written, while 38 percent foresee greater Lipitor utilization. But 81 percent said any changes would be made within six months.

Here are some of the findings…

– 18 percent expect a possible tier change (especially to Tier 3, or non-preferred);
– 8 percent foresee the possible addition of step therapy or prior authorization;
– And 5 percent say their P&T committee will evaluate Vytorin.

And here are some remarks…

A PBM pharmacy exec:
•“We have it on formulary and we are unlikely to move it. The results of [ENHANCE] might affect our [step therapy] on Lipitor and Crestor. Currently, [the protocol] requires simva, then Vytorin, prior to Lipitor and Crestor. We likely will remove the step through Vytorin in order to get Lipitor and Crestor. We are also evaluating the need for either Lipitor or Crestor on Tier 2.”

MCO medical execs:
•“Probably no change; will let physicians make decision on use of the medication. Contracts would not allow immediate change to tier.”
•“Unlikely to change our position based upon Enhance. We will leave choices to the treating MD.”
•“Right now there is no change; will discuss it at our next P&T (meeting) in May.”

MCO execs:
•“We are considering doing something to disadvantage (Vytorin) compared to Crestor. We already have Crestor and Vytorin on step therapy.”
•“Will probably be moved from Tier 2 to Tier 3 unless they come back with a tremendous contract change that makes Vytorin the same price as simvastatin.”
•“We are considering moving Vytorin from 2ndto 3rdtier to maximize generic utilization and Lipitor rebates at the same time.”
•“Ever since the initial ENHANCE information came to light the Pfizer regional rep has been hounding us to replace Vytorin with Lipitor. This is a very small study whose endpoint was IMT, not cardiovascular events. We trust our provider network to keepus informed of their thoughts.”

MCO pharmacy execs:
•“ENHANCE only looked at a specific subset of patients (heterozygous familial hypercholesterolemia) and not the general population. I am more concerned about the article published in New England Journal of Medicine 3/30/08 [regarding] use of ezetimibe in the U.S. and Canada, which basically showed increased cost with no clear improvement in outcome.”
•“Wish I didn’t have a Zetia contract.”