The answer may not be known for weeks, even months, but already one big insurer is pulling back and two big pharmacy benefits managers will review their reimbursement policies. In other words, the money machine that was Vytorin may be on the verge of unraveling.

For instance, Cigna will no longer recommend Vytorin as an alternative for patients who currently use higher-priced cholesterol drugs that aren’t covered. “That particular step therapy is being suspended,” a Cigna spokeswoman tells The Star-Ledger of New Jersey. The insurer’s pharmacy and therapeutics committee will decide later about any further changes.

And UnitedHealth will also conduct a review. “As of now we aren’t making any changes but we’ll clearly review the evidence as it’s made available to us,” a spokeswoman tells Dow Jones. Meanwhile, Medco Health Solutions will look at Vytorin and Zetia (which along with Zocor comprises Vytorin) later this month, a spokeswoman tells the newspaper. Such reactions explain why Schering-Plough and Merck are scrambling to chat up insurers and PBMs.

A key turning point will occur in the next few months when the American College of Cardiology issues new guidelines for docs on which patients should be given Vytorin and Zetia. At the group’s annual meeting, ACC chief executive Jack Lewin noted it will be at least four years before results looking at whether Vytorin and Zetia cut the number of heart attacks and strokes will be available, and docs need advice in the interim, Dow Jones notes.