On Wednesday November 30, a generic version of Lipitor the popular cholesterol lowering drug becomes available. This will substantially lower the cost of taking this drug.
It also means that many health plans will require patients to switch to the generic version of the drug or pay a considerably higher co-payment. Some plans may allow a transition period and the manufacturer of Lipitor is offering a co-pay deal.
If you are taking Lipitor, now is the time to check with your doctor and your health plan or pharmacy benefit manager (PBM) about the new generic version. This is true for Medicare beneficiaries as well.
For the next six months due to the Pfizer rebate structure, Lipitor will be less expensive than the generic. PBMs normally steer folks to generics but this case will be the exception. Many PBMs have such a pricing arrangement with Pfizer. So where does that leave the patient? The PBM may save money via the Pfizer rebate, but will the patient pay the brand co-pay or generic co-pay? And what about plan provisions that require the use of a generic when available? During this six month period using a generic may save the patient money, but cost the plan more. Best to check with your plan, your employer or your PBM.
For example, from Businessweek:
UnitedHealthcare has 9.5 million individuals, according to the company. After Nov. 30, the insurer’s customer will pay about $30 to $35 for brand-name Lipitor, compared with $50 to $60 for the generic, Mason (a UHC spokeman) said.
After six months, the co-pay on the copycats will drop to about $15 as more generic competitors begin selling the pills, said Lynne High, a UnitedHealth spokeswoman. The co-pay for Lipitor at that point will depend on Pfizer’s pricing, she said.
Such a change in co-pays may not be so easy in employer plans with fixed co-pays for brand and generic drugs and requirements that a generic be used when available.
The generic version will look different, some inactive ingredients may be different, but the chemical make up is the same as the brand version.
In some states, such as New Jersey, unless the doctors checks otherwise on the prescription order, the pharmacy will dispense a generic when available.
In an effort to keep you using Lipitor, you can receive a one month prescription for $4.00 even if you have private coverage paying a portion of the cost (but not Medicare or Medicaid).
Here is the link to Lipitor For You
- Pfizer Cuts Deal with PBMs to Continue to Profit from Lipitor (labsoftnews.typepad.com)
- UnitedHealth Chooses Pfizer’s Lipitor Over Generic Versions (businessweek.com)
- New Lipitor generics: What you need to know (cbsnews.com)
Tags: Atorvastatin, Lipitor, Lipitor co-payment, Lipitor for you, PBM, Pfizer