Insurers Should be the First Line of Defense Against Vytorin

Implications: The pharmaceutical industry continues to lay its collective head on the chopping block by pushing drugs like Vytorin that demonstrate at best marginal activity. Insurers have a fiduciary duty to push back against the poor judgement of drugmakers who take advantage of confusion and DTC advertising to make money.

Analysis: I earn my living as a member of the pharmaceutical industry and am proud of the many lifesaving and life-enhancing products that we've produced. However, I am quite dismayed at the number of questionable products that continue to be touted via DTC advertising. The latest, and possibly most egregious example is Vytorin. At best, it's a mediocre competitor to the statins, with less experience available regarding safety. Of course, if it turns out to be true that Vytorin confers less benefit than say, Lipitor, then patients taking Vytorin are depriving themselves of the potential benefit of the proven statin drug.

Merck and Schering continue to take out full page ads in city newspapers that imply that Vytorin should be considered when trying to lower LDL and prevent cardiovascular events. Insurers will, in many cases, pay for this more expensive therapy as patients ask their doctors for Vytorin. Of course, another option is to refuse to pay for the more expensive treatment. While unpopular with patients, it will save them money on premiums in the longer term. It will also serve notice to drugmakers that just because a treatment is approved, that doesn't mean that it will be covered if it doesn't demonstrate a meaningful improvement over existing (and presumably cheaper) therapies.

A paradigm shift? Yes and no. European countries have pushed back forcefully against paying more for what they deem to be equivalent therapies. Witness Pfizer's situation in Germany and England. Germany set much lower prices on many drugs, including statins, and under free trade policy within the EU, distributors could export cheaper German drugs to England. Pfizer basically shut off shipments to Germany to preserve sales in England at the higher price. The US Government might step in via Medicare after the general election in November, but it wouldn't hurt for private sector insurers to take the first big step for mankind.