Some of the nation's most popular prescription drugs are about to get a lot cheaper.
By January, both anti-depressant Zoloft and cholesterol-lowering Zocor will cost pennies a pill. Pharmacists expect sleep aid Ambien and hypertension drug Norvasc to become equally inexpensive in late 2007.
"It's never been a more exciting time for an opportunity to save cost on drugs because so many of the blockbusters are going off-patent," said Dr. Steve Nolan, Rocky Mountain Health Plans' pharmacy director.
Employers, patients and governments could save up to $50 billion in the next four years as popular brand-name drugs lose patent protection and generics sweep in to take their place.
But much will depend on whether doctors and patients embrace the low-cost copycats. As a result, health plans are doing everything they can to push members toward generics.
The same dynamic has allowed Target and Wal-Mart to offer $4 generics: a boom in the number of widely used drugs that are now, or soon will be, off-patent.
The Food and Drug Administration grants the inventor of a drug a period of marketing exclusivity in which companies charge what the market will bear for their medicines. Witness Avastin, a breakthrough drug for colon cancer, which costs $645 a vial.
But when a drug's patent expires after several decades, any drug maker can apply to manufacture it, and usually many do.
Generics, or copycats, are made exactly like the original drug, but the cost comes down dramatically. For patients, generics often go by the drug's chemical name - Zoloft becomes sertraline, Zocor becomes simvastatin.
In the past year, along with Zocor and Zoloft, the antidepressant Wellbutrin, cholesterol-lowering Pravachol and nasal spray Flonase have gone generic.
Employers, governments and patients paid $9.4 billion for these drugs in 2005. Generics can cost 80 percent less than the brand, a potential savings of $7.5 billion on those five drugs alone.
Health plans say that as many as 75 percent of all prescriptions could be filled by generics. But in 2005, just 54.1 percent of Colorado's prescriptions were generic, according to pharmacy benefit manager Express Scripts.
"There is no greater opportunity to protect the affordability of health care than maximizing the utilization of gold standard generic drugs," said Rob Seidman, WellPoint's chief pharmacy officer.
The question is, how?
Most health plans charge members far less for generics, $5 to $15 vs. $40 or more for brand-name drugs.
Rocky Mountain Health Plans' Nolan believes patients see the financial advantage.
Pharmacies most times will replace a brand-name with a generic if one exists, and that conversion, which used to take months, happens in a matter of weeks.
The huge opportunity, he insists, lies in steering doctors toward prescribing generics even when the brand-name drugs that patients are taking don't have a direct equivalent.
Critics say this pushes patients into drugs that don't work as well for them, but health plans, and many academics, insist most drugs in a therapeutic class are interchangeable.
"It's up to the doctor to prescribe Prozac, which has a generic, or Effexor, which doesn't," Nolan said. "In some areas of the country, the doctors aren't really thinking that way. They see a lot of drug reps. You may have a specific physician whose generic percentage is 30 percent."
To get the message across, Rocky Mountain brings doctors to educational drug seminars called PharmaSuitables, plies them with coupons for free generics and in some cases gives away Palm Pilots loaded with generic-drug finding software.
The health plan also has started tying bonuses to the extent to which doctors prescribe generics.
With these tools, Rocky Mountain believes it can move from 66 percent of prescriptions being generic to 70 percent next year.
Kaiser Permanente, which hires its own doctors, has a generic prescription rate of 80 percent.
The integrated health plan banned drug representatives from doctors' offices five years ago. Doctors are educated to go with the "preferred agent" - or generic - first.
And unless there's a medical reason for a brand-name drug, patients pay the cost difference between the off-brand and the brand- name.
"The funny part is, especially Medicare patients, a lot of those patients constantly ask for generics even if there isn't a generic available," said Jiro Ramirez, Kaiser's director of outpatient pharmacies and support services.
"The wary consumer, they understand a lot more than they used to."
Pushing toward generics
. Drugs that went off-patent in the past 12 months
BRAND NAME CHEMICAL NAME USE
Flonase fluticason Nasal spray for allergies
Zithromax azithromycin Antibiotic
Zoloft sertraline Anti-depressant
Zocor simvastatin Lowers cholesterol
Pravachol pravastatin Lowers cholesterol
. Drugs expected to go off-patent in the next 12 months
BRAND NAME CHEMICAL NAME USE
Ambien zolpidem Sleep aid
Norvasc amlodipine Treats high blood pressure
Imitrex sumatriptan Treats migraines
Meridia sibutramine Weight loss
Zyrtec cetrizine Allergies Sources: Generic Pharmaceutical Association, Express Scripts
Prices fall
. Just because a drug loses patent protection doesn't mean it will immediately cost cents to buy. Many drugs retain their patents because of pending litigation. Even if a generic is permitted, the FDA grants the first generic competitor on the market a 180-day window of marketing exclusivity. During that first six months post-patent expiration, the drug usually costs only 20 percent less than the brand. After six months, prices usually drop to 80 percent less than the original. |
