Lipitor sales are big news these days–in case you weren’t aware of it, the blockbuster Pfizer cholesterol drug went off patent Dec. 1, making way for a generic drug. But many drugstores were asked to keep fulfilling prescriptions with the more expensive Lipitor by companies like Medco Health Solutions, one of the nation’s largest drug benefit managers.
The reason? The New York Times has reported that Pfizer has agreed to big discounts to benefit managers that steer patients toward the more expensive brand name, according to a letter from Catalyst Rx, a benefit manager that’s a smaller competitor of the giant Medco.
The result: Pfizer and the benefit managers, who work as middlemen between the companies that make the drugs and the ultimate payers (both insurance companies and employers) make more money. Patients, employers and taxpayers will pay extra.
In that vein, here’s a coupon that was published in The New Yorker a couple of times this fall. It’s also available on the Lipitor site.
But a friend who used the coupon writes that it wasn’t really a $4 monthly Lipitor prescription after all.
“What does Lipitor (atorvastatin) cost? Well, it depends.
“I have been paying Medco, my Oxford insurance plan’s pharmacy benefits manager, $210 every three months for Lipitor tablets. That price is supposed to drop to a $30 copay after my
family policy’s $5,700 deductible is met. Looking at my records, however, I discovered I was recently charged the full $210 price even though we had met my deductible. Then I noticed my wife was just charged full price for her meds as well. Medco’s customer service rep’s lame explanation was that all they know is the amount of our deductible and how much we’ve spent on Rx purchases, not any other covered expenditures that count toward the deductible. In fact, she said she had no way of knowing if non-pharma expenses even counted toward our deductible. Hmm. I called Oxford, where the rep confirmed that all covered health care expenses counted toward our deductible, that it had indeed been met, and that ‘it appeared’ Medco had overcharged us. Oxford agreed to initiate an audit and said I could expect a refund in about a month. Aargh! I asked how it was that their pharmacy benefits partner would not be informed of where I stood vis-a-vis my deductible. They couldn’t explain that.
“In November Pfizer’s Lipitor’s patent expired, opening the market to generics. Pfizer has been advertising a ‘$4 co-pay card,’ in an effort to get consumers to stay on the branded version of the drug. I called Medco again to find out if I could use the card for my next Lipitor refill in January, when my deductible will have reset. Nope, they do not accept coupons. But, I was told, switch to the chemically identical generic (atorvastin)and the price will be just $58 for a three-month supply. A nice savings over their $210 for Lipitor but still, not $4! I guess, I figured, I’ll just take the card to my local pharmacy.
“But wait, there’s fine print on the $4 card. Among the many other restrictions there is this:
“If your out-of-pocket expenses for a 1-month supply (30 tablets) are $54 or less, you will pay $4 for a 1-month supply. If your out-of-pocket expenses for a 1-month supply (30 tablets) exceed $54, you qualify for up to $50 in savings for a 1-month supply. In either case, you can only qualify for up to $600 of savings per calendar year. After maximum of $600, you will pay usual monthly out-of-pocket costs.
“My ‘out of pocket expense’ for branded Lipitor would increase to about $80 a month at my local drugstore. Even saving $50 a month, I’d still be paying at least $90 for a three-month supply, $32 more than Medco’s price for generic atorvastatin. So I guess I’ll stick with that. Do I need to worry that the generic is not as good in some way as Lipitor? I don’t think so. Not only does the law mandate that it be chemically identical, this particular version, one of three authorized for sale, will be manufactured by – guess who? – Pfizer.”