LIPITOR IS THE TOP-SELLING DRUG IN THE WORLD, ACCORDING to the Canadian Medical Association, with 9.8 million prescriptions last year in Canada. And at a cost of $1.66 to $2.25 a day, it’s not cheap. In fact, it’s one of the costlier statins: anti-cholesterol drugs that include Zocor, Mevacor and Pravachol.

Despite its higher cost, Lipitor utilization tends to be very high in most benefits plans. Perhaps this need not be the case. A new study published in the April issue of the Canadian Medical Association Journal which examined statins such as Lipitor, Lescol, Zocor, Mevacor and Pravachol, found anti-cholesterol drugs to be virtually indistinguishable from each other. “Each statin had similar effects when compared with atorvastatin(Lipitor)” found the survey of 18,637 Ontario, Quebec and B.C. heart attack patients.

It’s easy to comprehend why statins are being prescribed. According to Statistics Canada, almost 50% of the Canadian population is overweight or obese— and this number is on the rise. Obesity, in turn, is leading to record rates of hypertension, type 2 diabetes and coronary heart disease. It makes sense that drugs that can curb cholesterol-induced diseases are being welcomed by employers who fear losing employees to illness.

“There are so many people for whom the cholesterol reducing drugs are important to their health; the majority of people taking Lipitor should be on the product, or a similar product for good reason,” says Tim Clarke, a senior benefits consultant at Hewitt Associates in Toronto.

Adds Montreal-based Silvie Letendre, senior manager, corporate affairs for Pfizer Canada—the maker of Lipitor—the drug is proven to reduce total cholesterol levels by 29% to 45% and LDL cholesterol(or “bad cholesterol”)levels by 39% to 60%. “Lipitor is unique within the statin class. [It] is supported by the most extensive clinical trial program and realworld experience within the statin class.”

But what is interesting is Lipitor’s largely unbridled use. “Zocor, Prevachol, Mevacor—we’re seeing formularies where those are not included,” says Clarke. “Lipitor, however, is being included in most formularies.” He says many sponsors are hesitant to restrict the higher-cost, newer drugs, believing they are denying their employees best-in-class medications.

What can plan sponsors do to minimize the impact Lipitor has on their drug plans? One line of defence, says Clarke, is to look at formularies which direct patients to lower-cost statins when higher-cost medications are prescribed.

That means that if an employee gets a prescription for Lipitor, they can be given the generic Zocor—or a lower-cost statin—in lieu. He cautions that a more restrictive approach doesn’t mean it’s the right thing to do for all plan sponsors.

Another option is reference pricing, where an insurer covers only the price of a low-cost, benchmark drug in each drug class. Patients who want a highercost medication—like Lipitor—have to pay the difference between that drug and the reference drug.

Most importantly, says Clarke, employers should encourage staff to have less reliance on medication to reduce high cholesterol, and to boost healthy eating and exercise habits as preventive measures. “The investments in wellness programs make more sense when the dollars being spent on the health treatment side get bigger,” he says. “Certainly having communication with employees that deals with specific conditions or just in general to encourage healthy lifestyles—be it diet, exercise, smoking—are in your best interests.”

Certainly, anti-cholesterol medications have their place. But sponsors do have ways in which they can reduce their usage of higher-cost statins. A careful assessment of a drug’s true benefits coupled with a carefully designed formulary and a preventive stance can successfully reduce the drug expenditures of many employers.

Anna Sharratt is managing editor of BENEFITS CANADA.

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Copyright © 2020 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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