Expanding cholesterol drug market leads to increased health plan costs; get ready for super-statins

Drug Cost Management Report, Nov, 2002

Figure 1. PBM Drug Expenditures
by Therapeutic Category, 3Q2002

Asthma              3.69%
Cholesterol         7.84%
Diabetes            4.80%
Hypertension        7.11%
Migraine            2.04%
NSAIDs/COX-2        5.01%
Psychiatric        12.07%
Allergy/Rhinitis    4.40%
Ulcer               9.43%
Other              43.62%

Source: AIS

Note: Table made from pie chart.

Figure 2. Cholesterol and Hypertension Drugs as
Percentage of Total Drug Expenditures, 2Q2000 to
3Q2002

                     % of Total Drug Expenditures

               2Q2000   3Q2000   4Q2000   1Q2001   2Q2001

Cholesterol     6.53     6.25     6.06     6.21     6.26
Hypertension    7.02     7.74     7.41     6.88     7.22

                 % of Total Drug Expenditures

               3Q2001   4Q2001   1Q2002   2Q2002

Cholesterol     6.71     7.30     7.52     7.70
Hypertension    7.28     7.41     7.30     7.22

Note: Table made from line graph.

Figure 3. Sales Performance of Oral
Statins, 2000 and 2001

Oral Statins             Manufacturer     2001 Sales      2000 Sales

Lipitor (atorvastatin    Pfizer          $6.4 billion   $4.15 billion
  calcium)
Pravachol (pravastatin   Bristol-Myers   $2.2 billion   $1.89 billion
  sodium)                  Squibb
Zocor (simvastatin)      Merck           $5.3 billion   $2.79 billion

Figure 4. Status of Statins on Selected MCO Formularies

                            National
                               Total   Contracted/
MCO                       Enrollment   Affiliated PBM

Aetna Incorporated        15,225,000   Aetna U.S. Healthcare
                                       Pharmacy
                                       Management

Anthem Blue Cross          8,200,000   Anthem Prescription
and Blue Shield                        Management, LLC

Blue Cross Blue Shield     2,461,265   Medco Health
of Florida                             Solutions

Blue Cross Blue Shield     2,013,674   WellPoint Pharmacy
of Georgia                             Management

Blue Cross Blue Shield     3,000,000   AdvancePCS
of Illinois

Blue Cross Blue Shield     2,397,284   Express Scripts
of Massachusetts

Blue Cross Blue Shield     4,119,419   Medco Health
of Michigan                            Solutions

Blue Cross Blue Shield     1,649,114   Medco Health
of North Carolina                      Solutions

Blue Cross Blue Shield     2,800,000   AdvancePCS
of Texas

Blue Cross Blue Shield       493,143   WellPoint Pharmacy
United of Wisconsin                    Management

Blue Cross of              6,671,630   WellPoint Pharmacy
California                             Management

Blue Shield of             2,300,000   Express Scripts
California

CareFirst BCBS             3,200,000   AdvancePCS

CIGNA HealthCare          14,300,000   CIGNA Pharmacy
                                       Management

Connecticare                 270,067   AdvancePCS

Coventry Health Care       1,805,311   CaremarkRx

Empire Blue Cross          4,523,937   AdvancePCS
Blue Shield

Health Net, Inc.           5,200,000   AdvancePCS

Highmark, Inc.             2,937,330   Medco Health Solutions

HIP Health Plan              754,477   Express Scripts

Horizon Blue Cross         1,091,528   AdvancePCS
Blue Shield of New
Jersey (BCBSNJ)

Humana, Inc.               6,435,517   AdvancePCS

Independence Blue          3,141,872   Medco Health Solutions
Cross

Kaiser Foundation          8,821,446   MedImpact
Health Plan

Lifeguard                    268,776   AdvancePCS

Mid Atlantic Medical       1,900,000   Medco Health Solutions
Services, Inc.

Premera Blue Cross           922,791   Medco Health Solutions

Regence Group, The         2,326,533   NA

Trigon Healthcare, Inc.    2,200,000   NA

Tufts Health Plan            936,449   AdvancePCS

UHP Healthcare               101,326   MedImpact

UnitedHealth Group,       17,100,000   Medco Health
Inc.                                   Solutions

MCO                       Formulary Status of Statins

Aetna Incorporated        Preferred brand drugs are Lescol, Zocor,
                          Lescol XL at middle copay. Lovastatin generic
                          preferred at lowest copay. Lipitor and
                          Pravachol covered at highest copay with
                          formulary alternatives suggested. Quantity
                          limits of 1 tab/day for all formulations of
                          the brand-name products.

Anthem Blue Cross         Lipitor and Pravachol plus generic lovastatin
and Blue Shield           are on formulary. Zocor and Lescol are
                          nonformulary.

Blue Cross Blue Shield    Lipitor, Pravachol, Zocor listed as preferred
of Florida                meds. All generics covered at first-tier
                          copay. Lescol not covered.

Blue Cross Blue Shield    Lipitor on formulary. Lescol, Pravachol,
of Georgia                Zocor, Mevacor nonformulary.

Blue Cross Blue Shield    Lescol/XL, Lipitor and Pravachol on
of Illinois               formulary. Generic lovastatin on formulary.
                          Zocor nonformulary.

Blue Cross Blue Shield    Lescol, Lipitor, Pravachol Tier 2. Zocor is
of Massachusetts          Tier 3 or not covered. Generics covered on
                          Tier 1.

Blue Cross Blue Shield    Preferred brands covered at Tier 2 are
of Michigan               Lipitor, Zocor. Generics covered at Tier 1
                          do not include any statins. Lescol and
                          Pravachol are nonformulary or Tier 3.

Blue Cross Blue Shield    Lipitor and Zocor Tier 2; Pravachol and
of North Carolina         Lescol/XL Tier 3; Mevacor Tier 3/generic
                          lovastatin Tier 1.

Blue Cross Blue Shield    Lipitor ($$$) and Pravachol ($$$) are
of Texas                  preferred. Lescol ($$), Zocor ($$$$) and
                          Mevacor ($$$$) nonpreferred.

Blue Cross Blue Shield    Generic lovastatin Tier 1. Pravachol, Lipitor
United of Wisconsin       Tier 2. Lescol/XL and Zocor are nonformulary
                          or Tier 3.

Blue Cross of             Lescol/XL and Zocor nonformulary with QL.
California                Lipitor, Pravachol and generic lovastatin on
                          formulary with QL.

Blue Shield of            Lescol ($45) preferred for mild/moderate
California                conditions. Lescol XL ($60), Pravachol ($85)
                          and Lipitor ($110) on formulary with quantity
                          limit 1/day. Zocor ($135) nonformulary.
                          Lovastatin on formularyNgeneric only.

CareFirst BCBS            Lescol, Lipitor and Pravachol brands are on
                          Tier 2; Zocor is on Tier 3. Lovastatin is
                          available at Tier 1 for generic or at Tier 3
                          for brand-name Mevacor.

CIGNA HealthCare          Preferred brands are Lescol and Zocor at
                          middle copay. Generic lovastatin covered at
                          lowest copay. Lipitor and Pravachol, as well
                          as brand-name versions of lovastatin, are
                          covered at highest copay as nonpreferred
                          brands.

Connecticare              Pravachol (< $76.55) and Lipitor (< $61.02)
                          Tier 2. Lescol ($84.41) and Zocor ($71.60)
                          Tier 3.

Coventry Health Care      Zocor ($$$) and Lipitor ($$$$) on formulary.
                          Pravachol, Lescol, Mevacor nonformulary.

Empire Blue Cross         Pravachol, Zocor, Lescol/XL and generic
Blue Shield               lovastatin on formulary. Lipitor and
                          brand-name Mevacor nonformulary.

Health Net, Inc.          Lipitor is on recommended drug list.
                          Pravachol and Lescol are on recommended drug
                          with with quantity limits.

Highmark, Inc.            Lipitor ($$$), Pravachol ($$$), and Zocor
                          ($$$) all on formulary. Generic lovastatin
                          ($$) on formulary. Lescol nonformulary.

HIP Health Plan           Lescol/XL, Lipitor, Zocor and generic
                          lovastatin are on formulary. Pravachol is
                          nonformulary.

Horizon Blue Cross        Lipitor, Pravachol, Zocor on formulary.
Blue Shield of New
Jersey (BCBSNJ)

Humana, Inc.              Zocor, Lescol, Advicor Controlled Release
                          preferred brands at Level 2 copay. Lipitor,
                          Pravachol covered at third-tier copay.

Independence Blue         Zocor ($$, $$$) and Lipitor ($$$$) on
Cross                     formulary with maintenance drug status and
                          PAR for under age 15. Dosage adjustment may
                          be required for Zocor after age 65. Lescol,
                          Pravachol are nonformulary. Generic
                          lovastatin on formulary.

Kaiser Foundation         Covered products are Lipitor 80mg, Mevacor
Health Plan               (lovastatin) 10mg, Zocor 40 mg and Zocor
                          80mg.

Lifeguard                 Lescol ($$), Lipitor ($$$) and Pravachol
                          ($$$) on formulary. Mevacor ($$$$) on
                          formulary. Zocor not listed.

Mid Atlantic Medical      Zocor, Lipitor on formulary. Pravachol,
Services, Inc.            Lescol nonformulary.

Premera Blue Cross        Lovastatin Tier 1; Pravachol and Lipitor
                          Tier 2; Lescol and Zocor Tier 3.

Regence Group, The        Lescol, Lipitor on formulary. Pravachol,
                          Zocor are nonformulary.

Trigon Healthcare, Inc.   Lescol, Lipitor and Zocor on formulary Tier
                          2. Generic lovastatin Tier 1. Pravachol not
                          listed.

Tufts Health Plan         Generic lovastatin Tier 1; Lescol/XL,
                          Lipitor, Pravachol Tier 2.

UHP Healthcare            Lipitor on formulary with PAR and QL for 20mg
                          and 40mg dosages. Lescol/XL on formulary with
                          QL all dosages. Pravachol on formulary with
                          QL and PAR. Mevacor on formulary with QL.

UnitedHealth Group,       Brand-name drugs on formulary are: Lipitor
Inc.                      (QL); Zocor (QL); Pravachol (QL). Lovastatin
                          and nystatin are covered at generic level.

Note: Most formularies include other antihyperlipidemic drugs that
are not statins.

Figure 5. Lipitor Preferred on HMO Formularies

                Number of HMO
            Formularies Preferred

Lescol               15
Lipitor              28
Pravachol            19
Zocor                15

Source: AIS

Note: Table made from bar graph.

Figure 6. HMO Formulary Preferences
by Affiliated PBM

                            Number of Formularies Listing
                                   Drug As Preferred

                         Lescol   Lipitor   Pravachol   Zocor

AdvancePCS                 7         8          9         3
Medco Health Solutions     0         8          4         7
Other PBMs                 8        12          6         5

Source: AIS

Note: Table made from bar graph.