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The cost of prescription medicines used by millions of people every
day is about to plummet.
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The next 14 months will bring generic versions of seven of the
world’s 20 best-selling drugs, including the top two: cholesterol
fighter Lipitor and blood thinner Plavix.
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The magnitude of this wave of expiring drugs patents is
unprecedented. Between now and 2016, blockbusters with about $255
billion in global annual sales are set to go off patent, notes
EvaluatePharma Ltd., a London research firm. Generic competition
will decimate sales of the brand-name drugs and slash the cost to
patients and companies that provide health benefits.
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Top drugs getting generic competition by September 2012 are taken
by millions every day: Lipitor alone is taken by about 4.3 million
Americans and Plavix by 1.4 million. Generic versions of
big-selling drugs for blood pressure, asthma, diabetes, depression,
high triglycerides, HIV and bipolar disorder also are coming by
then.
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The flood of generics will continue for the next decade or so, as
about 120 brand-name prescription drugs lose market exclusivity,
according to prescription benefit manager Medco Health Solutions
Inc.
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“My estimation is at least 15 percent of the population is
currently using one of the drugs whose patents will expire in 2011
or 2012,” says Joel Owerbach, chief pharmacy officer for Excellus
Blue Cross Blue Shield, which serves most of upstate New
York.
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Those patients, along with businesses and taxpayers who help pay
for prescription drugs through corporate and government
prescription plans, collectively will save a small fortune. That’s
because generic drugs typically cost 20 percent to 80 percent less
than the brand names.
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Doctors hope the lower prices will significantly reduce the number
of people jeopardizing their health because they can’t afford
medicines they need.
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Dr. Nieca Goldberg, director of The Women’s Heart Program at NYU
Langone Medical Center in Manhattan, worries about patients who are
skipping checkups and halving pills to pare costs.
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“You can pretty much tell by the numbers when I check the patient’s
blood pressure or cholesterol levels,” that they’ve not taken their
medications as often as prescribed, she says.
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Even people with private insurance or Medicare aren’t filling all
their prescriptions, studies show, particularly for cancer drugs
with copays of hundreds of dollars or more.
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The new generics will slice copayments of those with insurance. For
the uninsured, who have been paying full price, the savings will be
much bigger.
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Daly Powers, 25, an uninsured student who works two part-time jobs
at low wages, says he often can’t afford the $220 a month for his
depression and attention deficit disorder pills. He couldn’t buy
either drug in June and says he’s struggling with his Spanish class
and his emotions. He looks forward to his antidepressant, Lexapro,
going generic early next year.
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“It’d make all the difference in the world,” says Powers, of Bryan,
Texas.
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Generic medicines are chemically equivalent to the original
brand-name drugs and work just as well for nearly all
patients.
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When a drug loses patent protection, often only one generic version
is on sale for the first six months, so the price falls a little
bit initially. Then, several other generic makers typically jump
in, driving prices down dramatically.
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Last year, the average generic prescription cost $72, versus $198
for the average brand-name drug, according to consulting firm
Wolters Kluwer Pharma Solutions. Those figures average all
prescriptions, from short-term to 90-day ones.
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Average copayments last year were $6 for generics, compared with
$24 for brand-name drugs given preferred status by an insurer and
$35 for nonpreferred brands, according to IMS Health.
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Among the drugs that recently went off patent, Protonix, for severe
heartburn, now costs just $16 a month for the generic, versus about
$170 for the brand name. And of the top sellers that soon will have
competition, Lipitor retails for about $150 a month, Plavix costs
almost $200 a month and blood pressure drug Diovan costs about $125
a month. For those with drug coverage, their out-of-pocket costs
for each of those drugs could drop below $10 a month.
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Jo Kelly, a retired social worker in Conklin, Mich., and her
husband Ray, a retired railroad mechanic, each take Lipitor and two
other brand-name medicines, plus some generic drugs. Both are 67,
and they land in the Medicare prescription “doughnut hole,” which
means they must pay their drugs’ full cost, by late summer or early
fall each year. That pushes their monthly cost for Lipitor to about
$95 each, and their combined monthly prescription cost to nearly
$1,100.
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Generic Lipitor should hit pharmacies Nov. 30 and cost them around
$10 each a month.
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“It would be a tremendous help for us financially,” she says. “It
would allow us to start going out to eat again.”
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For people with no prescription coverage, the coming savings on
some drugs could be much bigger. Many discount retailers and
grocery chains sell the most popular generics for $5 a month or
less to draw in shoppers.
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The impact of the coming wave of generics will be widespread – and
swift.
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Insurers use systems that make sure patients are switched to a
generic the first day it’s available. Many health plans require
newly diagnosed patients to start out on generic medicines. And
unless the doctor writes “brand only” on a prescription, if there’s
a generic available, that’s almost always what the pharmacist
dispenses.
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“A blockbuster drug that goes off patent will lose 90 percent of
its revenue within 24 months. I’ve seen it happen in 12 months,”
says Ben Weintraub, a research director at Wolters Kluwer Pharma
Solutions.
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The looming revenue drop is changing the economics of the
industry.
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In the 1990s, big pharmaceutical companies were wildly successful
at creating pills that millions of people take every day for common
conditions, from heart disease and diabetes to osteoporosis and
chronic pain. Double-digit quarterly profit increases became the
norm.
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But the patents on those blockbusters, which were filed years
before the drugs went on sale, last for 20 years at most, and many
expire soon.
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In recent years, many drug companies have struggled to develop new
blockbuster drugs, despite multibillion-dollar research budgets and
more partnerships with scientists at universities and biotech
companies. The dearth of successes, partly because the “easy”
treatments have already been found, has turned the short-term
prognosis for “big pharma” anemic.
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“The profit dollars that companies used to reinvest in innovation
are no longer going to be coming,” warns Terry Hisey, life sciences
leader at consultant Deloitte LLP’s pharmaceutical consulting
business. He says that raises “long-term concerns about the
industry’s ability to bring new medicines to market.”
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But pharmaceutical companies can save billions when they stop
promoting drugs that have new generic rivals, and U.S. drug and
biotech companies are still spending more than $65 billion a year
on R&D.
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The 20 new drug approvals in the U.S. this year, and other
important ones expected in the next few years, eventually will help
fill the revenue hole.
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For now, brand-name drugmakers are scrambling to adjust for the
billions in revenue that will soon be lost. Many raise prices 20
percent or more over the last couple years before generics hit to
maximize revenue. Some contract with generic drugmakers for
“authorized generics,” which give the brand-name company a portion
of the generic sales.
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Brand-name companies also are trimming research budgets, partnering
with other companies to share drug development costs and shifting
more manufacturing and patient testing to low-cost
countries.
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Pharmaceutical companies have cut about 10 percent of U.S. jobs in
four years, from a peak of about 297,000 to about 268,000,
according to Labor Department data. Nearly two-thirds of the cuts
came in the last 1 1/2 years, partly because of big mergers that
were driven by the need to shore up pipelines and boost profit in
the short term by slashing overlap.
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Drug companies also are trying to stabilize future sales by putting
more sales reps in emerging markets such as China and India, and
diversifying into businesses that get little or no generic
competition. Those include vaccines, diagnostic tests, veterinary
medicines and consumer health products.
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As the proportion of prescriptions filled with generic drugs jumped
to 78 percent in 2010, from 57 percent in 2004, annual increases in
prescription drug spending slowed, to just 4 percent in 2010.
According to the Generic Pharmaceutical Association, generics saved
the U.S. health care system more than $824 billion from 2000
through 2009, and now save about $1 billion every three
days.
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The savings are only going to get greater as our overweight
population ages. People who take their medicines regularly often
avoid costly complications and hospitalizations, says AARP’s policy
chief, John Rother, bringing the system even bigger savings than
the cheaper drugs.
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In addition, many patients taking a particular brand-name drug will
defect when a slightly older rival in the same class goes
generic.
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Global sales of Lipitor peaked at $12.9 billion in 2006, the year
Zocor, an older drug in the statin class that reduces bad
cholesterol, went generic. Lipitor sales then declined slowly but
steadily to about $10.7 billion last year. That still makes Lipitor
the biggest drug to go generic.
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For patients, it’s a godsend.
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Douglas Torok, 59, of Erie, Pa., now spends nearly $290 every three
months for insulin for his Type 2 diabetes, plus four daily pills,
including Lipitor, Plavix and two generics, for his blood pressure
and cholesterol problems. The $40,000-a-year foundry supervisor
fears not being able to cover the out-of-pocket costs when he
retires and doesn’t have a generous prescription plan.
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In the meantime, once Lipitor and Plavix get generic competition
his copayment will plunge from the current $1 per day for
each.
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“I will pay $16 for 90 days” for both, says Torok, who hopes to
travel more. “It’s a big deal for me on my income.”
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—
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Brand-name drugs going off patent through 2015:“text-decoration: none; color: #000066;” href=
“http://www.medcohealth.com/art/corporate/anticipatedfirsttime-generics.pdf”
target=
“-blank”>http://www.medcohealth.com/art/corporate/anticipatedfirsttime-generics.pdf
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Brand-name and generic drug price comparisons:“text-decoration: none; color: #000066;” href=
“https://www.flrx.com/calculator/generic/advanced-calculator.html”
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