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Generics aren't always cheaper.

In the drug update on statins, you listed the cost of generic lovastatin as $6.40 per day, which is significantly higher than every brand name statin included in the list ("Statins for Very-High-Risk Patients," Drug Update, Aug. 1, 2005, p. 44).

Is that correct? If so, is there some explanation why a "generic" version of the oldest and weakest statin costs the most? What's wrong with this picture?

David A. Edwards, M.D.

Reno, Nev.

Editor's reply:

Dr. Edwards is justified to be surprised by the unexpected fact that the generic formulation is substantially more expensive than many trade formulation alternatives; we were surprised, too, but there is no mistake.

The cost information for generic lovastatin is correct. The federal upper limit price for a 40-mg tablet of generic lovastatin, the largest formulation available, is $192.07 for 60 pills, as listed on page 471 in the 2005 Red Book. This computes to $3.20 per pill, and since a patient would need to take two of these pills daily to reach a dosage of 80 mg/day, the cost per day is $6.40, as listed in the Drug Update.

Although lovastatin and its trade version, Mevacor, are labeled to be used to a maximum dosage of 80 mg/day, no manufacturer formulates this drug to be used at that dosage. All generic makers of lovastatin, as well as Merck (which makes Mevacor) sell the 40-mg pill as their highest dose formulation of this drug. This is probably because few physicians would prescribe the drug at 80 mg/day. A patient who needed that high a dosage would likely receive atorvastatin (Lipitor) or another, more potent statin. The need to use two pills a day to reach the 80-mg dose boosts the cost of this drug; several other statin formulations are sold in size formulations that allow single-pill dosing at the maximum approved dosage. Drug Updates often list many possible treatment options, even if some are seldom-used options.

The price is based on the federal upper limit (FUL), which is set by the Centers for Medicare and Medicaid Services as the maximum amount that Medicare will reimburse for a generic drug, and is always the lowest price. The fact that a FUL exists for lovastatin indicates that the Drug Update included the absolutely lowest cost that exists for lovastatin.

So, why should the FUL peg lovastatin to such a high price? The cost of $3.20 per 40-mg pill is high compared with the trade formulations of Lipitor and Crestor. Great question, unknowable answer. Sometimes drug pricing defies logic and reason. This is yet another of those cases.
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Title Annotation:LETTERS
Publication:Internal Medicine News
Article Type:Letter to the Editor
Date:Dec 15, 2005
Words:440
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