Lipitor in decline as PCTs take control
pharmafile | May 9, 2008 | News story | |Â Â Â
Sales of Lipitor dropped more than £50 million in England last year, as the blockbuster cholesterol drug fell victim to aggressive cost cutting by PCTs.
The decline in Lipitor is especially significant because it is the surest sign yet that PCTs have seized control of the primary care prescribing budget, and are now dictating the market to GPs and pharmaceutical companies.
Sales of Lipitor (atorvastatin) from GP prescribing fell £53 million in 2007 compared to the previous year, representing a very substantial 15% decline for the UK's biggest selling drug.
Lipitor has been targeted by PCTs as one of the most obvious targets for cost cutting, with GPs instructed to switch patients en masse away from the drug to simvastatin, a much cheaper generic alternative.
Dr Stephen Head is a Nottinghamshire GP and he thinks Lipitor has been widely over-prescribed in the past compared to simvastatin.
"There might be a reckoning up going on here, because there's no reason to prefer atorvastatin if simvastatin does the job," he said.
Pfizer maintains that its drug is far more effective than simvastatin, and therefore still represents good value for money, but this message fell on deaf ears during 2007 when PCTs were under pressure to find cost savings.
The figures outlining Lipitor's decline emerged from Department of Health statistics on prescribing for 2007, which saw England's GPs prescribe treatments worth a total of £8.4 billion.
This represented a rise of just 2% overall, a figure which will be considered a triumph by prescribing advisors and chief executive of PCTs, who were last year told to clamp down on GP prescribing costs by two separate reports.
The total number of prescriptions for lipid regulating drugs rose nine million, but spending nevertheless fell £29 million as GPs switched to generic simvastatin, which continued to fall in price.
Dr Head acknowledged prescribing advisors were an influence on prescribing, but said they couldn't make the 'big wins' of a few years ago when switching from one NSAID to another could save PCTs tens of thousands of pounds.
"But it's not all about price," he added. "There are times when prescribing advisors want us to use more of an expensive medicine, such as a narrow spectrum antibacterial like azithromycin rather than ciprofloxacin."
Sartans targeted
Another area of high volume prescribing heavily targeted by PCTs is hypertension medicines. In particular, PCTs have concluded the ARB class of drugs for high blood pressure – known as the 'sartans' – have also been overprescribed and overpriced.
Last year saw GPs instructed to switch away from the most expensive sartan, Merck Sharp & Dohme's Cozaar, in favour of cheaper drugs in the same class.
The figures for 2007 suggest this has had a major impact on the market, with prescribing of Cozaar (losartan) dropping by 6%, allowing Takeda's Amias (candesartan) to take a slim lead of some 11,000 prescriptions over its more expensive rival and become the most prescribed sartan.
Nevertheless, despite the fall in prescriptions for Cozaar the drug's higher price allowed MSD to retain the lion's share of sales – £93 million compared to Amias' £50 million.
