Vytorin coverage unlikely to change, physician prescribing habits might
Pharmacy and medical executives at managed health care companies see few immediate changes in how their organizations cover the cholesterol reducers Vytorin and Zetia after Merck/Schering-Plough released its not-so-favorable ENHANCE study results, according to research conducted by Cognet-X, a healthcare research firm.

However, Cognet-X reported that the utilization of the brands is expected to decrease after ENHANCE showed that Vytorin (a combination of the statin simvastatin and Zetia) was not statistically better than simvastatin alone at reducing arterial plaque build-up. Simvastatin is also available as a lower-cost generic.

Cognet-X surveyed managed care executives, including pharmacy and medical executives who have the ability to influence which drugs are reimbursed by health plans, during the week of Jan. 14, when ENHANCE data were released.

Two-thirds of the pharmacy executives surveyed said abrupt coverage changes for Vytorin and Zetia were unlikely because:
  • They were awaiting release and evaluation of full ENHANCE results;
  • Formulary design promotes first-line use of cost-effective generic simvastatin;
  • Controls such as prior authorization and step therapy ensure appropriate use of Vytorin and Zetia (and other cholesterol-lowering brands); and
  • Vytorin and Zetia were seen as having a place in therapy to lower cholesterol.
However, 64% of the pharmacy executives surveyed said they expected the prescribing of Vytorin/Zetia by their network physicians to change because of ENHANCE, resulting in less utilization, according to Cognet-X.

“I think [physicians] will think twice before starting someone on Vytorin or Zetia, especially since the media have jumped in with both feet. This will have patients in an uproar, especially since Zocor [simvastatin] is available generically,” one pharmacy executive said.

The medical executives polled were less certain prescribing would change; approximately 30% said Vytorin/Zetia prescribing would decrease, with an equal percent uncertain.

“ENHANCE has generated interest across the industry and in the press as much for the questions it raises as for the questions it answers. Against this backdrop, one of Merck/Schering-Plough’s challenges will be to reinforce Vytorin’s widespread favorable formulary positioning by successfully framing the brand’s cholesterol-reduction benefit in its promotional messages to managed care executives and prescribers,” according to Sharon Bender, executive director of strategic studies at Cognet-X.