Hang on for real savings when we get generic lipitor (atorvastatin) on about 11-30-2011 with the expiration of the patent on Lipitor (generic name atorvastatin), the highest gross sales drug in the world. Lipitor, by Pfizer, was still the top gross selling drug in the US despite competition since simvastatin became a generic option. We all were ecstatic when Zocor, now generic simvastatin, lost its patent last year. Prior generic statins, including lovastatin and pravastatin just were not as potent as simvastatin (see table below). Lipitor and Crestor are the two currently available statins that are more potent that simvastatin. Currently both are expensive branded drugs. Lots of physicians have kept some patients on Lipitor or Crestor (#14 in gross US sales in 2009) even after simvastatin became available, because their increased potency allowed patients to get to their goal LDL. Once generic atorvastatin is available, it is likely to dominate the statin prescription market. I anticipate that generic lipitor will quickly become the market leader in the statin prescriptions. Simvastatin is a great drug, but recent evidence suggests that at higher doses needed to approach the LDL lowering efficacy of atorvastatin, it has a higher incidence of myalgias and hepatic dysfunction. In patients with extremely high cholesterol, with desired reductions of LDL cholesterol in the 50% range, generic lipitor as atorvastatin will be extremely popular once it becomes affordable. It will also be popular in patients who need more modest LDL reduction; it will just be used at lower doses in those patients. See the table below with statin doses, average LDL reduction expected, and current costs:
| Drug Name | Anticipated LDL Reduction | Cost on Costco Online/ 30 days |
| Pravastatin 10 mg | 18-25% | $5.90 * |
| Pravastation 20 mg | 23-29% | $5.90 * |
| Pravastatin 40 mg | 26-34% | $10.54 |
| Lovastatin 20 mg | 24-27% | $5.90* |
| Lovastatin 40 mg | 31% | $11.75 |
| Simvastatin 10 mg | 26-33% | $$5.90 |
| Simvastatin 20 mg | 30-40% | $5.90 |
| Simvastatin 40 mg | 35-45% | $5.90 |
| Simvastatin 80 mg | 35-48% | $7.31 |
| Lipitor (atorvastatin) 10 mg | 34-38% | $98.87 |
| Lipitor 20 mg | 42-46% | $139.96 |
| Lipitor 40 mg | 47-51% | $139.96 |
| Lipitor 80 mg | 46-54% | $139.96 |
| Crestor 10 mg | 43-50% | $127.52 |
| Crestor 20 mg | 52-55% | $127.52 |
| Crestor 40 mg | 52-57% | $127.52 |
*Also on $4./ month at several discount pharmacies.
The annual potential for cost savings after next year from this generic alone can be in the range of >$5 billion for the US alone, and <$1500./ per patient if atorvastatin pricing approximates simvastatin pricing after it goes generic. Let’s celebrate the little bits of good news as they come along.
Addendum: With the 6-2011 FDA warning about simvastatin 80 mg causing a higher incidence of serious myopathy than other statins, and since at low doses myopathy seems to cause less common lipitor side effects, generic lipitor is going to leap to the front in use as soon as its price comes down.