Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Bending the Curve Toward Increased Use of Generic Drugs Comment on “When Choosing Statin Therapy”

Brian K. Alldredge, PharmD; Steven R. Kayser, PharmD
JAMA Intern Med. 2013;173(3):233-234. doi:10.1001/jamainternmed.2013.1777.
Text Size: A A A
Published online


Prescription drug costs account for an increasingly large fraction of overall health care costs in the developed world. Given this and the increased scrutiny paid to the large profits reported by the pharmaceutical industry, it is not surprising that reducing drug costs, while simultaneously maintaining health care quality, is an important goal. Promotion of generic drug use is a key strategy in this effort.

Despite the individual and societal benefits associated with lowering drug costs, generic drugs are underused. This is occurring even in the face of compelling evidence from bioequivalence and randomized controlled trials supporting the equivalence of generic drug products1 and efforts from payers to move patients and prescribers toward generics (eg, tiered pharmacy benefits and prior authorization for less cost-effective agents). As Green et al2 point out, the adoption of generic statins to decrease coronary heart disease risk has been slow and disappointingly incomplete, given the equivalence (in terms of clinical efficacy and safety) of generic-available and brand-only statins.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment
Why clinicians prescribed less simvastatin.
Posted on February 22, 2013
David L. Keller, M.D.
Providence Medical Group
Conflict of Interest: None Declared

In their commentary on generic drug use (1), Alldredge and Kayser state that, “In 2011, fewer prescriptions for generic simvastatin were written than for [branded] Lipitor despite a significant cost differential and no apparent clinical differences in efficacy and safety”. That statement seems to be in conflict with the views of the FDA. On June 8, 2011, the FDA issued a safety warning concerning simvastatin (2), in which physicians were advised to discontinue the use of simvastatin 80 mg (except in patients who had already been taking it safely for over one year). In addition, FDA advised that the dose of simvastatin should not exceed 10 mg for patients taking diltiazem or verapamil, and that, when prescribed to patients taking amlodipine, the maximum dose of simvastatin should be 20 mg. These safety warnings were based on reports of serious myopathy-related adverse events caused by simvastatin 80 mg, or by lower doses of simvastatin when combined with widely-prescribed calcium-channel blockers. Clinicians now have a maximum safe simvastatin dose of 40 mg, which lowers LDL cholesterol levels by about 40%, while atorvastatin 80 mg reduces LDL by about 55% (3). To date, the FDA has not deemed it necessary to issue such stringent safety restrictions on the use of atorvastatin.

Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
The Biological Agent

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
Is There Potentially Compelling Evidence for a Class Effect?