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Invited Commentary |

Prescription of Brand-Name Medications When Generic Alternatives Are Available—Patently Unfair

Walid F. Gellad, MD, MPH1,2,3; Chester B. Good, MD, MPH1,2,3,4,5
[+] Author Affiliations
1Division of General Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
2Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
3Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
4Pharmacy Benefits Management Services, US Department of Veterans Affairs, Hines, Illinois
5Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
JAMA Intern Med. 2016;176(9):1323-1324. doi:10.1001/jamainternmed.2016.3389.
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In December 1996, 8 days before Christmas, the US Food and Drug Administration (FDA) approved Lipitor (atorvastatin; Pfizer) for the treatment of hyperlipidemia. Lipitor would become one of the most profitable prescription drugs in history, bringing in $130 billion in sales during its lifetime as a brand-name product and peaking at nearly $13 billion in sales in 2006 alone.13 Lipitor was far from the first statin in its class (simvastatin, pravastatin, and fluvastatin were already on the market), but 1996 was also the year that the FDA began allowing direct-to-consumer broadcast advertising. Lipitor was aggressively marketed based on its more potent lowering of cholesterol levels compared with other statins.1

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Figure.
Number of Monthly Prescriptions for Statins in the Veterans Affairs Healthcare System

Data are from the VA Pharmacy Benefits Management national dispensing records from December 2010 to May 2013. The vertical lines represent the months when generic atorvastatin first entered the market with limited competition (December 2011) and 6 months later on entry of additional generic products and full generic competition (June 2012).

aIncludes combination products with niacin.

bIncludes fluvastatin, pitavastatin, and the combination of ezetimibe and simvastatin.

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