Why was lipitor such a blockbuster drug when cheaper generics existed

Miscellaneous and Personal Stuff I Must Share
1

Lipitor was the best selling pharmaceutical of all time I believe, but there were several generic statins on the market while lipitor was still patent. So what benefits did lipitor offer over cheaper generics like zocor or mevacor that would explain why it was used so widely?

2

IANAD. IAIPM*

  1. Back in the day (late 1990s), Lipitor and Baycol were competing with one another. They both were much better reducers of LDL cholesterol than other statins. Caveat: I’m guessing there was no head-to-head comparisons in LDL cholesterol reduction at the time, but when one looked at the individual trials for these drugs compared to trials for the others (which you’re not supposed to do), these were superior
  2. Baycol got withdrawn from the market in 2001 due to deaths from rhabdomyolysis. So Lipitor was alone as the superior agent of its class
  3. Pfizer invested heavily in a number of morbidity and mortality trials (i.e., those that actually show a reduction in heart attacks, strokes, death, etc.) rather than just showing it reduced lipids
  4. These trials showed Lipitor to be superior not only in reducing LDL cholesterol, but also reducing CV events than Zocor and Pravachol
  5. The fact that the Pravachol company had funded the trial showing Lipitor was superior (PROVE-IT) was a particularly compelling supporting evidence for Lipitor
  6. Zocor and Pravachol may have been genericized, but due to the good evidence showing Lipitor’s superiority over them in terms of morbidity and mortality, it was hard for payers to insist on the generic options
  7. Crestor came along in the early 2000s, and had even better LDL cholesterol reduction than Lipitor, but Lipitor had the morbidity and mortality data whereas Crestor was just promoting on LDL cholesterol reduction
  8. Add to this some really effective marketing and a large, well-funded sales force
  9. And that’s why Lipitor was such a blockbuster drug!

I’ll certainly defer to the doctors and pharmacists on the board about the science of all of the above, but from a promotional standpoint, I think that covers it

*I Am In Pharmaceutical Marketing

3

The above is correct, or as we say in the medicine biz “end-organ data”.
The other medications had data showing they lowered cholesterol.
Lipitor had data showing it lowered cholesterol AND prevented heart attacks, strokes and death in general.

Add that to the fact that Lipitor is more effective than the other statins except Crestor, and that the next most effective, Zocor(simvastatin) interacts poorly with several other commonly used medications (although so does Lipitor albeit to a lesser extent) and you get a strong pressure to use Lipitor.

That said, there was a short window between when Zocor went generic and Lipitor went generic when most insurances required you to try to Zocor first. Now that Lipitor is also generic the problem is getting the Crestor approved (has better effectiveness than either of the other two, much less interaction with other medications and many people can tolerate it who can’t tolerate the others).

Most recent ACC/ACA recommendations say that if you are treating cholesterol you should use a high-potency statin (Lipitor or Crestor) so there will be more and more use of generic Lipitor (atorvastatin, since Crestor is not generic.