Caremark.... pill pushing or disease awareness?

From John Curry, June 13, 2007

Did YOU receive a newsletter from Caremark touting the benefits of the cholesterol pill Vytorin? If you did, please let me know by dropping me an email and....save the document.

Thanks,

John
curryjo@watchtv.net

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Blurring lines of advice, advertising
BY KATHLEEN KERR
kathleen.kerr@newsday.com
June 13, 2007

Caremark, a company that manages prescription drug insurance plans, has accepted payments from a pharmaceutical maker to produce newsletters that appear to promote one of its medications - a practice that has raised questions of conflicts of interest.

Last month, some Long Island prescription plan participants received a Caremark newsletter touting the benefits of the cholesterol pill Vytorin.

Vytorin's manufacturer, Merck/Schering-Plough Pharmaceuticals, paid Caremark to produce the cholesterol newsletter. But those who received the newsletter wouldn't have known that without wading through the small print at the end of it.

The newsletter stated there had been changes to Caremark's drug lists that name medications available for lower co-payments. It also devoted more than a quarter-page to Vytorin - one of Caremark's preferred drugs. Other cholesterol drugs on the list - Lipitor and the generic forms of pravastatin and simvistatin - received only brief mention.

"There is always a potential for a conflict of interest when you see something like this," said Larry Sasich, consultant to the Public Citizen Consumer Group in Washington, D.C., and assistant professor of drug policy at the School of Pharmacy at Lake Erie College of Osteopathic Medicine in Erie, Pa.

"It might lead a patient to ask a doctor about Vytorin rather than what [the drug] they're already on." Sasich said. "It sounds like an ad for Vytorin."

Caremark spokeswoman Carolyn Castel disagreed.

Castel said the payments Caremark has accepted from Merck/Schering-Plough, as well as from other drug companies, have not influenced decisions about which drugs are placed on its preferred list.

However, Castel did not explain why Caremark required outside money to pay for the newsletter; she would not reveal the amount of the Merck/Schering-Plough payment and declined to explain why Vitorin received such prominent display.

"Caremark does not believe that its relationships with pharmaceutical manufacturers create a conflict of interest," said Castel, in an e-mail response to questions from Newsday.

Promoting Vytorin could help Merck/Schering-Plough capture a larger chunk of the $32-billion worldwide cholesterol drug market. Vytorin, approved by the FDA in 2004, had U.S. sales that topped $2 billion in 2006.

The Caremark newsletter also provided information about high cholesterol. It also pointed to a study that found Vytorin - which contains two drugs, Zocor and Zetia - more effective in lowering LDL cholesterol than AstraZeneca's Crestor, a single drug also known as rouvastatin. Crestor is not among the preferred cholesterol drugs listed in the newsletter, and using it would probably mean higher co-payments. Under most Caremark-managed plans, listed drugs have lower co-payments.

AstraZeneca spokesman Christopher Sampson said he was not familiar with the claims in the Caremark newsletter comparing Vytorin with Crestor.

When Merck lost its patent protection for another cholesterol drug, Zocor, in June 2006, cheaper, generic forms of the drug, also known as simvistatin, posed a threat to the company's revenues. To protect itself, Merck entered into a deal with India-based Dr. Reddy's Laboratories Ltd., giving the company its Zocor formula and licensing it to make what it called "an authorized generic" in return for a revenue share.

Dr. Stanley Katz, chief of cardiology at North Shore University Hospital in Manhasset, advises cholesterol patients not to switch from one drug to another simply to get lower co-payments. He urges patients and their doctors to exercise caution when changing cholesterol drugs.

"The bottom line is I don't think there is scientific data proving one statin to be superior to the other," Katz said. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, called the Caremark newsletter and Merck/Schering-Plough's payment for it "ethically odd."

"It's very surprising because part of the credibility of Caremark and any PBM [pharmacy benefits manager] is to be seen as trying to recommend the best drug at the best price," Caplan said. "It may raise an eyebrow or two about is there too close a relationship formed between what is supposed to be a prudent purchaser of drugs and manufacturers."

Skip Irvine, a Merck Schering-Plough spokesman, said the newsletter was an "educational program."

He said, "It's disease awareness. We do that through a number of different channels. We underwrite the cost of the mailing."