An outraged retiree, “Mr. Edwards,” recently wrote on a health care blog that despite taking a particular brand name cholesterol-lowering statin for 17 years with good results, his United Healthcare/AARP health insurance policy would not cover his preferred prescription. It would, however, authorize another statin—Merck’s Zocor.
Unfortunately for Mr. Edwards, a recent U.S. Food and Drug Administration safety advisory just released a report on the risks associated with Zocor, a document that may have Mr. Edwards and patients like him seeking another prescription to lower blood pressure.
Within any drug class there are several versions of most medications, each version made by competing drug companies. Doctors choose the preferred drug based on individual patient criteria such as age, potential drug interaction and specific symptoms.
However, countries that favor socialized medicine regularly practice “mandated switching”—forcing patients to use one version of a drug over another to ease financial pressures and/or meet deals made with manufacturers. This kind of medicine is a dangerous business, as demonstrated in one Canadian province where 60% of doctors reported patients’ conditions worsened or their disease accelerated after mandated changes.
Although this sounds like a perversion of the patient-doctor relationship found only under government-controlled health care systems, it can also be found in America’s private health insurance market.
The American Association of Retired Persons (AARP) is America’s largest membership association for seniors, and United Healthcare (UHC) is the insurer providing Medicare supplement insurance plans under the AARP brand. Through royalty fees, UHC provides AARP with its largest single source of revenue.
These fees averaged $340 million annually in recent years—nearly $500 million in 2007. These two massive health care giants and their intertwined financial concerns create the perfect environment for drug-mandating policies to flourish. Ultimately, this kind of collusion begs the question: does coverage under the AARP and UHC consider patients or profits the first priority?
Medically, after pre-term infants, seniors are the most fragile population. Doctors take particular care in prescribing and monitoring their medications, and one of the most widely prescribed therapies is cholesterol-lowering statins.
In June 2006, the patent for Zocor expired, and sales of its generic alternative, simvastatin, increased rapidly. At about the same time, UHC made a deal with Merck that Zocor would be covered in AARP plans at a lower cost than even generic simvastatin.
This created a disincentive for AARP-branded plans to cover any other generic statins or those still under patent—as “Mr. Edwards” discovered.
On March 19, 2010, the FDA released its safety announcement, “Ongoing Safety Review of High-Dose Zocor (simvastatin) and Increased Risk of Muscle Injury.” Based on clinical trials, patient reviews, and adverse event reports, the FDA determined the 80-mg. dose of Zocor caused increased incidence and severity of muscle injury compared to other generic and branded statins.
After the FDA released this advisory, the logical next step for insurers should have been adapting coverage guidelines to ensure that alternate medications in the statin class were authorized. This apparently did not happen.
Additionally, as a result of UHC’s Zocor deal, the largest percentage of patients taking the medication within any single insurance plan is under the AARP. Yet there appear to be neither changes nor notations addressing Zocor or the FDA warning in recent formulary change reports on UHC’s AARP products.
All medicines—from aspirin to chemotherapy—come with side effects. Significant events are rare; most patients experience mild reactions or none at all. Statins are no different. Their most common side effect is muscle weakness and tenderness, with particular sensitivity in patients of Asian descent.
The potential for rationed care, including medications, was hotly debated before the health care “reform” bill passed in March. The plan is full of new ways to interfere with the doctor/patient relationship, containing provisions for a “Healthcare Choices Commissioner” and regulatory mechanisms allowing bureaucrats to fiddle with patient care to lower system costs.
By ignoring FDA’s warning on Zocor, the AARP and UHC have aptly demonstrated the problems patients face when finances and budgets take precedence over individual health care needs. Restricting access to medications is dangerous in limited populations like the 2.9 million in AARP plans, and even more so when applied to a wider swath of health care consumers under the guise of reform.
By acknowledging that not every drug works for every patient, AARP and UHC could still do the right thing and cover other statins effective at lowering cholesterol.
Or they can continue to deny patients the drug alternatives that exist, simultaneously encouraging that enrollees experiment with lower doses of Zocor, thereby potentially jeopardizing patients’ health—but certainly not causing harm to the AARP/UHC/Merck pricing deal.
The FDA directive on Zocor/simvastatin advises patients to consult their doctors to review treatment, report side effects and discuss possible medication changes. Mr. Edwards may join other seniors and physicians as they take the FDA’s advice. One wonders if the AARP will follow suit?
Kerri Toloczko is Senior Vice President for Policy at the Institute for Liberty and Director of its Center for Healthcare Security and Access.