"My doctor prescribed Vytorin to me about three years ago," says Jack. "I'd never heard anything about it before and I didn't read the literature she gave me too closely. I figured, like she did, that it would lower my cholesterol to an acceptable level.
But my financial situation has changed drastically in the three years and so the $121 a month I pay for Vytorin, plus around $320 for other medications that I have to all pay out of pocket, means I have to rely on samples and when the next set runs out I won't be able to refill again. I'm in kind of a donut hole."
In May 2006, after a two year waiting period, Jack was declared disabled by Social Security. During that wait time, however, he lost his house and used up his savings, 401K and IRA to meet his living expenses. Shortly after the start of his Medicaid benefits, which paid for his Vytorin, Jack turned 55 which instantly disqualified him from patient's assistance.
New criteria dictated that his spend down--the amount he had to spend on medication in order to requalify for patient's assistance--was then fixed at $1,349 per month. While spending that amount would lower and fix his prescription costs at $3.00 a pop, he is in no position to take advantage of the opportunity.
"I only draw $1,030 a month plus a small $860 pension, which unfortunately puts me just over the limit to get that patient's assistance," says Jack. "And anyway, if I spend down $1,349 I haven't got anything left for gas or anything. I have custody of my son since he was five and you can't raise a kid on nothing. Vytorin would cost me almost $1,500 by itself. At this point, I would like to get more information on whether Vytorin is equal to generics."
On average, consumers pay $3.00 per pill for Vytorin compared to a third of that for the six other generic statin drugs on the market. Statins, the world's top-selling class of drugs, are routinely and heavily prescribed to lower 'bad' (LDP-low density lipoprotein) cholesterol. Co-manufactured by Merck and Schering-Plough, Vytorin is a composite of Zetia and Zocor, and its excessive price was justified by marketing claims that Vytorin is the best help for lowering cholesterol by blocking its absorption through food. What the pharmaceutical companies hid from the public was a two-year old report that proved the contrary.
An April 2006 study revealed that Vytorin was no more efficacious for slowing the clogging of arteries than generic statin drugs. Outrage over the findings and the price gouging quickly followed. The company is being sued across the country for fraudulent marketing and a class action suit was launched in Florida in January 2008 demanding that Merck and Schering-Plough reimburse the proceeds of sales that topped $5 billion last year, paid for mostly by Medicaid, Medicare, private insurance and the taxpayer.
In Jack's case, as of October 2008, he becomes eligible for Medicaid Part D which will subsidize his spend-down to $700 per month. "But what I really need to know now," says Jack, "is if Vytorin is problematic, is it bad for you? I really don't know anything about it and I don't think it's right that the FDA would approve it and not give all the story."
While statins are heralded for reducing the risk of heart attacks, they also have the ability to inhibit the liver enzyme, HMG Co-A, that produces cholesterol. At the same time, however, the drug reacts negatively on other invaluable enzymes. Cardiologist Peter Langsjoen of Tyler, Texas discovered after placing 20 patients on a low dose of statin over six months, that the drug directly interferes with the production of Coenzyme Q10, an essential nutrient of the heart needed to prevent heart failure.
"Should I even be taking it?" Jack wonders. "I can't tell if it's working; I don't feel any nausea or anything so I can't tell if there are any side effects. It's hard to pinpoint since I've got so much else wrong with me. And because I have to pay all my medical bills out of pocket, I have to be real limited in doctor visits, which means I can't afford any of the tests, like blood tests, to see if it's working or am I going to end up with liver damage. Which is better--high cholesterol or a wrecked liver? I don't think my doctor knows and the only way I know is from subscribing to the Lawyers and Settlements newsletter."