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[e-drug] brand vs generic simvastatin prices? (2)

E-DRUG: [e-drug] brand vs generic simvastatin prices? (2)

Dear Valeria, 

First of all, I think your posting makes a good
starting point for referring the readers to the
website of the Pharmacy Benefits Management Strategic
Healthcare Group. Washington D.C, US. (www.vapbm.org) 

This organisation manages the Veterans Association
National Formulary and in order to do so, they prepare
very extensive evaluations and reviews about all sort
of drug classes like antihistamines, HMG CoA
inhibitors, calcium channel blockers etc. In these
reviews all available clinical, toxicological, and
pharmacological data of the drugs in a class are
compared to one another. The ultimate goal is being
able to recommend the most optimum drug for first line
therapy in each class. 

In their own words "The purpose of the reports and
reviews is to assist
practitioners in clinical decision-making, to
standardize and improve the quality of patient care,
and to promote cost-effective drug prescribing."

As far as I know the organisation itself is not linked
to any industry and to me this makes their assessments
very valuable and one of the best sources for
non-marketing influenced prescribing information. 

Therefore, I would strongly recommend to all
e-druggers to check out their website. 

For you, Valeria, they have a nice review on the
statins, comparing: lovastatin, pravastatin,
fluvastatin, simvastatin and rosuvastatin. 

Brand vs Generic prices? 

Getting back to your main question I can only say that
the pharmaceutical industry uses the tactic of
creating confusionpolies. 

What is a confusionpoly and when is it used? 

A prime example of a existing confusionpoly can be
found in the mobile phone industry. In telecom, you
have a zillion different companies all of them
providing exactly the same service to you the
customer, making mobile phonecalls possible. In the
early days, the telecom industry could compete on
things like being able to take a phone call anywhere
even in the rural areas, or if you had access to
another network.  

In the mean time, these start-up issues have been
solved by all companies and now technically and
quality wise it doesnt really matter anymore which
companys mobile phone you use. 

The telecom industry then switched to another means
off attracting customers, marketing. In the marketing
they focussed on making lots of offers and scripting
very difficult cost price structues. Effectively
making their cost structure and offers impossible to
compare. An objective choice between T-Mobile,
Vodafone, MTN, Celtel, Orange etc is nearly
impossible. At least even after chosing, one day later
when I see a new advertisement, I always feel that a
better deal would have been possible. By creating a
confusionpoly, the phone companies ensure that each of
them gets and keeps a chunk of the market. 

In my opinion such a confusionpoly is exactly what the
pharmaceutical industry has been creating in the last
decades. Everybody will agree that practically
speaking there is no need for 7 or 8 different brands
of statins or antidepressants, one or two will do just
as nicely. But since all companies want to have a
chunk of the market, they develop their own me-too
version of a really novel drug (one  with a new mode
of action), creating classes of molecules which all
act on the same target. 

Offcourse it is true that the newer drugs do have less
side-effects or a better use profile, but in the end
these effects are mostly only just significant in
carefully monitored clinical trials and one can wonder
if in the general population the same effects can be

Therefore, the pharmaceutical industry, innovators as
well as generic companies,  started to create
confusionpolies, thus making it nearly impossible for
the general practitioner to make out which drug in a
class is the better and/or cheaper one. 

And judging from your valid question, they are very
succesfull in their setup. 


Hans Platteeuw
Dafra Pharma

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