Looking at Statins and LDL? Be Inventive
Looking at Statins and LDL? Be Inventive
Dr. Weintraub: We have also been using a newer statin, which regrettably has not worked its way into the formularies as much as we would like: pitavastatin, made by a Japanese company and tested extensively in the Pacific Rim. It has been out about as long as rosuvastatin has and was brought to this country after some necessary phase 3 trials. It's reasonably potent but metabolized totally differently. It's glucuronidated rather than handled by P450.
We have found that in many cases of statin-intolerant patients...There is one of yours whom I take care of and whom I saw on Tuesday who was intolerant of statins, and she is just happy and asymptomatic on pitavastatin. And there are others like her.
It's just a matter of knowing about it, and here is the problem: If the drug is not available easily on a formulary, then the doctor writes a prescription, the doctor gets a denial, and the doctor says, "I don't have a minute to spend on the phone with somebody who is going to be difficult, disruptive, and verging on anencephalic; I don't want to have to deal with this." So they just throw their hands up and say to the patient, "Sorry, you're out of luck." That is what it is. I'm sure not all of the people in managed care are that way, but when you are on the phone for 20 minutes or half an hour, that seems to be the way it goes.
Dr. Black: You need prior approval.
Pitavastatin: A New Statin
Dr. Weintraub: We have also been using a newer statin, which regrettably has not worked its way into the formularies as much as we would like: pitavastatin, made by a Japanese company and tested extensively in the Pacific Rim. It has been out about as long as rosuvastatin has and was brought to this country after some necessary phase 3 trials. It's reasonably potent but metabolized totally differently. It's glucuronidated rather than handled by P450.
We have found that in many cases of statin-intolerant patients...There is one of yours whom I take care of and whom I saw on Tuesday who was intolerant of statins, and she is just happy and asymptomatic on pitavastatin. And there are others like her.
It's just a matter of knowing about it, and here is the problem: If the drug is not available easily on a formulary, then the doctor writes a prescription, the doctor gets a denial, and the doctor says, "I don't have a minute to spend on the phone with somebody who is going to be difficult, disruptive, and verging on anencephalic; I don't want to have to deal with this." So they just throw their hands up and say to the patient, "Sorry, you're out of luck." That is what it is. I'm sure not all of the people in managed care are that way, but when you are on the phone for 20 minutes or half an hour, that seems to be the way it goes.
Dr. Black: You need prior approval.
Source...