Wisconsin DUR Project—January 2004 1
To:
Prescribing Physicians, Pharmacies
From:
Wisconsin Medicaid, Division of Health Care Financing January 2004
PRIOR AUTHORIZATION GUIDELINES
In order to encourage the use of generic lovastatin, the Wis-
consin Medicaid program began requiring prior authorization
for brand name HMG-CoA reductase inhibitors on April 15,
2003. Prior authorization was made available through the
STAT-PA system. Only recipients new to statin drugs are re-
quired to try lovastatin first. The criteria for determining prior
authorization includes:
• Any recipient currently on an effective brand name statin
will be granted PA to continue on that statin drug.
• Any recipient who requires >35% reduction in low-density
lipoprotein (LDL) cholesterol will be granted PA to start
on the brand name statin drugs.
• Any recipient who has impaired renal function will be
granted PA to start on the brand name statin drugs.
• Any recipient who is at high risk for drug interactions will
be granted PA to start on the brand name statin drugs.
For more information, go to the Wisconsin Medicaid phar-
macy handbook website at
http://www.dhfs.state.wi.us/Medicaid2/handbooks/pharmac
y/index.htm.
Wisconsin Medicaid analyzes claim data to review adherence
to prior authorization policies.
Utilization and Program Costs of Statins
for Wisconsin Medicaid
THE COST OF GENERIC VERSUS BRAND-
NAME HMG-COA REDUCTASE INHIBITORS
In June 2002, lovastatin became the first HMG-CoA reduc-
tase inhibitor with an AB rated generic equivalent. All other
statins are currently available only as brand name products.
Brand name lovastatin is also still marketed as Mevacor. Other
brand name products include Altocor (lovastatin ER), Lipitor
(atorvastatin), Zocor (simvastatin), Pravachol (pravastatin),
Crestor (rosuvastatin), Lescol (fluvastatin), and Lescol XL
(fluvastatin XL). Products that contain an HMG-CoA reductase
inhibitor combined with another ingredient (e.g. Advicor) were
not included in this analysis.
The generic form of lovastatin is significantly less expen-
sive to the Medicaid program than brand name products.
Average cost to the Wisconsin Medicaid Program for generic
lovastatin 40 mg is $1.20 per tablet1 and for a brand name
HMG-CoA reductase inhibitors (including the brand name
forms of lovastatin) range from $1.65 to $4.18 per equipotent
dosage2 (table 1).
Trade Name Generic Name Cost Per
Tablet
Mevacor 40 mg Lovastatin $4.18
Zocor 20 mg Simvastatin $4.03
Pravachol 40 mg Pravastatin $3.98
Crestor 10 mg Rosuvastatin $2.31
Lipitor 10mg Atorvastatin $2.28
Lescol 40 mg or Lescol
XL 80 mg Fluvastatin or
Fluvastatin XL $1.79/$2.09
Altocor 40 mg Lovastatin ER $1.65
Lovastatin 40 mg
(Generic) ------------- $1.20
Table I
Cost Per Tablet for Wisconsin Medicaid
