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Editor's Correspondence
Oct 22, 2012

Generic Competition in a Flawed System: Pill Them, Bill Them—Reply

Author Affiliations

Author Affiliations: Sections of General Internal Medicine (Dr Ross) and Cardiovascular Medicine (Dr Krumholz) and Robert Wood Johnson Clinical Scholars Program (Drs Krumholz and Ross), Department of Internal Medicine, School of Medicine, Yale–New Haven Hospital Center for Outcomes Research and Evaluation (Drs Ross and Krumholz), and Section of Health Policy and Administration, School of Public Health (Dr Krumholz), Yale University, New Haven, Connecticut. Mr Downing is a medical student at Yale University School of Medicine.

Arch Intern Med. 2012;172(19):1522-1523. doi:10.1001/2013.jamainternmed.806

In reply

Hay questions whether consumers were actually harmed by Abbott's branded reformulations of fenofibrate, suggesting that Abbott likely offered rebates and discounts to payers in an effort to improve formulary position. Our article included an analysis of wholesale prices for fenofibrate that showed that Abbott's branded reformulations were twice as costly as generics.1 Given this difference in price, generic fenofibrate almost certainly would be listed on a more favorable formulary tier than branded versions, even if Abbott was offering significant rebates or discounts. Thus, patients who continued to use branded fenofibrate likely faced higher copayments than those using generic formulations. In addition, the continued use of branded formulations likely increased overall health care costs, which impose indirect costs on patients through higher insurance premiums. Hay also draws attention to the findings of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which showed that fenofibrate did not reduce cardiovascular risk when added to statin therapy.1 We agree that the broad use of fenofibrate, especially the more costly branded reformulations, should be re-evaluated in light of this study.