Press Release Feb 08, 2008

21st Century Solutions Designed To Meet 21st Century Challenges

Vytorin Coverage Unlikely to Change Near Term, According to Leading Health Plans—but Physician Prescribing Expected to, Cognet-X Reports

PHILADELPHIA, PA --(BUSINESS WIRE)–- According to research from Cognet-X, Inc., conducted after Merck/Schering-Plough released its ENHANCE study results, pharmacy and medical executives at managed health care companies see few immediate changes in how their organizations cover the cholesterol reducers Vytorin and Zetia.

However, utilization of the brands is expected to decrease after ENHANCE showed that Vytorin – a combination of the statin simvastatin and Zetia – was not statistically better than simvastatin alone at reducing arterial plaque build-up. Simvastatin is available as a low-cost generic.

Cognet-X surveyed managed care executives during the week of Jan. 14, 2008, when ENHANCE data were released. Respondents included pharmacy and medical executives who have the ability to influence which drugs are reimbursed by health plans for over 150 million Americans.

Two-thirds of the pharmacy executives surveyed, as well as two-thirds of the medical executives, said immediate coverage changes for Vytorin and Zetia were unlikely, in part, because:

They were awaiting release and evaluation of full ENHANCE results

Formulary design already promotes first-line use of cost-effective generic simvastatin

Controls such as prior authorization and step therapy ensure appropriate use of Vytorin and Zetia (and other cholesterol-lowering brands)

Vytorin and Zetia were seen as having a place in therapy to lower cholesterol

At the same time, 64% of the pharmacy executives surveyed said they expected prescribing of Vytorin/Zetia by their network physicians to change because of ENHANCE, resulting in less utilization. Said one:

“I think [physicians] will think twice before starting someone on Vytorin or Zetia, especially since the media have jumped in with both feet. This will have patients in an uproar, especially since Zocor [simvastatin] is available generically.”

Medical executives polled were less certain prescribing would change; approximately 30% said Vytorin/Zetia prescribing would decrease, with an equal percent uncertain:

“I expect markedly less use within the network.”

“Some [physicians] will change, but most awaiting more studies on long-term outcomes.”

According to Cognet-X’s Sharon Bender, Executive Director, Strategic Studies, “ENHANCE has generated interest across the industry and in the press as much for the questions it raises as for the questions it answers. Against this backdrop, one of Merck/Schering-Plough’s challenges will be to reinforce Vytorin’s widespread favorable formulary positioning by successfully framing the brand’s cholesterol-reduction benefit in its promotional messages to managed care executives and prescribers.”
About the Cognet-X Report

For more information about the Cognet-X Report, “Initial Payer Response to Enhance Study Results: A Managed Care Pharmacy/Medical Director Perspective,” please contact Gayle Leahy at (215) 396-8300, ext. 121 or via e-mail: gaylel@cognetx.com

About Cognet-X

Cognet-X is a privately held, employee-owned healthcare research, consulting and software development firm based in Bucks County, PA. Our focus is on providing and developing business intelligence solutions centered on the managed care marketplace for pharmaceutical and biotechnology companies.

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