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May 5, 2012 -- 3:08pm EDT

Attention Stent Patients: Plavix Going Generic!
Plavix and stent
On May 17, less than two weeks from now, U.S. patent protection will end for Plavix (clopidogrel), the best-selling antiplatelet drug made by Bristol-Myers Squibb / Sanofi-Aventis. In 2010, worldwide sales of Plavix topped $6 billion (yes...billion!). For a typical stent patient, one 75mg tablet of Plavix a day costs more than $210 a month. Those with drug-eluting stents (80% or more of patients) must take Plavix for a year minimum. So the required medication actually can cost more than the stent itself.
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Needless to say, most patients without health insurance cannot afford Plavix. Some forward-thinking cardiologists will query their patients before placing a stent: if they are not covered by insurance, they'll get an older bare metal stent instead -- only a couple months of Plavix is necessary there. Hopefully the patient won't restenose (reblock) -- something drug-eluting stents are much better at preventing. It's a cynical economic version of what's known in scientific jargon as a "class effect"!

Our Patient Forum Topic on Financial Assistance for Plavix is (unfortunately) one of the more popular message boards on Angioplasty.Org. We've attempted to make resource information available to those unfortunate patients who have gotten a drug-eluting stent and suddenly find they also have been given a $200/month drug habit -- necessary to prevent the stent from clotting up and causing a heart attack (called "stent thrombosis", this complication, although infrequent, is fatal more than a third of the time). There are patient prescription assistance programs available if a patient's income qualifies. There also are discount prescription cards and plans: some are issued by local governments, some are private, some are scams.

But with the expiration of the Plavix patent, generic clopidogrel will become available immediately from several different companies, we are told, on May 17. No word yet on how deeply discounted these generic versions will be, but this is certainly good news for stent patients throughout the U.S. (clopidogrel has already gone generic in Canada and other countries).

There remains, of course, the issue of Plavix resistance. Some studies show that more than 20% of the population does not metabolize clopidogrel completely -- these patients should be treated with increased dosages, or possibly a different antiplatelet drug, such as Effient (prasugrel) or Brilinta (ticagrelor) which do not need to be metabolized first. You can read more about this in our interview with Dr. Eric Topol.

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