What 72 Million Americans on Cholesterol Meds Could Mean For Costs

The demand for more statins could impact health care costs, but maybe not in the way you’d expect. REUTERS/Jeff Zelevansky

New guidelines to combat cholesterol may double the number of Americans taking statins, but consumers should hold off on the price-hike freakout (especially if they've got heart trouble).

A report this week from the American Heart Association and the American College of Cardiology provides new guidelines for statin use, claiming such regimens could help patients' health even if they don't have high cholesterol. Statins, a class of drug that includes prescriptions like Lipitor, Zocor and Crestor, are already a $19 billion industry, but experts say a spike in demand won't necessarily drive up costs.

"To the degree that everyone who is newly eligible to take a statin [could] demand a brand-name drug, I could see prices rising," Devon M. Herrick, a health economics and policy expert, tells Newsweek. "But a lot of people will go on generics."

Lipitor, which earned Pfizer more than $5.3 billion in U.S. sales, fell out of patent in 2011. Zocor's patent expired in 2006, and Crestor's will expire in 2016.

The new AHA guidelines recommend that statins be prescribed to prevent stroke and heart attacks in several high-risk groups, such as patients with cardiovascular disease, patients with Type 2 diabetes between the ages of 40 and 75, and patients with "an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years old," according to the association. (The AHA's old guideline still holds, though: Patients with "low-density lipoprotein cholesterol, commonly known as LDL, or 'bad cholesterol'" of 190 or higher should still get statin treatments.)

The report has already generated some controversy, as the agencies' new method for calculating risk – largely based on an algorithm – hasn't undergone clinical trials. Add to that a general wariness about putting nearly a quarter of Americans on statins.

Larry Van Horn, a health care economics expert at Vanderbilt University, does not expect statin prices to increase, but said that different hidden costs could swell under the new guidelines. Since consumers are shelling out more and more for health care, Van Horn says, this might deter statin users from doing follow-up diagnostics and doctors' visits required with statin therapy.

"While the cost of the drug itself is not going to be particularly high, when individuals are on a chronic-use medicine like a statin, there are clinical recommendations that need to be followed," he explains to Newsweek. "You need to have various testing done and visits with a provider on a periodic basis. In a world where people are paying a greater share out-of-pocket, where we shift to greater patient accountability, they might not be inclined to go see a physician when they feel healthy and well."

Another potential problem - and source of long-term cost increases - has to do with personal responsibility. Van Horn says widespread statin use could serve as a disincentive to living a healthy lifestyle – putting patients at risk for diseases the medication is meant to prevent (and that are expensive to treat). Think swallowing a fat-burner and then chowing down on cheesecake.

"If I'm taking a statin, I might think, erroneously, that this drug is taking care of my problem and I can actually make bad decisions," Van Horn says. "Because I've got this drug that's taking care of my bad behavior, I'm less responsible."

So at-risk Americans may not break the bank by turning to statins, but misbehaving, either by not going for check-ups or eating poorly, still could.