Answer: Cholesterol drugs can definitely strain the family budget. Brand-name statins like Lipitor (atorvastatin) can sell for more than $100 a month. There's no generic for Lipitor yet, but three other drugs in the statin family do come in cheaper, generic forms, and it may be OK to switch. They cost as little as $4 for a 30-day supply -- offering substantial protection against heart disease for less than the cost of a daily vitamin.
The generic statins include:
They're older and generally have longer safety records than the medications still under patent protection: rosuvastatin (Crestor), atorvastatin (Lipitor), fluvastatin (Lescol) and Vytorin (a combination of ezetimibe and simvastatin).
Who can safely go generic?
One key factor is your level of LDL, the "bad" cholesterol. How low do you need it to go? "If somebody needs a moderate reduction of cholesterol, it is often safe to switch to something like simvastatin," says Joseph Miller, MD, clinical director of the heart health program at Piedmont Hospital in Atlanta. "Ten milligrams of Lipitor might translate to 20 or 40 milligrams of a generic statin."
Simvastatin is the most potent of the three generics and may be useful for people who need a 35% or greater drop in LDL cholesterol.
Pravastatin may be an appropriate generic for people taking multiple medicines because it appears less likely to cause undesirable drug interactions.
When only a brand-name statin will do
Choosing the right cholesterol medicine for your individual needs can be a complex decision best made by your personal physician. For some people, only a brand-name statin will do.
If you fall into a high-risk category for heart disease or have very high LDL cholesterol, you may require the most potent statins available, like Crestor or Lipitor, which are not yet available in generic form.
Niacin: A potent drug in a vitamin bottle"One option that's potentially extremely cheap is niacin," says Alan Daugherty, PhD, a cardiovascular researcher at the University of Kentucky. Niacin can improve your entire cholesterol profile but must only be used with your doctor's approval and close supervision. Used wrong, it can worsen ulcers and lead to gout, high blood sugar and even liver failure.
Over-the-counter niacin supplements generally cost $15 or less a month. Prescription niacin is more expensive, but your health insurance plan may pay pick up the tab.
Eating more fiber
Boosting your intake of soluble fiber can lower blood-cholesterol levels as much as 10%, Miller says. Oatmeal helps, as do special margarines, juices, vitamins and yogurts fortified with plant sterols. "If you're close to your goal on a generic drug, these other options can get you there," he says.
Splitting or skipping pills
Pharmacies often charge the same price for different doses, so many doctors will prescribe a stronger dose than needed and tell patients to split their pills. You get the dose you need at a lower cost. This is safe and widely accepted. What doesn't work is skipping doses or taking a drug "holiday" without your doctor's approval in order to save money. Your "bad" cholesterol will rise, and with it, your risk for a heart attack or stroke.
When medicine costs are simply out of reach, people can try the Partnership for Prescription Assistance, which provides free medication to those in need.
"Cholesterol-Lowering Drugs" americanheart.org. 3 Oct. 2008. American Heart Association.15 Oct. 2008 <http://americanheart.org/presenter.jhtml?identifier=163>.
Daugherty, Alan, PhD. Personal interview. 20 Oct. 2008.
"The Healthy Heart Handbook for Women." nhlbi.nih.gov. Mar. 2007. National Heart, Lung and Blood Institute. 15 Oct. 2009.
Miller, Joseph I., MD. Personal Interview. 22 Oct. 2008.
Rosenson, Robert S. "Lipid Lowering With Drugs Other Than Statins and Fibrates." uptodate.com. May 2008. UptoDate Inc. 15 Oct. 2008 <http://www.uptodate.com/online/content/topic.do?topicKey=lipiddis/6977> (subscription).
Rosenson, Robert S. "Lipid Lowering With Statins." uptodate.com. May 2008. UptoDate Inc. 28 Oct. 2008 <http://www.uptodate.com/online/content/topic.do?topicKey=lipiddis/7436> (subscription).