Monday, October 5, 2009

Eli Lilly Hires CVS Caremark to Push Cymbalta

Eli Lilly has discovered a new advertising strategy: your pharmacy.

Check out this package of material I just received from CVS Caremark, a prescription benefit plan associated with CVS pharmacy. Pure and simply, it is an advertisement for Cymbalta, Eli Lilly's antidepressant which was recently approved for the treatment of fibromyalgia.

But it doesn't look like an ad. It looks like a letter from a pharmacy that is deeply concerned that my fibromyalgia patients receive the best treatment.
Here's how the letter starts:

Dear Doctor:

CVS Caremark administers the prescription benefit plan for one or more of your patients. We are committed to providing health care professionals with information about drug therapy. As part of this commitment, we are providing you with this issue of RXViewpoints®, which focuses on the management of fibromyalgia with Cymbalta® (duloxetine HCI). Cymbalta is a therapeutic option on the CVS Caremark preferred drug lists. Patients may have a lower copayment for medications on these drug lists. Some prescription benefit plans may limit quantities or require prior authorization.

The letter came in a 9 X 12 inch envelope proclaiming "Confidential--May Include Protected Health Information." Along with the letter is a newsletter called "Rx Viewpoints" that appears to be written by Eli Lilly staff extolling the benefits of Cymbalta for fibromyalgia.

How touching that CVS Caremark is, in their words, so "committed to providing health care professionals with information about drug therapy." At the end of the letter, in small print, the source of all this benevolence becomes a tad clearer:

How much is Eli Lilly paying CVS Caremark to perpetrate this deception? Which executive at CVS became so overcome with greed that he or she approached Eli Lilly about this joint venture? Has CVS Caremark informed its patients that it is selling their pharmacy information to a drug company?

Whatever amount of money CVS is making on this scam, it had better be a bundle, because the pharmacy is going to have to spend at least that much dealing with the PR fiasco certain to be triggered by this foolish business decision.

I've called doctors who speak for drug companies "drug whores," a term that offends some readers. CVS Caremark has added another flinch-worthy phrase to the lexicon of medicine: "Pharmacy whores."


Joe said...

I've gotten to the point where when some "healthcare" infor comes to my office that I haven't paid for I throw it out without even looking at it. The exception to this is the monthly mailing I get from my state medical board on disease alerts.

If I haven't paid for it, someone else has, and so its sure to be an ad of some sort. Therefore its junk mail and gets treated as such.

Howard Brody said...

Sorry, Danny, I would not have regarded this news as worthy of a post. As a family physician in practice up till 2006, during the later years of my practice lifetime I received mailings like this regularly. As to the pharmacy benefit managers, well, we have already established what they are; we are just haggling over the price. Thanks for your great work as always, Howard

Anonymous said...

Dr. Carlat,

When I was taking Prozac and filling it at CVS pharmacy, my information was definitely sold. I received a mailing from Eli Lilly (forgot what it was about) and the only way that would have happened is that my information got sold. I never was on Eli Lilly's site and I never filled out anything as I guard my privacy very religiously.

I found the whole process disgusting.

Thank you for what you do in speaking out against this corruption.


SteveM said...


CVS probably didn't even need to be bribed. I'm sure the gross margins of brand name drugs versus generics is much higher for the pharmacy distributors.

Selling generic pills that cost a CVS 5 cents a piece for 6 cents (20% markup) is chump change compared to selling a 1 dollar pill for a buck twenty. Better to push the physicians to prescribe the high cost stuff of any type for any indication.

If I'm a pharmacy exec, do I make more money filling a bottle with Prilosec or Nexium? Methylphenidate or Concerta?

This is nothing new in sales and marketing tactics where manufacturers "upsell" campaigns with their sales channel partners to induce people to buy what they may not need. And with health care, buy what may be economically destructive.

It is just another example of the twisted economic symbiosis among the various players that is rotting the health care delivery system from within.

james gaulte said...


From what I have been reading the markup on generics is often much higher than with brand names and that pharmacies do quite well on generics.

James Gaulte

Stiff Man said...

Dr. Carlat,

As a patient that was prescribed Cymbalta for nerve dysfunction, my information was definitely sold. I also use CVS as my pharmacy of choice. Neither CVS nor Eli Lilly would confirm selling/buying my information but I was inundated with mailers for approximately a year offering me more information about Cymbalta. Anthem, my insurance company, also got into the act and was sending me info every month about Cymbalta after I had asked to be removed from all mailing lists from all three companies (Eli Lilly, CVS and Anthem).

If I forgot to take a dose of Cymbalta and refilled my Rx a day late I was getting letters from a Pharmacist at Anthem informing me that I was non-compliant and to discuss this with my doctor immediately. CVS was sending me nearly identical letters from their staff Pharmacist.

I am a disabled veteran from Gulf War I with multiple chronic health conditions, including gastric problems. There are days when I absolutely cannot stomach my meds, losing them during spells of vomiting. I threatened legal action against CVS and Anthem because of all the mailers mentioned above because, if they were to check their records, my Neurologist has written for my records that the gastric problems are known and that I AM compliant with his directions for my healthcare.

It took me a year but I am finally free of the mailing lists.

SteveM said...

Kids on Cymbalta - YEOW!

Furious Seasons reports that Lilly is recruiting kids for a Cymbalta pediatric clinical trial.

Discontinuation syndrome has already wrecked thousands of adults. Imagine a little kid trying to comprehend and work through that psycho-pharmaceutical brain bomb.

There is no way any parent would sign their kid up for this - if they are truly informed of the risks. But of course they won't be.

Lilly is criminal enterprise for targeting kids with Cymbalta. FDA is a co-conspirator for letting them do it. And the APA is committing a huge sin of omission if it does not intervene to halt this study.

This trial is a massive insult to psychiatric integrity.


Daniel Carlat said...

While I'm obviously no great fan of Eli Lilly's marketing department, I think you've gotten extreme in your critique of Cymbalta. Like any antidepressant, it has potential benefits and side effects. As long as parents are adequately informed of potential hazards, there's nothing unethical about doing clinical trials of antidepressants for children. There are many very troubled kids out there who need help, and we need more studies to figure out what works and what doesn't.

SteveM said...


Cymbalta self report at WebMD (10/5/09), 45-55 yr old male.

Took Cymbalta after having poor results from Paxil. It helped to control my anxiety attacks and the underlying depression symptoms. The problem though is getting off this stuff. The withdrawals are terrible. Brain zaps, foggy brain, loss of thoughts, dizzy feelings, nausea. Do not, I repeat do not follow the canned Dr. instructions to tapper off over 2-3 weeks. It really takes 4-6 weeks. My doctor said to cut the 60 mg. to 30 for a week, then go 30 mg every other day for a week. Bad idea! I am tapering it off over 4 weeks more by opening the capsules and reducing by 1/4 each week. Still have side effects, but not as bad.

I was turned inside out by Cymbalta and I was prescribed it for ADD! Can you imagine a 9 year old experiencing the withdrawal symptoms listed above?

Sure psycho-pharm can be helpful. But for what level of distress is Cymbalta truly indicated? Especially for kids?

BTW, note the WebMD submission date. Lilly is still not up front about the phenomenon. Wouldn't you at least demand that before the clinical trial begins?

Anonymous said...


Actually, antidepressants should be tapered at 10% of current dose every 3 to 6 weeks. I learned that on the Paxil Progress Boards, which is run by an RN whose son experienced horrific withdrawal symptoms thanks to a tapering schedule that was way too fast. Fortunately, he is fine and is no longer on Paxil.

With Cymbalta, the rate may have to be more slowly because of its short half life.
Of course, we know that during these trials, kids will be tapered way too quickly.

Heck, people are tapered way too qucikly who aren't in trials. Tapering at the rate you mentioned, even over 4 to 6 weeks is like putting the car in reverse at 60 miles per hour.

And by the way, an every other day regime is putting your body into withdrawal. Meds need to be taken on a consistent basis every day.

SteveM said...

Re: Anonymous

Thanks. But I fully understand the mechanics of tapering.

Lilly is egregious at multiple levels. First, doctors and patients are not presented with an accurate benefit/risk profile so cannot make a truly informed decision to prescribe/take the drug.

Secondly, Lilly has not published a clinically validated process for safely discontinuing. And in fact, the FDA updated the PI to state that severe withdrawal symptoms may occur even with tapering.

Lilly also does not offer small dose formulations to taper. The onus is on the patient to break apart capsules.

Those are facts not opinions. Everything about Lilly and Cymbalta is odorous. The kids that experience withdrawal episodes will be totally trashed. And Lilly won't give a shit. And that stinks...

Anonymous said...

Excuse me for I ask a stupid question: Are there diagnostic criteria for pediatric depressive disorder and where are these criteria published? said...

This kind of greed makes me ready for government-run health care, ASAP.

PMFAddictionTreatmentCenter said...

thanks for post.
I do believe this sort of bahavior happens, although I think that blanketing all CVS Pharmacies is a bit, well, a bit of generic bias overall.
I use CVS and they have actually recommended different over the counter medicines that cost less than my co-pay.

Anonymous said...

My doctor prescribed Cymbalta to me (after a post traumatic car accident) and I've been taking it for 4 weeks. I started with 20mg, then 40mg, then 60mg.
I felt better while I was on 20mg, but my doctor told me I needed to get the 'maximum benefit' so she told me to increase the dose. After starting 40mg I had a little difficulty sleeping so she prescribed Trazodone and I've been taking 25mg at night.
I have felt to be in better spirits recently, but I have also been feeling worried that I will develop an addiction to the drug. Also I don't it's good for me to be taking a drug every night just to fall asleep.

Margaret Polaneczky, MD (aka TBTAM) said...

CVS and Caremark did the same thing for Bayer

Looks like they're for sale to whoever will pay.

Anonymous said...

This post is so old its dead, but I'll just post this. Dr. Carlat, in response to what you were saying about experimenting on kids with Cymbalta, I'm really curious how that goes about. Because I'm from that generation of kids when the doctor literally did not even interview the kid. Adderall was not a controlled substance and free samples could be obtained just from walking into a doctor's office and grabbing it off the front desk. I've heard its gotten a lot better since then. I've heard that they will actually talk to the kid now, but when I was younger all it took was a crazy parent telling all kinds of lies and inanity to a psychiatrist to get an antipsychotic prescription for their kids. And I know what you're thinking. Why would a parent do that??? Why would a parent try to make a kid seem more sick than she or he actually is? Some parents have issues. They can't take responsibility for their own behaviors and they take it out on their kids. Their kids are the ones with the problems and not them. And I'm curious how depressed and messed up these kids will be once they get away from their parents. Because I come from that generation of kids who were massively drugged on a whim, and I know so many who got incredibly better once they went away to college and got away from their parents. The most drugged kids I ever met were always the ones who probably would have been fine had their parents taken a parenting class.