Let the gushing begin. The new son-of-Plavix, Brilinta, beat Plavix in a randomized trial, published this week.

Plavix is a leading blood thinner given to patients after a heart attack or stent procedure. Only problem is that it's set to go off patent in 2011, leaving AstraZeneca needing to fill a $6 billion/year revenue hole.

Looks like Brilinta is all but inevitable. The incremental benefit is 1.9%, leaving insurance pharmacy benefit managers having to scratch their heads over whether a 1.9% benefit is worth billions of dollars in incremental drug spending.