Tuesday, September 20, 2011

At PSA: Thinking Primarily About Primary Care Rx

Has the life gone out of primary care drug market?

Referring to the category as “dead” is hardly a jaw dropping comment in today's marketplace given regulatory and reimbursement hurdles. Indeed, when it comes to launching successful drugs into traditional mass-market categories, as an industry, biopharma's track record is painfully diminished.

But surely better ways exist to describe the state of primary care, a business that is of vital importance to pharma. A panel of experts will discuss the topic on the afternoon of Sept. 22 at Elsevier’s annual Pharmaceutical Strategic Alliances conference. Yes, the landscape is challenging, with the advent of generics, diminishing physician autonomy, increasing interest in accountability for costs, and greater complexity in sales strategy. But pharmas are adapting. McKinsey director David Quigley and colleagues forcefully outline this evolution and the corporatization of American health care in this month’s issue of IN VIVO. Quigley will also be on the PSA panel, where he will lead off the discussion by pointing out key commercial trends.

True, the widely-cited Express Scripts 2010 Drug Trend Report calculates that specialty spend (inflammatory conditions, MS, cancer, anti-coagulation, growth deficiencies, and pulmonary hypertension) is rising far faster than money spent on traditional medicines (high cholesterol, diabetes, high blood pressure, depression, asthma, and ulcers). The former accounted for 25% of all payer drug spend in 2010 – and grew nearly 20% from 2009 to 2010, albeit off a smaller base, compared to less than 2% growth for the latter.

Worrisome statistics, but primary care is still the bulk of Big Pharma's bread and butter. And execs like Pfizer's Adele Gulfo, who will likely have responsibility for at least one ultra-high profile launch in the next year, believe the key to a successful commercial strategy in mass market drugs rests -- as it has historically -- largely on doctors’ interaction with manufacturers. Other top commercial executives set to give their thoughts on successful drug launches in 2012 and beyond include Wael Fayad, VP, business development at Forest Laboratories, and Riad el-Dada, SVP, diabetes and obesity, at Merck.

The tools driving that doctor-sales rep interaction, however, may be changing – although in proportions one might not expect, based on media hype. Traditional ‘reach and frequency’ and “mirrored territories’ may be strategies of the past. The panelists are likely to have lots to say on this issue. The best route to success, of course, is addressing unmet medical need with a truly innovative offering. But it's the road that may be steepest: not every drug can be a Januvia(Merck)or the anti-coagulation medication apixiban (Pfizer/Bristol).

So, they talk about the best ways to think about me-too drugs (or not). Forest Laboratories, for instance, is an expert in maximizing the value of drugs that are latecomers to competitive categories--witness the slow build of its anti-hypertension drug Bystolic. Can Forest pull off another slow-build surprise with its new anti-depressant Viibryd?

On the whole, these panelists – as PSA attendees will hear -- have a surprisingly vibrant attitude towards primary care – one likely to hold up over time, given that biosimilars should start making a dent in demand for older, until now, protected specialty brands. Industry doesn’t expect biosimilars to have a significant competitive impact until 2015. Then, the seasoned primary care experts will be able to show specialty executives a thing or two about what's what and help them weather the onslaught of low-priced competition and tightening payer control over utilization.

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