Category: Economics

Make way for Retrodal, Preprexa and Preoquel

published date
October 3rd, 2006 by

Make way for Retrodal, Preprexa and Preoquel

J&J is smarter than it sometimes lets on. As reported earlier (Clarinex, Nexium, Nexperdal?), the company isn’t testing its ‘new and improved’ anti-psychotic, paliperidone against its soon-to-go-generic blockbuster Risperdal, because despite the hype there’s no reason to think paliperidone is better.

They’re also not testing paliperidone against older drugs, and here’s one reason why. From The Washington Post (In Antipsychotics, Newer Isn’t Better), subtitled –in an apparent attempt to be even more dramatic than the New York Times— “Drug Find Shocks Researchers” says:

Schizophrenia patients do as well, or perhaps even better, on older psychiatric drugs compared with newer and far costlier medications, according to a study published yesterday that overturns conventional wisdom about antipsychotic drugs, which cost the United States $10 billion a year.

The results are causing consternation. The researchers who conducted the trial were so certain they would find exactly the opposite that they went back to make sure the research data had not been recorded backward…

“The claims of superiority for the [newer drugs] were greatly exaggerated,” wrote Columbia University psychiatrist Jeffrey Lieberman. “This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information.”

How long until someone dresses up one of the old drugs in a new formulation and demonstrates superiority over the newer classes?

Move over Risperdal, Zyprexa, and Seroquel. Make way for Retrodal, Preprexa and Preoquel!

And yes, Virginia it turns out there already is a Desperal, but still no Nexperdal or Ripofferdal.

Clarinex, Nexium, Nexperdal?

published date
September 29th, 2006 by

Clarinex, Nexium, Nexperdal?

J&J is stealing a play from AstraZeneca and Schering-Plough. AZ couldn’t come up with a worthy successor to Prilosec, so when the drug went off patent the company introduced the infamous Nexium, which is the substance the body turns Prilosec into. Basically you get Nexium when you swallow Prilosec, yet Nexium managed to become a multibillion product. Clarinex is just a tiny tweak on Claritin, introduced when Claritin’s patent expired.

Now J&J is faced with the expiration of its blockbuster for schizophrenia, Risperdal. When a patient takes Risperdal the body converts it to paliperidone. So just like AZ, J&J is going to market paliperidone as the next thing. J&J claims paliperidone is better than Risperdal, but that’s doubtful. From the Wall Street Journal:

The research backing J&J’s claims for paliperidone seems a little thin. Clinical tests, involving 1600 patients, pitted it against a sugar pill, not Risperdal or other antipsychotic drugs…

“They can’t claim its better than risperidone [Risperdal’s generic name] because they didn’t do the comparison,” said [Duke psychiatry professor] P. Murali Doraiswamy.

Basically, J&J is proving that paliperidone is better than nothing. That’s not a very high standard.

Meanwhile doctors, health plans, and patients haven’t set a very high standard either. Doctors continue to accept Nexium samples and prescribe the drug, most payers still have it on formulary, and patients continue to insist on the purple pill. Time to wise up!

J&J hasn’t picked a brand name for paliperidone yet. Here are a few suggestions:

  • Nexperdal
  • Ripofferdal
  • Desperal

This is news?

published date
September 28th, 2006 by

This is news?

Did anyone else notice how yesterday’’s announcement that health care premiums were rising at 7.7% was treated as such a big story? I got “breaking news” emails from most of the lists I subscribe to, and it was treated as a major item by today’’s newspapers. The angle was that premiums are rising twice as fast as wages, although in the full stories it was usually noted somewhere that the rate of growth is slowing.

This really isn’t news, never mind BIG NEWS. I wonder whether the focus on comparing premium increases with salary increases was what made everyone jump.

Citigroup doesn’t think Wal-Mart price cut move is significant

published date
September 22nd, 2006 by

Citigroup doesn’t think Wal-Mart price cut move is significant

Yesterday’s price cut on generic drugs, led by Wal-Mart and quickly matched by others, shouldn’t have a big impact on other players in the pharmaceutical supply chain, according to Citigroup analyst Charles Boorady.

Upon perusal of [the list of drugs to be sold for $4] we find no change to our [earning estimates for PBMs] and therefore find the stock drop unwarranted. The vast majority are drugs PBMs bill and collected almost nothing for anyway because (1) were already low priced, (2) mostly acute drugs such as antibiotics and not maintenance meds, or (3) OTC drugs like multivitamins or pain meds

That narrow analysis is probably on target, but as I posted last night, the danger to payers is that it represents the beginning of the end of routine costs being paid by insurance, by making people see that it’s not worth the hassle. For example, here’s an excerpt of an email I received today from a family member:

I see in the paper today that K-Mart is offering generic drugs, including Atenolol, which I take, for $4 per 30 pills. After my insurance coverage does its thing, I pay $20 for 90 pills. Interesting.

That’s the kind of realization I’m talking about. Unlike Boorady, I don’t think the market oversold these stocks.

Can Wal-Mart save the American health care system?

published date
September 21st, 2006 by

Can Wal-Mart save the American health care system?

No one seems to have an answer to high and rising health care costs. A parade of solutions –managed care, disease management, health care IT, pay for performance, consumer directed care and so on– are tried, but nothing really works. Costs continue to rise at double digit rates with no end in site.

A big problem with health insurance now is that it covers everything, from the most routine items like checkups to the most expensive, like transplants. That coverage for everything has a way of distorting the market. If car insurance paid for gasoline, oil changes, wiper blades and car washes it would likely dull consumers’ shopping skills and boost costs by adding an administrative layer. Initiatives like “consumer driven auto care” wouldn’t change things that much.

Wal-Mart seems to have a strategy that could fundamentally shift the market: it’s making routine items cheap enough that insurance for them isn’t even worth the hassle. Today’s announcement of $4 generics is an important step in that direction. It makes the cash price lower than the typical co-pay. In-store clinics with low prices are the other component.

Why did Wal-Mart’s generic price announcement put such a dent in the stocks of pharmacy retailers and mail order players? It’s because those companies have been making very juicy profits on generics while payers weren’t noticing. Because of the dynamics of the insurance market, payers focus on getting patients switched over to generics from high-priced branded products. They haven’t really paid attention to the fact that while generic wholesale prices have been sliding due to the entry of many new players, prices haven’t been dropping at the retail level and payers haven’t been ratcheting down reimbursement.

Generics are a great market for Wal-Mart to play in because it can use its traditional supply chain management, scale and negotiating expertise. Even before today’s announcement Wal-Mart was selling many generic drugs below its competitors’ cost of acquisition, just like it does in other segments. It’s true that only cash customers –a small segment of the market– are directly affected by the announcement. But the long-term implications are significant.

In-store clinics are the other area where we can expect some serious moves by Wal-Mart. The typical independent physician office is a lot less efficient than the mom and pop stores Wal-Mart has buried. Physicians aren’t exactly like store owners, but in some parts of the country they will have plenty to fear as Wal-Mart (and maybe others) pull away patients for routine services and minor ailments. That will encourage patients to drop coverage for routine services (if they can) and enable health plans to set lower rates. I wouldn’t be at all surprised to see Wal-Mart start to hire significant numbers of doctors and put them to work in its stores.

If Wal-Mart can spur significant reductions in the cost of routine services and products, it will go a long way to cutting overall costs. It may also enable the emergence of appealing catastrophic insurance policies.