So much for "best in class." Despite having the brightest data set of all the oral anticoagulants, the newest one is ofito a rocky start. What's behind the Factor Xa fail? A confluence of factors, from sales strategy to market access. DTC advertising and medical education are under way, but it may take more to revive this launch.
Mention a primary care sales force in a pharmaceutical company boardroom today and you're likely to elicit a lot of frowns and scowls, if not a spear thrown in your general direction. With specialty medicine, biotech and rare diseases on fire, everyone is seeking to emulate
Yet, if you're going to build a multi-billion-dollar cardiovascular franchise, effectively capturing the hearts and minds of the PCP is still critical. And those CV marketers who don't engage the PCP as fervently as in years past may elicit a lot of frowns and scowls-and possibly a spear-from disappointed investors.
Which brings us to the case of Pfizer and
"We expected a lot more out of Eliquis in terms of sales," notes
That's just one of the questions swirling around what's been an extremely sluggish launch. While the drug is still expected to be a blockbuster, it's way offthe consensus estimate for 2013 sales, which started out at
And even that may be a stretch. BMS reported
Drugmaker efforts to improve performance have included deploying a DTC campaign and increasing peer-to-peer med-ed activities-basically paying physicians to lecture other docs about the full data set. "We are the only agent with superiority claims vs. warfarin in the three key outcomes of stroke and embolism, major bleeding and also mortality," said BMS CEO
"The other two new agents cannot make the same triple-superiority claim," he said, referring to the two previously approved factor drugs, Boehringer Ingelheim's Pradaxa (dabigatran) and
Yet differentiation through data has yet to prevail, perhaps because the company has not put sufficient marketing muscle behind PCP efforts, despite good initial uptake in cardiology. Since cardiologists may be more difficult to see, PCPs are the ones who are driving the Factor Xa anticoagulant business. They have little time to fight with insurers and thus they may be more likely to cave when access becomes a challenge, especially when warfarin is available cheaply.
Another factor is market access. The drug has over 80% of lives covered in the commercial space, BMS said, and over 75% of lives covered in the
Eliquis has slightly higher rejection rates than Xarelto in both commercial (9% vs. 6%) and
As to why Eliquis 'scripts are being bounced more frequently, the reasons for that relate specifically to restricting utilization. Symphony's analysis of
"The launch did not go as expected for a product that had superior data compared to the competition; demand and access could have been better,"
To improve access, Whang, who is also a board-certified cardiologist, suggests the companies leverage the AVERROES study with, and target populations more clearly to, payers. He also advises that they better support patient cost share, and demonstrate net process-of-care benefits over Coumadin clinics.
Some still see reason for optimism. "With renewed vigor, the sponsors have been re-focusing on the rank-and-file docs, and we see the gap closing," says inThought's Henderson.
Indeed, according to a November note from
The slow launch has dampened recovery plans for both marketing partners. Eliquis was seen as the sign of a new beginning for Pfizer following the devastating financial crater that was leftby the patent expiry of Lipitor. The drug was also expected to fill a hole in the BMS balance sheet that was leftby the LOE on antiplatelet drug Plavix.
Their setback could work to the advantage of the two oral anticoagulant incumbents, Pradaxa and Xarelto. According to Henderson, "There are some data that J&J has done a great job of approaching the PCP."
On the other hand, the Eliquis situation may or may not foster opportunity for a potential new Factor X entrant in Phase III trials,
"Edoxaban is not likely to set the world on fire, but it should nonetheless be an approvable new entrant into the category," notes Anderson. "And, as Xarelto's resilience in the setting of Eliquis' launch has shown, once-daily dosing does appear to have commercial value."
Dr. Anderson posits two potential commercial pathways for
Does the Eliquis experience suggest that pharma's pendulum has swung too much toward specialists? As drugmakers have shifted toward specialty drugs, and sized their field forces accordingly, the big companies no longer have armies of PCP sales reps able to blanket the country's internists on a moment's notice with a sales message. That whole model is a thing of the past. But the small sales force adept at getting to specialists doesn't work when launching a drug for anticoagulation.
Henderson sums up the lesson learned: "When you are third to market...you have to be better. This is a case where data did not win-and hopefully it will at some point."
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