The biggest-selling drug in 2018 will be…

EvaluatePharma, a UK based company specializing in pharma and biotech analysis has been gazing long and hard into its crystal ball.

Having scrutinized the world’s leading 3,500 pharmaceutical and biotech companies they have come up with a list of what, they believe, will be the top 10 selling drugs in 2018.

  1. Januvia       (diabetes) – $9.7 billion
  2. Humira        (arthritis) – $8.2 billion
  3. Avastin        (cancer) – $7.5 billion
  4. Enbrel          (arthritis)  – $7.2 billon
  5. Revlimid     (myelodysplastic syndrome) – $6.75 billion
  6. Prevnar 13  (pneumococcal vaccine) – $6.72 billion
  7. Rituxan         (cancer) – $6.3 billion
  8. Lantus           (diabetes) – $5.9 billion
  9. Remicade     (arthritis) – $5.8 billion
  10. Advair            (COPD)  – $5.7 billion

Surprised?  No conventional molecules, no cholesterol lowering agents, no blood pressure meds and not a single new drug among the top ten.  However, they predict the #11 best seller will be GS-7977 – the much anticipated oral hepatitis C drug from Gilead Sciences .

Not so surprising, given the obesity epidemic sweeping the western world that 2 of the front runners are diabetes drugs. Likewise, given the globally aging population – 3 are for arthritis.

#5 may be a surprise to many. Few people had ever heard of myelodysplastic syndrome before ABC news anchor Robin Roberts announced last week that she has the disease.  Still, it’s predicted number 5 status doesn’t mean that an epidemic is expected – it’s still relatively rare with only 10,000 or so new cases detected each year. Its lofty status on the list is more to do with the price. It costs a staggering $10,000 or so for a 28 day supply of the pills.

Other predictions from the EvaluatePharma World Preview 2018 report:

  • Worldwide prescription drug sales are forecast to total $885bn in 2018 an increase of 3.1% from 2011
  • Over $290bn of pharmaceutical sales are at risk from patent expirations between now and 2018
  • Pfizer was the top company for prescription drug sales in 2011, but  Novartis will top the list by 2018
  • Global pharmaceutical R&D spend forecast will grow by 1.5% per year to $149bn in 2018
  • Anti-coagulants (blood thinners) are set to record highest growth of major therapy categories to 2018

Interesting stuff. But the problem with such long term predictive models is that they are but a snapshot  trying to project out six years.

In reality, life is a movie, with a frequently changing plot. For example if J&J’s canagliflozin can reduce obesity and improve blood sugar levels better than Januvia then the projected No. 1 ranking is suspect, at best.

Could “No See” docs be doing a disservice to patients?

One of the biggest challenges facing any Pharma rep is the increasing number of  doctors who won’t see them. Every week, more and more physicians are restricting, and some even eliminating, their face time with sales reps.

In fact, the number of doctors willing to see reps has declined by about 20% since 2008.  And while some clinicians chose to do this, others have had it thrust upon them by their institutions or employers who are concerned that medical practice may be unduly influenced by pharmaceutical industry representatives.

Although  “no see” advocates argue that removing commercial influence is better for patients, a new study suggests the practice has downsides too.

This should be good news for the Pharma, who has always maintained that the clampdown on reps amounts to overkill and that more than selling, reps  provide information that can benefit patients.

The study, published in the Journal of Clinical Hypertension, divided medical practices into four categories. Based on the degree of sales representative access to clinicians, they were classified as either very low, low, medium, or high.

The clinical decisions, and prescribing behavior of over 72,000 physicians were then statistically analyzed, with regards to the drugs listed below:

The authors found that after the FDA approved Januvia, docs who had little interaction with reps took longer to write prescriptions than docs whose access to reps was not as restricted. Meanwhile, physicians who rarely, if ever, saw reps were slowest to change their prescribing habits after negative news emerged about Avandia and Vytorin .

Specifically, the study found that docs with very low access to reps had the lowest adoption rates for Januvia. They took between 1.6 and 4.6 times longer to start writing prescriptions after the pill was launched than docs who had low, medium or high access to reps. Docs who had very low access to reps were also 4 times slower than those of their counterparts to reduce their use of Avandia, after the Black Box warning was issued in 2007.  There was also “significantly less” change in the prescribing habits of those who had less access to reps in response to controversial and disappointing trial results released in 2008 for Vytorin, than those with fewer restrictions on rep interactions.

The study authors commented, “These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs.”

George Chressanthis, professor of healthcare management and marketing, and acting director for the Center for Healthcare Research and Management at Temple University Fox School of Business, agrees.

The study affirms simple intuition that when physicians have to make decisions involving complex issues with less than complete information available to them, and where the consequence of a wrong decision is significant… unintended consequences are likely to appear. Policies that promote physician ignorance of new medical information resulting from access limits, run counter to protecting patient health.”

Could increasing, rather than decreasing  sales representative access to physicians lead to better clinical decision making and better patient health? Let us know what you think.