The PolyCap

Further to my last post, here are some considerations about the Polypill, which is five drugs combined into a single capsule. Firstly, the man behind the phase  2 testing of the drug.  Dr. Salim Yusuf, his bio can be found here, is a very, very respected investigator and physician in Canada.  In fact, it was through his work with the HOPE study (I think every physician in Canada knows this study inside and out), that lead to Ramipril becoming the #1 Ace Inhibitor in Canada.  Of course with a lot of marketing by the manufacturer.  Actually this points to another difference between Canada and the US.  The Number of total prescriptions for Ramipril in Canada was 4,736,000 for the one manufacturer that made the top 20 list from my previous post.  There are of course other manufacturers so that number is even higher.  It is the only ACE to make the list.  If you look at the US data you see that Lisinopril is the only ace to make their list and has 75.5 M prescriptions.  So the marketing efforts in the US for Ramipril were not as good. Two different companies had the marketing rights for Canada and the US.  

Ok, now back to the Polycap.  You can watch an ABC News story here to get more info, but I want to discuss what is next.   

They are suggesting a large follow up study.   This is a perfect time for Canada's Health bodies to get behind this world leader in his field and make the follow-up study happen.  It is most likely not a study that the BIG PHARMA group is going to fund.  These are drugs that have gone off Patent.  The Generic Industry most likely will not do this either.  One of the cornerstones of this product is that it can save $ and lives.  If, it saves dollars, then someone is not making as much.  That is a simple fact.  So who could see lost revenue from the introduction of such a pill.  I suspect the list includes the following, Big Pharma, Pharmacy (one prescription as opposed to 5), Insurance (if they are based on % of book of business), wholesalers, Generic companies (lost revenue of selling 5 products),  and perhaps even Consultants dependent on how their payments are structured.   So really it encompasses the whole supply chain.  But look at the masses that could potentially benefit.  Imagine, Benefit plans  and government plans could save money thereby  allowing more new break through drugs on their formularies.  The potential benefits may well be there in the end for the supply chain.  

The US Health structure promotes a desire to reduce pharmaceutical expenditures .   If a study is going to happen in the US , I hope we are getting behind Dr. Yusuf and helping him make this happen here in Canada. 

Something for future consideration is the following.... If the Study is done and indeed it proves that it saves lives, reduces expenditures, improves compliance,and makes it to market, how will it be promoted? Or Who will Promote it?  As from the Ramipril vs Lisinopril explanation, marketing is very very necessary.  

A Quick comparison of Canada and the US

IMS Health released the numbers last week for both Canada and the US .   It is interesting to compare some of the results as it gives a bit of insight into the differences between the two countries.   Firstly the US market as a whole is $291 B while Canada is $21.4 B.  So nothing startling there, Canada  is equivalent  7.3 % of US  Market.   

But we know that there are major differences in pricing between the US and Canada.  For example , US Brand pricing is the highest in the world and Canada is less due to our Price regulations.  The US has some of the lowest generic prices as seen with the Walmart introduction of $4 and $10 prescriptions which has lead most other retailers to follow suit.   In Canada, we have some of the highest generic prices in the world as there is little competition and a MAC pricing across the country.  So it is difficult to compare on $.  So lets look at Prescriptions.   ( I'll concentrate on statins here) 

If we look at Top 15 Drugs dispensed in the US you see 66.7 Million Prescriptions for Simvastatin (Primarily generic, trade name Zocor) and 57.9 Million Prescriptions for Lipitor.  Now compare this to The Top 20 Drugs Dispensed in Canada Table 6  .  Simvastatin is nowhere on that list, Lipitor has 14.8 Million Prescriptions and Crestor is there with 6 Million prescriptions.  My understanding is that Simvastatin has drastically declined in prescriptions in Canada while it has grown 39% in the US!   If you just look at Lipitor alone, as it is the only one with the high level data for both countries,  Canada is equivalent to 25% of the US usage. Think about that for a minute..... Canada is equivalent to 7.3 % of the total US Market in terms of dollars  but on a prescription basis for the #1 product in the world, Canada is equivalent to 25% of the prescriptions!!!!!  Obviously , Crestor has to have an even higher percentage and Simvastatin a really low number.     

So , some of the questions we need to ask are,  

1. Are all of these Americans at significantly greater risk than Canadians? 
2. Why is there such a difference? 
3. Why do Canadian governments and Industry not take advantage of the price reductions?
4. Can we learn from what is happening in the US ?
5. Are there ways the Canadian health Care system can save $?
6. etc. etc. etc

I've concentrated on Statins here but , we could have discussed other classes of drugs as well.  Perhaps my next post will be on the PolyPill .  You can read about it  here at the Lancet... 

Could save lives and money! 

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AZ going to battle again

This story just out from Reuters about the patent challenge on Crestor.  Quite a list of companies seeking to produce the generic form.  As the article states this is just the start of the battle.  You will recall that AZ has already inked a deal with Ranbaxy on some of their other products , such as   Nexium .  Perhaps this will lead to a deal on Crestor... Only time will tell. 

Pfizer is now increasing its Generic Business

Indeed things are very grey.  No longer can you assume that Brand and Generics are separate businesses..  Most if not all of the major Brand companies have either their own Generic Business or arrangements with generics.  Here is the latest from Reuters " Pfizer to license generics from India's Aurobindo"

Funny new commercials by TEVA in the US

This is cute.... TEVA for those of you who don't know it is called NovoPharm in Canada.  Here is a link to the you tube broadcast. "TEVA's Year of Affordable Healthcare"  There is a second video that you can watch called , Where am I?

A look from a global perspective

This article at Seeking Alpha, entitled" Biotech Going Generic Like Big Pharma?" is a great look at the movement within pharmaceuticals.  

Ed