Street Prices of Rx Brand-Name Drugs Increase as Much as 400%!

Drug companies always claim that the wholesale price of drugs is not an good indicator of what patients, insurers, and the government pay. So a new study published in JAMA Dermatology looked at the retail prices 19 brand-name prescription dermatologic drugs sold at four national chain pharmacies in the West Palm Beach, Fla., area (Costco, CVS, Sam’s Club and Walgreens) in 2009, 2011, 2014 and 2015.

The authors found that between 2009 and 2015:

• Prices of all surveyed classes of brand-name drugs increased; the average increase was 401 percent. Prices of topical antineoplastic drugs had the greatest average absolute and percentage increase of nearly $10,927 and 1,240 percent. 
• Prices of drugs in the antiinfective class had the smallest average absolute increase of almost $334. 
• Prices of psoriasis medications had the smallest average percentage increase of 180 percent. 
• The retail prices of seven drugs more than quadrupled during the study period, with the vast majority of price increases occurring after 2011. 

“Percent increases for multiple, frequently prescribed medications greatly outpaced inflation, national health expenditure growth, and increases in reimbursement for physician services,” the study concludes.

There was one surprising finding.

A Pfizer-Stuffed Allergan for Wall Street Thanksgiving!

See the recipe below.

Increased DTC Advertising and Rising Drug Prices - Is There a Causal Link?

There's no denying two facts:

FACT #1: Spending on prescription drugs is increasing dramatically. The Chicago Tribune, quoting data from IMS health, reported (here) that "Spending [in 2014] rose 13 percent [vs. 2013], the biggest jump since 2001, to a total of $374 billion" and

FACT #2: Spending on Direct-to-Consumer Advertising (DTCA) of prescription drugs is also increasing - more so, in fact. Kanter Media reported that the drug industry increased measured media ad spending by 19% in 2014 vs 2013 to $4.5 Bn (see chart below).

Click on chart for an enlarged view.

Is there a causal link between these two facts? Does DTC advertising raise the cost of drugs?

Bernie Sanders Blasts FDA Commish Nominee Califf on Drug Reimportation

Senator Bernie Sanders laid into FDA Commissioner nominee Robert Califf during yesterday's Senate hearing. Here's a snippet of his comments regarding reimportation of Rx drugs as a means to lower drug prices - an issue of importance to 91% of voters (for more on that, read this):

Bernie Sanders to Robert Califf: "You're Not the One."

How Kim Kardashian Got Hired to Shill for Diclegis by "Auditioning" in a Nutraceutical Ad

You may recall that the FDA sent a letter to Duchesnay Inc. because an Instagram post by Kim Kardashian promoting the company's morning sickness drug Diclegis violated the law (read "Kim Kardashian's Diclegis Instagram Post Raises Issues").

Some time afterward, Alex Peterson, SVP, Health Practice Director at Makovsky -- the agency that hired Kim to do the Diclegis Instagram social media campaign - claimed that Makovsky, through social monitoring, knew that Kardashian was struggling with nausea during her first pregnancy. She’d been talking about morning sickness for weeks (read this account).

No doubt Makovsky also knew that Kardashian promoted nutraceuticals years earlier in 2010. As reported by STAT, in a video ad for QuickTrim (see end of this post), "Khloe Kardashian rolls languorously in a tangle of white sheets and asks, 'Do you feel sexy? Do you have the body you’ve always dreamed of?' The shot switches to her sister Kim, shimmying out of a pool and commanding viewers to 'Create the body you deserve'" (read "Celebrity selfies, lax regulations drive booming supplement industry").

Makovsky claimed they reached out to tell Kim about Diclegis and found out that she was already taking the drug -- her doctor had just prescribed it.

But could Kim have been talking about her morning sickness as a prelude to working with Makovsky so that the above account by Peterson would sound perfectly plausible?

Pharma Digital Investment is Increasing, But Still Only 3-6% of the Total Promotional Spend

Every year I get a call from a market analyst asking me what the trend is for digital marketing spending in the pharmaceutical industry. He wants to know if the profits of health websites, which depend on drug display ads, will increase or decrease next year.

Who am I to judge?

I only report the data I glean from various sources. For example, recent data from IMS Health Global Pharmaceuticals Marketing Channel Reference indicates that worldwide pharmaceutical industry investment (i.e., spending) in sales force and marketing channels was nearly $71 billion in 2014 - a drop in 1.4% from 2013. BUT... the digital channel investment increased 32%!

Source: IMS Health. Click on image for an enlarged, readable view.

However, spending on digital channels accounts for only $2.3bn or 3.2% of the total $71 billion promotional spend worldwide.

Let's dive a bit deeper into the data and compare it to other estimates over the years.

In-Video Drug Ads on YouTube: Should They be "Non-Skippable?"

Yesterday, I wanted to cook stuffed artichokes for dinner. So, I searched Google for a video and found this on YouTube: "ITALIAN STUFFED ARTICHOKES - SICILIAN STYLE - EASTER DINER RECIPE."

Before the cooking lesson started, there was an in-video ad for an Rx drug, the name of which I can't recall right now. No matter. After 15 seconds or so I realized I could click on "Skip Ad" and not hear any more of the side effects, aka FDA-required Important Safety Information (ISI), "major statement," and "Fair Balance" stuff that is usually crammed into Direct-to-Consumer (DTC) TV ads after about 20 or 30 seconds.

Ruth Day of Duke University once said of print and TV DTC drug ads (here): “Risk information is physically present but functionally absent.” This accurately describes what's happening in skippable in-video DTC ads on Youtube.

According to YouTube Help, there are two versions of in-video ads: (1) skippable ads like the one I saw, and (2) non-skippable ads.

It seems that pharma uses only the former, not the latter. Is this acceptable?

History of the Pharmaguy Pioneer Hawaiian Shirt

The yellow and black Hawaiian shirt is the symbol of the Pharmaguy Social Media Pioneer Award, better known as the “Pharmaguy Pioneer Award” for short.

What began as an outlandish ploy to grab attention has gradually become one of the most iconic and recognizable trophies in digital pharmaceutical marketing.

After the U.S. Food and Drug Administration (FDA) announced it would hold a public hearing regarding regulation of pharma's use of the Internet and social media in November, 2009 (here), Pharmaguy started appearing at conferences in the iconic shirt, which was left over from a Hunter S. Thompson Halloween costume (here).

Left: Pharmaguy as Hunter S. Thompson at a 2009 Halloween party.
Right: Pharmaguy at the 3rd Annual Digital Pharma East "un" conference
(there is some controversy regarding the sequence of these events)

That Halloween season was a scary time and attendees of the 3rd Annual Digital Pharma East "un" conferences anticipated much "fear in loathing" in Washington, DC at the upcoming FDA hearing!

AMA #AHealthierNation Tweet Chat: How to Get Physicians Involved in Development of Digital Tools

Yesterday, while trolling my Twitter streams for content, I happened upon #AHealthierNation chat sponsored by the American Medical Association (AMA). According to AMA's promo page (here):

"The potential impact of digital technology on health care is undeniable. Our tweet chat examined the role physicians should play in shaping the future of digital medicine and how new innovations can enhance workflow and expand the physician-patient relationship."

According to symplur analytics, the chat included over 100 participants, more than 500 tweets, and 22.4 million impressions! I was responsible for 10 tweets, which garnered 239,000 impressions.

Seven questions were up for discussion:

1. How do you get physicians involved in the development of tools for digital medicine?
2. Not everyone can be an inventor, so where do physician feedback opportunities exist?
3. Have too many digital solutions overlooked the basics of a physician's workflow and the need to create efficiencies?
4. With user-centered design, what are the biggest challenges for two very different users: physicians and patients?
5. For a patient, what does engagement look like? How has the attention around wearables figured into that definition?
6. What are the obstacles that must be addressed for wearable to receive broader physician adoption?
7. What do we need to learn to make digital health/medicine a success in the future?

Questions 1, 2, 3, 5, and 6 generated the most discussion. Here's my synopsis/review (see the complete #AHealthierNation tweet timeline embedded at the end of this post).

Is Martin Shkreli a Psychopath?

Martin Shkreli, CEO of Turing Pharmaceuticals, is a former hedge fund manager who has become the public face of the drug pricing controversy after his company raised the price of the anti-infection drug Daraprim by more than 5,000 percent.

Now the Senate’s special committee on aging requested documents and information from Turing and invited Shkreli to testify.

Shkreli taunted politicians on Tweeter days before the Senate invite, saying he was "In DC. If any politicians want to start, come at me" (read "Senate Invites Turing CEO Shkreli to Visit. Just What He Wanted!") - a taunt typical of a Psychopath. Indeed, Shkreli has been called a "morally bankrupt sociopath," a "greedy sociopath," a "sociopathic bounty hunter," and an "evil sociopathic asshole."

I don't think Shkreli is a sociopath - I think he better fits the profile of a psychopath. To find out, I took a PsychCentral "Psychopathy Quiz" posing as Shkreli and supplying answers I thought indicative of his behavior. So, how did he score?

The Value of Medical Content Channels According to HCPs vs Pharma Professionals

A study conducted from July – August 2015 by EPG Health Media, publisher of epgonline.org (a website for healthcare professionals) found some "significant gaps and imbalances" between how healthcare professionals (HCPs) and pharma industry professionals (Pharma) view the value of medical content delivery channels.

Keep in mind that the results are based on a very limited number of survey participants, which include 216 HCPs and 137 pharmaceutical industry professionals (66 pharmaceutical professionals and 71 service providers).

I selected a few channels to look at (mostly digital) and replotted the data in the following chart, which shows the percent of respondents (HCPs v. Pharma) who consider that the channels have moderate or significant value for HCPs.

Click on image for an enlarged view.

What are the key takeaways from this study?

Relaxing Rules for Off-Label Prescribing: "Akin to Crying 'Fire!' in a Crowded Theater?"

In the Amarin court case, the court ruled that the company has the right, under the First Amendment, to promote information to health-care professionals about certain uses of the drug Vascepa that aren't covered by the drug's FDA-approved labeling -- as long as the information is true and not misleading (read "Amarin Wins Off-Label Case Against FDA"). This case is likely to influence new guidance from the FDA regarding off-label drug promotion by pharma marketers.

"Might changes in rules for promotion of off-label indications based on free speech arguments lead to a situation akin to crying fire in a crowded theater?," asks authors of Commentary published in the recent issue of JAMA Internal Medicine. The authors of the commentary -- Chester B. Good, M.D., M.P.H., and Walid F. Gellad, M.D., M.P.H., of the Veterans Affairs Pittsburgh Heathcare System -- referred to "compelling evidence" that "off-label prescribing is frequently inappropriate and that prescribing in these circumstances increases the risk for an adverse event substantially."

That evidence was presented in a study published in the same issue of the journal titled "Off-label Prescription Drug Use and Adverse Drug Events" (JAMA Intern Med. Published online November 2, 2015. doi:10.1001/jamainternmed.2015.6058).

What is the "compelling evidence?"