December 2008

Atypical Antipsychotic Drugs Primed for Significant Growth in Antidepressant Market

Summary: Study reveals growth for Abilify and similar atypical antipsychotic therapies depends on increasing physicians’ comfort in prescribing for a broader range of depression patients
 

Abilify, one of the first atypical antipsychotics to receive an indication as an add-on therapy for the treatment of depression, has garnered the attention of physicians since its FDA approval in November 2007. But real growth for this brand – and other market entrants such as Seroquel, which is expected to receive a similar indication in 2009 – will require greater comfort among primary care physicians (PCPs) in using atypical antipsychotics with a broader set of depression sufferers, according to new research by GfK Market Measures.

While the research revealed that 35 percent of PCPs were familiar with Abilify as a newly approved augmentation therapy for the treatment of depression, the drug faces challenges in increasing PCPs’ confidence in the category; only 20 percent of PCPs participating in the study reported “comfort prescribing atypical antipsychotics for my unipolar depression patients.”

However, PCPs’ reported use of add-on therapies with depression patients – and prescribing of atypical antipsychotics in particular – points to the significant growth opportunities for Abilify and future market entrants. PCPs participating in GfK’s study reported prescribing add-on therapies for approximately 25 percent of depression patients in order to treat the signs and symptoms of depression. Furthermore, the specific add-on therapy prescribed for 12 percent of these patients was an atypical antipsychotic.

While the growth potential in this category is clear, one likely limitation to greater use of Abilify is the stigma associated with the use of atypical antipsychotics. As part of its research study, GfK looked at physicians’ self-reported prescribing habits and attitudes toward the use of this drug category in order to identify key drivers in PCPs’ likelihood of prescribing the atypicals as add-on therapy. By far, the predominant driver of success was PCPs’ agreement with the statement, “I am comfortable prescribing atypical antipsychotics if a patient’s unipolar depression is ‘refractory.’” However, only about one-third of PCPs reported “strong agreement” with this statement, suggesting a considerable lack of comfort with the use of atypical antipsychotics in a broad set of patients.

“One avenue of opportunity may be the activating benefits being associated with Abilify,” said Geoff Penney, Vice President and Category Business Leader, Psychiatry, GfK Market Measures. “In qualitative interviews, physicians are telling us the ‘brightening’ effects of Abilify are seen as a positive in the treatment of depression and other psychiatric conditions. These activating or ‘brightening’ benefits are likely to find use in appropriate patients, given the relatively high proportion of patients who report fatigue, sluggishness and general indifference to daily activities.”

In comparing reported symptoms, GfK’s depression research with both physicians and patients showed both groups are in general agreement that about 40 percent of patients report fatigue and general lethargy; the symptoms are among the highest reported by both physicians and patients. These stakeholders also tend to agree that depression patients struggle with focus and concentration. The study showed physicians and patients are in general agreement that about 30 percent of patients report troubles with focus and concentration.

“Once again, the activating or ‘brightening’ benefits of Abilify could find use among these patients,” said Mr. Penney. “Physicians are accustomed to using antidepressants’ side effects to patients’ advantage. For many years, some physicians have used the Wellbutrin brand to provide ‘activating’ benefits in addition to the antidepressant effects. Physicians, however, have told us through qualitative depth interviews that Wellbutrin feels more like an amphetamine or caffeine ‘rush’ that of course can represent overly activating effects. So while physicians appreciate the activating qualities of the Wellbutrin brand there are limitations that may spell opportunities for Abilify.”

Reflecting insights from 1,484 diagnosed sufferers of depression and/or anxiety, fielded via Internet questionnaire in March 2008, GfK Market Measures’ 2008 Depression-Anxiety Patient Study provides a comprehensive analysis of the depression and anxiety markets from the perspective of diagnosed sufferers. Reflecting insights from 260 physicians, including general/family practitioners, internists and psychiatrists, fielded via Internet questionnaire in December 2007, GfK Market Measures’ 2008 Treatment of Depression Physician Study provides a comprehensive analysis of the depression market from the perspective of treating physicians.

Contact: Geoff Penney, VP, Category Business Leader, Psychiatry
gpenney@gfkmm.com


  
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Managed Markets Monitor Provides Industry’s First Continuous Audit of Sales and Marketing Activities Targeted at Managed Care Decision Makers

Summary: Monitor features routine reporting from 40 managed care decision makers on specifics of sales force interactions and their impact on key brands; pilot study reveals value of competitive insights for manufacturers
  GfK Market Measures announced today an exclusive new tool for pharmaceutical manufacturers to assess the value and impact of their increasingly important managed markets sales and marketing activities. Managed Markets Monitor provides the industry’s first-ever continuous audit and tracking of sales force interactions, through quarterly reporting from a panel of 40 managed care decision makers who are collectively responsible for almost half of all commercially covered lives.

Monitor engages this panel in routine reporting of specifics surrounding the frequency of sales force activity and, moreover, feedback across five dimensions related to these sales call interactions: who represented the manufacturer, specific products discussed, specific messages relayed, value of the exchanges, and likelihood that the interaction will yield positive outcomes for manufacturers based upon the information relayed during the interactions. Monitor’s ongoing measurement of key account management sales force effectiveness enables manufacturers to determine whether strategies and programs are on target or need refinement.

While the first quarterly report from Managed Markets Monitor will not be available until early April, GfK recently conducted a pilot study that lends insights into the type of information future reports will capture. Specific to sales force activity, the pilot study showed that during the month of October, Novartis (cited in 58 percent of all reported interactions) and GSK (55 percent) reached the greatest proportion of managed care decision makers surveyed; J&J, Pfizer and GSK made the most calls, ranging in number from 75 to 63, respectively. As MCO participants report on both in-person and non-personal interactions (e.g., phone calls, e-mails, Web presentations), the study revealed that J&J, Pfizer and particularly AstraZeneca engage in substantially less frequent in-person interactions than by other means. Conversely, interactions with Novartis and Schering are equally as likely to be in-person as well as by other means. Dyslipidemia and diabetes were the therapy areas most discussed during this time frame with Pfizer leading the way on discussions about lipids (cited in 46 percent of the company’s reported interactions) and Merck (57 percent of Merck interactions) driving diabetes discussions.

In addition to assessing which manufacturers were most active, MCO decision makers provided feedback across five dimensions related to these sales call interactions. Here, the study showed that product discussions overwhelmingly focused on single products (68 percent of all reported interactions) with interactions concentrated toward clinical data and contracting at equal levels. Additional detail revealed that when a group meeting is held, GSK is most actively leveraging the medical science liaison as part of the interaction. Further, more than 30 percent of interactions were considered very or extremely valuable and almost 40 percent were also considered very or extremely relevant. Finally, the pilot study demonstrated that, according to the panel, likelihood to consider changes to formulary status or restrictions is largely influenced by the specific information provided during these interactions, while the MCO decision maker’s prior experience in the therapy area often presents a lingering obstacle.

“The growing influence of managed care on prescribing and dispensing makes understanding of sales and marketing activities to this stakeholder increasingly important,” said Sue Ramspacher, Senior Vice President of Managed Markets Research at GfK Market Measures. “Just as pharma sales management needs to assess effectiveness of its detail force, managed markets’ key account management must understand how their own – and their competitors’ – sales and marketing tools and techniques are being perceived by and are influencing managed care decision makers.”

While in recent years pharmaceutical manufacturers have engaged in other means of research on managed care sales force effectiveness, GfK’s Managed Markets Monitor is an industry first because of its continuous audit component: the ability to track and trend reported sales force interactions – both for a manufacturer’s products as well as its competitors’ products – on an ongoing basis.

“For an assessment of this nature to be effective and actionable, a single point-in-time or occasional evaluation is not sufficient. Rather, a continuous examination is needed of which companies are most active, which products are most discussed and which messages are most often relayed. Also critical is feedback on how valuable and relevant the messages are perceived to be and how strongly they will influence formulary decision making,” said Ms. Ramspacher.
GfK’s Managed Markets Monitor pilot reflects insights from 40 managed care decision makers (29 pharmacy directors and 11 medical directors) from unique organizations including four PBMs and 36 MCOs (representing 48 percent of all commercially covered lives and with 31 organizations that offer Part D benefit in addition to commercial coverage). Respondents are asked to complete a three-minute Web-based survey (The “Pulse”) on a weekly basis to quantify the number and type of interactions that occurred in the past week. Over the course of four weeks, they are asked to complete a minimum of four, and a maximum of eight, five-minute surveys (The “Particulars”) to explore, in detail, a specific interaction that occurred within the past week.

Contact: Sue Ramspacher, SVP, Managed Markets Research
sramspacher@gfkmm.com


  
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