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The impact of infertility

The views of young women late adolescence to mid-twenties

Vignette 2: Kate, age 26

For Shauna, the early emotional disruptions in childhood and issues associated with repeated surgery, alongside support from her family and hospital doctor, seem to have given her a determination to adapt to the condition, to think about infertility and to move forward. Shauna was also young enough to have growth hormone treatment Buy Kamagra online and to be part of a somewhat more optimistic milieu of assisted reproduction that implies more choice for adult women with TS. For Kate, just a few years older, growth hormone had not been available. As Kate did not attend the hospital clinic she did not have the early hospital counselling opportunity to talk about the lack of control over the body that she experienced in her childhood and adolescent medical reviews, or even to talk over teasing and being short. Sinason writes about the alienation of some people from their bodies when there is a trauma to the body of a physical or social kind. She postulates that after the primary trauma, there can be a secondary trauma, which may have been present for Kate in her mid-twenties as a result of not speaking about or understanding the original insult to her body.

The perspective from adult women mid-thirties to sixties

To explore the place of fertility from a longer perspective, I invited adults with TS from the VTSA, through their newsletter, to a semistructured group discussion on the topic of fertility. Five women accepted. They ranged in age from mid-thirties to early sixties; two were married with adopted children, one was married with no plans for children, a fourth was unmarried, and a fifth was engaged to be married and interested in IVF.

Fertility began to matter to the women in their late teens and early twenties although three had learned about it in their early teens. Of these, one woman said it mattered to her after the end of her first marriage at 24; two others said it mattered to them at 17 and 19 years. The other two women had only learned later about their syndrome (at 16 and 20 respectively) and infertility mattered to them straight away. But even then, as one woman said:

  • It was not on my mind a terrible lot, I thought I’d cross that bridge when I come to it – it was a mighty bridge.

The five women said, looking back, infertility impacted on their self-worth, self-esteem or on making new relationships. One woman referred to TS impacting on sexuality:

  • It’s more unsureness about the missing X chromosome. Am I a full woman? Can I have a full sexual relationship?

Phytopharmaceuticals

A clear distinction exists between gentle or mite phytopharmaceuticals on the one hand, and powerful or forte phytopharmaceuticals on the other. Between them lies a wide transitional field, i.e. the many medicinal plants with actions somewhere between ‘gentle’ and ‘powerful’- Liquiritia, Arnica and Khella, to mention just a few. These might also be referred to as ‘intermediate’ phytopharmaceuticals. The situation is the same for phytotherapeutic agents as it is for chemotherapeutic ones. With these we have a similarly wide spectrum from gentle and largely non-toxic drugs such as calcium carbonate, or even aspirin, to the modern cytostatics with their very powerful actions. Here too the majority of drugs are in the middle. Like everywhere else, life swings between two poles. It is wrong, or at least one-sided, to think only of gentle phytopharmaceuticals when speaking of phytopharmaceuticals, and to belittle them, if not in words, then at least in one’s thoughts. It is nevertheless true, with most gentle phytopharmaceuticals, that there is no standardized active principle that solely or largely determines the drug action. The gentle pharmaceuticals in particular demonstrate that with plant remedies one very often has a comprehensive complex of active principles, with individual components interacting with others, so that only the complex as a whole will produce the therapeutic action. One might speak of a bio-pharmaceutical. The diagram overleaf will help to illustrate this.
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Where Did the Term Phytotherapy Originate?

The term was introduced by the French physician Henri Leclerc (1870-1955). He had published numerous essays on the use of medicinal plants, most of them in La Presse Medicale, a leading French medical journal. These essays were outstanding for their style, and superb examples of the art of presenting a subject. He summed up his life-time experience in Pr&s de Phytothkrapie, a concise work that has since become a classic. Leclerc’s life and work were described in lively terms in an obituary which appeared in La Presse Medicale on 14 May 1955. Herbal medicine has come a long way since the days of the ancient ‘herbalism’. The study of the use of medicinal plants is now a scientific subject, a field of medicine in the same way as chemotherapy, hydrotherapy, electrotherapy and others. Knowledge of medicinal plants and their uses has been recorded from antiquity – by Imhotep, the priest-physician of ancient Egypt who devised the Step Pyramid of Sakkara, by Galen, personal physician to the Roman emperor Marcus Aurelius, and later by Paracelsus, the Abbess Hildegard of Bingen, and the authors of the great herbals of medieval times, right to the present day. The rise of chemistry, the development of numerous synthetic chemical drugs, and the possibilities opened up by experimental pharmacology have caused herbal knowledge to be neglected. A new climate was created by methods evolved on the basis of modem physiology, concerned predominantly with effects that were measurable under experimental conditions. In this framework it was difficult to know what to do with the medicinal plants. Chemical compounds could always be exactly analyzed giving results in parts by weight of so and so many milligrams, etc. In phytotherapy this method on the whole applies only to medicinal plants with powerful actions – great difficulties arise in other aspects of the work, particularly with many of the plants with gentle actions.

Pharmacy Industry News: Four legs or two, same pharmacy

Four legs or two, same pharmacy

Millions of people adore their pets and consider them almost family. Kroger is now offering prescription medications for their four-legged kin at all 100 of its pharmacies in the Houston area.

After launching a pilot program last year, Kroger has more recently expanded pet meds into all its pharmacies nationally. The Cincinnati-based grocer aims to undercut veterinarians on price, and many pet medications are included in Kroger’s $4 generic drug program, said Marla Fielder, the assistant director of pharmacy in Kroger’s Southwest division.

Many other pharmacies offer drugs for pets that are also used by humans, such as blood pressure medicine, but Kroger is among the relative few selling pet-only medications such as, for example, Baytril, a broad spectrum antibiotic for cats and dogs; and Rimadyl, a non- steroidal anti-inflammatory drug for dogs. Target also offers pet-only meds in 670 pharmacies nationwide, although none of them are in Houston.

Some grocery analysts say offering prescription drugs for pets is a good way to increase revenue. The U.S. animal health industry generates about $4 billion in sales of packaged pharmaceuticals and vaccines annually, said Bob Fountain, president and CEO of Stonington, Conn.-based Fountain Agricounsel, a management consulting firm for agribusiness and animal health industries.

“I wouldn’t be surprised if Kroger’s pet medication business became very popular,” said Terrie Ellerbee, associate editor of the Shelby Report, a Gainesville, Ga.-based supermarket trade publication.

“It’s an interesting concept and something the grocery industry will be watching,” said David Livingston, a grocery industry analyst at Waukesha, Wis.-based DJL Research. Grocers are already selling pet food, he said, and there are vast numbers of pet owners.

Once mainly restricted to veterinarians, the selling of prescription pet medications by retailers such as Kroger represents a significant change in the animal health industry, Fountain said. There is also a growing market for animal health products via the Internet, he noted. Online companies such as PetMed Express and Drs. Foster & Smith sell prescribed pet medications once they receive copies of veterinarians’ prescriptions.

Kroger’s offering of vet-prescribed pet drugs “is a natural extension of what’s been going on in the industry,” said Fountain, who noted that many retailers, including mass market, drug and pet stores as well as grocery chains, are selling more and more over-the-counter pet medications such as flea and tick treatments.

Traditionally, vets have marked up their pet medication prices by as much as 100 percent, he said, but in a still less-than-robust economy, many pet owners are looking for lower prices from over-the counter retailers like PetSmart, Petco, Wal-Mart and Target – particularly for flea and tick medications, he said.

Ask a vet

Along with selling over-the-counter flea and tick products, all 20 Houston-area PetSmarts have Banfield Pet Hospitals that can prescribe pet meds, PetSmart spokeswoman Toni Eberhardt noted.

While Kroger offers a full range of medications, there are other pet drugs that consumers may be able to find only at their vets, Fielder said: “It’s wise for pet owners to ask their vet if they’re able to purchase the prescribed medication at a retail pharmacy.”

Doctors who treat humans do not fill their own prescriptions, whereas it is a huge profit center for veterinarians, Fountain noted: “Vets will have to work hard to maintain their income from medications.”

Dr. Diane Wilkie, co-owner of Richmond Ave. Animal Hospital, said she tries to be competitive on pet med prices.

“We’re usually $5 or $10 more, but sometimes less than retailers,” she said. “I understand it’s a competitive market. My only concern is whether retailers get their meds directly from the manufacturer or from a third party.”

PHO supports pharmacy at Blenheim Warehouse

Discussions are underway between Nelson Marlborough DHB, The Warehouse and a potential new owner of its Blenheim pharmacy to keep the chemist open.

The Warehouse announced before Christmas it would be closing its six pharmacies based at stores around the country. The closures affect 29 staff members, four in Blenheim, reports in town’s newspaper, The Marlborough Express, show.

PHO keen to see pharmacy stay

Kimi Hauora Wairau (Marlborough) PHO chief executive Christine Smith is keen to see the pharmacy, based at The Warehouse store, stay because it increases accessibility for high needs families and the elderly.

“We are concerned about the pharmacy at The Warehouse, being a very strong community pharmacy, under threat,” Ms Smith says.

She says the pharmacy at The Warehouse is easy for people to access given its central location and opening hours – 9am to 8pm.

“That (pharmacy) has made particular inroads into families we know would not have scripts filled but will take them to The Warehouse because it is so accessible,” Ms Smith says.

Negotiations with new owners proceeding

Commercial negotiations were proceeding between The Warehouse, DHB and potential new owners, she says.

Ms Smith could not name the potential new owner.

Nelson Marlborough DHB also would not give any information about the potential new owner.

“We are aware of contract negotiations currently underway and are waiting to hear the outcome of these,” DHB clinical services support directorate service director James Bowyer says.

Chief pharmacist at the chemist, Debbie Carter said she could not give any details.

“We should have information by the end of the week,” she says.

Closure delayed

Reports in The Marlborough Express reveal The Warehouse initially intended to close the pharmacy at its Blenheim store after the end of January but it has decided to delay closure while negotiations are underway.

Several pharmacy users have commented on The Marlborough Express website.

One reader commented that the pharmacy is willing to compound two medications into a liquid and order special prescription formula for her child without charging extra fees, saving her about $200 per month.

Online poll shows good support

The Marlborough Express, ran an online poll asking readers: Do you use the Warehouse pharmacy?”

This morning, almost half of the 313 respondents said “yes, it’s great”.

Those who use it “sometimes” totalled 15.7 per cent. Just over 12 per cent said they used it “once or twice” and the remainder (22.4) per cent said they “never” used it.

Pharmacy Industry News: Truveris Introduces TruBid to Cut Prescription Drug Costs

Truveris Introduces TruBid to Cut Prescription Drug Costs

In its mission to simplify the complex payment process that plagues the prescription drug benefits industry, today Truveris, Inc. introduced TruBid, a Web-based software tool that helps health insurance companies and self-insured organizations negotiate and enforce more favorable contract terms with their Prescription Benefit Managers (PBMs). TruBid is the latest addition to the Truveris product suite which can save customers up to 12 percent annually on prescription drug claims by inviting PBMs to bid for their business through a standardized, automated reverse auction. TruBid helps PBMs expedite their contract, pricing and bidding initiatives, creating a dramatically more efficient process for everyone involved.

“Until now, the RFP process has been so static and cumbersome that customers typically stick to their incumbent PBM and end up overpaying for healthcare. The automation provides results in under half the time at a much reduced fee.“”

“While PBMs are integral to the prescription claims process, when we revisit our terms each year, it is time consuming and we never know if we’re really getting the best deal,” said John Cove, director of benefits, Hanley Wood. “PBM contracts are complicated and confusing. TruBid helps us structure an agreement with PBMs that we understand and can enforce.”

Americans spend in excess of $307 billion a year on prescription drugs. By serving as an intermediary among pharmacies, drug manufacturers and employers, PBMs can secure favorable pricing for payers to minimize spending. TruBid helps these payers – insurance companies and self-insured organizations – drive even more savings by making their request for proposals (RFP) to PBMs through an automated, Web-based software program, creating a reverse auction. This approach ensures standard contract terms, enforces drug pricing definitions and establishes consistent benchmarks. By using TruBid, CFOs mitigate risk and financial waste, human resources professionals, who commonly manage health benefit plans, save time and CIOs streamline business processes by shifting from a manual to automated process.

“TruBid puts customers back in control of their pharmacy benefit costs by fostering transparency and equitable business practices among PBMs,” said Bryan Birch, chairman, president and CEO, Truveris. “Until now, the RFP process has been so static and cumbersome that customers typically stick to their incumbent PBM and end up overpaying for healthcare. The automation provides results in under half the time at a much reduced fee.“

To fairly compare bids, TruBid can be implemented by customers directly or through their existing consultant or broker and get objective results within 30 days. Brokers who often help negotiate PBM contract terms, can scale their advisory services and run more RFPs per year. To use the system, clients work with Truveris to develop a Web profile on their plan design, needs, existing PBM contract and claims data. Then, PBMs are invited to enter their bids in a blind auction. Afterwards, users log in to review the results and PBMs can see where they stand compared to other bidders. A second round is then initiated and TruBid reviews, ranks and recommends the PBM.

TruBid is the latest addition to the Truveris product suite, whose first offering, TruGuard, catches billing errors in real-time. TruGuard enables payers with existing PBM contracts to verify and pay only for correctly priced and adjudicated claims, prior to payment, rather than relying on a manual, annual, retrospective audit. As a cloud-based patent-pending software application, TruGuard automatically reviews claims, with reports available on a secure, customized site, for cost accuracy, member cost share, eligibility, fraud, Sarbanes-Oxley (SOX), Retiree Drug Subsidy (RDS), Health Insurance Portability and Accountability Act (HIPPA) compliance.

UnitedHealth 4Q Profit Up 21% As Membership Grows

UnitedHealth Group Inc.’s (UNH) fourth-quarter profit rose 21%, helped by growing health-insurance membership, signs of light health-care usage in some areas and fast-rising sales in the company’s Optum health-services unit.

The Minneapolis-based company, the largest managed-care concern by revenue, capped a strong year helped by a continued trend of muted patient traffic in hospitals and doctors’ offices.

Still, UnitedHealth held its 2012 guidance in check while maintaining a guarded outlook for the new year. The company anticipates patients will ramp up medical-system use, and it’s making big investments related to the U.S. health-care overhaul law and changes in its pharmacy-benefits business, among other pressure points.

“At this early stage, we continue to take an appropriately cautious posture on 2012 financial performance,” Chief Executive Stephen Hemsley said on a conference call with analysts.

He also said the company was expecting “accelerating performance” in 2013 and 2014.

UnitedHealth shares, which have risen about 29% in the last 12 months, were down 3.1% to $52.29 in recent trading. Shares of most other large managed-care firms also traded down, even though analysts said UnitedHealth’s strong year-end performance was a good sign.

“As the bellwether and first to report, UNH results bode well for managed-care earnings season, although we believe strong results are already broadly expected,” Goldman Sachs analyst Matthew Borsch said.

Analysts believe investor sentiment this year may hinge more on key big-picture developments that could affect the industry’s fortunes, such as an upcoming Supreme Court ruling on the health overhaul law and the presidential election.

UnitedHealth reported a fourth-quarter profit of $1.26 billion, or $1.17 a share, up from $1.04 billion, or 94 cents a share, a year ago. Revenue increased 7.8% to $25.92 billion. Analysts polled by Thomson Reuters expected earnings of $1.03 a share on revenue of $25.69 billion.

The company’s UnitedHealthcare insurance business posted revenue of $24.17 billion, up 7.3% from a year earlier. The company’s membership grew by 175,000 people in the fourth quarter and 1.6 million last year. Enrollment at the end of the fourth quarter was higher than expected, Susquehanna analyst Chris Rigg said.

Hemsley noted on the call that UnitedHealth’s January membership growth for Medicare Advantage plans positions the company to meet its 2012 growth target. On the flip side, the CEO said UnitedHealth may miss its goal for members on Medicare Part D drug plans because it’s starting the year in a 625,000-member hole, which is deeper than the company previously expected.

Some Part D members are assigned automatically to plans each year, and UnitedHealth’s bids wound up being too high. The company expects to make up some ground by adding members through the open market, where returns are more favorable, Hemsley noted. The company closed 2011 with nearly 4.9 million Part D members.

The company’s overall medical-loss ratio, which reflects the portion of insurance premiums used for patient care, rose slightly to 79.7% from a year ago but declined from the third quarter and was less than analysts expected. The sequential decline occurred despite an increase in the ratio for the company’s commercial business, which analysts said indicates that health-care costs elsewhere, such as those for its Medicare-based plans, were likely light.

The commercial medical-loss ratio rose to 82.8%. UnitedHealth chalked up the increase to premium rebates to certain customers–the U.S. health-care overhaul law requires insurers to return money if spending on patient care falls below certain levels–plus lower levels of reserves that reflect prior overestimates on future costs for patient claims.

Additionally, the company noted that utilization was unusually low in the comparable fourth quarter of 2010.

Revenue from Optum, a health-services business that includes a pharmacy-benefit manager, jumped 23%. Optum’s earnings were helped by comparisons with a charge-plagued period the prior year. But that benefit was partially offset by investments in the business.

Pharmacy Industry News: Walgreens spat sends millions to new pharmacies

Walgreens spat sends millions to new pharmacies

San Francisco resident Anne Crawford has been putting off getting her prescriptions filled because she was hoping a contract dispute between Walgreen Co. and a firm that handles drug benefits for millions of customers would be resolved.

But that has not been the case. Negotiations broke down and since Jan. 1, Walgreens, the nation’s largest drugstore chain, has refused to do business with Express Scripts Inc., a company that manages the drug benefits for employers, insurers and other groups.

As a result, tens of thousands of Californians, including members of one of California’s largest insurers, Anthem Blue Cross, have been unable to get their prescriptions filled at Walgreens, by far the largest pharmacy chain in the Bay Area.
Inconvenient alternatives

“I have some prescriptions I have to refill. I’m not going to be able to put it off any longer, so I’m going to have to move to a different pharmacy,” said Crawford, 46, an Anthem member who lives in San Francisco’s Glen Park neighborhood. She said there is no convenient alternative in her insurer’s pharmacy network near where she lives or works.

“A situation like this is pretty much unprecedented in the industry,” said Walgreens spokesman Michael Polzin.

The dispute, which is affecting million of patients nationwide, is particularly being felt in the Bay Area, where Walgreens has 40 percent of the market share. CVS Caremark is a distant second with 27 percent, according to Chain Drug Review, an industry publication.

Pharmacy benefit managers like Express Scripts serve as the middlemen between drug makers and pharmacies and their customers, which include health insurers, employers and other groups. With the goal of saving money for their customers, these companies negotiate prices for drugs and the rates pharmacies will be reimbursed for filling prescriptions.
Reimbursement at issue

Express Scripts and Walgreens have been locked in a battle for the past year over how much the pharmacy benefit manager would reimburse the pharmacies. Walgreens had been filling about 88 million prescriptions a year nationwide for Express Scripts.

Officials from Express Scripts say the drugstore chain wanted too much – as much as 20 percent higher than what other pharmacies in the network agreed to accept. Walgreens’ executives have denied that figure and accused the benefit manager of offering less than the industry average cost to provide a prescription.

The dispute has affected about 10 percent of Walgreens’ more than 60 million pharmacy customers. These include people in the Tricare program, which covers members of the military and their dependents, as well as WellPoint Inc., the parent company of Anthem Blue Cross in California, and most of the employers that use the pharmacy benefit manager.
Terms of agreement

Express Scripts spokesman Brian Henry said the company would be willing to accept Walgreens back into the network, but only “at rates and terms that are right for our clients and consistent with other pharmacies.”

The company has more than 56,000 pharmacies in its nationwide network even without Walgreens, and most customers have an alternative option within a half mile, Henry said.

Other pharmacies, including CVS and Safeway and to a lesser extent Costco, have reported increased business since the beginning of the year. Officials from the pharmacies all welcomed the new customers.

But Dr. Edward Machtinger, director of the women’s HIV program at UCSF, said switching pharmacies may disrupt care for people who are both poor and sick. He said the dispute affects patients in Anthem’s Medi-Cal managed care plan.

“These are chronically ill, socially and physically stressed people who now suddenly go to the pharmacy and find out they can’t pick up any of their prescriptions,” he said. “They are often not equipped to figure out how to have those prescriptions transferred and filled at alternative pharmacies.”
Am I affected?

If your prescription benefit card says “Express Scripts,” you may be affected by the contract dispute between Walgreens and the pharmacy benefit manager.

Next IT Expands Bench of Pharmaceutical Industry Expertise

Next IT, a leading provider of Intelligent Virtual Assistants for business, is expanding its sales team to address the significant customer support needs of the healthcare and pharmaceutical industries. Victor Morrison and Mitch Lawrence, formerly of Teva Pharmaceutical Industries, bring valuable experience and perspective to tailor online self-service solutions that improve pharmaceutical compliance and healthcare outcomes.

During his 22 years at Teva — the world’s largest manufacturer of generic drugs and a world leader in the treatment of multiple sclerosis (MS) — Victor played a critical role in defining Teva’s vision for pharmacy and specialty pharmacy interaction. He also conceived and developed the parameters for the clinical study of an enhanced interface between MS patients, specialty pharmacies and physicians and its impact on compliance, adherence and, most importantly, patient outcomes.

“Next IT’s Human Emulation Technology will transform the patient experience,” says Mr. Morrison. “It gives patients the ability to interact with a virtual assistant knowledgeable about them, their disease and their therapy, 24/7, via the web, smartphone or SMS. From the payer perspective, healthcare entities will have unlimited opportunities to engage the patient with dosing reminders, education, coaching and counseling and, importantly, to move the interaction to a live pharmacist or nurse when appropriate. Compliance and adherence to medication regimens should be dramatically increased, which will lead to better outcomes while decreasing the overall cost of care.”

Mitch Lawrence, with nearly 27 years of experience in sales gained in medical, pharmaceutical and information technology, is a born leader with a knack for the creation and development of highly effective sales and account-management teams. Most recently, he was accountable for all of Teva’s formulary, contracting and brand initiatives with third-party payer accounts in the Western U.S., overseeing and training an award-winning staff of account managers.

“Advancing Next IT’s technology across the healthcare industry is an exciting prospect. The potential benefit is huge,” says Lawrence. “Conversational interfaces allow people to use their own words to find the exact piece of information they’re looking for, allowing electronically stored resources to be of much greater practical value because they’re easier to use. I can see widespread applications, from guiding people through insurance billing forms to answering questions about medications and more. It truly gives patients a powerful tool for efficiently and effectively serving themselves.”

Rite-Aid in Allston to close in spring; rival pharmacy CVS to open in fall

Retailer CVS Corporation plans to open a new 13,000 square-foot convenience store with a drive-thru pharmacy in an Allston shopping plaza that will take over the space of an existing Rite-Aid store by the coming fall.

The Woonsocket, R.I.-based chain plans to begin renovations of the building within the retail plaza along Brighton Avenue by late spring, company spokesman Mike DeAngelis said by phone.

“We like that location because it’s near the corner of Brighton Avenue and Cambridge Street,” and also near where Brighton and Harvard Avenues intersect, making it “conveniently accessible to shoppers,” the CVS spokesman said.

Spokesman Eric Harkreader confirmed that rival pharmacy chain Rite-Aid plans to vacate the retail spot this spring after the company was unable to come to terms with the property’s landlord to extend its lease there.

The spokesmen for each of the two companies declined last week to provide more specific dates for their respective closing, renovation and opening plans. The Rite-Aid spokesman said he could not provide a more specific timeline for that store’s closure because those details have not yet been finalized.

The shopping plaza is comprised of five commercially-zoned parcels that together account for about 67,200 square feet, or about 1.5 acres, of property worth a combined $4.15-million, city assessing records show. All five plots and their buildings are owned by Hallston Realty Associates, LLC, according to the city and state records.

According to filings with the state, that entity is owned and managed in part by two prominent developers John L. Hall II, president of Suffolk Downs race track, and Richard L. Friedman, whose company transformed the former Charles Street Jail into the luxury Liberty Hotel and who regularly hosted President Clinton and his family at his estate on Martha’s Vineyard in the 1990s.

Messages left for Hall at downtown-based Hall Properties, Inc., where he is a principal, and for Friedman at Cambridge-based Carpenter & Company, Inc., where he is president and COO, were not returned last week.

Norwood-based company HallKeen, which manages the Allston shopping plaza, also did not return messages seeking comment about the impending exit of Rite-Aid and arrival of CVS and about an adjacent building in that plaza that was demolished recently, about 15 months after the city labeled it among about 150 properties fire officials deemed unsafe and just over three years after a fire forced the closure of the then-decade-old, flagship location of Brazilian restaurant chain Cafe Belo, which for a while afterward ran a small, take-out only location in another spot in that plaza.

And, prior to a Globe review about the local towing industry, neither Hall nor Friedman had returned phone messages for a story published last month that detailed the staggering number of vehicles that have been towed from the Allston shopping plaza where CVS plans to open.

That Globe review found that roughly 3,550 vehicles over a 31-month span from spring 2009 to fall 2011 were towed for illegally using the Allston shopping plaza’s 63-space lot, more than twice as many cars than at any other address in Boston over that same timeframe. The second-leading location was at the South Bay mall in Dorchester, a lot with more than 30 times as many parking spots.

The CVS spokesman declined to comment last week about the lot’s parking and towing situation since the retail company does not own or lease any of the plaza’s parking area. Two of the plaza’s current tenants, Rite Aid and Dunkin’ Donuts, said through spokesmen in last month’s Globe story that they do not request that cars be towed.

The Globe’s review also found that Robert’s Towing Inc., which owns an impound yard one mile away in Brighton, generated an estimated $465,000 in cash from towing cars from the Allston shopping plaza, assuming the company collected the $131 fee they charge per tow.

The towing company’s trucks were watched by Globe reporters patrolling the customer-only parking lot, hiding with their lights off behind a building as they were hunting for cars to tow.

Pharmacy Industry News: Watson Pharmaceuticals Incorporated (WPI) EPS Estimates Cut by Goldman Sachs (GS)

Watson Pharmaceuticals Incorporated (WPI) EPS Estimates Cut by Goldman Sachs (GS)

Investment analysts at Goldman Sachs (NYSE: GS) lowered their EPS estimates on shares of Watson Pharmaceuticals Incorporated (NYSE: WPI) in a note issued to investors on Friday. They currently have a “buy” rating and a $78.00 price target on the company’s shares.

Separately, analysts at Jefferies Group (NYSE: JEF) reiterated a “hold” rating on shares of Watson Pharmaceuticals Incorporated in a research note to investors on Tuesday, December 20th. They now have a $70.00 price target on the stock. Analysts at Citigroup (NYSE: C) reiterated a “buy” rating on shares of Watson Pharmaceuticals Incorporated in a research note to investors on Tuesday, December 20th. They now have a $82.00 price target on the stock. Also, analysts at Canaccord Genuity reiterated a “buy” rating on shares of Watson Pharmaceuticals Incorporated in a research note to investors on Tuesday, December 20th.

Watson Pharmaceuticals, Inc. (Watson) is an integrated global pharmaceutical company engaged in the development, manufacturing, marketing, sale and distribution of generic and brand pharmaceutical products. It operates in three segments: Global Generics, Global Brands and Distribution. It operates in international markets, including Western Europe, Canada, Australasia, Asia, South America and South Africa with its commercial market being the United States of America. As of December 31, 2010, it marketed approximately 160 generic pharmaceutical product families and approximately 30 brand pharmaceutical product families in the United States, and distributed approximately 8,500 stock-keeping units (SKUs) through its Distribution Division. In January 2010, the Company acquired 64% of Eden Biopharm Group Limited (Eden). In May 2011, it acquired Specifar Pharmaceuticals S.A.

Shares of Watson Pharmaceuticals Incorporated traded up 0.23% during mid-day trading on Friday, hitting $62.19. Watson Pharmaceuticals Incorporated has a 52 week low of $51.39 and a 52 week high of $73.35. The stock’s 50-day moving average is $62.05 and its 200-day moving average is $65.82. The company has a market cap of $7.908 billion and a price-to-earnings ratio of 42.68.

Lawsuit Says Walgreen, Par Pharma Overcharged

A union benefits fund filed a class-action lawsuit against Walgreen Co. and Par Pharmaceutical Cos., accusing the companies of engaging in “at least two widespread schemes to overcharge” for generic drugs.

The lawsuit alleges drugstore chain Walgreen and generic pharmaceutical maker Par established a partnership in which Par manufactured and/or marketed generic versions of antacid Zantac and antidepressant Prozac in dosage forms that weren’t subject to private and governmental reimbursement limitations.

It further said Walgreen purchased those dosage forms from Par—at a cost substantially higher than the widely prescribed dosage forms—and then “systematically and unlawfully filled its customers’ prescriptions with Par’s more expensive products, rather than the inexpensive dosage forms that were prescribed by physicians.”

The suit was filed by the Union Food and Commercial Workers Unions and Employers Midwest Health Benefits Fund in the Northern District Court of Illinois. The union benefits fund is requesting a jury trial.

A Walgreen spokesman said the company doesn’t comment on pending litigation. A Par representative wasn’t immediately available to comment on the allegations.

The lawsuit alleges insurance companies, self-insured employers, and union health and welfare funds were overcharged, paying two to four times more than they would have had the prescriptions been filled as written. The union benefits fund’s complaint alleges members of the class-action suit paid “many millions of dollars” for the higher-priced generics.

The plaintiff is seeking unspecified damages, according to the complaint. The news was reported earlier by Bloomberg.

Walgreen in 2008 agreed to pay $35 million to the U.S., 42 states and Puerto Rico for overcharging state Medicaid programs by filling prescriptions with more expensive dosage forms of ranitidine, a generic form of Zantac and fluoxetine, which is a generic form of Prozac.

Excellence Services Program Delivers a Road Map to Successfully Guide the Pharmaceutical Industry Through the New Alliance Landscape

Facing patent cliffs and shrinking pipelines, the pharmaceutical industry is turning to alliances – either through in-licensing deals or M&A activities – as a way to maintain growth and profitability. It’s a sound strategy, but a difficult one to effectively put into practice. The process of identifying, negotiating and consummating a business is fraught with potential pitfalls. With 2012 shaping up to be a pivotal year for organizations to position themselves for future success, business development leaders need a relationship road map to help guide them through the new alliance landscape.

To that end, Best Practices, LLC has collected hundreds of best practices, narratives, and metrics around the issue of developing strategic alliances. To provide biopharma executives with the critical information they need to succeed in the highly competitive alliance/partnership arena, we have consolidated our best research and services regarding in-licensing and mergers & acquisitions into the Alliance Excellence Services.

The Alliance Excellence Services provides benchmarking and networking solutions that address a variety of mission-critical issues that includes:

In-licensing

Defining and executing the corporate in-licensing strategy

Staffing your group with the right talent and in the right numbers.

Shepherding compounds through the in-licensing process

Mergers & Acquisitions

Ensuring a strategic alignment with potential partners

Understanding and managing cultural issues with potential partners

Executing post-deal closure integration activities

Trends in merger and acquisition integration

This information and much more has been consolidated into the Alliance Excellence Services, a comprehensive database, report and solution service that provides valuable insights and data that business development executives can use to ensure superior results. These services contain valuable material for each phase of the alliance process. Pharmaceutical executives will find the primary and secondary research information provided in this product essential for helping pharma leaders to coordinate, communicate and execute the critical activities that are required to have effective partnerships.

Pharmacy Industry News: Military RX’s No Longer Being Filled At Walgreens

Military RX’s No Longer Being Filled At Walgreens

A decision by Walgreens is making their biggest competitor and other drug stores very happy.

Back in June, Walgreens and Express Scripts were unsuccessful in negotiations to renew a contract.

As of January 1st, Walgreens stopped working with Express Scripts.

TRICARE is the military insurance that covers prescriptions and is processed through Express Scripts.

Express Scripts manages TRICARE’s claims for prescription military members.

The decision by Walgreens has made their rival CVS/Pharmacy and other independent stores happy, as more uniform customers are going to them.

CVS/Pharmacy has taken advantage of this opportunity and told KTXS they have launched a new service for TRICARE members.

All members who go online to CVS.com about prescription transfer, CVS/Pharmacy will donate $3 to the USO for the month of January.

Smaller independent pharmacies like James McCoy’s Drugstore, across from Abilene Regional Medical Center has also seen a jump.

Pharmacist, Trey Gufley told us, “We have Dyess Air force Base, here locally we more then welcome these people to come to us.”

Gufley continued, “We’ve received an increase in number of customers that know about us and that’s our best advertisement is word of mouth.”

Ty’s Drugstore on South 14th agrees, they have even put a sign out letting everyone know that they accept TRICARE.

Lee Terbush, owner of Ty’s Drugstore said, “It’s been a steady increase since the new year, anywhere from one to 10 people a day.”

Drug shortages wearing thin for patients, doctors

Theresa Hart has encountered major problems filling her prescription for Adderall, the hyperactivity medicine she has taken for 10 years.

She, her pharmacist and her doctor spent months repeatedly calling around in search of a supply of the medicine. Finally, Hart decided to try a similar drug, Vyvanse, but she doesn’t think it gives her the same focusing power as Adderall.

“I just don’t feel it’s as sharp,” she said.

Dr. Joel Young, Hart’s psychiatrist and a hyperactivity disorder specialist, said he has patients who have to call five or six pharmacies just to get their medication.

“It’s been terrible in the last quarter,” Young said.

Prescription drug shortages — a national issue for the past few years — are getting worse, raising new safety concerns for patients, delaying treatment plans and even surgeries, and causing higher out-of-pocket costs and rising prices in health care, pharmacy groups say.

The most common causes are manufacturing violations, production delays, shipping problems or ingredient shortages. The problem — called a national health crisis by federal regulators and leading industry groups — has worsened because of complex legal, regulatory, economic and other factors, according to a 2011 report from the federal Food and Drug Administration.

Shortages grow as generic manufacturers have consolidated and fewer plants are left making certain drugs, the FDA and others say.

Pharmacists at the University of Michigan, the Detroit Medical Center, St. John Providence Health System, Henry Ford Hospital, the Barbara Ann Karmanos Cancer Institute and Priority Health all report increased problems finding medicines recently. The issue consumes at least 40 hours a week — double what was spent a few years ago to manage drugs in short supply, said Ed Szandzik, director of pharmacy services at Henry Ford Hospital, Detroit.

Pharmacists feel “like day traders who are on the computer constantly all day” for supplies, sometimes to replenish stocks of those drugs that could get tight, said Gary Blake, director of pharmacy at St. John Hospital & Medical Center, Detroit.

“If we don’t buy it, somebody else will,” he said.

Drugs in short supply more than tripled from 61 in 2005 to more than 200 this year, according to industry groups and the FDA, which lists drugs with shortages on its website — www.fda.gov.

The most critical shortages involve cancer, antibiotic, nutrition and electrolyte imbalance medicines, according to a fall report from the FDA.

Those used for neuromuscular conditions, anesthesia in surgery, pain and anti viral conditions also have had bad shortages, the report said. Some hospitals have had to postpone surgery because they didn’t have the right anesthesia drug, pharmacy groups say.

A University of Michigan study found three different drugs are hardest to get: succinylcholine injections, a muscle relaxant used in surgery; dextrose 50 percent syringe medicine, to restore blood glucose levels, and epinephrine injections, used in cardiac surgery.

Labor costs associated with managing the shortages contribute an estimated $216 million in extra spending a year, according to research published by U-M pharmacist Burgunda Sweet in the October issue of the American Journal of Health-System Pharmacy. The 353 pharmacy directors surveyed overwhelmingly agreed that drug shortages increased costs.

The worries are prompting new alerts about what people need to know about searching for replacement drugs.

The health system pharmacy group, for example, has consumer resources at www.safemedication.com that raise questions about the safety of medicines purchased online or through so-called gray market sources — nontraditional or alternative distributors and brokers.

Drugs bought those ways may be much more expensive and may not be properly monitored for minimum production standards, the group says.

Consumers also need to alert their pharmacists and health care providers about other medicines they take so they know about any possible adverse interactions between medicines that can cause complications or not be suitable for people with other chronic medical problems.

“Safety becomes a big issue,” said Stephen Smith, pharmacy director at the Karmanos Institute.

“Physicians, pharmacists and nurses are used to certain regimens (to treat cancer),” he said. “We use the gold standard. If you throw in drugs they are not as familiar with, you may have to remind them that these drugs work a little differently.”

Shortages also have raised concerns about higher prices and gouging by wholesale drug companies that obtain supplies of hard-to-get drugs and jack up the costs.

On a typical day earlier this month, Szandzik said he got a half-dozen unsolicited inquires from companies charging four to 10 times the cost of a drug.

Bob Lytle, who owns Lytle Pharmacy in Rochester, Mich., said the price of Adderall tripled over the past three months from $30 for 100 pills to more than $100.

Part of the problem is that the FDA doesn’t have authority to order manufacturers to report shortages — though many do voluntarily.

President Barack Obama has asked some manufacturers of drugs with no generic equivalent to do more to report product interruptions to the FDA. He’s also expanding a five-person staff at the FDA that has investigated shortages.

Last month, the Generic Pharmaceutical Association suggested other possible solutions. Those include creating a high-level team within the FDA to respond to shortages and hiring an independent third party to study drugs identified as having or likely to have shortages soon.

Pharmacists expect the problem will persist. They say people should work with their medical teams and pharmacist to understand drug options and other issues, particularly if problems continue beyond three months. Internet sources of drugs may not be safe or reliable, so don’t look for options there, Szandzik and others said.

Pharmacy industry news: Bets On as Industry Awaits PBM Merger Decision

Bets On as Industry Awaits PBM Merger Decision

It could be a watershed year for retail pharmacy as a proposed merger of two of the country’s largest pharmacy benefit managers — Express Scripts and Medco Health Solutions — looms. A ruling is expected within the next several months.

Even before the Federal Trade Commission’s decision, the impact of what it could mean for chain pharmacy is seen in Walgreens’ failure to renew its contract with Express Scripts due to unsatisfactory reimbursement rates. Dropping the PBM network cost the drug chain 2 cents per share in first-quarter results. It did $5.3 billion in prescription sales through Express Scripts in fiscal 2011.

Walgreens is trying to recoup those losses and Express Scripts patients with a transition plan designed to retain some business through discounts.

Meanwhile, Supervalu and CVS are actively soliciting Express Scripts patients. Supervalu’s Jewel-Osco said it is hiring more associates to serve the new business it expects from Express Scripts transfers from Walgreens.

If the largest drug store chain in the country can’t come to terms with the nation’s second largest PBM, imagine negotiations, or lack of them, under a merged entity that would control anywhere from 30% to 60% or more of the PBM market?

Here’s what’s at stake in the $29 billion merger as Dennis Wiesner of
H.E. Butt Grocery told a House Judiciary Subcommittee hearing last year: a network covering 135 million Americans, representing about one in three U.S. prescriptions filled, and control of more than 40% of the national prescription volume, 60% of mail orders and more than 50% of specialty pharmacy.

The fear is such a market dominator can hold retail chain pharmacy hostage by dictating low reimbursement rates and limiting competition. Importantly, the merger could limit consumer choice and health services.

Numerous trade organizations and consumer groups vigorously oppose the merger. Those in favor say it will lower prescription drug costs for consumers through efficiencies gained from the merger. Express Scripts said it expects $1 billion in cost savings.

Wendy Barnes Joins Rite Aid as Group Vice President of Managed Care

Rite Aid Corporation RAD
-0.75%
announced today that Wendy Barnes, a managed care executive with more than 17 years experience in contract negotiations, new business development and hospital administration, is joining Rite Aid as Group Vice President of Managed Care.

In this position, Barnes will be responsible for all aspects of managed care, including contracting, maintaining relationships with managed care organizations, pharmacy benefit managers and third-party payers and developing new strategic partnerships. Barnes will report directly to Chris Hall, Rite Aid Senior Vice President of Pharmacy Services.

“Wendy is a veteran of the managed care industry, and we are excited about the extensive knowledge and experience she is bringing to Rite Aid,” said Hall. “Her expertise will be an invaluable resource as the company executes its managed care strategy in the rapidly changing healthcare environment.”

Prior to joining Rite Aid, since February 2009, Barnes served as a pharmacy contracting and new business development director for Premier Healthcare Alliance, servicing 2,500 hospitals and 78,000 alternate site members. While at Premier Healthcare Alliance, she served as a member of the specialty pharmacy acquisition team and established a first-of-its-kind prescription drug savings program for Oregon state employees. Barnes has also held several hospital administration positions while serving as an active duty Medical Service Corps Officer in the United States Air Force including Vice President of Managed Care, Vice President of Supply Chain and Chief Resource Management and Financial Officer.

Barnes holds a Master of Business Administration degree from the University of Alaska Anchorage and a bachelor’s degree in biochemistry from the United States Air Force Academy.

India, the pharmacy of the developing world – Poser over medicine supplies

India may be more famous for the Taj Mahal, its religious ceremonies, Bollywood films and one of the highest economic growth rates in recent years. But more than all these, India has had positive worldwide impact through its large supplies of low-cost, good quality generic medicines. Millions of lives have been saved or prolonged by this.

Many people go to India to buy life-saving generic medicines from pharmacies and bring them back in suitcases to give to relatives who cannot afford the expensive original products. A decade ago, an Indian company called Cipla produced HIV-AIDS generic drugs that could treat a patient for US$300 a year, far cheaper than the branded product’s cost of $10,000 a patient a year. Today, the Indian drug cost has been cut further to below $80. This has enabled millions more AIDS patients to be treated. India supplies 70% of the HIV-AIDS drugs obtained by Unicef, the Global Fund and Clinton Foundation for developing countries. And 75%-80% of medicines (not only for AIDS) distributed by the International Dispensary Association to developing countries come from India. No wonder India has been termed the pharmacy of the developing world.

Last week, the Indian Drug Manufacturers’ Association (IDMA), which has 700 drug companies as members, celebrated its 50th anniversary. There was much to celebrate, including the industry’s high growth, wide range of medicines, and its contribution to good affordable drugs. But there are also many factors that may hinder the continuation of the companies’ role as chief supplier of medicines for developing countries.

A main factor of the industry’s success has been the government’s move in 1970 to exclude pharmaceutical drugs from product patents. This paved the way for local companies to produce generic versions of the expensive foreign drugs, and within a few decades they had taken over 80% of the local market, while also supplying cheap medicines abroad.

The situation took a negative turn when the intellectual property agreement known as TRIPS was established in 1995 together with the World Trade Organisation. It disallowed countries from excluding medicines from patentability.

However, TRIPS allowed countries to determine the criteria for an invention that can be granted a patent, and the ability of the government to grant a compulsory licence to local companies to produce the patented products if their requests to patent owners to give a voluntary licence do not succeed.

To implement its TRIPS obligations, India passed changes to its patent law in 2005 so drugs could now be patented. However, the new law also contained flexibilities such as strict criteria for patentability (trivial changes to a patent-expired product would not qualify for a new patent), allowance for public opposition to a patent application before a decision is made, and compulsory licensing. India has one of the best patent laws in the world that still gives some space to its producers to make generic drugs. But it is also true that the old policy space has been eroded because many new drugs since 2005 have been patented by multinational companies which are selling them at exorbitant prices.

Indian companies can no longer make their own generic versions of these new medicines unless they successfully apply to the government for compulsory licences, and that is quite cumbersome; or unless they obtain a licence from the patent-owning multinational, and that usually comes with stringent conditions, especially for export. Another worry is that India is negotiating a free trade agreement with the European Union. Such agreements usually contain provisions such as data exclusivity and extension of the patent term, which prevents or hinders generic production. Finally, six Indian companies have recently been bought up by large foreign firms. If this trend continues, the Indian drug market may be dominated by multinationals again. It is uncertain whether they will continue to supply the developing world with cheap generic medicines when this may be in conflict with their own branded products. International health organisations such as Unaids, Unitaid and Doctors Without Borders have raised their serious concerns that these recent trends may threaten India’s role as the chief supplier of affordable medicines to Africa and other developing countries. “Millions will die if India cannot produce the new HIV-AIDS medicines in future, it is a matter of life and death,” said Michel Sidibe, Unaids executive director, during a visit to India last year.

Thus, a strategy is needed that involves the government and the drug companies, that ensures the local drug industry continues to thrive, that it produces not only the existing medicines but also new medicines even if they are patented, and that they are supplied at cheap prices not only in India but to the developing world, too. That was the sobering message that emerged at last week’s 50th anniversary conference of the Indian drug association, even in the midst of congratulations on the achievements of the past.

Pharmacy Industry News: Super resolution microscopy for pharmaceutical industry: Patents granted for 3D complex labeling

Super resolution microscopy for pharmaceutical industry: Patents granted for 3D complex labeling

Mechanism of action of drugs in body cells becomes transparent – the LIMON 3D microscopy (LIght MicroscOpical Nanosizing) of Prof. Dr. Dr. Christoph Cremer opens new possibilities for pharmaceutical research. 3D molecular complexes so-called biomolecular machines, targets of drugs can thus be studied in vivo.
“By means of these issued patents, our super resolution microscopy is especially important for molecular biotechnology and the pharmaceutical industry, with emphasis on target identification and personalized medicine,” according to Dr. Andrea Nestl, innovation manager of the Technology Licensing Office (TLB) and responsible for the patent management and the commercialization.
Biomolecular machines (BMM) are highly complex nanostructures consisting of several large molecules and which are responsible for basic functions in the body cells. Depending on their functional status they have a defined 3D structure. Examples of biomolecular machines are nucleosomes which enable the DNA, a two meter long carrier of genetic information, to fold in the body cells in a space of a few millionth of a millimeter in diameter only. Therefore, the DNA can serve as an information and control center.

By using Professor Christoph Cremer`s LIMON 3D in combination with LIMON complex labeling it is possible for the first time to make hidden proteins or nucleic acids of a 3D-molecule complex of the so-called biomolecular machines visible without destroying the complex. Up to now, the problem in most cases was that the complex had to be destroyed for detailed analysis of the individual macromolecules therein. Alternatively, virtual computer simulation models or expensive nuclear magnetic resonance methods were used to visualize the three-dimensional structure of such complexes.
The issued LIMON patent family allows the identification and the spatial positioning of individual components of the complex in its original native i.e. in a biologically relevant composition.
Besides the usual labeling of a macromolecule with a single fluorescent molecule, LIMON offers the option to label the target molecule with a variety of fluorescent markers of the same type in order to highlight several different areas. This is especially important for the investigation of such complexes in which not all binding sites for labeling probes are accessible, and thus it is difficult to visualize the individual partners.
“The pharmaceutical industry can trace in this way the interactions of biomolecular machines with pharmaceutically active compounds specifically and answer fundamental mechanistic questions about drugs”, according to Dr. Andrea Nestl, responsible for the development of patenting and marketing strategy on behalf of the University of Heidelberg. The mechanism of drug action in the cells becomes thus transparent, and the expensive development of drugs, which reaches the region from 500 million up to 2 billion U.S. dollars and usually lasts for 10 to 12 years, can take place in less time, and additionally, it is less cost-intensive.
The 3D Super Resolution Microscopy LIMON is an excellent tool for the development and validation of therapeutically active substances. As an example for the importance in pharmaceutical industry by using LIMON, it was possible for the first time to investigate in detail the gene product which is responsible for 20 percent of inherited metastatic breast cancer. The aim is the patient-specific optimization of the existing Herceptin therapies.
Due to individual genetic equipment patients with an identical diagnosis often respond very differently to treatment with the same medicine. Personalized medicine considers and takes into account all diagnostic possibilities for characterizing the personal particularities. Thus the Super Resolution Microscopy LIMON patents will offer a significant contribution. The results of this breast cancer study were recently published in the notable Journal of Microscopy (“Analysis of Her2/neu membrane protein clusters in different types of breast cancer cells using localization microscopy”).
To realize the 3D LIMON Super Resolution Microscopy Professor Christoph Cremer combines two of his 2D Super Resolution Microscopy methods: the localization microscopy SPDM (Spectral Precision Distance Microscopy) and the structured illumination SMI (Spatially Modulated Illumination), both patented by TLB as well. The main LIMON patents are issued in Europe and in the USA. With this European divisional patent application the third member of the LIMON patent family is being granted.
Christoph Cremer is full Professor and Chair of Applied Optics and Information Processing at the Kirchhoff Institute of Physics, and the Institute of Pharmacy and Molecular Biotechnology (IPMB), both at the University of Heidelberg, and he is group leader in the field of Super Resolution Microscopy at the Institute of Molecular Biology gGmbH (IMB) at the University of Mainz. In addition he is scientific member of the US-American Jackson Laboratory in Bar Harbor / Maine.
Professor Christoph Cremer is longtime coordinator of the BMM-network “Biomolecular Machines / Biomolecular microscopy” of the Rhine-Neckar bioregion, where numerous working groups in Heidelberg participated in the in the fields of medicine, mathematics / computer science, chemistry, pharmacy, physics and biology. Objective target is the quantitative analysis and modeling of “biomolecular machines” outside the cell and within the living cell itself.

Pharmaceutical Industry at a Cross Roads

The pharmaceutical (pharma) industry, once a thriving sector, has been cutting costs right and left by closing plants, laying off people, outsourcing jobs to third-world countries, and reducing research efforts to the minimum.

“The good old days of the pharmaceutical industry are gone forever. Even an improved global economic climate is unlikely to halt efforts by the developed world’s governments to contain spending on drugs,” according to a December McKinsey Quarterly report, a business journal published by McKinsey & Company.

Despite a strong third quarter financial performance, Novartis International AG, a Swiss-based pharmaceutical giant, announced that it is closing down three of its subsidiaries, resulting in the layoff of 2,000 people. About 35 percent of the jobs will be outsourced to China and India, according to a conference call.

“Novartis is announcing today additional cost reduction activity, which will be executed over three to five years … resulting in closure of two sites in Switzerland and one in Italy. … In total, approximately 2,000 positions will be reduced in the Group … mostly in Switzerland and the US offset by 700 new positions in low cost and other countries,” according to a Novartis press release.

During the third quarter, net sales had increased by 18 percent to $14.8 billion compared to the same time period in 2010. Net income increased by 7 percent to $2.5 billion.

Global giant AstraZeneca, based in London and the world’s seventh-largest pharmaceutical company in terms of revenue, announced in December that it would reduce its U.S. sales force by 1,150 people, about 24 percent of their U.S. sales force, by February 2012.

Cost reduction efforts, including the above reduction in force, saved the company between $50 million and $100 million, resulting in a third quarter profit of $3 billion, an increase of 36 percent over the third quarter 2010 numbers.

Rich Fante, president of AstraZeneca U.S., said in a recent press release, “These are difficult decisions that impact valued employees. The changes we are making, however, will help us deliver better results for our business and, most importantly, continue delivering on our mission of patient health.”

Global Pharmaceutical Firms’ Business Model Flawed

“Profit margins will be substantially lower than they are today. This dramatic situation requires Big Pharma executives to envision responses that go well beyond simply tinkering with the cost base or falling back on mergers and acquisitions,” the McKinsey report advised.

Despite total global 2010 drug sales of $856 billion, the pharmaceutical industry is distressed, given that the industry has not produced a blockbuster drug over the past years. New drugs are just improved copies of existing drugs.

Drug development history suggests that out of 10,000 drugs under development only one or two will hit the market big time, and that each one will take between 10 to 15 years to be developed. Although development costs are hard to assess, suggestions are that it costs more than $1 billion to develop a new drug.

In 2011, there were around 3,000 medicines being tested in clinical trials and/or awaiting Food and Drug Administration evaluation.

Most importantly, the industry is facing the expiration of a large portion of patents, such as Plavix (Bristol-Myers Squibb) and Zyprexa (Eli Lilly & Co.), resulting in the loss of revenue-producing income. Generic drug manufacturers are lurking around the corner and probably already have cheaper generic drugs waiting, which will be sold the day the patents expire.

“The next five years are expected to reflect a significant imbalance between new product introductions and patent losses,” suggested an article on the Zacks Investment Research website.

In response to large corporate inflexibility and bureaucratic environments, the industry has begun to fragment into different segments, including generic, biotech, life-sciences, health-care equipment, and midsize pharma companies.

From 84 companies in 1989, the industry has grown to 192 companies, with 51 midsize pharma and 51 health-care equipment firms being the majority of firms.

“Fragmentation is especially troubling for Big Pharma because it would be natural to expect that economic rents will accrue to an industry’s most innovative companies. Since some Big Pharma players can’t deliver innovations as quickly as biotech players can, only brand strength and a global commercial footprint would allow it to go on charging premium prices,” according to the McKinsey article.

Furthermore, unbridled research and development (R&D) spending are a sore point for investors, who have become vocal as such activities cut into their dividends and just don’t bring value to the investor.

Analysts have been especially honing in on the pharma industry and suggest that most growth will no longer happen in the large global companies, but will be found in the small and midsized firms that have sprung up over the past few years. Most importantly, the best results would be achieved when the industry players work collaboratively in the development of new drugs instead of going at it alone.

Pharmaceutical News: Scripts-Walgreen dispute forces consumer switch

Scripts-Walgreen dispute forces consumer switch

With less than two weeks left before Walgreen’s contract with Express Scripts expires, can the two corporate giants resolve their differences?

If not, tens of thousands of consumers relying on Express Scripts Inc. – one of the nation’s largest pharmacy benefit managers – are likely to switch pharmacies and fill prescriptions at a location other than Walgreens, the nation’s largest drugstore chain.

Walgreen Co. broke off talks with Express Scripts on June 21, saying Express Scripts had offered a 3-year contract that would have cut reimbursement rates to below the industry’s average cost to fill prescriptions. Express Scripts – which manages prescription benefits for large employers, insurers and the Defense Department – says Walgreen has proposed dispensing rates that would eventually put the drug chain at about 20 percent above the rate paid to other contracted pharmacies.

The sides now remain at loggerheads.

“We would welcome them back to the table at any time to negotiate,” said Express Scripts spokesman Thom Gross. “We would love to have them back in the network if their prices are competitive to other prices.”

Michael Polzin, a Walgreen vice president, responded: “We’ve said all along, if Express Scripts presented us a fair and competitive offer, then we would certainly be willing to consider it….We are still planning to be out of their network as of Jan. 1.”

Some consumers say they are at the mercy of the health insurance and pharmacy titans.

“It certainly seems like several local health care players are throwing their weight around….It is hitting the consumer,” said Dolores Dace, an elementary school teacher who lives in Florissant, Mo.

If she changes pharmacies, Dace said, she’ll need to switch from a Walgreens that’s nearby and open until 10 p.m. to either a supermarket or independent that is up to three miles away.

Meanwhile, operators of chain discounters such as Wal-Mart and Target have posted signs welcoming new customers. In addition to Walgreen’s most obvious local competitor, CVS, prescriptions can be filled by smaller pharmacies and specialty pharmacies along with grocery stores and warehouse stores like Costco and Sam’s Club.

Meanwhile, Express Scripts, based in north St. Louis County, Mo., downplays the significance of the switch for consumers. If Walgreen leaves Express Scripts, “we’ll still have 56,000 (pharmacies) in our network,” Gross said. “On average, there’s one pharmacy in our network within one-half mile of any Walgreens. And over 90 percent of independent pharmacies are in our network.”

Walgreen Co., based in Deerfield, Ill., has about 7,800 stores nationwide, including 6,600 drive-through pharmacies nationwide.

TIPS FOR SWITCHING PHARMACIES:

Customers can switch their retail pharmacy by taking one of these steps:

— Take a pill bottle or a prescription to a new pharmacy of your choice. The pharmacist will call to verify the information with your physician or current pharmacy.

— Phone your current pharmacist and request that your prescription information be transferred.

— Phone your physician’s office and ask that your prescription records be sent to a new pharmacy.

Insight: Pharma asks the money question earlier for new drugs

Pasteris is one of 25 executives appointed last year to shepherd the British drugmaker’s experimental medicines. He consults insurance companies and former officials from national health agencies about the Alzheimer’s drug on the best way to show its value to patients.

In the past, that meant proving that a drug worked, and did so safely, so that health regulators would approve it. But as governments in the United States and Europe look to slash spending and avert a debt crisis, Glaxo and its rivals want to make sure their medicines are a must-have for patients.

To do it, they are seeking input from the people who hold the purse strings earlier than ever in the clinical research process, in some cases five years or more before regulators would even look at a product, executives told Reuters.

“The ultimate goal was not optimal reimbursement and access,” Pasteris said. “Today it is.”

These views are shaping more clinical trials, such as which products to test against and study goals to pursue. And that’s having major ramifications for the business of Big Pharma.

“If you’re going to go out there with a drug that you don’t know whether it’s better than what’s out there, what are you trying to do? Who are we all trying to kid?” said Angus Russell, CEO of British drugmaker Shire Plc. His company has more than doubled its “pharmaco-economic” staff focusing on the value of medicine in the past few years.

Russell said companies “all over the industry” are dropping experimental products they fear will not gain strong reimbursement. For example, Glaxo abandoned a diabetes treatment in mid-stage development in 2009.

Pharmaceutical investors are also a huge source of pressure, with little forgiveness on Wall Street when it comes to medicines that cost hundreds of millions of dollars to develop, but do not get widely used once they reach the market.

Even smaller players are changing their ways. Ron Cohen, CEO of Acorda Therapeutics, regrets not consulting insurers early about its Ampyra, the first drug to help multiple sclerosis patients walk better.

Now, Acorda plans to hold discussions with health insurers once products reach mid-stage development and is getting informal input earlier — including for a potential multiple sclerosis treatment yet to enter human testing.

“I have no question that the entire industry is moving toward this sort of model,” Cohen said.

As drug manufacturers invite marketing input earlier than before, some fear they risk the very innovation that leads to landmark new medicines.

Industry experts point to advances that took time to prove their worth or worry that drugmakers may abandon categories where “good enough” medicines already exist, like depression, partly because it’s not worth the economic risk.

“There is a concern that in five, 10 years we won’t have anything really new for patients with major mental illnesses, and that would be absolutely a tragedy,” said Dr. Alan Schatzberg, former president of the American Psychiatric Association. “It’s an unfortunate outcome that we are slowing drug development.”

Glaxo, which brought antidepressants Paxil and Wellbutrin to market, is one company to pull away from the field. Atul Pande, who leads Glaxo’s neuroscience research, says the science has not advanced enough to identify new ways to significantly improve treatment, but he acknowledged the reimbursement fears.

CLOSER TIES

In this climate of soaring healthcare costs, the drug industry has been sharply criticized for launching expensive new medicines that proved only slightly better than their predecessors. Health insurers and government agencies pushed back, and now drug companies are forging closer ties with those “payors”.

This year alone, Pfizer Inc allied with insurer Humana Inc to research elderly health; AstraZeneca Plc and HealthCore, a unit of insurer WellPoint Inc, agreed to study how to economically treat disease; and Sanofi SA signed on pharmacy benefit manager Medco Health Solutions Inc.

Sanofi may soon overtake Pfizer as the world’s top drugmaker. CEO Chris Viehbacher says the industry’s new crop of drugs must demonstrate “why is this better than what we’ve already got.”

“In defining value — in whose eyes? So you need a payor perspective,” he said.

A closer relationship to payors allows access to vast databases of medical claims to see how drugs are used once they are approved. Drugmakers can learn which medicines they should be comparing their own products to and what goals they should seek in clinical trials.

That can help demonstrate the value of new treatments over a growing pool of cheaper generic drugs. For example, instead of testing a drug just to show whether it lowered blood pressure, the manufacturer could also show that it helped reduce stroke rates or hospitalizations.

Medco, which manages prescription benefits for millions of Americans, is discussing Sanofi’s drugs in their initial human trials.

“We’re there at late Phase I, stress-testing their entire development program, and it’s a very rich conversation,” said Medco’s chief clinical research and development officer, Robert Epstein.

He believes more companies should not wait until a drug is being tested in hundreds, or thousands, of people by Phase II or III, when they are close to being submitted to regulators.

“Most of the companies still show up in mid-Phase III saying they have a cake in the oven and it’s baking and you’re going to love it when it comes out,” Epstein said.

FAILURE TO LAUNCH

The motivation for these tie-ups strengthened with a series of new drugs that did not catch on widely.

Dendreon Corp’s Provenge therapy for advanced prostate cancer is one cautionary tale. Provenge is a novel treatment for patients who have limited options, but sales of the $93,000 therapy have been a huge disappointment.

That’s largely because doctors fear they will not be reimbursed after they buy and administer the drug in their offices. The company’s market value has plunged about 80 percent.

Glaxo is grappling with similar issues with its lupus drug marketed with Human Genome Sciences Inc.

To try to avoid such hurdles in the future, Glaxo and other companies hold advisory board meetings on their experimental products with representatives of insurers and others with expertise on payment for medicines.

Pfizer’s advisory panels also include pharmacy benefit managers and employers to review many of the products in the company’s mid to late-stage portfolio, said James Harnett, Pfizer’s senior director of U.S. health economics and outcomes research.

But some are concerned that bringing in market considerations too soon will undermine the serendipity of scientific discovery, such as medicines that were found to treat a different condition than initially intended.

Pfizer might have never developed a rheumatoid arthritis medicine, now one of its most important experimental products, according to former research chief John LaMattina. The drug was first developed to prevent rejection of organ transplants, he said, a far less enticing market.

Only when Pfizer began human testing of tofacitinib did it see the potential for treating rheumatoid arthritis with a conventional pill, a more attractive option to the injectable medicines that dominate the market, he said.

“I don’t think people dreamed that you could have a small molecule that would successfully challenge the large biologics … so you never would have gone down that pathway,” said LaMattina, Pfizer’s research chief from 2004 to 2007.

LaMattina likened this to how Steve Jobs, Apple Inc’s founder, said that people often did not know what products they wanted until they saw them.

“When you’re doing market research, people are basing their responses and judgments on what’s known and not necessarily looking out of the box,” LaMattina said. “The earlier you get in the discovery/development continuum, the less valuable I think it is.”

Drugs also can prove more useful when used with other therapies, which has been true in the cancer field. That testing may never occur if they look marginally beneficial on their own.

“You find other uses, you find combinations, you find other indications — so many things can happen,” said Nils Behnke, a healthcare partner with Bain & Co.

PAYOR NEEDS

Glaxo has also changed how it rewards researchers. Bonuses are linked to winning reimbursement, not just drug approval.

“This balance between cost control and innovation arguably has swung a little bit more to cost control,” said Jack Bailey, Glaxo’s senior vice president for institutional customers.

In his discussions about the Alzheimer’s drug, SB-742457, Pasteris learned that in some countries, Pfizer’s Aricept is the standard therapy, while in others, Forest Laboratories’ Namenda is being used with Aricept. Both drugs likely will be sold more cheaply in generic form by the time SB-742457 would reach the market.

“If we have to satisfy the regulators, all we need is a trial versus Aricept,” Pasteris said. “To satisfy the payors in some countries, we may need to show evidence versus the combination of Aricept plus Namenda.”

Researchers presented mid-stage data on SB-742457 this summer and are designing Phase III studies, the last stage before seeking approval.

“That’s really where we shape the asset the most,” Pasteris said. “We want to make sure that the endpoints, the trial design, the clinical development plan, the medicine development strategy — it’s all aligned, and it’s all trying to meet the payor needs.”