PlanetRx just sold out to the dark side.
news.com
Physicians, medical groups, Managed Care Organizations (MCOs), and Pharmacy Benefit Managers (PBMs) who are at financial risk for the cost of pharmaceuticals will not want to send their patients to web sites to receive ads and subtle promotions from companies like Warner Lambert. The only reason that Warner Lambert is "sponsoring" a site about diabetes is so they can try to sell Rezulin to naive patients.
In theory Rezulin is appealing because it tends to not raise insulin levels as much as some other drugs. Insulin is a growth hormone. Higher insulin levels mean more wieght gain and more complications. Lower insulin levels mean less adverse events. At maximum dose (600 mg per day) Rezulin costs $159 per month. But there are NO studies of clinical endpoints available on Rezulin. Meanwhile there are well over 60 deaths (perhaps hundreds) associated with liver damage in about two years use of Rezulin in the U.S. latimes.com
When the FDA recently had their special meeting, they decided to leave Rezulin on the market. But it was pulled off the market in the United Kingdom in December 1997. Lets just charitably call Rezulin a very controversial medication.
In contrast, Glucophage, at $82 per month, causes less weight gain than Rezulin. The 15 year UKPDS study found that patients randomly allocated to initial therapy with Glucophage, compared with conventional diabetic therapies, had risk reductions of 32% for any diabetes-related endpoint, 42% for diabetes-related death, and 36% for all-cause mortality Lancet 352: 854-65. 1998. It is a stunning success to be able to reduce a diabetic patient's chance of dying by 36% with a single medication.
From the perspective of physicians, Bristol Myers owns the market for oral therapy for Type II Diabetes with Glucophage due to these UKPDS data. Interestingly, since that study came out, they have lowered the prices on Glucophage. The actual battle for market share involves which is the second drug that is added if Glucophage is not sufficient to get the blood sugars under control. Rezulin competes with all others. Avandia (rosiglitazone) is in the same class with Rezulin, also very expensive, but does not have the liver toxicity. Amaryl is the best of the sulfonylureas. It has some preliminary animal data supporting a claim of minimal increases in insulin levels-but these data are limited and somewhat inconstent. More studies are under way. Amaryl costs $44 per month in maximum dose, but is most commonly used at a dose that costs $22 per month.
So, Glucophage costs half as much as Rezulin, has compelling endpoint data, and does not cause weight gain in diabetics. Amaryl can attempt to claim some of Rezulin's advantages at much lower cost, without any liver toxicity. And since rosiglitazone is on the market, there is no reason for ANY patient to be on Rezulin anymore. So what do you do it you are Warner Lambert? You promote your expensive, dangerous, worthless drug to naive patients at PlanetRx.
This is an easy way for PlanerRx to gain cash, but at the cost of alienating physicians and MCOs. MCOs see direct to consumer (DTC) advertising as a means of driving up drug costs. Physicians see it as a way to encourage inappropriate prescribing. Some MCO's are making decisions about which drugs they will allow on their closed formularies based on the amount of DTC advertising a company has. There was powerful sentiment in my medical group to stop seeing reps from companies that use DTC, but since everyone does, it would have made it a meaningless gesture. Here is a fine article about DTC advertising...
amcp.org
An important theme in promotional advertising for medications is the unspoken implication that patients have the sophistication and intelligence to have a meaningful opinion about which medication is prescribed. While it may be politically correct to support the concept of empowering patients/consumers, the thesis that consumers have the knowledge and experience to prescribe their own medications--or formulate opinions about them--(which is the same thing) is simply wrong and irresponsible. Physicians have been forced into the unenviable role of convincing their patients that they are not competent to have opinions about which medications are prescribed, while somehow maintaining a trusting physician-patient relationship.
So, who will want to send business to PlanetRx?
Not physicians.
Not Managed Care Organizations.
Not PBMs.
Drugstore.com will now enjoy a competitive edge in selling their services to the above parties. Warner Lambert's Rezulin is the best ammunition PlanetRx could give to Drugstore.com's marketing department.
Just my opinion,
Tom D |
