Sales Of Pfizer's Viagra Drop As Publicity Fades, Patient Fears Grow
October 15, 1998 12:51 AM
By Robert Langreth and Andrea Petersen, Staff
Reporters of The Wall Street Journal
Just a few short months ago, Pfizer Inc.'s impotence
medication Viagra seemed unstoppable. Men of all ages,
including many who weren't really impotent, rushed to
try the drug when it went on sale in April. By early May,
Pfizer had racked up 300,000 prescriptions a week,
unheard of for a new drug. Some analysts predicted that
sales could reach $10 billion to $20 billion a year
world-wide -- many times that of any other drug.
Now Viagra sales have come back to earth, thanks to a
cooldown of media hype, fear of side-effects and a
managed-care crackdown on reimbursement. Late
Tuesday, Pfizer reported Viagra sales of $141 million
world-wide for the third quarter, including $115 million
domestically -- a fraction of Viagra's $411 million sales
in the second quarter.
Analysts had known that sales had fallen, but the
magnitude of the drop surprised many. "They are not
anywhere close" to earlier projections, says Hemant
Shah, an independent analyst. "We all miscalculated the
demand."
What changed? Just ask Freddy Hahne, a 48-year-old
artist in San Francisco, who tried Viagra once for fun in
the spring. He said it gave him "a nice tingling sensation"
and he thought he would try it again soon. Now, he
says, the hype is gone, and so is his desire for the
experience. "I think it is old technology now," he says.
News of adverse reactions -- including deaths -- among
a small number of Viagra users led Donald Witt to cut
back on his Viagra consumption. "I have used it a
couple of times since the problems surfaced on the news
but I have slowed down," says the 69-year-old retired
engineer in Jupiter, Fla. "I'm concerned. But it worries
my wife even more than it worries me."
At Men's Health Centers, a chain of
impotence-treatment clinics based in Boca Raton, Fla.,
patients who had switched to Viagra from injectable
medications started coming back for injections again. It
turns out that some men with premature ejaculation
problems prefer the nearly immediate and long-lasting
erection produced by the shots, instead of having to wait
up to an hour for Viagra to kick in.
"Viagra has a reputation as a Disney ride: an hour wait
for a two-minute ride," says, Seth Koeppel, the clinics'
CEO.
Then there's the cost factor. Managed-care companies,
which initially didn't have policies on Viagra, started
clamping down on reimbursement for the pills, which go
for $8 to $10 each. In recent months, companies such
as Prudential Insurance Co. of America and Humana
Inc. decided not to cover Viagra, while other insurers
limited coverage to a few pills a month.
Those changes in HMO policies seem to be having an
impact on sales. According to Pfizer, the average size of
a Viagra prescription has fallen to six to seven pills,
down from 10 to 15 pills when the drug first was sold.
Certainly, Viagra is still doing well compared with the
vast majority of new drugs, with about 170,000
prescriptions filled each week, according to IMS Health,
a provider of prescription data. Pfizer says that sales,
which have stabilized in recent weeks, should grow
again as men start to refill prescriptions and doctors start
prescribing it in Europe, where it was recently approved.
"There is no reason to be disappointed in the sales. We
are not," says Pat Kelly, senior vice president for
world-wide marketing at New York-based Pfizer.
"There was a honeymoon effect," but now the company
is just beginning to see normal usage patterns for the
drug.
Pfizer says that the real surprise isn't the decline, but the
initial buying binge. Media coverage contributed heavily
to the craze. Major newspapers and magazines wrote
hundreds of stories on Viagra. Tabloids dubbed Viagra
"the love drug," leading to a false impression that it
would increase libido and make old men virile
youngsters again.
But then men started realizing that the drug, while
helpful, doesn't work miracles. "Initially, people thought
it was a cure" for impotence, says Stan Kardatzke, a
doctor and chief executive of Integrated Medical
Resources Inc., a Lenexa, Kan., company that manages
impotence clinics. "But it is only a tool" for treating the
disease.
"Older men thought this would make them 20 years old
again," says Mr. Koeppel of the Men's Health Centers.
"But it just doesn't work that way. The emotional and
relationship issues (with sex) don't go away."
Richard Roberts, a family physician in Belleville, Wis.,
has half as many patients on Viagra as he did this spring.
He says some men were hoping the drug would fix other
problems in their relationships, and once they realized
that Viagra only worked on an erection, they stopped
taking it. "Some men thought if I make love better, she'll
love me better," Dr. Roberts says. "But that didn't
happen."
John Weigel is writing only half as many Viagra
prescriptions now as he was during the first few months
the drug was available. About 10% of the patients who
stopped taking it did so because of cost or fear, says
Dr. Weigel, a urologist at the University of Kansas
Medical Center in Kansas City, Kan. "There are enough
things in the literature that have scared some folks off,"
he says. "You read about sudden death on this drug so
people say they are afraid to take it." Dr. Weigel,
however, still thinks Viagra is safe.
The Food and Drug Administration has received reports
of at least 100 men suffering serious adverse reactions,
such as heart attacks, strokes or death, while taking
Viagra. But it isn't clear how many of the problems are
actually related to the drug, since most of those men
were elderly and had other medical problems. Some
patients with problems did take Viagra in combination
with nitroglycerin drugs or other nitrates, against
package warnings. Both Pfizer and its regulators have
said they see no signals that anything is seriously wrong
with the medication.
Other urologists, especially those with a large number of
older patients, say many men -- or their wives -- have
decided that they don't want to keep up the frenzied
pace of their initial Viagra-enhanced days. "A lot of
seniors overestimated the amount of sexual interest they
would have," says Steven Varady, a urologist in Boca
Raton. Adds Stanley Korenman, a reproductive
endocrinologist at the University of California at Los
Angeles: "Viagra really works, but guys don't have sex
as much as they think."
Some sex therapists say patients aren't refilling their
Viagra prescriptions because just having a bottle in the
medicine cabinet is enough to cure their problem. Some
men with "performance anxiety" or other psychologically
induced erectile dysfunction can have sex just knowing
that Viagra is a room away, says William Granzig, a sex
therapist in Winter Park, Fla.
Meanwhile, among urban hipsters who were trying it out
as a party pill, Viagra is last season's fashion. Club
denizen Brad Moyer used to see other young nightowls
down Viagra just for kicks or to combat the
erection-squelching effects of other recreational drugs.
But these days, his stomping grounds, the New York
hot spots Twilo and Sound Factory, are Viagra-free, he
says.
"I don't see people doing it or talking about it anymore,"
the 29-year-old computer programmer says. "The buzz
has died."
Copyright (c) 1998 Dow Jones & Company, Inc.
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