Caduet

Although the overall prospects for the pharmaceutical industry are still positive, growth in both dollars and prescriptions dispensed is slowing gradually as several trends negatively impacting the industry are picking up steam.

Prescription trends are a little more bleak for pharmacy operators, especially as the average drug store mix shifts more toward prescription drugs and away from front-end merchandise---and as the dispensing of those prescriptions continues to flow increasingly to mail order in place of retail.

But no one should be reaching for the panic button just yet.

"To put this in context, we have a market that in the last 12 months [totaled] $227 billion, of which retail and mail captured $166 billion, Doug Long, vice president of industry relations at IMS Health, told a roomful of pharmacy operators and pharmaceutical executives on the last day of the National Association of Chain Drug Stores Pharmacy & Technology Conference held here at the San Diego Convention Center.

So the pharmaceutical market is still quite healthy with $15.9 billion in incremental growth through the retail and mail channels, Long suggested. Plus, the market for prescription drugs is still growing in dollars an average of 10 percent to 11 percent--a pace that should hold year after year through 2008, Long said.

The challenge coming from mail order is significant, however. Currently, mail order pharmacy is experiencing a 16.1 percent lift in dollar sales for the 12 months ended in June, claiming an 18.8 percent share of the overall retail market, and is easily the fastest-growing market. Dollar growth at chains and mass retail pharmacies is trending at 10.8 percent, independents at 6.9 percent and food stores at 7.1 percent.

In 1999, mail order made up 13.5 percent of the prescription drug market and held a 10 percent market share in the number of pharmaceutical units dispensed (as opposed to prescriptions dispensed). Today, mail order unit market share stands at 12.5 percent.

The thing that surprised me the most when I tracked this, on an absolute growth basis, Long told attendees, is that 12.5 percent of the market on a unit basis accounted for over 50 percent of the incremental units over the past 12 months." That means that mail order pharmacies have contributed more growth in units over the past year than retail. "A lot of that probably is accounted for in the movement from 30-day prescriptions to 90-day prescriptions, Long said, not to mention a managed care trend toward mandatory mail programs today.

Looking forward, the utilization of Medicare discount cards is ramping up, with more than 300,000 cards in use as of Aug. 6. What is more significant ... Medicare discount cards accounted for more than 3 percent of all the prescriptions to people 65 and older ]as of Aug. 13], Long said.

Pharmaceutical trends

Currently, four factors are contributing to a slower growth rate in prescription drug sales. First, pharmaceutical companies are arguably less innovative today than they were in the mid- to late-1990s, Long said, when the cox-2 inhibitors, Viagra and Lipitor all were launched. "Although that's recently turning around," he added.

"So far this year, through July, we've seen 17 new molecular entities, so the pace of innovation is starting to pick up in this marketplace, particularly on combination products, he said, noting that products like GlaxoSmithKline's Advair Diskus have been successful, and the recent launches of Merck/Schering-Plough's Vytorin and Pfizer's Caduet--both projected to be major blockbuster drugs--have generated a lot of buzz.

Other factors impacting pharmaceutical growth include the continued loss of patent protection for major blockbuster products, which consequently has spawned tremendous growth in the generics industry. And as copayments on prescription drugs continue to increase, consumers are exploring less-expensive therapies--whether it be through over-the-counter alternatives or through Canadian import services.

But even as current trends retard pharmaceutical growth, there is still plenty of potential in the business of pharmacy, Long noted. There are still disease states, like diabetes and hypertension, that are under-diagnosed and, consequently, undertreated. And there is still growth potential in other areas, including treatments for Parkinson's disease, Alzheimer's, cancer and obesity.

There also is much potential in biologics, Long noted. Sales of biologics today already represent 10 percent of the overall prescription drug market. More importantly, biologics represent 25 percent of all drugs currently in development--suggesting a bright future for that class of drugs.

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