October 6, 2008

Lollypops for Pain

We have been following the market trajectory of Actiq, the lollypop for pain manufactured by Cephalon. Actiq contains fentanyl, a highly addictive substance about 80 times more potent than morphine. It provides relief within 15 minutes. The drug, intended for breakthrough cancer pain, costs about $2,400 for a month's supply.

Cephalon bought the small company that developed the drug in 2000; annual sales of Actiq prior to the purchase were just $15 million - a limited market share dictated by the narrow target audience. By 2005 Cephalon had pushed sales to $500 million. That's a lot of lollypops and, you might think, a lot help for cancer patients. Not so. Fewer than 20 percent of the patients receiving the drug have cancer. Actiq's meteoric rise was fueled by off label prescriptions, most often involving doctors treating transient pain. (As many as 90 percent of prescriptions were off label.)

Back in 2006 John Carreyou wrote in the Wall Street Journal (subscription required) that Cephalon sales reps fanned out to visit all kinds of doctors, few of whom specialized in cancer patients. Doctors reported hundreds of visits from sales reps, who gave the doctors coupons for free trial doses. Nothing like freebies to stimulate sales.

Cephalon is supposed to self-monitor the off label use of its drugs. When they receive a report of a doctor prescribing the drug for non-cancer purposes, the company is supposed to send a (strongly worded?) letter to that doctor reminding him or her that Actiq is only for cancer pain. The company sent out more than 3,300 such letters. I would love to read one: a pharma company making the case against its own product...We can assume that the letters were rarely read and even more rarely effective.

Cancer and Comp?
Through aggressive marketing, Actiq worked its way into the workers comp system (where cancer is is almost never compensable). Lollypops for pain became a major player in comp pharma: NCCI reports that by 2006 Actiq ranked number 11 in frequency of prescription and number 4 in total cost. These are astounding numbers, given that virtually every prescription was off-label.

Cephalon describes itself as "a global biopharmaceutical company driven to expand the boundaries of science to improve human health." It appears they confused expanding the boundaries of science with those of sales. The company states that they are "Driven by why." Actually, they are driven by "why not?" Why not expand market share ten fold? Why not put this powerful drug in the hands of people with transient pain?

Well, here's one reason why not: Cephalon recently agreed to pay a whopping $437 million to settle a bunch of federal and state claims. Our colleague Joe Paduda reports that they are also going to reveal the names of doctors they have paid to promote the drug. Insurers and PBMs take note: The list will be a compelling read.

So Long, Sucker!
Lollypops date from about 1784, but initially referred to soft, rather than hard candy. The term may have derived from the term "lolly" (tongue) and "pop" (slap). The first references to the lollypop in its modern context date to the 1920s. This latest incarnation of a "tongue slap" is a long way from a little sugar high. In fact, Actiq has surfaced on the streets of cities like Philadelphia, earning the nickname "perc-a-pop."

Oh well, look on the bright side. It's relatively hygienic: you can get stoned without sharing a needle and nobody wants to share a lollypop. Yuck!

| 1 Comment

1 Comment

Whether the lollipops are only supposed to be used for cancer patients or not, any drug can legally be used off label.

As a nurse who was permanently disabled from a work related injury which was not treated in a timely manner, leading to major back surgery with nerve damage and chronic pain, I can empathize with others in this state. While I do not need fentanyl to control my pain, the delivery system of such a drug is important.

Patients have died from Fentanyl patches; perhaps dosing via the lollipops is actually a safer alternative.

Then again, if that is true, I can understand why WC would not want to pay for them. Every injured worker who dies from the patches or overdoses on oral pain meds is one fewer person who gets benefits and therfore increases the bottom line.

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This page contains a single entry by Jon Coppelman published on October 6, 2008 1:51 PM.

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