I'm going to propose a very rational and plausible scenario here and I know 99% of you will dismiss it out of hand because you unquestionably believe Belviq is superior in every way to Qsymia and EVERY doctor knows and believes this just a strongly as you ARNA long but hear me out.
- Qsymia has now been prescribed by at least 12,000 unique physicians within 5 months and may be up to at least 14,000 today if the trend line continues.
- We know percentage of obese and overweight. The simplest of math shows these 12K physicians are seeing many many more patients that fit within prescribing parameters of Qsymia AND Belviq then they are giving out scripts for.
So it's a legitimate and serious question for this market to ask what's going on? Why the ultra-low scripts per physician to date? Now for simpletons here the answer is obvious to you, qsymia sucks, the physicians are just waiting for Belviq. And if that's what you think, we'll all know soon enough and it's not very interesting, but if there's anyone here with some fresh thoughts on the subject I'd like to hear them.
On the surface it appears physicians are being ultra-conservative and only placing a very small select number of patients on a weight loss drugs to see what happens before they make any decisions about increasing their scripting. If I were Eisai I would be watching this closely and be trying figure out how to address this. Any thoughts on this?
Q didn't have a true "launch" from a pharma distribution network. VVUS doesn't have a partner, whereas Arena has a partnership that has a network and relationships with doctors already in place. Bet all the endocrinologists Eisai deals with already has some sample packs in their drawers, ready to go as soon as it clears the DEA.
We don't have data to properly analyze why the scripts are low, but we do know the sales limitations that contribute to the poor sales of Q. My guess as to why the rate has not increased much is that only a small proportion of doctors are willing to prescribe it. Some will certainly advise patients to wait for Belviq, and if they are non-responders, try Q since Q has dangerous side effects. That will help Q sales later this year, but only until ARNA begins selling a Belviq-combo drug. At that time, Q sales will level off or fall. At that time ARNA's pipeline of drugs in combination with Belviq and Belviq-combination drugs will keep pushing share price higher.
Sentiment: Strong Buy
This is a good point. It doesn't seem doctors prescribe weight loss medications at a very high rate. I was overweight for many years and neither my primary care physician nor my cariologist ever suggested a med to get my weight down. It may be because of the bad safety rap.
When I talked to my doctor about Belviq a couple of months ago he said he would prescribe it if patients asked for it. Therin lies the difference between Qsymia and Belviq.....public awareness.
I have no idea if Eisai plans DTC advertising initially but I'm do feel certain that they won't let $155 mil in upfront payments go without doing what is necessary.
Also, having spent a number of years as a medical practice management consultant I can tell you that sucessful medical practices will prescribe a drug that brings patients in to their offices. Yes, its all about the money.
Borrowing from another of my posts, IMO:
I thought this part in AF's article was interesting:
"Vivus said 27,000 unique patients have been prescribed Qsymia since the drug launched five months ago. A Qsymia script costs approximately $135 per month for the recommended middle dose, so under the most
optimal circumstances (all 27,000 patients taking five months of Qsymia), best-case sales to date would have been roughly $18 million. The $2 million in actual Qsymia sales reported suggests a lot of patients are trying Qsymia for a month or two, then giving up. How many patients are discontinuing Qsymia and when? Vivus was asked this question on Monday's call but declined to answer directly."
(side note: it's funny that they are giving 2 weeks supply for free, since the titration adjustment period is 2 weeks! So, the period of patients learning to tolerate side effects is covered... kind of a negative way to ask people to start, no? ....told you the titration used to assist clinical stages could come back to bite later).
The difference between 18M and 2M is impressive, but what is obviously missing is the reason why discontinuations are happening at such an awesome rate. I suspect it is because this stuff is nasty
medicine..... it is difficult enough to get motivated to lose weight by any traditional means and then have to go through a titration period, and to also overcome the list of side effects like dry mouth, altered taste (metallic taste), tingling (neuropathy), constipation, dizziness, and insomnia? People are under-estimating the
psychological affect of these effects. Diet and exercise could start to look pretty appealing after this. At least a weight loss clinic a patient can use phen alone and then add topo in short courses (or not at all) and my guess is they can understand and tolerate the amphetamine buzz better than the full Q suite of ASE's.
Meanwhile, we have Belviq that gives some people a mild transient headache, helps them deal with food cravings (to encourage diet and exercise), gives some people a feeling of well-being.
BUT on Wallstreet perception is reality and apparently the perception is V is proving "diet drugs" are not
selling, and B costs more than Q, therefore B is going to have the exact same problems..... I would not be so sure as these are entirely different drugs. Amazing logic further tested when we also consider that V is going it alone on marketing (experts at hype no doubt, but actual pharma sales is a brand new thing for them), while Eisai has top 25 Pharma status, experience, contacts, and corporate strategies. It appears that Arena-Eisai are going directly at medical obesity as the primary marketing strategy..... their strategy and capabilities appear to be VERY sound, imo.
Will there be a lag time until we see how sales ramp up? Makes sense, but don't be surprised if Arena has some other things to spring into this lag period that could go further toward detaching and distancing B from Q....and they also have been able to use this time to be launch ready and jump start sales.
Will be fun to watch...... that's what makes a ball game.
Physicians aren't prescribing Qsymia, and patients aren't asking for it. At my Doctors practice, there are many (30+) who are waiting for Belviq and are not going with Qsymia because of side effects (2/3 of these are women of child bearing age).
Though, overall, I don't think there is any massive pent up demand, and that is the real issue. There is an OPPORTUNITY, but it isn't as if there are 75M people calling their doctor daily asking if Belviq is available yet. The masses will have to be marketed and sold.
Absolutely right - the risk of birth defects, whether small or not - would discourage any doctor from recommending Q to women of child bearing age. And would prevent the same women from asking for it. Too extreme a chance.
So yassen you sit in your doctors waiting room and ask random patients about Belviq and Qsymia? Is that what I'm to believe from your post? How big is your sample size so far? Has your doctor expressed any opinion about you wandering around his/her waiting room asking these questions?
"On the surface it appears physicians are being ultra-conservative and only placing a very small select number of patients on a weight loss drugs to see what happens before they make any decisions about increasing their scripting."
The fact that physicians are only putting a small number of their patients on Qsymia has nothing to do with their actions once Belviq is available. The lack of current scripts can only be evaluated in terms of why they are not prescribing Belviq. After Belviq is available, then the situation of scripts written vs. patient eligibility can be properly assessed.
Nice try with the sincere angle, tod. But it's a little late for you to put on a front of legitimacy.
VVUS was less a launch than an intentional seepage of product. Arena is going to launch a product. Eisai will be using real pharmaceutical reps and making a real effort.
As I have said in the past, I want VVUS to be a presence, (granted a lesser presence), in the market, as there should be a choice. This 'launch' followed by the odd choice to re-emphasize the failure in Europe was done very poorly.
We are going to show you how it is supposed to be done.
These 12K physician made the determination Qsymia is safe enough to prescribe at least once. Marketing and sales is separate issue that doesn't stop a physician from prescribing more. So what can be learned from this launch and this market so far? Other then re-enforcing your pre-conceived convictions about qsymia.
Doesn't Vvus only have 17,000 scripts total? Thats practically 1 script per physician. It says to me that Physicians are only giving it to their most serious cases OR to someone who asked for it. aka, poor marketing/ poor selling team are killing Vvus. No doctor is ONLY going to give it to one patient for their own trial to "See" how it goes. who would they have to compare it to?
Best to get your facts straight before posting your rubbish.
Last 4 weeks data was for 17,383. scripts.
More importantly an expected REMS modification in April will allow QSYMIA to be sold in select retail pharmacies... e.g. CVS, Walgreens, Walmart.
Once the retail market opens up for QSYMIA distribution and VVUS begins its DTC campaign, sales will dramatically ramp up.
I have read your posts and we all know you are Q stockholder and that is the horse you are backing up. The medical world isn't always the bigger the better...Just because Q has a "higher" weightloss % now (until belviq is used in combo), does not mean they will be selling. You cannot compare Q (REMS, no advertising, Small sales force) to Belviq that has a partner that is doing majority of the leg work Q has obviously (by the #'s) failed at. The writing is on the wall and you might be in a little bit of a shock, because you are behind Q, but CHMP denial x2, drop in PPS from $30 to now and sales numbers that don't mean squat and burning $50 million a quarter, execs selling their shares in the $20-30 range and you ask yourself why? This isn't a bash against Q and pumping ARNA it is a reality check man. I see you spend so many hours on this bored, trying to convince us that Q is better....In reality you are trying to convince yourself that Q is better and again you can see where that has taken you...GL to you, there is a reason why Esai is paying us millions. Strong Buy beause $8.00 is stupid low.
Sentiment: Strong Buy
no. no. no. Let's stay on topic. This issue is scripts per physician. Why are scripts per physician so fantastically low on Qsymia to date and does this saying anything about ANY new weight loss drug? pps, chmp, number of sales reps, etc, etc are irrelevent to the specific question of why are physicians once they decide to prescribe are holding back prescribing in any volume so far and does this have any broader lessons learned for ANY weight loss drug that may enter the market. Again i understand many of you think Belviq is very very beautiful and smells as sweet as a rose so of course not, but just maybe some one here some additional thoughts on this.