"Pill counts up by 20% compared to last quarter. "
I take this to mean that in the first 5 weeks of Q4 the total number of pills sold is up 20% compared to the first 5 weeks of last Q (as opposed to pills/script = impossible and as opposed to all of last Q).
The scripts during the first 5 weeks of this Q are up ~15.7% compared to the first 5 weeks of last Q. This accounts for most (but not all) of the difference in the total numbers of pills sold. What about the remaining?
We’ve suspected for a long time and it’s been confirmed by AVNR that LTC scripts are relatively light on pills/script. We’ve seen a stable PC/script despite an ever-increasing proportion of LTC. The only way the PC/script can stay stable in that scenario is if retail PC/script are increasing over time to counteract the greater proportion of lower count LTC scripts.
The ever-increasing LTC script proportion has been accompanied by an ever-decreasing proportion of Wolters Kluwer scripts relative to IMS. That is, until this summer. We’ve had a stable ratio If anyone has paid attention, the ratio at 44% since May….that is until this week when, based on SRK’s numbers, the ratio has reversed to ~50% (a ratio we haven’t seen since Feb). This scenario is not all roses as its mainly been a slowdown in LTC rather than an increase in retail to accomplish this. Never-the-less, if retail PC/script has continued its growth trend while the LTC proportion did not continue to increase then we’d expect the average PC to increase. This week’s apparent jump in retail compared to LTC would further push that average up.
This is just one theory to explain why the total pills sold are up 20% while increased numbers of scripts only explains 15.7% of that 20%. There are some holes but time should fill them in. We’ll see.
The STAR trial gave preliminary indication that 20 dex/10 quin is not effective for pain but 30 dex/10 quin showed some effectiveness.
That's why physicians would be more likely to prescribe two Nuedextas twice a day for pain.
I beg to differ. They would not prescribe a higher dose, the Dr. would merely be more likely to write a longer term script for 90-days faster than they would for PBA. The Dr. would likely want to wait and want more rechecks for PBA since it may not be viewed as urgent of a problem.
Still over time, the same thing happens. 90-day scripts which cumulate. Hidden by short term LTC scripts. Pain would happen much much faster, but the end result is the same. Pill count growth and Script Growth create a double whammy on net revenues.
Heck, I hope KK meant that the average pill count went up 20% from 51 to 61 AND scripts grew 6.4% TOO in one month for a 26.4% INCREASE in net revenues. OFP's analysis is probably correct. Regardless, pill count increases are all good.
Temperance is the word, for sure.
Ignoring that for a moment, a healthy conversation was started for the level-headed to consume which may lead to definitive answers to tomorrow's meaningful questions.
True although 20 milligrams of otc dex as a supplement to a Nuedexta would be much cheaper than two Nuedextas and about as effective.
If off-label pain use were occurring, this outside-the-box WK number for the week ending 8/3/12 would itself be only a wisp of what would follow.
If the neurology thought leaders recommended Nuedexta be tried for neuropathic pain ahead of opiates, for example, I could easily see the first full quarter of genuine off-label pain use being $50 million in net Nuedexta sales which would be almost four times present PBA sales!
Perhaps it did, but LTC's faster percentage script increases HID the true Retail Growth for a while with respect to refills and renewals.
Now, maybe the cumulation effect is starting to take hold on the retail side for continuing refills and renewals with longer term scripts.
In any event, no one wants to go to the pharmacy every 30-days if you can go every 60 or 90-days. Does not matter if it is PBA or asthma.
I think this 20% increase in pill count reported by the CEO wouldn't necessarily be due to an increase in average pill count. It could just be more scripts as correctly or incorrectly reported by WK for the week ending 8/3/12.
It occurred to me this could be the first scent of off-label pain use which would quickly outpace PBA sales.
But I think temperance dictates waiting for confirmation of this outside-the-box WK weekly number, thus far uncorroborated by the corresponding IMS number.
So I'm not getting excited.
If a PBA retail patient is being helped and needs to stay on the drug, why would they keep refilling their script every 30 days instead of 60 or 90-days. It does not matter what indication it is if you need the help.
Agreed about the need for more data and tempered expectations.
If a sustained increase in avg. pill count can be confirmed in time, do you think it may be a sign of traction being gained in off-label retail prescribing?
I can't see why there would be a marked increase in avg. pill count for PBA prescribing in the retail or LTC setting at this point and suspect that prescribing for pain and agitation would be longer-term (90 days).