Thursday, October 23, 2008

Pipeline Execution

Parexel consulting just published a new white paper highlighting the key limiting factors in getting new drugs to approval. The paper focuses on perhaps the 2 most critical factors shaping the pharmaceutical industry’s future performance at a time when R&D costs continue to rise in relation to output and ‘safety first’ becomes the dominant principle in the US regulatory environment. The most pressing challenge for industry executives “has shifted from building the pipeline to executing the pipeline”, it comments. The hurdle has resulted in a decade long decrease in submissions of New Molecular Entities (NME's) in the US. After averaging 45+ per year in the mid-1990s, NME filings to the FDA dropped to 21 in 2006. Last year they recovered slightly to 28 submissions. The preliminary results of an FDA study on NMEs released in June indicated that the overall decline may reflect industry’s waning interest in seeking approval for less innovative NMEs.



First Cycle Approval


How much is getting a new drug through the FDA approval process at first attempt worth? About $639.2 million according to Parexel. For NMEs signed off by the FDA in 2007 and the first half of 2008, the approval times for compounds cleared in a single review cycle were less than one third those for NMEs requiring resubmissions (8.6 months versus 27.7 months).

The good : there has been a recent increase in the percentage of US NDAs gaining first-cycle approvals. In the 2006 fiscal year cohort (the latest to mature fully), the FDA’s Center for Drug Evaluation and Research set a record for the user-fee era of approving 51% of NDAs in the first review cycle.

The bad: In FY 2007, nearly a quarter of Class 1 NDA submissions – the less complex refilings in response to minor issues raised in the first-cycle review – failed to gain approval.

The ugly: Close to two-thirds of Class 2 NDA resubmissions – typically filed in response to more significant questions arising in the initial or previous review cycle – during FY2007 did not make it to approval.

Priority Review

Priority review status – usually reserved for drugs with indications where there are no satisfactory alternatives or that offer significant improvements over what is already available- is the second most critical factor that directly correlates with revenue loss. Nearly US$448.4 million worth .

The FDA’s performance goals specify six months for taking action on priority NDAs, compared with 10 months for standard NDAs, the white paper notes. However, the implications of a priority rating are “far more significant” – for example, between 1 January 2006 and 30 June 2008, priority NMEs were cleared on average 13 months ahead of standard-rated NMEs.

Moreover, 94% of the priority NMEs approved in 2006, 2007 and the first half of 2008 were cleared in the first review cycle, while around one quarter of all standard NMEs approved over the same period needed three cycles to get through the process. To make matters worse after granting priority ratings to 30% of the NDAs submitted in 2005, the agency has done so for only 18% of applications filed in FY 2007 and up to 31 March 2008
.

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Tuesday, September 30, 2008

A Thin Red Line ...

Developing nations - once ignored & considered to be closed economies, but now the biggest area of growth for most multinational corporations- have always had a strangely dichotomous relationship with the industrial powerhouses of the west. Cheap labour, abundant resources, large talent pools, have all spurred on the R&D investment & outsourcing by major pharmaceutical firms. Even though the generic, CRO & API scene is thriving in many Asian & east European countries, big pharma is still very reluctant to launch their new drugs here. Perhaps where this is most prominent is India - where most multinational pharma companies have held back from launching new products since 1995 for fear of them being immediately copied & manufactured by the generic mafia.

India has had a booming, cost effective generic industry since the 1970's when the government decided to amend its patent act to exclude pharmaceutical products from patent protection. This action catapulted India from a country importing most of its medicines at some of the highest prices in the world to a country that was self-reliant in producing life-saving medicines. India has been and remains the producer of choice for medications in most developing countries, producing medicines of assured quality that meet all international standards, at the lowest costs and highest volumes. Self sufficiency did come at a price though, and for India this meant sustaining a closed economy void of any foreign investment.

On Jan 1, 2005, India finally opened its doors to the world by becoming a member of the WTO. This also meant embracing the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. TRIPS required WTO member states to grant patents on all classes of products (including medicines), to provide protections for a minimum of 20 years, and to allow patent rights to be satisfied either by importing the drug or by producing the drug domestically. India was now required to start collecting drug patent applications filed between 1995 and 2005 and to amend its patent law by Jan. 1, 2005. Despite these new requirements, the TRIPS agreement allowed the continuing production of pre-1995 drugs and several "transitional" years to become TRIPS-compliant. It also contained important allowances enabling access to lower-priced medicines. These included rights to issue compulsory licenses (involuntary rights to the process and product with payment of a reasonable royalty) and rights to parallel import (unrestricted rights to buy patented medicines previously produced and sold elsewhere at a lower cost).

The new Patents (Amendment) Act of 2005, attempts to balance the interests of the domestic industry while trying to entice big pharma to increase their capital investment in the subcontinent. No small feat for a nation known for notoriously one sided policy making. Intense lobbying & political pressures mean that the new Act does leave some loopholes that have social activists up in arms. Some of the main points of contention are:

1. Instead of limiting patent protection to "new chemical entities," the act creates rights to patent certain new uses, formulations, delivery systems, combinations of existing products, and minor variations of existing chemical entities.

2. The act makes no changes to the procedurally laborious and inefficient compulsory licensing scheme.

3. The act fails to specify guidelines for setting modest royalty rates (2-4 percent) for compulsory licenses and, except in a government-declared emergency, it requires applicants for compulsory licenses to wait three-years before applying.

4. The act grants 'patent-like' rights for patent applications between the publication and approval of the patent deterring generic entry even in cases where the patent application may later be denied.

Plans to enforce 5 year data exclusivity for clinical trial information are also on the table even though this is not required by TRIPS. This TRIPS-plus exclusivity would prevent a generic producer and the drug regulatory authority from relying on previously submitted data. The generic producer would be required to duplicate costly, time-consuming and possibly unethical clinical trials to prove what is already a matter of record.

India's policy makers now find themselves in an unparalled situation. Do they continue to champion the effort to provide low cost, effective medication for the millions of poverty ridden individuals or should they risk the countries rich generic heritage in their pursuit of becoming an economic powerhouse? The government is being increasingly vocal in trying to allay big pharma's fears and are pushing the agenda of greater investment. However, the numerous opposition avenues being utilised by the domestic companies & activists are clearly retroactive. GSK has had to withdraw its patent applications for the antiretrovirals Combivir, Abacavir & Trizivir, and Novartis lost its landmark case against section 3d of the Indian Act in 2006. Perhaps more importantly India has set a precedent for other developing nations. Thailand is working swiftly towards an efficient compulsory licensing system & the Phillipines is also modeling its strict patent standards to be in line with that of India's.

The million dollar question is: With the increasingly westernized population (in terms of disease profiles) & burgeoning middle class in these developing economies, how much longer can big pharma afford to stay out of these markets? With drying pipelines, patent clocks ticking down, & increasingly negative publicity perhaps embracing compulsory licensing and forming north-south networks isnt such a bad idea?

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Tuesday, September 16, 2008

Chicken or the egg ?

"What we are seeing here is the 21st century scientific parallel to the Great Depression of 1929." - Anonymous

I have had the pleasure of conversing with many academics, industry professionals & students about the issues surrounding today's healthcare systems, and what policies should be implemented to effect the changes we wish to see. Despite the complexities involved, there is always one basic question that somehow always perplexes the respondent - regardless of their background knowledge. Its also a great conversation starter mind you. Today, I pose this question to the greater community:

What is (or rather should be) the single most important goal of drug manufacturers (biotech/pharma)?

A) To discover new ways to treat/prevent a medical condition or disease
or
B) To maximize shareholder return on investment


Yes, I only provide you with two very simple options, but only because I believe that such a reductionist approach is necessary to re-evaluate an intricate system. From idealistic researchers to the more conscientious investors and economists, I have heard arguments for both sides. Many more have refused to entertain my requests for an answer to such a seemingly inane question.

Those that choose "A" are posed questions such as - Is discovery enough justification for massive capital investment? Will venture capitalists continue supporting purely altruistic organizations that continue to lose money? What would be the driving force for enterpreneurs if there is no sustainable reward? Legally, all publicly traded companies are mandated by legislation to pursue investment return on behalf of shareholders. Is the answer then, to ensure privatization of the drug discovery sector?

Choose "B" and once again many queries come to mind. No really good team comes to work to "maximize shareholder profit/return"- At least not in this arena. Companies largely dependent on innovation are only as good as their intellectual property, and if their goal isn't to feed that quest then what are they selling? How can they ever gauge what an adequate investment in R&D should be? In a society placing increasing emphasis on corporate & social responsibility how can a money hungry entity ever gain any trust? More importantly, how would it be possible to keep churning out new technology/products & progress science given the conditional basis that they must be profitable. After all trial/error has been the most foolproof strategy throughout history.

Given the ostensive business model of biotech/pharma companies, it seems that B is generally accomplished through A. It is also true that a well-rounded establishment should ensure that different functional areas have different priorities (eg. R&D chooses A, Finance & Sales deals with B, etc). The truth is that it is extremely hard to pick one as being a priority over the other. Both objectives are so intertwined that anyone who confidently picks one over the other risks being deemed "not educated/experienced enough".

I do not know what the right answer is, either realistically, idealistically, psychologically or even nasally. But I do know that the problem is cultural & very soon we will come at a crossroads where we will be forced to pick a priority unless society as a whole can come up with an alternative to Laissez-faire economics.

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Tuesday, September 9, 2008

DNA makes RNA makes Protein makes Money...

The surge in start-up ventures and academics setting up shop in the hopes of bringing the the latest in biotechnology to the consumer, presents investors with a major problem. One that has its fundamentals embedded in traditional number-crunching, and yet is so subject to external variables that it seems to involve more guesswork than science. The problem I refer to is that of "Valuation". How does one find that hidden gem amidst the slew of companies promising future success? How do you value a company that has no track record, no revenue and almost no assets? If Steve Jurvetson Managing Partner at Drapper/Fisher/Jurtvenson were here, his response would be - "in a very subjective & capricious way".

Valuation can take on many forms. However, When performing a valuation, you will find there are three well known approaches : DCF or income approach, market approach, & the asset approach. The generally accepted approach to valuing healthcare companies that are years away from payoff uses Discounted Cash Flow (DCF) which tries to work out the value of a company today, based on projections of how much money it's going to make in the future.


DCF analysis says that a company is worth all of the cash that it could make available to investors in the future. The major difference in using DCF in valuing healthcare companies versus other sectors is the flexibility to take a product-centric approach. What this means, is that you must be willing to treat each potential drug as a separate entity within a portfolio. Hence, in order to obtain an amount representing the fair value of the entire company today you must:

  • Determine Free Cash Flow (FCF) of each drug
  • Adjust FCF to Risk
  • Determine a Discount Rate
  • Determine DCF (which is Risk adjusted FCF x Discount)
  • Obtain Total Enterprise Value
It is generally safe to say that it is only worthwhile conducting a DCF analysis on drugs that are in the clinical trial stage. A drug that is in the discovery or pre-clinical stage is a very risky proposition, with less than a 1% chance of getting to market (according to an industry report published in 2003 by the Pharmaceutical Research and Manufacturers of America). So, drugs in the pre-clinical stage are usually assigned zero value by public market investors.

Determining FCF requires the Peak Annual Sales Revenue and an estimation of costs. Forecasting sales revenue for each drug is probably the most important estimate that needs to be made. Some considerations that must be taken into account especially for biotech/pharma are:
  • Market Potential (estimated market size)
  • Market Share (penetration rate)
  • Sales price Estimate
  • Royalty Rate
When forecasting future cash flows for a drug, you need to consider the costs of discovery and bringing the drug to market. The commonly used criteria are:
Deducting the drug's operating costs, taxes, net investment and working capital requirements from its sales revenues, you arrive at the amount of free cash flow generated by the drug if it becomes commercial.

Next Step - Inclusion of risk into our estimates. As the drug moves through the development process, the risk decreases with each major milestone. The Pharmaceutical Research and Manufacturers of America reported in 2003 that drugs entering Phase I clinical trials have a 15% probability of becoming a marketable product. For those in Phase II, the odds of success rise to 30%, and for Phase III, they climb to 60%. Once clinical trials are complete and the drug enters the final FDA approval phase, it has a 90% chance of success. These improvements in the odds of success translate directly into stock value. By multiplying the drug's estimated free cash flow by the stage-appropriate probability of success, you get a forecast of free cash flows that accounts for development risk.

Applying a legitimate discount rate will allow us to figure out what these cash flows are worth today.
So, how do we figure out the company's discount rate? That's a crucial question, because a difference of just one or two percentage points in the cost of capital can make a big difference in the total value. There are many ways of calculating discount rate, and an in depth discussion is beyond the scope of this post, but a safe strategy is to use the Weighted Average Cost of Capital (WACC) which incorporates both debt & equity into the overall picture.

Finally, we can obtain a value for a drug by multiplying the FCF to our discount rate. Repeating this process for the entire portfolio of products and adding up their individual DCF's will give us the Total Enterprise Value of the company.

As you can see, valuing of early stage healthcare entities is possible even by the dilligent individual investor. The issue of contention arises when the methods/models used do not accurately reflect the potential for failure. This, unfortunately, means that there can be several different valuations on the market for the same company. So really, recognizing a good valuation when you see one is the real measure of success.

For more in depth information visit the DCF valuation section under research & papers at Professor Damodar's site http://pages.stern.nyu.edu/~adamodar/


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Thursday, August 14, 2008

About Us

Healthcare Nexus is a social project that aims to educate, provide critical analysis, and be an active sounding board for issues surrounding todays global healthcare systems. The hope is not only to initiate change & create innovative functional systems through the collective expertise of various players in the industry, but also to question & criticize current developments to instil value for continuous improvement on a societal basis.

We are a small but dedicated team of researchers and writers holding advanced degrees in varying scientific backgrounds. Our approach & work style focus on our complementary skill sets, making us a perfect fit for clients looking for integrated solutions to their healthcare research and report/article writing needs.

Our portfolio of work includes:

- Research reports for medical conditions, drugs, therapies & healthcare systems
- Systematic & literature reviews
- Content generation for medical websites & blogs
- Editing and proofreading of thesis, scientific reports, academic articles
- Translation & interview transcription services (To/From English)
- Health Economics research

Join! There are openings for collaborations. Healthcare Nexus needs both bloggers and designers with a passion for shaping the future of the healthcare & life science industry. If you are a forward thinking student, researcher, employee of pharma/biotech, policy maker, market researcher, health economist, member of the medical community- and want to be part of a forum of passionate individuals with progressive perspectives please contact admin@healthcarenexus.net.


Chief Contributor -  Rohan Deogaonkar is an independent healthcare industry analyst. He is available for consultation and commentary on health economics, regulatory affairs, health technology assessment, and competitive intelligence in the healthcare/life science sectors. He can be contacted at rohand@healthcarenexus.net

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Hot Jobs

Got a few weeks off? Gap year? Looking for field credits? In between jobs? Volunteer opportunities ranging from 2 weeks + for all levels available:
http://www.uniteforsight.org/

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Tuesday, March 4, 2008

Jan 09 approvals

USA>>
- Forest Labs> Savella (milnacipran hydrochloride): Fibromyalgia
- Galderma Labs> Vectical (calcitrol): B3 ointment for plaque psoriasis
- Watson> Gelnique (oxybutynin chloride): Gel for overactive bladder (OAB)
- Takeda> Kapidex (dexlansoprazole): Erosive esophagitis


Canada>>
- Alexion> *Soliris (eculizumab): Paroxysmal nocturnal hemoglobinuria (PNH)
- Biovitrium> Kineret (anakinra): Rheumatoid arthritis
- Biovitrum> Stemgen (ancestim): Supportive oncology
- Biovitrum> Kepivance (palifermin):
Supportive oncology
- Bayer> Helixate FS & Kogenate FS: Spontaneous hemorhagic episodes & prevention of joint damage in children
- Bausch & Lomb> Lotemax (loteprednol etabonate): Opthalmic corticosteroid
- Paladin> Trinipatch (nitroglycerin): Anti-anginal
- BMS> Reyataz (atazanavir): Treatment naive HIV
- CSL Behring> Humate-P: Von Willebrand disease, excess bleeding
- ScheringPlough> Deca-Durabolin (nandrolone): Anabolic androgen
- ScheringPlough> Andriol (testosterone): Anabolic androgen


Japan>>
- Novartis> Xolair (olabizumab): Bronchial Asthma
- Novartis> Tasigna (nilotimib): Philadelphia chromosome-positive chronic myeloid leukemia
- Novartis> Diovan (valsartan/hydrochlorothiazide combi): blood pressure
- Novartis> Lucentis (ranibizumab): Wet macular degeneration

EU>>
-Janssen Cilag/J&J> Stelara (ustekinumab): Moderate to severe plaque psoriasis

*Priority review drug

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Wednesday, February 13, 2008





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