Australian healthcare trends

Suite 15/20 Young StNeutral Bay NSW 2089

Consultations With ...

General Practitioners Specialists Nurses

Pharmacists

KOLs

Health consumers CarersRepresentatives

Overview

Global Themes Industry Responses

End of Blockbuster drug era Medication Of Risk

Drug Re-positioning

Greater investment in Orphan Drugs

Pressure to cap rising public health spend

P-Health Initiatives

Technology-Based Monitoring

Overview

Global Themes Industry Responses

Rise of Functional Foods & Bevs

Increased Demand for Rx Choices

Increased Consumer Engagement

Personalised Medicine

Increased Consumer Influence on Rx

Rising promotion & use of natural and alternative

therapies

Increased pharma engagement with consumers

End of Blockbuster Drug Era

The Patent Cliff

• 20 years ago, many new and powerful drugs launched

• Many now coming off patent• In US, >$100 billion of branded

drug sales expected to go generic 2010 - 2015

• In Aus, Lipitor predicted savings to Govt of • $529 mill in 2012-13

• $546 mill in 2013-14

• medication to prevent illness

• people educated to expect health/ well being benefits that REMOVES the NEED FOR PERSONAL RESPONSIBILITY

Eg nicotine patches

• increased role for drugs that modulate emotions and behaviour

• Next Steps• Products for memory enhancement • Multi-function drugs

• e.g. Sanofi’s Acomplia• Medications for social anxiety disorder & generalised

anxiety disorder and for ‘naughty kids’Big Pharma & Natural Therapy co’s seeing unprecedented profits in disease prevention

The Medication Of Risk

Orphan Drug Pipeline increasingly active

• Probability of market approval ~13%. • 1988, 253 orphan drugs -> 36 approved• 2011, 2507 orphan drugs -> 393 approved

Pharma increasingly working with rare-disease support orgs to advocate for

market access and cement relationships

Higher likely re-imbursement than many other markets

Govt Preparedness to Pay for Orphan Drugs High In Aust

Pressure to cap rising public health spend

Public Sector - Initiated P-Health

• To combat rising health costs, incl rising spend on originator

drugs

• Govt Public Health Aims

• Developing new foods to prevent illness

• Finding new ways to diagnose disease early

• Using genes & proteins to predict & prevent ill

health

• Objectives

• Help Australians live longer

• Reduce rising cost of health care

Public sector becoming an important competitor in disease prevention products

Encouraging Consumers to Self-Regulate• Nutritional Analysis Kiosks and software

• for specific medical conditions (e.g. diabetes/ special diets)

  

Earlier Identification

Intelligent toilets • test urine for glucose, kidney disease

(eventually even cancer)• Test faeces to measure weight and fat

content• let you know if there's anything unusual

going on

  

Diagnosis Outside Healthcare Settings

Treatment & Monitoring Outside Healthcare SettingsRemote Patient Monitoring

  

Increased consumer engagement

Rise in patients blogs / forums

Bio-oil 600 Youtube videos

Increased Information Access -> Empowerment• Customer switching costs are low

• Don’t define themselves as patients

‘Person Living with .....’ rather than ‘patient’ given it references the individual’s complete experience

• a ‘chronic condition’ rather than ‘disease’

Consumers becoming more educated and discerning,

Physical Health Mental/Emotional Health

Environmental Health

• Heart disease• Physical Appearance• Food Scares

• Stress• Depression &

Anxiety

• Animal Welfare• Soil erosion, pollution• Toxins

• Better For You products• Weight loss products• Cosmeceuticals• Nutraceuticals

• Herbal Products • Aromatherapy• Vitamins & Minerals

• Vegetarian Products• Natural• Organics

Concept of Health has come a long way from Norm’s ‘Life Be In it’ message

Health Is No Longer Just Physical

Realisation that it

• does not have all the answers

• Is one of a range of options

Greater Willingness to Try Alternatives

Failure of western medicine to solve major health issues

Pharma Brand Positioning Much More Important

• Pharma manufacturers are concerned to raise their parent brand image

• Significant spend

Consumer Empowerment means pharma brands need to have good corporate image to engender long term

support

Increased Prevention & Treatment Choices

Rise of Functional Foods & Beverages

XANGO• The whole fruit puree of

the Mangosteen fruit• Powerful natural

antioxidant & anti-inflammatory

XANGO• The whole fruit puree of

the Mangosteen fruit• Powerful natural

antioxidant & anti-inflammatory

Why would anyone use a drug, if you can get the same benefits from a food?

Functional Foods & Beverages

• Mainstream manufacturers making functional products

• Disease prevention claims (e.g. anti-cancer) currently restricted

“

Functional foods an increasingly popular alternative to preventive medicines

Natural Therapies

• Australians spend ~$2.3 billion a year (4 x their spend on pharmaceuticals)

• 120% increase in spend since 1993

• Over half of Australians use

• ~40% with chronic diseases use

• 60% of women & 44% of men (and increasing) visit alternative practitioners

Significant and growing use reflecting consumer preferences

Vit C injections

Ginkgo Biloba

Lycopene

Zinc

Naturopathy

Chiropracty

Oxygen therapy

Colonic irrigation

Natural Therapies

Beliefs

• Look for safety above proven clinical efficacy

• Wide availability from non-pharmacy outlets and derivation from natural products has promoted perceptions of safety.

The ‘wellness’ market often demonises pharmaceutical products

Patterns of Use

• To complement rather than replace conventional treatment

• pragmatically select treatments to best fit particular medical and health problems

• Upsurge in use as• anti-depressants

• cholesterol reducers

• improving CV health

Reasons For Growth

• Disillusionment with orthodox medicine/ hospitals given perceptions of reduced quality of care.

• Dissatisfaction with doctor-patient interactions

• Practitioners regarded as more convincing, informative, considerate and available

• many using evidence-based methods

Consumers increasingly dissatisfied with using just prescription pharmaceuticals

Strong DTC Advertising Presence

Increased consumer influence on treatment decisions

Self-Dx & Treatment A Growing Possibility

Will Growing Availability of Cheap OS product erode local sales?

A challenge for Pharma and HCPs

• pressure to increase counseling & support

• nurses and allied HCPs’ increasingly important in providing credible patient information

Industry Responses…

Patient Support Programs?

Personalised Medicine?

Personalised, Integrative Medicine• ‘the capacity to predict disease development and

influence decisions about lifestyle choices or to tailor medical practice to an individual’

• Uses knowledge of individual metabolism or genetic make-up

History

• ABX resistance testing (bacterial infection)

• Viral resistance testing (eg HIV)

• Genomic Medicine• Gene Sequencing• Genetic Mutation testing (eg breast cancer, IBD)

• Drugs targeted to narrower indications, hence limited populations

• Well established in Europe & US

Personalised, Integrative Medicine

Can facilitate disease prediction, prevention and treatment :

• determine if increased risk of disease, followed by promotion of and support for compliance with prevention

• Diagnosing earlier using optimal surveillance, allowing more effective interventions or treatment options;

• enhancing therapeutic efficacy by ensuring the most appropriate drug is used and that dosing takes into consideration any genetic variants, which may influence metabolism of the drug;

• avoiding preventable drug related complications and side effects

Personalised, Integrative Medicine

• Opened Aug 2012

• Incorporates a wellness centre offering complementary therapies eg acupuncture, massage, mind body therapy.

Genea Holistic

• to add safe and comprehensive complementary healthcare to our world leading fertility science and care – giving you the best possible chance of conceiving a healthy baby.

• aims to deliver you the maximum benefit from complementary healthcare to give you the best possible chance of a healthy baby.

• individualised programs that address your particular needs and incorporate the most appropriate treatments for you

Earlier identification and treatment of risk factors for disease

Increase in self-prescription & self-medication

Convergence of pharmaceuticals, complementary medicines, functional foods & beverages

Increasing community adoption of preventive health measures

At point of purchase:

Self-service computer technology to help diagnose, prescribe and dispense on-line

Self-service terminals in supermarkets• Consumers can plug in age, family medical

history & lifestyle • Provide a printout of recommended vitamins,

herbs, supplements and food choices

One-stop shop model of product purchase

Specialised pharmacies

Pharma Industry Opportunities

Closer relationships with end-users

Increasing consumer awareness of Big Pharma’s community involvement

Complementary medicine partnerships to boost consumer perceptions of a ‘holistic health’ provider better monitor/control disease management

Sponsoring ‘wellness’ clinics and disease screening services

Micro-chip technology (implants) to record health/disease status and monitor drug intake

Capitalising on the political trend towards disease prevention

Micro Chipping Consumers

VeriChip™ - There when you need it

• Used to access a subscriber-supplied database providing personal information

• Cannot be lost, stolen, misplaced or counterfeited.

• Can be scanned when necessary

• Provides instant access to a Subscriber Registry - secure, password protected web access.

Future potential to track brand-switching …?