What will work?

What will work?

With nearly every diabetes drug company laying off sales reps and refocusing R&D the question needs to be asked; What will work? We know what doesn’t work. We know that these companies can no longer afford an army of sales reps. That the role of the sales rep in a commodity market is becoming irrelevant. It doesn’t help either that it’s payors not physicians who chooses which drugs are used to treat the patient. Add in all the new disclosure laws, the constant micromanaging from management and then being thrown under the bus by clueless executives and it’s easy to understand why sales reps feel underappreciated.

When it comes to R&D in a commodity market the days of me-too copycat incrementally better products just won’t cut it. Now that biosimilar’s are becoming available the standard for new banded drugs has risen dramatically. Payors will not pay for any drug that does not significantly outperform the existing standard, being slightly better is not good enough.

So, since we know what won’t work, let’s look at what will work.

Let’s start with sales which even in a commodity market still provides a necessary function. A function that will be largely replaced by technology with humans used in more targeted roles. Let’s be honest here and the smarter reps know this; this most recent round of layoffs is needed, that these jobs are NEVER coming back. If a physician needs information on a new drug they hit the web. The physician who as we keep saying has less and less say over which drugs are prescribed. Bottom line here almost every function reps used to do can and will be replaced by technology.

When it comes to R&D its overly obvious to say that new drugs must seriously outperform existing drugs. The question is by how much. Toujeo is a perfect example here as it is better than Lantus but it’s just not majorly better. Or put another way not better enough to justify either premium reimbursement or favorable formulary position, especially when Basaglar will do the job just fine and be cheaper than the existing gold standard Lantus.

We believe what payors will pay for is any drug that increases patient adherence. Two products we are watching closely are the Intarcia micropump and Novo Nordisk (NYSE: NVO) oral GLP-1. Neither works that much better than what’s on the market already. However, both go a long way towards improving patient adherence.  The same could be said about an oral, not inhaled, version of insulin. The problem here is getting the damn thing to work and given Novo’s decision to halt their work in this area we doubt anyone can make it work.

Let’s also not forget about delivery systems which do matter. Yes, the simplest delivery system is a pill but even patients who take orals forget to take their meds. It would not surprise us to see more micropumps, transdermal or nanotechnology used as delivery systems for what now are oral meds. Again, the goal here is to make sure the patient takes their meds as prescribed and what’s the best way to do this; make drug delivery an afterthought.

We can’t wait for the day when drug companies add in way cool whiz bang technology. When drug delivery is either controlled by or enhanced using a smartphone. Once again the goal is to do whatever it takes so that patient is adherent with their therapy regimen. That this regimen be monitored in a non-obstructive manner so that when a regimen isn’t working an intervention can take place which will prevent a small problem from becoming a big one.

We’ve said it before and we’ll say it again while newer and better drugs are always welcome, there is nothing wrong with the drugs we have today PROVIDED they are taken by the patient as prescribed.

This is what will work in the future. Organizations who embrace technology and understand how it should be applied. This does not mean all human functions will be replaced this is ludicrous thinking. However, there will be far fewer tasks performed by human’s sales being the first to take a major hit. As Momma Kliff used to say; “Change is difficult to accept even when it’s necessary change. But change we must.”