e-Commerce Developing Fast in Southern Europe

As more and more countries go into lockdown to enforce social distancing, the way that consumers do their shopping is of course having to change dramatically. Some countries are better adapted to this change than others – according to a recent report in the Financial Times, southern European countries like Italy and Spain currently only have low e-Commerce penetration, with respective shares of 4% and 5% of total retail revenues (prior to the Covid-19 pandemic).

France (10%) has a higher share than the two countries at its southern border, but still lags behind other markets in Europe (20% in the UK) and globally (36% in China). However, this situation looks set to change fast, with Covid-19 leading to a revolution in e-Commerce sales of groceries in southern Europe – for example, according to the FT report, supermarket chain Carrefour stated that its online customer base in Italy has already doubled to 110,000. Is this a trend that will outlast the current crisis?

And what impact will Covid-19 have on online sales of consumer healthcare products? Our recently published Digital Marketing & e-Commerce Report outlined the Top 20 leading internal & mail order markets for CHC products, with China and the USA the clear leaders, followed by Japan, Germany and the UK. Inevitably, the projected growth rates for 2020 will have to be revised, especially given this fast-changing crisis could also lead to changes in regulations governing the online sale of OTC medicines.

For example, Europe’s largest e-Commerce pharmacy group, Zur Rose, today submitted a request to Switzerland’s Federal Office for Public Health calling for a temporary exception that would allow mail order sales of OTC cold & flu medicines (at present, all non-prescription medicines can only be sold by mail order if specifically approved by a doctor). As well as owning Germany’s best-known pharmacy brand, DocMorris, Zur Rose is also active in France and Spain, and could be at the forefront of overcoming strict regulations governing the sale of OTC-registered medicines in those markets too.

For an in-depth look at the rising power of e-Commerce in the CHC market, order a copy of Digital Marketing & e-Commerce: Tapping the Potential of Online Sales and Digital Promotion in Consumer Healthcare! This report also explores social media, which CHC brands are employing effective digital marketing strategies, and the opportunities and challenges e-Pharma faces. For further details, please contact melissa.lee@NicholasHall.com.

Covid-19: France advises against ibuprofen to treat symptoms

France’s Health Minister Olivier Véran delivered a message via his Twitter account over the weekend, advising against taking anti-inflammatory medicines (ibuprofen, cortisone, etc) to treat Covid-19 symptoms, as they could be an aggravating factor for the infection. His advice for those with a fever was to take paracetamol instead. Patients already on anti-inflammatory drugs for other illnesses, or anyone with any questions, are advised to seek advice from their doctor.

⚠️ #COVIDー19 | La prise d’anti-inflammatoires (ibuprofène, cortisone, …) pourrait être un facteur d’aggravation de l’infection. En cas de fièvre, prenez du paracétamol.
Si vous êtes déjà sous anti-inflammatoires ou en cas de doute, demandez conseil à votre médecin.

— Olivier Véran (@olivierveran) March 14, 2020

Public health interventions like this, with directives specifically citing which OTC medicines to take or not take, are rare and so the story was picked up by major news outlets in the UK (Guardian), USA (New York Times) and elsewhere. According to a report in The Local, Véran’s tweet prompted several members of the public to ask for the source of his reasoning on not taking ibuprofen to treat Covid-19 symptoms.

This is not the first time France has warned against the use of systemic NSAIDs. In April 2019, the country’s medicines body, ANSM, warned that certain anti-inflammatories to treat pain or fever increase the risk of serious complications when suffering from an infection; the regulator shared information with European counterparts on the basis of what it said were 337 cases of infectious complications linked to ibuprofen since 2000.

Reaction to the latest comments has been mixed. Several countries suggested consumers continue to take their preferred pain reliever, including ibuprofen, while some health experts pointed out the lack of published scientific evidence that the virus is worsened by ibuprofen (WHO is silent on the point). Some NSAIDs have previously been contra-indicated in certain countries for other viral infections such as dengue fever (because they may exacerbate internal bleeding), but that may not be relevant to Covid-19. At present, we all await further clarification.

Where will NPD take the CHC market in the future? Find out in our upcoming report, Innovation in CHC: NPD & Innovation in CHC under the Spotlight! This report, drawing on Nicholas Hall’s CHC New Products Tracker, assesses the global picture of CHC innovation in 2019, featuring ingredient trends, delivery format trends, analysing innovation trends by region and by marketer, plus much more! To pre-order your copy and save with the pre-publication discount, or for more information, please contact melissa.lee@NicholasHall.com.

Combination OTC painkillers gaining ground

Following the approved switch of Voltaren Arthritis Pain by the FDA in mid-February, there was more positive news for GSK’s US analgesics portfolio over the weekend with the FDA approval of Advil Dual Action. This is the first FDA-approved OTC combination of ibuprofen and paracetamol (acetaminophen) in the USA, and GSK is expected to launch the product later this year.

Franck Riot, Head of R&D at GSK Consumer Healthcare, said: “For decades, many consumers have been using ibuprofen and acetaminophen (paracetamol) to get the benefits of both active ingredients when safely treating their headaches, muscle aches, backaches, arthritis and other joint pain. Now Advil, the No. 1 selling OTC pain reliever, will offer US consumers the first-ever alternative option – a single, fixed-dose combination pain reliever.” According to the reported clinical research, this fixed-dose combination achieves superior efficacy compared to the individual monocomponents of ibuprofen (250mg) and acetaminophen (500mg) alone.

Dolostop Plus, another recent combination launch

Another combination OTC painkiller we tracked recently, formulated with both ibuprofen and paracetamol, is Kern’s September 2019 launch of Dolostop Plus in Spain. Indicated to provide symptomatic relief from mild to moderate pain in adults, these film-coated tablets are formulated with paracetamol 500mg and ibuprofen 150mg, with a stated dose of 1-2 tablets every 6 hours, and claimed to be the first and only OTC paracetamol and ibuprofen combination available in Spain.

In several markets around the world, such as the UK, Russia, Japan and Indonesia, combination paracetamol + ibuprofen OTC remedies are already well-established, but these recent developments in the USA and Spain point to growing acceptance among global regulators about the safety of fixed-dose OTC analgesic combinations.

Where will NPD take the CHC market in the future? Find out in our upcoming report, Innovation in CHC: NPD & Innovation in CHC under the Spotlight! This report, drawing on Nicholas Hall’s CHC New Products Tracker, assesses the global picture of CHC innovation in 2019, featuring ingredient trends, delivery format trends, analysing innovation trends by region and by marketer, plus much more! To pre-order your copy and save with the pre-publication discount, or for more information, please contact melissa.lee@NicholasHall.com.

Focus on China: Trade agreement with USA imminent?

Some welcome news for the global economy which broke over the weekend, as announced by the US trade representative, is that the US and China are “close to finalising some sections” of an interim agreement to ease trade tensions between the two countries. This is also a welcome development for OTC marketers, including RB, whose newly-appointed CEO Laxman Narasimhan recently stated that the company’s disappointing Q3 performance was primarily due to issues in USA and China.

Growth in China’s OTC market slowed to 5.3% in the MAT Q2 2019 period, owing to a low key cough & cold season and a weakening economy. Nicholas Hall was a speaker at the Global Self-Care Federation (GCSF) conference – a joint meeting of the Chinese, Asian and global CHC associations, held in Beijing last week – and wrote: “It is always valuable to come to the second-largest CHC market, which in just a few years will be the world’s biggest economy. There are major opportunities here, but increasing challenges too as the Government takes a tougher line on pricing and distribution, without easing the regulatory barriers.”

Judy Stenmark kicked off proceedings at the GSCF 2019 conference

Nicholas Hall also wrote that: “Among the many presentations during the 2 days, some of which lasted for as little as 15 minutes – this was truly a conveyor belt conference, with only one panel discussion and no questions from the floor – a presentation that stood out for me was from Conba, a company about which I knew very little. Hu Jiqiang, Chairman of Conba Group, made the startling claim that Conba will become the biggest producer of medical cannabis in China and possibly the world … And, of course, the presentation by Alibaba Health was one to sit up and listen to at the end of an exhausting two days. This really is a game-changing company as I discuss in my New Paradigms report.“

The rise of Chinese marketers within the global OTC rankings has been a notable trend in 2019. Our latest MAT Q2 2019 data shows that China Resources 999 now takes 9th position globally, and grew by 7.3% in the year to end-June 2019. Additionally, as explored in one of our recent blog posts, By-Health has broken into the global Top 20 and now claims 15th spot. This company has bucked the trend of decelerating growth in China, with sales growing by 31% in MAT Q2 2019. China accounts for over 90% of By-Health’s OTC portfolio turnover, with Australia accounting for the remainder.

Some of the latest innovations and technologies impacting CHC will be at the forefront of the agenda at next month’s OTC.NewDirections Executive Conference, which will take place in London on 14 November, with speakers from key players including Mundipharma, J&J and Bayer. Please contact jennifer.odonnell@NicholasHall.com to book your place or find out more. If you are unable to join us, you can always view Nicholas’ opening address live at 09:05 GMT here

Lifestyle OTCs still the best hope for OTC switch revival

2019 has been a slow year for Rx-to-OTC switch news, with activity dropping off markedly in the key US market in recent years, and Asia-Pacific (especially China, Japan and Indonesia) and Europe (Poland especially) the main source of developments. In this context, it was welcome news last week that Norway will become the second European market for OTC Viagra, after the Norwegian Medicines Agency approved the OTC sale of Viagra Reseptfri (Pfizer, sildenafil 50mg) erectile dysfunction treatment to men aged 18+ years, with this to be accompanied by pharmacist advice.

Pfizer plans to launch Viagra Reseptfri in pharmacies in early 2020, while Rx Viagra will remain available. The medicines agency recommends that men have a check-up with their doctor within six months of purchase so that any potential underlying conditions can be investigated. Viagra Reseptfri will be the first medicine available in Norway under the country’s new category of non-prescription medicine with guidance, and the Rx-to-OTC switch follows similar measures elsewhere in Europe. In Poland, sildenafil 25mg is available OTC from a number of domestic players, with initial launch from Adamed in May 2016, while Viagra Connect was launched in the UK in March 2018.

Of the 20 key markets covered by OTC New Products Tracker every month since the start of 2013, Poland has been the most active in terms of Rx-to-OTC switch activity, with 54 products reclassified to non-prescription status. A liberal switch environment has helped bring about a raft of Rx-to-OTC switches since 2014, including Europe’s first OTC erectile dysfunction brand and Poland’s first OTC systemic cold sore treatment.

Despite some notable failures (such as urinary product Flomax Relief), so-called “lifestyle” drugs remain the primary source of switch activity, helping to extend the reach of the OTC market into new categories such as contraception, erectile dysfunction and cardiovascular disease. A key switch development in 2019 was the downscheduling in Japan of Taisho’s hyperlipidaemia treatment Epadel T (ethyl eicosapentaenoate) to Class I OTC, where sales are permitted in pharmacies (and online) after professional consultation. Downscheduling may have come just in the nick of time – sales data suggest Epadel T had failed to make any noticeable impact on the OTC market in its almost six years as an Instruction-Required Drug.

There also remains hope that Sanofi may one day market Eli Lilly’s erectile dysfunction treatment Cialis as an OTC medicine (it owns the rights to market Cialis OTC in the USA, UK, Canada and Australia), but is switch application has been stuck at the FDA a full five years since its submission. In July 2019, Sanofi also signed a deal with Roche for the exclusive OTC rights to Tamiflu (oseltamivir 75mg capsules, Genentech / Roche Group) for flu prevention and treatment in the USA. Under the terms of the agreement, Sanofi will be responsible for leading negotiations with the US FDA for the OTC switch and subsequent exclusive marketing, scientific engagement and distribution of Tamiflu OTC in the USA. Let’s hope for the sake of OTC growth that its negotiations go smoothly.

Clear your diary for Nicholas Hall’s 31st European Conference, which will be held in Athens on 28-30 April 2020, on the theme of Advancing in CHC: The Must-Dos and  Reasons Behind Them. To register your interest in this event, or for more information on sponsorship opportunities, please contact jennifer.odonnell@NicholasHall.com.

Alibaba and Walmart report strong Q2

Our blog this week rounds up the latest retail news, including recent Q2 results from Walmart and Alibaba, and a focus on M&A activity in Asia-Pacific. China’s Alibaba trumped analysts’ expectations with a 42% year-on-year jump in quarterly revenues to Rmb114.92bn (US$16.3bn), contrasting with its rival Tencent which one day earlier disappointed the market by falling short with a more modest quarterly growth (though Tencent did report a 26% year-on-year increase in profit).

Alibaba’s CEO, Daniel Zhang, said the company “had a great quarter, expanding our user base to 674mn annual active consumers, and demonstrating our superior user experience. We will continue to expand our customer base, increase operating efficiency and deliver robust growth. With strong cashflow from our core e-commerce business, we will continue to invest in technology and bring digital transformation to millions of businesses globally.” 

Alibaba is also reportedly looking to acquire Kaola’s cross-border online shopping platform from rival NetEase, according to two people familiar with the matter, as China’s highly competitive US$2tn e-commerce market takes early steps towards consolidation.  

Meanwhile, Walmart has raised its outlook for the USA and said US consumers were in “solid” financial health as it shrugged off the Trump administration’s trade war with Beijing and turmoil elsewhere in bricks-and-mortar retail. Walmart revenues rose by 1.8% in fiscal Q2 2020 to US$130bn (+2.9% on a constant currency basis). USA sales were US$85.2bn (+2.9%) and the retailer noted that it is gaining market share in key categories, including health & wellness; e-commerce sales grew by 37%. International sales fell by 1.1% to US$29.1bn (+3.3% excluding currency impacts). Strength in Mexican subsidiary Walmex and China were offset by softness in UK and Canada. 

In Brazil, No.1 drugstore chain RaiaDrogasil (RD) reported better than expected results, seeing its national share rise to 13% in Q2 2019 (up 1.6% vs Q2 2018). Another drugstore chain quickly gaining share in Brazil is Farmarcas, which looks set to become the No.4 ranked chain by end-2019 after reporting even stronger results than RD, putting pressure on established players Drogaria DPSP and Pague Menos.

As for M&A activity:

• In Japan, drugstore operator Cocokara Fine is pursuing a merger with rival Matsumotokiyoshi in a deal that could create a market leader with sales of around ¥1tn (US$9.4bn)

• Amazon, which is looking to boost its bricks & mortar presence in the fast-growing Indian market, is reportedly in advanced talks to acquire up to 10% of Future Retail, the country’s No.2 retailer

• AS Watson (an affiliate of CK Hutchison Holdings) is in talks with potential partners in UAE with a view to introducing its health & beauty stores there

Take a look at the evolution of Pharmacy and Pharmacy Point-of-Care in the Distribution chapter in our new report, Nicholas Hall’s New Paradigms for CHC 2019: Over the Horizon, written by Nicholas himself! Other chapters will include Healthcare Trends, Regulation, Digital engagement amongst many others. Nicholas will also unveil the 15 “Infinity Zones” he has identified as being crucial to the future growth of the industry. You can upgrade your purchase to include a customised in-house presentation or webinar with Nicholas for an additional GB£10,000. To find out more or to pre-order your copy, please contact melissa.lee@NicholasHall.com.

Homeopathy under increasing scrutiny

France is the latest country in recent years to call into question the role and efficacy of homeopathy, as governments look for savings in the healthcare budget. Last week’s announcement by France’s Minister for Solidarity & Health Agnes Buzyn that homeopathic medicines will be dereimbursed in France from 1st January 2021 is another blow to this consumer healthcare niche. In 2017, NHS England recommended that doctors no longer prescribe “ineffective, over-priced and low value treatments”, including homeopathy, which is said to have no clear or robust evidence to support use.

The French decision was based on a final recommendation by the Haute Autorité de Santé (HAS) stating that homeopathics have little proven efficacy and should not be covered by health insurance. In its assessment, which spanned 9 months, HAS evaluated close to 1,200 homeopathic products, many of which are currently reimbursed up to 30% when prescribed. In the interim, the level of reimbursement available for certain homeopathics will be cut from 30% to 15% on 1st January 2020, allowing consumers, manufacturers and prescribers time to prepare for eventual dereimbursement.

Voicing its shock at the decision, key homeopathic player Boiron – which markets various leading OTCs in France, such as teething product Camilia – stated that around 1,000 jobs would be directly affected by the dereimbursement, given that 60% of the company’s business is in France and almost 70% of that is linked to reimbursed medicines. A November 2018 survey by Ipsos revealed that 77% of French people have used homeopathics.

In other countries, such as Spain and the USA, there has been a clampdown on homeopathic health claims. In November 2018, as part of a new marketing authorisation process for homeopathy, the AEMPS (Spanish Agency of Medicines & Medical Devices) indicated that homeopathics with no permitted therapeutic indication must state, “Sin indicaciones terapeuticas” (Without therapeutic indication) on packaging. Likewise, in May 2018, the American Association of Homeopathic Pharmacists announced that all homeopathic manufacturers will be encouraged to use the new disclaimer: “Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.”

Keep up to date with the latest in-depth reporting on homeopathy by subscribing to OTC INSIGHT! We have 4 title covering the latest developments in Europe, Asia-Pacific, Latin America and North America. Click here to find out what key features OTC INSIGHT includes. To receive a sample issue or for details of subscription rates, please contact melissa.lee@NicholasHall.com.