Rx-to-OTC switch outlook for 2020

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One of the factors contributing to lower global consumer healthcare growth in recent years has been a falling-off in Rx-to-OTC switch activity in key markets like Japan and the USA. Looking ahead, however, there are reasons to be positive. In December 2019, Sanofi CEO Paul Hudson cited the company’s “plans to accelerate the over-the-counter switches for Cialis and Tamiflu” in order to fulfil its ambition of growing faster than the CHC market over the mid-term. In light of the current coronavirus epidemic, the benefits of wider OTC access to flu remedies is all the more evident.

Sexual health is another category with huge Rx-to-OTC switch potential, notably erectile dysfunction medicines and daily oral contraceptives. Though the switch of Cialis (tadalafil) has been stuck at the FDA for several years now since its submission, sildenafil (Viagra) is enjoying ever wider OTC availability, especially in Europe. After switching in Poland in 2016, sildenafil was launched as Viagra Connect (Pfizer) in the UK in 2018 and will be launched OTC as Viagra Reseptfri in Norwegian pharmacies in early 2020.

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There is also renewed interest in OTC triptans for migraine. A handful of switches took place in the mid-2000s but were held back by OTC purchase limits (a 2-tablet emergency pack). Over the past year, various countries have again began discussing triptan switches including Australia, Ireland and Germany (which is expected to expand the number of triptan molecules in the OTC sector), though major expansion of the segment is unlikely without larger pack sizes.

All that said, reverse-switch remains a threat and one OTC ingredient of ongoing concern is codeine. In late 2019, New Zealand’s Medicines Classification Committee, following Australia’s lead, recommended that all codeine-containing medicines should be reverse-switched from OTC to Rx. In January 2020, citing “widespread concern about the abuse of codeine-containing preparations nationally and globally”, the South African Health Products Regulatory Authority said it is reviewing the scheduling status of codeine and codeine-containing medicines which are available without a prescription.

CHC.NewDirections is an e-newsletter sent every Tuesday, with a focus on innovation, science and regulationCoverage spans Rx-to-OTC switch, CBD, relevant medical research, probiotics, medical devices and new delivery formats, digital health / AI, e-cigarettes and much more! For more information, or to arrange a free trial, please contact Melissa.Lee@NicholasHall.com

Stays-Hard is an instant success

It is estimated that 300mn men worldwide suffer with erectile dysfunction problems and 30% of men will experience premature ejaculation at some stage in their life.

Current solutions such as pills, pumps and surgical procedures are known to be effective but are time-consuming and can cause long-term hassle and discomfort.

A new device however, created by British manufacturer Tyna International, has taken the OTC sex aid market by storm, promising to conquer erectile dysfunction and premature ejaculation, helping men sustain intercourse for as long as they wish.

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Though targeted at 40s-60 age group, it could also transform the sex lives of many men including the elderly and disabled without the need for invasive surgery. It could also help the estimated 7% of men in their 20s and 11% in their 30s who are suffering from erectile dysfunction.

Gaining global recognition, the device called ‘Stays-Hard’ holds the penis aloft to maintain an erection and can continue after orgasm. Safe to use with condoms and other contraceptives, the device can be fitted by either partner in a matter of seconds.

First going on sale last month, Stays-Hard sold out almost immediately, attracting strong interest from both customers and commercial distributors all over the globe.

Stays-Hard elongates the penis allowing for increased blood flow, it is comfortable, easy to use and pleasurable for both partners, giving a natural feeling.

After five years of research, the product was developed with advice from urologists and Professor Peter Ford of De Montfort University. A number of successful case studies in men of all ages confirmed Stays-Hard’s ability to maintain a pain-free erection, even after ejaculation.

OTCs in Action: OTC for ED in Poland

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This week, OTCs are in Action in Poland, where Adamed is launching MaxOn Active (sildenafil 25mg, the active ingredient in Pfizer’s Viagra), the second market for legitimate OTC access to erectile dysfunction drugs. The first de facto OTC market for the ED category was New Zealand, where Douglas Pharma switched Silvasta in October 2014.

Of course, Rx drugs and dietary supplements for ED can be quite easily available “under-the-counter” (pharmacists dispensing without a prescription) or online in many markets around the world. However, some of these dietary supplement products can have serious and even deadly side-effects, and many feature unsafe ingredients from unscrupulous marketers looking to meet the product demand. Additionally, in many Emerging Markets, pharmacists are often the only healthcare providers accessible to consumers, so the “under-the-counter” trade is widely accepted.

In Poland, where MaxOn is available only in pharmacies, men are asked to take a test to determine safe use of the OTC when they purchase a 2-count pack for about $10.00. It’s estimated that about 1.7mn men in Poland experience ED, so OTC competitors will surely be keeping an eye on this first European OTC ED market.

It’s intriguing that the test to ensure consumer compliance is a like a first KISS (Keep it Simple, Stupid). The test asks consumers several questions regarding their use of drugs and about previous diseases. A man will have three possible answers to each question: yes, I don’t know or no. If the question is marked “yes” or “don’t know”, the patient should consult the doctor about use of the medicine.

Click the link below to see how men will self-test for MaxOn Active:

OTCs in Action Episode 32: ED in NZ, not .com

OTCinActionheaderIllegal internet sales of Rx and OTC drugs, as well as adulterated dietary supplements, put consumers at great risk. “Tainted Sexual Enhancement Products”, published on the FDA’s website, warns consumers:

“The FDA has identified an emerging trend where over-the-counter products, frequently represented as dietary supplements, contain hidden active ingredients that could be harmful. Consumers may unknowingly take products laced with varying quantities of approved prescription drug ingredients, controlled substances, and untested and unstudied pharmaceutically active ingredients. These deceptive products can harm you! Hidden ingredients are increasingly becoming a problem in products promoted for sexual enhancement. Remember, FDA cannot test all products on the market that contain potentially harmful hidden ingredients. Enforcement actions and consumer advisories for tainted products only cover a small fraction of the tainted over-the-counter products on the market.”

Last week, this blog’s sister publication, OTC.NewDirections, reported that an international crackdown on  illegal internet trade of medical products yielded $81.8mn worth of items from 115 different countries, and 156 arrests. In the UK, a record $25.1mn worth of counterfeit and unlicensed medicines and 15,000 devices was seized, including potentially harmful slimming pills, erectile dysfunction, anaemia and narcolepsy tablets. The US FDA took action against 1,050+ websites that illegally sell potentially dangerous, unapproved Rx medicines and medical devices.

In fact, regulators around the world are playing a high stakes game of Whack-a-Mole, a popular arcade game in which players hit cheeky little moles with mallets, but as soon as one is knocked out another appears elsewhere.

WHACK A MOLE_0However, the risky business is driven by consumer demand, and now OTCs are in Action in New Zealand to satisfy those needs safely and legally. One of the more common unapproved ingredients in the FDA’s list of adulterated products is sildenafil, more commonly known by its legal Rx brand name, Viagra. The Rx-to-OTC switch of Silvasta (sildenafil) erectile dysfunction treatment in New Zealand was approved in late 2014. Men aged 35-70 years can purchase Silvasta without an Rx following a screening process with a trained pharmacist. This spring Nicholas Hall & Company awarded Douglas Pharma its top marketing award for the launch of Silvasta. A consumer campaign includes TV ads featuring an “everyday” man explaining that help is at hand from pharmacies without the need to see a doctor, while a pharmacy finder website directs men to the nearest outlet.

Another interesting development that will ensure consumer access to safer drugs is the UK’s new requirement that online medicine sellers must be registered with the Medicines & Healthcare products Regulatory Agency. They must display on every page of their website the new European common logo, which will be linked to their entry in the MHRA’s list of registered online sellers. The medicine being offered online must be licensed in the member state where the purchaser is based, and the seller must be legally entitled to sell medicine in accordance with UK legislation. Registered pharmacies can sell general sales list and pharmacy medicines or supply Rx-only medicines that they have dispensed against a prescription. Other retailers can only sell GSL (self-selection OTC) products. The penalty for disobeying the registration and logo rules is up to two years in prison, a fine or both.

In an somewhat related matter, as it affects consumer safety and appropriate use of OTC medicines by reducing illicit methamphetamine manufacture, Acura Pharmaceuticals has entered into an agreement with OTC cold remedy giant Bayer to license its IMPEDE technology. IMPEDE technology, which is available in the US in Acura’s Nexafed, has demonstrated significantly reduced yields of methamphetamine compared to traditional formulations in lab tests and has been associated with a reduction in meth labs in local markets of up to 90%. OTCs in Action covered the launch of Acura’s Nexafed Sinus Pressure + Pain (pseudoephedrine and acetaminophen) in February.

Episode 17: Outwitting meth manufacturers