e-Commerce Developing Fast in Southern Europe

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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?

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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 HealthcareThis 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

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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.

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. The main concern appears to be that anti-inflammatories have an “immunosuppressive effect“, plus the background in France is that medicines agency ANSM has already removed medicines containing paracetamol, ibuprofen and / or aspirin from the self-selection list in January 2020 to reinforce the advisory role of the pharmacist and guarantee safe use.

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Meanwhile, the effect of the Covid-19 pandemic on sales and availability of painkillers in other markets is already becoming evident, with UK retailer Boots imposing a limit of two items per customer on cough & cold and pain medicines and US marketer J&J reporting a spike in demand for its Tylenol range and other self-care products. In the wake of the Covid-19 outbreak, and India’s decision last week to restrict the export of some ingredients (including paracetamol), there have been fears of shortages and disruptions to supply chains, but J&J said it did not anticipate a shortage of Tylenol and that it was taking all possible measures to maximise availability of its consumer healthcare range.

The good news is that we have extended the campaign entry criteria and deadline for our 2020 Marketing Awards! Coinciding with the new event dates, the Awards will now be presented on 30 September during our 31st European Conference in Athens on 29 September–1 October 2020. If you’re proud of your latest campaign or brand, ensure that you enter before the new deadline of 14 August! For more information on entry criteria, contact jennifer.odonnell@NicholasHall.com without delay.

France clamps down on OTC painkillers

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First came a public consultation launched by French medicines agency, ANSM, in August 2018 on how to increase consumer awareness of the risks of paracetamol misuse or overdose. Then followed the decision in July 2019 that, within 9 months, all paracetamol-based medicines must carry a prominent warning on packaging, to inform consumers about risks associated with paracetamol overdose, particularly hepatotoxicity. Paracetamol is the most commonly prescribed and used medicine in France, and the change affects more than 200 medicines.

Now, the ANSM has decided that, to reinforce the advisory role of the pharmacist and guarantee safe use of medicines containing paracetamol, ibuprofen and / or aspirin (in particular to avoid the risk of overdose), such products should be removed from the OTC self-selection list from January 2020 and kept behind the counter in pharmacies. ANSM has launched a consultation period with marketers, who have one month to comment.

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According to our estimates, the decision (if implemented) could affect around 90 SKUs on the French market. This includes the trio of leading paracetamol-based brands – Doliprane, Dafalgan and Efferalgan – as well as the top OTC ibuprofen-based (Nurofen, Advil) and aspirin-based (Aspirine Upsa) analgesics. Various OTC generics from the likes of Biogaran, Sandoz and Mylan, as well as systemic cold & flu remedies (Fervex, HumexLib) and topical analgesics, could also be affected.

The true effect that this decision could have on sales of OTC systemic analgesics remains to be seen, but it would clearly not be welcome news for marketers active in a category that remains in persistent decline, in part because of another regulatory decision (reverse-switch of codeine in July 2017). Leading brands such as Doliprane (Sanofi) and Efferalgan (formerly BMS, now Taisho) are available in both semi-ethical (reimbursed) and pure OTC versions, the latter often backed by TV ads, and it’s these latter SKUs which marketers have invested in over recent years that are most at risk.

Rapid regulatory change will be one of the themes at Nicholas Hall’s upcoming OTC.NewDirections Executive ConferenceTaking place in London on 14 November, the meeting will ultimately focus on the latest CHC Innovations and Technologies, with presentations from RB, Mundipharma, J&J and many more experts from CHC and beyond. To book your place or find out more, please contact jennifer.odonnell@NicholasHall.com without delay.

Homeopathy under increasing scrutiny

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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.

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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.

BMS to sell French subsidiary?

According to an exclusive report in Reuters, BMS is looking to sell its French OTC subsidiary, Upsa, in a potential deal which could exceed €1bn (US$1.2bn). Deutsche Bank and Jefferies are said to be preparing the auction process, which will begin after the summer. It is rumoured that potential bidders may include Stada, Zentiva, Mylan and P&G, while Recordati could also decide to make a play for the company.

Upsa has been in operation for over 80 years and the company itself is a well-established brand in France, by far BMS’s key OTC market. According to DB6, BMS generated global OTC sales of US$477mn in 2017, 60% of which were generated in France (US$285mn). BMS’ next two biggest OTC markets are Belgium and China.

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Upsa’s key brands are Dafalgan and Efferalgan analgesics (both paracetamol), as well as the paracetamol-based Fervex systemic cold & flu line. According to the latest OTC DASHBOARD trend report, Upsa is the No.2 OTC marketer in France behind Sanofi but sales there fell by 4.8% in 2017, with mid-single digit declines for Dafalgan and Efferalgan.

Price cuts for reimbursed semi-ethical painkillers like Dafalgan and Efferalgan have contributed to the decline in France, causing marketers like Upsa to shift focus from reimbursed options to pure OTCs; reimbursed Efferalgan SKUs were rebranded as Efferalganmed in October 2015. In December 2017, the marketer also rebranded Fervex medical device options as Les Élémentaires, in response to rising concerns about the use of umbrella branding which could confuse consumers.

With M&A activity in the CHC industry rapidly increasing, it might be the right time for your business to explore interesting and suitable growth opportunities coming from M&A. Our specialist M&A boutique is working with a number of strategic and financial partners to assess potential opportunities — for buyers and sellers — and is well placed to discuss the current business climate and possible synergies. To find out more, please contact ammar.basit@NicholasHall.com.

OTCs in Action Episode 34: One small step for French OTCs, a giant step for Greek

OTCinActionheaderThis week, OTCs are in Action in France, where 21 medicines have jumped over the pharmacy counter to retail shelves, where they can be selected by consumers. Famenpax homeopathic antinauseant, AsproFlash aspirin, Flustimex acetaminophen / chlorphenamine and MycoHydralin clotrimazole VYI treatments were among the brands leaping to freedom.

Earlier this year, regulators liberated Maalox Reflux (aluminum / magnesium hydroxide), as well as nicotine gums and lozenges from Nicorette and Nicotinell. To see the full list, click here: French OTCs by self-selection.

Although the move to front-of-store is a significant win for consumers, OTC sales are still restricted to pharmacies in France. This provides an interesting contrast to the recent bailout agreement which stipulates that Greece, with a similar distribution model, should go a leap further to liberate OTC from pharmacies and permit mass market sale of OTCs as part of the international economic rescue package.

For more international news, see OTC.Newsflash, published weekly by Nicholas Hall & Company every Friday.

OTCs in Action Episode 30: Kava kava, glucosamine shift status in Germany, France

OTCinActionheaderThis week’s OTCs in Action starts out in Philadelphia, where last week some Germans who came to visit me purchased the dietary supplement melatonin for personal use, because it’s only available on prescription at home. The German OTC sleep aids market is largely composed of natural products, such as valerian and homeopathic remedies, so it was somewhat surprising that melatonin is not available OTC.

In contrast, the Cologne Administrative Court overturned a ban on the calming herb, kava kava, last year. Owing to concerns about liver toxicity, the ingredient was withdrawn from most European markets in 2002, and the FDA issued a warning letter discouraging use of the product in the US. Subsequent research has indicated that the original studies were flawed, and the German court ruled that the risks did not outweigh the ingredient’s benefits.

Click on this link to access OTC INSIGHT Europe’s latest report on the German OTC sleep aids market.

Elsewhere in Europe, France has approved the Rx-to-OTC switch of Biocodex’s Dolenio (glucosamine 1,178mg, 30-tab pack), a slow-acting anti-arthritis medicine. This follows the dereimbursement of several anti-arthritis brands, which had been reimbursed at 15% when prescribed by a doctor. Affected brands included Piasclédine (Expanscience, avocado-soybean unsaponifiables), Chondrosulf (Genévrier / IBSA, chondroitin sulphate), Art 50 (Negma, diacerein) and Voltaflex (Novartis, glucosamine).

Piasclédine and Chondrosulf (in particular) used to command huge sales as semi-ethical brands in France, but now face a challenging, but potentially lucrative, new future in the self-medication sphere.