Stada Health Report 2021

According to the third Stada Health Report, a representative survey of 30,000 participants in 15 European countries, 29% have suffered from increased levels of anxiety during the pandemic, while 25% are troubled by stress and inner restlessness and 15% have reported sleep disturbances. Some 52% of respondents are more affected by the lack of personal contact with family & friends than fear of Covid infection (42%), while almost 1 in 3 worries about the financial and work-related repercussions.

However, 70% of Europeans have been willing to invest more in their own health. For 73%, their doctor is the first point of call for all health-related issues, with pharmacists and scientists also highly trusted (60% each). Despite a 14 percentage-point increase in people purchasing medication online, 43% stay loyal to community pharmacies, 13% of which specifically single out their local branch. Europeans care more about brand names and what is associated with them (38%) rather than sustainable & environmentally-friendly packaging (25%) or whether a product was made in Europe (20%).

In the report, Stada asks the question, “With an increased interest in and an aspiration to healthy living, how did people in Europe procure information on these topics? The short answer is: The internet. 54% of Europeans have increased their online searches for health-related information compared to previous years.” However, this spike in online health searches and literacy has not automatically translated into European consumers looking to bypass their pharmacist when acquiring medication, or information about it. According to Stada’s survey, only 14% of Europeans have ordered more OTC medicines via online pharmacies post-pandemic, and 43% flat out refuse to order them online at all. Despite the ever increasing number of e-Commerce platforms and other channels for obtaining medicines online, community pharmacies are still Europe’s first choice for OTCs.

Nicholas Hall’s Touchpoints: The Stada report quoted above is further evidence that increased levels of stress and anxiety, and disrupted sleep, are by-products of Covid. Insomnia was already considered a pandemic in the Western world by the World Health Organization; and sleep, stress and mood have joined immunity and disinfection as categories with rocketing sales in the past two years … The theme continues in the latest Gallup survey, which notes the high incidence of “worry, stress, anger and sadness among employees worldwide”. It seems that substantial numbers of office workers are refusing to go back to work in the traditional way and are insisting on continuing to work from home … This localisation of labour will almost certainly change our concept of shopping and could benefit independent neighbourhood pharmacies, giving a whole new meaning to the concept of Pharmacy Point-of-Care. It’s too soon to draw definite conclusions, but consumer healthcare companies would do well to re-examine their sales force objectives. One of the most successful modules of the CHC Training Academy is “Winning in Pharmacy”, and I can see this being even more popular as we come out of the Covid lockdown.

To find out more about Winning in Pharmacy, or the offerings from The CHC Training Academy, please contact maricar.montero@NicholasHall.com. The CHC Training Academy can also work with you to develop your own in-house customised training programmes according to your specific strategic needs.

Survey shows growing support for pharmacies in Europe

According to a YouGov survey, commissioned by Stada and focusing on four European countries (Germany, Italy, Spain and UK), hope and confidence in healthcare professionals has grown in the wake of the Covid-19 crisis, though the picture does vary from one country to the next. With measures to reduce coronavirus infection rates defining daily life, Spaniards show the greatest concern for their health (51%), while people in Germany, Italy and UK are less worried (36-39%).

Germans (18%) are least likely to believe their healthcare system has absolutely proven itself, while 47% of Spaniards gave their health system top marks, followed by the UK (35%) and Italy (29%). Spaniards (32%) and Italians (28%) are most likely to have avoided visiting pharmacies vs only 14% in Germany and 19% in UK. In total, one in five people have greater respect and more recognition of what pharmacies provide on a day-to-day basis.

The potentially good news for community pharmacies in Europe is that the coronavirus crisis does not appear to be leading to a large number of people ordering more medicines online. In fact, only 6% of those surveyed say they are taking this action. However, it will remain to be seen how consumer attitudes to internet & mail order purchasing of OTCs change in the coming years, especially in Europe. According to DB6 VP, Celine Waller, internet & mail order is expected to account for 19.2% of the total CHC market within the next decade, more than doubling its share from 9.4% currently. 

The survey also highlighted the likely impact of Covid-19 on the VMS market in Europe. UK consumers and Germans are generally not motivated to take more vitamins or similar products (<9%). In Italy and Spain, the readiness to do so is higher, particularly for vitamin C, D and multivitamins (13-15%). Paying greater attention to nutrition and taking more exercise hold greater attraction in the southern countries than in Germany and the UK, where people are more likely to say that the coronavirus situation has not changed their habits. 

Ensure that you have registered to join Nicholas online for a special webinar presentation with Q&A, which will take place next week! On 29 April at 10:00-11:30 UK time, Nicholas will review 2019 CHC market performance, explore the impact of Covid-19 and identify growth prospects for the future. For those unable to join, there will be the option to purchase a recording and submit up to 3 questions via email. To find out more or to register to join, please contact elizabeth.bernos@NicholasHall.com without hesitation!

Update on Walgreens Boots Alliance deal

Since the global financial crisis, mega dealmaking has gone out of fashion but could now be making a comeback with Stefano Pessina’s planned leveraged buyout of Walgreens Boots Alliance, described as potentially the “largest private equity deal on record”, according to the UK Financial Times. Days after it emerged that Walgreens Boots Alliance had held preliminary talks with private equity groups regarding a potential US$70bn deal to go private, shares in the US-based company rose again on reports that KKR had made a formal approach.

Pessina has a 16% stake in the company and already teamed up with KKR to take Alliance Boots private in 2007, though this time there is a far more challenging amount of debt to be raised in the high-yield bond market, which will be a test of market appetite for a deal of this magnitude. Nicholas Hall commented: “Last week I wrote about the possibility of WBA’s delisting from the stock market and going private: “The general view is that this deal is just too big; and yet, and yet!” Seems I was right to be cautious about writing off what might be Stefano Pessina’s magnificent swansong and the world’s largest private equity deal.”

Walgreens Boots Alliance is the global leader in the retail pharmacy sector, operating just under 20,000 stores in 11 countries and recording revenues of US$136.9bn in the year to end-August 2019. WBA’s US retail pharmacy business accounts for 76% of this total, but operating income has declined by 20.5% owing to drug reimbursement pressures and increased competition from Walmart and Amazon. In addition, WBA’s international retail pharmacy business reported weak growth owing to a “challenging UK market”. According to a report in Forbes, the advantage of going private would be a chance to arrest the decline in WBA’s share price, down nearly 10% this year, as the deal would take the company away from the public eye and could make it easier to focus more on pharmacy point-of-care services.

Separately, under an agreement with Mitra Adiperkasa (MAP), a leading lifestyle retailer in Indonesia, WBA is to create a Boots branded pharmacy-led, health & beauty retail business in one of the world’s most populous countries. The first stores are expected to open in H2 2020. “Boots is a great addition to our diversified brand portfolio, which will help MAP further unleash the power of its 360° retailing strategy,” said Group CEO, VP Sharma. “We are confident that the combination of Boots cutting-edge products together with MAP’s solid competitive advantages will elevate the unique Boots experience to a whole new level in Indonesia.”

Announcing Nicholas Hall’s Reports End of Year Sale! Up to 25% off – valid until 31 December. We are pleased to announce a special End of Year offer for our CHC Reports! Until 31 December, we are offering a 15% discount on the 2019 Reports Catalogue, plus an additional 10% discount on orders for multiple reports. If you would like additional information on any of our publications, or would like to place an order, please contact Melissa.Lee@NicholasHall.com

PPoC initiatives key to future CHC growth

For the final instalment in our series of blogs on Nicholas Hall’s Infinity Zones for future CHC growth, we turn to the topic of Pharmacy Point-of-Care (PPoC). As our recent blog on e-commerce indicated, internet & mail order sales of OTCs are growing fast but store-based sales still account for 78% of the global OTC market. In an increasing number of markets, PPoC initiatives are providing new, speedy and effective alternatives for consumers unable or unwilling to wait for a GP appointment. Below is a summary of some PPoC initiatives in recent years from all four corners of the globe.

In February 2019, PTS Diagnostics and Kroger Health, which operates 2,100+ pharmacies and clinics in the USA, announced the full rollout of CardioChek Plus analysers for point-of-care blood testing to help identify individuals at risk of heart attack, stroke and diabetes. The CardioChek Plus system accurately tests lipid profile and glucose simultaneously with one fingerstick, enabling a more seamless process for the customer. It measures total and HDL cholesterol, triglycerides and glucose, providing on-site results in as little as 90 seconds.

In Vietnam, Chris Blank and his team at Pharmacity have the ambition to reach 1,000 stores in just 1,000 days. But, as Nicholas Hall said, it’s more than just store openings that is propelling Pharmacity to national dominance – it has carefully figured out the offline and online needs of its customers and is working hard to build traffic in each store, so the proposition is for vertical as well as horizontal growth. Ultimately, Pharmacity will succeed by delivering holistic PPoC solutions to the unmet health needs of its customers.

Turning to Europe, LloydsPharmacy (Celesio / McKesson) started offering sore throat tests for people aged 18+ years in 600 stores across England, Scotland and Wales in November 2018. Pharmacists ask questions and examine the throat to determine the possible cause of pain. If necessary, they will take a swab test to check for infection. If the results are negative for Streptococcus A, the pharmacist is able to offer advice, as well as a range of OTC treatments.

As for Latin America, Brazil’s ANVISA approved a resolution in late 2017 that allows any health establishment nationally, including pharmacies and drugstores, to administer vaccinations, providing that they meet certain requirements. This follows a number of local legislation changes permitting pharmacies to offer a greater number of services – among them, the application of vaccines, health monitoring with point-of-care testing and self-test equipment – in the states of Sao Paulo, Amazonas, Para, the Federal District and the city of Sao Paulo in November-December 2017.

Don’t miss out on your final chance to benefit from our pre-publication discount when you pre-order Nicholas Hall’s New Paradigms for CHC 2019: Over the Horizon, written by Nicholas himself! Analyse each aspect of the CHC industry, with a focus on crucial issues including Healthcare trends, Innovation, M&A, Switch and much more. Nicholas will also unveil all the “infinity zones” he has identified as being paramount to the future growth of the industry. In addition to this, you can upgrade your purchase to include a customised in-house presentation or webinar with Nicholas. To find out more or to place your order, please contact melissa.lee@NicholasHall.com.

10 Infinity Zones for future CHC growth

Nicholas Hall’s New Paradigms for CHC report, due to be published later this year, outlines 10 Infinity Zones for future consumer healthcare growth, which were shared as an exclusive preview with delegates at our recent Vienna conference. Below we outline these Infinity Zones to OTC DASHBOARD subscribers, with a short description of each.

1. Prevention: A long-term theme in the CHC industry which is now taking root. Nicholas Hall presented a slide of the fastest-growing OTC subcategories by CAGR (2014-18), comparing those focused on prevention with those centred around treatment, and this showed that seven of the Top 10 most dynamic subcategories had a preventative focus.

2. Probiotics: One of these Top 10 fastest-growing subcategories was probiotics, an area of the global consumer healthcare market that has moved from adjacency into the mainstream. In the 2014-18 period, probiotics delivered more value growth (in €mn terms) than established subcategories like systemic analgesics and sore throat remedies.

3. Food Intolerance: Changing diets across the globe are causing a huge increase in food intolerance issues. Nicholas Hall is planning to provide an estimate of the size of this emerging category in his New Paradigms report, but for now he emphasised to delegates the opportunities that OTC marketers have here, notably in terms of cross-branding.

4. Natural & Organic: Like prevention, this is not a new trend in consumer healthcare, but instead one that is increasingly on the radar of major multinationals. A recent example here is J&J’s acquisition of the Zarbee’s Naturals line of OTC products.

5. Cannabis: Nicholas Hall outlined the huge investment already being seen in this fast-growing market, especially in key countries like Australia, and outlined how the future CBD market could be split into five categories, including Rx, OTC medical cannabis via Rx-to-OTC switch, VMS & topicals, beauty & food and lifestyle marijuana.

6. Sexual Health: Nicholas Hall said that, while Bayer has made it clear that erectile dysfunction treatment Levitra will not switch, we’ve already seen the Rx-to-OTC reclassification of Viagra Connect in the UK market and it’s possible that Sanofi’s Cialis could soon follow once the company has navigated the necessary regulatory hurdles.

7. E-commerce: This year DB6 has introduced an “all channels” version of the dataset, showing that total OTC sales through all channels were worth US$174bn in 2018, of which store-based sales account for 78%, with direct sales (MLM) generating 14%. Internet & mail order currently accounts for 9% of the “all channel” universe, with sales dominated heavily by VMS supplements in China and USA. However, this channel has seen a CAGR of 20% since 2014 and will continue to increase dramatically in importance.

8. Pharmacy: Nicholas Hall also emphasised the continuing importance of bricks & mortar retailers to consumer healthcare, with Pharmacy Point-of-Care still the driving force behind recommendations and purchases of key OTC brands.

9. Big Data: The Big 5 tech companies are now dominating healthcare information, and while there are concerns about privacy, Apple CEO Tim Cook has stated that his company’s “greatest contribution to mankind” will be within the sphere of healthcare.

10. Emerging Markets: Nicholas Hall said that Emerging Markets now account for a 55% share of global OTC sales (in the retail channel). Recent figures from the IMF’s World Economic Outlook forecast that developing economies will continue to outpace advanced economies.

Take a look at what the future holds for the CHC industry in our upcoming Signature report, Nicholas Hall’s New Paradigms for CHC 2019: Over the Horizon, written by Nicholas himself. The report will take a look at major issues including innovation, future competition, emerging categories and markets and M&A. You also have the option to upgrade your purchase to include a customised in-house presentation or webinar with Nicholas. To find out more or to place your order, please contact melissa.lee@NicholasHall.com.

E-commerce: Amazon picks up PillPack

Amazon’s latest foray into the healthcare sector – a definitive agreement to acquire US online pharmacy, PillPack – has huge disruptive potential for the traditional drugstore pharmacy sector. A start-up founded in 2013, PillPack is licensed in 49 US states to offer pre-sorted doses of medications, coordinate refills and renewals, and ensure timely home delivery to customers. Financial terms of the deal were not revealed, but the transaction is expected to close during Q2 2018, subject to regulatory approvals and other customary closing conditions.

Walmart was rumoured to be interested in acquiring PillPack earlier this year, and the company lost US$3bn in market capitalisation after the Amazon deal was announced on Thursday 28th June. The two companies are now locked in an intense global rivalry, with Walmart coming out on top in India after acquiring a 77% stake in Flipkart in May 2018. Such huge M&A investments will advance e-commerce’s share of the pharmaceuticals market in key markets like India and the US, with the potential to revolutionise the consumer healthcare sector too.

PillPack is currently a small operation, expected to post revenue of US$100mn this year, but Amazon’s existing customer base and shipping infrastructure could allow it to quickly scale up. Brick & mortar pharmacy chains are already seeing the consequences of the deal; as the news broke, shares in Rite Aid fell 11%, Walgreens Boots Alliance 9.9% and CVS Health 6.1%, a collective US$11bn in market value.

Though consumers in many markets remain hugely reliant on pharmacist advice when making OTC purchases, there’s no doubt that price is a very sensitive area that makes traditional brick & mortar retailers vulnerable in this evolving retail landscape. Certain OTC categories where there is a strong wellness or personal care element, such as VMS and dermatologicals, are most likely to see a significant rise in e-commerce sales.

E-commerce, as well as OTC adjacencies and digital health, are three of the hot topic areas that OTC DASHBOARD will be focusing on this year, in its weekly briefings, infographics and blogs. For a free trial of the service, please contact hannah.burke@nicholashall.com

Barcelona Conference Report

In this week’s blog, we report back from Nicholas Hall’s OTC INSIGHT 29th Conference & OTC Training Academy Workshop in Barcelona, the first to ever see Nicholas Hall’s keynote address livestreamed to an audience across the globe via YouTube.

Nicholas’ opening address to delegates explored the 4 elements of PACE, which all marketers need to adopt in order to increase their pace and move faster:

P = Pharmacy and retail, the bedrock of the OTC market = 80% of revenue outside US (70% if inc US)

A = Adjacency, reaching beyond the 6 core categories of OTC and seeing where we can branch out (i.e. diabetes, Alzheimer’s, hearing screeners, etc)

C = Consumer (Nicholas was joined on stage by Luca Pagano of BeMyEye who explored how social changes have impacted how and when people buy, and the power of crowdsourced insights to transform in-store execution)

E = Engaging with the consumer and e-commerce (as Nicholas said, the topic of e-commerce would be deserving of a whole conference of its own)

Nicholas Hall encourages OTC marketers to pick up the PACE

On Day 2, another packed schedule of speakers was rounded off with David Blair, Google’s Head of Industry Heath. His presentation to delegates explored three major trends which are impacting everything we do: chip, cloud computing and AI / machine learning.

Today we practically live online, and the smartphone is now the consumer’s main device – through which nearly all traffic passes – a fact that is having a massive impact on the health industry. Blair said that voice search is going to become the next key driver and could have implications for healthcare marketing (see our recent blog on this topic), as we move from Point of Care, where we expect the consumer to wait for appointments, visit the doctor and then the pharmacist, to a space where we can have care anywhere.

In 2017, there were 160bn searches for healthcare globally via Google, with 2bn alone just for the allergy category! Almost two-thirds of these searches were conducted via a mobile device. There was also an increase for searches for “best non-drowsy allergy medicine”, “best cold & flu medicine” and so forth. Last year, Google also saw a 60x increase in searches for “near me”, highlighting the shift towards immediacy.

Google’s David Blair closes out proceedings

For more updates on consumer healthcare trends, and a full round-up of Day 1 and Day 2 proceedings, be sure to follow Nicholas Hall on Linkedin. 

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

This 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.

New regulations rocking the boat in Switzerland?

While preliminary figures for DB6 show only modest growth for Switzerland in 2014, recent developments in the Alpine state make for more exciting reading.

In December, the Swiss Parliament’s Upper House voted in favour of allowing all non-prescription medicines to be sold in drugstores, merging the Class C (pharmacy-only OTCs) and Class D categories (pharmacy + drugstore OTCs). The vote was made on the condition that the new larger category will be reviewed in the near future, to see which medicines might either be moved to the current Class E free sale category (which includes supermarkets) or reverse-switched, hopefully the former. In the short term, the measure should help to boost both overall OTC growth through increased availability, as well as the fortunes of the little over 500 drugstores in Switzerland, whose number has dwindled a little over the past few years.

As part of the same bill, the Upper House also passed a proposal giving pharmacists the ability to dispense a select list of Rx medicines to consumers without a prescription, which will depend on the pharmacists having already dealt with the purchasing consumer on a previous occasion. Given time and a healthy dose of Swiss caution from pharmacists, these medicines may also find their way on to the self-medication bill.

Meanwhile, the Swiss National Bank’s decision to remove the Swiss Franc’s cap against the Euro in January was a real thorn in the side of Swiss retailers on the nation’s borders, with numerous German pharmacists reporting floods of Swiss consumers pouring into Konstanz to stock up on cheap(er) OTCs. Whether these international pharmacy-shopping trips will continue in the long term remains to be seen, but it may take drugstores starting a price war on their new OTC options to keep the Swiss at home.

OTC in Action Episode 23: Is there a pharmacist in the house?

Last week, sister publication OTC.Newsflash reported that the College of General Practitioners and the Royal Pharmaceutical Society in England have proposed that pharmacists work in general practitioner “surgeries” (offices) to improve safety, patient care and waiting times for GP appointments. It brought to mind helping to care for my father-in-law, who had multiple health conditions that required a broad range of specialists prescribing Rx and OTC medications. Joe had four daughters, temporary visiting nurses and therapists, so coordinating his medication was a real challenge, in part because there were so many “helpers”.

The English proposal is meant to improve patient care by softening demands on a stable population of GPs treating an increasing number of patients. Apparently, there is an over-supply of pharmacists who train for five years — one year less than a doctor, one year more than a nurse.

Dr Maureen Baker, Chair of the RCGP, explained: “This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce. Patients with long-term conditions such as asthma or diabetes and with complex medicine needs would particularly benefit from having a pharmacist to help navigate the conflicting and confusing information they sometimes receive about their treatment as they move between hospital and community care. Practice teams can also benefit from a pharmacist’s advice to help avoid medicine waste, improve the management of medicines and rationalise costs.”

OTCs will be in Action as pharmacists bring them into the office “surgery” setting by recommending effective, safe and affordable medicines to patents, while ensuring safe use of multiple treatments.