Survey shows growing support for pharmacies in Europe

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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.

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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

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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.”

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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 SaleUp 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

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.

Tracker hits 20,000 innovations

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Our sister product OTC New Products Tracker has hit a significant milestone – 20,000 innovations added to a database that tracks consumer healthcare launch activity all the way back to the start of 2013, across 20 key markets. In this week’s blog, we look back at some of the highest-ranked innovations added to the archive over the past year.

A recent 4-star innovation is medical device Flow from Flow Neuroscience, a first of its kind home treatment on the European market. Positioned as a non-medicated alternative treatment for depression, the medical device comprises a brain stimulation headset and a therapy app. While stimulation is in use, the app acts as a virtual therapist that the user can interact with. Available in the UK since summer 2019, Flow retails for £399.

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Adjacent OTC categories have been fuelling the fire of consumer healthcare innovation in recent years, with medical cannabis / CBD and probiotics two of the most active categories in terms of launch activity. US marketer CBDfx is arguably the most pioneering innovator among the new wave of medical cannabis companies, launching several new delivery formats over the past two years, including vaping pens (January 2018), “chill shot” drinks for anxiety (March 2019), sublingual hemp strips (April 2019) and acne face masks (June 2019).

Like CBD, probiotics have also enjoyed high levels of innovation in terms of delivery formats and positioning. Two examples of probiotics targeting a new consumer healthcare niche include Elebiotic, a recent Recordati launch in Spain positioned to manage recurrent acute otitis media in infants, and Khan’s Morning, a probiotic launched in South Korea in early 2019 that is claimed to help break down the alcohol and acetaldehyde that causes hangovers.

Review 20,000+ launches and innovations with OTC New Products Tracker, the ultimate competitive intelligence tool! Products are graded with a star rating, from 1* (essentially “me too” and generics) up to 4* (1st Rx-to-OTC switches in a category, creation of a new OTC class or other major leaps in innovation). With a recently-released major update including eye-catching new graphics and powerful search filters that help you visualise and explore the vast archive according to your exact specifications, now is the perfect time to set up your free trial. For a demo or more information, please contact waisan.lee-gabell@NicholasHall.com.

PPoC initiatives key to future CHC growth

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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.

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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.

Medical cannabis diversification

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In terms of number of innovations by OTC subcategory, medical cannabis moved into the Top 20 in 2018 according to OTC New Products Tracker, with 86 new product developments. Europe and North America have been driving the trend in terms of high-quality innovations, from Swiss Cannabis Gum in Switzerland to PharmaCare’s Naturopathica lozenges in the UK and Foria Basics Suppositories in the USA.

As well as an ever-growing diversity of delivery formats, another characteristic of the emerging medical cannabis category is the increasing width of positioning. This is exemplified by a new range of hemp-based hair & body care products launched by HempMeds. Distributed by Naturewell in the US market, the personal care line is composed of 4 products – shampoo, conditioner, body wash and body lotion – all formulated with CBD oil (derived from hemp) and natural extracts such as argan and goji berry (shampoo), argan and green tea (conditioner), peppermint and liquorice root (body wash) and jojoba oil and almond oil (body lotion). 

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Available now to buy online, this new range was just recently showcased at the Natural Products Expo West in California, where HempMeds President Todd Morrow said that design and development of the line was “focused on consideration of women in particular”.

According to a recent report by Eaze, the number of US women buying cannabis products almost doubled in 2018, up 92%, and women now make up 38% of all US cannabis consumers. This report shows that not only is the medical cannabis product mix diversifying in terms of format and positioning, but the consumer base is also widening too, with more women and older people now entering the market.

Review 17,000+ new launches and innovations with OTC New Products Tracker, the ultimate competitive intelligence tool! Products are given a star rating, with “me too” items ranked 1*; launches / line extensions in a new category / adjacency 2*; major launches / line extensions with strong new benefits / positioning 3*, and 1st Rx-to-OTC switches in a category, creation of a new OTC class or other major leaps in innovation 4*. With a recently-released major update including eye-catching new graphics and powerful search filters that help you visualise and explore the vast archive according to your exact specifications, now is the perfect time to set up your free trial. For a demo or more information, contact waisan.lee-gabell@NicholasHall.com.

OTC Innovation Report 2018

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Lamenting the fact that Scott Gottlieb is stepping down as FDA Commissioner, Nicholas Hall commented in Friday’s OTC.Newsflash that: “Although producing few tangible results so far, FDA under Gottlieb has displayed a greater openness to finding new switch models at a lower cost and with shorter lead times, including the use of new technologies.” Nicholas Hall also said that “government support is vital to our industry” and that “more liberal regulations are at the heart of a successful self-care sector”.

A drop-off in switch activity over the past year is part of the explanation for lower levels of high-quality OTC innovation. In 2018, OTC New Products Tracker awarded just six products with 4 stars – eye care brands Lumify (USA) and Zabak Eye Drops (Poland), antacid Reza Band (USA) and antispasmodic Scopolan Compositum (Poland), plus Viagra Connect (UK) and allergy remedy Talerc (Brazil). Compared to previous years, this marked a falling-off in terms of 4-star innovations.

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The number of total OTC innovations (3,747) in 2018 was roughly in line with the previous year, and still much higher compared to 2014, 2015 and 2016. However, the number of 2* (528), 3* (94) and 4* (6) innovations was much lower, while the number of 1* innovations (3,119) was at an all-time high.

VMS continues to be a major source of innovation, with three of the Top 5 subcategories in 2018 – probiotics, multivitamins and hair & beauty supplements. Derma is another key source of innovation, with three of the Top 10 – acne remedies, eczema & psoriasis and lip care. The three other innovative subcategories which complete the Top 10 are sedatives & sleep aids, topical analgesics and sore throat.

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Please contact us for the full report. You can also review 17,000+ new launches and innovations with OTC New Products Tracker, the ultimate competitive intelligence tool! Products are given a star rating, with “me too” items ranked 1*; launches / line extensions in a new category / adjacency 2*; major launches / line extensions with strong new benefits / positioning 3*, and 1st Rx-to-OTC switches in a category, creation of a new OTC class or other major leaps in innovation 4*. With a recently-released major update including eye-catching new graphics and powerful search filters that help you visualise and explore the vast archive according to your exact requirements, now is the ideal time to set up your free trial. For a demo or more information, contact waisan.lee-gabell@NicholasHall.com.

High on innovation, but CBD faces regulatory uncertainty

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Various Nicholas Hall publications, notably OTC.NewDirections and OTC New Products Tracker, provide in-depth coverage of medical cannabis developments owing to the category’s huge potential to boost future consumer healthcare growth. High levels of innovation, both in terms of positioning and delivery format (like those detailed below), continue to characterise the category, but recent regulatory moves by the WHO and EU mean that the status of CBD supplements remains far from settled.

Looking at delivery format innovations, recent developments include a new mouth spray in the UK (Natures Aid CBD Oil Spray from Thornton & Ross / Stada) and a new nasal spray in the USA (Rhinodol from New Leaf Pharmaceuticals). The latter claims to deliver the highest concentrations of medical CBD at an affordable cost (US$69.99). According to New Leaf, the oral administrative route provides the lowest bioavailability, owing to the digestive processes that occur when CBDs enter the blood stream (a significant amount of CBD goes into the liver and is broken down into unusable compounds).

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Screenshot from New Leaf Pharma’s website

Meanwhile, attitudes to CBD and cannabis are changing at a regulatory level. According to news sources, a leaked World Health Organisation internal letter to the UN Secretary-General recommends that whole-flower cannabis and its resins should be removed from Schedule IV of the Single Convention on Narcotic Drugs (1961), the most restrictive international drug category. Cannabis scheduling was discussed at the Expert Committee of Drug Dependence 41st meeting in November 2018 but the discussions have not been published. The letter also clarified that cannabidiol should not be scheduled within the International Drug Control Conventions, while tinctures and extracts of cannabis should also be deleted from Schedule I. WHO recommendations will be voted on by the UN’s Commission on Narcotic Drugs, which could take place in March 2019.

In Europe, marketers of CBD supplements are facing new regulatory hurdles. The European Food Safety Authority has amended the entry for cannabinoids on the Novel Foods register, which now states: “Extracts of Cannabis sativa L. and derived products containing cannabinoids are considered novel foods as a history of consumption has not been demonstrated. This applies to both the extracts themselves and any products to which they are added as an ingredient (such as hemp seed oil). This also applies to extracts of other plants containing cannabinoids. Synthetically-obtained cannabinoids are considered as novel.”

This means that CBD supplements are now classed as a novel food in Europe and manufacturers face the prospect of having to take their products off the market while they apply for approved novel food status, which can take around a year. In December 2018, Austria banned the sale of CBD extracts, stating that the ingredients fall under the EU’s Novel Foods regulations and cannot be marketed without authorisation.

Join Nicholas Hall at our upcoming New Jersey meeting, hosted with our partners Everything Health. Based on the theme, Innovate, Digitize, Integrate, the meeting takes place on 26-27 June, with representatives from Perrigo, MarketHub, Google and many others, joining us to discuss and debate topics including:

  • Market Trends and Innovation
  • Key Developments in the Cannabis Market
  • Connected Health
  • Consumer Insights using Artificial Intelligence  

Vaping among middle-aged growing fast

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According to a recent report by Mintel on e-cigarette and smoking control use in the UK, vaping among the middle-aged (45-54 years olds especially) has undergone a sharp rise. While only 13% of 45-54 year olds used e-cigarettes in 2016, this proportion has grown sharply to 20% in 2018, and this age group is also reported as being most likely (71%) to believe that vaping is fashionable.

Young people (18-24 year olds) are still the most prominent vapers; the share of e-cigarette use among this age group grew from 24% in 2016 to 28% in 2018. Although this represents a slower rate of growth compared to their middle-aged counterparts, over half of Brits (57%) still believe that too many young people vape.

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Overall, about 19% of British adults vape, up from 17% in 2016, with men twice as likely to vape as women. Sales of e-cigarettes are reported to be performing well, with the market experiencing strong growth of 12% in 2018, to total £283mn (US$366mn). This is compared to a UK smoking control market declining by 1%, according to the latest OTC DASHBOARD MAT Q3 2018 figures, a trend caused by smokers turning to e-cigarettes rather than traditional NRT when cutting back on tobacco.

In his latest message to the consumer health industry, Nicholas Hall wrote about the importance of true innovation, including the following points:

• Embrace the outer adjacencies of consumer health, of which sexual health, e-cigarettes / vaping and medical cannabis are the most interesting, potentially adding another 20-30% to CHC market sales; BUT, every time I propose these categories to a client, all I hear is a sharp intake of breath, followed by a nervous giggle

• Refocus on organic growth, which means more differentiation of the new products we launch. Our OTC New Products Tracker (see below) has recorded 17,000 launches in the past 6 years, of which 99 appear to be game-changers and another 1,000 have a genuine point of difference. But I’m sorry to say that for many of the other 93%, the marketers would have done better to keep their money in the bank, even at 0.1% interest.

Review 17,000+ new launches and innovations with OTC New Products Tracker, the ultimate competitive intelligence tool! Products are given a star rating, with “me too” items ranked 1*; launches / line extensions in a new category / adjacency 2*; major launches / line extensions with strong new benefits / positioning 3*, and 1st Rx-to-OTC switches in a category, creation of a new OTC class or other major leaps in innovation 4*. With a recently-released major update including eye-catching new graphics and powerful search filters that help you visualise and explore the vast archive according to your exact requirements, now is the ideal time to set up your free trial. For a demo or more information, contact waisan.lee-gabell@NicholasHall.com.

Medical cannabis products legal in UK

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Three hot topics we focus on at OTC DASHBOARD, in our blogs and infographics, are OTC adjacencies, e-commerce and new technology. Medical cannabis falls within the sphere of OTC adjacencies, and here at Nicholas Hall & Company we believe that this category will progressively become part of the consumer healthcare market.

Recent legislative moves show that government attitudes to cannabis use are becoming more and more liberal. Just last week, the UK Home Secretary made the decision to allow the legal prescription of cannabis-derived medicinal products by specialist doctors. The UK’s regulatory agency, MHRA, is now working on a clear definition of what constitutes a cannabis-derived medicinal product.

The UK has also been one of several markets that have seen the launch of innovative cannabidiol (CBD) products, such as CannaQIX (Precision Healthcare / Creso). Launched in April 2018, CannaQIX is formulated with CBD organic hemp extract, as well as vitamins and minerals. Available as lozenges, the product is positioned as a cognitive booster that maintains mental and nervous function, reduces fatigue and releases energy. The product is also available in Switzerland and being rolled out across Europe.

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Other key countries for CBD products include Germany, Israel, Australia and the USA, with 45 products in the latter market already listed in our OTC New Products Tracker archive, in a variety of innovative formats including pens, vaporisers and gummy bears.

Canada is another country becoming more liberal in its approach to cannabis. In June 2018, legislation permitting Canadians to consume cannabis for recreational purposes was finalised, the final step that will pave the way for official legalisation in October 2018. The regulatory package is 390 pages long and provides details about how cannabis may be grown, harvested, processed and sold.

Looking ahead, Europe and North America are likely to be at the forefront of market development. According to a report from Prohibition Partners, the European cannabis market will be worth €115.7bn (US$135bn) by 2028, with the majority of European states expected to pass legislation to legalise medical cannabis programmes and recreational cannabis in that time.

Nicholas Hall’s upcoming OTC.NewDirections Executive Conference will reflect rising interest in the fast-developing cannabis market worldwide with two presentations on this key topic, from Canada and Israel. Being held on 12 September in London, this one-day meeting will explore Where Innovation Meets Regulation. For details of the full agenda or to reserve your place contact lianne.hill@NicholasHall.com