Tivorbex Numbers?

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anonymous

Guest
Amazing we haven't heard shit about Tivorbex numbers. That can only mean they absolutely suck. Our district progression sucks and a review of MicroStrategy shows an average of 1 rx per territory. Good luck with that.........
 












anonymous said:
its brutal - docs see no use for this-no coverage i have 0 scripts
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Just wish there was a more honest, straight forward discourse here than the constant character assassination and sophomoric BS. Hate to be job jumping but how likely will inVentiv be to help you on anothet contract if you jump ship. This industry is getting crushed by the insurance consolidation and our drs are often the biggest victims, costing us access. I never should have come back and its probably time to look outside. The glory days are over. My boss wants me to churn the OF5s and the high volume rxes but they are the ones with the biggest access issues, if they even see reps period. You can't get blood from a stone....
 
























anonymous said:
I like the story and I think it may take off eventually, but its not selling. MC may have alot to do with it. The bottom line is, its not selling well at all.
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It is not selling in my geography either and it is concerning to me. The EEK are not being utilized either. Hopefully, it will take off and we will hit the goal set for us.

Good selling to all my fellow PSR's.
 












anonymous said:
we will transform the pain market with Tiborvex wait and see chumps!!
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Transform the pain market???LOL. Most people don't even have 1 prescription yet. Keep dreaming. Open up Microstrategy. What is the area average genius? 1? You are the chump because you aren't a rep and you work at the home office. Nice launch strategy smart guy. Get some managed care and stop wasting time on CP.
 












Pharma is in the control of mc now. T&A doesn't even matter anymore because the drs are no longer middle aged perverts. Frankly, I don't think 75% of my drs would give a shit about a former blonde bimbo cheerleader. Most of my drs are women, gay or foreigners. Considering meloxicsms tolerability, I'm not sure how were going to crack that market. If you're considering Iroko, take another job if you have the option. Its not too long before most of the rest of us are gone. :-(
 






Pharma is in the control of mc now. T&A doesn't even matter anymore because the drs are no longer middle aged perverts. Frankly, I don't think 75% of my drs would give a shit about a former blonde bimbo cheerleader. Most of my drs are women, gay or foreigners. Considering meloxicsms tolerability, I'm not sure how were going to crack that market. If you're considering Iroko, take another job if you have the option. Its not too long before most of the rest of us are gone. :-(
 






The safety data is based on a 2 day trial!?!? REALLY? No 7 - 14 day follow up trial onnamy of those pts? How many drs have you had the opportunity to present the entire data set to? How many of them expressed concern over this? The new numbers are just as bad as the old....maybe worse, its hard to differentiate submicron numbers with a quantum computer!!!
 






anonymous said:
The safety data is based on a 2 day trial!?!? REALLY? No 7 - 14 day follow up trial onnamy of those pts? How many drs have you had the opportunity to present the entire data set to? How many of them expressed concern over this? The new numbers are just as bad as the old....maybe worse, its hard to differentiate submicron numbers with a quantum computer!!!
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People. People. If you are not currently interviewing to get the flock out of here....you are behind the curve! Seriously, look out for yourselves and be smart! Flee!!!
 






Good luck...But I think with the level of lack of knowledge, the expectations and the constant negative attitude demonstrated here, you guys will not succeed anywhere. There is enough science, enough managed care coverage to succeed. It comes to your knowledge of the details and the outlook to focus on the things you have rather than the things you don't and a never say die attitude that will separate the stars. People complain about a 2-day study and a bunch of other ignorant ones join these losers. However, a winner would have correlated the new statement that came out from the FDA that with NSAIDs the serious AEs set in really early and understand that not having seen serious AEs early is a good thing. The top 4 commercial payers in most geographies are ESI, CVS Caremark, Anthem and United. In some markets, the local blues may be in them and typically even in a geography the blues dominate they do not account for more than 20% of the commercial lives. Z is covered as Tier 2 in ESI, Tier 3 unrestricted with CVS Caremark and 3rd Tier with a step in Anthem. Step edits are electronically adjudicated steps and typically requires the patient to have had a generic in the last 4-6 months. Of the NSAID prescriptions written every week, only about 20% of them are for patients that are totally new and never had a NSAID Rx. 80% of the NSAID prescriptions written every day, every week are for patients who have had an NSAID before and since the 95% of the prescriptions written are generic, 80% of the NSAID Rx written in your offices every week are for people who have some generic NSAID before. So if you have one of your major plans that has a step, it is how you message this to the doctor to state clearly that he should be writing Z or T for patients who have had a NSAID in the last 4-6 months. Use MMIT app and it gives detail coverage information by local geography. Make sure that doctor knows not to write for United patients or Medicare and Medicaid patients.

There is no branded product that has coverage in all the plans. Sovaldi was blocked by ESI. In today's news ESI and CVS Caremark came out and said that they will over only one of Praluent and Repatha - the new PDK9 inhibitors (breakthrough therapies). Payers have also signalles that they may have a step edit or PA on these drugs. Similar treatment to Novartis' new Enteresto that was proven in head to head studies to save lives and reduce ER visits etc. So if you expect everything to be given on a platter, you will not succeed. First get objective information about the composition of the various payers and plans in your geographical area and the complexities and the coverage of Z and T in these plans. Then understand the complexities - doctors may not know the PBM coverage as they dont get the pharmacy information - so when you diagnose a complaint from the doctor you can understand the details and provide clarity.

Like any endeavor where you need to be successful, you need to invest time to get the knowledge needed and then have a positive attitude. The fact that you are in these jobs show that you have excellent communication skills. Adding the knowledge and combining it with the right attitude will make you succeed.
 






anonymous said:
Good luck...But I think with the level of lack of knowledge, the expectations and the constant negative attitude demonstrated here, you guys will not succeed anywhere. There is enough science, enough managed care coverage to succeed. It comes to your knowledge of the details and the outlook to focus on the things you have rather than the things you don't and a never say die attitude that will separate the stars. People complain about a 2-day study and a bunch of other ignorant ones join these losers. However, a winner would have correlated the new statement that came out from the FDA that with NSAIDs the serious AEs set in really early and understand that not having seen serious AEs early is a good thing. The top 4 commercial payers in most geographies are ESI, CVS Caremark, Anthem and United. In some markets, the local blues may be in them and typically even in a geography the blues dominate they do not account for more than 20% of the commercial lives. Z is covered as Tier 2 in ESI, Tier 3 unrestricted with CVS Caremark and 3rd Tier with a step in Anthem. Step edits are electronically adjudicated steps and typically requires the patient to have had a generic in the last 4-6 months. Of the NSAID prescriptions written every week, only about 20% of them are for patients that are totally new and never had a NSAID Rx. 80% of the NSAID prescriptions written every day, every week are for patients who have had an NSAID before and since the 95% of the prescriptions written are generic, 80% of the NSAID Rx written in your offices every week are for people who have some generic NSAID before. So if you have one of your major plans that has a step, it is how you message this to the doctor to state clearly that he should be writing Z or T for patients who have had a NSAID in the last 4-6 months. Use MMIT app and it gives detail coverage information by local geography. Make sure that doctor knows not to write for United patients or Medicare and Medicaid patients.

There is no branded product that has coverage in all the plans. Sovaldi was blocked by ESI. In today's news ESI and CVS Caremark came out and said that they will over only one of Praluent and Repatha - the new PDK9 inhibitors (breakthrough therapies). Payers have also signalles that they may have a step edit or PA on these drugs. Similar treatment to Novartis' new Enteresto that was proven in head to head studies to save lives and reduce ER visits etc. So if you expect everything to be given on a platter, you will not succeed. First get objective information about the composition of the various payers and plans in your geographical area and the complexities and the coverage of Z and T in these plans. Then understand the complexities - doctors may not know the PBM coverage as they dont get the pharmacy information - so when you diagnose a complaint from the doctor you can understand the details and provide clarity.

Like any endeavor where you need to be successful, you need to invest time to get the knowledge needed and then have a positive attitude. The fact that you are in these jobs show that you have excellent communication skills. Adding the knowledge and combining it with the right attitude will make you succeed.
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This knockoff has a lot in common with Solvadi - right!
 






anonymous said:
Good luck...But I think with the level of lack of knowledge, the expectations and the constant negative attitude demonstrated here, you guys will not succeed anywhere. There is enough science, enough managed care coverage to succeed. It comes to your knowledge of the details and the outlook to focus on the things you have rather than the things you don't and a never say die attitude that will separate the stars. People complain about a 2-day study and a bunch of other ignorant ones join these losers. However, a winner would have correlated the new statement that came out from the FDA that with NSAIDs the serious AEs set in really early and understand that not having seen serious AEs early is a good thing. The top 4 commercial payers in most geographies are ESI, CVS Caremark, Anthem and United. In some markets, the local blues may be in them and typically even in a geography the blues dominate they do not account for more than 20% of the commercial lives. Z is covered as Tier 2 in ESI, Tier 3 unrestricted with CVS Caremark and 3rd Tier with a step in Anthem. Step edits are electronically adjudicated steps and typically requires the patient to have had a generic in the last 4-6 months. Of the NSAID prescriptions written every week, only about 20% of them are for patients that are totally new and never had a NSAID Rx. 80% of the NSAID prescriptions written every day, every week are for patients who have had an NSAID before and since the 95% of the prescriptions written are generic, 80% of the NSAID Rx written in your offices every week are for people who have some generic NSAID before. So if you have one of your major plans that has a step, it is how you message this to the doctor to state clearly that he should be writing Z or T for patients who have had a NSAID in the last 4-6 months. Use MMIT app and it gives detail coverage information by local geography. Make sure that doctor knows not to write for United patients or Medicare and Medicaid patients.

There is no branded product that has coverage in all the plans. Sovaldi was blocked by ESI. In today's news ESI and CVS Caremark came out and said that they will over only one of Praluent and Repatha - the new PDK9 inhibitors (breakthrough therapies). Payers have also signalles that they may have a step edit or PA on these drugs. Similar treatment to Novartis' new Enteresto that was proven in head to head studies to save lives and reduce ER visits etc. So if you expect everything to be given on a platter, you will not succeed. First get objective information about the composition of the various payers and plans in your geographical area and the complexities and the coverage of Z and T in these plans. Then understand the complexities - doctors may not know the PBM coverage as they dont get the pharmacy information - so when you diagnose a complaint from the doctor you can understand the details and provide clarity.

Like any endeavor where you need to be successful, you need to invest time to get the knowledge needed and then have a positive attitude. The fact that you are in these jobs show that you have excellent communication skills. Adding the knowledge and combining it with the right attitude will make you succeed.
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You must be Iroko's managed care guy. You have too much free time because you clearly aren't working on managed care. If zorvolex and tivorbex have such great coverage then where are all of the prescriptions? 48 hour studies with no comparative data isn't science. It's speculation. You are asking the doctor to use a lower dose and can't prove if zorvolex at 20% lower dose is any safer. Fewer GI bleeds? Don't know. Fewer heart attacks? Fewer strokes? Don't know. Sorry doctor. Iroko put these drugs in a blender and raised the price by 800% and there are plenty of step edits. Are you interested doctor?
 






Which NSAID has proven it has lower GI bleeds or lower heart attacks or lower number strokes? The reason it is not possible in clinical trials is the numbers needed to prove that goes into 100s of thousands. And there are other practical issues when you track patients in the long run. That's why studies with NSAIDs have failed to demonstrate these advantages. if you have someone knowledgeable examine some of the studies done with other NSAIDs, they add a lot of additional end points such as anemia etc. to the GI bleeds to try to show a difference. In fact, studies done with all the COX 2s show that there was no difference between the COX 2s and diclofenac when it comes to GI bleeds and serious complicated GI events. They add uncomplicated ulcers (endoscopic lesions) to try to show a difference. There have been studies that have shown that endoscopic lesions are not predictors of bleeding or any other clinical consequences. One could have a lesion and have no clinical sequelae and on the other hand have no lesions and end up with a bleed. Speaks to the issues with clinical studies. It easy to say that you have not shown lowering the dose lowers AEs but when you investigate it, there are no practical solutions to how you could demonstrate lower AEs. For example, Pfizer was asked by the FDA to do an outcome study called PRECISION to evaluate the CV safety of Celebrex. The study was started in 2006 and were able to complete enrollment only by end of 2014. There were already critique at the last FDA ADCOM about the issues with the data from the study. It shows you the difficulty this therapeutic class of demonstrating comparative LT safety. It is because of this all the NSAIDs have the same Black Box warnings.

AHRQ, the government agency, recommends that when data from randomized clinical trials are not feasible, you should consider data from systematic reviews of retrospective case or cohort studies. Studies commissioned by the EU have clearly shown that all the serious NSAID AEs are dose related. Respected pharmaco-epidemiologists have mapped out the exact dose AE relationship for diclofenac. A 20% reduction in dose is estimated to reduce serious GI bleeds by 18%, CV events by 7% and acute renal events by 19%. This is the effect of just the dose. Systematic reviews have also shown that the more faster release products or products with a shorter half-life also additionally reduces these three serious AE events. If you add that, the impact that you could make is even more.

Regarding managed care coverage, if you dont take my word, get the MMIT app and check coverage for Z and T. If you suspect MMIT, google 2015 Managed care formulary listing for Z and go through each one of the plans and their formulary listing printed by the plans themselves. You will see that what I said is true. This would be objective piece of data. Anyway Good Luck
 






OK Sherlock, one simple question, let's assume you are right, can you point me to the data that shows that the submicron is either equally effective or more effective than standard generic doses. You could make the argument to use submicron and reduce risk if you had some comparative efficacy data. Sherlock, you must surely know the the answer. Management would be too scared to do this study, they know that there would be a reasonable chance that sub-micron would be less effective than generics and those studies would be quick to do.

anonymous said:
Which NSAID has proven it has lower GI bleeds or lower heart attacks or lower number strokes? The reason it is not possible in clinical trials is the numbers needed to prove that goes into 100s of thousands. And there are other practical issues when you track patients in the long run. That's why studies with NSAIDs have failed to demonstrate these advantages. if you have someone knowledgeable examine some of the studies done with other NSAIDs, they add a lot of additional end points such as anemia etc. to the GI bleeds to try to show a difference. In fact, studies done with all the COX 2s show that there was no difference between the COX 2s and diclofenac when it comes to GI bleeds and serious complicated GI events. They add uncomplicated ulcers (endoscopic lesions) to try to show a difference. There have been studies that have shown that endoscopic lesions are not predictors of bleeding or any other clinical consequences. One could have a lesion and have no clinical sequelae and on the other hand have no lesions and end up with a bleed. Speaks to the issues with clinical studies. It easy to say that you have not shown lowering the dose lowers AEs but when you investigate it, there are no practical solutions to how you could demonstrate lower AEs. For example, Pfizer was asked by the FDA to do an outcome study called PRECISION to evaluate the CV safety of Celebrex. The study was started in 2006 and were able to complete enrollment only by end of 2014. There were already critique at the last FDA ADCOM about the issues with the data from the study. It shows you the difficulty this therapeutic class of demonstrating comparative LT safety. It is because of this all the NSAIDs have the same Black Box warnings.

AHRQ, the government agency, recommends that when data from randomized clinical trials are not feasible, you should consider data from systematic reviews of retrospective case or cohort studies. Studies commissioned by the EU have clearly shown that all the serious NSAID AEs are dose related. Respected pharmaco-epidemiologists have mapped out the exact dose AE relationship for diclofenac. A 20% reduction in dose is estimated to reduce serious GI bleeds by 18%, CV events by 7% and acute renal events by 19%. This is the effect of just the dose. Systematic reviews have also shown that the more faster release products or products with a shorter half-life also additionally reduces these three serious AE events. If you add that, the impact that you could make is even more.

Regarding managed care coverage, if you dont take my word, get the MMIT app and check coverage for Z and T. If you suspect MMIT, google 2015 Managed care formulary listing for Z and go through each one of the plans and their formulary listing printed by the plans themselves. You will see that what I said is true. This would be objective piece of data. Anyway Good Luck
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anonymous said:
OK Sherlock, one simple question, let's assume you are right, can you point me to the data that shows that the submicron is either equally effective or more effective than standard generic doses. You could make the argument to use submicron and reduce risk if you had some comparative efficacy data. Sherlock, you must surely know the the answer. Management would be too scared to do this study, they know that there would be a reasonable chance that sub-micron would be less effective than generics and those studies would be quick to do.
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A neurologist in my territory did her own study. Zorvolex vs. Zipsor and the patients reported back that Zipsor 25mg, 50mg, 25mg (instead of QID) did better than Zorvolex 35 TID. She switched about 15-20 Zipsor patients to Zorvolex and a majority of them said they had better pain relief with the Zipsor than they did when they were switched to Zorvolex. I couldn't argue with her own clinical trial.
 






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