Tivorbex Numbers?

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OK, I guess you were a science major not an economics major. This is the Dr./Patient discussion, "I want to prescribe diclofenac you can pay $4 or you can pay $50. The $4 drug may actually be more effective than the $50 drug almost certainly not less effective. There may be a slight theoretical cardiovascular risk but there is no studies that actually show this. Do you want to pay $46 more?

anonymous said:
Read the FDA statement - it says that it should be the lowest effective dose that meets the patients needs (not a low dose that is equivalent to a generic diclofenac).

When a patient presents with joint pain or back pain, he doesnt say I need the pain relief offered by generic diclofenac or ibuprofen or naproxen. What he needs is pain relief from his symptoms. And what has been demonstrated with Zorvolex is that patients with OA, who had base WOMAC scores of >40 showed that they had significant reduction in pain, stiffness etc. The quantum of reduction seen with Zorvolex was similar to what has been generally demonstrated in other OA studies with other NSAIDs - Celebrex, diclofenac or meloxicam.

What is important is that a high percentage of patients achieved substantial pain relief which is why they came to the physician in the first place. They achieved that at the lowest doses of diclofenac used.

This obsession with head to head with generic diclofenac has no practical meaning or relevance. I am not the physicians do not ask those questions. But however, if you answer them like the above, they see the stupidity of their question. I have stated these to physicians, including experts, across the US and have won them over
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Not everything in Pharma or even what doctors do in their clinical practice is proven in clinical trials. Physicians will buy in if they understand the logic or the rationale. with regards to the $4 or $50 for the patient, with the co-pay cards, the issue does not exist from a patient perspective. When a physician raises that exact question, it shows that he has not understood the differentiation or bought in to the AE burden - if I were you, I would work on that a little bit more. If you had done that already and he or she still doesn't buy in, this may not be the right physician for us. Physician attitudes, just like any consumer's are heterogenous. They carry their biases and influences like every one else. The good news is that there are enough physicians in the U.S. who are reasonable and will write provided you can take them through this logic. Some of the toughest national KOLs who initially started off with the same attitude as you have stated, but after hearing this rationale and the data behind it have become huge converts. It's a fallacy to think head to head data or endoscopy studies will somehow magically drive the product TRxs forward. I don't know if you have reviewed the clinical studies with Duexis or Vimovo - elegantly done head to head studies with endoscopic evaluations, and all they manage to do is sell a couple of 1000 prescriptions more per week than Zorvolex. Even that lead is just recently. Prior to that we had beaten them in both Rxs as well as product perceptions. We started off well selling the right way,but got distracted because a few miscreants began to abuse the co-pay card for cash patients and have lost our way. If you get back to the basics, you can absolutely dominate. However, you need to believe and go in and win with the right attitude. If you are one of those who is generally negative in your outlook or have lost confidence, I think the best thing for you and the product is leave. Do something that fits you and think is the best product. The right person with the right attitude who makes an earnest attempt to understand the science, your customers, the details of managed care - the distribution of lives by the various plans, coverage for your product etc - can dominate with this product and do a lot of good for the patients
 






anonymous said:
You are obviously not a rep. Any idiot can use Google and type in the word Tivorbex. Look at the 7th selection down and read what was written in The Medical Letter. This is what they had to say about Tivorbex and please offer a response:
"The problem with Tivorbex is the same as the problem with Zorvolex: there are no studies comparing its efficacy to that of standard doses of indomethacin or to any other NSAID. In addition, indomethacin is generally considered one of the most potent NSAIDs and one of those most likely to cause GI bleeding, increase cardiovascular risk, and damage the kidneys. There is no good reason to use indomethacin in any dosage for treatment of mild to moderate pain."
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Medical Letter is not literature. It is nothing better than the opinion of one doctor who is generally a cynic. Unfortunately the guy has not invested to be uptodate with the literature in this area. It is difficult too because he generally writes reviews for 4-5 products from different therapeutic areas every week. The guy is no expert. About a couple of decades ago, medical letter was popular because physicians thought it gave them a quick read and a third party view. However, the popularity of Medical Letter has declined because of half baked review and the cynicism has made their readers tired. But Medical Letter is all you have to counter with, it's weak. As with anything, when you promote something some people will like you and adore you and some people will hate you. You see that in the presidential primaries - the entire media berates Trump but he leads where it counts - in the polls. That is why this is fun. You have to beat the cynics of the medical letters of the world and win where it counts Rxs. Do you know how many products the Medical Lettrt has dissed but went on to make billions and billions of dollars. In my tenure at GSK, I don't know one product they didn't have a bad review on - Paxil, Relafen etc. all of them went on to be multi-billion $ products yearly.
 






anonymous said:
I wish more drs would take the initiative to do this. It also reinforces my belief that many reps in this industry waste their talents pushing snake oil. It kills me to listen to executives pushing an agenda as if it was the word of God. (I hold preachers in pretty low regard as well.).
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I wish some of your sales managers or HQ would resend unsolicited stories that sales reps sent when Zorvolex was launched - close to atleast 100 such stories - where patients whose symptoms had not responded to other NSAIDs had responded remarkably to Zorvolex. Patients had written thanking Zorvolex. Again, before you may want to generalize one neurologist anecdotal experience as the ultimate reality, you may want to consider the other view points too.
 






Articles for The Medical Letter are drafted by either an editor or external consultant using both published and available unpublished studies that are reviewed for methodological rigor with special attention to the results of clinical trials. A preliminary draft is circulated to every member of the advisory board and 10-20 other investigators with relevant clinical or experimental experience with the article's topic. Drafts are also provided to the Food and Drug Administration and Centers for Disease Control and Prevention and to all first authors of articles cited in the text. The evaluation of each drug includes a discussion of its efficacy, side effects, and a comparison with older, more established agents. The final version of the paper includes comments from the reviewers and is checked and edited for accuracy and readability.
 






The Medical Letter, Inc. is a nonprofit organization that publishes critical appraisals of new prescription drugs and comparative reviews of drugs for common diseases in its newsletter.

The Medical Letter, Inc. is committed to providing accurate and practical information on drugs and treatments of common diseases and helping our readers make the best decisions for their patients—without the influence of the pharmaceutical industry.

Many of our readers know that pharmaceutical companies and their representatives often exaggerate the therapeutic effects and understate the adverse effects of their products, but busy practitioners have neither the time nor the resources to check the accuracy of the manufacturers' claims. Our publication is intended specifically to meet the needs of busy healthcare professionals who want unbiased, reliable, and timely drug information. Our editorial process is designed to ensure that the information we provide represents an unbiased consensus of medical experts.

The Medical Letter is supported solely by subscription fees, and…
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If Medical Letter is your authority, so be it. To me they are a biased, cynical, not well informed, throw away piece. It just shows what you value and what I value. I have dealt with these guys. They make up their mind on the slant of the story and search for information that fits their slant. Good luck to you
 






anonymous said:
If Medical Letter is your authority, so be it. To me they are a biased, cynical, not well informed, throw away piece. It just shows what you value and what I value. I have dealt with these guys. They make up their mind on the slant of the story and search for information that fits their slant. Good luck to you
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Biased? They don't accept outside funding. However you are on Iroko's payroll Dr. Loser.
 






Bias just doesn't come from funding - it is derived from all sources - envy, ego, lack of knowledge etc.

Now that you have run out of arguments, you have to resort to name calling - fits someone who considers a throw away like The Medical Letter as a proof source.....
 






Bias does not come just from funding sources - it comes from ego, preconceived notions, ignorance, philosophies, general attitude themselves - and through the years the Medical Letter has exhibited these despite what their official statement says. I have dealt with their so call fact finding. My parameters of knowledge are the leading KOLs who have and are working with every single NSAID since the first ones - understand the pharmacological properties of each one of them - just cutting edge science, when you have interacted with that level of knowledge and gotten their views, these clowns in the Medical Letter are amateurish and do a huge disservice to their audience and patients because of that because of their biases built out of their arrogance, ignorance and ego.

In my dictionary, a loser is someone who surrenders to low intellect throwaway journals such as The Medical Letter - not one who exposed them for what they are
 






What gets me most is the arguments about success stories. I could easily get 1000 drs to offer pt success stories for any number of maladies using Obecalp. Misdiagnose, relatively mild symptoms, transient symptoms that mitigate on their own or due to other modalities. We all often focus on the wrong reason for the solution of a problem. I think some of the best reps on the markets are the biggest and most persistent bullshit artists, no questions asked. Every shitty product has a cadre of reps that sell the shit out if the snake oil. And there are plenty who make drs hate great treatments just the same.

I am hard pressed to disagree with the drs who feel our data is soft, thin and underpowered. My simple argument to them is the Dr based trial. That's where managed care is getting in our way. As a pt, I balk at high copays, so why should we expect pts to pay for a questionable alternative.

I'm already planning to leave because I just don't see how micromelo is going to be any better.
 






Thanks for the education. Back to the original question. Tivorbex numbers really suck. More then a month after launch and more then half the area still have "0" rx's. A couple have had "1" rx. The need in the marketplace may not be as robust as the rationale.
 






anonymous said:
Bias does not come just from funding sources - it comes from ego, preconceived notions, ignorance, philosophies, general attitude themselves - and through the years the Medical Letter has exhibited these despite what their official statement says. I have dealt with their so call fact finding. My parameters of knowledge are the leading KOLs who have and are working with every single NSAID since the first ones - understand the pharmacological properties of each one of them - just cutting edge science, when you have interacted with that level of knowledge and gotten their views, these clowns in the Medical Letter are amateurish and do a huge disservice to their audience and patients because of that because of their biases built out of their arrogance, ignorance and ego.

In my dictionary, a loser is someone who surrenders to low intellect throwaway journals such as The Medical Letter - not one who exposed them for what they are
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You should take your loss like a real man. Your 9th grade logic got exposed and your pseudo scientific response was to act like you are more knowledgeable than the brilliant, unbiased minds behind The Medical Letter. You are nothing more than a washed up RBM who gets an extra 100 dollars a week to serve as Iroko's hallway monitor on CP. How does it feel to be defeated by the PSRs on CP? You must feel like a loser! Loser.
 












anonymous said:
You should take your loss like a real man. Your 9th grade logic got exposed and your pseudo scientific response was to act like you are more knowledgeable than the brilliant, unbiased minds behind The Medical Letter. You are nothing more than a washed up RBM who gets an extra 100 dollars a week to serve as Iroko's hallway monitor on CP. How does it feel to be defeated by the PSRs on CP? You must feel like a loser! Loser.
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Actually when you look at competitive games or shows, when the other guy wins, it is the loser who resorts to angry tones, name calling and getting nasty...I could see that I have had that effect on you....For a kid in 3rd grade some one in 10th grade might look brilliant. You adoration of The Medical Letter reminds me of that. If your exposure to real brilliance is limited, i could see your fascination with the Medical Letter is understandable. Best of luck to you.
 






anonymous said:
Not everything in Pharma or even what doctors do in their clinical practice is proven in clinical trials. Physicians will buy in if they understand the logic or the rationale. with regards to the $4 or $50 for the patient, with the co-pay cards, the issue does not exist from a patient perspective. When a physician raises that exact question, it shows that he has not understood the differentiation or bought in to the AE burden - if I were you, I would work on that a little bit more. If you had done that already and he or she still doesn't buy in, this may not be the right physician for us. Physician attitudes, just like any consumer's are heterogenous. They carry their biases and influences like every one else. The good news is that there are enough physicians in the U.S. who are reasonable and will write provided you can take them through this logic. Some of the toughest national KOLs who initially started off with the same attitude as you have stated, but after hearing this rationale and the data behind it have become huge converts. It's a fallacy to think head to head data or endoscopy studies will somehow magically drive the product TRxs forward. I don't know if you have reviewed the clinical studies with Duexis or Vimovo - elegantly done head to head studies with endoscopic evaluations, and all they manage to do is sell a couple of 1000 prescriptions more per week than Zorvolex. Even that lead is just recently. Prior to that we had beaten them in both Rxs as well as product perceptions. We started off well selling the right way,but got distracted because a few miscreants began to abuse the co-pay card for cash patients and have lost our way. If you get back to the basics, you can absolutely dominate. However, you need to believe and go in and win with the right attitude. If you are one of those who is generally negative in your outlook or have lost confidence, I think the best thing for you and the product is leave. Do something that fits you and think is the best product. The right person with the right attitude who makes an earnest attempt to understand the science, your customers, the details of managed care - the distribution of lives by the various plans, coverage for your product etc - can dominate with this product and do a lot of good for the patients
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First off no "National KOL" would ever endorse a silly product like this. But a doctor who wants speaker fees and can present the story without chuckling is happy to endorse it.
You sound like a real rookie and a big dummy!
 






You are not living in the real world, Vimovo and Duexis are dogs also what's the point? Iroko is company run by es-GSKers who knew how to market products 20 years ago. Those days are over. In today's world, you get rewarded for having good data. The gap is that there is zero data, safety or efficacy, against generic diclofenac, and the market is punishing Iroko for it.

Outside of Iroko no one talks about Iroko, why because there is nothing interesting about this company. We will diclofenac into a real small powder make it a tablet and call it innovation.

anonymous said:
Not everything in Pharma or even what doctors do in their clinical practice is proven in clinical trials. Physicians will buy in if they understand the logic or the rationale. with regards to the $4 or $50 for the patient, with the co-pay cards, the issue does not exist from a patient perspective. When a physician raises that exact question, it shows that he has not understood the differentiation or bought in to the AE burden - if I were you, I would work on that a little bit more. If you had done that already and he or she still doesn't buy in, this may not be the right physician for us. Physician attitudes, just like any consumer's are heterogenous. They carry their biases and influences like every one else. The good news is that there are enough physicians in the U.S. who are reasonable and will write provided you can take them through this logic. Some of the toughest national KOLs who initially started off with the same attitude as you have stated, but after hearing this rationale and the data behind it have become huge converts. It's a fallacy to think head to head data or endoscopy studies will somehow magically drive the product TRxs forward. I don't know if you have reviewed the clinical studies with Duexis or Vimovo - elegantly done head to head studies with endoscopic evaluations, and all they manage to do is sell a couple of 1000 prescriptions more per week than Zorvolex. Even that lead is just recently. Prior to that we had beaten them in both Rxs as well as product perceptions. We started off well selling the right way,but got distracted because a few miscreants began to abuse the co-pay card for cash patients and have lost our way. If you get back to the basics, you can absolutely dominate. However, you need to believe and go in and win with the right attitude. If you are one of those who is generally negative in your outlook or have lost confidence, I think the best thing for you and the product is leave. Do something that fits you and think is the best product. The right person with the right attitude who makes an earnest attempt to understand the science, your customers, the details of managed care - the distribution of lives by the various plans, coverage for your product etc - can dominate with this product and do a lot of good for the patients
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