NY- 1010.483/020312Yn ithHR2

CONFIDENTIAL

Duragesic Disease Modeling
Workshop 2 Takeaways

Synthesis document
March 14, 2002

This report is solely for the use of client personnel. No part of it may be
circulated, quoted, or reproduced for distribution o utside the client
organ ization without prior written approval from McKinsey & Company.
Th is materia l was used by McK insey & Company ~l,lfu,i:~
presentation; it is not a complete record of the d isctl§~ . •

6'0b2

 NY-1010.483/020312YnithHR2

Contents

• Current hypo theses , quest ions , and analyses
• Updated aspects of pat ient flow ana lys is
- Pat ient pop ulatio n def initio n
- Patient segmentation
• Updated phys ician flow analysis
- Physic ian flow map
- Physic ian segmen tat ion
• Next steps
• Appendix

s1253-0003

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 IS1253-004

NY-1010.483/ 020312Yn ithHR2

Workshop# 2 Surfaced Three Fundamental Opportunities

1. Increase share of patients shifting from immediate-release
sustained-release opioids captured by duragesic

to

2. Increase total flow of chronic back patients from immediate-release
to sustained-release opioids
3. Increase retention of chron -ic back pain patients on duragesic
whenever medically appropriate

 NY-1010 .483/020312 YnithHR2

Initial Estimates Of Chronic Back Pain
Patient Stocks And Flows

PRELIMINARY
Pr imary f lows
- - •

Th ousands of patie nts per year
100 °/o= 8.6 million patie nts*

Non-opi oids
• Total: 2,800

..

----~

___

Self-m edicat ing
• Total: 2,700
• Diagnosed: 1,500
• Undiagnosed: 1,200

___

'--

,___

Secondary objective is to
move patients out of this
stock and into sustainedrelease opioids

Imm ediat e release
opioid s
• Total: 2 ,300
• Class Ill & IV: N/A
• Class II: N/A
• Ultram: 200

.~
.

..

5

Oth er susta ined
release opioids*
, 500 _ • Total : 525-690
,
• Oxycontin: 415-585
I
• Others: 110
I
I

I
I
I
I
1----.oL

Potentiall y
negligible flows

30

-

♦

•

20

Dur agesic
• Tota l: 85-115

<5

.
90

Primary objective is to capture
more sha re of patients
currently moving to sustainedrelease ooioids

* Init ial estimates inc lude only patients with 3 months or greate r of moderate to severe back pain
Note : All immediate release opioids (C lass 11, 111,& IV) grouped together due to data limitat ions during
preliminary analysis
51253-0QOS

Tertiary object ive
is to extend the
duration of
Duragesic use
whenever
medically
appropriate

Source: Decision Resources ; Patient Longitudina l Study July 2001; Janssen marketing research ; NDTI ; team analys is

3

 NY-1010 .483/020312Ynith HR2

0 portunity #1. Increase Share Of Patients Shifting From Immediaterelease To Sustained-release Opioids Captured By Duragesic
PRELIMINARY
Strategy

Key questions

Analysis/data

Key contacts

• Re-direct sales
force toward
spec ific physician
segments and
other key
influencers

• Are Duragesic prescr iptions cu rrently
driven by physician preference or
specific patient attributes?

• Pareto analysis of chronic back pa in
prescr ibing behavior (IMS Exponent data );
Quant itative data on physician behavior
(Segmentation study)

• Beth Woodhead ;
Mike Lee

• How many chronic back pain patients
are currently receiv ing long-term, highdose regimens of short-acting opioids?
Are we currently targeting the physicians
who prescr ibe these regimens?

• Analysis of chronic back pain
prescriptions/patient stocks (Mscan );
Understand Purdue call patterns and
implications for Duragesic (Janssen
experts, targeted interviews)

• Beth Woodhead ;
Guy Nuyts

• What is pattern of opioid use from
chronic back pain in elder ly/long te rm
care? Are we properly target ing and
influencing prescr iption behavior in this
sett ing?

• Breakdown patient stocks by age (Mscan,
Longitudinal study) ; Understand
prescr iptio n dec ision process in long-term
care (Janssen experts, targeted
interviews)

• Guy Nuyts ; Mike
Lee

• Are we proper ly targeting and
influe ncing prescr iption behav ior in the
pain clinics? Wou ld creat ive contracting
help in this setting?

• Breakdown physicia n stocks/dec iles by
setting of care ; Understand prescr iption
decis ion process in pain clinics (Jansse n
experts, targeted interviews)

• Beth Woodhead;
Ourages ic brand
team

• Are certain physician specia lties more or
less likely to prescr ibe long-acting
opioids? Can we influence flo ws to take
advantage of this diffe rence?

• Breakdown physician stocks/deciles by
spec ialty; Op iod prescript ion behavior by
spec ialty (NDTI )

• Bet h Woodhead;
Jenna Kelly;
Durages ic brand
team

s1253-0006

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 NY-1010.483/020312YnithHR2

Opportunity #1: Increase Share Of Patients Shifting From lmmediaterelea
IMINA RY

• Re-direct s
force towar
spec ific ph·
segmen ts
other key
influencers

head;

•

saes
head ;

owar
I

I

s1c1an

Mike

ead;
rand

ead·

'

rand

•

1n uencers
4

 NY-1010.483/020312YnithHR2

• Are we properly targe ting a nd
influencing presc ription behavior in the
pa in clinics?
ould crea tive co ntr act ing
help in this sett ing?
• Are we properly targeting and
influe ncing prescr iption behavior in the
pain clinics? Would creat ive contracting
help in this sett ing?

• Breakdownphysicianst
settingof care;Understand
decision processin painclln

•---Are--certain-physician ..-specialties-more-o
less likely to presc ribe long-act ing
opioids? Can we influence flows to take
advantage of this diffe rence?

• Breakdown physician stocks/deciles by
specialty; Opiod prescription behavior by
spec ialty (NDTI)

agesic brand
team
vu,

'

expe rts, ta rgeted Interviews)

s1253-0006

• Beth Woodhead;
Jenna Kelly;
Duragesic brand
team

4

 NY-1010.483/020312YnithHR2

Opportunity #1: Increase Share Of Patients Shifting From Immediaterelease To Sustained-release Opioids Captured By Duragesic
PRELIMINARY
Strategy

Ke~ Questions

Analysis/data

• Re-direct sales
for

• Are Duragesic prescr iptions currentl y
driven by physician preference or
specific patient attributes?

• Pareto analysis of chronic back pain
• Beth Woodhead ;
presc ribing behav ior (IMS Exponen t data );
Mike Lee
Quantitativedata on physician

Key co ntacts

(Segmentationstudy)
• How man chronic back p in patents

• Are Duragesic prescriptions currently
driven by physician preference or
specific patient attributes?

s1253-0006

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 NY-1010.483/020312Ynith HR2

Opportunity #1: Increase Share Of Patients Shifting From Immediaterelease To Sustained-release O ioids Ca tured B Dura esic continued

1spay cases

• Target high
abuse-risk
patients (e.g.,
males under 40)

• What are the patient segment
breakdowns for Duragesic and
Oxycontin for chronic back pain (i.e. ,
age , gender)?

• Use clinical data
to influence
physician/payor
choice of longacting opioid

• What data will influence
payors/physicians ' choice in near-term?
Is there a potential role for return to
functionality data (i.e., Thomas
Jefferson University)?

c 01ce o ongacting opio id

unc 1ona 1ty a a 1.e.,
Jefferson Univers ity)?

omas

81253-0007

_______,.

 NY-1010.483/020312YnithHR2

Opportuni
lmmedi

nts From

Strategy
PRELIMI NARY

Strategy

~

• Move physicians

Key contact s

1

who are ''stuck in
Class 111/IV
opioids to Class 11
opiods

• Move physicians
who are "stuck" in
Class 111/IV
op ioids to Class II
op iods

'

• Ada pt marketing
tactics to
changing
regulations (e.g.,
triplicate sc ripts)

•

• Adapt marketing
tactics to
changing
regulations (e .g.,
triplicate scripts)

s

of

• Beth Woodhead ;

Mike Lee

• Beth Woodhead

ws

sen

• Duragesic brand
team

• Jeff Mathis;
Duragesic brand
team

6

 NY-1010.483/020312Yn ithHR2

Opportunity #3: Increase Retention Of Chronic Back Pain Patients On
Duragesic Whenever Medically Appropriate
PRELIMINARY

Stat egy

Key questions

An alysis/ data

• Intervene to stem
specific patient
out-flows

• What does the current Duragesic
duration profile look like? Do patients
that leave Duragesic early flow to a
different destination than those which
stay on Durages ic for a long time?

• Duragesic duration and out-flow
analysis of long itud inal or crosssectional database (Mscan, Duragesic
longitudina l study)

• Target
patient/phys ician
segments with
high Duragesic
duration

• Does average durat ion vary
systemat ically accord ing to pat ient
segments (e.g., age , gender)?

• Segment by segment duration analysis
of longitudina l or cross-sect ional
databases (Mscan , Duragesic
longitudinal study)

• Does average duration vary
systematically according to physician
segments (e.g., specialty, setting of
care)?

• Segment by segment duration analysis
of longitudinal or cross-sectional
databases (Mscan, Duragesic
longitud inal study)

• Wh ich adverse events are most likely to
cause patients to terminate use of
Duragesic?

• Adverse event rate analysis of clinical
studies; Targeted physician interviews ;
Janssen experts

• Are particular patient segments more
prone to adverse events?

• Adverse event rate analysis of clinical
studies ; Jansse n experts

• Decrease impact
of adverse events
on duratio n of use

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Key co ntacts

• Guy Nuyts ; Mike
Lee

• Juergen Haeuss ler;
Durages ic brand
team

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 NY-1010 .483/020312Yn ithHR2

Opportunity #3: Increase Retention Of Chronic Back Pain Patients On
Dur
RY

•
,
• Tar.
pati
seg
hig
dur

I

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ens
•
1......

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ura

I

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•

I
•

es1c

r·
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It

ura

10n
7

 NY-1010.483/020312Yn ithHR2

Opportunity #3: Increase Retention Of Chronic Back Pain Patients On
Duragesic Whenever Medically Appropriate
PRELIMINARY

•

 NY-1010.483/020312Y nithHR2

Duragesic Patient Segments

Segmentation

Segments

Rationale

Age

• Under 40

• Duragesic may have natural
advan tage in older patients
(e.g., less active, diffic ulty
swallow ing)

•40-64
• 65 and over

• Duragesic currently trails
Oxycontin in under-40 market
even its though abuse
advantage is strongest here
Gender

• Male
• Fema le

• Duragesic has traditional
advantage over Oxyconti n wit h
females
• Durag esic may have a natural
advantage in males due to
abuse conce rns

s1253-0012

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 NY-1010.483 /0203 12Ynit hHR2

Chronic Back Pain Physician Flows
100°/o = All physicians who treat back pain
• What are settings of care for
opio id high-p rescr ibe rs and
treaters of back pain (e.g.,
elderly/long-term care)?
• Are we currently ta rgeting
and influenc ing these
groups properly?

Prescrib es
non-opioids
only

Prescribes
Class Ill/IV
opioids only

• How can data min ing
influence physicians/payers
to prefer Durages ic over
other sustained release
opioids?

Prescribes
Class II
opioids,
immediate
release only

• Which phys icians are
currently prescribing the
U .S.'s 80 million
hydrocodone scripts?
• Are they cu rrently being
detaile d for Duragesic?
• How can they be inf luenced?

Prescribed
sustained
release Class II
opioids, but
rarely
Duragesic

Prescribes
Duragesic
often as first
choice Class II
sustained
release opioid

s1253-0013

11

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11

 NY-1010.483/0203 12YnithHR2

Chronic Back Pain Physician Segments

Segmentation

Segments

Rationale

Sett ing of care

• Pain clinic

• Share of vo ice is setti ng-depe nde nt

• Elder ly/long -term ca re

• Key influencers of presc ription
behavior vary among settings

• Other
Physician
specia lty

• GP
• Orthoped ist
• Pain spec ialists
• Neurologists

• Comfort with opioids likely to va ry
systematically with specialty
• Encounter patients at diffe rent
points in treatment path

s1253-0014

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 NY-10 10.483/020312YnithHR2

Gender Of Oxycontin And Duragesic Patients
Oxycontin
Per cent prescriptions

Male

Duragesic
Percent prescriptions

35

45
55 o/o

Female

65 3/o

Sou rce: Patient Long itudi nal Study 2000 ; Janssen marketing research

s1253-0019

Fema le

17

 NY-10 10.483/020312Yn lthHR2

Patient Stocks Calculation

Duragesic
To tal
prescriptions
2001

Oxycontin

3,430 ,000

1 , 183,ooo

Pe rcent of Rx
prescribed for
back pain *

20%

Rx wr itten for

MS Contin

I

Morphine
Sulfate
(generic)

Confidenc e

1,099,0 00

34%

34%

34%

686,000

2,427,712

253,147

371,440

Avg number of
Rx per patient

5.8

5.8

5.8

5.8

• Assumption: 140 days per
patient/24 days per
prescriptio n

Number of back
pain patients

117,600

416,179

43 ,397

63 ,675

• (Rx written for back pai n)/
(Average number of Rx per
patient)

* 34% based on 20% for Durages ic and 30% for ove rall market

Sou rce: IMS; Janssen marketing research; team analysis

High

0

Low

Source

749,o oo

back pain

•

• IMS - National Prescrip tion
Audit; Janssen Marketing
Research

0

• IMS - National Drug and
The rapeutic Index; Ja nssen
Marketing Resea rch

0

• (Tota l Rx) x (Percent due to
back pain)

s1253-0020

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