How much for docs speaking on Eliquis, Xarelto and Pradaxa? $20M and counting

If you've watched television lately, you know that Pfizer ($PFE) and Bristol-Myers ($BMY) have been spending a lot of money on advertising to back their new anticoagulant, Eliquis. So have rival Boehringer Ingelheim, with its Pradaxa drug, and Bayer and Johnson & Johnson ($JNJ) with Xarelto.

What's not quite as obvious is that these companies have been plowing big money into speaker programs, too.

Pfizer and Bristol-Myers shelled out $8 million in payments to doctors on behalf of Eliquis during the last 5 months of 2013, Pro Publica reports in its latest analysis of Sunshine Act data. That's the second-largest amount devoted to any single drug, behind Novo Nordisk's ($NVO) diabetes remedy Victoza. Xarelto comes in sixth with $6.93 million, and Pradaxa 13th at $4.43 million.

Marketing-wise, there are good reasons for this spending--and the relative amounts, too. These new-generation anticoagulants are billed as more convenient because they don't require warfarin's constant dosage-monitoring and dietary restrictions. In some trials, the newer meds have beat warfarin for safety--fewer major bleeding events--and for their ability to prevent strokes and other serious blood clots.

But as of now, they lack quick, FDA-approved antidotes--warfarin's is Vitamin K--and some doctors have been wary for safety reasons. Plus, they're an entirely new generation of drugs, and warfarin has been on the market for years. Doctors know how to use it. So, there's good reason for the drugmakers to get other doctors involved in "educating" physicians about the meds.

Eliquis was third to debut in the market for warfarin-alternative drugs, and despite some study data that might give it an edge over its rivals, it struggled to gain traction at first. But because it's a priority drug for Pfizer and Bristol-Myers, the companies put an extra push behind it, and the promotions paid off, if recent quarterly sales are any indication.

Meanwhile, Xarelto was second to hit the scene, but it quickly began to grab market share from Pradaxa. J&J would like to keep that share, thank you, so it's backing up Xarelto with ads and--obviously--other promos.

Pradaxa is the entrenched drug, with a 2010 approval and a lot of marketing already behind it. But safety concerns have been in the headlines, and some doctors say they're uneasy about the drug. The FDA has reviewed the data, and concluded that Pradaxa is safe when used as directed, but some experts--and some lawsuits--suggest that dosing on the Boehringer drug should be monitored as warfarin's is.

Antidotes for the three drugs are in trials now, and when and if those hit the market, another round of speaking events is no doubt in store.

Meanwhile, in a statement to Pro Publica, Pfizer and Bristol-Myers said their spending on doctor-speakers helps ensure that other physicians understand how to use Eliquis appropriately. "[I]t is critical to have a speaker program that adequately provides robust education to these physicians," the statement said (as quoted by Pro Publica).

- read the Pro Publica coverage

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