New chief expands Novo team for stepped-up assault on U.S. diabetes market

When we hear about companies actually hiring reps, that's news. Given the thousands of sales layoffs over the past several years--and recruiting focused on emerging markets, especially China--staffing up in the U.S. or Europe is out of the ordinary. When that hiring isn't about a new drug launch, we hardly know what to make of it.

That's just what Novo Nordisk ($NVO) has been doing: hiring reps by the hundred in the U.S. First, it was in anticipation of the Tresiba launch that didn't happen in 2013, but last fall, another 350 joined the company. Couple that with 120 new nurse educators, and the Danish drugmaker has expanded its field force by almost 15%.

Jesper Hoiland--Courtesy of Andy Spot, Creative Commons BY-SA 1.0
Jesper Hoiland--Courtesy of Andy Spot, Creative Commons BY-SA 1.0

No one knows this better than North American President Jesper Hoiland, who went out to Las Vegas in December to meet with the new recruits. Just 100 days into his new job running North American operations, Hoiland outlined his goals for 2014, quoting statistics on the cost of diabetes treatment (10% of the entire healthcare system) and growth at Novo Nordisk in North America--from a staff of 65 in the 1980s, when he joined the company, to more than 6,100 today, about 3,500 of whom work in sales and marketing.

On his to-do list is talking with employees across his region, and the Vegas trip allowed him to do just that. Soon, the sales force would be fanning out across the country, aiming to keep its key diabetes treatments Victoza, NovoLog and Levemir on doctors' radar. And because diabetes treatment can't be successful if it's inconsistent, the nurse educators' task is to train first-line healthcare providers on helping to keep patients' blood glucose under control--with diet and exercise, regular monitoring, and, of course, taking their meds and getting refills on time.

Later in the year, Novo's reps could have a new task as well: marketing liraglutide, a.k.a. Victoza, for a new indication in obesity. The company has racked up the data and files for FDA approval in late December. If approved, liraglutide will be sold under another brand name for the new use, and Novo's marketing team will be working to build the brand and make its case to primary-care doctors, the typical prescribers of weight-loss drugs. Of course, the drug has been in use for years, so many doctors have experience using it in their diabetic patients. That comfort level could help when the new brand comes around.

A key part of that rollout will be winning over payers, which historically have been reluctant to pay for weight-loss meds. But liraglutide's competitors in that market may have done it a favor there. Vivus ($VVUS) and Arena Pharmaceuticals ($ARNA) have lobbied hard to obtain coverage for their drugs Qsymia and Belviq, and that work with payers could make it easier for Novo to do the same with liraglutide.

Which brings us to one of the challenges Hoiland says he will face this year: working with increasingly strict pharmacy benefits managers. Novo took a blow from Express Scripts ($ESRX), which excluded two key treatments, the GLP-1 drug Victoza and the "modern insulin" NovoLog, in favor of AstraZeneca's ($AZN) Byetta and Eli Lilly's ($LLY) Humalog. It was the PBM's first exclusionary formulary. "There's no doubt that we have seen ESI going out and basically comparing two products that we feel are very different, saying they're in the same class, and then making a [pricing] offer we can't meet," Hoiland said in an interview with FiercePharma. "It was a big surprise to us,"

Hoiland expects more pressure from Express Scripts, as well as its competitors, especially CVS Caremark ($CVS), which has similar heft in the marketplace. So, Novo will need to work more closely with them on mutually agreeable price points. "Basically a handful [of PBMs] make up more than 65% of the market," he notes. "Prices are going to come under pressure as a logical consequence of this."

Novo is working with Express Scripts to turn the situation around; as Hoiland notes, the company is "disappointed" in the decision, but "we are still a business partner with them." Novo is also going to Express Scripts' customers, which can opt to use the PBM's national formulary as written--or not. "Some may want to stay," Hoiland says. "We see, from our perspective, a meaningful number have opted out of the restrictive formulary."

Last year, Novo's diabetes sales grew by 18% in North America, fueled mostly by increased market share for its modern insulins, including Levemir, and 31% growth for Victoza. This year could be more difficult, given the payer landscape. Though Novo has started new trials required by the FDA, its new long-acting insulin, Tresiba, won't see the light of day in the U.S. for years. Plus, Novo's treatments face new competitors, including Johnson & Johnson's ($JNJ) Invokana and AstraZeneca's Farxiga, both part of a new class of drugs that flush glucose from the body through the kidneys.

Novo has some tricks up its sleeve, though. It plans to introduce its new delivery device, the FlexTouch pen, with several insulin products; only about 41% of insulin is delivered via a pen system in the U.S., compared with more than 95% in Europe, so the company sees opportunity to convert U.S. patients--another task for the marketing team. Plus, a new nationwide TV campaign for Victoza could help sales folks boost scripts for that drug.

Bottom line, though, says Hoiland, is the day-to-day task of getting patients to manage their glucose levels. Prevent costly complications of diabetes, and that's persuasive, even--or perhaps especially--for payers. "It's a question of treating the disease or seeing downstream complications," Hoiland said. "If you help manage it and stave off complications, you can pull a lot of cost out of the system."

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