VYVANSE – EARLY LOOK AT THE GSK IMPACT ON THE ADULT ADHD MARKET
As the school year winds down and summer underway, we expect prescriptions for the ADHD
medications as a class to drop off for the next couple months. Because of the anticipated decline in
prescriptions for the pediatric population, this time provides us with an opportunity to examine the adult
segment of the ADHD market. Year-over-year growth in this class in this period this year could be
more attributed to the growth in the adult segment – a population that has not been actively targeted
until recently, as both Shire’s Vyvanse and Johnson & Johnson’s Concerta only received their
expanded adult indications within the past year.
Shire announced at the end of Q109 that they had entered into a co-promotion agreement with
GlaxoSmithKline (GSK) to market Vyvanse for the treatment of adults with ADHD. With GSK initiating
its efforts in May, we set out to examine the early impact of GSK’s marketing effort for the adult
indication.
We surveyed 25 physicians who have been detailed by the GSK salesforce. Our sample comprised of
6 specialists and 19 PCPs. We asked if they could rate the effectiveness of the message from a scale
of 1-5, (1 being most effective and 5 being least effective).
Of the 24 evaluable responses, the average of the ratings was 2.8, which we would characterize as
average with a positive bias.
How effective was the Vyvanse message? (n=24)
Very effective
14%
Effective
24%
Moderately effective
33%
19%
Somewhat effective
Not effective
10%
0%
5%
10%
15%
20%
25%
30%
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35%
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We also asked whether the GSK detail has either already had or if it will have an influence on the
physician’s potential prescribing of Vyvanse. Of the 22 evaluable responses to the question, 59% of
the physicians stated that the rep’s visit would have an impact.
Will the GSK rep's detail influence your prescribing of Vyvanse? (n=22)
Possibly
5%
No
36%
Yes
59%
0%
10%
20%
30%
40%
50%
60%
70%
.
Given the nature of how adult ADHD patients are identified, it appears that a DTC campaign would be
very effective, as over 50% of physicians polled stated that ADHD therapy for adults is initiated by
a discussion by the patient. NOTE: We are not suggesting that Shire should take on a DTC
campaign, but only point out that the patients of these physicians tend to self-diagnose and
consequently, a greater awareness among consumers would likely lead to more adults seeking ADHD
therapies.
In several cases, patients who come seeking therapy are those who had been diagnosed and treated
as a child and who want to resume therapy as an adult. It would be interesting to consider how over
time this could be the key source of growth for the adult ADHD market – as these children mature,
instead of falling off therapy as they finish grade school or high school, they continue therapy well
into their adult lives and perhaps for the rest of their lives.
Based on the study results, when it comes to what the physicians view as their “go to” treatment
options, 44% of physicians mentioned that generics/older drugs are their top choice. Some drugs
mentioned specifically by name included Adderall, Ritalin, and “short actings.” Vyvanse has the
greatest share of voice among the brands per the results of the study, with 32% of the physicians citing
it as their top choice, though some qualified that Vyvanse was a first choice only if formulary conditions
were favorable.
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Other notable mentions:
16% (n=4) of respondents cited Adderall XR specifically as their first choice
12% (n=3) chose Strattera as first line therapy
1 mention of Concerta
1 mention of Provigil/Nuvigil. This particular physician treats only Medicare patients and
finds the contraindications of the CV risks to be too great to use a stimulant. Therefore
he/she chooses to use Provigil/Nuvigil off label.
What are your "go-to" treatments for adult ADHD?
SSRI
4%
Provigil/Nuvigil
4%
Concerta
4%
Strattera
12%
Adderall XR
16%
Vyvanse
32%
generics
44%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
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50%
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In terms of market growth, when asked how much they expected their adult ADHD patient pool to grow
over the next 12 months, there was a large cluster of physicians that cited numbers in the 10-15%
range. A weighted average of all the responses yielded a 9.8% growth rate over the next 12 months.
By what % do you expect your adult ADHD patient population to grow in the
next 12 months? (n=23)
33%
4%
25%
4%
20%
9%
15% in 2 years
4%
15%
9%
10-15%
4%
10%
26%
5-10%
9%
unsure
4%
no change
26%
0%
5%
10%
15%
20%
25%
30%
% physicians responding in this manner
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Finally, we asked our physicians how they are currently dividing up their prescriptions to treat adult
ADHD. Vyvanse and Concerta appeared to have the greatest share among our physicians, with
approximately 50% using these drugs on a consistent basis. Short acting drugs such as Ritalin and
Adderall remain popular with the sample of physicians we surveyed as well.
The chart below illustrates usage of drugs by each physician and how it is split between patent
protected and off patent options.
Physician 1
Physician 2
Physician 3
Physician 4
Physician 5
Physician 6
Physician 7
Physician 8
Physician 9
Physician 10
Physician 11
Physician 12
Physician 13
Physician 14
Physician 15
Physician 16
Physician 17
Physician 18
Physician 19
Physician 20
Physician 21
Physician 22
Physician 23
Physician 24
Physician 25
n=
% using drug
Mean
Mode
Median
Patent protected options
Off patent options
Vyvanse Concerta Provigil Strattera Other/not Adderall XR Adderall Ritalin Dexedrine Short-acting Long-acting
specified
40%
20%
30%
10%
40%
20%
40%
30%
20%
50%
30%
5%
5%
30%
30%
20%
80%
25%
25%
25%
25%
75%
20%
10%
70%
20%
80%
10%
20%
30%
40%
10%
20%
30%
50%
10%
10%
15%
60%
5%
5%
15%
30%
50%
50%
50%
20%
40%
40%
15%
80%
5%
mostly
some
90%
10%
20%
50%
80%
50%
100%
13
52%
22%
20%
20%
12
48%
19%
20%
20%
1
4%
90%
N/A
90%
1
4%
40%
N/A
40%
8
32%
35%
30%
30%
8
32%
32%
50%
30%
9
36%
65%
80%
70%
100%
5
20%
39%
N/A
30%
2
8%
5%
N/A
5%
2
8%
35%
N/A
35%
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1
4%
80%
N/A
80%
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FORMULARY TRENDS
Below we show a chart of the formulary coverage scores for the ADHD class using the Epocrates
MedInsight Formulary Trends database. The chart illustrates the coverage scores for brand name
drugs only.
At an overall score of 20 (out of 100) Vyvanse has less than half the coverage score as Adderall XR
(score of 45).
70
59
46
50
45
40
23
20
20
14
14
13
13
12
11
11
9
Dexedrine
25
Ritalin SR
25
Ritalin
27
30
Adderall
Coverage score
60
10
Focalin XR
Daytrana
Ritalin LA
Focalin
Vyvanse
Strattera
Metadate ER
Metadate CD
Concerta
Adderall XR
Methylin
Methylin ER
0
We also wanted to take a look at the amount of restrictions that formularies are placing on Vyvanse.
While the coverage score is listed at 20 for Vyvanse, what % of formularies provide access such that
the only potential hurdle is cost based on tiering? In other words, “Does Tier 3 mean you just pay a
higher copay? Or does it mean you pay a higher copay AND you have to have prior authorization?” It
would seem intuitive that the more steps or effort the physician’s office has to go through to prescribe a
drug, the less likely they will prescribe it and instead pick the drug that provides the “path of least
resistance.” In reviewing what percent of formularies do not cover the drug at all or require step
therapy, prior authorization or other similar restrictions, it appears that Vyvanse’s greatest challenge in
the market is the fact that it is not covered at all on the majority of formularies.
We found that Vyvanse is not covered by formulary or holds “non formulary” status in 73% of
formularies. This compares to a 30% no coverage rate for Concerta and 24% no coverage rate
for branded Adderall XR. Furthermore, of the remaining 27% of formularies that do provide access to
Vyvanse, 8% have restrictions that include step therapies, prior authorizations, etc. This compares to a
rate of 17% of plans for Concerta and 23% for Adderall XR.
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The table below summarizes some of the differences:
Not covered Covered w/restrictions Covered and "restriction free"
Adderall XR
24%
23%
53%
Concerta
30%
17%
53%
Vyvanse
73%
8%
19%
Based on these results over time, we would look for Vyvanse’s distribution to smooth out to the similar
pattern of Adderall XR and Concerta, unless formularies become more restrictive than in the past. A
lack of redistribution in the percentages above could help to explain for a slower uptake of Vyvanse in
the future.
TAKEAWAYS
In just about a month’s time, GSK reps have made their way into PCP offices and are delivering
a moderately effective message about Vyvanse for adult ADHD.
While Vyvanse is the most popular/top of mind branded drug to prescribe, most doctors see the
older generic options as their first choice when starting therapy.
Vyvanse is certainly in the armamentarium of physicians, with 52% of our sample stating that
they actively consider prescribing it to their patients.
Vyvanse has poor formulary coverage, with 73% of formularies not providing any coverage
whatsoever, according to the MedInsight Formulary Trends database.
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