Pepin’s Pharmaceutical Prattle for 08-11-2003
	Quote of the day: I don't know the key to success, but the key to failure is trying to please everybody. Bill Cosby (1937 - )

Good morning! How is buying a car like buying PBM services? I have been trying to find a replacement for the aging mini-van but have a problem….too many constituents! My wife wants a safe but inexpensive car, my oldest son wants the testosterone infused 4x4 sport utility truck…my almost a real driver son wants ANYTHING that isn't Beige and totally uncool…..and I have to pay for it. Buyers of PBM services must feel the same pressures: a CEO who wants a safe and inexpensive plan, the unions who wants the latest and greatest but don't want to pay a nickel more for it, and the HR staff who want a good plan but don't want their phones to ring off the hook. So how do you pick a PBM? In driving many cars this weekend I determined that some were not of the quality I wanted. Surprisingly enough, they were the cheapest. I had to determine the 'marginal value' of one car over another. .. buying based on price alone was not going to make me happy. (buying the Porsche Cayenne would make me happy until the second payment was due) What is the marginal value of a PBM? Should it be outstanding client service, trust, flexibility, communications, clinical programs… or have you let PBM service become a commodity? Subaru has a reputation for SAFETY and is now moving toward PERFORMACE as its marginal values (WRX anyone?). What do you bring to the table that the "other guys" don't? What makes YOU more valuable, and even more expensive, than the others? If your sales force can't answer that question then you might as well as well be priced per pound (no mater what your "product" is). You can get information on drugs practically anywhere... so what is the "marginal value" of the PRATTLE? Timely? ..yes... Authorative? ...I'd like to think so. The real difference is that we offer opinions (often actionable)and blend in some humor (and it is still free!).

My car choice? I'll probably keep the same vehicles for a little longer… I know them, they are still working, and the cost of changing (disruption from SOMEONE in the family) is daunting. I know where to get them fixed and have developed a friendly relationship with my mechanic. but after this weekend I know where to get SAFETY AND PERFORMANCE. Unlike cars, PBM services only get better with time... renewal anyone?

1) Generic Biotech drugs soon?
	The "truism" perpetuated is that biotech drugs will not have generic versions available….This assumption is being challenged now. .. I really don't expect there will be much price relief because of the difficulties in their production but this may be a chink in the armor of the biotech firms. …Click here for full text of story. http://www.nytimes.com/2003/08/09/business/09DRUG.html?th

2) Big wig flips it at drug counterfeiters.
	FDA chief out to get perps who make real or placebo copies of drugs. "We know who you are…we know where you live!"… book 'em Danno! …Click here for full text of story. http://biz.yahoo.com/djus/030808/1804000772_1.html

3) Pfizer joins Glaxo in reducing drugs going to Canada.
	See what the Canadian press thinks about it….AYE? Legitamte buyers will not be harmed but the internet pharmacies are going to be hurting… I hope! …Click here for full text of story. http://www.canada.com/news/story.asp?id=452FB4F4-F1D8-45DF-8955-ABE57D3C82D7

4) …but AARP want to make reimportation legal.

. Sounds like I may have to switch jobs…. "600 lobbyists with unlimited resources"… sound like they should spend some of those resources to pay for their own medications instead of asking everyone else to subsidize their drug use….(just my opinion, Mom… don't cut me out of the will!) …Click here for full text of story. http://news.moneycentral.msn.com/ticker/article.asp?Feed=RTR&Date=20030807&ID=2777483&Symbol=US:PFE

5) More bad news for hormone replacement…. doubled breast cancer in British.

Lancet has the reputation as being on the bleeding edge of new developments.(many initial studies do not hold up under more extensive research). This study has a large number (1 million) of subjects and reinforces the work of others. Message: AVOID COMBO HRT if possible. …Click here for full text of story. http://story.news.yahoo.com/news?tmpl=story&u=/nm/20030807/hl_nm/health_hrt_dc_1 …and if you don't believe the Brits then see the work done in the New England Journal of Medicine discussion about the CARDIAC effects …Click here for full text of story. http://content.nejm.org/cgi/content/short/349/6/523

6) Medco leaves the nest with a $1.5 Billion debt

...(and I thought my daughter college debt was big!). When Merck tried to sell a small percentage of Medco to investors for over $1 billion, it didn't fly (in 3 attempts). Now they spin off the stock to Merck stock holders… the two companies will still be joined at the hip (bound together by the debt)…dosen't sound like the deal of the century to me…(but I'm sure my stock broker will be all over it!) …Click here for full text of story. http://story.news.yahoo.com/news?tmpl=story&u=/thedeal/20030806/bs_deal_thedeal/mercksetsmedcospinoffterms

7) Body builders who use insulin may die.
	Just like a cheap detective thriller where the killer injects insulin into the victim…. these guys are doing it to themselves. A banned substance that is not easily detected places "Arnold-want-to-bes" in mortal danger. …Click here for full text of story. http://www.reuters.com/newsArticle.jhtml?type=topNews&storyID=3217714

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	Looking for something to do? Do your part to eliminate virtual West Nile! …Click here for some smacking good fun. http://www.mosquitoweb.nl

Have a GREAT week! Steve

Disclaimer: "Pepin's Pharmaceutical Prattle" (AKA "The Prattle") is the property of PHARMWORKS, LLC and Steven M. Pepin, Pharm. D, BCPS. The opinions expressed are those of the bald-headed author. To start or stop any drug without the advice a supervision of you physician would be stupid. So don't do anything based upon what you read here without professional advice. To be added to or removed from the distribution list please e-mail your request to spepin@pharmworks.com . All insightful comments from readers are thoughtfully considered (the rest are callously discarded). Copyright 1998-2003 PHARMWORKS,LLC all rights reserved.