The blood thinner market in the United States was worth over $8 billion in 2012 and is expected to grow to over $15 billion by 2018, according to a June 2013 report by pharmaceutical analysts EvaluatePharma. Xarelto, one of a new type of anti-coagulants that doesn’t require individual dosing (unlike category leader Warfarin) is big business for drug maker Johnson & Johnson with expected sales of over $1 billion a year.
Johnson & Johnson is consistently on a charm offensive with medical professionals, spending over $154 million in 2014 alone , according to the U.S Governments Open Payments Database, on outlays to Doctors. This includes wining and dining, speaker programs and consulting fees. An investigation by the New York Times in January 2015 showed that $19.3 million had been spent in the last five months of 2013 promoting just three anti-coagulant drugs to doctors (not all made by J&J).
Data from ProPublica reveals that Xarelto had $6.93 million spent on promoting it in the last five months of 2013, and a further $1.8 million spent on research payments directly related to it (4). It is also important to realize that despite these large payments that this data does not take into account amounts spent on the drug reps who visit the doctors, advertising to patients or doctors, or drug samples that are left for the doctors to try. Therefore, the real amount spent on promoting Xarelto is considerably higher.
It is with this backdrop of massive revenues and promotion budgets that the checkered safety history of Xarelto should be considered. The drug has only been approved by the FDA since 2011, but has already made significant in-roads into the territory of older-style blood thinners such as Warfarin, despite costing approximately 15 times more per year ($3,000 compared to $200 for Warfarin) in treatment costs.
The reasons for this are largely due to four factors that give Xarelto a perceived advantage, despite the high cost:
- Patients are not required to change their diet or alter their lifestyle.
- Regular checkups and monitoring are not felt to be needed.
- Risk of brain hemorrhage are reduced.
- Dosing is consistent and so much easier for the doctor to prescribe.
These four factors make prescribing Xarelto an easier sell to doctors, but there have already been rumblings coming out of the FDA about the safety of this new drug, despite it only having been available for a few years.
Xarelto was launched onto the drug market in a big way, but already there is mounting evidence of greater safety implications with the use of the drug then were first thought. Johnson & Johnson are keen to play down these fears, as one of the big selling points of this (expensive) drug to doctors is its supposed simplicity to prescribe and monitor. However, as the evidence mounts of these complications there is a distinct possibility that what is currently a rockslide of legal cases around the drug could very quickly become an avalanche.