Race-based pill puts niche marketing to the test

Sales falling short of expectations
The researchers who developed BiDil didn’t start out looking for a drug that worked better for a particular racial group. After reviewing earlier studies indicating black participants in clinical trials benefited more from taking the drug than those of other races, NitroMed began its own study involving only blacks.

That study revealed a 43 percent reduction in deaths among black patients taking BiDil along with standard heart failure drugs, compared with those receiving standard therapy and a placebo.

So far, BiDil sales have fallen short of expectations, and NitroMed’s chief executive officer and chief financial officer resigned March 21. Nine days later, the Lexington-based company announced plans to cut 30 research and development positions from its 100-person staff.

Initial BiDil sales came in at $4.5 million in last year’s final six months from 14,000 prescriptions, behind some analysts’ initial projections of around $200 million in annual sales next year.

Analysts and NitroMed officials agree the main problem is difficulty persuading pharmacy benefit plans to approve low patient co-payments for BiDil of around $20 a month, rather than the current $50 a month most plans charge.

Insurance plans pose challenges
To turn sales around, the company is focusing on increasing that insurance reimbursement by trying to convince health plans that BiDil offers easier dosing and greater health benefits than taking two older generic drugs. BiDil is a combination of those two drugs, which are approved for high blood pressure and heart pain but not for heart failure. The two together can increase the blood’s level of nitric oxide, which is found in lower amounts in blacks and which has several roles in heart health.

NitroMed also has partnerships with the National Association for the Advancement of Colored People and the Association of Black Cardiologists to sponsor health screenings and reach more of the estimated 750,000 American blacks suffering from heart failure.

The first BiDil ads aren’t expected until this summer, and those will run only in black media, including radio stations and community newspapers.

NitroMed also hopes to market a once- or twice-a-day version of BiDil, rather than the current three-tablets-a-day formulation.

“We think the product has great growth potential,” Jerry Karabelas, NitroMed’s new interim CEO, told analysts the day after his appointment.

Liana Moussatos, an analyst with Pacific Growth Equities, said a once-a-day formulation could prove a strong selling point and lead NitroMed to launch a mass-media campaign for BiDil.

Even if that doesn’t happen, she believes NitroMed will get past its initial missteps and eventually see BiDil sales balloon.

“It’s the classic things early in a launch that you have to go through,” she said. “They’re pioneers in a new market, and there is a learning curve.”

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