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MERCK’s PROSCAR DETAILING WILL FOCUS ON PRIMARY CARE PHYSICIANS

Executive Summary

MERCK's PROSCAR DETAILING WILL FOCUS ON PRIMARY CARE PHYSICIANS who are expected by the company to generate most of the prescriptions for the newly-introduced treatment for benign prostatic hyperplasia, Merck told analysts at a July 31 briefing on the launch. Proscar (finasteride) was approved on June 19 ("The Pink Sheet" June 22, p. 4); detailing began on schedule during the last week of July ("The Pink Sheet" June 29, p. 6). Merck VP-U.S. Marketing Martin Carrol reportedly told analysts that the company will not position Proscar against prostate surgery (TURP) or alpha blockers -- treatments that, according to Merck, are generally administered by urologists to patients with severe symptoms. Instead, Merck plans to focus on patients with diagnosed symptomatic BPH who are currently receiving no treatment. Carrol estimated that 70% of such patients are being monitored by primary care physicians. According to materials prepared for the meeting, Merck estimates that 4,000 TURPs are performed each year at an annual cost of over $3 bil. The company estimates that 100,000 patients receive alpha blockers such as Abbott's Hytrin (terazosin) or Pfizer's Cardura (doxazosin) for relief of BPH symptoms. Merck estimates that the alpha blocker BPH market is currently about $15 mil. Merck told analysts that its target patient population is approximately 4 mil. in the U.S. The company believes that the target population may increase as both patients and physicians become more aware of the condition. Merck has estimated that 29 mil. men over age 50 in the U.S. have BPH and that 10 mil. of those are symptomatic. Merck management expects that most of Proscar's use, at least initially, will be in patients with bothersome symptoms. However, Merck predicted that over time the bulk of use will be in patients with earlier-stage disease. Carrol reportedly told analysts that Merck has done market research which indicates that both primary care physicians and patients are receptive to a medical therapy that offers the possibility of halting disease progression. Carrol said that Merck will emphasize Proscar's potential disease-modifying effect in its promotion to physicians. Within 72 hours of the Proscar approval, Merck installed a toll-free hotline manned by pharmacists to answer physician questions about Proscar and BPH. Urologists, while an important focus of marketing, may be a harder sell since they are used to the rapid symptom improvement offered by surgery and alpha blockers and, therefore, may not be as receptive to Proscar therapy as primary care physicians. In addition, urologists receive a significant portion of their income from prostate surgical procedures. Other physician targets of Merck's Proscar marketing will be endocrinologists and gerontologists. Merck told the analysts that it is backing Proscar with over 1,000 sales reps. Carrol explained that Merck's 600-person "sales force one" will detail Proscar to community-based physicians, while its 400-person hospital force will address the community hospital environment. Smaller speciality forces will detail Proscar to urologists/endocrinologists, military hospitals, nursing homes and managed care markets.
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