To Take on Botox, Rival Tries Rebate
Allergan and Medicis Pharmaceutical are the Coke and Pepsi of vanity medicine. Medicis Pharmaceuticals is turning aggressive in its marketing, offering $75 off treatments with the wrinkle drug Dysport.
Allergan makes Botox Cosmetic, the well-known injectable anti-wrinkle treatment. Medicis markets Dysport, a competing anti-wrinkle shot, in the United States. The Food and Drug Administration has approved both drugs to smooth skin furrows between the eyebrows.
And now Medicis has introduced a new marketing campaign that pits Dysport directly against Botox, essentially issuing a Pepsi challenge for the wrinkle wars. The campaign is even called the Dysport challenge.
Medicis is offering more than rebates on its own product. For customers who feel unsatisfied after trying Dysport, the company is also offering a rebate on a treatment with Allergan’s Botox.
“We are so confident that we are literally willing to bet our money that patients will love their Dysport treatment,” said Jonah Shacknai, the chief executive of Medicis.
The Dysport campaign, which runs through April 30, is thought to be the first time a drug maker has offered a rebate on a competing drug. But it is hardly the first instance of pushing pharmaceuticals with a marketing zeal more typical of consumer products that do not carry a risk of medical side effects.
These days, hoping to inspire patient loyalty, various makers of prescription drugs are promoting giveaways, rebates and discounts. Sepracor, for instance, is offering a seven-day free trial of its popular sleeping pill Lunesta. Merck is running a print ad with a voucher for a free 30-day supply of its Januvia tablets for Type 2 diabetes. Another Merck ad carries a $20 coupon for the allergy and asthma drug Singulair.
But it is vanity medicine — including products like Botox and Dysport — that has been at the forefront of consumer enticement programs. That is because insurance typically does not cover such medical products, meaning consumers must pay for them out of pocket, buying directly from physicians. Volume discounts or rebates for the doctors have also been part of the marketing push.
Some medical ethicists worry that the discounts and deals may prompt doctors and patients to make decisions based on money rather than efficacy and safety. When doctors sell cosmetic medical treatments on which they themselves receive rebates, it poses inherent conflicts of interest, said Dr. Carl Elliott, a professor of bioethics at the University of Minnesota medical school
“It’s like a doctor who has his own drugstore, and he’s writing the prescriptions and selling them,” Dr. Elliott said. “It’s the treatment of medicine as a consumer product that seems a little creepy.”
Neither Botox nor Dysport is entirely risk-free. Both are purified forms of botulinum toxin — a nerve poison produced by the bacteria that can cause botulism. The injections have occasionally resulted in temporary cosmetic problems like droopy eyelids or uneven eyebrows. And such drugs now display federally mandated “black box” warnings on their labels stating that botulinum toxins have been associated with rare but potentially life-threatening health problems.
Mr. Shacknai of Medicis said he understood ethicists’ concerns about the marketing of medications prescribed to treat specific diseases. But Dysport and Restylane, a skin-plumping injection marketed by Medicis, are not disease treatments, he said, but cosmetic products intended to improve the appearance.
“What we are doing with the Dysport challenge and ongoing promotions for Restylane,” he said, “is to make it easier financially for people to try our products after consulting with a physician and determining if it’s right for them.”
The Dysport promotion, running on the product’s Web site and in a few glossy magazines like Us Weekly, offers a $75 rebate check on an initial Dysport treatment for wrinkles between the eyebrows, a procedure that can cost consumers $300 to $500.
The “challenge” comes into play for those who elect to have a second procedure three months later. Satisfied customers can receive a $75 rebate on a follow-up Dysport treatment, while dissatisfied customers who want to switch can receive a $75 rebate on a Botox treatment.
“This is really a novel spin,” said Dr. Kenneth Beer, a dermatologist in West Palm Beach, Fla., who is a paid investigator, consultant and speaker for both Allergan and Medicis. “There are always loyalty or affinity rebates, but they never come in and say, ‘Check out the neighborhood and, if you don’t like it, we’ll pay you to move back.’ ”
The campaign demonstrates the lengths to which a new entrant to the wrinkle-smoother category will go to gain market share from Botox, which enjoyed a virtual monopoly on injectable toxins in the United States until the introduction of Dysport last year.
Botox, a drug that has both cosmetic and medical uses, had worldwide sales last year of about $1.3 billion. Gary Nachman, an analyst at the health care investment bank Leerink Swann, estimated that Dysport could eventually gain a 20 to 25 percent market share in the United States. He described the Dysport rebate effort as a kind of “Hail Mary pass” that could help Medicis get to that point faster.
Last month, Medicis sent out a mass message about the rebate to its physician customers.
“Financially speaking, there’s no reason not to try Dysport,” said the Medicis message. “This offer is so unique that we expect plenty of news coverage. And we have promotional items for use in your office.”
Caroline Van Hove, an Allergan spokeswoman, responded to a reporter’s query with an e-mail message that described the Dysport promotion as a price-cutting exercise meant to cannibalize the market — at the expense of patient education. She wrote that “incentive programs like Medicis’s engage consumers for the wrong reasons, deflecting their attention to bargain shopping versus proper physician dialogue on product benefits/safety.”
Mr. Shacknai of Medicis said the Dysport promotion “understandably would create fear and concern with our competitors” because the rebate could lead to a significant shift in market share.
Drug advertising is often expensive. But given the economics, the Dysport rebate promotion is not sustainable for long, said Ronny Gal, an analyst at the research firm Sanford C. Bernstein & Company.
With a list price to physicians of $475 per vial — enough to treat the eyebrow furrows of perhaps five patients — Dysport brings Medicis about $100 per treatment, he said, so a $75 rebate for each is steep. Moreover, the rebate program effectively repositions Dysport as a value brand, a risky strategy in the luxury sector of vanity medicine, Mr. Gal said.
In any case, critics like Dr. Elliott of Minnesota say this latest wrinkle in the wrinkle wars pushes drug marketing one step further away from evidence-based medicine and deeper into the realm of product promotion.
“I’m not fan of turning medicine into a consumer product,” Dr. Elliot said. “But we are so far into it already that I don’t see the tide turning back.”
A version of this article appeared in print on March 12, 2010, on page B1 of the New York edition.
