Primary care continues to play a major role in improving overall population health by managing high-prevalence, chronic conditions. Despite the broad availability of generic versions of former blockbusters, which offer low-cost treatment options for many chronic conditions, significant unmet need still exists in primary care.
In this paper, we explore unmet needs in primary care and how they translate into different innovation opportunity segments. Through case studies, we identify critical success factors for primary care innovation, highlight specific barriers innovators have to overcome and outline winning strategies.
The pharmaceutical industry as we know it was shaped by primary care. Tackling chronic illnesses or conditions, such as cardiovascular, GI or respiratory, that affect large patient populations ranging in size from 100 million to 1 billion, provided the foundation for a highly successful business model. It saw the emergence of global pharmaceutical companies, spurred big investments in R&D which culminated in blockbuster products with global annual sales exceeding $1 billion – Zantac being the first to pass this historic milestone in 1987. Powered by vast investments in share-of-voice based commercial infrastructure, this model sustained double-digit growth for the industry over several decades, while generating attractive returns.
However, primary care has become a victim of its own success. Following the wave of primary care innovation in the 1990s through 2000s, loss of exclusivity led to the arrival of generic versions of former blockbuster products, offering low-cost treatment options for many chronic conditions. Between 2008 and 2018, over $230 billion of blockbuster pre-LoE global sales have faced erosion through genericisation.
Primary care today: Down but not out
Today, innovation in specialty care is the dominant driver of sales growth in the developed markets, forecast to contribute 85% and 87% of absolute value growth between 2017 and 2022 in the US and Europe, respectively.
To fund specialty innovation in a world of constrained healthcare budgets, payers aggressively drive greater utilisation of generics in chronic illnesses. In the US, in 2017 generics accounted for 90% of all prescriptions and were dispensed 97% of the time when it was possible to do so1 . As a result, in the developed markets we see value sales in typical primary care conditions at best stagnating, but more often in decline, while volumes continue to grow. For example, between 2007 and 2017, value sales of hypertension drugs in Europe declined by $6.6 billion, with volumes increasing by 20 billion Standard Units (one standard unit representing one tablet in this case) over the same period.