Schering Plough and Merck have now both retraced about half of their loses from a week ago when Vytorin and Zetia were condemned publically at the ACC meeting.
So far prescriptions haven’t dropped off a cliff, just continued to fall as they had been since January. The 7 day rolling average of the scripts shows a change of -33.2% for new prescriptions for vytorin and 30.1% for zetia. The total prescriptions are down 22.2% and 19.4% respectively( also the 7 day rolling average for vytorin and zetia. The total prescriptions are the new scripts plus the refills and tend to change more slowly than the new script numbers.) Crestor numbers, as I predicted, have looked much better- up 11% for news, and 6.9% for total scripts. Obviously these numbers are pretty bad for Merck and Schering and pretty good for AZN but why aren’t these numbers even more dramatic. The reason, as I see it, has a lot to do with the practice of medicine these days. First, about 15-20% of prescriptions for lipid drugs are written by cardiologists- as a group we are generally better informed about the recent trials and more likely to react quickly to news like the ENHANCE data. Among this population, use of zetia and vytorin has fallen fast and far. The other 80% of scripts come from primary care physician of all stripes. These doctors, manage a wide variety of medical issues and often are unable to keep up with the lastest advances in subspecialties. Unfortunately, they get a fair amount of their information directly from the drug companies. Generally though, changes in the standard of care filter down to many of these doctors- through counter-detailing , and new guidelines, new pharmacy benefit guidelines, discussions with cardiologists etc. This can take a while however. None of the PBMs have downgraded Vytorin or Zetia yet, but they certainly will. No new guidelines have been released, and this will be happening over the next few months. Pfizer and AZN have increased their counter-detailing, and will certainly continue to do so. I expect the new and total scripts to continue to trend down for the next several months. Deutsche Bank released a survey today suggesting that some primaries are starting to get the message.
So, I think both of these stocks still represent attractive shorting opportunities. I shorted some Merck this evening- it is up 2% on the back of one of Cramer’s rants. Merck also is expecting news from the FDA regarding another lipid drug called Cordaptive. It is a combination of simvastatin, niacin and a new compound which blocks flushing- which is the big problem with using niacin in general. I looked at some of the data regarding this compound at the ACC. It is very promising, but I don’t think there is nearly enough long term data regarding the safety of this new agent for the FDA to feel comfortable approving this combination. This upcoming FDA rejection should also provide downward pressure on Merck’s stock. As I have stated in the past, Merck has a well diversified portfolio of drugs and vaccines, and I will be looking buy the stock in the mid 30s.
Astra Zeneca has had a nice bump from the above news, but I believe that for them too this story will continue to evolve over a few months. I still believe that the current price of their stock represents a buying opportunity.
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