Page 55 - Retail Pharmacy November/Decemeber 2020

54 ANNUAL REPORT FROM PAGE 53 Products that bucked the trend were biologicals. It’s worth noting that higher demand for support services for patients receiving biologic treatment for cancer and dermatological conditions are inevitable. It would be best if you prepared for increased focus on hospital-in-the-home and other professional services in this area of medicine. Given the therapeutic nature of hepatitis C treatments, a slowdown in demand was inevitable as the population received treatment. Also of little surprise was the collapse in sales of anti-infectives such as amoxicillin, driven by the low rates of bacterial infections in the community thanks to behavioural changes caused by Covid (social distancing, isolation and lockdown, along with border controls). Class-by-class prescription highlights Antineoplastic and immunomodulating agents increased by $174 million (9.3 per cent), driven by adalimumab, ustekinumab and other biological agents. It was palbociclib that contributed the most to this growth, adding $38 million to this class in the ongoing battle for people with advanced breast or metastatic cancer. Dermatologicals increased by $72 million (24.4 per cent), dominated by new biological inhibitors guselkumab, ixekizumab, risankizumab and tildrakizumab. Given that biologicals have driven most of the PBS growth in the previous year, it’s becoming increasingly important for pharmacies to consider patient support services for these more complex and tailored therapies to support better health outcomes. The third highest growth category was blood and blood forming organs, by $66 million (10 per cent). Apixaban drove the growth in this class, quite possibly due to its superior safety profile compared with warfarin (PBAC) and its more recent competitors (Bonde, 2020). Systemic anti-Infectives fell by $173 million (16.1 per cent), driven primarily by the hep C treatments sofosbuvir/velpatasvir and glecaprevir/ pibrentasvir. Also, most likely due to lower rates of other transmissible infections, there were significant falls in amoxicillin-containing products. The other casualty was genito-urinary system and sex hormones, which fell by $34 million (4.8 per cent). As sildenafil lost patent protection, it didn’t lose volume (in fact it was up three per cent), but generic impact wiped 34 per cent off its value, promising a stark future for tadalafil. It’s possible that before generic competition, patients were forgoing treatment due to cost. Less dramatically, demand for respiratory medicines remained elevated by 2.73 per cent, driven by an influx in asthma patients and the second wave of Covid infections in Victoria. This follows the peak in demand during the early Covid wave that saw respiratory medications at their highest dispensation rates on our records. Use of antidepressant medications has been on the rise in Australia for several years. In a concerning (or comforting?) trend since the initial outbreak of the virus in March, more Australians have turned to antidepressant medications to deal with the increased mental health burden. We observed clear spikes in prescriptions for antidepressants in March, and unlike other chronic medication categories where stockpiling occurred followed by subsequent reduced demand, the demand for antidepressants has remained high (Brown, et al, 2020). Doctors report significant increases in mental health presentations, as well as higher use of antidepressants and new initiations for antipsychotics. In contrast, a decline in new starts to anxiolytic medications suggests some patients may be missing out on necessary treatment, or may be moving across to more clinically appropriate antidepressants such as SSRIs and supplementing with CBT and other support services (Lampe, 2013). Perhaps doctors are shifting away from prescribing benzodiazepines due to concerns around dependence, tolerance and side effects. Mounting evidence suggests significant delays to the diagnosis and treatment of cancer patients are also taking place, raising concerns over longer-term patient outcomes (Brown, et al, 2020). Consumer health: hand sanitiser and no-touch thermometers the winners, thanks to Covid It’s common knowledge that the key drivers of the consumer health market in 2020 were sanitising products, masks and temperature recording equipment. For Victorians, the mask sales have been more pronounced than in other states, due to the mandatory requirements. However, the remaining products appear to be distributed relatively evenly across the nation. Class-by-class consumer health category highlights Since the peak in sales in March 2020, sales have slumped in 11 of the top 15 categories, with notable exceptions being personal hygiene (including hand sanitisers) which is up 30.6 per cent or $57 million, and tests and measuring Instruments (including digital thermometers), up 17.3 per cent or $23 million. We expect these categories will start to decline unless Australia experiences additional peaks in Covid- related illness. The biggest category, cough, cold and other respiratory products, initially appears to have only slipped by 2.6 per cent, but this is deceptive as, while Asmol and Ventolin have risen strongly (up by $16 million), this has been all but cancelled out by the much greater fall in cold remedies, with the top three Codral medicines falling a collective $12 million. More cold and flu and allergy remedies have driven this category into negative territory. Reduced transmission of traditional winter illnesses such as flu, due to social distancing, improved hygiene standards, higher vaccination rates and reduced willingness to spend because of increased economic uncertainty, also drove declines in most categories. (Brown, et al, 2020). Vitamins and supplements have seen a further decline in 2020, slipping 8.6 per cent in the year-to-date sales value compared with the same time last year. Iron (eg, Maltofer and Ferrovance) and vitamin D supplements (eg, Ostelin) showed strong growth, while pregnancy and breastfeeding related supplements declined. Declines may be caused by lower discretionary spending, a fall in daigou (Chinese personal shoppers) and direct exports. The ABC reported recently that “Australia’s multi-billion dollar daigou industry has been upended by the pandemic, with the effects being felt not just by thousands of personal shoppers but by major Australian businesses as well.” (Xiao, 2020) In the pain category, osteoarthritis medicines such as Apohealth Osteo Relief and Osteomol took most of the growth in this area, collectively growing $7.7 million. In contrast, the top TO PAGE 56 RETAIL PHARMACY • NOV/DEC 2020