Migraineurs in the United States found some relief in recent years when a handful of new treatments hit the market. New additions include a group of injectable drugs that help prevent the painful headache and a pill, Ubrelvy, which was approved in late 2019 to help relieve migraines after they started.
Most of these new drugs are sold by giants like Amgen, Eli Lilly, Teva, and AbbVie. But a smaller company, Biohaven Pharmaceuticals, is also using an oral drug called Nurtec ODT, which is now approved for both the prevention and treatment of migraines. All of them work similarly by targeting a protein called CGRP.
It can be a daunting task to compete against much bigger competitors. Nevertheless, Biohaven was able to capture a larger market share than some had expected. From early April to late June, Nurtec’s revenue was $ 93 million – roughly double what Wall Street analysts forecast.
Vlad Coric, CEO of Biohaven, says several factors contributed to these sales. For example, his company was able to build up a patient base at an early stage through the use of access programs. And in the course of the introduction, celebrities, advertisements for racing cars and platforms such as TikTok were used to inform patients about Nurtec.
This marketing has been fruitful, but not without complications. According to Coric, Biohaven’s digital-first strategy requires rapid analysis and integration of data, which can be challenging. The company also received a warning from the Food and Drug Administration for an interview that one of its celebrity partners, Khloe Kardashian, did last summer. The FDA wrote that the interview makes “false or misleading claims and representations” about the risks and effectiveness of Nurtec.
Coric spoke to BioPharma Dive about the introduction of Nurtec and how the newly discovered success is positioning Biohaven for the future.
This interview has been slightly edited and shortened for reasons of clarity.
BIOPHARMA DIVE: Why do you think the recent Nurtec sales were much higher than expected? What drives this achievement?
CORISH: There are always some dynamics at the start.
We’d talked about the importance of building the patient base for the first year, and we’d put many of these affordability programs in place while negotiating with insurance companies. Last year we got really good coverage – we had over 90% commercial coverage.
Biohaven Pharmaceuticals CEO Vlad Coric Pharmaceutical
Courtesy Biohaven Pharmaceuticals
Once the coverage is in place, you end up having some benefits when you start modulating your affordability program because you don’t need it that often. That really improved the revenue.
I think it’s a combination of really strong demand growth and very good number coverage. Both made up a quarter that really exceeded expectations.
How do the markets differ between migraine treatment and prevention? Do you approach marketing differently for these indications?
CORISH: What is really important to our strategy is that one drug can do both. It is the first time you have received migraine therapy dedicated to both acute and preventive therapy. It allows you to adjust your prevention and think about choosing it up or down. It enables people to define prevention in ways they have never been able to do before.
I think that’s why we’ve grown so much in the past few weeks. Our new brand [prescription] Numbers yesterday were at 53.7%. We were under 50% for most of the year because of a tug of war with AbbVie.
Another thing that you should keep in mind about prevention is that people generally act on it [monoclonal antibody drugs] Have taken injections. But there are a lot of people who don’t want injections. And quite a chunk of people who haven’t had injections before now say, “Oh, is there an oral solution? I’ll try.”
So we have the advantage of the oral over the injectable drugs as well as the advantage of being [for migraine prevention and acute treatment].
How much does Biohaven invest in direct-to-consumer advertising and what return has the company achieved?
CORISH: We took this multiple patient voices approach while we were digital first.
We have more famous people like Khloe [Kardashian] and Tori Spelling and Whoopi Goldberg, but everything to reinforce the patient voice. Our NASCAR driver who has Nurtec in his car – what we’re trying to do is use a multi-pronged approach to bring out the patient voice. We believe the best way to promote Nurtec is to let people learn about the benefits directly from patients.
We have been really efficient with our marketing budget. What has made acute and prevention possible for us is a series of advertising campaigns. You will only see dual therapy so there is no redundancy.
We spend less than our competitors. We spend less than AbbVie and have the same market share, and this digital-first approach has gotten really effective for us. It is a highly efficient approach and we plan to continue this and combine acute and prevention in one set.
What is the biggest challenge in this digital first strategy?
CORISH: One of the biggest challenges is to integrate the wealth of incoming information, to use it and to adapt very quickly.
The other challenge is just the size of our competitors. They have a much larger physical footprint; ours is about a third smaller than you have.
So how do you use your physical and digital resources and constantly evolve to stay one step ahead? I think our team has done very well so far and the numbers show it.
How is Biohaven building market share after Nurtec’s performance in the second quarter and how does it compete with the larger companies that also sell new migraine drugs?
CORISH: Look at the things we did – and not just the DTC which felt a different way in my opinion – but also the first Twitter takeover. We had advertisements on TikTok and other places that a lot of drug companies really didn’t make good use of.
We did this to try to transfer the medical knowledge from our studies and our approvals directly to patients much more efficiently. It is certainly more cost effective than in the old days when every single doctor was assigned a sales representative. Even before the pandemic, we had used virtual collaboration with doctors, these virtual centers where we can reach many more doctors remotely.
I think if you start a pharmaceutical company from scratch, you create a modern company that has no previous opportunities to bring drugs to market. This allows you to incorporate new technology and digital-first approaches to pass knowledge about this new drug to patients faster. If you look at how long it traditionally takes to reach peak sales, then is the years that this information is published. With the tools we have now, we can just do it a lot more efficiently.
How will Nurtec’s sales affect Biohaven’s experimental drug pipeline and the company’s ability to remain independent?
CORISH: A drug like Nurtec gives you the opportunity to fund your future assets and pipeline once you hit profitability without having to go back to the stock markets. So it’s a transforming drug.
We’re already well on our way to billions of dollars in sales, so this is the type of drug that can fund a lot more innovations in human neuroscience going forward.
We are particularly excited because it absolutely allows us to remain independent. However, we must always do what is in the best interests of our shareholders. We will make sure that we evaluate potential partnerships and weigh them against going it alone.
As CEO of Biohaven, how do you prioritize the introduction of Nurtec? Is that something you can take a step back from now that the ball is rolling?
CORISH: We are constantly integrating and analyzing the incoming data to optimize the start.
However, the year before it launched, people were wondering if a small company like Biohaven could really compete against AbbVie’s Goliath with our approach. We have now shown that not only can we keep up from head to toe, but we also excel in many ways. With this dual strategy of acute plus prevention, our goal is to become the market leader in the field of oral CGRP.
We have now shown people that we are on the right track, but we will not rest on our laurels. We always have to be one step ahead, so we will constantly monitor and optimize the data in order to be one step ahead of our competitors.