Migraine sufferers in the U.S. found some relief over the past few years as a handful of new treatments came to market. The additions include a group of injectable drugs that help prevent the painful headaches, as well as a pill, Ubrelvy, which was cleared in late 2019 to alleviate migraines after they start.
Most of these new drugs are sold by giants like Amgen, Eli Lilly, Teva and AbbVie. But one smaller company, Biohaven Pharmaceuticals, is also in the mix with an oral medicine known as Nurtec ODT, which is now approved both to prevent and treat migraines. All work similarly by targeting a protein called called CGRP.
Going against much larger competitors can be a daunting task. Yet Biohaven has been able to carve out a bigger market share than some expected. From the start of April to the end of June, Nurtec sales totaled $93 million — roughly double what Wall Street analysts forecasted.
Biohaven's CEO Vlad Coric says several factors drove these sales. His company was able to establish a patient base early on, for example, through the use of access programs. And as the rollout progressed, it tapped into celebrity endorsements, racecar advertising and platforms like TikTok to get the word on Nurtec out to patients.
This marketing, while fruitful, hasn't been without complications. Biohaven's digital-first strategy requires it to quickly analyze and integrate data, according to Coric, which can present challenges. The company has also received a warning from the Food and Drug Administration for an interview one of its celebrity partners, Khloe Kardashian, did last summer. The FDA wrote that the interview "makes false or misleading claims and representations" about Nurtec's risks and effectiveness.
Coric spoke with BioPharma Dive about the Nurtec launch and how the drug's newfound success positions Biohaven for the future.
This interview has been lightly edited and condensed for clarity.
BIOPHARMA DIVE: Why do you think the recent Nurtec sales were much higher than expected? What's driving that performance?
CORIC: There are always a couple dynamics at launch.
We had been talking about the importance of building up the patient base in year one, and we had a lot of these affordability programs in place while we were negotiating with insurance companies. We ended up getting really good insurance coverage this last year — we had over 90% commercial insurance coverage.
Once the coverage is in place, you end up having quite a bit of favorability with regard to when you start to modulate your affordability program because you don't need it as much anymore. That really improved revenue.
So I think it's a combination of just really strong growth in demand, along with doing very well with payer coverage. Both of those amounted to a quarter that really exceeded expectations.
How do the markets differ between migraine treatment and prevention? Do you approach marketing for those indications differently?
CORIC: Really important to the strategy we have is that one drug can do both. It's the first time you've had a migraine therapy dedicated for both acute and preventative therapy. It allows you to customize your prevention, think about dialing it up or down. It allows people to define prevention in a way they've never been able to before.
I think that's why we're getting such strong growth in the last few weeks. Our new-to-brand [prescription] numbers yesterday were at 53.7%. We had been hovering below 50% for most of the year because there's been a tug of war with AbbVie.
One other thing to keep in mind with prevention is that, generally speaking, people on [monoclonal antibody drugs] have been taking injectables. But there are a lot of people who don't want injectables. And a whole segment of people who haven't taken injectables previously are now saying, "Oh, there's an oral available? I'll try it."
So we're getting the oral versus injectables advantage, as well as the advantage of being [for migraine prevention and acute treatment].
How much investment is Biohaven putting toward direct-to-consumer advertising, and what kind of return has the company seen?
CORIC: We've taken this multiple-patient-voice approach while being digital first.
We have more well-known figures like Khloe [Kardashian] and Tori Spelling and Whoopi Goldberg, but all that is to amplify the patient voice. Our NASCAR driver who has Nurtec on his car — what we're trying to do is use a multiple-pronged approach in order to get the patient voice out. We think the best way to promote Nurtec is for people to hear directly from patients about its advantages.
We've been really efficient with our marketing budget. What acute and prevention have allowed us to do is one set of ad campaigns. You're only going to see the dual therapy, so there's no redundance.
We're spending less than our competitors. We spend less than AbbVie and we have equal market share, and it's because of this digital-first approach that's really become effective for us. It's a highly efficient approach, and we plan on continuing that and consolidation of acute and prevention to one set.
What's the largest challenge with this digital-first strategy?
CORIC: One of the biggest challenges is integrating the wealth of information that comes in, using it and adapting 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 they have.
So, how do you deploy your physical resources and your digital resources and constantly evolve to stay one step ahead? I think our team thus far has done a great job of doing that, and the numbers show it.
So, following Nurtec's second quarter performance, how is Biohaven building market share and competing against the larger companies that also sell new migraine drugs?
CORIC: Look at the type of things we've done — and not just the DTC, which I think had a different feel — but also the first Twitter takeover. We've had advertising on TikTok and other venues that a lot of pharma really haven't utilized in a meaningful way.
We've done this to try to transfer that medical knowledge from our studies and our approvals directly to patients in a much more efficient way. It's more cost effective, certainly, than the old days of putting a sales rep on every single doctor. Even before the pandemic, we had been using virtual engagement with physicians, these virtual centers where we can reach a lot more doctors remotely.
I think when you start a pharmaceutical company from scratch, you create a modern company that doesn't have previous ways of doing drug launches. So you can incorporate new technologies and digital-first approaches to transfer the knowledge of this new drug more quickly to patients. When you look at how long it takes, traditionally, to get to peak sales, it's the years of getting that information out. We can just do it much more efficiently with the tools we have now.
How do Nurtec sales affect Biohaven's pipeline of experimental drugs and the company's ability to stay independent?
CORIC: 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 equity markets. So it is a transformative drug.
We're already on trajectory for multibillion-dollar sales, so this is the kind of drug that can go on to fund a lot more innovation within human neuroscience.
It particularly excites us because it does absolutely allow us to remain independent. Having said that, we always have to do what's in the best interest of our shareholders. We'll make sure we assess potential partnerships and weigh them against going it alone.
As Biohaven's CEO, how are you prioritizing the Nurtec launch? Is this something you can step back from now that the ball is rolling?
CORIC: We're constantly integrating and analyzing the data that comes in, wanting to optimize the launch.
Having said that, in the year before launch, people questioned whether a small company like Biohaven, with the approach that we have, could really compete against the Goliath of AbbVie. We've shown now that we can not only go toe-to-toe, but in many ways we can excel. Certainly with this dual strategy of acute plus prevention, our goal is to become the market leader in the oral CGRP space.
We've now shown people we're on a great trajectory, but we're not going to rest on our laurels. We've got to stay one step ahead, and so we'll be constantly watching the data and optimizing it to stay one step ahead of our competitors.