FROM THE ECONOMIST INTELLIGENCE UNIT
Greece's austerity measures are once again hitting the country's pharma industry, as cost-containment tightens.The pain is far from over for pharma companies in Greece, as new cost-containment measures for the sector come into force. As part of its efforts to cut spending in the wake of its latest EU bailout, parliament has passed a new law limiting drug spending by the country's social insurance funds to ˆ2.88bn (US$3.8bn this year. The industry itself will be liable for any overspend.
The new law also makes it a criminal offence for doctors to prescribe drugs by brand rather than generic name. This draconian measure will apply to the top ten therapeutic classes from April 1st, and then to all drugs on the reimbursement list from June 1st. The country's reimbursement scheme will only cover the generic cost, with any additional cost to be covered by the patient. In addition, doctors will be fined if they fail to prescribe via the new electronic prescription system, while pharmacy opening hours will be extended.
The aim of these measures is to slice ˆ1bn off the country's drugs bill this year.
In December 2011, while Greece was negotiating its latest bailout, the EU and IMF reportedly asked for drug spending to be reduced to 1% of GDP. The Greek National Organisation for Medicines declared this goal was unrealistic. If the latest measures do succeed in cutting spend to ˆ2.88bn, then that will amount of around 1.4% of Greece's projected ˆ199bn in GDP this year.The government also wants to raise the market share of generic drugs, which is currently one of the lowest in Europe at around 16% by volume in 2009, according to the
European Federation of Pharmaceutical Industries and Associations . Critics attribute this low share to the minimal difference between generic and branded drug prices, as well as incentives in the pharmacy sector which favoured more expensive drugs. The government has already moved to limit pharmacy profit margins to a flat fee, a measure that is expected to cut the number of pharmacies by 30% over the next few years.These and other measures have already proved highly controversial. In May 2010, in the wake of previous austerity measures, pharma prices were cut by a weighted average of 21.5%, prompting protests from pharmaceutical producers. Two Danish pharmaceutical companies, Novo Nordisk and Leo Pharma, withdrew a number of their products from the Greek market (they reversed this action only after the government eased the price-cuts slightly .
Despite this, the government introduced a new referencing pricing system in September aligning Greek prices with the average of the three lowest-priced EU countries. The effect was to cut prices by a further 20%.
As a result, Greece now has some of the lowest pharma prices in Europe, a fact that has prompted a huge parallel trade with other EU markets. Moreover, many hospitals have failed to pay for the drugs they have received, with debts to pharma companies deepening every month.This latest announcement will lead to more controversy and further deter launches in the pharma sector. The government is clearly prepared for that, however. According to Pharma Times, ministers have in any case been contemplating banning new drug launches until such drugs have been accepted for reimbursement in 8-10 other EU countries. Though that measure would probably exclude cancer drugs, the main losers would be Greek patients.
ABC News, 42-year-old Dr. Hsiu-Ying "Lisa" Tseng, an osteopathic physician from Rowland Heights, reportedly wrote an average of 25 prescriptions per day over the past three years. Tseng, who the
Associated Press (AP said has been nicknamed "Dr. Feelgood," is being charged with second-degree murder in the deaths of "three otherwise healthy men in their 20s." In addition, she faces 21 other felony counts and could face a total of 45 years to life in prison, said AP reporters Linda Deutsch and Greg Risling. Her first court appearance was last Friday, they said. Her arraignment was postponed for one week, and her bail, which is currently set at $3 million, will also be reviewed at that time. She has been charged with the deaths of 29-year-old Vu Nguyen, 25-year-old Steven Ogle, and 21-year-old Joseph Rovero. Nguyen, a Lake Forest resident, died on March 2, 2009. Ogle, a Palm Desert resident, died on April 9, 2009, while Rovero, an Arizona State University student, died on December 18 of that year. "Tseng wrote more than 27,000 prescriptions over a three-year period starting in January 2007 -- an average of 25 a day, according to a DEA affidavit. DEA agents swept into her office in 2010 and suspended her license to write prescriptions," Deutsch and Risling said. In Rovero's case, an autopsy discovered that he died as a result of acute intoxication of Alprazolam and Oxycodone -- better known by their respective brand names, Xanax and OxyContin. An
AP report published by USA Today on Friday said that Tseng prescribed the medicines to him, as well as Somas, after he had come to her office complaining of anxiety as well as pain in his hand, wrist, and back. Those prescriptions were issued "after performing only a partial physical examination that didn't even note which hands or wrists were in pain," according to Osteopathic Medical Board of California records. They accused her of failing to get a patient history and an explanation of the origins of his pain, failure to get prior treatment records to verify his medical history, failure to identify previous doctors, and failure to acquire a history of drug and/or alcohol abuse. Similar failures were found in the other two cases, the AP said. James Acker, a professor at the University of Albany School of Criminal Justice who is not involved with the ongoing proceedings, told Taylor that it was unusual for a doctor to be charged with murder in a case such as this. He said it was "far more" typical for a physician to face the lesser charge of "criminal homicide" -- or, as was in the case of Michael Jackson's doctor, Conrad Murray, involuntary manslaughter. "Where you are knowingly engaging in risky behavior, and it's likely that an adverse consequence such as a death will result, that's sufficient to consider it homicide," he added. --- On the Net:
Lindsay Lohan's "Saturday Night Live" performance may not have been Emmy-worthy, but her efforts on the show could be the baby steps she needs to repair her long-tarnished brand.
"She showed that she wants to work again," Cooper Lawrence,
author of "Cult of Celebrity" told The Huffington Post. "She was relaxed, confident and professional. She may not have been funny the whole time, but she did show up, seemed sober and did not come off like a drug addict pulling the wool over our eyes. I was left with the feeling that she may be tired of being the punch line."
Lohan
received mixed reviews for her work on "SNL" this weekend, where she was quick to lampoon her past legal troubles and made light of the fact that she is often less than reliable, but she still wasn't able to pull off the kind of top-notch performance she proved she was capable of years ago when she hosted the show.
Still, following years of personal ups and downs and a handful of cancelled movie projects, simply not failing at the task put before her was enough for Lohan to start creeping her way back into the market as an actress, not a pin-up or a punchline.
"She was sober and knew that the critics would come down on her," said Hollywood publicist Michael Sands. "With her legal woes behind her ... perhaps she will take some acting classes and surprise us all."
"Do not count Lindsay out yet," he added.
However, not all critics were convinced that this weekend's show made the actress more viable as a real Hollywood player.
"Unless she's angling for a role as a not-terribly-adroit cue-card reader, or perhaps a sleepwalker, Lindsay Lohan didn't do her career any favors by hosting 'SNL,'" said April Bernard, the senior television editor for
Us Weekly
. "Referencing past successes such as a?˜Mean Girls,' as she did in one sketch, only reminded viewers how appealing she used to be. If she'd shown half the spark and talent that Maya Rudolph or Melissa McCarthy did this season, people would be talking about her comeback."
Love it or hate it, "SNL" was at least a minor step toward redemption for Lohan's brand --
a high-rated one at that-- but industry authorities believe it will take more than a few funny skits at her own expense to convince producers to take a chance on her as an actress again.
"Lohan's current brand rehabilitation tour -- including stops along the 'SNL' and 'Today' show highway -- have been orchestrated effectively but they hardly wipe away the memory of years of news coverage focused on her addictions, court appearances and her arrogance," said Mark Stevens,
author of "Your Marketing Sucks."
"There's always room for human redemption," he added, referencing former President Bill Clinton's rise from scandal. "But the directors and producers who hired her in the past still aren't going to be hiring Lindsay Lohan for the time being."
Head over here to see some of Lohan's "SNL" skits from the weekend.
The Android-based platform developed by two industry veterans processes payments, manages inventory and, perhaps most importantly, displays nutritional information that will soon be required the federal government.
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VendScreen co-founder Paresh Patel launched
Twenty years later, with
an 1,800-machine vending operation that stretches from Salem to Vancouver, he's about to launch a device that experts say could transform the industry and potentially become standard on all machines.
VendScreen, developed at his Northeast Portland operations base a half-mile from his alma mater, is an Android-based platform that connects vending machines to 3G technology. The touch-screen device accepts payments, displays ads and manages inventory, connecting manufacturers to consumers at the point of sale and giving operators a direct, cloud-based connection to their machines.
But, perhaps most important, it also displays nutritional information, a pending requirement under the
Affordable Care Act of 2010. The new rules stand to cost operators hundreds of thousands of dollars to update the estimated 7 million vending machines across the United States, and gives VendScreen the perfect cue to enter the market.
"Someone is going to win big doing what they're going to do," said Gerry Langeler, a managing director of venture capital firm
OVP Venture Partners. "The only question is -- is it them?"
Other digital products dot the vending landscape. But industry experts say VendScreen is the first platform that tracks inventory, processes credit cards and discloses nutritional facts, all while fitting on existing machines. And because it's based in the cloud, VendScreen can be updated wirelessly, adding new applications as competitors introduce new options. Eventually, the device will be able to accept payments via smartphone.
In turn, VendScreen plans to charge operators 2.75 percent of all sales that go through the machine. Patel and his business partner Glenn Butler, another industry vet, plan to target such brands as Coca-Cola and Pepsi as the devices are added to more and more machines. The technology already has attracted $12 million in venture capital ahead of its targeted April launch at
an industry trade show.
"To me, that's the best kind of venture deal," Langeler said. "You come in at the end of the meeting, you slap your head, and you say, 'Wow.'"
Patel and Butler handpicked VendScreen's first customers and say they've signed two deals worth $5 million in sales. They're beta-testing 500 devices now to prepare for its launch this spring.
"We want to make sure we're disrupting the marketplace in a way that succeeds," Patel said. "We want to make sure we can deliver."
Technological solutions
The path to VendScreen started three years ago at a Gresham Baskin-Robbins, when Patel looked closely at the menu. There, printed next to the ice cream options, were their calorie counts. "They're going to start making us do that too," he recalled thinking.
His small vending operation had served as an applied learning lab while he worked his way through Portland State University and graduate school at the University of Washington. Then, in 1999, it became his full-time job.
He doubled the business year after year, eventually buying out seven area operators. By 2005, he had built
Courtesy Vending into an 1,800-machine operation. "I've watched Paresh's brand of entrepreneurship for a few years," said Angela Jackson, who co-manages the Portland Seed Fund, a local startup incubator. "He owns that space, going back to high school."
Technology, meanwhile, had always fascinated him. At 16, he launched his first business, a desktop publishing service that created business cards. Years later, as his vending operation grew, he started tracking its inventory, down to the chocolate bar, and managed the massive database electronically. The move increased the company's efficiency and boosted its sales. Drivers knew which machines to prioritize and which to skip. "I didn't invest in technology for technology's sake," he said. "I was ultimately looking to solve our problems."
Calorie counts presented a big problem. Vending machine lineups rotate often as operators swap out less popular options with new ones. The only way to account for all the possible snack combinations, Patel thought after that trip to Baskin-Robbins, was a digital platform.
Meanwhile, Butler, who served as chief technology officer for vending-machine-maker
Crane Merchandising Systems, was working on the same problem in Boston. The pair met last year and decided in June to move forward as a team.
Months later, and just hours before they interviewed for one of eight spots with the
Portland Incubator Experiment, they powered on the prototype. They hoped it would work.
It did. As part of Wieden+Kennedy's startup lab, they built the business from the ground up. They met with investors, refined the prototype and pitched to customers.
"We weren't sitting at the computers," Patel said. "We were making deals."
In January, Patel stood before a packed crowd at the Bagdad Theater in Southeast Portland, where hundreds were waiting to hear presentations from the startup incubator's first class.
After making his pitch, he started to leave the stage, then paused. "I have a very exciting announcement to make as well," he said. "Last Friday (Jan. 13 , I signed a term sheet that will commit an investment into VendScreen for $12 million."
He tried to go on, but had to stop until the cheering subsided.
Patel and Butler have declined to disclose any details about the investors, citing Securities and Exchange Commission regulations as the deal closes, though Patel did say the funding is largely local.
Portland investor Nitin Khanna said he is leading the investment round. His
MergerTech firm helps broker deals in the tech sector.
"I looked at the technology ... I immediately said yes," he said. "It's probably the most disruptive technology that I've seen for any industry. In my mind, the single biggest reason is to display nutrition information."
The cost of compliance
When President Barack Obama signed the Affordable Care Act in March 2010, a small section in the landmark legislation stood to wallop the vending industry. It required access to nutritional information before purchase.
For many vendors, compliance would mean adopting stickers or posters to display calorie counts. The Food and Drug Administration estimated that that task alone could cost vending machine operators 14.1 million hours a year to update such information on millions of U.S. vending machines.
It's a costly proposition for an industry already functioning on thin margins. Operators' pretax profits averaged 2.4 percent in 2010, according to the
National Automatic Merchandising Association.
The recession hurt vendors as their corporate clients downsized, leaving fewer workers to buy from machines. Experts pegged the industry's value at $23.2 billion in 2007. By 2010, it had fallen to $19.3 billion, a 17 percent drop.
Last summer,
comments from frustrated vendors poured into the FDA, the agency tasked with implementing the new regulations. A handful said it would push them out of business. Others urged the agency to require manufacturers to print calorie counts on the front of packages that would be visible through machines' glass windows. Some of the nation's biggest brands also weighed in on the conversation, from Starbucks to Kraft Foods, which both make products sold in vending machines.
The FDA has yet to issue final guidelines on when the changes will take effect. Still, manufacturers already are scrambling to figure out how to comply with the rules.
Mark Stein, whose Mark Vend Co. operates 2,000 machines in the Chicago market, said his company plans to switch to a digital product for convenience and aesthetics.
In comments to the FDA, Stein endorsed a separate nutritional information system known as the
Make Informed Nutritional Decisions (MIND touch screen. Unlike VendScreen, the system isn't connected wirelessly to operators. Instead, every machine is updated with memory cards.
Regardless of the system, a digital solution is the only one that makes sense, said Mike Kasavana, a Michigan State University professor who studies the technologies that drive self-service vending machines. He serves as the endowed professor of the industry's trade group, the National Automatic Merchandisers Association.
"You're not really sure if the item that's in A-1 this month is going to be the same item in A-1 next month," Kasavana said. "It's got to be digital."
The college students Kasavana teaches view vending machines as passive, aging devices, he said. Most expect to make their purchases with a debit card, an option that 96 percent of today's vending machines don't afford.
Devices like VendScreen could change those perceptions, making sales that machines wouldn't have otherwise.
"Once you put digital media on the machine, you've changed the whole interface," Kasavana said.
--
Molly Young;
@PDXSmlBizNews
You can say anything to your best friend, right? Well, yes and no. Your close relationship gives you lots of leeway, but there's a fine line between honesty and insult. While you may think you've never said anything offensive to your BFF, there have likely been times when your words have inadvertently stung. Saying something as simple as "Hey, have you lost weight?" could elicit a different reaction than you expected, thanks to its loaded meaning, says Jill Melton, communication expert and author of The Power of the Zip. Read on for nine things you should never say to your best friend, plus learn better ways to get your point across.
"Don't you want children?"
Sure, there are obviously offensive comments you wouldn't make to childless friends, like what a pal once told Helen*: "Good thing you never had kids—you can hardly take care of yourself!" But even the mild-sounding Don't you want children? makes assumptions about what's going on in another person's head and life, says Melton. What if your friend desperately wants kids but is
struggling with infertility? Or what if she doesn't want to be a mother but would rather avoid an awkward conversation about her decision? When it comes to discussing kids, let your friend take the lead. "If she wants to discuss her choice, she'll bring it up herself," says Melton.
ON WOMAN'S DAY:
How to Handle Tricky Friend Situations
"You've lost weight!"
"Weight is a dirty word—period," says Lillian Glass, Ph.D., body language expert and author of The Body Language Advantage. if you're trying to give a compliment, this statement can confuse, or even insult, your friend. What if she lost weight because she's been depressed? Or perhaps she didn't think she'd lost any weight and now worries that you thought she was overweight before.
If you suspect that your friend has slimmed down, just say, You look wonderful! advises Glass. Who knows? She could look great thanks to a
fabulous haircut or new outfit; there's no need to make assumptions about what changed. That said, if a friend has dropped an alarming amount of weight and you're worried about her health, then bring it up in a way that conveys your concern, says Melton. Try, I've noticed you're looking thinner lately. Is something going on that you want to talk about?
ON WOMAN'S DAY:
What Your Best Friend Won't Tell You
"That guy you're dating? Not marriage material!"
Lisa's* friend asked her opinion about a new beau, and she gave him the thumbs-down—with friendship-fizzling results. "My pal ended up marrying the guy, and now she's distant," says Lisa. "I thought I was being a good friend by pointing out the facts, but I should have listened to my dad's reminder, 'Everyone chooses their own sweetheart,' and kept my mouth shut."
If your friend's guy seems like a bad choice to you—but she hasn't asked your opinion—then keep your judgments to yourself. Aside from having hard evidence about serious stuff (like he has a wife and kids in another city, or is a drug dealer, for example , you really don't know if he's "wrong" for her. If she does ask what you think, then "turn it back to her," suggests Melton. Try, I don't know him as well as you do. Tell me what you like and don't like about him. Then you can base what you say on her response, so your thoughts don't seem out of the blue.
ON WOMAN'S DAY:
Marriage "Rules" You Can Break
"You bought what?"
If your best friend constantly complains about tough financial times before showing up with a trendy designer bag, then it can be tempting to call her out on her spending. But a judgment-riddled Are you kidding me? What did that cost? is decidedly the wrong thing to say, because "you're not in charge of her budget. She is," says Melton. Consider, too, that you may not know where her money's coming from, says Glass: "What if she's spending a gift from someone else?" So if you notice something brand-spanking new and expensive, then just say, Wow, cool boots or What a great new car. That said, if she asks you for help managing her money (or to borrow some of yours , then gently point out ways she can trim her costs.
"Congrats on a well-deserved promotion! You've been in that position for so long."
What's the problem with a congratulatory remark? A lot, if it's actually a backhanded compliment. The above implies that your friend didn't quite earn the promotion. Instead of suggesting that anyone in her (worn shoes would have gotten a bump at work, try a hearty, Good for you! Very impressive! suggests Melton. And if your friend suspects that she, say, got that promotion because she'd been in that job so long it would've been embarrassing not to, then leave the door open for her to discuss that with you. You should be a sounding board for your friend, not a sniper.
"How dare you not tell me [you bought a new car/got a new job/met a new guy]!"
On the one hand, says Glass, "It's reasonable to feel slighted if your good friend doesn't share news with you." It's expressing your anger over being left out that's a no-no. "Some friends don't keep you posted on everything for reasons that have nothing to do with you," says Melton. Saying something like this makes the situation all about how you feel excluded, not about what's happening in your friend's life.
When you do hear your pal's good news, just tell her, I'm so happy for you. If this happens often and you worry that your friend is keeping updates from you, then open up a discussion about it. Could it be that you haven't been that enthusiastic about her news in the past, or that you've shared her info with others without her permission? See what you could do differently before scolding her for not filling you in.
"I wish my husband were as great as yours!"
Why wouldn't it be wonderful to hear you've scored big in the life-partner department? Because the friend who says this is subtly (or not so subtly downgrading her own spouse, which can be awkward for the person on the other side of the conversation. "A friend said that to me about my husband when she was
going through a divorce," says Shelly.* Feeling uncomfortable and unwilling to bash her friend's spouse, Shelly's taken to responding with, "Yep, he's a good guy," and changing the subject.
While occasional compliments are completely fine, avoid making comparisons: "They reveal jealousy," says Glass. If you're having problems with your partner, then you can certainly ask your happily married buddy for advice, adds Melton, "but since every relationship is unique, a comparison isn't a good way to start that conversation."
"Your wedding was so tiny!" or "You're so much bigger than I was when I was pregnant!"
What may seem like a harmless observation to you can actually come across as a cruel comparison. Anna's* friend once said, "It was good you got married first; now I know what I don't want at my wedding!" Anna was floored. Before you say something like that, examine your motives for wanting to do so, suggests Melton. Anna's friend, for example, may have wanted planning advice, and she could have told Anna what she loved about her wedding instead of cutting down her friend's choices. "Try to figure out what exactly your friend's wedding [or pregnancy] triggered in you," says Melton. Are you having second thoughts about some of your wedding choices? Worrying about how much weight you've gained by your second trimester? Once you uncover what's at the root of your observations, you can express your feelings without sounding snarky.
"Don't worry. It'll be fine."
Shelly still feels the sting of friends' trite platitudes when her mother was terminally ill, because, of course, things weren't fine. In situations like this, your friend might be worried for good reason, so saying Don't worry is dismissive, explains Melton. Instead, use your judgment based on the situation. In some cases, saying It'll be fine in a loving, sincere way can show your compassion, says Glass. But much of the time, it's better to use words that show your friend that you feel her pain, that you're pulling for her, and that you may not know what it's like to, say, lose your mother, but you're in her corner as she goes through the worst of it. A simple I'm here if you need me goes a long way, especially if you follow that up with concrete ways to help her through her rough time, whether that's picking up her kids from soccer, bringing over dinner, or just sharing some wine and company.
*Name has been changed
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