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`"Unbelievable...Toe Nail Fungus?....Seriously?"
`June 23, 2015
`
`With over 35 years of experience as a
`pharmacist, Bob Schenk is uniquely qualified
`to write about pharmacuetical care, savings
`opportunties in plan benefit design, and
`abuses by PBM's and Big Pharma. His
`experience includes building and operating
`two retail pharmacies, working as a hospital
`pharmacist, consultant pharmacist, and
`manager of three ambulatory pharmacies for
`a leading healthcare system. 
`
`Featured Posts
`
`Front Line Pharmacists Publish Real-World
`Medication Savings Opportunities Blog
`June 23, 2015
`
` 
`These words blare from the start of a commercial that sometimes seems to run continuously during
`certain television events and they are shouted hysterically by the famous tennis player, John
`McEnroe while animated toes encrusted with fungus swing tennis rackets about a tennis match. The
`hero in the commercial is Jublia as it cures the fungus.  What HR Benfits Managers and payors are
`shouting however is probably slightly different. When confronted with the claims from their
`beneficiaries asking their physicians to prescribe the higher than gold priced agent, Jublia,
`manufactured by Valeant Pharmaceuticals, they are appropriately shouting,           "
`Unbelievable...$6,600 to treat Toe Nail Fungus?...Seriously?"  That is the average wholesale price to
`treat one big toe nail for 48 weeks. (assuming two drops per day using one 4ml bottle per month).
`AND many patients may need to treat more than one nail .  And what part does your patient pay?
`How about $0? Thats right, the manufacturer offers a discount off of their co-pay to $0.  Last we
`checked Gold was worth about $1200 per ounce and Jublia, ($600 per 4ml bottle) is worth almost
`four times that at $4,500 per ounce! 
`Unfortunately, the cost of the product may not even be the worst of it. You see, the package insert
`from the manufacturer states that when used as directed and applied everyday for the entire length
`of recommended treatment of 48 weeks, Jublia has a complete cure rate of only 15.2% to 17.8%.
`Interestingly, the very same studies reported that the liquid alone without the medicine had a
` 3.3% to 5.5% complete cure rate. When determining coverage of this agent one consideration could
`be whether to consider Jublia and drugs like as medical or cosmetic drugs, and that would be one
`way to decline coverage if your plan does not cover drugs used for cosmetic purposes (i.e. Latisse or
`Botox and Retin-A for wrinkles).  
` 
`Another agent used for this purpose Ciclopirox Nail Lacquer, is available generically and had
`published cure rates of 29-36% according to a study in the Journal of the American Academy of
`Compounded Prescriptions-
`Dermatology(1). This product was available for as little as $18 for a 6.6ml bottle. However, the
`What's not in your wallet ?
`manufacturer of the branded version, Penlac, reported in its package insert that the cure rate was
`February 13, 2016
`closer to 12%. Still, most patient, being given the choice and having to pay the entire cost out-of-
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`.com. It's easy & free. Create Your Website
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`ACRUX DDS PTY LTD. et al.
`
`EXHIBIT 1628
`
`IPR Petition for
`
`U.S. Patent No. 7,214,506
`
`

`

`Pharmacy Benefit News
`
` A Pharmacists Guide To Savings Opportunities In Prescription Benefit Plan Design And Cost Effective Management Of New Drugs
`
`Create Your
`
` Site
`
`HOME
`
`ABOUT
`
`"Unbelievable...Toe Nail Fungus?....Seriously?"
`June 23, 2015
`
`With over 35 years of experience as a
`pharmacist, Bob Schenk is uniquely qualified
`to write about pharmacuetical care, savings
`opportunties in plan benefit design, and
`abuses by PBM's and Big Pharma. His
`experience includes building and operating
`two retail pharmacies, working as a hospital
`pharmacist, consultant pharmacist, and
`manager of three ambulatory pharmacies for
`a leading healthcare system. 
`
`Featured Posts
`
`Front Line Pharmacists Publish Real-World
`Medication Savings Opportunities Blog
`June 23, 2015
`
` 
`These words blare from the start of a commercial that sometimes seems to run continuously during
`certain television events and they are shouted hysterically by the famous tennis player, John
`McEnroe while animated toes encrusted with fungus swing tennis rackets about a tennis match. The
`hero in the commercial is Jublia as it cures the fungus.  What HR Benfits Managers and payors are
`shouting however is probably slightly different. When confronted with the claims from their
`beneficiaries asking their physicians to prescribe the higher than gold priced agent, Jublia,
`manufactured by Valeant Pharmaceuticals, they are appropriately shouting,           "
`Unbelievable...$6,600 to treat Toe Nail Fungus?...Seriously?"  That is the average wholesale price to
`treat one big toe nail for 48 weeks. (assuming two drops per day using one 4ml bottle per month).
`AND many patients may need to treat more than one nail .  And what part does your patient pay?
`How about $0? Thats right, the manufacturer offers a discount off of their co-pay to $0.  Last we
`checked Gold was worth about $1200 per ounce and Jublia, ($600 per 4ml bottle) is worth almost
`four times that at $4,500 per ounce! 
`Unfortunately, the cost of the product may not even be the worst of it. You see, the package insert
`from the manufacturer states that when used as directed and applied everyday for the entire length
`of recommended treatment of 48 weeks, Jublia has a complete cure rate of only 15.2% to 17.8%.
`Interestingly, the very same studies reported that the liquid alone without the medicine had a
` 3.3% to 5.5% complete cure rate. When determining coverage of this agent one consideration could
`be whether to consider Jublia and drugs like as medical or cosmetic drugs, and that would be one
`way to decline coverage if your plan does not cover drugs used for cosmetic purposes (i.e. Latisse or
`Botox and Retin-A for wrinkles).  
` 
`Another agent used for this purpose Ciclopirox Nail Lacquer, is available generically and had
`published cure rates of 29-36% according to a study in the Journal of the American Academy of
`Compounded Prescriptions-
`Dermatology(1). This product was available for as little as $18 for a 6.6ml bottle. However, the
`What's not in your wallet ?
`manufacturer of the branded version, Penlac, reported in its package insert that the cure rate was
`February 13, 2016
`closer to 12%. Still, most patient, being given the choice and having to pay the entire cost out-of-
`This site was created with
`.com. It's easy & free. Create Your Website
`
`Recent Posts
`
`Page 1 of 2
`
`

`

`GET READY TO CATCH THE
`WAVE OR WIPE OUT (A Sea
`Change is Happening in
`Pharmacy- Hang on tight)
`January 19, 2016
`
`Traditional vs Passthrough
`PBM selection-How to choose
`September 19, 2015
`
`EXCLUDING DRUGS IN YOUR
`2016 PRESCRIPTION
`PLAN....... A NECESSARY
`STRATEGY
`August 18, 2015
`
`Connect
`
`pocket would most likely try the generic ciclopirox first (and probably only ever) versus having to fork
`over more than $6,000 for a possible 3-5% better outcome.
` 
`BUT WHAT CAN I DO ABOUT IT?
`Most pharmacists (and most rational-thinking people) do not believe that a drug to treat a supeficial
`cosmetic condition with a possible 15% cure is worth a $6,600 investment to achieve the perfect
`looking toenail. Unless your professional livelihood depends on perfect looking nails, the return on
`investment here is probably just not worth the added costs. As a benefits manager or decision maker
`you do have several options;
`1. Consider drugs used for treatment of toenail fungus cosmetic agents and non-covered
`2. If you want to cover topical drugs for nail fungus, restrict covered agents to generics only or add
`Jublia and similar Brand Name agents to a step therapy program requiring patients to try and fail a
`full course of a lower cost agent first
` 
` 
` 
` 
` 
` 
` 
`
`  J
`
` Am Acad Dermatol. 2000 Oct;43(4 Suppl):S70-80.
`Ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis.
`Gupta AK1, Fleckman P, Baran R.
`
`Contact Me
`Tel: 732-239-2192
`BAYSHOREBOB@AOL.COM 
`
`© 2015 JSCHENK
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