Innovation is the lifeblood of the biopharmaceutical industry. New medicines pharma brings to market save lives, reduce suffering,
and, not incidentally, generate new revenue streams. Today's increased emphasis on innovation—discovering breakthrough medicines
that provide significant therapeutic advantages—is driven in part by the growing resistance of both public and private payers
to pay premium prices for medicines that are not demonstrably superior to those already available.
In the United States, pharmacy benefits managers and managed care organizations have adopted tiered formularies and other
cost-containment measures that relegate new drugs to a lower reimbursement status unless a significant advantage over existing
medicines can be demonstrated. In Europe, a new drug may only receive reimbursement at the level of the lowest-cost alternative—perhaps
a generic—if superiority cannot be demonstrated.
The biopharmaceutical industry is responding by focusing on "better" medicines—drugs with novel mechanisms of action that
target new diseases or treat familiar ones in new ways. While such drugs may have real therapeutic and financial advantages,
they present substantially higher risks in terms of technical success. That is, they are much more likely to fail in development.
As a result of this higher level of technical risk in their pipelines, pharmaceutical companies are launching fewer new molecular
entities (NMEs) than at any time in recent memory.
Taking on additional scientific risk is not the only path to innovation. In many cases, companies have defined innovation
too narrowly by focusing on pure scientific novelty. This, in turn, has reduced R&D productivity and is likely to erode shareholder
value. But evidence shows that focusing on first-in-class drugs may not be the best strategy for all companies.
First, it is important to recognize that not all innovation is purely scientific. Innovation is in the eye of the beholder,
and in the medicine, there are at least four beholders: patients, physicians, regulators, and payers. These stakeholders do
not always focus on first-in-class medicines. They value innovations in safety, reduced side effects, convenience, and dosing
schedule. Such improvements can also speed drug approval, promote physician prescribing, and enhance patient compliance.
Blockbusters arise from various commercially important innovations. The "Innovation Matrix" framework has two axes. The vertical
axis, disruptive versus incremental, shows the degree to which a new medicine reshapes the therapeutic landscape, whether
or not it is a scientific breakthrough. Disruptive drugs trear maladies witout available, adequate therapies. In some cases,
these drugs create new markets or product classes.
When First Place Does not Win
The other axis shows whether the medicine has a , new target versus existing target, shows the extent to which a new drug
is acting on a known target, for which medicines are already available, or has a novel mechanism of action.
The examples given, and there are many others, show that important medicines—those that add value to the company—arise from
all four quadrants.
At one extreme, there is Enbrel, a drug that combined a novel mechanism of action with a reshaping of the therapeutic landscape.
It has become a blockbuster, with 2004 sales of nearly $2 billion, according to the manufacturer's Web site. For this type
of molecule, there is a high degree of technical risk, because it relies on a novel mechanism of action. The commercial risk
tends to be lower, because there is no demonstrable therapeutic alternative.
Lipitor lies at the other end of the spectrum. The fifth statin entered a market that was well defined, with a biochemical
target similar to its competitors: HMG-CoA reductase. Yet it has become the best-selling drug on the planet. For a molecule
such as this, the technical risk was significantly lower. But it carried a higher level of commercial risk as a late entry
into a market whose existing products already performed well.