Trailblazer

When Hilarion Henares insisted on buying two coronary stents, Johnson & Johnson Medical Phils. managing director Bayani Santos, Jr. was placed in a quandary. "Larry Henares is an informed heart patient. At that time, he insisted on buying our Cypher Sirolimus-eluting stent , which had not yet gotten approval from the Bureau of Food and Drugs. We had to get a special one-time dispensation from BFAD," he said.

Cypher, the J&J trademark for a drug-coated stent, got the BFAD nod last Aug 28, making the Philippines the third Asian country after Singapore and Malaysia to sell the product. (Unlike the Philippines, Singapore and Malaysia do not require government approval to locally sell food and drugs).

A scaffolding device, the stent is a small, stainless steel tube mounted on the balloon that is inserted into the artery during angioplasty. The use of a stent, which costs about P140,000 per lesion (a lesion requires a single bypass; two lesions, a double bypass), enables a heart patient to get up and go back to his/her regular activities within three to five days.

"We haven’t increased market prices despite the very good market response to Cypher and fluctuations in the peso-dollar rate," said Santos. "Because we didn’t expect that kind of demand, our plant in the Netherlands has had, however, to make production adjustments. Sometimes, heart patients have to wait for delivery."

Value proposition

Unlike its competitors, JJMP does not sell its medical devices through distributors. Its 64-man sales force deals directly with doctors. Some of the orders are, however, made by doctors at the insistence of informed patients like Henares.

"There’s a value proposition in selling any product where there are other alternatives. It’s not necessarily the price that closes the deal but the perception of value by either the patient or his/her doctor," said Santos.

For example, Cypher’s value proposition is a significant reduction in the restenosis rate. Of the 1.3 million people who undergo balloon angioplasty ever year, 25% to 30% result in restenosis (which is caused by repeat build-up of fatty deposits or the growth of scar tissues at the artery wall that was disturbed by the placement of a stent). It is estimated that 20% to 30% of patients with restenosis go through another angioplasty within six months of the initial procedure.

"Cypher eliminates restenosis through the consistent and controlled release of an active drug to control cell growth while reducing the risk of blood clot formation. The drug, known as Sirolimus, is a naturally occurring antibiotic marketed by Wyeth Pharmaceuticals under the name, Rapamune, to prevent renal transplant rejection," said Santos. "J&J has an exclusive worldwide license agreement with Wyeth for the delivery of Sirolimus via a stent."

JJMP markets Cypher only in Metro Manila and Cebu in part because a CAD laboratory is a requirement and in part because these are the home bases of the country’s 20 interventional cardiologists. There are currently 10 hospitals in Metro Manila and three hospitals in Metro Cebu which can do stent implants.

Leadership role

Cypher is the result of a $500-million research and development program. "We believe in taking a lead role in innovation. We blaze the trail and doctors, like consumers remember the first one in the market," said Santos.

Additionally, JJMP uses key thought leaders in the United States and Asia to push its products, which include a hip and knee replacement systems and a stapler-like device to treat hemorrhoids, within the medical community.

"In the United States, the medical device business is big," said Santos, whose company is better known in the Philippines for its consumer health care and pharmaceutical products. "For the business to increase here, the question of who ends up paying the bill (or asked another way, can it be treated like medical insurance) must be answered."