AN UNTAPPED OTC MARKET

Men’s Health: An Untapped OTC Market Published by Nicholas Hall’s Reports, July 2014 © Nicholas Hall & Company Guernsey

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Definitions & Methodology

Definitions

An oblique mark (/) is used to show the ultimate owner of a company, e.g. “McNeil / Johnson & Johnson”; the term “for” is used to indicate that the former company markets a brand under license from the latter, e.g. “Novartis for Boehringer Ingelheim”.

The term “mass market” is used to mean sales through non-pharmacy retail outlets.

“Principal markets” or “key markets” for a given company are examples of some of the most important countries or regions where the company generates sales, rather than an exhaustive list of countries where it markets products.

OTC Market Definition

Market sizes, growth rates and brand sales are, unless stated otherwise, based on Nicholas Hall & Company’s global OTC database, DB6. All data is being updated continually, and is believed to be accurate at the time of going to press.

All OTC market data contained in this report is expressed at manufacturer’s selling prices (MSP), although it relates to consumer purchases. Sales data includes all non-prescription sales. Data includes retail sales in all outlets. Mail order, multi-level, e-commerce and other non-retail sales are not included.

Sales data is for the calendar year January-December for each year shown, unless otherwise stated. All data is calculated in local currency and converted to US dollars at the exchange rate that applied on 31 December 2013. The symbol $ refers to United States dollars unless otherwise stated.

Under-the-counter (UTC) sales are not included except in countries where there are few or no legal OTCs (such as Turkey) where UTC sales are included for products that fall within the DB6 category definition and would be considered consumer items in most established OTC markets.

Non-prescribed sales of semi-ethical brands (which can be sold both with and without a prescription) are included in all sales estimates. Prescription sales of OTC-registered brands are included where these sales are significant. Sales of traditional medicines (e.g. TCM, jamu and ayurvedic), homeopathic medicines, food supplements and medical devices are included where they are packaged and positioned alongside registered OTCs.

A+P advertising & promotion

BTC behind-the-counter

j-v joint-venture

L&A licensing & acquisition

MSP manufacturer’s selling price

M&A merger & acquisition

OTC over-the-counter

POS point-of-sale

Rx prescription

SPD separation of prescribing and dispensing

UTC under-the-counter (illegal OTC sales of Rx-only products)

Abbreviations

4

OTC Market Definition (continued)

Manufacturers’ sales data is based on branded products alone. Manufacturers’ sales do not include any private label sales to retailers or bulk sales of unbranded products to other manufacturers or distributors. Sales of individual private labels are included in “others” in each sub-category.

Sales data for each manufacturer includes sales made by any national or international subsidiaries.

All acquisitions are added to manufacturers’ historical data so growth excludes the effect of M&A activity.

Volume sales, where available, represent the absolute number of packs sold (unadjusted for size / dosage).

All forecasts take into account published socio-economic and demographic forecasts plus OTC-specific factors such as switch, regulatory change and historical trends.

Featuring unique insight from the European Men’s Health Forum

The European Men’s Health Forum (EMHF) was established in 2001 and is an autonomous, non-profit-making, non-governmental organisation based in Brussels.

EMHF is the only European organisation dedicated to the improvement of men’s health in all its aspects. Its vision is a future in which all men in Europe have an equal opportunity to attain the highest possible level of health and wellbeing. Its mission is to improve men’s health across all countries in Europe by promoting collaboration between interested organisations and individuals on the development and application of health-related policies, research, education and prevention programmes. EMHF is committed to gender equality and fully supports activities to improve women’s health.

www.emhf.org

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Table of Contents

Definitions & Methodology 3

Introduction 7

Men’s Health: a neglected area 7

Men’s Health: an OTC opportunity 9

Men’s Health in Context 10

Key areas for concern 10

Barriers to access 12

Positive trends for men’s health 15

The OTC potential 20

Changing Attitudes 21

Change is essential 21

The power of stereotypes 22

Moving beyond stereotypes 28

The impact of “man flu” 30

Manflu (Manflu) 32

Beauty ≠ Health 33

Healthcare professionals 34

OTC Areas for Men 35

Demographic context 35

Age-related concerns 37

Health maintenance 40

Cosmetic concerns 43

Active lifestyles 45

Sexual health & fertility 48

Poor lifestyle choices 50

Berocca (Bayer) 52

Essentiale (Sanofi) 54

Flomax Relief (BI) 56

Lamisil (Novartis) 58

Menevit (Bayer) 60

Osteo-Bi-Flex (NBTY) 61

6

Oxy (Rohto) 62

Prilosec (P&G) 64

Prostamol Uno (Menarini) 65

Regaine / Rogaine (J&J) 66

Voltaren (Novartis) 68

Wellman (Vitabiotics) 70

The Role of Pharmacy 72

Barriers to access 73

Opportunities for pharmacies 75

Pharmacy Point-of-Care 81

Opportunities for OTC marketers 82

Empowering pharmacists 84

Utilising Technology 86

Wearable tech 86

Mobile apps 88

The gamification of health 89

Changing retail environment 90

Technology at point-of-sale 91

Online resources 92

Rx-to-OTC Switch 97

Drivers of switch 97

Sexual health 98

Cialis (Eli Lilly) 100

Viagra (Pfizer) 102

Cholesterol / lipid-lowering 105

Lipitor (Pfizer) 106

Omacor (Pierre Fabre, Abbott) 107

Overactive bladder 108

Hair loss treatments 109

Smoking control 110

Conclusion 111

7

Introduction

• Women live longer than men in virtually every country in the world with men experiencing a higher mortality rate than women for almost every comparable major cause of death, and this cannot simply be explained by biology

• While there are differing innate health risks between men and women, the differences in men’s health outcomes between different countries and between different demographic groups within individual countries suggests that other causes, such as lifestyle, social and environmental factors, provide a much better explanation

• Historically, the common consensus has been that men are to blame for their own downfall, with lifestyle choices (smoking, drinking alcohol and eating a poor diet) and a refusal to interact with healthcare professionals leading to the inevitable conclusion of poor health

Men’s Health: a neglected area

“We need to acknowledge that we are losing a significant proportion of our working age men through

premature mortality”

– Professor Alan White, The State of Men’s Health in Europe

28%

17% In the UK significantly more

men than women die from

avoidable causes

76

pharmacist about any niggling health concerns they had

• On-the-ground research found that men were unwilling to visit their GP for what they considered minor health concerns, and relied upon their partners to look after their health for them

• The campaign had a humorous edge, with free ear plugs for the long suffering wives and partners of the target audience available at pharmacies

• Pharmacies displayed bold PharMANcy stickers in their windows, encouraging men to get “quick and easy help and advice from your local pharmacist”

• Four key benefits of pharmacies were highlighted:

» No appointment necessary

» Private consultation room

» Highly qualified staff

» Convenient opening times

• In addition, a range of promotional material, including beer mats, ads in local papers and handing out flyers in the town centre, reached men in a non-pharmacy setting

• Pharmacy staff attended a half-day programme designed to cover key areas, including gender differences in communication and techniques for building rapport

• While the campaign was not successful in its attempt to get more men to use the pharmacy, it did lead to a great deal of learning about the barriers

• The response from the pharmacy staff was extremely positive, with their knowledge and skill reportedly increasing by 79%

• Other NHS initiatives have included health checks, such as the Birmingham Heart MOT pilot, which was open to men and women, but marketing targeted men, while women were encouraged to bring their male partners

• This clearly illustrated that marketing can reach out to men, as 60% of the participants were men

• In Knowsley a project piloted the use of community pharmacists to deliver health checks in a pharmacy setting

• 64% of the respondents had not been to a pharmacy for health advice before, but all but one was likely to recommend the checks in pharmacies to other men

• Success was also achieved in signposting clients to other services, illustrating how health checks can form an initial point of engagement for further pharmacist intervention

NHS initiatives

• NHS North Yorkshire and York launched the “No more niggles” campaign in 2011, aimed at encouraging middle aged men in Scarborough to talk to their local

61

Osteo-Bi-Flex (NBTY)

Overview

• NBTY’s Osteo-Bi-Flex is the leading herbal & natural joint health OTC brand, despite its limited international presence

• Brand’s success is a result of its patented formulas and continued A+P support

• Many of the wide array of joint health supplements marketed under the Osteo-Bi-Flex banner contain at least one of the company’s two patented formulas, Joint Shield and 5-LOXIN Advanced

How men are targeted

• Looking at the key men’s health areas, Osteo-Bi-Flex targets older men concerned about osteoporosis, as well as younger men whose physical activity could create wear and tear on their joints

• The range has a number of presentations, and activity levels are a key differentiator between the available products

• TV ads have focused on the former category, with ads generally featuring middle-aged people unrestrained by joint pain (see right)

• TV ads over 2013-14 showed middle-aged men and women dancing after taking the supplement, as well as the tagline, “the best stuff in the joint”

Categoryherbal & natural joint health

Leading MarketsUS (98%)

Turkey (1%)

Sales 2013 $164.6mn

Growth 13/12 +6.5%

CAGR 13/09 +4.9%

09 10 12 1311

+1%+8% +5%

+7%$

13

5.7

mn

$1

37

.0m

n

$1

47

.6m

n

$1

54

.5m

n

$1

64

.6m

n

43

Cosmetic concerns

Hair loss

• Hair loss is a significant concern for men, and can affect them from their 20s onwards

• While OTC options for women do exist, it is one of the few OTC areas that is primarily male-focused

• After a period of disappointing sales over 2009-12, which saw the category drop from $903mn to $791mn, there was strong growth in 2013, with the emerging markets helping drive global sales up to $828mn

• Hair loss can affect confidence and relationships and, according to one survey, men experiencing hair loss are willing to go to significant lengths to have a full head of hair: 10% would give up a year of their life and 38% said they would prefer to stop drinking alcohol for a year than lose their hair

• According to www.askmen.com articles on hair loss are one of the website’s most clicked through

• Half of a man’s head of hair will be gone before it becomes cosmetically visible, so a key message for OTC marketers is the necessity of treating the condition early

• The leading treatments are topical options formulated with minoxidil, such as J&J’s Regaine (see p66)

• However, systemic herbal remedies do form a notable portion of the lower tier

• This is one category that could see expansion through Rx-to-OTC switch (see p108)

Acne remedies

• Despite the prevalence of male acne, the majority of the OTC acne remedies category, which reached sales of $1,891mn in 2013, consists of products aimed at women

• One male-focused option that reaches the top tier is Rohto’s Oxy, which is positioned for teenage boys (see p62)

• In addition, there is a notable recent trend towards male-oriented products, with a number of new launches in this niche

• In Japan in 2013 Kao launched two products aimed at male consumers, Men’s Bioré acne face wash and facial lotion

65% 20% 43% 66% 90%

of balding men cite hair loss as their No.1

cosmetic concern

of all men will experience some hair loss by the

time they turn 35

of men in their 30s have acne

of men in their 20s have acne

of men in England are overweight

or obese

30

• ‘Man flu’ is a common term in many countries (particularly the UK and Australia) reflecting the idea that men exaggerate the symptoms of a common cold, dramatising their suffering and making out it is a more serious illness

• The idea is reflected in popular culture across numerous mediums (see right)

• Many OTC marketers have embraced the term, running successful humourous ad campaigns

• However, when considering the wider context of men’s health, joking about man flu could be having a negative impact on men’s attitude to their own health, and their willingness to interact with healthcare professionals

• One study found that 43% of men felt that the term ‘man flu’ was denying them the right to be ill, while 52% felt it was preventing them from seeking advice for a legitimate illness

• As cold & flu remedies are the domain of OTCs, marketers should be rejecting this idea of ‘man flu’ to ensure that their male customers do not feel unable to purchase the products they need

• In the UK the stereotype was echoed by leading pharmacy chain Boots, with an ad featuring the tagline: “when he’s ill and you don’t have time to be – get cold and flu products for just 99p at Boots”

• This prompted complaints, although the Advertising Standards Agency did not take action

• What it reflects, however, is that pharmacies view women as their intended customers and while they continue to do so – and if they do so in a way that denigrates men – there is unlikely to be a shift in purchasing patterns

• However, ‘man flu’ has also been used as a successful hook in attracting male consumers, utilising the humour opportunities of the stereotype

• In Poland USP launched a Man flu campaign for its cold & flu brand Gripex

• This included TV, outdoor and online ads focusing on men coming down with cold & flu symptoms, and the different methods they had for coping

• The campaign received a lot of attention, particularly on social networking sites, gaining notoriety owing to its comical use of gender stereotypes, helping to boost sales in both mass market (responsible for around 20% of brand sales) and pharmacy channels

• It also went on to win gold in the European Excellence Awards in the health category

The impact of “man flu”

27

• It is within this context that Pfizer’s Viagra launched, and the success of the brand can definitely be linked with the strength of its advertising

• Viagra is a strong example of how male stereotypes can be utilised as a driving force for change in relation to men’s attitudes to health

• The first spokesperson for Viagra, Bob Dole, was a presidential candidate in the US; he was a respected figure in the country, and his openness and manner of discussing the problems he had as a result of prostate cancer ensured that the product was not seen as something only used by weak men

• Advertising for Viagra in later years moved further into embracing male stereotypes, reinforcing the idea that real men could suffer erectile dysfunction

• Pfizer has presented Viagra as a practical solution to a practical problem (far from a source of shame): the people that take it are confident with themselves, and simply take a medication for a physical condition without considering what anyone else might think about it

• Pfizer has, in effect, rewritten what it means to have erectile dysfunction by utilising the very stereotypes that make it such an uncomfortable issue for men in the first place

Viagra • Impotence forms the punchline to many jokes, and can be seen in many ways as the antithesis of manliness, where virility is often associated with success

18

• The concept of ‘Men’s Sheds’ originated in Australia in the mid-90s at a Men’s Health Conference, and there are now over 850 in Australia, with the concept spreading to countries including Canada, Ireland, the UK and other European countries

• Men’s Sheds are venues where older men can meet and participate in practical activities, such as learning a new skill, and generally socialise with their peers in a welcoming environment

• Men’s sheds have been shown to cater informally but very effectively to the social, wellbeing and learning needs of older men, and have also been utilised to raise awareness of specific health issues through guest speakers and events in collaboration with local health service providers (see right for health check-up campaign)

• One of the reasons that the Sheds have found such success in Australia is that any health benefits or health education is a secondary benefit; as one user commented, “if sheds were promoted as a men’s health strategy [...] men would turn away in droves”

Cosmetic concerns

• Grooming products for men are a fast-growing category, which has helped to normalise the idea that men can and should ‘look good’

• Male celebrities, such as the footballer David Beckham and actors Hugh Laurie, Clive Owen and Steven Seagal, have publicly associated themselves with this trend through product endorsement

• The rise in the incidence of relationship breakdown – marriage can no longer be assumed to be ‘until death us do part’ – has meant that an increasing number of men in their 30s, 40s and 50s are looking for new relationships and many feel that to be successful they need to be ‘in good shape’ physically, which can help to encourage better self-care

• The ‘ideal’ male body is now on widespread public display and explicitly held to be the look that men should aspire to (e.g. the front cover of every Men’s Health magazine) and that women desire (e.g. the Diet Coke ‘gardener’ ads)