AIA Board Meeting Analyzes New Neurotoxin Competition
THE Aesthetic Industry Association’s (AIA) December 16, 2022, virtual board meeting attracted dozens of top CEOs, physician KOLs, and other medical aesthetic industry leaders. The meeting program featured an expert panel that focused on trends in the cosmetic neurotoxin sector, with an emphasis on how the longer-lasting DAXXIFY (Revance Therapeutics, Nashville, Tenn.) will impact the marketplace. Also, Medical Insight’s latest research confirmed the continued global growth in the neurotoxin sector.
Michael Moretti
When assessing that growth, AIA Executive Director Michael Moretti noted dramatic changes in patient trends. “From now on, we will see a wider demographic for cosmetic neurotoxins,” he said. “Patient age, gender, and even economics are behind this evolution. For example, recently Evolus reported that the average household income of its neurotoxin patients is under $100,000. We now know that the long-held notion that facial injectable patients are all affluent one-percenters is clearly a myth.”
As presented by Medical Insight’s Senior Market Analyst Daryl Bogard, “The cosmetic neurotoxins segment is growing faster than the overall medical aesthetic market. Though Allergan Aesthetics is the market leader with BOTOX Cosmetic, the marketplace is becoming very competitive. Galderma, with Dysport, is the number two player, and the number three is Xeomin, from Merz Aesthetics. Right now, in the U. S. we have four FDA-approved products including Evolus’ Jeuveau, and we think Daxxify will launch its toxin in Q2-2023. Others like Hugel will follow. It’s going to be an interesting fight to see what kind of market share each company can gain, maintain, and grow. It’s going to be a game of unit growth, price points, and sales tactics.”
The chief impact of these changes is at the practice level, stated one KOL dermatologist, and the challenge of how to price neurotoxins. “In the past I relied on unit pricing, but with DAXXIFY I moved to pricing by anatomical area. I want to differentiate this product from some of the other neurotoxins I carry. So, I price DAXXIFY at a premium because it delivers something different, meaning a longer duration. It is also a more expensive product for the physician to buy and to profit. I priced it at 1.8 times what I charge for BOTOX, Xeomin, or Jeuveau. I keep all the other products at a more or less equal level. For example, even though I pay less for Jeuveau compared with BOTOX, I don’t under charge because I’m charging for my expertise. I’m not transactional.”
Pricing neurotoxin treatments according to the anatomical area is very common, she added. “I lot of my colleagues have done this for years. Others price by unit, as I did before. So far, my patients have responded very well. I also like area pricing because people can’t just call my office and find out what we charge per unit. That’s price shopping, which we discourage.”
A plastic and reconstructive surgeon at the AIA meeting was excited to adopt DAXXIFY in her clinic. “Patients are always interested in trying something new,” she said. “I am cautious before taking on a new product. I want a chance to see what other people think of it, and to make sure there aren’t side effects. If it lives up to the labeling and expectations — meaning maybe a six-month duration or longer — pricing will be an issue, but more important, what the individual patient needs plays a big part. There are some who may want to come back after six or nine months, and others that are higher maintenance and I’ll want to see them more frequently. Those patients may not want to have a longer-lasting toxin. Some may want a shorter acting toxin, so you can give them a bit of product each time they come back. All that being said, I think there will be a huge market sway for DAXXIFY because of the longer-lasting effect.”
According to a dermatologist and clinical investigator, who was involved in early DAXXIFY trials, “I think there’s going to be premium pricing and discount pricing in the toxin market. The plastic surgeons and dermatologists are generally premium practices, and there’s a middle tier of providers, and then discount offices like non-core medspas. We’ll see some differentiation of price point based on product, but also based on the provider. This is going to be an interesting exercise for the free market economy. Also, Revance is launching DAXXIFY in medspas and the premium offices concurrently. Where will the discounting take place?”
One must also not discount the effect of DAXXIFY on other toxin manufacturers, he added. “They can’t perform head-to-head trials with DAXXIFY because it is not yet commercially available. I suspect they will figure out various dosing strategies, in order to see how long DAXXIFY lasts. Among patients, some will get that six-to-nine-month duration, but I’m more concerned about the patient you promised six months’ duration, but they come back at four or five months all grumpy. That expectation of performance match or mismatch is really critical to success.”
Some practitioners will attempt to convert patients from one neurotoxin to DAXXIFY. “It’s easier to drive the demand rather than try to convert,” expressed another dermatologist. “Think of the patient who’s been coming to you for years, getting the same neurotoxin. If you switch on them, they’re going to pay very close attention to the result of the new toxin. Suddenly, they’ll hold you to a higher level. The worst that can happen is that we over-promise and under deliver. We’ve seen that with other injectable products and early adopters. Providers get very excited and buy the claims the manufacturer made about a product. They turn around and tell that patient, this is going to last for six months. And there’s the big promise. So, I’m not really pounding home the duration with my patients. I respond to their needs based on what they tell me. With that knowledge, I find out whether to use DAXXIFY or one of the other toxins. I’m not setting myself up for failure. All disclaimers aside, though, this is an exciting time. It means there’ll be more noise in the marketplace, more clinical trials, and more positives.”
The VP of marketing at a top injectables manufacturer company welcomes the new cosmetic neurotoxins, and the associated competition. “We have the strength of our entire portfolio behind us,” he said. “A lot of the newcomers have to rely on one or, maximum, two products. We can offer more to the patient and the provider. We also have programs that are unique, promoting loyalty to providers and patients. Ours is a combination of products and services, which are clearly differentiated in the marketplace.”
The appearance of DAXXIFY and other products is “proof of a maturing cosmetic neurotoxin market segment,” stated an executive with another manufacturing company. “The world is changing, and we’re going to see some changes in how toxins are priced. Any company in our space has to make sure that it comes to market with value-based offerings that allow for maximal profitability for practices. Providers need to believe in the science behind them and feel well supported, but we must help them engage new patients. There’s plenty of room for all of us, and I think we can have a great economic sustainability. The current brands that are out there continue to grow and develop, as well. Let’s bring more patients into the party.”
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