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Inhaled Insulin Becomes Billion Dollar Blunder

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Pharmaceutical giant Pfizer recently announced it will stop selling Exubera, a relatively new inhaled insulin product. The tab for this marketing mistake is $2.8 billion, one of the biggest boondoggles in the history of the industry.

Exubera is not being yanked because it doesn’t work or has a known safety problem. It simply flopped in the marketplace. Too few patients decided to take Exubera, so it was cheaper for the company to stop selling it than to keep on manufacturing and marketing this medication.

The company was apparently surprised to learn that diabetics and their doctors weren’t exuberant about Exubera. If they’d asked patients at the outset, they might have avoided a $2.8 billion debacle.

If you start with incorrect assumptions, it’s hard to reach the right conclusion. Pfizer made two assumptions, both incorrect, about people with diabetes who use insulin.

First, Pfizer assumed that most diabetics find injecting insulin so unpleasant that they’d do almost anything to avoid it. Some people with diabetes would like an alternative to injection, but most don’t find modern insulin pens difficult or painful to use. In addition, insulin pumps are in widespread use. As a result, instead of two or more injections a day, many diabetics need to inject the tip of a slender plastic line under their skin just once every few days.

The second incorrect assumption was that people with diabetes would not be concerned about potential long-term health effects of blowing powdered insulin into their lungs for the rest of their lives. There is no data to suggest that this is a problem for otherwise healthy diabetics, but product testing is short term and doesn’t always reveal what may happen over years of use.

Smokers and asthmatics are warned against using Exubera. Even those without lung problems are cautioned to get regular lung function tests.

Exubera has other problems as well. It costs more, around $5 a day compared to $2 or $3 for injectable insulin. Exubera doesn’t work any better, though. The inhaler is large and cumbersome. It is challenging and time-consuming to adjust the dosage, especially since Exubera doses are calculated in grams. Physicians and patients alike are much more familiar with the international units (IU’s) used for all other insulin products.

Pfizer failed to get physicians excited about Exubera. As a result, many weren’t willing to take the extra time needed to teach patients how to use inhaled insulin properly.

Pfizer’s stockholders are no doubt disappointed by the $2.8 billion loss, and perhaps equally upset by not making the projected $2 billion Pfizer had foreseen for this product. Some people worry that the tab for this marketing mistake might one day be added to the cost of other medications in the company’s portfolio. That means patients could pay for this miscalculation.

Other companies should pay attention to Pfizer’s faux pas. If drug company executives had bought dinner for groups of people with diabetes and their physicians they could have asked them what they thought about inhaled insulin. This might have left Pfizer execs breathless, but saved the company billions.

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Re: your recent article on defribillaters. Why is it I can buy a car jumper for $50 and yet these things cost over $1200 for the last 5 years at least; are the public not being held hostage here??? john

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