Does JEUVEAU make the BOTOX prices fall?

BOTOX against wrinkles continues to be in vogue, the latest statistics leave no doubt about it: Over 5 million treatments annually, so BOTOX continues to lead the charts of plastic-cosmetic medicine unchallenged, far ahead of liposuction and breast augmentation, lip injections and liposuction surgeries. Germany accounts for around 220,000 of these treatments. That’s a lot, but not very much. Even the Italians and Japanese inject more toxin per year, not to mention the Brazilians, who inject almost twice as much. Of course, the absolute largest market for cosmetic surgery, the USA, towers above all others. Almost 1.2 million times BOTOX was injected there in 2017, a record. BOTOX prices are as high as ever, so people are willing to pay a lot for their looks.

Now, of course, there are slightly more people living in Brazil and the USA than in Italy and Germany. If one therefore calculates the impressive total numbers down to 1000 inhabitants in each case, then one comes in Europe to 2, in Brazil to 3 and in the USA to 4 treatments per year. That puts things into perspective a bit, but still: In the USA, 2 more people per 1000 go to the beauty doctor than in Germany, which can make you frown (but only if you haven’t had a BOTOX injection 😊). Even more so when you know that the BOTOX prices in the USA are much higher than in this country. In view of these figures, it will surprise no one that developments that move the market for BOTOX take place first and foremost in the USA. As is currently the case with JEUVEAU.

JEUVEAU? Who or what is JEUVEAU?

JEUVEAU is new. And JEUVEAU is stepping up to shake the BOTOX market to its foundations. Better said: The company behind JEUVEAU, a startup called EVOLUS Inc. EVOLUS is in the process of launching their new top of the line JEUVEAU product into the American market. They have had FDA approval for some time, big promo events with top-selling doctors have also been behind them, at exclusive resorts on beautiful beaches. So nothing stands in the way of success.

Or better: almost nothing. Only ALLERGAN. The pharmaceutical giant. $16 billion in sales, $50 billion market capitalization, $2 billion cash in its coffers. ALLERGAN is also about to merge with another pharma giant called ABBVIE. Together they will be much more gigantic. If that’s even possible. In comparison, EVOLUS looks like the proverbial dwarf. And one has to ask oneself, with all entrepreneurial spirit, what devil is driving such a company to mess with someone like ALLERGAN? Or to put it another way: What is behind JEUVEAU that its developers are confident that they can successfully compete for market share with the top dog ALLERGAN?

JEUVEAU, which has already received approval in the USA and, according to the company, is about to be approved in Europe, is, like BOTOX, also a so-called “neurotoxin”. It inhibits the neurotransmitter acetylcholine. Like BOTOX, this makes it very suitable for treating expression lines by interrupting the transmission of impulses between the nerve and the muscle. Muscles that cause certain wrinkles are temporarily disabled. The wrinkles above them recede. In its effects, JEUVEAU is said to be comparable to BOTOX, if the results of studies published to date are to be believed. EVOLUS claims higher patient satisfaction scores and a longer lasting effect. But actual differences exist at most in the nuances when the results are closely examined. The manufacturer EVOLUS does not even try to distinguish its product from BOTOX and boldly calls it “NEWTOX” in marketing campaigns. Similarities with the hitherto undisputed market leader therefore seem neither coincidental nor undesirable.

So what is the advantage of JEUVEAU?

Apart from the manufacturer EVOLUS, no one has a convincing answer to this question. At first, it was rumored that JEUVAU would enter the market at a significantly lower price. There was talk of 20-30%, with which it would be below the usual market BOTOX prices. In the U.S., 100 so-called ALLERGAN units (AE) of cosmetic BOTOX cost the doctor about $600. The cost of BOTOX therapy for the patient is around $500 upwards, depending on the size of the area to be treated and the number of AEs required. On average, 1 AE thus costs about $12 in the United States. The theoretical price point for attacker JEUVEAU would thus be around $420. 1 AE would then cost the patient around 8 dollars. Undoubtedly an announcement.

Anyone who can undercut current BOTOX prices so deeply should surely expect to divert sufficient demand to their product. Market leader ALLERGAN (and of course the two other established manufacturers Merz and Ipsen) would thus be under pressure: either lower their own BOTOX prices as well or somehow take the new competitor out of the market, i.e.: buy it.

But how should EVOLUS be able to undercut BOTOX prices so radically? Stock market analysts speculate that, as a manufacturer focused only on aesthetic applications, the company could be more flexible in pricing than its established competitors. ALLERGAN, for example, offers BOTOX not only for the cosmetics market but also for a variety of neurological applications, such as treating bruxism or migraines. Therefore, analysts said, it must consider factors in calculating its BOTOX prices, such as the government reimbursement that exists in the U.S. for some non-cosmetic BOTOX applications. EVOLUS, which is not interested in the neurological botulinum therapy market, would not have to.

Meanwhile, however, expectations of falling BOTOX prices have become much more relative. JEUVEAU prices are probably at a similar level as BOTOX when introduced into the American market. This is what my American colleagues tell me, and it is also reported in the media. Only a voucher for 75 dollars for the initial treatment is issued by the manufacturer EVOLUS to interested patients, and they apparently make good use of it. According to the latest press release from EVOLUS, the company has probably been able to convince 3,000 practices to use JEUVEAU alongside or instead of the competitor’s product; and 2 out of 3 patients would have gratefully accepted the $75 voucher and had themselves treated with JEUVEAU.

What does this mean for Germany?

JEUVEAU does not yet have approval in this country, but it is strongly expected that it will soon. Whether EVOLUS will enter the German market with a strategy similar to that in the U.S. is an open question. In Germany, however, discount and voucher campaigns like those in the U.S. are not so easily possible, and EVOLUS will have to make adjustments at least in the design of its market launch. Whether this could actually mean that BOTOX prices will fall in this country? That remains to be seen.

Manufacturer ALLERGAN, at any rate, is keeping a low profile. On my explicit question about JEUVEAU to my ALLERGAN representative, she said during her last visit that she knew of nothing. No information. No plans. No news. And the BOTOX prices continue to be where they have been.

For now at least …