Does JEUVEAU make the BOTOX prices fall?

BOTOX as wrinkle treatment continues to be fashionable, the latest statistics leave no doubt about it:  Over 6 million treatments per year, which means that BOTOX continues to top the charts of aesthetic medicine unchallenged, far ahead of liposuction and breast augmentation, lip injections and liposuction surgeries. Germany accounts for around 400,000 of these treatments. That’s a lot. Brazil saw a similar number of treatments. Of course, the absolute largest market for cosmetic surgery, the USA, towers above all others. Almost 1.5 million times BOTOX was injected there in 2020, a record. BOTOX prices are as high as ever, so people are willing to pay a lot for their looks.

That’s even more impressive when considering that BOTOX prices in the USA are much higher than in Germany. Considering these figures, it will surprise no one that developments that move the market for BOTOX take place 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 U.S. market. They have had FDA approval for some time, big promo events with top-selling doctors are also 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 on hand. 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 mimic wrinkles by interrupting the transmission of impulses between the nerve and the facial muscle. Muscles that cause certain wrinkles are temporarily paralysed. 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 previously undisputed market leader therefore seem neither coincidental nor undesirable.

So, what is the advantage of JEUVEAU?

Apart from the manufacturer EVOLUS, nobody has a convincing answer to this question. Initially, it was rumoured that JEUVEAU would enter the market at a significantly lower price. There was talk of 20-30% discount to the prevailing market price of BOTOX. In the U.S., 100 so-called ALLERGAN units (AE) of cosmetic BOTOX cost the physician about $600. The cost of a BOTOX therapy for the patient is around $500 upwards, depending on the size of the area to be treated and the number of AEs needed. On average, 1 AE thus costs about $12 in the United States. The theoretical price point for challenger JEUVEAU would thus be around $420. 1 AE would then cost the patient around 8 dollars, or 4 dollars less than Botox. Undoubtedly, that would be significant.

Anyone who can undercut the current BOTOX prices so deeply should certainly be able to count on diverting sufficient demand to his 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 in the first place? Stock market analysts speculate that, as a manufacturer focused only on aesthetic applications, the company could be more flexible in its 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 neurological treatments, would not have to.

Meanwhile, however, expectations of falling prices have clearly been put into perspective. JEUVEAU prices are probably at a similar level to BOTOX when it is launched on the American market. This is what my American colleagues tell me, and the media report similarly. Only a voucher for $75 for the initial treatment is issued by 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 medical 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 has not yet been approved in Germany, but it is strongly expected that this will happen soon. It remains to be seen whether EVOLUS will enter the German market with a similar strategy as in the USA. 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. When I explicitly asked my ALLERGAN representative about JEUVEAU during her last visit, she said she knew nothing about it. No information. No plans. No news. And the BOTOX prices continue to be where they have been.

At least for now …

Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich