Life Science Leader Features Stefan Weber, CEO of Newron Pharmaceuticals SpA, on Drug Company Discovery & Commercialization

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Drug Company Discovery & Commercialization: An Election Year Analogy

stefanweberBy Stefan Weber, CEO and Executive Director, Newron Pharmaceuticals SpA

When smaller, boutique drug companies move from precommercial discovery to postcommercial marketing, they can experience a shock. Precommercial work is typically rigorous and controlled with trials conducted in sequential fashion and oversight done by recognized governing bodies. Of course there can be detours along the way, but generally speaking, the path itself is well-known. In contrast, postcommercial work expands the ecosystem and, therefore, brings with it an increasing number of participants, functions, relationships, and unknowns.

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Oticon uses pupil size to develop new hearing devices and measure brain strain

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Amanda Pendersen
Medical Device Daily
August 4, 2016

Oticon Inc. is using pupillometry science – a measurement of pupil dilation – to develop hearing aid technology designed to reduce listening effort and conserve energy so that people with hearing loss remember more of what they’ve heard.

In a recently completed study, researchers at the Denmark-based Eriksholm Research Center and the VU University Medical Center investigated how hard the brain has to work to understand speech in different environments and how that knowledge could be leveraged for use in new hearing devices.

Thomas Behrens, head of audiology for the center of applied research at Oticon, told Medical Device Daily that when people pay attention to sound, the muscles in their eyes contract and release based on listening effort. The more challenging the task, the larger the pupil.

“Hearing loss imposes a load on the brain,” he said. “It’s more difficult for the brain to get some of the little details in speech and to separate foreground noises from background noises.”

In most social situations, such as a family dinner or eating at a restaurant, it’s harder for the brain to function because there are multiple people speaking and other noise going on in the background.

In the study, researchers showed how pupillometry could be used to measure strain on the brain’s processing power when trying to understand speech. The results allowed Somerset, N.J.-based Oticon to measure how technology in the company’s new Oticon Opn hearing aid not only reduces listening effort, he said, but also allows people to save energy so they can remember more of the conversation.

Oticon’s technology is designed to open up different environments for people with hearing loss by removing background noise to make it easier for their brain to process what they’re hearing, Behrens said.

The researchers reported that in the study, which included 24 people, in looking into the eyes of Opn wearers compared to people with the company’s older Alta2 Pro hearing aids, they saw 20 percent less listening effort when trying to understand speech while others are speaking. Additionally, they saw an average reduction in peak pupil dilation of 26 percent during the speech-noise reduction task using Opn compared to Alta2 Pro.

“We placed speech and noise all around the person to mimic the family dinner,” Behrens said. He said the Opn reduced cognitive load for study participants by about 25 percent. This provided an objective measure of the cognitive load imposed by hearing loss, which is something audiologists have long searched for, he said, as most research in this area is based on more subjective measures.

Without the help of a hearing aid like this, he said, people with hearing loss get tired easily in these environments and tend to avoid social situations. But that’s not the best solution, he said, because social situations stimulate the brain in many good ways and works against Alzheimer’s and reduces cognitive decline.

“Social situations activate those parts of the brain that you need to keep fresh,” he said.

The company is now tasked with continuing to develop and improve the technology based on user feedback. One of the key challenges Oticon has faced in developing Opn, Behrens said, is actually limiting the technology’s power because early testers of the device reported that it was too effective and reduced too much of the background noise.

“We know we have a lot of power in this technology,” he said.

In the near future the company also wants to explore more ways to make the device more integrated with the wearers brain and more automated than they are today, Behrens said.

The company has started to receive feedback on the technology from people who have used Opn after suffering from hearing loss for many years. For example, Behrens said one person who uses the device is a lawyer who told the company that before having Opn he wasn’t really able to sense what mood people were in – something that made it difficult for him to be fully effective in court.

Others have reported a notable reduction in their anxiety levels because the device gives them the extra cognitive capacity they need to be more certain about what they are doing.

“People feel more free and empowered to live their life the way they want,” Behrens said.

For Tennessee pageant winner, hearing matters

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Jessica Bliss
The Tennessean
August 1, 2016

Emma Conn, who is representing Tennessee in the Miss United States Pageant, was born with sensorineural hearing loss. It inspired her pageant platform: Hearing Matters.

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The lowest tones troubled her the most.

The voice of an older woman.

Most any man’s, including her teachers.

Emma Conn never quite heard them clearly. She had to concentrate on every word. She processed slowly based on context, filling in the blanks of sentences that sounded incomplete in her ears.

She assumed, for a long time, that everyone heard the way she did.

Oh, she knew she had hearing loss — congenital and genetic. Her mother had it. So did her grandfather.

But she never realized to what extent until the day she didn’t have to struggle anymore.

It took 16 years.

Now, with the miracle of ear technology, this Page High School senior can hear more fully.

She can understand the lectures from her teachers in the summer school composition and history classes she takes at Columbia State Community College.

And, just as exciting for her, this pageant queen — who will represent Tennessee in this week’s Miss United States Pageant in Las Vegas — can fully hear the questions being asked by judges.

It all happened just a couple weeks ago.

This week, Conn carries a message of her struggles in her pageant platform: Hearing Matters.

The ‘party in their heads’

The rustling of the leaves. The air conditioner turning on in their house. All the sounds Emma and her mom, Shannon Conn, couldn’t hear before.

“You don’t realize what you don’t know,” Shannon Conn said. “What you miss.”

Emma Conn’s hearing impairment became apparent at age 5. An audiology test confirmed that she had sensorineural hearing loss, which occurs when there is damage to the inner ear or the nerve pathways from the inner ear to the brain.

Most of the time, this type of hearing loss cannot be medically or surgically corrected.

“I got the bad trait,” Emma Conn jokes.

At the time, more than a decade ago, technology couldn’t compensate for what she lacked. No hearing aids existed to help Conn collect the low-decibel sounds she lacked.

So she learned to accommodate. She sat in the front of class. She focused on people’s mouths, trying to read lips.

She got by. Just like when you see a sentence with missing words, you can still fill in the context. Conn did that with conversations.

And she excelled, taking Advanced Placement classes at school and carrying a 4.0 GPA. Pursuing summer classes for college credit as she applies for admission to Northwestern and Vanderbilt.

But she still got lost sometimes. Even if someone spoke loud enough to hear, it could still be sound unclear or muffled. It became difficult, sometimes, to pick out words against background noise. If someone tapped a pencil against the desk in the seat next to hear, Conn couldn’t concentrate on anything else.

“In the classroom, I knew I was missing things I was going to need,” she said.

And when Conn started competing in pageants, she faced other challenges. Often, judges sat six or seven feet away when they asked interview questions, making it difficult to make out what they said.

She has a video of a judge asking her the best thing about high school. She rambled on about her school’s history, not fulling comprehending what was asked.

Another time, she had to ask a judge to repeat the question three times from her spot several feet away. Finally, she just walked right up to the judges table and asked again.

She left embarrassed.

No one ever labeled her. But she knows other kids, whose hearing loss is more significant than her own, do face bullying and isolation. About two to three out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears, according to the National Institute on Deafness and Other Communication Disorders.

That’s why she made hearing matters her pageant platform.

“I want kids not to feel like they are apart from others,” Conn said.

But it’s not simple. Hearing is so expensive.

A survey published by the Hearing Review, suggests the average price of a mid-level pair of aids hovers between $4,400 and $4,500. Medicare and many private insurance agencies do not cover hearing aids, leaving many families without the assistance they need.

For years, Conn’s mother tried one type of hearing aid after another, spending up to $6,000 on each. None really helped her. She knew it wouldn’t help her daughter either.

Finally, technology caught up.

The family’s audiologist introduced Shannon Conn to Oticon’s new Opn hearing device, and suddenly she could hear new sounds. The hearing aid cost $8,000. Insurance, Shannon Conn said, covers $2,500.

But they were lucky.

The hearing aid company wanted to sponsor Conn, the Miss Junior Teen Tennessee United States, as part of her pageant run. Free hearing aids and a whole new world of understanding.

The first time she put in the hearing aids, Emma Conn cried.

“It was just powerful,” she said. “I spent my whole life being frustrated. In that moment, I felt one step up.”

If Conn wins the Miss United States Pageant in Las Vegas, she wants to travel the country talking to school boards and state officials, convincing them to prioritize the issue of hearing loss in students and provide the technology tools they need to learn.

“People look on the outside of Emma and not on the inside,” Shannon Conn said, “and they miss a lot of that disability, because they don’t realize.

“Now, she doesn’t have to be insecure, so she can perform at the best of her abilities.”

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Oticon’s hearing aid uses AI: Are high tech tools for hearing loss ignoring mass market?

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Varun Saxena
MedCity News
July 5, 2016

oticon_opn_in_handDenmark’s Oticon is tackling an unmet need among the hearing impaired with its recently launched Oticon Opn high-end hearing aid. Company vice president Don Schum touted Opn’s ability to provide natural hearing in loud environments with multiple speakers.

It’s the first hearing aid to use Oticon’s new Velox data processing platform, which apparently increases speech understanding by 30 percent, and with less effort required.

“Patients who have hearing loss, especially sensory-neural hearing loss, are at a great disadvantage anytime there is other noise in the environment, especially other people talking,” Schum said. “It’s due to the nature of hearing loss. It creates a certain amount of distortion in the auditory system, and when that distortion is spread the brain has a really hard time picking out the talker that the person wants to listen to, and suppressing other talkers.”

Hearing aid companies have served customers facing complex hearing environments using so-called “narrow beam forming,” but it isn’t a very satisfying solution, according to Schum.

“It creates a very unnatural listening experience, because you always have to be looking at only the one person you want to talk to,” he said, adding “People don’t want to only stare one person at a time. It’s just not the natural way to do things.”

Oticon says Opn enables better hearing in complex environments by enabling a wider listening field so that patients can listen to more than one speaker at a time. It achieves this feat using a noise reduction system that updates itself every 10 milliseconds.

Opn can also leverage the Internet of Things. Using the web-based, If This Then That (IFTT) platform, the presence of a low battery can result in an automatic text message being sent to caretakers. And external objects on the IFTTT network, such as doorbells, can be programmed to interact with the hearing aid via algorithms known as “recipes.”

Oticon began commercialization of Opn in June. It must be fitted by a licensed professional prior to use. Audiologists obtain the hearing aid on a wholesale basis from Oticon and set the sales price according to local market conditions Schum said. Therefore, he wasn’t able to provide a specific price for the product, though he said it will be at the high-end of the market.

It’s likely that lower-end versions will be made available over the coming years, for Schum explained that hearing aid companies typically launch premium products when they create a new platform and add less expensive devices over time.

Opn debuts as the hearing aid market receives renewed attention from investors, who were no doubt encouraged by the January 2015 sale of Siemens’ hearing aid unit to a Swedish private equity firm in exchange for $2.68 billion.

Hearing aid company Earlens recently raised $51 million for its FDA-approved Contact Hearing device, which emits infrared light to create the perception of sound. It too seeks to improve natural sound quality and reduce feedback.

New Enterprise Associate is one of the main backers of Earlens. It also led a $25 million financing of Eargo, whose device’s main pitch is its invisibility (at least externally).  And at almost $2,000, the company says its device is about half the standard price.

The FDA has also shown interest in hearing aids, and in April hosted a public workshop on improving their accessibility, usage and innovation of the devices, for Schum said the three-quarters of the hearing impaired population do not use any devices.

And med tech can play a role improving the lives of the deaf too.1776 Challenge Cup pitch competition finalist Pedius, based in Italy, is developing an app that enables the deaf to communicate over the phone by converting their text messages to speech.

Oticon launches hearing aid that lessens cognitive load

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Amirah Al Idrus
Fierce Biotech
June 21, 2016

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Denmark’s Oticon is tackling some issues that plague current hearing aid technology with the launch of its Opn device.

While hearing aids can improve quality of life, they still encounter some problems, including the inability to filter out background noise, such as traffic or multiple people speaking at once. The Opn hearing aid uses an “open sound”approach, allowing it to handle multiple speakers and noise sources in “complex listening situations,” the company said in a statement emailed toFierceMedicalDevices.

“With Opn we’ve taken a giant leap forward–for both hearing aids and the Internet of Things,” said Oticon President Søren Nielsen in the statement. “The potential of IoT is vast, but on a consumer level we’ve largely seen devices that focus on convenience. With Opn, the Internet of Things starts to matter–you could say that this will change people’s lives.”

The company touts its BrainHearing tech, which makes the device the first hearing aid that is “easier” on the brain. It makes listening more comfortable and improves memory and understanding by supporting the brain’s ability to interpret sound and reducing the mental effort required to do so. In a study that pitted it against Oticon’s older Alta2 Pro hearing aid, the Opn increased speech understanding by 30% while reducing listening effort by 20%.

In addition to improving hearing, the device offers increased connectivity. It supports communication between two hearing aids for a more natural hearing experience and uses Bluetooth for wireless communication with mobile phones, music players and the like. The Opn also connects to the internet through the If This Then That service, allowing a user to connect to a number of IFTTT-enabled devices, such as doorbells, smoke detectors and thermostats.

more opnOticon isn’t the first company to take on the challenges of the hearing aid. Menlo Park, CA-based Earlens raised $51 million last week to support the launch of its laser-based hearing aid. Its Earlens Contact Hearing Device converts sound waves into pulses of light, which are then converted into sound vibrations that are sent directly to the eardrum. Meanwhile, Mountain View, CA-based Eargo picked up a $25 million Series B last year to market its “invisible” in-ear device.

Even Hearing Aids Are Connecting To the Internet of Things

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David Meyer
Fortune
June 23, 2016

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Opn hearing aid can hook up with doorbells and smart lighting systems.

One of the world’s biggest hearing aid manufacturers, Denmark’s Oticon, has introduced a new hearing aid called Opn that it says is the first of its kind to be part of the “Internet of things.”

It’s certainly not the first hearing aid to be able to connect to iOS and Android devices for audio-streaming and adjustments—the likes of ReSound’s Linx2 can do that too. However, the Opn hearing aid can also hook up to other Internet-connected devices such as doorbells, smoke detectors and baby alarms, so the user can better hear important alerts.

Opn does this through If This Then That (IFTTT), the platform that lets people set up “recipes” for triggering certain reactions when certain things happen. A basic example of such a recipe might be an incoming text message from a particular person causing the user’s smart lights in their living room to turn blue.

In the case of Opn, IFTTT provides the means for an Internet-connected doorbell to trigger an automated audio message to the person wearing the hearing aid, saying something to the effect of “There’s someone at the door” (users can set up the recipe however they want).

“Missing a doorbell ringing is a common problem to someone with hearing loss,” Oticon audiologist and training manager Alison Stone told Fortune.

Stone said a recipe could also be created for sending a text message to a care giver or family member when the hearing aid’s battery is running low, so they can help change it. Or, when users turn on their hearing aids in the morning, that might trigger their lights or coffee machine to turn on.

“There’s a lovely example of a gentleman who set up a recipe so that, when he turns on his hearing aid, he will hear a message reminding him to take his medication,” Stone said. (The Opn has been on sale for a few weeks now, although it is only being publicized today.)

A more complex recipe might involve people setting up their connected TV set so that, when they turn it on with a spoken command, the lights dim and the hearing aid switches to receiving streaming audio from the TV (something that would require Bluetooth functionality in the TV set).

IFTTT isn’t the only technology available there these days for integrating different online services—there’s also Microsoft Flow and Zapier, for example. But IFTTT is the best known, and more than 300 services can connect with one another through it.

US Patent and Trademark Office Issues LHS Immersion™ Name Trademark to LaVoieHealthScience

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Exclusive Message Development and Positioning Program

Boston, MA – June 16, 2016 – LaVoieHealthScience, a strategic communications agency focused on the life science industry, announced today that the United States Patent and Trademark Office has issued a trademark for LHS Immersion™, the agency’s exclusive message development and positioning platform.

“This is exciting news”, said Donna LaVoie, President and CEO.  “Trademarking the LHS Immersion™ name is an important step to ensure our unique system retains its leadership position. Our clients appreciate the opportunity to bring together their vision and opportunities into a cohesive message platform.”

LHS Immersion™ is a proven methodology to develop communications programs that build value, awareness and differentiation.  Starting with leadership collaboration and the involvement of select external stakeholders, LaVoieHealthScience uses the methodology to optimize credibility, visibility and valuation for its client companies.

About LaVoieHealthScience
LaVoieHealthScience partners with leading life science brands to build value for their companies, attract capital, and reach key stakeholders through integrated communications and marketing. The firm provides strategic communications, investor relations and public relations to build recognition and increase sales and value for health science innovations. The agency has received 28 awards over the past seven years in recognition of the work it has done for its health and science industry-leading clients.

Contact
Beth Kurth, 617-374-8800 ext. 106
Vice President, Investor Relations
LaVoieHealthScience
bkurth@lavoiehealthscience.com
www.lavoiehealthscience.com

LaVoieHealthScience Honored with Bell Ringer Award for Healthcare Publicity Campaign

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Campaign featured signature event, digital content and media relations

BOSTON, MA – June 10, 2016 – LaVoieHealthScience (LHS), an integrated strategic communications agency that is focused on health and life science, announced today it has won a Bell Ringer Merit Award in the healthcare publicity category from the Publicity Club of New England for the agency’s work on behalf of its client, Hydra Biosciences, a biopharmaceutical company focused on the development of novel drugs to treat pain, inflammation, anxiety, and other diseases using its expertise in novel ion channels.

LaVoieHealthScience developed a multi-faceted awareness campaign to highlight the need for better alternatives to opioids for treating pain that would improve efficacy and side effect profiles.  Hydra Biosciences is the world leader in the field of Transient Receptor Potential (TRP) ion channels and is developing medicines that offer improved outcomes with minimal side effects for people with serious diseases and conditions.

The campaign included a signature event called PAIN: a conversation with highly-regarded speakers, digital content, advocacy group outreach, and media relations.  The event drew a standing-room crowd, including several leaders and advocacy groups, to a premier Boston hotel for a networking reception and panel.

“I want to thank our talented team and our client, Hydra Biosciences for their creativity and execution on this important awareness program.  We are honored to be recognized again in 2016 by the Publicity Club of New England,” stated Donna L. LaVoie. “Hydra Biosciences is a great company with leading technology in TRP modulation.  Their commitment to sound science is grounded by an ethical approach to the business of science with the patient in mind.”

Russell Herndon, President and CEO of Hydra Biosciences added, “Our science targets the same cellular pathways that other pain medications do but instead of acting in the brain, like opioids, our compounds work by blocking the pain signals directly in the area where the pain is occurring.  This initiative was  focused on identifying the need for innovation in the treatment of chronic pain while building the support and investment into research and development efforts focused on finding new solutions to this epidemic.  We are honored to receive the recognition for this program with our PR partner, LaVoieHealthScience.”

Since 1969, the Publicity Club of New England’s Bell Ringer Awards have been a symbol of outstanding achievement for New England public relations and communications professionals in every field and industry and across all forms of media.

About LaVoieHealthScience
LaVoieHealthScience partners with leading life science brands to build value for their companies, attract capital, and reach key stakeholders through integrated communications and marketing. The firm provides strategic communications, investor relations and public relations to build recognition and increase sales and value for health science innovations. The agency has received 28 awards over the past seven years in recognition of the work it has done for its health and science industry-leading clients.

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Contact:
Beth Kurth
Vice President, Investor Relations
LaVoieHealthScience
(617) 374-8800 ext. 106
bkurth@lavoiehealthscience.com
www.lavoiehealthscience.com

Donna LaVoie Delivers Workshop at BIO International on The LHS 15-Slide Presentation™

Donna LaVoie Delivers Workshop at BIO International on The LHS 15-Slide Presentation™

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Boston – June 10, 2016 – Donna LaVoie, president and CEO of LaVoieHealthScience (LHS), an award winning integrated strategic communications agency focused on health and life science, delivered a workshop on how to create an essential company presentation in just 15 slides in front of a packed room at this week’s BIO International Conference in San Francisco. Donna also reviewed the basics of creating an elevator pitch.

“Communication is an art acquired only from years of learning and practice, and I was thrilled to be selected by BIO to lead this important workshop on a process that drives a company’s key messages to engage stakeholders and achieve company goals,” said Donna LaVoie. “Being a great scientist or a great business visionary is just not enough; you must also be a great communicator to succeed in business today.”

Last month LHS was issued a U.S. Service Mark for The LHS Fifteen-Slide Presentation™, which designates a clear outline for life science companies to explain their product category, market differentiator, leadership position, regulatory pathway and financial position. The presentation is designed for use across audiences, including prospective partners, employees, investors and others. The 15 slides ensure key information is covered in a logical, digestible presentation. Starting with this structured approach, LHS uses the methodology to optimize credibility, visibility and opportunity for its client companies.

LaVoieHealthScience has developed a thought leadership series of videos and whitepapers on public speaking covering The LHS 15-Slide Presentation™, Public Speaking Strategies for the CEO and Creating Your Elevator Pitch. More information on this series can be found here.

About LaVoieHealthScience
LaVoieHealthScience partners with leading life science brands to build value for their companies, attract capital and reach key stakeholders through integrated communications and marketing. The firm provides strategic communications, investor relations and public relations to build recognition and increase sales and value for health science innovations. The agency has received 27 awards over the past six years in recognition of the work it has done for its industry-leading clients. The agency maintains a comprehensive list of investor, partnering and medical conferences which can be found here.

LaVoieHealthScience is ranked by O’Dwyer’s PR as one of the Top 30 Independent Healthcare PR firms in the US.

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Contact:
Beth Kurth
Vice President, Investor Relations
bkurth@lavoiehealthscience.com
617-374-8800 x106

LaVoieHealthScience Launches PR for Breakthrough Hearing Aids: Oticon Opn™

LaVoieHealthScience Launches PR for Breakthrough Hearing Aids: Oticon Opn™

New Technology Helps People Hear Better with Less Effort, Better Recall

BOSTON, MA – May 24, 2016 – LaVoieHealthScience (LHS), an award winning integrated strategic communications agency focused on health and life science, announced it won a competitive RFP process and is leading the public relations strategy and execution for the U.S. launch of Oticon Opn™, breakthrough hearing aids designed and manufactured by the world’s leading innovator of BrainHearing™ technology.

“We are thrilled Oticon selected LHS to introduce its new, premium hearing aid, Oticon Opn, to the U.S. market based on our 15 years of proven experience providing effective strategies for our clients,” said Donna LaVoie, President and CEO, LaVoieHealthScience. “Oticon is a global leader with more than a century-long commitment to providing innovative, ground-breaking hearing aid technology to people with hearing loss, and we are humbled and excited to join the team and lead public relations for this new product launch.”

The LaVoieHealthScience team is supporting the launch of Opn by providing media relations strategy and execution both nationally and locally, as well as leading development of a digital PR strategy with digital assets.

“The LHS team, its energy and creativity has proven to be a strong addition to the team leading the launch of Oticon Opn,” said Sheena Oliver, Vice President of Marketing, Oticon, Inc. “Opn marks a significant advance in hearing aid technology with its ability to provide people with hearing loss better speech understanding*, reduced listening effort*, and more conversation recall** and we’re glad to have LHS on the team.”

LaVoieHealthScience began work with Oticon in March 2016. Opn was introduced in the U.S. in April 2016 at the American Academy of Audiology’s annual audiologist conference in Phoenix, AZ. Opn will be available through select audiologists in the United States on May 31. More
information can be found http://www.oticon.com/.

About Oticon
Oticon is one of the most innovative hearing device manufacturers with more than 110 years of experience putting the needs of people with hearing loss first. Oticon has spearheaded a number of technological breakthroughs which have made a significant difference for people with hearing loss. Oticon’s “brain first” audiological focus recognizes that speech understanding and comprehension are cognitive processes that happen in the brain. Oticon’s innovative BrainHearing™ technology is helping to provide better hearing with less effort by giving the brain the clearest, purest sound signals to decode. Oticon designs and manufactures hearing solutions for adults and specialized pediatric instruments. People First is Oticon’s strongest and most valued commitment to empower people to communicate freely, interact naturally and participate actively. For more information visit: http://www.oticon.com/.

About LaVoieHealthScience
LaVoieHealthScience partners with leading life science brands to build value for their companies, attract capital and reach key stakeholders through integrated communications and marketing. The firm provides strategic communications, investor relations and public relations to build recognition and increase sales and value for health science innovations. The agency has received 27 awards over the past six years in recognition of the work it has done for its industry-leading clients. The agency maintains a comprehensive list of investor, partnering and medical conferences which can be found here.

LaVoieHealthScience is ranked by O’Dwyer’s PR as one of the Top 30 Independent Healthcare PR firms in the US.

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Contact:
David Connolly
Senior Vice President, LaVoieHealthScience
dconnolly@lavoiehealthscience.com
617-374-8800 Ext. 108

*Compared to Alta2 Pro

**Individual benefit may vary depending on instrument prescriptions