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Building brand loyalty in pharma

While doctors cannot be rewarded for prescribing a particular drug, there is still a lot marketers can do to promote decision makers' engagement with a product

It must be a sign that confidence is returning to the high street, as this week a new bread shop opened in my part of town. Never one to miss a carbohydrate fix, I sampled a few of its offerings. The person serving me asked whether I wanted a 'bread loyalty card'. It had never occurred to me before that I might want to be loyal to the humble white loaf I had just bought but so many retailers seem to be offering the same thing. For everything from cosmetics, to groceries, to books, to coffee, to petrol, you can collect a wallet-filling card denoting your loyalty to their outlet, products and brand.

The theory behind the loyalty card concept is that in return for my frequent custom, I can build up points to redeem for either free items or money off. If I take this at face value, my local store wants to reward my loyalty, which seems like a positive thing. However, if everyone is offering me a reward card, surely the value is undermined? In addition, I feel slightly nervous about the data which they must be collecting about me.

Prescribing space
How can the concept of loyalty be applied in the pharmaceutical space? I do not suggest that physicians are given some sort of reward each time they prescribe a particular branded product; this would be unethical. While we would like to think that each prescribing decision is made based on a careful assessment of the clinical data and the parameters of the patient symptoms, the reality is that there is a whole host of underlying emotional and subconscious motivations which go into brand choice. Otherwise, there would not be a need for a marketing function.

But the physician that the patient sits in front of is not the sole decision maker in the prescribing outcome. Payers, insurance companies and government agencies also have an impact on what can or cannot be prescribed. Healthcare is not like a supermarket; it is not a one-on-one decision; there are multiple stakeholders involved in the decision for whether a particular product is available and right for the patient.

Difficult environment
In addition, today product pipelines are not what they used to be and the blockbuster era is over, due to the unpredictable nature of discovery and to changes in the regulatory process. Agencies like the US Food and Drug Administration are being ever more careful in the approval of new chemical entities. More time elapses from submission to approval, with additional data and subsequent clinical trials being required, as well as increased postmarketing surveillance programmes.

The impact of regulatory agencies can also be seen in a stringency regarding product indications and warnings as well as withdrawals of products from the marketplace. Many new products coming to market are more 'me too' than game changers and, along with the pressure for increased generic prescribing, they reveal a difficult market environment for branded pharmaceuticals.

This is an environment where customer or brand loyalty could have a significant impact. What if you could show that your key prescribers are loyal to your product in the face of a new market entrant or generic pressures? That would be really powerful.

Formulary decisions, competitor activities and patent expirations may all change the space within which a brand is experienced

So, what does 'loyalty' mean? I feel uncomfortable using this term in the context of pharmaceuticals, as it implies that someone is making a brand choice as a result of the payback he might be getting from the originator, just like my bread loyalty card, promising me a free loaf for every 12 I buy. It is not a connotation we should be conjuring up when critical decisions are being made about people's health. Instead, I would put forward the term 'engagement'. This implies a level of interaction and trust along with a positive brand experience, which can translate into greater support – not necessarily through increased prescriptions – and positive feeling.

If I am 'engaged' with a brand or a corporation, I have repeated positive experiences beyond what I am used to. I am open to its communications and supportive of its approach. I have seen the benefits of what it can offer and they are in line with my thinking and my personal objectives. I can depend on it in the future. At the highest level, I am an advocate; I will openly promote my positive experience through word of mouth. This means that I am aligning my personal image and reputation with that of the brand. I know it will not let me down.

These concepts go a long way beyond the theory of satisfaction. If I am satisfied with a brand, I am merely happy with it; it is OK, I might use it again. However, if I am engaged, I am not only responsive to the brand, I am proactive about it. This is a much deeper measure of commitment.

Measuring engagement
Engagement does not come from one interaction or one single channel. To reach the highest level, there needs to be a constant drip-feed of positive experiences. This can be from the interaction with the sales representative, the positive experience with the product in the target patient types, the reinforcement through medical press, websites, learning and so on. There are multiple layers of experience which build the perception over time. It is the aggregate noise which combines to build the positive commitment. We are all living in a multiple media environment; to try to focus on one element and its individual influence misses the real-life context in which we all operate.

Measuring engagement also needs to take a multi-layered approach. There are numerous attributes on which a brand needs to score positively to build up an overall picture of engagement. For instance, you could have a familiar brand, which delivers high quality and value in a relevant setting. However, if this is not considered to be a collaborative approach, then the impression is left that the brand is being promoted for its own commercial benefit and is not aligned with the decision maker's benefit and personal image; he is not engaged.

The level of engagement which can be achieved is relatively meaningless without a competitive context. It is not, for instance, like an awareness measure, where you can easily tell if performance is good or bad. Brand experiences need to be considered from both an absolute and relative perspective. However, this is not to say that just because standards are set low by the competition that a low level of performance is acceptable. Indeed, a competitive context can help to identify the specific elements from decision makers' brand experiences that are critical to the development of more positive levels of brand engagement.

Finally, as engagement is the result of a multi-platform, 'surround sound' of noise and experience about the product, so the measurement of the level of engagement needs to be conducted over different time periods and not just rely on single episode research.

There is no point measuring engagement unless there is something that can be done about it. Once understanding is gained over what engagement exists, look at how different decision makers have responded to the brand communication. What beliefs, attitudes and emotions exist with different levels of engagement? This can help with the development of the appropriate tactics and messaging to address any underlying issues or reinforce strong performance. In addition, it can clarify who should be spoken to and what the most motivating message is for that audience.

The longitudinal assessment of level of engagement can demonstrate the impact of various marketing strategies; however, the situational analysis cannot be forgotten. Formulary decisions, competitor activities and patent expirations may all change the space within which a brand is experienced. Many evaluative dimensions could be negatively impacted for a brand because it is in an unfavourable formulary position. For instance, the decision maker may be 'forced' to use another brand instead and therefore positive engagement cannot translate into return on investment. Also, unless properly supported, the brand choice 'forced' on the decision maker does not, even if the experience is positive, necessarily lead to engagement; it could be merely satisfaction.

Ultimate goal
Generating engagement in a brand can have an emotional and rational hook into the decision maker's justification for his actions. It is a complex market and a complex measure to assess. Not only are there multiple stakeholders involved in the ultimate decision, but there are multiple channels of influence. My loyalty and engagement to my local bread shop is a relatively linear experience in comparison.

The level of sophistication required to develop and assess the return on investment for a pharmaceutical product is very high. However, the rewards are worth the effort – understanding who your advocates are and how to target those open to the message can provide valuable insight for a marketing strategy, which either needs to expand within the category or defend itself from new entrants. Engagement is about belief, loyalty and alignment of personal objectives with the brand. It is the ultimate goal.

Sarah Phillips
The Author

Sarah Phillips is Head of Health at Ipsos. She works closely with pharmaceutical companies in designing and interpreting market research to support their strategies and brand development. She is widely published in the pharmaceutical press and a board member of Ephmra.

15th December 2011


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