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Golden opportunity

Hospital pharmacy can be a gold mine for marketers in the austerity era

Gold barsThe key to unlocking value in your brand may be buried in the basement of your nearest district general. But despite rhetoric from the pharma industry that it recognises the importance of hospital pharmacists as a vital customer-group, why does it appear that so few marketers (figuratively) wander downstairs to visit them?

Firstly, let's dismantle a myth. It's a well-oiled cliché that hospital pharmacy can always be found deep in the bowels of the local hospital. Historically, of course, this has largely been true, but it's engendered the perception that the hospital pharmacist's role is a seemingly faceless one whose remit is simply to prepare and dispense medicines. That's the myth. But the bunker mentality is rapidly disappearing.

In most hospitals, while central pharmacy's physical home remains in the basement, its role and, more importantly, its value have risen way above it. The profession is taking on more responsibility: hospital pharmacy is evolving into clinical pharmacy, and its protagonists are playing a more active role in patient management. Not only do they now spend more time on wards engaging with patients, but they have also emerged as significant members of the clinical team and are highly influential in ensuring that patients are prescribed the most appropriate medication.

Hospital pharmacists have at long last been integrated into the ward team, but the question for pharma is: have they also been integrated into the brand team's marketing plan? In many cases, the answer, sadly, is no.

Why bother? This is a common retort from marketers apparently keen to pay no more than lip service to the notion that hospital pharmacists are influencers. Perhaps the industry has been put off by the traditionally adversarial relationship between pharma and pharmacy. Mike Farrar, chief executive of NHS North West, once famously questioned whether there was a 'more significant co-dependent relationship transacted so sub-optimally' than that of the NHS and pharma. He could well have been describing pharma and pharmacy.

For many years, pharmacy has had a deep-seated scepticism of the industry. In turn, pharma has refrained from effective engagement with pharmacy, much to its cost. But the parties are indeed co-dependent — pharmacy deals in pharmaceuticals, after all — and now, it would seem, the two are finally conceding that they need each other.

Austerity
The austerity measures currently dominating the political landscape are placing a great strain on healthcare resources across the UK. But, in part, proposals outlined in Equity and Excellence, the recent NHS reforms White Paper, represent the continuation of an efficiency drive within the NHS that has been operating for some time. The quality and productivity agenda (QIPP), which has been gaining traction for over 18 months, has also provided a catalyst for greater moves towards joint working between the NHS and industry — and, despite its historically fractious relationship, even pharma and pharmacy are beginning to take the plunge.

So where can the two parties work together? And why should the industry bother to engage with specialist hospital pharmacists? The answer is value. Since the introduction of NICE in 1999, demonstrating cost-effectiveness as well as clinical effectiveness has been paramount for marketers. The economic downturn has merely sharpened the pencil, but demonstrating value is a perennial challenge. What's more, in the cases of expensive, specialist drugs, the task of demonstrating value has taken on seemingly Everest-like proportions.

Most specialist drugs are intended for use in the secondary care setting but many struggle to reach that stage. The list of products that fail to achieve NICE recommendation on the grounds of cost-effectiveness is ever increasing and the problem is such that the shared goal of pharmacy and the pharmaceutical industry — improved patient care — is not being met. The ABPI says that health is wealth and that medicines are part of the solution. NICE, on the other hand, just says no.

Getting it to say yes requires a more proactive, long-term multi-disciplinary approach to brand development.

Demonstrating value
The process of demonstrating value begins long before a drug is licensed for use. Defining and delivering value requires a customer-centric approach from the outset; from trial design to economic modelling, managed entry and launch. All too often throughout the process, the industry fails to capture the voice of a key end-user — hospital pharmacy.

Hospital pharmacy can be a great utility to pharma in helping marketers define and develop value propositions. Working together effectively offers pharma and pharmacy a simple mutual benefit: patient access to life-changing therapies. In this regard, there are many reasons why hospital pharmacy is well-placed to help the industry, for example in terms of clinical trial design, modelling and the NHS reforms White Paper.

Clinical trial design
Securing reimbursement for a product is a priority for cross-functional brand teams. Failure to do so presents a significant barrier to market access and can have a detrimental impact on development costs, time to market and market share. But true competitive advantage can be achieved through effective clinical trial design that captures perspectives from all key stakeholders. Hospital pharmacists can play an important role in helping to create the right evidence base at this crucial stage, as well as providing insights into the potential service delivery of a product and how it could fit into the care pathway. Yet this opportunity is rarely exploited.

Brand teams are often guilty of building their approach around the insights of traditional KOLs and overlooking the important perspective of clinical pharmacy. Insight is often only sought when it's too late but the pre-launch involvement of specialist pharmacists at the trial design stage can have major long-term benefits at launch: helping to identify the right clinical and economical end-points to build into studies, for instance. The value of this involvement cannot be overstated.

Modelling
The need to demonstrate value has driven a greater scrutiny of pricing and reimbursement (P&R), and so economic modelling has become critical. Defining cost-effectiveness is a subjective and arduous task, and the need to assess care pathways and develop evidence around them has become central to it. Generating health economic data that resonates with your marketplace is essential but pharma cannot second-guess. Marketers must be customer-centric and, more importantly, ensure that they seek insight from a truly multi-disciplinary cross-section of their customers, which must include hospital pharmacy.

Developing an effective P&R strategy in the current climate requires the industry to seek new and innovative ways to enhance the value proposition. One example has been the growing trend in the UK of developing Patient Access Schemes (PAS), particularly in oncology. However, evidence suggests that the industry is struggling to make PAS work: a recent study showed that the onerous paperwork associated with PAS could cost the NHS millions of pounds in missed reimbursements. Steve Williamson, a consultant pharmacist at Northumbria Healthcare NHS Foundation Trust, said that while the health service was delighted to have the schemes because they enabled patients to access drugs, many of them had 'not been executed very well' and were therefore unmanageable.

NICE chairman Professor Sir Michael Rawlins has gone further and suggested that simple discounts on drugs would be better for the NHS. PAS were, in his opinion, complicated for NHS Trusts to implement and have high associated costs. In one recent, high-profile case, NICE failed to recommend Avastin, Roche's treatment for bowel cancer, because it considered the drug too expensive and questioned the manufacturer's calculations on a proposed PAS. It is not the first product to fall at the NICE hurdle despite a risk-sharing proposal.

So how can PAS be made more effective? Once again, hospital pharmacy can play an important role. It is clear that, with the administrative burden of PAS acknowledged to be so great, more thought needs to be given to how these schemes are designed. Hospital pharmacists play a pivotal role in implementing PAS at the important patient end of care, but are currently bedevilled by their complicated and onerous nature. Effective engagement with hospital pharmacy can help develop PAS that demonstrate value to the NHS, the industry and, most important of all, the patient.

The White Paper
The NHS White Paper makes very little explicit mention of pharmacy, simply describing pharmacists as having 'an important and expanding role in optimising the use of medicines and in supporting better health', but pharmacy has a significant part to play in the bigger picture. Chris Green, director of pharmacy at the Countess of Chester Hospital NHS Foundation Trust and chair of the UKCPA, says the White Paper underlines the need for pharmacy to make sure its evidence-base is 'clear, patient-focused, demonstrates value for money and is aligned with the goals and objectives for those who are commissioning care for the NHS and its patients.' Are these not the same goals pharma sets itself?

If NHS/industry joint working relies on matching agendas, the aims of pharmacy and pharma could not be more aligned. Current policy reaffirms a continuation of the QIPP agenda — driving up quality and productivity — and pharmacy is vital to achieving this. Hospital pharmacy has a clear role to play in ensuring the safe and appropriate use of medicines can be improved to prevent readmission, reduce costs and deliver budgetary savings. The imminent NHS restructure also provides a stimulus for pharmacy teams to identify opportunities for the integration and delivery of services across primary and secondary care. Moreover, the move towards GP-commissioning will place greater emphasis on the need for clinical pharmacy to increase its liaison with GPs to ensure pharmacy services are designed in ways that match NHS objectives and deliver improvements to patient care.

All of this underlines the growing significance of specialist hospital pharmacists and drives a need for the pharma industry to engage more effectively with them. The spiritual home of hospital pharmacists may remain on the lower ground floor, but with a role and value that towers way above it, marketers may just find that some hidden treasures lie buried in the basement.

The Author
Chris Ross is a freelance writer.

To comment on this article, email pm@pmlive.com

28th October 2010

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