The world of drug promotion has changed. It has ceased to be a simple matter of detailing to physicians and an occasional pharmacist; it has evolved into a much more sophisticated activity, supported by new technology and much more targeted. However do we use these new technologies to do the same old things or do we use them instead to change our approach to promotional activities?
A
journey from ‘one to many’ to ‘one to one’ As Heraclitus
said, “The only thing that is constant is
change.” Well the world of drug promotion
has changed. It has ceased to be a
simple matter of detailing to physicians and an occasional pharmacist; it has
evolved into an activity that is more sophisticated, more technologically
supported and more targeted. In the past, a sales rep would talk to any physician,
office manager or nurse practitioner who would listen. From a marketing
perspective, it was a ‘one to many’ concept that involved creating a message, blasting
it out, following it up and blasting it out again. A lot of this ‘mass
marketing’ of primary care products still goes on but the days of Willy Loman
are over. Given the shift to specialty, pseudo-specialty and orphan drugs, the
concept of ‘one to many’ has run its course. Interest in deciles has been
largely replaced by targeting and profiling for connections and not just
physician connections. Connecting to patients, care givers and advocacy groups
has become more important for some diseases. We are now in a ‘one to one’ world
that is supported and facilitated by technology and social media. The question facing
Pharma is; are we rethinking promotion or are we just adding new tools to the
same old process. Reengineering and rethinking In other words,
do we use these new technologies to do the same old things but in a more
efficient way or do we use them instead to change our approach to promotional
activities that transforms them into something more effective? One of the best definitions of reengineering can
be found in the seminal book on business transformation written twenty years
ago by Michael Hammer and Jim Champy entitled ‘Reengineering the Corporation’.
They describe reengineering as, “the opportunity to develop the rules by which
business in the future will be conducted rather than being forced to operate by
the rules imposed by someone else. As such, reengineering underpins every
attempt to seize and maintain a true competitive advantage.” Add a liberal dose
of technology to the reengineering approach and the Pharma marketer has the
potential to create not just the ultimate competitive advantage but also the
best customer experience. So is it evolution or revolution?
The answer is
both. For example, physicians are still bombarded by reps, although the number
of reps has dropped dramatically in recent years, from 95,000 in 2008 to 65,500
in 2013[i].
Consumers still have to watch drug commercials on TV but increasingly now also on
internet banners and YouTube. In fact,
the first Pharma commercial on YouTube was launched by Pfizer 6 years ago. Innovative?
Yes. Cool? Definitely. More effective? Maybe. Changing the conversation? Not really.
In reality, it was just the evolution of technology used for a
traditional promotion, a more efficient way of utilizing existing promotional
approaches. There are
however great examples of technology leveraged, ground breaking, revolutionary
ideas used by pharmaceutical and biotechnology companies. Starting with the
basics of promotional activities and spend (see figure 1)[ii],
these innovative companies ‘reengineered’ the promotional process. In other
words, they rethought (i) who they were targeting, (ii) who was making the
buying decision, (iii) who were the additional influencers, and (iv) what is the
evolving perception of the disease and drug in question. They then used technology
and new promotional strategies that effectively changed the conversation. Changing the conversation with patients One of the
earliest adopters of technology and social media to change the conversation
with patients, was Genentech. Starting from the position of caring about the patient,
Genentech created the Herceptin website. It was a markedly different site with
information about breast cancer, what to expect for treatment, what to ask your
doctor and most importantly, frank information about side effects and results. The
site became the standard for breast cancer, so much so that most women when
diagnosed would often go to the Herceptin site whether they were being treated
with the drug or not. Herceptin and Genentech had created a standard of care
for a website that was greater than the product by changing the conversation with
the patient about breast cancer and care. In doing so, they reengineered the
idea of promotion. Changing the conversation with patients and
influencers With the
ubiquitous nature of the internet, information good or bad is readily available
for the informed consumer and the influencer. Doctors, especially those of the
younger generation, increasingly tend to access valuable clinical and product
information via the internet and proprietary networks. They also make increased
use of technology in their interactions with patients. My doctor, for example,
is my generation, our meetings are face to face and we communicate by
telephone. His follow ups are timely and usually involves the office manager
giving me a call. My son’s doctor is his
generation. His follow ups are text messaged and more timely and personal. If needed he is only a FaceTime session
away. Increasingly, for drugs with truly unique
clinical differentiation, physician awareness and education can be best
leveraged via the internet. Not only does this facilitate two way communication,
it also enables the ability to provide up to date real time information,
patient service and diagnosis support, as well as patient and caregiver
support.
Take for example,
the product Juxtapid used to treat Homozygous Familial Hypercholesterolemia
(HoHF). A drug with a small patient population and a disease with a complex
diagnosis needs to leverage two important promotional activities, educating the
doctor and finding the patients. While educating doctors on something as
complex as the diagnosis and treatment of HoHF is important, for a rare disease
and specialty drug, finding the patients to be treated is even more so. This can
be accomplished by leveraging advocacy groups and then creating patient to
patient networks for referrals. Or it can simply be finding others that share
the disease and share the symptoms by connecting via LinkedIn or Facebook. Word
of mouth supported by social media is a powerful promotion tool. Rethinking how
to go to market as a specialty or orphan drug is critical given the patient
populations as there is no possibility of mass marketing, blast marketing or
even ‘pull at your heartstrings’ YouTube commercials for rare diseases. This is
what Aegerion Pharmaceuticals did with Juxtapid; they changed the conversation
with the patient and influencers, and in doing so, they reengineered the idea
of promotion.
Changing the conversation about the disease It is important
to understand promotional ‘mix’ not just in the context of the disease profile
(primary or specialty or orphan) but also the type of drug being promoted and
how this is clinically differentiated in its competitive environment. Understanding
these dynamics will result in being able to determine the opportunities that
can make most effective use of technology and social media as tools to develop innovative
promotions to patients or caregivers or advocacy groups or all of the above.
Take Multiple
Sclerosis (MS) for example. MS has four different disease manifestations:
Relapsing Remitting (RRMS), Secondary Progressive (SPMS), Primary Progressive
(PPMS) and Progressive Relapsing (PRMS). Although MS is considered a specialty
disease and therefore treated with specialty drugs, it is in fact marketed as a
primary care (RRMS), specialty (SPMS and PRMS) and rare/life threatening
disease (PRMS). When first treated over 25 years ago, it was simply promoted as
a specialty disease; patient diagnosis was difficult as were finding physicians
who understood the disease. Today however, given the research and the
development of new drugs, RRMS is treated almost as a primary care issue. This is
due in a large part to Biogen’s approach and leadership in the treatment of the
disease. Unlike other pharmaceutical companies in the MS space, Biogen chose
the Genentech/Herceptin route to the market and developed a supported disease
website, as well as patient support, online services and connections. While promotional
spend on their drug Tysabri at launch was focused on specialist detailing and
medical events, the promotional mix has evolved with increased direct to
consumer spend and direct to patient information.Biogen changed the conversation about
the disease as well as the conversation with patients. In doing so, they
reengineered the idea of promotion. Today’s reengineering will need reengineering tomorrow As powerful as
today’s technology and social media ecosystems are, the opening words from
Heraclitus remind us that these too will change. And with them, the challenges
and opportunities facing Pharma marketers when it comes utilizing these
resulting changes in its promotional strategies. How they succeed will ultimately
depend on whether they have the same conversations more efficiently, or whether
they will reassess each conversation with a view to transforming the communication
not just more efficiently, but critically, more effectively. In doing so, they
will continually be reengineering the idea of promotion to create the ultimate
competitive advantage as well as the best customer experience. They will truly change the conversation.
[i] Source: PharmaForce
International Deployment Analyzer [ii] Source: Cegedim
Strategic Data, 2012 U.S. Pharmaceutical Company Promotion Spending (2013) About the author
Jim Hall is President at Cello Health
BioCONSULTING
Cello Health BioCONSULTING is a
Strategic Management Consulting Firm focusing on Pharmaceuticals, Biotechnology
and Medical Device companies in the United States. Cello Health BioCONSULTING offers
a unique set of services that focus on early product development,
commercialization and business development support for small and mid-cap
companies.
Cello Health
BioCONSULTING has offices in Boston, New York City, Philadelphia, Chicago and
San Francisco.
http://www.cellohealthbioconsulting.com This article was first published in the September 2015 issue of PharmaVOICE
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