If trust, as the saying goes, takes a lifetime to build, seconds to break and forever to repair, it’s fair to say that the pharmaceutical industry is living the cliché. Over the years, the sector has been dogged by scandals and behaviours that have sullied its reputation and led to an enduring public perception that it puts profit over patients. It’s not a good look. Fortunately, better compliance with tightened regulations has meant that allegations of bribing doctors or misrepresenting clinical trial data are now extremely rare. However, controversies around drug pricing – fuelled by the unhelpful interventions of Martin Shkreli as the pin-up boy for big, bad pharma – have undermined progress and reinforced the view that the industry is in it for the money. It’s time we changed the narrative. The question is: how?
Research consistently reveals that, on a global scale, pharma is one of the least trusted industries. Last year, for example, Edelman’s Trust Barometer showed that, while trust in pharma had increased by 4%, almost half (49%) of respondents distrusted the industry and, in the US alone, eight out of ten people agreed it puts profits before people. Interestingly, the technology industry – voted the most trusted sector of all – now faces similar allegations. In the intervening year, two of its biggest players have been exposed for selling customer data and deliberately slowing down ageing phones to force users to buy new handsets. The impact on brand loyalty is not yet clear. But as we know, trust takes a lifetime to build, seconds to break and forever to repair…
So how is pharma trying to repair the damage of yesterday’s behaviours? At the macro level, industry bodies are working harder to win the hearts and minds of consumers by raising awareness of the value pharma provides to society. They’re fighting fire with facts – and the facts speak volumes. Industry invests hugely in innovation, with it costing around £1.1b to bring a product to market. Moreover, pharma invests, on average, 11% of turnover in R&D – only software and internet firms spend more as a percentage of sales. Individual companies are doing their bit too. For example, in September 2017, Roche commissioned Ipsos/MORI research that showed the UK public trusts supermarkets more than they do drug firms. Alongside the research, Roche published a report that outlined the contribution the company makes to the UK economy and society – highlighting £483m investment in UK R&D (2015), 17,000 UK patients involved in clinical trials (2016) and £67m reimbursement to the NHS via the PPRS rebate (2015). In total, Roche contributed £820m to the UK GDP in 2015, with its medicines reaching 52,600 patients and treating 25 million people globally. The societal value of that investment is significant – and it’s a value that is matched by other companies across the industry on a global scale. And yet the sector still has widespread challenges around trust. So how can it accelerate progress and finally establish the reputation its endeavour and value undoubtedly deserves?
Perhaps pharma needs to tell a different story; one that relies less on hard data about its value to the economy, but focuses more on humanistic attributes that connect emotionally with all its various stakeholders. If pharmaceutical companies are to cement a new reputation and achieve high levels of trust, they must project – and, more importantly, live – a new image where their perceived purpose shifts from making money to making a difference. This will ultimately require an authentic customer-centred approach and the widespread redefinition of the old pharma business model. Following interviews with industry thought leaders, here are five individual perspectives and recommendations as to what companies may need to do if they are to shift old perceptions and truly make a difference.
#1. Think like, and collaborate with, healthcare providers
The ways in which the industry has tried to build trust in the past decade have largely focused on maintaining better levels of compliance against regulation in the core areas where pharma has tripped up in the past, says Dennis O’Brien, CEO, Lucid Group. “We’ve come a long way – and we’ve removed a lot of the scepticism around how we influence customers. But trust will ultimately be defined by how industry collaborates with stakeholders to ensure that its focus is on improving health systems and driving meaningful patient outcomes. In the long term, pharma should be looking to transition from medicine manufacturers to becoming healthcare providers in their own right. But getting there requires a radical shift in approach. Whereas healthcare providers are set up to improve health, pharma companies are set up to sell medicines; the quality of GP and hospital services is measured against patient outcomes, the quality of pharma companies is measured by product sales. Yet the provider landscape is changing. Disruptors like Babylon Health are transforming GP services, using technology as a platform for online consultation and all the associated gains of digital innovation. If pharma is to avoid becoming nothing more than a commodity, it needs to look at how it can redefine its business model to help provide healthcare services. It cannot afford to let others – like Amazon and Google – own the patient consultation. Through trusted collaboration, companies can improve the quality of healthcare services, unlock better access to care and greater access to the right medicines. Innovation is the key to making a difference. It’s a long-haul journey, but we have to start planning it now.”
There have, however, been incremental steps. “We’re beginning to see pharma companies work closely with providers to develop ‘above brand’ programmes that help HCPs manage specific patient pathways. For example, a major multinational has developed an evidence-based treatment algorithm that’s helping UK GPs define and manage the treatment paradigm for every part of the diabetes pathway. The programme is influencing clinical practice and driving improvements in long-term outcomes. Significantly, it’s totally independent of individual medicines and focused purely on patients’ needs. This is the way pharmaceutical companies need to go if they are to change public perception. The pioneering companies are those who are not focused simply on selling their drugs – they are committed to a therapy area, committed to the experts and, fundamentally, committed to the patients. Moreover, they’re investing in activities beyond those designed to help sell drugs. Instead of focusing commercial strategies on market share or product sales, companies need to develop a granular understanding on the issues that patients and physicians face, and concentrate their efforts on developing the interventions that will make the difference in overcoming them. It’s time to think like a healthcare provider.”
#2: Rethink incentives to move from providers to peers
If pharma is to address the challenge of its public image, it may need to rethink the way it motivates its people, says Cath Brassington, Managing Director, H4B Manchester. “We’ll never remove negative associations with the pharmaceutical industry while our people are being motivated by sales. Where is the incentive to ensure patients are given the most appropriate treatment when pharma executives are being paid per script? It’s at odds with the principles of patient-centred care. Companies need to shape their investment in ways that transition them from being providers of drugs to facilitators – and peers – in conversations around the health system. Whether we’re talking about patient education, medical education or branded campaigns, industry can play a huge role in ensuring people are provided with the most appropriate information to make informed decisions. If we focus on that – rather than pushing products – we’ll start to shift public opinion.”
Companies, says Cath, should focus on how they can change their business model to become better, rather than fixating on projecting the right image. “It’s easy to jump on the bandwagon of patient-centricity and believe you’ll improve your reputation simply by focusing on the patient. But the truly patient-centred companies are those who have looked at how they operate and have developed cultures and processes that genuinely embody it. Rather than including ‘patient-centricity’ as an oblique term in their marketing briefs, the most effective companies are living the experience and reaping the rewards.”
A great example is Sanofi Genzyme, whose MS solutions have been built around a long-term programme to understand the individual challenges of living with MS. ‘The World versus MS’ has become a poster child for patient-centric engagement. “The project was purely based on non-pharmaceutical interventions – collaborating with the MS community to establish the lived experience of patients long before developing briefs for any solutions. Rather than assuming anything, Sanofi Genzyme took a step back and asked patients: how can we help? Its success shows what pharma can do when it moves from provider to facilitator. In Sanofi Genzyme’s case, it culminated in a set of briefs that were owned by the patients living with the disease. And it’s led to genuinely co-created solutions that focus on benefits to patients rather than being contrived to meet pre-conceived endpoints.”
The model, built on the principle of ‘assume nothing’, should not be limited to patient communications. “There’s a widespread focus on patient-centricity, but if you look at the healthcare system in its entirety, the biggest impact pharma could have is to become peers to the people we’ve previously sold to – healthcare professionals. We have the tools, the expertise and the resources to help them make crucial decisions. We’ve previously told them all about our treatments. What we should also be doing is using our expertise to look at the services they provide and asking how we can help. Then we can start to make a difference.”
#3: Treat people as consumers, not patients – and engage them on their terms
The way we communicate with customers is key to progress. Thankfully, says Julie Adrian, President, Europe Communications, Syneos Health, pharma has raised its game. “Companies have realised that, in an era where there’s an increasing breadth of healthcare constituents, they need to abandon their traditional didactic approach to communication and engage audiences in ways that are relevant to customers’ behaviours and needs. Many are adopting an FMCG mindset, treating patients as consumers and opening two-way dialogues to help uncover relevant, relatable and useful solutions. However, while the stakeholders at the centre of the health challenge – the physicians, pharmacists, advocacy groups and professional societies – can see that pharma is making real strides, those further out remain sceptical. There’s a sense among the wider public that pharma still puts profit before patients. To overcome that perception, companies need to move beyond engaging those customers closest to home. It’s only by going out to the masses, and communicating in ways that are super relevant, that we will get a sea change. We’ve got to get out and meet people where they are.”
The signs are encouraging – pharma is starting to think and act differently. “The industry is beginning to collaborate with companies like Amazon and Google – establishing non-traditional partnerships to develop customer-oriented solutions built on rich, relevant engagement that can drive behaviour change,” says Julie. “For example, progressive organisations are exploring how technology like Amazon Alexa can be used to help the homebound or elderly better manage their health; leveraging the power of the patient voice to support medicines compliance, monitor conditions or provide patient-reported outcomes to clinicians in real-time. Similarly, voice technology has a potential application in drug development – enhancing the clinical trial experience by engaging patients and connecting them with researchers to provide immediate feedback that can improve trial outcomes. How we join the loop between clinical and commercial – ensuring everything we learn in the clinic informs customer communications, and vice versa – will be crucial to developing solutions that benefit society.
“Our research indicates a huge appetite for the use of AI technology in healthcare among both patients and consumers. However, their appetite is not yet being fulfilled. To progress – and to develop the healthcare solutions, beyond drugs, that truly make a difference – pharma companies must get at the front edge of technology to drive richer, more relevant and authentic ways of engaging customers. If we do that, we will transform the industry’s reputation.”
#4: Co-create – and bring the patient into the journey
Patient advocacy groups have become very influential. However, their perception of pharma is arguably not favourable. A common view is that the industry is in it for the money, with some companies charging too much for their drugs and thereby restricting patient access to treatments. Shifting this perception is vital.
“There’s a great willingness among pharma companies to engage with patient advocacy groups,” says Alex Morton, Patient and Healthcare Writer, The EarthWorks. “They recognise these groups are becoming very powerful – particularly in rare diseases – and that their opinion matters. Fundamentally, if an advocacy group has a negative opinion of a pharma company, it can have a major impact. There’s still some way for the industry to go in this regard. Patient advocacy groups are, however, willing to work with pharma. They know that the industry can help in key areas such as funding research, recruiting patients for trials or campaigning for access to treatments. But they will only engage on their own terms. The drug company’s offer has to be worthwhile – and it needs to recognise the value of the advocacy group, rather than try to duplicate or plagiarise it.
“A good example of this is around patient information. An advocacy group may have really strong online information about a certain condition and the treatments available for it. This is often the case; advocacy groups are typically run by people who have the condition and who know their patients – and their needs – better than anyone. So rather than a drug company producing its own online assets that duplicate patient information, it might make more sense to partner with an advocacy group and signpost patients to their website rather than their own. The most effective partnerships are where pharma companies have recognised that patients are better served elsewhere and have leveraged the understanding and engagement that exists within advocacy groups.
“We are slowly beginning to see examples of pharma companies developing patient support programmes that are ‘above brand’. Rather than being configured to support the use of a specific drug, these programmes are designed to benefit the whole population of a disease, engaging patients across the board, irrespective of the treatment they are on. ‘Above brand’ programmes remain rare, but where they exist, they’re proving highly beneficial. The best support programmes are co-created; they’re built on a collective understanding of patient needs, the patient journey and the problems they encounter along the way. It’s only by securing – and responding to – real-world patient insight that we can develop interventions that truly make a difference. How the industry engages and collaborates with advocacy groups will be critical in developing that granular understanding.”
#5: Seize outcomes-based contracting as the mechanism to redefine value
The shift toward outcomes-based contracting (OBC) presents a real opportunity for pharma to demonstrate broader value to society and shake off its old public image, says Aaron Bean, EY, Life Sciences, UK & Ireland. “Historically, the industry has had a narrow definition of ‘outcomes’ – measuring them largely on clinical response rates such as whether patients respond to treatment. This approach has led to customer conversations that typically focus on price and that, in the current economic climate, are naturally subjected to downward pressure. OBC can help companies redefine outcomes beyond clinical measures and shift the conversation from price to value. It provides a mechanism to contract around other types of outcomes such as pathway performance, cost-savings and humanistic or societal benefits. This allows companies to align incentives across all the different stakeholders in the system and put in place longer-term agreements that create a win-win-win all round. This fundamentally changes the relationships companies have with their customers; by taking ownership of a broader set of outcomes and aligning incentives more effectively, companies can become true partners in the healthcare ecosystem. True OBC can be a trigger – and indeed an incentive – for pharma to engage in patient pathways to enhance or help de-risk target outcomes. Ultimately, closer alignment with customers’ agendas is a powerful commercial differentiator.”
So how can companies get there? “There are, broadly, five things the industry should consider focusing on to optimise the opportunities of OBC,” says Aaron. “Primarily companies should collaborate with all their stakeholders to co-create authentic, real-world definitions of value. That needs to extend beyond clinical value to encompass economic and humanistic outcomes. Secondly, the industry should engage in a more open debate around the investment it makes and the value it brings. Pharma shouldn’t need to be apologetic about making a profit – but it does need to explain why profit is important and what the industry does with it. Thirdly, companies should invest in OBC as the mechanism to deliver mutual value across the healthcare system. This will stimulate a move from ‘claimed value’ to proven value and, in the process, build levels of trust. When the evidence-base is there, pharma should not shy away from publishing the broader societal impact its interventions deliver. Finally, to sustain meaningful long-term outcomes, companies should drive for industry-wide solutions that help it deliver OBC at scale.”