Excellence in pharma launches

All pharmaceutical commercial personnel understand the critical importance of the first few months of any product launch. There have been plenty of features that have covered this topic, highlighting the financial consequences both in the short and longer term, of underperforming.

What is interesting, however, is that despite this understanding, how many new chemical entities (NCEs) still fail to meet expectations and on the flip side, how many far exceed expectations. That in itself is quite an enigma, given the number of people involved in the classic elements of product launch: preparing the market, preparing the molecule, preparing the brand and preparing the organisation.

There are a multitude of reasons why some product launches fail and some are a phenomenal success. What we would like to discuss here are two particular aspects relevant to launch excellence to provide you with some food for thought.

In any particular therapeutic area, healthcare professionals (HCPs) will be treating their patients to the best of their ability, with the tools, including pharmaceuticals, they have available. That means they will be doing something.

What is critical for the owner of any pharmaceutical asset, is to provide the intended 'target customer' with a 'reason to change' what he is are currently doing. Historically in pharma, when NCEs were a step change in treatment due to any combination of better efficacy, safety or tolerability, then the 'reason to change' was clearly evident to any HCP intent on achieving better outcomes for his patients.

However, today's commercial challenge is to identify that 'reason to change' in an evidence-based, outcome driven, cost-effectiveness focused healthcare environment. That means modern and much more complex healthcare environment already has a significant number of 'structural' barriers to overcome before companies can even get their NCE truly considered.

It is no longer possible just to rely on the traditional approach of telling the molecule story that has worked in the past. The barriers in today's healthcare environment are too significant, the hurdles too high, and the influence of stakeholders on prescribing decisions too great.

With all the inhibitors to changing treatment and prescribing habits we need to consider a new approach. An approach that really understands behaviour change and helps to overcome the inertia that these barriers and hurdles create. An approach that does more than just the provide the 'evidence' and key messages for the molecule.

There is plenty we can learn from other disciplines to help us with 'reason to change'. We all know how hard it is to change our own habits, so why do we assume an HCP will change just because we provide him with the evidence about our product?

Facilitating change

The first step is to create the desire to change. For anyone to adopt a new behaviour or product, they have to want to do it. That may seem like an obvious statement but, experience has demonstrated that human agency (ie the human capacity to make choices) is rarely considered important when we are developing strategies or having discussions about behaviour change. There seems to be an assumption that people can be convinced to act by the persuasiveness of a messaging campaign or by an environmental 'nudge'. While this may be true for short-term changes in behaviour, it can't be true for sustained behaviours where people have to independently reinvest their time and energy to maintain a behaviour or product long into the future. In other words, sustained behaviour change means people must believe they are attaining an outcome that matters for their lives or practices. And, because they aren't stupid, it goes without saying that the behaviour or product has to work.

Secondly, we need to 'enable the environment'. Environmental factors exert a tremendous influence on our behaviour. For example, in order for people to stop driving they need rapid, easily accessible, safe, comfortable public transport that goes where they want to go. Anything less and they're liable to just keep on driving. Tackling obesity has as much to do with making the right food available as it is with people wanting to eat healthy food. So Michelle Obama's Let's Move campaign is now working with food retailers to establish 1500 shops selling healthy food in inner city “food deserts”. So, how can we help change the environment to make the desired change easier?

Change is scary! We therefore need to give people the confidence to change, encourage/enable that 'can do' attitude. In order to change, people must have confidence they can manage the social, physical and financial risks that are involved. People must have belief in their own capacity ('self-efficacy') to get results with certainty and without embarrassment, humiliation or personal loss. 

Nothing happens in today's world without conversation. Conversation carries change along social networks. It connects people, determines social norms, and it's how societies and groups make choices. Conversation is the key to culture change, since a group's culture is the sum of its conversations. Conversation is also how people decide what is true. When people experience a new behaviour or product that really works in their lives, they talk about it.

So, in order to change behaviour you need to 'create more buzz', increasing other people's desire to change. We know that people learn from people they know who've already trialled the product

So what methods should we use to drive change? Research by the Kings Fund provides some interesting pointers.

According to the literature, educational materials alone are generally viewed as ineffective in influencing clinician behaviour, despite being the most regularly used intervention. Not surprising really given the thinking behind behaviour change outlined above. Education is a necessary and an essential part of the process but is not sufficient to change behaviour. No surprise it is more effective if combined with other approaches that reinforce the change required as part of a multifaceted intervention (see below).

Interestingly, although used for many years, large scale didactic meetings are generally seen as ineffective, especially if trying to change complex behaviours. Smaller-scale interactive meetings are far more effective. Experience has shown that, peer-to-peer work with local 'opinion leaders' or the HCPs' local specialists really can make a difference.

Educational outreach visits to professionals in their practice have been found to be effective, particularly in changing prescribing behaviour. This form of intervention has also been shown to work in the delivery of preventative services and the management of common problems in general practice. Such educational outreach visits (also known as academic detailing) were first used by pharma to influence pharmacist-prescribing behaviour, by offering information, support and instruction.

There can be limitations - the effect of outreach visits on more complex behaviours is unclear - but they may be particularly effective if combined with social marketing techniques.

A real world example is provided by the 2012 PMEA-winning programme in HIV testing:

The challenge: Why were so many patients in non-GUM clinics not getting tested for HIV?

The solution: Engage experts and patients in creating a model for change, building the tools that enable the conversation, providing the necessary assets to practitioners to make the change.

The result: “Since using these materials, there has been a 60% increase in routine HIV testing by junior doctors and a 13% shift in earlier diagnosis,” Dr Dushyant Mital, Consultant in Sexual Health & HIV Medicine, Milton Keynes NHS Foundation.

To be confident in your launch plan you need to recognise that you have to give key decision makers a strong 'reason to change'. But it is not just about a strong differentiating message. It is a process that involves creating the 'desire to change', 'enabling the environment', helping develop a 'can do' attitude and 'creating a buzz'.

How do we do that? With a joined-up multichannel approach. Too often we initiate elements that appear connected but that may not actually take the key customers on the necessary journey to facilitate the 'reason to change'.