Things are going to be different

Addressing the global reality of the impact of COVID-19 is the most significant challenge the pharmaceutical industry has faced in recent history. While many other industries have had to adapt and change quickly in the face of other major global economic or political events, the life sciences industry has been somewhat insulated; change has been more evolutionary than revolutionary. COVID-19 has disrupted this historical pace of change, wreaking immediate havoc on day-to-day activities and challenging long-term strategies.

Early insights point the way

In the rush to make sense of the current uncertainty, there is a natural, human tendency to move quickly to predictions about what this ‘new normal’ will be. Unfortunately, the risk is finding more speculation than informed evaluation; hypotheses are often based on early insights and incomplete data from markets across the world.

There is, however, value in learning from these early experiences and picking up the signs that will guide decisions on response strategies in the short to medium term. At IQVIA, our data assets and analytic capabilities, combined with our everyday experience of how our customers are responding, come together in a body of market research and analysis to inform, enable and empower customers around the world as they consider their postCOVID-19 commercial planning.

A unique perspective

Our Contract Sales and Medical Solutions (CSMS) team is involved in delivering over 500 commercial or patient support services globally, and evidence from these projects gives good insight into how life sciences companies across the spectrum of size and therapy areas are responding. Combining this with first-hand feedback from healthcare professionals, payers, providers and patients across countries and therapy areas delivers unique global insight that, in turn, will help identify the critical success factors for pharma to emerge successfully from the pandemic.

With the vast majority of field activities still suspended globally, and only a limited return in countries relaxing restrictions, there appears to be a patient approach from many companies outsourcing their field services. Most representatives are now working from home with companies waiting to see the practical implications of differing relaxation arrangements across countries. Interestingly, while we have seen the vast majority of our CSMS services move to amended working arrangements, the number of customers making fundamental changes represents less than 30% of our total operation.

Digital and remote engagement

The biggest change has come in how companies are reaching out to customers using different channels while movement restrictions remain. With face-to-face promotional activity falling by more than 90% in April 2020 compared to the same period last year across each of the EU Big Five (see Figure 1), many companies have moved quickly to fill the void with email engagement or telephone contacts. However, we are also seeing an increasing number moving to more sophisticated models of remote detailing (ReD), using specialist resources designed specifically for this task. For example, we have seen a 500% increase in users and interactions using IQVIA’s remote engagement platform between December 2019 and April 2020.

Indeed, the need for an effective response to COVID-19 has forced healthcare systems to drive significant changes in behaviour that support the use of remote approaches. In the US, we have seen the use of telehealth grow rapidly, with IQVIA claims data showing a 1500% growth in claims in March 2020 compared to March 2019 and a noticeably large increase in its use by physicians over the age of 50. It should therefore come as no surprise that 73% of healthcare professionals (HCPs) say they have increased their use of digital resources as a result of the pandemic (source KLICK Health). In parallel there has been a 62% increase in the use of remote detailing compared to the preCOVID baseline, with that rate increasing week by week, but with some levelling off at the end of April. Taken together, this demonstrates how the pandemic is driving greater acceptance of the use of remote interactions and digital resources in healthcare, even among those who have been more sceptical in the past.

It is interesting that countries hit earliest by an explosion in COVID-19 infections have seen the highest accelerations in the use of remote detailing. China has a near 600% increase, Korea 165%, Italy 286% and Spain 145%. But the significantly lower rates in France, Germany and the UK show that this is not universally true and remind us that country-by-country variations will be significant.

Patient services

Similar efforts have been made to shift most pharma-sponsored patient services to digital, virtual and online support, although some nurses remain in the field where they are providing essential services. What is most interesting, however, is the noticeable increase in the volume of pharma companies looking to extend homecare support as health systems have come under pressure. Data here is hard to come by, but assessing the picture based on enquiries IQVIA has received suggests more companies are trying to find constructive ways of shifting support into patients’ homes. Indeed, in the UK it is government that has approached the industry about helping to release hospital capacity by investigating alternative options for some therapies already in use. In the US rules have been relaxed to allow more at-home infusions and in Australia IQVIA research suggests up to 60% of hospital specialists now want to refer more patients for home treatment.

Implications

It is important to put these developments in context. The pharma industry has been slow in its uptake of virtual and remote engagement models over recent years, partly because of caution related to the highly regulated nature of the industry and partly because of a lack of experience of ReD. This is despite IQVIA market research demonstrating positive feedback from most HCPs who receive remote calls. Estimating the size of residual effects of COVID-19-related changes will depend somewhat upon their scale and duration, but it is certain we will see some, if for no other reason than the greater use of remote engagement and telehealth as part of everyday healthcare practice during the pandemic. This will likely make HCPs more accepting of life sciences companies using these for promotional and non-promotional services and encourage more companies to embrace them as they adapt to new customer preferences.

The bigger impact may come from the support industry gives to enabling a shift to more home-based care. It will take considerable time for healthcare systems to recover from the strain of managing the impacts of COVID-19 and pharma can certainly play its part in helping to shoulder the burden while systems catch up. Patients are also likely to be much more accepting of home-based care and the role of industry in providing this, creating the ideal circumstances for industry to demonstrate its wider value. With company pipelines dominated by specialist and rare disease products for the foreseeable future, embracing this change may turn out to be one of the industry’s better decisions.

In the next article I will share further insights as they emerge, and will begin to explore their implications for promotional and medical services as we move into 2021. If you would like to know more about our work on COVID-19 please visit IQVIA’s COVID-19 Resource Center at www.Iqvia.com.

Note: Unless otherwise noted, data cited in this article is drawn from IQVIA’s proprietary data assets accessed in May 2020, including IQVIA ChannelDynamics, IQVIA Medical Claims Data, IQVIA National Prescription Audit, IQVIA Formulary Impact Analyzer and IQVIA BrandImpact Network.

John Procter is VP Patient Engagement & Medical Affairs, Contract Sales & Medical Solutions Global Business Unit at IQVIA