PMN SFE Supplement - Pharma Marketing Network

Special Supplement Increase Physician Access and Detailing Effectiveness

Published by:

VirSci Corporation PO Box 760 Newtown, PA 18940 [email protected] © 2005. All rights reserved.

Contents Introduction .................................................................................................. 1 Topics A Crisis in Professional Detailing ............................................................................ 2 Marketing’s Role in Limiting Physician Access ....................................................... 4 Finding the “Right Stuff” to Revitalize Sales Productivity ........................................ 6 Facilitating Physician Access and Education Through Online Conferencing.......... 7 The Targeted Model................................................................................................ 9 Limbic Market Research ......................................................................................... 11 Intelligent Online Sampling Strategies .................................................................... 13 Increase Prescription Sales with Smart Tools at the Point of Care......................... 16 A Novel Approach to Communicating with Physicians............................................ 18

Case Studies Increase Sales Representative Performance and Productivity by Building Collaborative Physician Relationships .................................................................... 20 Promoting Pull Through Prescriptions via Value-Added Free Medical Practice Web Sites and Patient Education .................................................................................... 21 Gauging Physician Behavior and CE Impact with Two-Way, Real Time, Web-Based Technology.............................................................................................................. 22 Live, Online, Interactive Conference with Experts to Provide Detailed Product Information to Physicians ........................................................................................ 23 Audio with Synchronized Visuals Streaming Over Low Bandwidth Internet Connections for Physician Detailing........................................................................ 24 Online Content Management System for Sales and Marketing Representatives ... 25

List of Resources & Experts Cited .......................................................................... 26

Introduction

I

s it time for the pharmaceutical industry to revamp its physician marketing strategy? Pfizer thinks so. The world’s largest pharmaceutical company recently announced that it plans to “reverse a decadelong infatuation with multiple sales forces pitching the same products to the same doctors” (see "Pfizer Plans $2 Billion in Cost Cuts," WSJ, 2/11/2005). As one commenter to a recent post I made to Pharma Marketing Blog said: “The strategy to approach physicians and inform them about the benefits and advantages of one product in comparison to another (or others) is a never ending story.” Everyone knows that pharma sales reps are less effective than they used to be (see "A Crisis in Professional Detailing"). Although the pharmaceutical sales force has doubled between 1995 and 2000, the number of audited calls has only increased by 10%. Experts like Gerald J. Acuff Jr. (“Marketing’s Role in Limiting Physician Access”) and Hossam Sadek (“Finding the ‘Right Stuff’ to Revitalize Sales Productivity”) advise the pharmaceutical industry to focus more on quality than quantity and offer a variety of solutions that are discussed in this Special Supplement. Rick Blockinger, Senior product Director, Gastroenterology, Janssen Pharmaceutica emphasizes a “targeted” approach to regain a focus on customer (i.e., physician) need (see “The Targeted Model: The Future of Pharmaceutical Marketing?”).

“sample delivery vehicles” and allow them to focus more on middle and low tier prescribing physicians (see “Intelligent Online Sampling Strategies”). Physicians don’t have time to ask sales reps all the prescribing information they need about drugs. Pharma companies can provide physicians with value-added smart tools to allow them instant access to up-to-date prescribing and treatment information (see “Increase Prescription Sales with Smart Tools at the Point of Care”). Physician’s want more education about drug products from pharmaceutical companies and their reps. Indeed, in the post-VIOXX more attention must be paid to this unmet need of physicians in order to allow them to be better learned intermediaries between the drug company and the patient (see, for example, “Marketing in the PostVioxx Era”). The pharma industry is responding to this need for physician education by sponsoring CME via the Internet (see “Facilitating Physician Access and Education Through Online Conferencing”). This Special Supplement also provides case studies illustrating how these solutions have been implemented in real life. I hope that you find this selection of articles helpful in giving you a better understanding of the issues relating to physician access and how to improve the effectiveness of your physician marketing and sales campaigns.

It helps to know what motivates phsyicians so that your messages are optimized for specific segments of physicians (see “Limbic Market Research: Plumbing the Subconscious Motivators of Physicians”). Pharma companies also need to deliver customized messaging to physicians in a variety of formats, including in person, at meetings and symposia, via direct mail, on the Internet, via email, and via hand-held electronic devices. Internet and electronic communications channels are discussed in this Supplement. Electronic detailing (eDetailing) is a topic covered in a separate Special Supplement (Click Here to order).

John Mack, Publisher & Editor Pharma Marketing News

Online sampling, for example, is a new technique that promises to curtail the use of sales reps as

Pharma Marketing News Supplement

© 2005. VirSci Corporation. All rights reserved

1

A Crisis in Professional Detailing

the doc,” quips Bavasso with tongue in cheek, “because of the donuts, coffee, and pizza.”

By John Mack PMN Reprint #37-02

A

lthough many people argue that physician detailing is inefficient, is often unproductive, and is difficult to do effectively, it is still “the best way for a doctor to find out about a product,” according to Richard A. Bavasso, EVP/COO, Pharmedica Communications, LLC. He was speaking at an industry conference on Sales Force Effectiveness, where he also moderated a panel of physicians who gave frank insights into what physicians want from pharmaceutical sales reps. At least $15 billion annually is spent on physician marketing activities (2004), including: • • • • • • • • •

Sales rep details Samples Patient education materials Brand awareness items Peer selling Medical meetings Market research/consulting Medical journal articles Medical journal advertising • Call centers/support

The increase in the number of sales calls is not proportionate to the increase in number of sales reps. Although the sales force has doubled between 1995 and 2000, the number of audited calls has only increased by 10%. Realistically, reps average only 2 quality details per day (quality details includes discussion of features, benefits, and data). The reps have less time per call, are only able to deliver incomplete messages, and aren’t able to really differentiate their product from the com-petition’s. “The pharmaceutical sales representative has one of the most difficult jobs in the country,” remarked Bavasso. What Do Doctors Want? The physicians on the panel were: Peter Alagona, MD, FACC, a clinical intervention cardiologist from Florida, a specialist who writes about 60 prescriptions per day (“a million dollar customer,” says Bavasso) and Robert Green, DO, FAOA, a primary care physician from Connecticut.

Twenty-five percent of the annual $27 billion spent on pharmaceutical marketing is on the field force. “It’s a significant investment,” says Bavasso. Not Just Donuts, Coffee, and Pizza While medical practice has changed dramatically in the past 30 years, professional detailing has not. It still relies on a colorful piece of cardboard with some charts and graphs and claims and benefits. The representative still tries to convince the doc that his or her company’s product is better than the competitor’s product. After warning the audience that the series of referenced declaratives he was about to share with the audience were not going to be pleasant to their ears, Bavasso began to describe the physician perception that the value of the representative as a resource has declined over time. Instead of an educator, their perceived value has denigrated to the most negative connotation of “sales person” and, in worst case scenarios, just a delivery person dropping off samples and pizzas! “The receptionist gets more excited about seeing the sales rep than


Trends Impacting Effectiveness It’s a very crowded and noisy marketplace with lots of fighting for share of voice. An average physician is called upon by 20 reps per day according to Bavasso who cited research by Ernst and Young and Hambrecht & Co. as sources. A high-volume prescriber may have 50 reps knocking on the door each day. Is it any wonder that reps are turned away 43% of the time or that some physicians are even considering charging for access?

Dr. Alagona has always viewed healthcare in the US as a cooperative venture that includes thirdparty payors, the government, insurers, hospitals, medical centers, physicians, and the drug and medical device industries. At the risk of sounding “politically incorrect” Dr. Alagona emphasized that the pharmaceutical industry has been an indispensable partner. “I look at the industry as a resource, not just a partner,’ said Dr. Alagona. “That’s why I try to interact with as many company representatives as I can.” Dr. Green has also enjoyed interacting with representatives. “Unfortunately,” says Dr. Green, “not every representative has the ability to teach and some just push the sales aid. Only 10% to 20% have remarkable abilities, the rest can communicate, but tend to push the same message all the time. Towards the end of the day I’ve had enough.” Dr, Green especially welcomed reps that could bring to him concise results from clinical studies about new indications for products. “It’s an indispensable form of education for me.”


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Good Rep vs. Bad Rep Although Dr. Alagona praised reps who could engage in informative interactions and provide supporting evidence from the literature, he also was adamant the inadequacy of current detailing practices has less to do with sales reps than a failure of leadership and lack of vision. “Sales reps,” said Dr. Alagona, “have been hog-tied and gagged to the point where they are of very little value.” Dr. Alagona specifically cited PhRMA guidelines and other restrictions imposed on sales reps by their companies. The problem is made worse because companies interpret the guidelines differently. “The most valuable representatives I’ve interacted with,” said Dr. Green, “were those that brought the education that I need, not the exact same message they give other docs over and over again.” “It is much better to have one rep who is valuable, who has a relationship with the office staff, and knows when it’s a good day or not a good day to see me,” suggested Dr. Alagona, “than to have ‘storm trooper’ representatives coming to the door.” “Successful representatives,” said Dr. Green, “can build upon the relationship and remember what they talked about a week ago and now talk about a different point rather than come in with the same information over and over again.” Samples & Patient Education Both doctors agree that pharmaceutical samples are a great benefit to their patients and pharma companies should talk more about their sample programs in their public relations activities. “You are talking about billions of dollars worth of free medicine given out by the industry,” said Dr. Alagona, “but I have never seen this mentioned anywhere in the lay press. Doctors don’t appreciate and patients don’t appreciate it. To me this is a typical pharmaceutical PR faux pas.” He also suggested that by dropping off samples without getting any commitment from the doctor is rewarding bad behavior. Dr. Green pointed out that he and many other doctors have had patients that were kept alive by samples due to their inability to pay for prescriptions. “Samples are indispensable,” said Dr. Green, “I would never start a patient on a new prescription without a trial run with samples first.” “Patient educational information materials are extremely important,” suggested Dr. Alagona. “The problem I have is getting copies of scientific articles from reps. They just can’t do it even though the articles may be available on Web sites or are otherwise in the public domain.”


Sales Rep Preparedness Sales reps don’t seem to know much about the relationships physicians may already have with their company. Dr. Alagona, for example, was a speaker at a product launch meeting, yet the rep inquired if he knew about the product! “There’s not enough education of the reps about the docs they are visiting,” say Dr. Alagona. Reps need to understand better the people they are trying to sell to. Dr. Green would also like to see a progression in the information that reps deliver. “Each time I see a patient,” Dr. Green mentioned as an analogy, “I don’t go through their whole medical record with them starting from the beginning. A lot of times reps come in and start at the beginning with the same message. It would be much better if they built upon what they covered a few weeks ago.” Local Dinner Meetings An audience member asked about the worth of dinner meetings and what factors influence whether or not physicians decide to participate? “A restaurant is nice to go to,” suggested Dr. Green, “but what’s important is who is presenting. Although the information is important, the presenter may not be a great communicator. You end up bored and wondering why you went! These types of meetings have real value for physicians who want to keep up to date in their practice.” “Dinner meetings also take up a lot of my time,” says Dr. Green. “The future,” suggested Dr. Alagona, “will include more electronic education. But the reality today is that most doctors still want education where they can see their colleagues and ask them questions.” Closing Remarks Dr. Alagona asked “how come I’ve never seen anyone from the main office, the marketing VP in charge of cardiovascular drugs, etc., down here? How come they don’t spend any time in the field? How can they know what the problems are if they don’t go and see what the problems are?” In closing, Dr. Green demonstrated a new tool being tested by some drug companies to help the rep better educate the physician. This tool, a new tablet PC, stores all of the materials formerly held in the sales representative’s bag and allows the rep to focus discussions and/or rapidly answer questions posed by the doctor. “This is the future of professional detailing and this is adding value to the sales rep’s ability to educate clinicians,” remarked Dr. Green. Pharma Marketing News


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Marketing’s Role in Limiting Physician Access And What to Do About It By John Mack PMN Reprint #43-01

I

n the 1950’s and 1960’s, the relationship among healthcare professionals and sales representatives was collegial, cordial and one where the pressures of time and economics were secondary to the quality of care, bedside manner, and professional interactions between pharma sales representatives and the healthcare community. As manufacturers developed more products to fight more diseases and the competition between “blockbuster” drugs intensified, it became apparent to major pharmaceutical companies that they needed an expanded and better-trained sales force to generate market share and increased sales. Coupled with a steady drumbeat to accelerate profits and retain margins, senior executives embarked upon a road of “more reps equal more sales.” This expansion, however, negatively affected the quality of the sales call and the physician-rep relationship. The pharmaceutical sales interaction has lost much of its value over the last 10 years in the mind of the customer (i.e., More Data from the physician). The data on this has Accel Report been presented Only 43% of pharma reps ever many times at get past the receptionist various conferences and in this Only 7% of pharma rep visits last and other publicmore than 2 minutes cations. One Only 6% of physicians think study often cited representatives are very fair is the Accel balanced Report (“Through Only 8% of calls are remembered Our Customers' by the physician Eyes”), which was based on pro56% of physicians think prietary research representatives are more conducted by aggressive today than in the past Accel, an Omnicom agency, in March 2003 (see chart on next page and below).


“The pharmaceutical industry has only itself to blame for limited physician access and two minute sales calls,” claims Gerald J. Acuff Jr., Chief Executive Officer, Delta Point, a sales agency that enhances the effectiveness of sales representatives. He was speaking at a recent “Gaining Physician Access” conference hosted by the Center for Business Intelligence. Marketing’s Role Acuff emphasized that marketing departments have an opportunity to improve the impact of sales reps. He offered several useful insights about what marketers should do to change the negative perception that physicians have of pharma sales reps. Marketing’s role in limiting physician access could be due to either of the following two problems, according to Acuff: 1. Not truly understanding the difference between a marketing message and a sales message. The copy that accompanies sales aids, for example, is not written with an understanding of how sales are made. 2. Providing to the field suggested sales language that “closes down” customers. Examples of verbiage that signals the wrong thing include: • Dr. If I could show you that………….” • “Dr. Wouldn’t you agree……………….” • “Dr. Today I am going to talk to you about…….” • “Dr. Would you prescribe________ for the next 5 patients you see with __________” • “Dr I want to talk to you about your patients with………..” • “Dr. why do you prescribe a_____?” Such classic detail verbiage, says Acuff, turns the doctor off. Marketing often uses superlative language and claims. If you listen to the way doctors talk, you will seldom hear superlatives. Instead, you hear phrases like “appears to” or “has some benefits.” It’s no wonder that 94% of doctors think sales reps are overly biased. “Sales reps,” says Acuff, “should stop talking like a drug rep and begin thinking like a physician. Being like every other sales rep just diminishes your credibility.” The suggested sales verbiage offered by marketers does not resonate with the customer. Continued on next page…


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If the rep thinks the language won’t work, he or she won’t use it and will become convinced that marketing doesn’t know what’s going on! This drives a wedge between marketing and sales. What to Do About It Acuff cited a variety of pharma sales practices that have lead to the current situation: Detailing won out over true “selling” in the early 90’s A focus on activity over almost everything else Share of voice became royalty at the expense of share of mind Activity trumped accomplishment (and accomplishment became nearly impossible to measure)

A Blind Eye—not leveraging what great people do The last item, according to Acuff, holds the promise of the solution. “Great reps are islands of excellence in a sea of mediocrity,” said Acuff. “This is an opportunity to exploit NOT to ignore! The great reps today have no major access problems, so let’s do what they do.” Whether you hire an outside agency or do it yourself, the process begins with “picking the brains” of the very best reps. Marketers, unfortunately, are not in the field enough to get this kind of input from the sales force. Differences between these reps and others may be subtle, but the impact is great. The goal is to break down the disconnect between marketing and sales and to realize how sales messages differ from marketing messages. While the marketing message drives the sales message, the latter is a verbal interpretation of the former. Sales messages should be designed to engage the physician in meaningful dialog, which is the most likely way to get customers to “Think Differently” about the product. Marketing/sales messages that change behavior must first be truthful, believable and compelling to become powerful, memorable and highly effective.

A unit is a unit mentality (thanks to some consultants) No one accountable or responsible for the relationship A lack of understanding of how customers buy Meetings more important than field time Follow the leader mentality in Big Pharma A lack of understanding that many, many physicians see your product as a commodity

Pharma Marketing News

Percentage of MDs Indicating Attribute is Valuable 100%

84%

84% 78%

Percent of Physicians

80%

61% 60%

40%

20%

0%

Sensitive to time constraints

Trustworthy/credible

Friendliness

Scientific knowledge

Representative attributes important to physicians (percent of MDs indicating attribute valuable; i.e., greater or equal to 8 on a scale of 1-10). Source: The Accel Report: Through Our Customers' Eyes.



5

Finding the “Right Stuff” to Revitalize Sales Productivity

year), negatively impacting the quality of the physician visit.

By Jim Lenskold PMN Reprint #31-02

D

eclining sales force productivity is a major issue on the minds of sales managers and corporate executives of pharmaceutical companies large and small. More and more physicians are limiting face time and closing their doors to sales reps. The nature of sales detailing has changed over the years and the time has come to reassess the process and potential of this sales channel. The solution, as presented by Hossam Sadek, VP of Sales Force Effectiveness, IMS Health, at an eyeforpharma Pharma Sales Effectiveness USA conference, is for pharmaceutical sales management to place greater attention on the quality of the physician-rep relationship than on traditional representative activity metrics such as number of calls per day. By focusing on relationships and the metrics that drive relationships, pharmaceutical companies enable their reps to deliver tailored messages that truly impact the prescribers in their territory. Two industry trends have a dramatic impact on sales effectiveness: 1. the dramatic increase in the number of sales reps (51% since 1997) leading to less experienced, younger sales forces (average age of a US rep is 26), and 2. the decrease in productivity per rep (24% since 1996) Pharmaceutical companies today have such a tight window of time to recover significant investments into R&D. Market exclusivity is getting shorter and putting more pressure on sales and marketing. Adding Reps Doesn’t Improve Success Rate The only proven solution to accelerate sales has been adding reps. However, IMS’ industry analysis shows that the growth rate of successful sales calls is significantly lower than the growth rate of sales reps (24% since 1996)—meaning the incremental calls per rep has been less and less each year (808 in 1996; 529 in 2001). Training and skill development of sales reps has also not kept pace due to high turnover (~18% of reps turnover each


The underlying problem is evident when looking at current sales practices from the physician’s perspective. “Physicians want trusted rep relationships for access to objective scientific data, patient case studies, and connections to thought leaders and other physicians,” said Sadek. Instead, they are getting bombarded with non-stop visits from reps that cannot give them the information they need. Success will come when reps and the metrics they are managed by are aligned with physicians’ true motivators. Traditional Metrics Don’t Measure Value “Sales metrics drive behaviors and traditional metrics are leading the industry down the path of decreasing productivity,” indicates Sadek. “For example, a measure such as the number of minutes spent with a physician does not indicate the quality or value of that contact. However, measuring how often a physician consults a company’s resources for product information can provide much better insight into the effectiveness of the contact.” Segmentation of Physicians is Key Marketing to physicians must also be reassessed. “The days of bombarding the physician with multiple reps are gone,” says Sadek. “Companies can’t send the same message to all physicians, five times per day and expect to make an impact.” The time has come to progress from the quantity of contacts to the quality of relationships. And the most critical step for making this transition is segmenting physicians based on their individual needs and preferences. Sadek offered three primary areas that drive effective segmentation approaches—physician behaviors, longitudinal insight and attitudes. Traditional segmentation approaches have primarily concentrated on physician behaviors alone, partially due to the difficulty projecting attitude-based segment membership to an every prescriber in every territory. According to Sadek, it is the corporate decision to take that first step of enhancing an existing sales process that, even with its imperfections, is the primary, known sales driver. Caution on the part of the pharmaceutical companies makes sense, given that managing such a change in the culture and approach of the sales force is no small task. Based on the sound logic behind a sales model that meets physicians’ needs, the potential upside in value, and the current trends in decreasing productivity, a relationship model cannot be ignored for long.


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Utilizing advanced predictive modeling techniques and access to its extensive databases, IMS is able to achieve a predictive accuracy of approximately 85% vs. an industry standard (for attitudinal-based segments) of 60%. For each segment, companies should prepare a distinct marketing approach and sales plan that incorporate “the right stuff” (see box below).

“The Right Stuff” for More Productive Selling 1. Right Customers – Segmenting physicians in such a way that is actionable and prioritizes true opportunities. 2. Right Frequency – Finding how often each physician segment should be contacted and through what channels. 3. Right Message – Choosing which message best matches the individual priorities of the physician. 4. Right Size – Identifying how many sales reps are truly needed. 5. Right Deployment – Appropriately setting up territories to support this sales model. 6. Right Training – Shifting the focus to the quality of the relationship. 7. Right Tools – Keeping the sales rep focused on selling and not reporting.

8. Right Motivation – Setting the metrics and compensation to support the right behaviors. Barriers Remain So what is the greatest barrier to adopting a sales approach that physicians are likely to embrace? IMS Health is already working with a number of clients to pilot this relationship-driven approach. Sadek is hopeful that motivation for change will come from the industry itself and not from physician groups. He anticipates that “the tipping point will come as these pilot projects objectively prove their value and clearly justify a business case for full scale rollout.” Pharma Marketing News


Facilitating Physician Access and Education Through Online Conferencing By John Mack PMN Reprint #41-02

P

harma companies are under increasing pressure to bring relevant clinical trial information to the marketplace. Recently, the Pharmaceutical Research and Manufacturers Association (PhRMA), announced that information about ongoing clinical trials -- beyond what is required by law -- will be made available by pharmaceutical companies and posted to the government’s existing clinical trial registry (www.clinicaltrials.gov) beginning July 1. 2005. "Patients and physicians have asked pharmaceutical companies to make available information about all clinical trials, not just some trials, and to make that information more easily accessible," said Billy Tauzin, PhRMA president and CEO. Several pharma companies have announced their own plans to provide more public information about the clinical trials they sponsor.

Physician Access is a Problem Pharmaceutical companies have also used Key Opinion Leaders (KOLs) and their Medical Science Liaisons (see other articles in this issue) early in the drug development process to provide physician education about clinical trials and other data supporting their product’s efficacy (see “Developing Win-Win Key Opinion Leader Relationships”). Sometimes, pharmaceutical sales reps act as facilitators, scheduling educational activities as a means of increasing access to physicians, gaining a bit more credibility and face time with their clients in the process. Access to physicians is becoming more and more of a problem. Doctors need immense amounts of medical information, but their patient loads limit their ability to see pharma sales reps or attend conferences or other educational activities away from their offices at such venues as local restaurants and hotels. And it is impractical to bring KOLs and experts into the physician’s office.


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Recent studies indicate, however, that more and more physicians are accepting and even preferring online interactions with pharmaceutical companies. In a recent Verispan ePromotion Annual Study released December 17, 2004, more than two-thirds of physicians said they participate in ePromotion in addition to face-to-face promotion, while 5% participate in ePromotion instead of face-to-face promotion. Participation in ePromotion is expected to grow; 43% of physicians reported that they expect their participation to increase in the next 6 months. Web Conferencing is the Solution One way in which ePromotions and educational programs are delivered to physicians is through Web conferencing. Web conferences allow physicians to interact directly with researchers and other physicians who have firsthand knowledge of the science and clinical trial results behind new drug therapies. The conferences, which are attended by physicians using a standard PC with Internet access, allow doctors to see and hear live medical presentations and also have the opportunity to submit questions and comments by voice or online chat. MedConferenceLive® – a managed, turnkey web conferencing service provided by the Maxwell Group – routinely connects some 25,000 physicians a month, or about 20 conferences per day, through live, online interactive web conferences between doctors in their own offices and leading researchers and opinion leaders working with top pharmaceutical companies. “MedConferenceLive® brings the experts directly to physicians whether in the office or at home using their own PCs,” says Bob Maiden, president of the Maxwell Group. A recent day's seminars included topics on new cholesterol reducing statins, the latest research on osteoporosis and the health benefits of new allergy medicines. Connecting the Dots "There are plenty of generic conferencing providers,” says Maiden, “but connecting the dots between physicians and key opinion leaders is a whole different ballgame. You need to have a thorough understanding of the goals and objectives of the sponsor, as well as the ability to customize and manage the technology."

“We currently average approximately 50 physicians per event with some attracting over 200 physicians per event,” says Maiden. “Our post event surveys allow us to measure satisfaction levels (speaker, message, level of content, ease of connection, etc.). In addition, participating physicians can be measured against peer groups for changes in script writing pre and post event.” The Maxwell Group also offers a companion service that allows live web events to be recorded and archived for 24/7 viewing (MedConferenceOnDemand®). Types of Conferences The conferences that the Maxwell Group provides fall into two broad categories. Brand drug promotional events allow drug sales representatives and physicians to jointly participate in the event. These presentations might be attended by a number of the practice's doctors at a lunch-and-learn session, for example. The following table compares this service to eDetailing. Feature

eDetailing

MedConferenceLive®

Message

Brand Specific

Balanced

Speaker

Pharma rep

Key Opinion Leader

# Docs

One

Many

Cost Per Doc

High

Low

TABLE: Web conferencing vs. eDetailing MedConferenceLive® has also found a major market in speaker training – a promotional technique whereby pharmaceutical companies train key opinion leaders to present information on new drug therapies to other health providers. “We view MedConferenceLive® as the wave of the future in how pharmaceutical companies will more intelligently and efficiently update their speakers," says Angela Fiordilino, executive vice president of Phoenix Marketing Solutions, a client of the Maxwell Group. Pharma Marketing News

During every live event, an experienced facilitator is available to support the speaker, and a toll-free help desk provides any necessary technical support. On the backend, the Maxwell Group provides an extensive survey and reporting component that allows drug companies to measure the success of their events.



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The Targeted Model

advertising, and consumers armed with information from the Internet. Rethinking the Brand Plan According to Blockinger, the pharma industry has not adapted to the changing influences and has lost sight of the customer. The easiest thing for a product manager to do is to take last year’s business plan and repeat it for the upcoming year. As a consequence, year after year the marketing plan stays essentially the same while the environment has changed drastically.

The Future of Pharmaceutical Marketing? By John Mack PMN Reprint #37-03

R

emember the good days of pharmaceutical marketing? When pharmaceutical reps and doctors had personal relationships? When the sales rep was the dominant influencer of physician prescribing behavior? When reps were knowledgeable and provided the physician with useful information that couldn’t be gotten anywhere else? Well, the days of the traditional marketing/sales model are over according to Rick Blockinger, Senior product Director, Gastroenterology, Janssen Pharmaceutica. Speaking at a recent industry conference in Princeton, NJ, Blockinger highlighted well-known survey data documenting the decline in effectiveness of the typical pharmaceutical sales rep. Some of the data Sales detail cited: • Physicians have less time: 43% of sales calls result in the representative not even seeing the physician

“Single-focused, ‘approved’ brand messages show no regard for differences among physicians.” Targeted marketing is the future. Whether your Rx brand message is delivered via a sales rep, direct mail, website, in-store display or TV ad, it must be applicable to each segment of your target audience. It's time to rethink the national brand plan and leverage our wealth of data on a market-by-market, audience-by-audience basis. Direct marketing principles lie at the core of this model and will help forward-thinking pharmaceutical marketers adopt a multi-faceted strategy to optimize each market opportunity and maximize ROI.

aids

Non-personal promotion

No regional differences Customizable media Little difference by specialty • Direct mail No ability to customize by • E-detailing physician “mindset” One-size-fits-all messaging

• More reps are trying to see the same doctors: data from the Bergen County (NJ) Record indicate that between 1996 and 2001 the number of pharma sales reps grew by 110% while the number of physicians grew by only 12.5%. The result is that there is now 1 sales rep for every 10 physicians. • The role of the representative as information provider has diminished: New technology—the Internet, PDAs, text messaging—has created new information sources. “We have not done a good job using these tools,” say Blockinger. Reps have learned to use 15-second sound bites to get one main point across. As a result, Doctors find only 35% of meetings with reps helpful. Other changes have influenced the physician-rep relationship as well. These include the influence of managed care’s multi-tiered formularies, DTC


What We Need on the Physician Side “We have created this problem and now its time to do something about it claims Blockinger, ““What we need is a flexible professional promotion model to customize messages to meet individual physician needs similar to how a skilled representative would communicate. Today’s pharmaceutical marketing and sales model must be opportunistic and flexible enough to allow customization to the influences of different sales territories, physician types, managed care formularies, reimbursement landscapes and consumer attitudes. We also need the ability to deliver customized messaging to physicians in a variety of formats (in person, at meetings/symposia, via direct mail, on the Internet, via email, via other electronic devices).


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What We Need on the Consumer Side Print and TV direct-to-consumer (DTC) advertising can raise awareness, but awareness should not be equated with action. “There is no guarantee,” says Blockinger, “that a consumer will come out a doctor’s office with the drug that he or she requested.” According to an FDA survey, when patients ask for a prescription for a specific drug, the doctor obliged 57% of the time, which is only slightly better than even odds (See “Results from FDA Physician Survey on DTC Advertising”). Consumers at different stages need different information and marketers need to develop flexible consumer promotion models to customize messages to individual prospects and patients according to their needs. The new model must differentiate among consumers who: • Have little knowledge of disease state or brands

vs. • Are already informed

• Are still complacent and need encouragement

vs. • Are ready to talk with doctor

• Are not on therapy and need incentives for trial

vs. • Are already on therapy and need compliance messages

The challenges for direct marketing to physicians are: • Good, honest clinical data, which is what physicians want and need for their practice. • Strict segmentation criteria. Blockinger suggests that today’s segmentation criteria based for the most part on prescribing volume is not focused enough. • Relevant messaging. Blockinger points out that brands are reluctant to customize messages for fear of “corrupting” the brand. • Media flexibility The challenges for direct marketing to consumers are: • Privacy issues, including HIPAA (Health Insurance Portability and Accountability Act) and evolving state medical privacy laws aimed at putting limits on access to consumer and prescribing data by pharmaceutical marketers. • Good data for segmentation (typing tools) • Careful message construction

Not only that, but patients need different information from prospects and marketing messages need to change as prospects go through the behavioral progression starting at Awareness (just finding out about the condition and whether it pertains to them), moving to Acceptance (the potential risk has been personalized and the prospect is considering seeking information and/or evaluation), and finally arriving at Action (ready to talk with physician about treatment or is already on therapy).


Challenges Blockinger believes that direct marketing can provide the customization pharmaceutical marketers need, but warns that several challenges need to be overcome.

• ROI measurement Blockinger ended his presentation by challenging direct marketing vendors to help solve these issues within the highly regulated environment of the pharmaceutical industry and to lead the industry into the future of customized marketing. Pharma Marketing News


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Limbic Market Research

Plumbing the Subconscious Motivators of Physicians By John Mack PMN Reprint #46-03

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s more and more pharmaceutical sales reps have been deployed in the field, it is becoming extremely difficult to gain access to physicians let alone leave an impression that will motivate them to prescribe your product. Now more than ever it is necessary to be sure that your message is optimized for specific segments of your physician customer base. Market research is a critical tool for developing the right message for the right audience, but stop and think—what do you really know about the physicians and patients your researchers are talking to. Sure, they passed the screener, but do you really know where they are coming from? Behind the Curtain “Conventional market research addresses a physician’s rational or higher brain and generally elicits responses that are not a sound guide to either what the physician really means or how he or she is likely to act,” says Peter Simpson, president of Segmedica, an industry leader in the application of behavioral science to medical market research. What’s needed is a way to look “behind the curtain” of verbal responses and reveal what truly motivates physicians. For example, physicians with certain deep seated concerns about their income will deceive

FIGURE: Conventional market research techniques measure rational responses that originate in the frontal lobe or intellectual cortex of the brain. The emotional response, however, lives in the emotional, limbic portion of the brain.


themselves into thinking that a new drug or procedure is “not ready” for them to recommend when in reality what they are concerned about is its financial impact on their practice or the risk of being the object of a malpractice suit. Lock, Stock, and Both Lobes Rational responses originate in the frontal lobe or intellectual cortex of the brain, whereas the emotional response lives in the emotional, limbic portion of the brain (see FIGURE, this page). Respondents to conventional market research often will not, or cannot, access their fundamental feelings about brand and marketing issues. Although all questions pass through the limbic brain on their way to and from the cortex, we tend to give our intellectual response first, and our emotional response only after probing. Basically, conventional research tells us what physicians do but not why they do it, and therefore cannot tell us how to effectively modify their behavior Getting Limbic “Our methodology works by profiling respondents for basic personality type (limbic) and for behavioral patterns (cortex),” says Simpson. “Knowing each respondent's profile enables us to interpret their responses more meaningfully, provides new ways of segmenting markets, and tells us how to communicate with target audiences in a way that will connect with them emotionally.” The answer to marketing questions does not always lie in what respondents say (content), but in how they say it (context), which can often override the stated answer to completely alter the meaning of the recorded response. “Building Segmedica techniques into market research provides important insights into human communication and decisionmaking that are often overlooked,” says Simpson. Psycholinguistics Individuals generally do not understand their deepest motivations, needs and desires that lead to purchase and use (prescription writing and compliance!) decisions. The most deeply held values have the greatest power to influence and are also the most engrained in beliefs, behavior and habits. For this reason they are most often not in the consciousness. However, these deeply held values and criteria are available by listening to the language patterns used when describing experiences with a drug, device or instrument and using psycholinguistic analysis to reveal their unstated motivations. Psycholinguistics must be practiced in supervised, open ended studies. “We make use of the technique in in-depth interviews, focus groups and


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X-Groups,” says Simpson. This methodology is used to uncover “X-Factors”, hidden and unconscious motivators that will not be revealed in regular market research.

violated in practice (linear relationship, normal distribution, homogeneity). Hence, they are less subject to biases associated with data not conforming to model assumptions.”

X-Groups Most marketers are familiar with focus groups, which is brings together a group of people in order to gather qualitative data on the preferences and beliefs of consumers or physicians through group interaction.

By introducing behavioral profiling questions and objective demographic data (such as gender, age, ethnicity and geographic region) Segmedica introduces independent variables that can easily be applied to the universe as a whole. Segmedica research shows that these demographic variables have a high level of association with specific attitudes and behaviors. Segmenting by Rx decile alone may be too restrictive to produce a robust working model of the market.

Segmedica’s X-Groups differ from focus groups in several ways. X-Groups are smaller in size. Focus group respondents participate in a dynamic and free flowing exchange between all members at once. With X-Groups, the facilitator moves sequentially from one respondent to another, delving in-depth into their past decision making processes. The effect is that one respondent builds on the input of previous respondents. This in-depth approach stimulates each successive respondent to dig more deeply into the subconscious feelings that were used in the decision process. This type of technique is often the only way of completely understanding the true motivations behind a decision making process. HealthEnact™ HealthEnact is a unique form of encounter research, in which actors and actresses are used to play the roles of physicians or patients in mock medical consultations. “The unique aspect of HealthEnact,” says Simpson, “is that we recruit a team of actors through a strategic partnership with a national theatrical agency, and train them to portray a variety of personality and behavioral types in both physicians and patients.” In a controlled environment, the team plays the roles of patients with real physicians or physicians with real patients, so that simulated medical appointments can be observed. Simpson cited the erectile dysfunction (ED) market, where emotions in both the physician and patient can play a major role in treatment choices, as an example where the HealthEnact methodology could help companies better understand the dynamics of the situation and how to influence them. Considering that drug sales in the ED category have been “limp” of late (see “ED Drug Sales Limp”), this kind of insight might indeed be valuable. Segmentation Segmedica pushes segmentation beyond simple regression modeling with Rx data as the independent variable. “We often use Latent Class models,” says Simpson, “which do not rely on the traditional modeling assumptions that are often


It often turns out that psycho-behavioral patterns associated with gender, ethnicity, age and experience or even region of the country are linked to prescribing behavior, so that high potential segments can not only be identified mathematically but also easily identified in the real world for selective sales and marketing treatment. The behavioral profiles of each segment can be translated into sales training, collateral design, advertising or CRM campaigns. Relationship Segmentation As well a segmenting physicians and patients, Segmedica can also segment relationships between them. Relationship segmentation results in physician/patient pairings that will lead to greater or lesser compliance and persistence with therapy or acceptance of interventional advice. This information can be used to design high impact physician education and information programs and patient push initiatives. An example is patient-physician cross-cultural or cross-racial pairings where a Caucasian physician, for example, is trying to persuade an Asian patient to be compliant with a specific treatment. Multicultural physician marketing programs designed to overcome the barriers in such situations revealed by “limbic” market research will be more effective and help the physician’s practice. Next Step in Pharmaceutical Marketing Pharmaceutical companies are actively seeking new and better ways to segment physician and patient markets. Understanding these markets at a fundamental psychological level and in a way that leads to practical execution is the next step in pharmaceutical marketing. New market research techniques will lead the way to sharper and more precise pharma marketing and sales strategies. When you think about it, it just makes sense to know more about your research respondents. Pharma Marketing News


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Intelligent Online Sampling Strategies

Samples Drive Rx’s After reps, samples are the most influential tool affecting prescriber behavior, according to a metaanalysis of 16 studies reported in JAMA (Wanzana; see FIGURE at bottom). In one published study, 55% of physicians acknowledged that drug samples influenced their prescribing (Shaughnessy et al).

By John Mack PMN Reprint #34-01

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or pharmaceutical marketers, sampling is the single largest promotional investment, accounting for 55 percent of the $19.1 billion spent on promotion in 2001 (see FIGURE below). It’s no wonder—efficiently expanding sample coverage has been shown to drive significant new prescrip-tion growth with impressive ROI.

• Samples are an integral part of enabling office based practices to have satisfied customers: ¾ 88% of samples are distributed to patients • Samples enable physicians to medicate patients who otherwise may not receive treatment ¾ 29% of samples distributed go to indigent patients ¾ 13% of samples distributed go to the elderly Samples: The Reps’ “Currency”? Pharmaceutical marketers have traditionally viewed samples as “currency” to help reps gain access to physicians. After all, they have to sign for the samples don’t they? Unfortunately the growing competition for physician attention appears to have eroded the effectiveness of samples as an access tool. IMS Health’s sample tracking has found that only 36 percent of samples are actually delivered by a rep in-person. The majority of samples, 54 percent, are distributed via service visits without seeing a doctor.

U.S. Promotional Spending Breakout 2001 Total Promo=$19.1 Billion Source: IMS Health, CMR, 2002

New online strategies have made eSampling a tool for significantly expanding targeted physician and sample coverage. Applications include accelerating new product uptake, efficiently maintaining physician coverage for mature brands, covering hard to reach physicians and driving patient demand.

According to a study by ZS Consulting (Physician Surveys, 2/02 Report; n = 215), drug samples are an essential practice tool:

“The industry is doing a very poor job servicing physicians with samples,” according to Gleason.

Receiving Insufficient # Of Samples

70%

Greater Than Needed Quantity Stopped/Reduced Prescribing…Because of Lack of Samples

40%

32%

This article summarizes a workshop Won't Prescribe New 25% Product Until Samples presentation made by Mark % of Physicians Available Gleason, Managing Partner, HyGro 0% 10% 20% 30% 40% 50% 60% 70% Group, Inc. at a recent eMarketing for Pharmaceuticals conference Source: Wanzana held in Philadelphia, PA. Gleason shared data from new studies on physician attitudes toward online sample ordering “Physicians are dissatisfied with sample delivery and provided insights on how to reach this and it affects their prescribing.” A survey of untapped market potential through expanding physicians has shown that 91 percent were dissatisfied with the current supply of drug samples sampling for both physicians and patients.



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Pharmaceutical Marketing Influence on Prescribing Behavior % of Physicians Reporting Rx Influence

Gifts Lunch Rounds/Rep Speakers Promotional Materials Industry-Paid Meals

for the taking. All that is required is to leverage a scalable technology platform and channel partners to access MD’s and deliver promotional services (e.g. sampling and educational materials).

Conference Travel

PDR.net and eSampling One major physician channel Pharma Rep that has embraced e-sampling is Thomson PDR, which has 0% 10% 20% 30% 40% 50% 60% 70% formed a marketing alliance Study 1 Percent Influenced Study 2 Percent Influenced with MedManage Systems to offer its PDR® Sample Service Percent of Physicians Dissatisfied with Sampling (Source: Sawaya) to physicians through the PDR web site (www.PDR.net). (Journal of General Internal Medicine, July 2000). MedManage provides the e-sampling platform for Erratic supplies have a significant impact on the PDR service. prescribing behavior (see CHART on pg. 13). Samples

Samples are an important rep tool. Without sampling, according to an Accel Report (“Through Our Customers' Eyes,” 2003), MDs indicated they would reduce access to