Just as the Internet—with instant content publishing, blogging, online conferencing and now social media—is rocketing through entertainment, news and business communications, so it is through pharma marketing. New hardware platforms, notably smartphones and tablet readers, are accelerating the transformation of both consumer and physician marketing. And while there’s no shortage of media experts to promote their preferred flavor of online communications, it’s clear that the long-promised advent of digitally driven communications is firmly taking hold in pharma marketing departments.
This transformation is occurring—and, to some extent, is a reaction to—the dwindling ranks of pharma reps that call on physicians. “Do not call” registries of physicians who don’t want to be visited by reps now approaches 40%, according to several surveys. Working reps now number around 75,000, down from over 100,000 a few years (see Fig. 1). Recent announcements of broadbased reductions by Novartis, Pfizer and others promise to reduce that headcount even more.
FIG. 1. SALES REP RANKS ARE NOSEDIVING AS INDUSTRY SHIFTS MARKETING RESOURCES. credit: SDI
Meanwhile, one of the fastest conversions in recent history is occurring with physicians’ use of smartphones. Simple cellphones, pagers, personal digital assistants (PDAs) and laptop computers are being chucked in favor of smartphones or tablet computers. Several hospital networks are conducting wide-scale conversions of pagers and other devices in favor of smartphones, simply as a more powerful and reliable means of gathering and transmitting data from physician staffs. According to Manhattan Research (New York), 75% of physicians now carry a smartphone. And whether they access the Internet through their phone or through a desktop computer, a comparable proportion of physicians make regular use of websites, e-mail and social media networks at work or at home.
RICK RANDALL, NATIONAL PATIENT SERVICES
With the continuing multiplication of new communication channels or networks, it makes sense to try to rationalize which media to invest marketing dollars in, and what kind of message to communicate. “Multichannel marketing is about delivering the right message to the right person at the right time, through their preferred channel,” says Rick Randall, president of Triplefin/National Patient Services (Scottsdale, AZ), which provides communications, sales support and patient services to the pharma industry. “Our services have been designed to facilitate communications between the physician, the patient and the pharma manufacturer with the result of excellence in patient healthcare management.”
In this sense, MCM is hardly new; any good marketing manager in any industry should be comparing response and ROI of marketing dollars spent in one communications channel compared to another. But the introduction of new types of digital media—with the tracking capabilities they afford—creates the possibility to manage marketing messaging almost as it is happening. “With all the new media, there’s a temptation to carpet-bomb the market,” says Steve Gransden, VP technical marketing at J. Knipper & Co. (Lakewood, NJ). “If all a company is doing is multiplying its message across four or five channels rather than one or two, they’re missing the point.” The key is to monitor response to a channel, be it a sampling program, a consumer coupon or an academic paper being delivered to a physician, and adjust campaigns as they are running to maximize the benefits. That type of marketing control, he says, is better identified as “cross-channel” marketing.
All this sounds good in theory, but the ability of pharma companies to scrutinize campaign data and adjust their marketing “on the fly,” as it were, is only beginning to appear. “MCM is this year’s version of closed-loop marketing, which was all rage a couple years ago,” says Tim Kelly, VP of business transformation services at IMS Health (Norwalk, CT). “Today, campaigns are conducted and an ROI evaluation might appear six or 12 months afterward. The problem is, how do you get information back from the agencies and service providers a pharma company works with in time to act on it?” The larger problem, he says, is to embed business analytics as a “corporate culture” to manage marketing programs cost-effectively. “Companies like Amazon or Best Buy are doing this in the consumer space, but it’s still in its infancy in pharma.”
FIG. 2. PROMOTIONAL SPENDING IS STILL DOMINATED BY DETAILING, BUT E-PROMOTION IS GROWING. ["PMEA" is med-ed events; "DTCA" is direct-to-consumer advertising.) credit: SDI
What’s up, what’s not
All this is happening at a time when face-to-face rep calls are being de-emphasized, and use of coupons and loyalty programs are growing strongly, while traditional sampling programs for physicians are moving into “non-personal” platforms employing online platforms and e-detailing. Data from SDI (Plymouth Meeting, PA) shows that through the first half of the year, “e-promotion” (basically, online media) has been rising, while other forms of marketing are relatively flat or declining (Fig. 2). The steadiness of detailing, despite the drop in the number of pharma reps, is surprising. Other SDI data show that the volume of rep details has dropped from around 92 million in 2006 to 88 million in the 2009-2010 period, or 5%, leading to the conclusion that while detailing activities are declining, they are also becoming more expensive.
In November, SDI published data on e-promotion setting a new record in volume through the first nine months of 2010, with more than 150 drugs being marketed with online events and detailing. Amgen’s Prolia was the most actively marketed new drug in this manner, with 7,600 online promotional activities in the period, while Merck’s Singulair (on the market for several years now) had over 110,000. Overall, 3.4 million online activities took place during the period, representing an expenditure of $396 million.
E-detailing is taking advantage of the new opportunities in digital communications. E-detailing is moving from passive, go-to-a-website-and-read engagement to an active, mediated event with reps online with the physician. Aptilon (Montreal), developers of the AxcelRx e-detailing platform, announced triple-digit increase in revenue through Q3 of this year. The company is beta-testing an e-detailing system, AxcelRx Mobile, that operates on the Apple iPhone and expects to roll it out next year. “Physicians love the convenience,” says Mark Gleason, SVP at the company. “Whether at a desktop or via a smartphone, physicians want access to relevant content, and the smartphone gives them the ability to do this during a consult or while walking between exam rooms.”
Aptilon is one of several e-detailing companies that act as “concierge” services for physicians’ information needs—its platform can incorporate real-time interaction with reps online or over the phone, and it has relationships with multiple medical
publishers to make academic papers and related content available. All these interactions are trackable, says Gleason, with the result that sponsor companies can see how extensively physicians are downloading a presentation, or requesting a sample.
In addition to smartphones-based formats e-detailing, the pharma industry appears to be taking them up rapidly for sales-force automation, along with formats based on Apple’s iPad tablet. Cegedim (Bedminster, NJ) one of the leading SFA vendors, announced its first client for its Mobile Intelligence branded SFA system, Mobile Intelligence on the iPad. The client is EKR Therapeutics (Bedminster, NJ). The complete Cegedim solution, which will be leveraged by EKR Therapeutics’ institution-based key account managers, includes:
Mobile Intelligence Multi-Tenant SaaS on the iPad
Help Desk and Data & Technical Services
Xtelligence Dashboard (advanced analytics)
Other SFA vendors are adapting to the technology, and pharma companies themselves may opt for them simply as a resource for their sales forces. According to press reports, both Abbott Labs and Boston Scientific have purchased thousands of iPads for their sales forces. In a multichannel context, one can imagine the iPads or smartphones in doctors’ hands facing off against the devices in the sales reps’ hands; in the final analysis, the actual multichannel activity may ride on whose finger touches are fastest on the devices.
One publisher who is also focused on physician interaction is HCPlexus, publishers of The Little Blue Book (TLBB), a physician-referral book (and, now, online information service) widely used by physicians. David Shrier, HCPlexus CEO, sees a critical communication need in the interaction between physicians and patients for medical information.
“Physicians want to be able to guide patients to relevant information at the point of care,” he says. HCPlexus recently formed a partnership with Healthline Networks (San Francisco), which rolls up over 40 trusted destination sites for consumer health information.
The pharma connection here, says Shrier, is that HCPlexus has polled its physician clients regularly, and found that when given the choice between paid subscriptions to information services and free, but advertising-supported ones, they strongly favor the latter. “Physicians feel confident that they can distinguish between advertising and unbiased content; the main driver here is access to relevant information,” he says.
Shrier’s company has also performed fairly extensive market research on physicians’ use of digital media. He says that while most physicians have adopted online media (desktop or mobile), group size is the biggest determinant of their participation: Large practices (six or more physicians) are significantly engaged with mobile media, while solo practices are mostly operating via desktops. The mid-sized practice (2-5 physicians) are neatly split between the two.
At Triplefin/National Patient Services, the interaction between physicians and patients is emphasized in another way: gaining access to prescription assistance plans (PAPs) that pharma companies sponsor for indigent patients. NPS is a sister company to RxHope, one of the larger national PAP-management firms. “We have an advanced communication portal designed to facility patient enrollment and benefit verification while reducing the administrative costs and approval times significantly,” says NPS’ Randall. “These services have been included in a multichannel communication approach that includes prior authorization, reimbursement verification, loyalty and discount card enrollments among others.”
That level of patient interaction, to some degree, depends on physicians’ own interest in attracting and keeping patient clients by means of offering superior service in handling prescription issues for them. With the growth of managed care organizations—and the consolidation of healthcare generally—that impetus might be hard to sustain. But another way of looking at the situation is to say that it is in pharma companies’ interest to connect more closely with patients themselves. Loyalty card programs and coupons have grown by over 250% over the past 3-4 years, according to various industry sources. And while some consumer advocacy groups (and PBMs) are critical of pharma’s attempts to influence patients’ drug choices with financial incentives, there is also evidence that coupons and loyalty programs have improved medication adherence, and thus improved overall health outcomes for many patients.
STEVE GRANSDEN, J. KNIPPER & CO.
The interaction between coupons, vouchers and samples is the target of online services offered by Knipper (with similar capability from others) called MySampleCloset.com and MyPharmaRep.com. According to Knipper’s Gransden, online sampling and coupon delivery not only gets past the “do not call” physician registries, but it also provides highly granular data on which physicians are making use of the programs, and what results are occurring in increased pharmaceutical usage via these programs. Historically, samples and coupons were handed out by reps, and these resources could have gathered dust on a shelf or in a cabinet, or conversely, interfered with the volume of non-discounted sales that could have been achieved. Now, with tracking from initial phone call, e-mail or online request, through to delivery and use of the resources, pharma marketers have a better handle on overall effectiveness. It’s worth re-emphasizing, too, that sampling still represents a commitment of around $14 billion annually by the pharma industry—the single largest marketing expenditure.
Adding to the muddle of marketing and communication channels, pharma companies are opting to increase their interactions with pharmacists as well as physicians in connecting with patients. Several pharma companies reportedly now have sales forces dedicated to calling on pharmacies (a return to a practice that had faded away decades ago). McKesson Patient Relationship Solutions (Scottsdale, AZ), Adheris (Burlington, MA; part of Medco Health Solutions) and others have established networks of thousands of pharmacies that can intercede as prescriptions are filled to make patients aware of coupons and related incentives. That’s a case where the “communication” channel is interesting with the “distribution” channel of physical product—and could that be the truest form of “multichannel marketing?” PC