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December 9, 2020 Bob Ehrlich0

This column is not about a DTC advertising campaign that already exists. Instead, it is about what should happen after the Covid-19 vaccine is approved. Unfortunately, too many Americans are skeptical of a vaccine. 

Trump clearly showed that he was not medically accurate in many of his Covid related treatment statements. His vaccine program was doubted by some for being an election booster if it could be fast tracked and approved before the election. His Democrat opponents cast doubt on any vaccine developed under his watch. Several states said they would independently review vaccine data even after the FDA approved it.

Now that Pfizer and Moderna have announced the phenomenal results, the hard work begins after approval in terms of timely distribution and getting enough Americans to take it. DTC must play a role in convincing Americans the vaccine is the solution to this worldwide nightmare. 

The conundrum is how much should a drug maker spend on DTC when they can sell all they make. Should the front runners Pfizer and Moderna run DTC even though they don’t need to create demand? The answer is yes. This is a case where all drug makers of vaccine have an ethical responsibility to make Americans want to get this vaccine as soon as it is available to them. We know that vaccine makers have done a good job creating ads for their other vaccines. The DTC goal is reassurance that the vaccine is safe and will end the pandemic.

It will be interesting to see the creative on Covid vaccines. The challenges are to first ensure that safety concerns are dealt with as safety data is only over a short period. We don’t want Americans to hold back and let their friends and neighbors go first. The second challenge is the two shots needed. Drug makers are going to have to convince us to get shots a month apart. Third, is the concern that the shot may only last months not years. 

Of course, we can expect that drug makers will see massive government investment in consumer outreach. Federal and state health departments will spend to get the message out. Employers will be adding their own efforts to get employees vaccinated. So, my estimate is we will see over $100 million invested in vaccine DTC. Money should not be a limitation given the Covid pandemic has cost this country hundreds of billions in economic losses. We can hope government will be setting aggressive targets to raise the percent of those vaccinated. Experts think we need at least 70% of the population vaccinated to nearly eradicate Covid. 

Particularly important is convincing African-Americans to take the vaccine. According to Pew Research only 42% said they are definitely or probably going to get vaccinated. The number among the total population is 60%, and among Hispanics it is 63%. All these are under the estimated 70% it will take to get herd immunity. DTC is one of the fastest ways to get Americans convinced the vaccine is necessary. All constituencies, public and private, need to invest in a major DTC effort and accelerate adoption.

Bob Ehrlich,
DTC Perspectives, Inc.

October 29, 2020 Bob Ehrlich0

A very interesting campaign from Abbott has launched that promotes its wearable technology to monitor symptoms of heart disease and blood glucose levels. These are not disease education ads in the traditional sense. Nor are they the common corporate ads promoting their laboratory research. This campaign is more of a plug for technologies that Abbott developed to change how diseases are monitored.

The theme of the television campaign is that you don’t wait for life, you live it. The idea is that new technologies to monitor disease allow people to go on with the moments of life. The glucose monitoring execution shows children playing with their siblings and mom. After about 20 seconds, we see one child wearing a glucose monitor device on her arm. Then the announcer identifies the Abbott glucose monitor which he says is always on so you don’t wait for life, you live it. 

In the second ad from this campaign, we see a man coming home to a dog apparently newly adopted, and then we see him later in scenes with his new dog. In this case, Abbott is promoting a small implantable heart monitoring device. Like with the glucose monitor ad, the announcer says the heart monitor technology allows you to live life.
The purpose of these ads is not to sell the technology to patients but to promote Abbott as a corporate leader in diagnostic technology. We have all heard about Abbott being active in developing the 15 minute Covid test. These spots seem to be designed to show Abbott is a leader across many disease states in diagnostic technology.

The campaign is an interesting take on corporate ads. We see consumers shown benefiting from the technology by making it easier to live life to its fullest. Abbott’s goal appears to be raising its consumer and investor profile as an innovative diagnostic company.
Abbott is also running print ads with the headline “Life. To the Fullest.” These are running in business publications like ForbesBloomberg, and Fortune, which discuss the rapid Covid test as well as the glucose monitor in a separate ad seen in The Economist
Covid has raised the profile of Abbott through its widely publicized rapid test and the company also wanted to promote its other innovations to investors and influencers. The campaign is well done as it is visually interesting in both television and print. At a time where diagnostics is taking an important role for most Americans, the Abbott campaign is well-timed and highly relevant.

Bob Ehrlich
DTC Perspectives, Inc.

October 9, 2020 Bob Ehrlich0
The new GSK campaign for its shingles vaccine is very interesting. They have coalesced their message around a very simple statement: “Shingles Doesn’t Care.” They are telling consumers that you can do everything right health wise and still get shingles. 

They are using a multimedia campaign which is well integrated in terms of creative approach. The 60-second tv ad is vignette style with consumers in different scenes saying they take various healthy actions through diet, exercise, and being outdoors. The authoritative voice over says each time that shingles doesn’t care. You can do everything right, but shingles is lurking and as you age the immune system is less effective keeping shingles from appearing.

The ad claims that Shingrix is over 90% effective. What is great about this ad is the clarity of the claims. Basically, shingles will affect 1 in 3 people. Your healthy lifestyle does not matter. Shingrix works well to prevent outbreaks. 

The print campaign is also very memorable. Each execution shows a full page visual of a person 50+ in a healthy situation with a small headline saying what they are doing to keep healthy. Underneath in the center of the visual is the “Shingles Doesn’t Care” headline. 

There is a digital component of the campaign as well with varying reminders to ask your doctor about Shingrix. The website is well integrated in look and feel of the media campaign. There is easy to understand additional information on shingles and Shingrix.

The GSK Shingrix campaign meets all the criteria for very successful DTC ROI. They have a large potential target, a simple solution to a frightening disease, and easy to understand advertising with motivating action steps. The spending to date, according to MediaRadar is about $10 million.
Bob Ehrlich,
DTC Perspectives, Inc.

September 30, 2020 Bob Ehrlich1

A very interesting DTC television ad, from AbbVie’s Humira, focuses on current users of their injectable pen. Humira users have sometimes complained about the pain as they inject, described as burning pain. Humira announced a reformulation which removed the citrate ingredient which was causing the pain. Is this a major improvement? Citrate was used as a buffer to keep the active ingredients stable. A new buffer was found that reduced pain.

I went on YouTube to see what patients said about the new formula because I was unfamiliar with the pain problem after injection. Humira has numerous indications for Crohn’s, Rheumatoid Arthritis, Psoriasis, and other categories. It is touching to see patients crying with joy as they demonstrate the pain free injection after many years of dreading the pain. Obviously having a pain free experience will help with retention and compliance. The testimonials on YouTube were compelling. One involved a young pregnant woman who demonstrated her first citrate free injection. She said for years she feared the searing pain which she had to endure every two weeks. She injected the new version, counted to ten, and then cried because she felt no pain.

The DTC ad announces to current users that Humira was inspired by its users and eliminated the citrate from the formula as well as cutting the volume of liquid in half. Both removing the citrate and injecting less results in less pain. They also are using a thinner needle also a benefit in reducing pain. Clearly, AbbVie heard numerous complaints over the years about pain and responded. With any drug, reformulating is a complex process with numerous regulatory hurdles.

The DTC campaign, introduced in April in a 60-second ad, is a well-executed announcement ad. Basically, it says Humira listened and changed the formula to reduce pain without reducing efficacy. Given the pain problem, the DTC ad had a very receptive audience. Announcing a citrate-free version was sure to get user attention. Humira wanted to reassure customers that there were several steps taken to improve the drug, but they could still count on Humira to focus on treating their disease.

The creative was similar to many DTC ads. The vignettes showed active people dancing, skating, camping, and being with their families. What was most important regarding the reformulation was communicated using voice over and supers. It was important to raise awareness for the new formulation because a new prescription is required, so patient and physician action was needed to switch over. The announcement portion was about 25 seconds and the next 22 seconds was fair balance. The final 13 seconds reinforced the benefits and mentioned patient assistance programs.

Based on what I saw on YouTube, use of patient testimonials would be compelling DTC should Humira want to extend the campaign. Humira has spent, according to MediaRadar, about $60 million on this campaign to date. New and improved is not common in drug advertising because few drugs can afford to tinker with their drug both in development time and money. Here, a major improvement was undertaken that changed the lives of many patients.

Bob Ehrlich,
DTC Perspectives, Inc.

September 24, 2020 Bob Ehrlich0
As we men age, the prostate gland grows about 2-2.5% a year. Eventually, most senior men get BPH which is a benign prostate condition that can lead to problems urinating as the enlarged prostate inhibits flow.

So, what can men do to alleviate the problem? There are prescription drugs and surgical alternatives where the prostate can be reduced in size. Surgery is invasive and most men fear any cutting done in that area. There are laser, cryogenic, and ultrasound treatments that also can reduce prostate size. Those techniques also can have side effect issues.
Enter Urolift which is a non traditional surgical alternative. Teleflex is the company that produces Urolift, as well as other devices for cardiac, respiratory care, and emergency care.  

Urolift has begun a multimedia DTC campaign to announce their alternative approach to treating BPH. The television ad is quite memorable. We see a presenter on a big stage talking to men asking if they have problems with frequency in urination, feeling like the bladder never fully empties. Behind him on a big screen are images of dripping pipes. After about 15 seconds stating the problem he announces a solution, Urolift. We see firehoses at full blast, a fountain spraying all representing improved flow.

The presenter then tells us that Urolift is a minimally invasive procedure that involves no cutting and preserves sexual function. Sexual function is a significant risk with prostate surgery as the nerves that men need for erections are sometimes cut or damaged.

What I really like in this ad is the benefits are clearly identified while not overly complicating the message. We don’t know exactly what Urolift is or how it works based on the ad. For that you can go to their website which is very clear on how the device is implanted. Basically, Urolift is a set of clamps that pull the prostate away from the urinary tract. The procedure is done in urologists office and recovery is quick.

DTC works when potential customers ask their doctor about the advertised product. DTC works really well when there is a large pool of potential users who are informed about something new to help them. Urolift meets both criteria. The pool of men with BPH is large and Urolift is a novel approach. The good news is that Urolift is covered by Medicare and most private insurance. 

I have no access to the results of the Urolift campaign, but my guess is the ROI is high based on the quality of the ad, the market size, urologist support in endorsing the effectiveness of the procedure, and patients wanting to avoid invasive surgical risks. Good job by Urolift recognizing what type of DTC will motivate patients to initiate physician discussions. The visually rich, simple approach makes the DTC campaign very likely to motivate patients.
Bob Ehrlich,
DTC Perspectives, Inc.

September 17, 2020 Bob Ehrlich1
Bristol Myers Squibb (BMS) has premiered a very interesting combo DTC ad featuring its two immunotherapy drugs Opdivo and Yervoy. The ad is for treatment of Non Small Cell Lung Cancer (NSCLC). What is very interesting is the approach of advertising two drugs in one ad. The FDA approved the combo for first line treatment for NSCLC in May 2020. I am not aware of another DTC campaign for two separate drugs. There are many combo drugs but they are marketed under one brand.

Trying to explain one drug is hard enough, but in this campaign BMS is trying to explain to consumers how the combo is effective versus chemotherapy. They premiered the campaign with an announcement print ad. This is not a visually rich ad, just a text announcement exposing consumers to the new indication. Using major newspapers BMS launched a blitz of their Big News headline “the first and only chemo free combo of 2 immunotherapies.” That was followed up with numerous magazine print titles through the summer months.

In September, BMS premiered its 90-second television ad which is also an announcement oriented ad. The creative approach is to announce the new combo with headline supers followed by the “chance to live longer” theme showing scenes of what that could mean in terms of real life experiences with family. The fair balance, as for all these cancer drugs, is lengthy, taking about 40 seconds. There are about 25 possible side effects mentioned which are recited in about 20 seconds. That lengthy list is normal for these powerful drugs.

With cancer drugs, the key message, which this ad communicates well, is hope. No one expects these ads to really explain much because treating cancer is complex. What the ad is designed to do is get consumers to ask their doctors if their lung cancer treatment could benefit by using this combo. Simply the ad is meant as an initial suggestion to consumers to raise the possibility with their doctor. All DTC ads do this, but some can actually create a more in-depth ad sell in categories more easily understood. 

Doctors don’t usually have a strong preference which statin, dry eye treatment, antihistamine, or insulin pen you use. Your wish is, in many cases, their command as far as writing the drug you mention. In cancer drugs, they very much control what you get and your request will not hold much sway unless it really is the best drug. In this case, the ads provide a basis for discussion if the Opdivo + Yervoy combo has relevance.

The ad’s “Chance to Live Longer” is a powerful message sure to get attention if the viewer has or knows someone with NSCLC. The clinical reality is these drugs can add months, not years, of life. That said, those extra months are precious to patients and loved ones, and this campaign hits the right tone. These ads help create consumer pressure on insurers to cover these expensive drugs, which BMS says is about $100,000 for a course of treatment. The premium price is what allows BMS to get a return on investment on using mass media for a narrow target audience. DTC has been increasingly used for these low incidence diseases as campaigns pay back if just hundreds of incremental patients get the advertised drug. 
Bob Ehrlich
DTC Perspectives, Inc.

September 10, 2020 Bob Ehrlich0
This is a big year for vaccines. The daily mentions of the progress on Covid-19 vaccine development and the push for increased flu vaccine coverage is raising the awareness of vaccines in general. The push from vaccine makers for their existing vaccines is likely to increase this year.

Certainly flu DTC is going to increase as the opportunity to increase sales is there with only about 50% of the population getting vaccinated. The government is sure to add to the DTC mix as they do not want to see flu cases increase along side of Covid.

Glaxo has two vaccines currently using DTC. Both are unbranded. They also do a corporate spot on the value of vaccines in general. The general campaign is multi-media and focuses on life’s moments worth protecting. It explains how vaccines have allowed us to have these moments of enjoying life because vaccines prevent disease. Both TV and print use vignettes of family moments like birthday parties, outdoor hiking, fishing with grandkids, and beach scenes. The one page ad in print has the headline saying Brought to You by Vaccines referring to the moments in the picture below.

Glaxo has two specific disease education campaigns. Shingles vaccine Shingrix, approved in 2017 is used to help prevent the approximately 1 million new cases diagnosed in the US annually. The campaign is multi-media using the line “Shingles can be Whaaat? Prevented.” Both TV and print use the theme. They show people being told about Shingles and responding surprised that this painful condition can be prevented. The campaign is targeted 50+. It is a very simple but effective campaign. Basically, Shingles is painful, is lurking in anyone who had chicken pox but can be prevented. 

The next campaign is for Meningitis B. Again a multi-media campaign is used. The target is parents with teens heading off to college. The latest TV campaign shows teens at prom, on the soccer field, and entering their freshman dorm. The message is that a rare but serious disease, Meningitis B, is possible in affecting teens. It kills 1 in 10 of those afflicted and causes lifelong problems in many who recover. This campaign is emotional and plays on the parental desire to do all they can to protect their kids.

The print campaign is similar to the TV spot. It uses the name of the teen as a headline supered over a picture of the teen. Inside the name is the letter B, highlighted to reinforce the Meningitis B. In print, the Robert execution is used; in TV we see Sabrina, Kimberly, and Robert with the highlighted B.

It is likely that all the Covid and Flu vaccine discussion will lead to general physician patient discussions on what other vaccines are available. The drug makers will be doing ads on the long history of vaccines and how safe they have been. This is needed to encourage the large skeptical population afraid to take vaccines for Covid, Flu, and other diseases. This has been caused by the anti-vaxxer movement and political issues surrounding the Covid warp speed project. 

Expect that once a Covid vaccine has been clinically shown safe and effective, HHS and drug makers will spend lots on DTC convincing us vaccines are safe and effective. All vaccines could benefit from the halo effect of Covid vaccine ads. Given the attention on vaccines, expect all vaccine makers will join the DTC push in late 2020 and 2021. This Covid year has been awful for most Americans, but the silver lining is the expected major investment in vaccine development as Covid will not be the last pandemic threat.
Bob Ehrlich
DTC Perspectives, Inc.

September 2, 2020 Bob Ehrlich0
In my June 24th column I discussed the Ubrelvy campaign. They had a pool of everyday situations at home or work at all times of the day. The “Anytime Anywhere” medicine is the positioning. Coinciding with the start of the US Open tennis tournament, Ubrelvy has engaged Serena Williams to be a spokesperson.

Debuting a television ad with scenes of Serena on the tennis court and working out, Ubrelvy has stayed with the basic theme in the creative. They kept the largely black and white scheme with large headlines in blue. Serena becomes the narrator for the selling message which is the first 22 seconds of the 45-second spot. She comes back to close for the final 8 seconds.

What I like is that the use of Serena does not change the campaign. She is seamlessly inserted without altering the look and feel of the vignette campaign. Of course Serena is the star of this execution, but is shown like the others in past executions struggling to deal with migraines. The illness is what is highlighted not Serena’s tennis accomplishments. This understated use of celebrity is what makes the spot so good. Serena is just like everyone else who struggles with unpredictable migraines.

AbbVie also has a 7-minute interview with Serena on their website detailing her struggle with migraines and her experience with Ubrelvy. The interview is conducted by a physician who makes sure Serena’s comments are on label and are supported by clinical studies. Celebrities have been an issue for some drug companies when they made claims in interviews or PR events without providing fair balance. Here, the physician modifies any statement made by Serena to add fair balance.

The concern with celebrity use is how genuine they appear. Are they just promoting a product for a paycheck or do they have a credible story on why this drug helped them? Serena is used by a number of companies to promote products such snack bars and energy drinks. She also runs a fashion line which she promotes on shopping channels.

In this Ubrelvy ad, she does pass the credibility test. Clearly Serena has a high stress job, and can not afford to let migraines ruin her practice schedule or, worse, come up during a match. The interview on their site adds to the credibility as this is a problem she has had for more than a decade. Since most viewers will only see the television ad, Serena still achieves the sincerity threshold in the 45 seconds.

There are several campaigns that have integrated a celebrity into their standard campaign theme. Cosentyx with Cyndi Lauper and Enbrel with Phil Mickelson have been successful using celebrities as part of but not dominating the campaign. Mixing real patients with a celebrity who also has the disease helps add to the believability of the core message. Serena, Cyndi, and Phil are just like the rest of us and have the same problems. Well, not like the rest of us most of the time, but they can have migraines, psoriasis, or psoriatic arthritis. In a way, it is reassuring that these stars are not exempt from nagging conditions no matter how much they have in money or prestige.

Ubrelvy has taken the opportunity to enlist Serena Williams in their campaign at a time tennis gets center stage. Is this a one shot celebrity use? We shall see but clearly it can work with others if AbbVie chooses to look for more celebrities who are sufferers.
Bob Ehrlich
DTC Perspectives, Inc.

August 26, 2020 Bob Ehrlich0
The multiple sclerosis (MS) category is increasing its DTC use. Historically, low incidence diseases have used print and digital targeted efforts rather than mass. That has changed over the last few years as drugs for Hep C, HIV, lung cancer, and other lower incidence categories have gone mass media including television.

Approximately 1 million Americans have MS with 12,000 newly diagnosed cases each year. This is more prevalent in women. New treatments have been making this a more competitive marketplace. Novartis’ Mayzent and EMD Serono’s Mavenclad joined the mix in 2019. Genentech’s Ocrevus was approved in 2017. Genzyme’s Aubagio has been around since 2012.

The big spender is Ocrevus at about $100 million over the past 12 months. While MS has been advertised using limited print historically, Ocrevus has gone full multimedia, including a huge television investment. Ocrevus started its campaign in late 2019. They use print, TV, and display ads along the theme “Dear MS.” This is an MS patient telling the MS disease they found a new treatment to help them take back control.

Using a vignette approach, each patient profiled tells MS that they used to be controlled and defined by the disease. Now, they found Ocrevus and have more space to live their lives. The ad is impactful, using real sufferers and an arresting first visual. The 60-second ad is nicely balanced with 25 seconds of benefits, 25 seconds of fair balance, and 10 second wrap up stating MS does not get to control the sufferer, with the end line “MS can’t own us.” The print ad is themed the same as television with the “Dear MS” headline. It states Ocrevus is a 2x a year treatment in the headline.

Aubagio has done a good job with their print based campaign. With a lower budget than Ocrevus of about $18 million, they used a headline in a two-page spread that reads, “To Find A Way to Keep Moving Forward.” Above the headline is an explanatory smaller type saying “With Relapsing MS Your Goal Is.” I am a big fan of eye catching headlines in an easy to read font, on a background that makes the headline stand out. Using white lettering on blue background accomplishes that. Aubagio, also in a sub headline, states it is a once a day pill.That is important since some MS drugs require infusion.

What I also like about the Aubagio campaign is its consistency. They have used the same headline for the past two years. The only change has been the color of the background which seems to be rotating with the blue version. Both versions show a 30-something female jogging along which goes with the moving forward headline.

Mayzent has just started its consumer print campaign with a two-page spread. They are going for an emotional approach of a woman with a cane, pictured with her child. Their indication is for secondary progressive MS where there is a worsening condition.

Zeposia, an oral pill from Bristol Myers Squibb, was approved March 2020 so we can expect that to be added to the DTC mix likely in 2021. Numerous drugs in oral and infusion doses are in phase 3 trials so this category will remain active for DTC. What is increasingly clear is that most new brands believe DTC is an important part of their marketing strategy.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.

August 19, 2020 Bob Ehrlich0

There are a number of drug makers that do disease education ads. Those companies have a drug that treats the disease or have one about to be approved. Disease education ads make financial sense when a drug company has the only drug to treat the disease or are the dominant competitor. Most disease education ads are followed with a branded campaign when competition emerges or when the addition of a branded campaign can help increase patient requests.

Neurocrine Biosciences is a a San Diego based company that currently gets 97% of its revenue from one product called Ingrezza, a pill that helps reduce uncontrolled eye, mouth, and body movements in people taking medications for schizophrenia, bipolar disorder, and depression. Tardive Dyskinesia (TD) is the name of this disease. Ingrezza was approved in 2017.

Neurocrine decided in early 2019 to do a disease education campaign on television and digitally. The current campaign rotates three executions. The 60-second spots do a very good job introducing the disease with an actor stating the problem and an animation that explains where on the body the symptoms might occur. The campaign is called “Talk about TD.” The campaign has the difficult job of educating patients, families, and caregivers to understand Tardive Dyskinesia. I never heard of it until I saw the campaign.

TD is a disease that affects about 500,000 people. About 58% of patients taking anti-psychotic drugs were unaware those treatments can cause TD. Thus, the need for patient education. Ingrezza is a premium priced drug at about $300 a pill retail. The dose is once a day so the revenue potential for Neurocrine is up to around $9,000 a month per patient. Of course, they get less from payers who negotiate the formulary position. Neurocrine reports revenue of about $5,700 per month per patient.

The educational challenge here is threefold. First is to identify the symptoms of TD which can affect any part of the body, and a second is to get patients to understand that these movement symptoms are something you can treat. Third is to explain how to get more information on treatments. Each of these challenges is dealt with well in the campaign. The ads are visually interesting in how the scenes shift from actor to animation of the symptoms.

Disease education on heart disease, diabetes, or cancer is common place. The TD campaign spending is relatively high for a small company. MediaRadar reports the television spending at around $19 million since the launch. An additional $2 million was spent on digital. Based on reported sales, Ingrezza has done very well. In 2019, it did about $750 million. In 2020, it looks like the drug could top $1 billion. The ad campaign seems to generate a very good ROI given the growth in 2019 and anticipated growth in 2020.

The trend towards doing DTC for limited size categories continues with Ingrezza. In the past, categories of this size would have used highly targeted patient marketing programs. What makes DTC enticing is the revenue per patient, as a $21 million disease education investment would require only a few hundred new patients to be successful. Without having any inside Ingrezza data, I think this campaign exceeded that break-even level.

Bob Ehrlich, Chairman
DTC Perspectives, Inc.