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March 29, 2016 0

4PL Models, Value-Based Services and Patient/Pharmacist Bloggers

In this US presidential election year, political candidates and commentators alike are engaging in passionate discussions about the current movement. The candidate campaign slogans run the gamut from “A Future to Believe In” to “Fighting to Break Down Barriers that Stand in the Way.” The pharmaceutical industry should go with the flow of the political karma, part of which is to pursue a path of emerging channel innovations including 4PLs, value-based services, and scientific evidence – as well as experience-based communication. As with every revolution, there are advantages/disadvantages, opportunities/threats, and benefits/obstacles. The only way that pharma can truly succeed is by owning it – assuming responsibility for the strategies – and making the best decisions possible to bring about change.

Moving from Wholesalers to a 4PL Model: Logistics of Selling/Delivering Drugs to the Patient

A fourth-party logistics model (4PL) hinges on providing services to patients for their supply chain management functions. 4PLs specialize in integrated operation, warehousing, and transportation services which can be adapted to fit patient needs.


4PL costs will be lower than the fee that is currently charged by wholesalers. The supply chain design is simplified because the current wholesaler and distribution centers will be eliminated. Shipment data, security, drug safety, and simplicity are increased and improved. Manufacturers will be allowed to build direct relationships with retailers and focus on their R&D and marketing efforts.


On the other hand, wholesalers believe that profits are hindered by unions. Manufacturers will be forced to retain product liability for a longer period. 4PLs have a trivial reach in remote areas. A copacetic ordering interface for patients will not be realized due to a lack of relationships with retailers. 4PLs also do not have the overall scale, size, or experience of wholesalers, and are not prepared to deal with business continuity planning. Waste will be increased, medications discarded, and supply chain inhibited by non-salable drug returns.

Moving from Price per Tablet to Price per Outcome: Value-Based Services

Designing services that are focused on value will enhance patient compliance and diagnostics through value-based health care. This approach will deliver the best probable health consequences at the lowest cost by using new health care informatics. Creative technology allows pharma to collect outcome data that identifies best practices, drives interventions that have the highest impact, and shares conclusions with clinicians and the public.


Pharma has a chance to not only reestablish strategies but also rearrange operating models to attain high efficiency. Corporations will engage in different strategies that take into consideration treatment paths, drug services, and partnerships in a challenging market. Their expertise in epidemiology, health economics, and e-health promotes collaborative efforts between R&D and commercial business. Improving health outcomes requires distinct ways of handling research, clinical development, regulatory, and medical affairs. Pharma has the resources to financially support investigations into different value-based business models.


Past regulatory approvals relied heavily on efficacy, safety, and the potential of pioneering drugs for unaddressed medical needs. With leading edge value-added services, both public and private payers will create health technology assessment (HTA) units that evaluate new drugs in terms of their comparative and cost-effectiveness based on real time, real-world evidence. Less reimbursement, benefits package exclusion, and lack of regulatory approval can result when established criteria remains unmet.

Moving from Non-Critical Thinking to Scientific Evidence- and Experience-Based Communication: Patient and Pharmacist Bloggers

The dynamics of patient and pharmacist bloggers in social media emphasize a patient-centric strategy, transparency, and scientific evidence- and experience-based communication. Gathering input from patients to understand their needs so that advanced health services can be delivered, engaging, interacting with patients individually and in group settings, and encouraging a patient-focused community culture is significant in the evolving communication styles.


Patient bloggers interact with an online population about their personal health experiences at individual stages of their illness and develop relationships and build trust each step of the way. Studies show that patients who ask questions and offer opinions about their treatment process have considerably better results and will often share more information and be more motivated to adhere to a treatment plan. Pharmacist bloggers provide scientific evidence-based information which identifies, resolves, and prevents unanticipated and unwelcome drug therapy issues. These bloggers educate in the decision making process and encourage patients to take an active role in their self-care.


The privacy issues of patient bloggers become paramount when patients expose the details of their illnesses and specific medications / treatments. Transparency is stifled and real life experiences are hidden. Patient ego prohibits inquisitiveness at the risk of appearing to be unintelligent and uninformed due to a lack of medical awareness. Patients adopt the idea that pharmacists may have ulterior motives, such as promoting certain drugs over others for personal monetary gain. They assume a passive approach and allow pharmacists to drive their care as a patriarchal figure and decision-maker in the absence of a physician.

In summary, pharma can learn from the heated presidential debates and town halls that are taking place all over the country this year. The message is clear for pharma. It needs to understand the strategy of emerging channel innovations by identifying goals, assembling teams, building business cases, communicating plans, and implementing innovations. The industry will move forward by confronting barriers and doing everything possible with channel innovations such as 4PLs, value-based services, and scientific evidence- and experience-based communication to effect positive transformation. Pharma needs to establish expectations that are higher than the norm and hold itself accountable while setting aside all doubts and fears.


March 11, 2015

Since 2009, the nascent medium called social media has blossomed into something that is now entwined into the very fabric of our personal lives. Billions of people flock to Facebook daily. Some 90% of journalists now get their news and news ideas from Twitter. LinkedIn has dramatically altered how we find and recruit talent, and YouTube has completely changed how we watch videos. Newcomers like Instagram and Pinterest are also garnering hundreds of millions of users.

Social media outlets have revolutionized the healthcare industry and are quickly becoming the preferred resource for individuals seeking healthcare information. Patients turn to social networking groups to find others who are battling the same diseases (for patients preparing for the same type of surgery, following tweets helps demystify the process, and ideally reduces anxiety about upcoming operations), share advice, recommend doctors, even send other members a virtual hug. Clinicians connect to share information and learn from each other.

Through it all, the pharmaceutical industry continues to either ignore this medium or dabble in it in a way that feels like an afterthought. There is still a fundamental misunderstanding of this medium and how it could be applied. While patients, advocacy groups, and the likes of the Mayo Clinic have flocked to social media, most of the pharmaceutical industry has largely ignored it.

It’s not to say nothing is being done – some major companies have established centers of excellence (created to understand this medium), hire agencies to help them and manage the process, and educate internal stakeholders. Some have dabbled with a single platform, like Twitter (corporate communications) or YouTube. But most have continued to say “No social media” in relation to the promotion or marketing of their products. When people have dabbled, it has mainly been around paid media on social channels – that is, advertising.

Brands have limited roles in our actual social life. We just have to understand how and where we can be part of the conversation. In our regulated industry, we’re limited in what we say, so we say very little. Once we’ve recited our label, we’re going to repeat what’s on it (and maybe offer a coupon). So, absent any true guidelines from the FDA, what can the industry do? Particularly now that most every manufacturer is looking at ways to “go beyond the pill” and promote more of a patient-centric approach to their business.

Social media should be viewed more as a way of doing business and less as a means of promotion. While promotion is a component, there are now aspects of social that can be applied to a number of areas, in a compliant way.


Socializing customer service

Industry leaders all provide programs for customer service that are manned by call centers all across the US. There are SOPs that are 10 years old that these centers abide by. These same SOPs could be applied to providing service via social channels, particularly Twitter or Facebook. Banks and financial services companies, who have a similar (but not the same) regulatory environment, have figured out how to do this. Combining social listening and customer service could enhance the patient experience and help with the patient-centric positioning most companies are striving to achieve.

Twitter has been embraced by the corporate communications function to blast out press releases, socially responsible acts committed by the firm, and medical meeting information. However, there is little engagement. This should change now that the FDA has provided guidance on the use of limited-character platforms.

Paid social will grow as more and more media planners come to grips with this medium, especially at drug launch. Planned and managed properly, paid social can be a great vehicle for targeting patients with an unbranded message for disease awareness campaigns. There will still be challenges in using this medium for branded media, primarily due to Important Safety Information (ISI) requirements.

The use of YouTube is a requisite now in most marketing plans. However, it is tied mainly to MOA or KOL videos. Tools such as are now enabling the capture of true patient/user-generated content that can be moderated and put through the same legal and regulatory framework that exists for other content.

From a patient perspective, the biggest opportunity for pharma will be with Facebook as it begins to hone its healthcare strategy. Even though pharma already has a presence on Facebook, pharma is all over the map with regard to Facebook communities. There are unbranded and branded communities, as well as communities based on partnerships with third parties.

Pharma has created product pages, such as and, disease awareness campaigns like, and unbranded presences such as

Pharma should look to truly engage the patient on these communities. By partnering with Facebook, pharma companies could:

  • Provide better, up-to-date product and scientific information in patient-centric language
  • Work with advocacy communities on Facebook to raise awareness of a disease
  • Expand the use of Facebook to reach specific audiences, such as rare-disease communities who are very active on Facebook


In summary

The marketing function of the pharmaceutical industry needs to begin focusing on changing its thinking around social media, to more of an engagement-oriented model and less around advertising and promotion. Social should be viewed as an integral part of the overall marketing mix and not something that is siloed or the domain of corporate communications.

Granted, this relegates the use of social media to a couple of areas, such as those outlined above. But that is much better than doing nothing at all, or doing it badly.

Ritesh Patel

February 4, 2015
A recent survey by Nielsen found that up to 70% of Americans now own a mobile device and that most of those mobile devices are smartphones. Healthcare marketers should take note because behavioral trends like these suggest new ways for us to interact with consumers, and share timely and relevant information with them. The Nielsen study illustrates a tipping point in the U.S. as well as underscoring an enormous opportunity for the healthcare industry to reach consumers in targeted and meaningful ways. The technology is advanced and ubiquitous, and it allows us to engage in places and at points we could never have imagined only a few years ago.

But the pharmaceutical industry lags behind. Few pharma marketers focus on the mobile environment beyond a couple of apps or the e-detail for sales representatives or HCPs, despite the fact that mobile devices are the primary means of communication for most people on this planet. To get the most benefit from the new multiscreen environment, marketers need to carefully consider their audiences and how they interact with all their devices. I call it “creating content for distracted use” because in this multiscreen environment, the common experience is one of distraction.

Consumers use smartphones while they watch TV, or check email and access the Internet on a tablet while they wait for an appointment or for a train. It is critical to ensure consistency of brand and message along these distraction points. Your brand and content should be consistent and relevant on all of these platforms. In fact, I would suggest these are the two most important factors to consider when you are thinking about engaging consumers. Studies are available to help marketers understand the rate and frequency of individuals’ interactions with their mobile devices at different times of the day. They follow a familiar cycle of content consumption. We all wake up in the morning and reach for our phones. We check email, social media and news sites. At work we interact primarily with desktops, laptops and tablets, and then we revert to smartphones and tablets in the evening. Multiscreen and distracted use are the norm in today’s marketing world.

Knowing when consumers are using specific devices allows us to more accurately render our brand or content in a way that is most relevant to the audience. For example, you could air a TV commercial during prime time to raise awareness about a drug and provide information on a responsive website that can be viewed on a cell phone, or run a banner ad with a similar video and a call-to-action with a coupon for tablets. In this way, the consumer viewing the TV ad can continue to consume information on a nearby mobile device and engage with a brand a second time for reinforcement.

Consumers can visit a website on a desktop computer at home before heading to work, continue looking at content on their smartphone or tablet during the day, and resume use of the desktop when they return home in the evening. The content and brand experience should be familiar and consistent across platforms. It should be seamless from one screen to another. We typically see bounce rates (people leaving a site after opening the home page) of about 80% on websites that are not responsive or enabled for mobile devices.

The primary aim of creating multiscreen campaigns is having the ability to create truly engaging content for various mobile devices. With the advent of advertising units in the HTML5 format, brands can create relevant and compliant content, using video and imagery that is immersive, educational and engaging. For DTC, this new format will provide more opportunities to engage a consumer in an increasingly mobile world.

Developing cross-screen advertising is not as simple as just adding a few mobile placements to your ad buy. Multiple operating systems, device sizes and new protocols are emerging, and marketers may need help navigating the path to multiscreen success. Fortunately, a number of technology vendors have developed the capability to create branded pharma ad units for the mobile platform. However, employing sophisticated tactics to attract mobile users reaps big rewards for the DTC marketing and media budget. We have seen click-through rates of up to 20% for some ad units on mobile devices. Compare that with the measly 0.003% on the web alone.

Multiscreen marketing can make a huge impact on the pharmaceutical industry if it is done right. Every mobile platform has its own set of rules, but all can be part of an effective marketing initiative. When you define the goals of a campaign, you also should determine how every available digital platform plays a role and fits into the bigger strategic picture. As you look at marketing in the multiscreen environment, think about consistency of brand, content and message, design for distracted use, and above all think holistically about a coordinated campaign. The days of siloed media are over. Ubiquitous mobile media is the path to engagement for your brand.

Ritesh Patel