Imagine there was no DTC advertising because of a government ban. Let’s put aside the free speech issues for a moment and assume the courts supported a ban. Also let’s assume the health care system is similar to what we have now. That is, it is still a mix of private insurers, Medicare, Medicaid, with free market pricing for drug makers. I am not saying a ban will happen but it is possible given the hostility towards drug companies.
Let’s examine what this world of no DTC means for the constituencies of health care. First, what would happen to drug sales? If we assume an ROI of $2 per $1 invested in DTC which is probably in the ballpark then drug companies will lose about $7 billion in annual sales. That is based on an actual estimated drug company DTC spending of around $3.5 billion versus Nielsen reported at $5.2 billion. Why? Drug makers get large discounts not accounted for in the reported numbers. Insiders tell me they spend about 70% of reported numbers.
That $7 billion dollar loss is only about 2% of total drug sales so it is not an industry killer. It does hurt newer drugs more because they use DTC to accelerate the awareness curve. It may also hurt high price drugs more because advertising those drugs puts pressure on insurers to cover them.
Congress would likely be happy with no DTC because they falsely think demand would decline for branded drugs. Unfortunately, they would soon find out that drug makers will ramp up physician promotion instead and make up for lost consumer awareness. Consumers would be back to having less information and trusting that physicians and insurers have their best interests at heart. We know physicians may not be up to date on newer drugs and insurers do not want to pay for expensive drugs. So, I am afraid consumers may not be informed there are newer drugs available.
Physicians may like a ban because consumers will not ask them about an advertised drug. On the other hand, DTC brings patients in the door and that means opportunities to do reimbursed tests and services. I am sure dermatologists, psychiatrists, ophthalmologists, podiatrists, cosmetic surgeons, and other specialties benefit by increased traffic from DTC. Physicians need to get used to the new world where patient information is widely available and trying to restrict it is just not practical.
Insurers would love a no DTC world because they can negotiate without those pesky consumers wanting to know if they cover expensive drugs like Harvoni, Keytruda, or Opdivo. Drug companies will try to negotiate fast access but I suspect formulary access will be delayed without consumer pressure.
What will happen to price under a DTC ban? Drug companies will not lower prices because there is no DTC. There is a general misconception that DTC expenditures are a cause of high prices. That is false. DTC, if successful, raises demand that more than offsets the cost. Therefore sales will be less without DTC so why would a drug maker lower prices? DTC allows new brands to enter faster and create competition which will lead to lower prices. Banning DTC ensures the established brand can keep its leadership longer and prices higher.
Banning DTC may make critics feel better but will have very minor impact on demand, pricing, and overuse. Instead less information will be available to consumers who will now have to trust biased insurers and busy doctors to suggest what is best for them. We all recognize DTC is meant to advocate use of a drug and is not unbiased information. Our healthcare system, because it is a mix of profit making entities and government payers concerned about budget, is inherently subjective. Therefore, banning DTC just leaves other constituencies to their push their own biases about what is best for patients.
A world without DTC will not make the patient better off. Drug critics were complaining about drug prices before DTC and will continue even if it is banned. Unfortunately, DTC has become an easy target and will remain in the crosshairs of legislators, physician groups, and insurers. As a DTC community, we must tell lawmakers the facts and the dangers of limiting speech.
The AHSP, the organization that represents 43,000 pharmacists and technicians in hospitals and other acute care settings, called for banning DTC. This was a change from previous positions that supported DTC in limited use. The AHSP does not represent retail pharmacy but it is still an important voice in health care. Along with the AMA this call for a ban adds fuel to the political fire related to drug company bashing over pricing and marketing.
The AHSP statement calling for a ban cites the much misstated data that says drug companies spend more on marketing than research. They also say that DTC can be misleading. Therefore they feel that pharmacists and other clinicians can best help consumers with drug selection. This reasoning is faulty. Drug company marketing data includes sales force expense, sampling costs, physician ads, as well as DTC. The drug companies spend over $50 billion on R&D. That is ten times the amount spent on DTC.
Are drug ads misleading? FDA requires all claims to be clinically supported and requires fair balance. They review all ads for accuracy. While advertising is designed to sell, drug ads are the most scrutinized of all advertising categories.
Despite the facts, the anti DTC forces are a major concern for drug advertisers. Hilary and Trump are not friends of the drug industry. It is clear from their statements that neither has their facts straight. Hilary sees drug companies as her enemy, an evil profit hungry industry. Trump sees drug companies as one of his vendors to be squeezed like a mattress supplier for his hotels.
What drug company employees and their media and agency partners must do is let Congress know the facts. Take the time to educate your Congressional representatives how important drug advertising is and why it is important to consumers. Have them understand that DTC does not raise prices. Banning commercial speech for lawful products is a bad idea. What category will be next?
The call for a ban by hospital pharmacists is hypocritical given the huge investment hospitals are making in DTC. Almost every hospital advertises these days. These same hospital based pharmacists think it is acceptable to advertise surgery on television but not drugs.
DTC advertising is not perfect but deserves to be one way for patients to get information. If pharmacists think banning information helps patients, they are wrong. Their input is valuable but to say they and the physician should have a monopoly on patient communication is unrealistic in the Internet era.
Programmatic advertising, the automation of media buying and selling using technology and data for hyper-targeting, is one of the ad worlds’ hottest trends. Research firm eMarketer recently estimated that digital display ads bought programmatically in the US grew 137% to more than $10 billion in 2014, and now account for 45% of all display ad sales. eMarketer expects programmatic spending to increase another 47.9% this year and by 2016 to reach $20.41 billion, or 63% of U.S. digital display ad spending.
Why the tremendous growth in programmatic? With the rapid increase in digital media over the past decade, there was simply too much inventory for humans, both buyers and sellers, to keep track of. Previously, the inventory that was hardest to monetize was aggregated into popular exchanges, bought and sold through real-time-bidding (RTB).
Buyers were purchasing “remnant” inventory via RTB. Premium inventory on premium sites was still limited. Enter “programmatic direct” or “automated guaranteed” – as the Interactive Advertising Bureau calls it – which allows advertisers to buy guaranteed premium inventory in advance from desired publishers. While programmatic direct made up only 8% of all programmatic sales in 2014, according to eMarketer, it’s expected to reach 42% by 2016.
And that’s where pharma advertisers should take notice. While RTB-based programmatic buying focuses on audiences, usually through some kind of cookie-based tracking, often behavioral in nature, programmatic direct brings the focus back to the editorial environment of context and content where pharma brands like to be.
DTC advertising, after all, has lagged behind every other category, as per Nielson reports citing a 22% decline in display ad spending from 2012 to 2014. For an industry specifically dubbed “direct-to-consumer,” DTC has often appeared to be neglectful of where consumers are actually looking for product information – online! eMarketer, after all, noted that since 2013, consumer digital use has even surpassed TV viewing.
The situation is compounded when you consider how quickly consumer mobile use is growing. comScore reportedin August that mobile use had overtaken desktop use. And while 44% of programmatic spending in 2014 was already on mobile, eMarketer projects that number will also surpass desktop this year.
DTC, alas, is also lagging in mobile. Funmobility’s Mobile Advertising Trends Report 2014 found pharma dead last in mobile spending amongst nine categories, and concluded: “This provides a gap in marketplace saturation that savvy advertisers can capitalize on.” The solution? “Preferentially target mobile ads to tablets, not smartphones. Tablet owners tend to have more disposable income, are 3x more likely to make a purchase based on a mobile ad, and use their devices primarily for web browsing – which is the behavior that health and pharmaceutical ads need to encourage, in order to educate users about their product.”
Of course, most pharma marketers are already vying for standard destinations and portals. But they can add programmatic strategically to improve the efficiency of their media plans, find relevant patients with larger reach, and get access to targeted consumers at lower cost. Here are some possibilities:
Contextual – Target via contextual analysis at the page level to reach patients in relevant environments along the patient pathway.
Overlaying first and third party data sources – IMS, Crossix and Symphony, to name a few, offer different products to better target relevant patients across the exchanges.
For Example, look-alike segments…cookie-based, without following patients
Geo-targeting – Use prevalence of a condition, script-level physician data, or patient data to improve campaign performance.
With safety being paramount to the placement of any campaign, the proliferation of brand protection services offiers pharma marketers the ability to verify context, block non-human traffic, optimize for viewability, and more.
So, for pharma media planners feeling the pressure from increased CPMs caused by lack of quality inventory and too much competition for premium inventory, adding programmatic placements to the media plan may well be the perfect prescription.
Why innovate? It’s a question frequently asked by many pharmaceutical marketers. From a campaign development perspective, innovation is seen as a way to break through the clutter in order to set new benchmarks for success. Unfortunately, in the process, it’s easy to just innovate for innovation sake, and implement the latest thing without regard to how it will accomplish brand objectives or scale in a meaningful way. Measurement is also often an afterthought that mitigates the cultivation of valuable insights and leads to irrelevant KPIs.
Widespread conservatism within the industry, due to regulatory burden, compounds the issue. Unorthodox innovation initiates a waterfall of time-consuming MLR reviews, which can lead to the dilution of the concept itself in order to gain approval. That new thing you were so excited about? Not only has it lost some of its luster, but the window for launch has been delayed to the point that it is no longer considered breakthrough. To make matters worse, the annual planning cycle compresses your once innovative idea to a four-month flight.
Marketers should never veer from paving new ground. It is essential that we identify and execute new marketing strategies that best align to our brands, can be effectively measured, and also meet the restrictions unique to our industry. In a time where technology, platform and content evolution is happening faster than ever in leading consumer and HCP channels such as mobile, social and point-of-care, it’s critical that marketers understand the challenges of adopting new strategies and utilize a tactful, big-swing approach to overcome each of them. That said, a methodical approach to prioritizing should be considered so that the new path leads to meaningful success.
Herein lies the innovator’s dilemma. How do pharmaceutical marketers embrace innovation successfully while adhering to the constraints unique to our industry?
For all of us, a brand’s life cycle is finite. FDA approval process and patent law has given us a clear start and end point. We’re all under pressure to use this time and our yearly budgets as efficiently as possible. Unfortunately, the default is to reinvest in tactics that have worked well in the past. While this is not 100% unwise, there are steps to be taken to reset our baseline for success.
Be Selective: Pursue innovative tactics that are conducive to meeting your objectives. Just because everyone is talking about the next big thing doesn’t mean it is right for you. It’s critical we take aggressive bets on the right innovation, as that is how we can raise the bar.
Think Big: Rather than pursuing many ideas at once, focus on a couple ideas that can make a meaningful difference.
Think Long-Term: Twelve month media planning cycles aren’t going to change anytime soon. What can change is the way we think about our most strategic programs. Rather than approaching impact from an annual perspective, you can focus on ideas that you incrementally improve over time. While you may not be committing to a multiple-year program, empower your partners to ideate with you on what a long-term vision could look like.
Consider Immediacy: Immediacy comes in two flavors – launch timing and time to impact. Innovation doesn’t have to mean creating new assets. It could be deploying them in new ways. Giving legs to proven assets not only squeezes more out of your creative budget, but it also allows for a more timely review so that you can move the needle for your brand faster.
As new technologies, channels and strategies surface in our industry, all marketers will inevitably face the innovator’s dilemma. Take confidence in knowing that innovation can truly change the success of your brand. If we as an industry can take an approach to adoption that is thoughtful, sustainable, and scalable, the pay-off will be tremendous for all groups involved.
The strategic role of content marketing in DTC campaigns is a hotly debated topic. While many industries have shifted their focus to building content that is authentic, educational and even whimsical in the hopes of building a rapport with patients, the healthcare industry is still finding its voice. Brands leading discussions can be perceived as self-serving, and creating authority in a world where brand communications are rarely heard is a challenge.
When determining the role of content marketing for Rx brands in the healthcare industry, our hands may be tied a bit, but it can still be a valuable tool when used correctly. The greatest opportunity for Rx brands is in content with broad appeal, because content has to compete for attention on a level playing field with everything from information to community to entertainment. This means that therapies addressing conditions with larger patient populations are most likely to have success with content marketing.
Given that content can travel across the Internet, many pharmaceutical marketers aren’t comfortable with models that distribute branded content into places their legal teams aren’t able to approve ahead of time. For many, this will mean that initial content marketing tests are best conducted with unbranded communications. Before you start producing content though, developing and agreeing upon a sound strategy is key.
It is important to focus on information patients, KOLs and caregivers want from you. Not trying to be everything for everyone is difficult to accept, but having focus can still allow your voice to be heard.
The recent campaign by Shire Pharmaceuticals does just this. The campaign focuses on driving education and awareness around Binge Eating Disorder (B.E.D.), a condition officially recognized in 2014 by the American Psychiatric Association. When treated, Shire benefits with approval of their drug Vyvanse being the only medication approved to treat moderate to severe B.E.D. in adults in the US. Because of this unique situation, they are in a position to drive the conversation around B.E.D. among patients in a landscape where they are one of the few voices.
When you are in a position to drive a conversation it is easy to be heavy-handed and talk only about your company or brand. This is one of the biggest mistakes Rx brands can make in this area. Eisai Pharmaceuticals developed a content and social campaign around their weight-loss drug Belviq. They have developed a social strategy under their corporate name, which is a step in the right direction, but it is clearly focused only on their own agenda.
It is no surprise that the above message has very little engagement as the entire program is focused on promoting their support and savings programs. Consumers can sense when they are being sold to versus having a conversation with, and will act accordingly.
While consumers hate being sold to, they do appreciate and trust authorities. Focusing your information to the right audience is important, but proving to be the authority on that information is what will gain traction and trust with your audience. Biogen Idec recently announced a partnership with two athletes who will act as patient advocates for the company’s multiple sclerosis campaign, MSInspiration.com. Both Tyler Campbell (former NFL prospect) and Chris Wright (former NBA player) suffer from the disease and take Biogen’s MS infusion treatment, Tysabri. The goal of MSInspiration.com is to drive MS sufferers to submit their own inspirational stories just as both Tyler and Chris have. Chris Wright (@self_madeest89) is regularly promoting the site as well as his own foundation while Tyler Campbell’s Hall of Fame father Earl (@earlccampbell) also actively promotes the effort.
This is a great example of a brand knowing they cannot always be the face of a content campaign and get the results they want. Instead they align themselves with an authority figure that can help get the message out.
A common hurdle most pharma content marketing campaigns face is keeping content fresh. A large part of this can be attributed to the seemingly insurmountable challenge that regulatory bodies can present in approving content at a pace that will keep patients engaged. With legal reviews, what goes in is not always what comes out, and unique and creative content is usually the first thing to hit the cutting room floor. Knowing this variable isn’t going away, it stresses the importance of thinking strategically about what role content marketing plays for your brand and if it is a channel worth pursuing. If you are not able to produce the content that is truly meaningful to your target audience, an alternative channel or platform may be a better option.
While there is no doubt that content marketing can have a large impact for Rx brands when done right, it is not always a feasible option for everyone. Before content development begins, it is important that the appropriate marketing teams think strategically about the role it plays and quantify the value to determine its worth.
Direct-to-consumer marketing efforts for many prescription drug brands rely not just on appropriate clinical targeting but on creative executions that are emotionally relevant and resonate deeply with appropriate patients. That creative, whether it’s a television or a print ad or a website or a brochure, needs to be grounded in a big creative idea that breaks through in a world crowded with health messages and experiences clamoring for patients’ attention.
We’ve been expanding our discovery of the target patient beyond their clinical profiles, disease conditions and standard demographics, and digging into the attitudes and behaviors of the target as a member of a generation. Baby Boomers (and Generation Xers and Millennials, and every other generation as well) have shared the same formative experiences, historical events and life stage milestones, developing generational attitudes and behaviors to culture, consumption, life, work, love – and health. We take these generational mindsets and apply them to the health and wellness experience of the target audience, especially when our Strategic Planners brief our creative teams on DTC television and digital marketing projects.
In one recent briefing on a specific disease condition, Tonic’s strategists ensured that the creative teams were steeped in Gen X’s favorite TV shows and music, their undeserved reputation as directionless slackers, their focus on family, as well as a typical day-in-the-life of a busy Gen X working mom. Our creative teams learned that the Gen X woman is a fan of the TV show “Parenthood”, is sentimental about Bon Jovi’s “Livin’ on a Prayer”, doesn’t think her post-college job at the thrift store meant she didn’t have a plan, has her work-life balance planned down to the minute, and puts her family first. All of this helped build a textured portrait of a very demanding patient who needs a treatment solution that meets their clinical needs and is easy to take, as well as one that doesn’t interfere with the hard-won and finely calibrated lifestyle and family life that Gen X values so greatly
Whether the brief is for Baby Boomers with diabetes or COPD, or Millennials or Gen Xers with allergies or HIV, Tonic strategists ground the creative teams in the experience of the generation with pop cultural references like hit songs and popular movies as well as news events and historical timelines. These shared experiences have shaped the values and beliefs of the generation and when these are extended to, say, how a person with allergies feels about their medicine or someone with HIV feels about talking to their physician, the stage is set for powerful insights that can inspire vibrant and resonant creative ideas.
“The more detailed the picture of the target is, the more the content we make for them will get their attention,” says Tonic’s Chief Creative Officer, Phil Silvestri. “Knowing the target is a Boomer or a Millennial helps us bring their broader lives into the creative, making it mean more to them.”
The creative teams have been reinvigorated and inspired, producing fresh creative ideas that are resonating with target audiences from all generations.
No matter the preparation, resources or rigor applied, there is often an element of marketing that is done in the dark. Even in today’s data-rich, hyper-connected world there is a degree of guesswork resident in the process. Don’t get me wrong, the marketers making these educated guesses are bright people who get it right a lot of the time. But just not all of the time. Absolute confidence in marketing is an elusive beast.
So with that as the backdrop, imagine there is a way to edge ever closer towards absolute confidence, to raise the odds of getting it right, and ultimately elevate the game to a whole other level where there is almost no darkness at all. And what if I told you there are special goggles that could give the DTC marketer “night vision,” the ability to see in the dark?
While unfortunately not available in goggle form, the full promise of the above is nonetheless realizable today. It all begins with patient influencers, the empowered patients who drive the healthcare conversation online. They are bloggers, tweeters, pinners, and leaders of Facebook pages. They are the leaders in their communities, from virtually every health condition.
A study published several years ago by Forrester’s Josh Bernoff and Augie Ray, Online Peer Influence Pyramid, indicated that the top 4% at the apex of the social pyramid are responsible for creating about 80% of all content online. Think about that – it’s an incredible statistic. Those at the top of the pyramid – the “social broadcasters” and “mass influencers,” using Bernoff’s and Ray’s labels – are the influencers.
In the DTC realm, patient influencers are the catalysts of the patient empowerment movement. WEGO Health, the company where I work, has a network of these 100,000 patient influencers. Each reaches approximately 15,000 health consumers every month. These patient influencers not only speak to their respective communities but are also in the unique position to be able to speak for them. They understand the macro and micro needs of these communities like no one else. They represent an invaluable body of knowledge. Patient influencers want to be heard, and DTC marketers need to hear them.
So what does this all have to do with night vision goggles and where is the real disruptive innovation, you may ask? The answer lies in patient influencer advisory panels.
By assembling a group of 30 or so patient influencers within a given condition area and then strategically accessing their wealth of knowledge on a regular and recurring basis throughout the course of the year –WEGO Health has found a solution that gives marketers ongoing, on-demand access to the patient voice. Patient influencer advisory panels can imbue the marketer with more certainty in knowing what consumers really want and need, to possess a keen understanding of the barriers in their way, and be able to gauge their perspective on solution concepts in their earliest stages of life – all before marketing to them.
An optimized combination of virtual online focus groups and short-form studies are the key to effective advisory panels, giving marketers ongoing, on-demand access to the patient voice. WEGO Health’s virtual focus groups are known as Community Insight Groups and its short-form studies are conducted via its smartphone platform, called Truvio, which enables marketers to quickly capture actionable insights in the form of keypad and often-poignant audio responses. Many companies even alter their marketing strategies based on this valuable patient input.
Seeking the perspectives from these patient influencers throughout the year enables marketers to unearth knowledge gaps, shape strategic and tactical planning, refine programs, and much more. But what it really does is minimize the guesswork in marketing. And it achieves that by enabling markets to see in the dark.
Todd Kolm will delve further into this topic during WEGO Health’s panel discussion with pharma marketers and patient influencers at the 2015 DTC National Conference. This session will address the patient-centricity gap and how DTC can help, in part by reacting to findings from the original study, Online Communities and Patient-Centricity 2015. This February 2015 study, with results presented for the first time ever, will feature both data and recorded verbal responses from respected Patient Community Leaders across multiple therapeutic areas. Don’t miss out – only at the 2015 DTC National Conference, held April 7-9 at the JW Marriott in Washington, DC. Register today!