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October 13, 2016 0

Contrary to popular belief that soaring drug prices translates to growing wealth for manufacturers, the royalties within the insulin market are going directly to the middlemen. Also known as pharmacy-benefit managers (PBMs), their purpose in the market is to negotiate rebates and fees based on list prices. In light of the recent price increase of Mylan’s EpiPen, angry consumers are voicing their opinions about the high list prices of everyday drugs.

Since 2011, there have been significant insulin price increases from big manufacturers such as Sanofi, Eli Lilly and Novo Nordisk. Harvard professor Aaron Kesselheim suggests that this can in part be attributed to the growing number of patients under high-deductible plans, shifting the cost from the insurer to the consumer.

However, the revenue acquired by the drug maker after discounts has stayed the same, or in some cases even fallen. Reason being, pharmaceutical companies compete to remain on the preferred drug list by offering deeper and deeper discounts. In exchange for their spot on the list, PBMs demand higher rebates, making it difficult for companies to turn a growing profit.

Steve Miller, CMO of Express Scripts, the largest PBM in the U.S., acknowledges that “certain patients get caught in the middle of this, and we have got to figure out how to put guard rails around that,” such as setting a maximum pharmacy price”.

To read more about insulin pricing and reimbursement from the Wall Street Journal, click here.


Lily Stauffer

April 15, 2015

We know that the formation of healthy lifestyle habits is critical to overall health. However, adherence to exercise programs, medication regimens, or dietary changes can be challenging. So how do we help patients develop habits to improve their overall health?

Habits are defined actions employed without conscious thought.1 Habit forming potential of any behavior is often driven by two factors: frequency and perceived utility. The more frequently a new behavior occurs, especially within a short period of time, the stronger the habit becomes. Likewise, the more rewarding the behavior is perceived to be (its utility), the greater the chance for habit formation. The “Hook Model” is one method that we use at Health Union to build value and encourage habit-forming behaviors within our communities. Four key components converge in the hook model – a trigger, an action, a reward, and an investment2 – to create ecosystems that cultivate engagement habits and motivate people to live better with their health conditions.


Health Union communities use both internal and external triggers to encourage patient engagement. External triggers may include advertisements or comments from doctors, family, and friends; while internal triggers are leveraged when an action becomes strongly tied to a thought, emotion or preexisting routine, like checking email every morning. While we utilize some paid external triggers, like Facebook advertising, we’ve found that relationship triggers (social media sharing/word of mouth) and owned triggers (opting into a weekly newsletter) are most effective for long-term engagement. Owned triggers are most likely to prompt repeat engagement until a habit is formed, and relationship triggers support continuous community growth.


The more people interact with your product, the more likely they are to keep doing it. Our community engagement strategy creates a “funnel” approach to increase the level of participation over time, knowing that simple actions can lead to big changes in future behavior.3 For instance, our members may start as site visitors, then progress to following us on social media and engage in passive activities like anonymous polls. Passive participation may lead to newsletter registration and eventually active engagement by posting comments or personal stories. It’s important to make it easy for even the most passive patients to engage while still providing outlets for the most active members.


Provide a real benefit to action – with variability – and do it quickly! Show people that taking action results in a clear benefit. Of course, keep in mind that the preferred benefits vary from one person to the next. Make sure to clearly communicate what the reward is – whether that is answers to basic questions, immediate poll results upon voting, published results from surveys, or community support. Don’t assume the reward is obvious and communicate the benefit gained by others as well as that of the individual. Variability can multiply the natural effects of a reward and keep people coming back for more. All Health Union communities provide daily content that is relevant and useful, but the type of content, topics, and authors are varied to create novelty.


Encourage people to make an investment, beyond just lurking or passively clicking. This may be an emotional investment, an investment of time, or a contribution of personal information. Investment implies action that will improve the service for the next visit. And, the greater the investment, the more likely they are to continue engaging over time, thereby increasing the value of the product. For example, the simplest investment is to follow one of our social media accounts. However, we also invite members to “own” part of the site by participating in surveys and publishing personal stories.

What else can we do?

In addition to the four elements of the Hook Model, don’t forget to …

  • Remove barriers and provide support. Be aware of both perceived and actual barriers. For example, in response to a perceived barrier that weight loss is dependent on foregoing all desserts, provide recipes for healthier dessert options.
  • Strengthen self-efficacy, the belief in one’s own ability to complete tasks and reach goals. Since many people are uncomfortable asking their doctors questions, provide discussion guides to encourage dialogue focusing on areas where the patient is the expert – like how a condition affects day-to-day life.
  • Find what people are doing already, and make it easier for them by linking habits to daily routines.4 Our content strategy focuses heavily on giving people the information we know they are seeking, where they are already seeking it (with social media and search).

The ultimate goal is to create a cycle of interaction where the investment itself becomes an internal trigger. Members seek responses to topics discussed within the community – that desire for shared experience is the trigger to continue engaging. And then, they’re hooked!


  1. E. Morsella, J.A. Bargh, P.M. Gollwitzer, eds., Oxford Handbook of Human Action (New York: Oxford University Press, 2008).
  2. Eyal, Nir. Hooked: How to Build Habit-Forming Products.
  3. J.L. Freedman and S.C. Fraser, “Compliance Without Pressure: The Foot-in-the-door Technique.” Journal of Personality and Social Psychology 4, no. 2 (1966) 196-202.
  4. Bas Verplanken and Wendy Wood, “Interventions to Break and Create Consumer Habits, Journal of Public Policy & Marketing 25, no. 1 (March 2006): 90-103, doi: 10.1509/jppm.25.1.90.


Amrita Bhowmick

January 20, 2015

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!

Todd Kolm