When it comes to diabetes, will marketers break with tradition?

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Sanofi's Lantus is expected to have generated $3.79 billion in U.S. sales in 2016. 

The fiercely competitive diabetes drug market is in line for a dramatic overhaul, one that would place more emphasis than ever on the well-being of the consumer. As diabetes strengthens its grasp on America's health, what's needed most is messaging that targets those at risk for the complex disease and better tools for those already diagnosed.

Many marketers believe diabetes patients have already started benefiting from the unprecedented volume of disease-awareness campaigns plucked straight from the clutches of pharma marketers' budgets. At the same time, others doubt pharma's ability to break from tradition.

See also: Lexicon developing type 1 diabetes treatment with Sanofi

Are drug manufacturers shying away from these efforts because they're worried the well of diabetes patients will dry up? Top executives have been vocal about their wish that marketers would recognize diabetes as a continually growing market. Contrary to diseases such as muscular dystrophy — where virtually every patient is enrolled in a clinical trial — the diabetes landscape is vast and the need is great.

As the number of people diagnosed with diabetes continues to surge, ad dollars are being spent at a staggering rate. One Sanofi television spot explains the company's once-daily injectable Toujeo will help people get their groove back. According to iSpot.tv data, Sanofi shelled out $30.2 million on Toujeo TV ad time in 2015, its first year on the airwaves.

Similarly, TV ad spending for Johnson & Johnson's Invokana nearly tripled, from $35.2 million in 2014 to $101.2 million in 2015, according to iSpot.tv. Full-year sales of Invokana spiked 118% in the same period, perhaps suggesting the outlays for TV ad time can have a positive effect.

GSW SVP Dirk Defenbaugh, group account director for insulins, says U.S. branded product campaigns largely look and sound alike, with diabetes brand campaigns emerging as some of the worst offenders. The problem, he explains, lies in the message. Simply put, it's not the channels that make great marketing; it's the work.

“The industry needs breakthrough creative and a focus on brand building that goes beyond ‘ask your doctor if this drug is right for you,'” he notes.

See also: Top 25 metabolic brands, by sales, 2015-2016

In such an innovative sector, the market tends to surge when a new company enters the playing field or a new treatment gets the green light from the FDA. Most recently, Sanofi's Soliqua and Novo Nordisk's Xultophy gained approval in succession, igniting a new battle for market share.

“It's similar to statin growth years ago,” explains James Nolan, CEO of InClinica, a clinical research organization. “Each time a new statin was approved, it made the lipid-lowering market grow.”



EMBRACE THE BRAND

However, even in a competitive market branded ad campaigns will have little effect if payers don't embrace the brand.

“The battle for diabetes manufacturers is with the payers,” Nolan adds. “They need to make sure they get on, and remain on, the formulary. Once secured there, they can increase demand.”

Novo Nordisk was recently reminded of this when Express Scripts banished its top-selling NovoLog insulin from the national formulary, setting off a cascade of events that included a 2% slash of the company's workforce.

See also: Diabetes marketers turn to big data, gaming to improve outcomes

In Nolan's estimation, advertising is memory retention. Patients will continue to ask their doctors for brands they recognize, particularly for diabetes. And they're likely to leave the office with a prescription in hand if the drug is on the formulary.

Can diabetes marketers take a cue from the erectile dysfunction market?

“Cialis is a brilliant campaign — the bathtubs are ingrained in our brains,” he explains. “Diabetes marketers need to get clever to push people to know, recognize, and remember their brand.”

Type 2 diabetes is a reality for more than 29 million Americans, many who live with other conditions, such as cardiovascular disease. Morbidity and mortality rates from untreated or poorly controlled diabetes create an opening for the right stakeholders.

To that end, drug manufacturers are increasingly studying the utility of approved diabetes medications in chipping away at rising mortality rates. Eli Lilly's Jardiance secured a trailblazing FDA approval in December for reducing the risk of cardiovascular death in adult patients with type 2 diabetes and cardiovascular disease.



TO PARTNER OR NOT TO PARTNER

Jason Cain, AstraZeneca's head of marketing diabetes oral brands, says the dissemination of information about a disease, as well as treatments, helps healthcare providers and patients make informed decisions to manage it.

“Taking a comprehensive approach to managing diabetes can be critical to improving outcomes and quality of life for patients,” he notes.

See also: Ogilvy's Michael Johnston on Using the Familiar in Diabetes Ads

Pharma marketing goals, including disease awareness, early diagnosis, and effective treatment, can be aligned with those of the rest of the healthcare system, adds Dr. Jerry Lee, VP and group director of science and medicine for the agency Digitas Health LifeBrands. Pharma's messages have advanced disease awareness, he notes, but far more needs to be done.

Despite a flood of messages about diabetes coming from a host of different sources, the disease keeps growing.

“If you asked me to measure the efficacy of the messages, we're failing,” says Vince Parry, president and chief branding officer at Parry Branding Group. “The incidence of diabetes should go down with the right campaigns.”

Parry draws a parallel to a crusade led by the American Heart Association to educate women at risk for heart disease. Over a 10-year span, the organization noted a 34% reduction in the number of women dying from heart disease. But for all the education and advocacy efforts, incidences of diabetes are still on the rise, he notes.

Not surprisingly, diabetes creates myriad challenges for brand managers.

“Marketers have to pick one behavior to change first. Once patients are empowered by controlling their disease with medications, they can tackle other areas,” explains Tom Kottler, CEO and cofounder of HealthPrize Technologies.

Building partnerships with other stakeholders may help pharma better understand patient needs, deliver receivable messages, and drive patient numbers down. Some pharma outreach has fallen flat because marketers don't understand why patients aren't staying on their medications.

See also: BI and Lilly face a new challenge: how to market a diabetes drug to cardiologists

“That's the core part, the very basis of the need to reach these patients,” Kottler notes.

Partnering doesn't necessarily mean pharma should throw the notion of new revenue streams out the window. Rather, Parry describes a scenario in which a pharma company partners with a major health system to position its diabetes drug as the standard of care for a program treating the comorbidities of obesity. If the drug becomes part of the formulary, the pharma company rides the program's coattails as it is franchised across the country.

Alas, pharma might need to tread lightly where obesity is concerned. Consumer watchdog Public Citizen asked the FDA to step in against TV ads that claim diabetes drugs have a weight loss benefit. Roughly 90% of patients with type 2 diabetes struggle with their weight and many treatments are associated with weight gain.

“Patient-centered care is coming and it will affect diabetes,” Parry says. “The pharma company that wins in the end is the one that figures out the wellness piece.”



OUTSIDE THE COMFORT ZONE

Pharma has started to roll out digital tools and disease education to improve lifestyle issues for patients with diabetes.

Cornerstones4Care, Novo Nordisk's online diabetes health coaching program, has been heralded as an innovative approach for an unmotivated population. Meanwhile, HealthPrize Technologies is working with Walgreens to offer a patient-engagement and medication-adherence platform through the chain's website.

In another twist on tradition, AstraZeneca created the On It Movement, featuring Dr. Phil McGraw, to help people with type 2 diabetes take an active role in overcoming emotional and psychological barriers to managing the disease.

“In a crowded space, the psychosocial focus stands out as unique and addresses a key patient need,” explains Cain.

AstraZeneca launched the On It Movement campaign in March 2016. 

Similarly, Lee believes pharma's marketing campaigns across social media channels are beginning to take hold.

“The demographics of diabetes is shifting — and, unfortunately, more young people are affected,” he says. “They're more comfortable using Facebook as a disease resource.”

But the industry needs to invest more deeply in social media and blogs because that's where consumers are spending their time and gathering product information. “Marketing's future is in blogs,” Nolan notes.

See also: Infographic: Type 2 diabetes, a country-by-country snapshot

Patients are already there, discussing the latest diets and weight-loss gimmicks. And they're talking about the drugs they take.

Pharma is paying attention, with many companies angling to penetrate the channel to uncover patient needs. However, there are inherent challenges that prevent pharma from pushing messages in new areas.

“The ability to reach out to patients, open a dialogue, and ignite change is limited by a heavy dose of regulation,” Kottler explains.

Traditional marketing channels may not be the best venues to change behavior and promote healthier new habits. Experiential channels, where patients are engaged in newer and deeper ways, may hold the keys to unlock better adherence and outcomes.

Lee notes an attitudinal shift toward patients taking more ownership in their health, which should spur opportunities for diabetes messaging.

“It's important marketing campaigns tap into that sentiment to convey that brands are partners in the patient journey to better health,” he says.

CORRECTION: An earlier version of this article incorrectly cited the agency that Dr. Jerry Lee works for. He is VP and group director of science and medicine at the agency Digitas Health LifeBrands. 

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