Maintaining successful relationships in life requires a considerable investment of time and energy; the same applies to direct-to-patient (DTP) marketing. Realizing that even a minimal improvement in patient compliance can increase ROI sharply, pharmaceutical marketers are focused on fostering strong relationships with patients. But to do that, they have to get to know them first.

“The more we know about someone, the more we can tailor specifically to them to help them reach their goal,” says Melissa Clark, director for Novartis' BP Success Zone program. “We are trying to really help patients understand why it's important to treat their hypertension, really understanding their mindset and their behaviors as to why they don't treat or why they don't think they need treatment.”

Customized DTP

BP Success Zone, developed by Novartis and MicroMass Communications, is a customized DTP approach that uses the patient/healthcare provider relationship to drive compliance and boost sales of three key blood-pressure-lowering products: Diovan, Diovan HCT and Lotrel. The program, essentially an overhaul of the previous year's highly acclaimed Take Action for Healthy BP effort, has met with remarkable results since its launch in July 2005, according to Clark.

A satisfaction survey shows 80% of BP Success Zone participants found the program to be important or very important in managing their blood pressure, with 77% saying they felt the program has helped them achieve their blood pressure goals. The initiative is initially delivered to patients through their physicians.

“The physician is the person patients trust most in making their healthcare decisions,” Clark says. “So we've established very strong relationships with physicians in the community, and these physicians are also on board with this mission. They realize they need the help

and the tools to get patients' blood pressure under control. They also have their own frustrations with treating these patients.

“We believe that working through the physician is really the best way to go to reach the patient, because it does establish that trust and it helps with the dialogue.”

Clark adds that almost 40% of the people responding to the program said that encouragement from a physician was the most frequently mentioned factor for motivating them to enroll.

As an incentive, BP Success Zone patients initially receive a starter kit with a free trial of medication, $10 off their next script and a $40 rebate on an Omron blood pressure monitor. Patients are then directed to visit the BP Success Zone Web site to learn more about healthy blood pressure levels and maintenance of their condition.

“We do that with our customized newsletters. People can choose a specific healthy lifestyle action plan, whether it's stress management, weight loss, exercise or smoking cessation, there are five different option plans that people can go through and choose for themselves,

in partnership with their physician, to help them get specific information about those areas, and tips and tools to help them manage their blood pressure, not only from a medication standpoint, but from a lifestyle modification standpoint. That's really important.”

What makes BP Success Zone innovative, Clark says, is that it is focused on patient well-being more so than driving a particular brand. “BP Success Zone actually takes a portfolio approach. It's a franchise that supports Diovan, Diovan HCT and Lotrel. So it's different, in that we are not just trying to push a specific medication. It's whichever is the physician's decision as part of the program,” she says.

The compliance component

The program initially started in April 2004 as Take Action for Healthy BP, but Novartis made significant changes for the relaunch. “The biggest enhancement to the program is the compliance and persistency patient-education aspect, because it's highly tailored and customized to the individual,” Clark says. “We didn't have that aspect of the program when we first launched. Really, the first phase focused on helping people to get focused on their numbers.”

Recent trends in DTP marketing, exemplified by programs like BP Success Zone, are showing that retention can drive ROI in a way that acquisition is unable to do, according to Wes Michael, EVP of marketing research company TNS Healthcare. “I think many people have been seeing that retention—driven by compliance and adherence—can boost business so much. It only takes a small increase, especially with a chronic condition where people may be taking a medication for the rest of their lives. That has a huge impact, and so the question becomes ‘How do you do that?'”

One of the answers lies with the Internet, where almost every brand is expected to have it own Web site. It's an environment that has expanded the reach of targeted efforts. “You could have your sales force call on a doctor individually, whereas they couldn't call on a patient individually. (The Web) gets you much closer to being able to do that,” Michael says.

Relationship or quick fling?

But just because there are new opportunities doesn't mean there aren't pitfalls. “You can have the best plan in the world, but if your message isn't motivating, it really won't push up the needle. It is very difficult, especially in terms of increasing compliance,” Michael explains. “With a Web site, consumers are very eager and willing to go there for a specific piece of information, but it doesn't mean they are going to come back every month to develop that relationship to make it a compliance tool. It's a difficult challenge to get beyond that information-providing side. In terms of targeting spending, it has to be done. You can't go to the mass market to have that effect.”

The customized approach is paying off for Gilead Sciences in its efforts supporting the hepatitis B treatment Hepsera. “Sometimes, just talking a lot about a disease doesn't do enough,” says Denton Chase, product manager, community/patient marketing, hepatitis B, at Gilead Sciences. “The reason why a targeted approach works is that within that targeted approach, you have action built behind it. There's a way to change things. With broad brush strokes, sometimes you aren't giving people the things that they need to make an actual difference. When you take a more personalized approach, you can really personalize the tools and really make a difference to better the lives of patients.”

Chase heads up the StopHepB grassroots campaign that utilizes community partnerships and interactive online education to drive awareness and testing for hepatitis B. A fundamental element of the effort is the StopHepB.com Web site, designed by Gilead and Ignite Health, to inspire visitors to become vocal advocates, or “warriors,” committed to fighting hepatitis B by informing family, friends and community groups about the disease. Web site content is also available in multiple languages, and the site has a search tool that helps people find local physicians who specialize in treating hepatitis B.

“It's just not enough to think about your drug and your market share,” Chase says. “If you are in it for the long run, it's how do you better the lives of your patients? We can all change the nature of the disease state for the patient. I do think that this kind of targeted partnership approach is the way of the future, because we are already starting to see that you can make a difference in the lives of patients.”

Up and running for just over six months, the Web site is averaging 27,000 pages views a month and reaching 6,000 unique users.

Gilead has already registered almost 150 HepB warriors—people who have taken the time to go the site, go through educational sessions and actually start spreading the word actively through face-to-face interactions and blogs.

“It's a commitment, and the fact that we have close to 150 HepB warriors say a lot about what you can do with this approach. Sure, Gilead makes a drug called Hepsera, but this campaign is kind of separate from that,” Chase explains. “This campaign is about trying to work with different community organizations and advocates to try to change or basically provide solutions for the disease state, not so much worrying about the drug. So it's actually quite separate. We believe that physicians will ultimately make the right treatment decision. And that's the way Gilead believes in the science of the products and the physicians making that choice. But the disease state has some issues even before we get to treatment, and this is what the campaign is all about.”

It's not all about the Web

Although the successes of BP Success Zone and StopHepB lean on the Internet, not everyone wants to receive their communications from pharma companies online.

“You hear and see that digital marketing is the panacea,” says Julian Parreño, senior vice president, pharmaceutical markets, at Harte-Hanks. “It isn't. One of the principles of direct marketing is that you have to offer people the opportunity to respond by channel. To give you the opt-in and tell you how they want to receive communications, you should do that, not just for the patient, but for the physician as well. The e-channel is a critical channel but not the only channel. We still have the targeted marketing initiatives—direct mail, one-to-one marketing or telemarketing.”

According to Parreño, the Internet can't always give marketers the reach of some of the more tried-and-true methods. “Certain segments of the population are still not Internet-savvy, [such as] those who take Alzheimer's drugs and Parkinson's medications. The Internet is one channel. It is a very important channel, but it's one of many channels. You still have to offer the opportunity to communicate with patients the way that they want to be communicated with.

“We've got to be smarter. It's the age of what I call smart bombs versus carpet-bombing days where you hoped you hit the target. Now you've got to really find out. You've got to be more specific and precise. Companies are under pressure to deliver double-digit earnings growth in light of all of these challenges. The marketing model needs to become more efficient. We have a lot of waste out there, and when you see a lot of DTC ads on the airwaves, it also doesn't help pharma.”

However, nobody seems to have come up with an ironclad solution.

“There's over $20 billion-plus left on the table every year because of poor compliance,” Parreño explains.

To create compliance, pharma marketers must be aware that consumers want to be involved, and they want to be tended to much more, says Soren Skovlund, senior adviser, manager, corporate health partnerships,

at Novo Nordisk. Skovlund is the manager responsible for the DAWN (Diabetes Attitudes Wishes and Needs) program, a global initiative in collaboration with the International Diabetes Federation aimed at promoting patient-centered healthcare and community initiatives in 25 countries.

During a recent conference addressing compliance, persistency and adherence, Skovlund pointed out that patients want integrated patient-centered care. “They don't want compliance,” he says. “Nobody wants compliance. That's a condescending word to a patient. They want to be focused on health, to live a full life, and the compliance term is certainly not very suitable terminology. I would not like to go to a doctor and be told I have to comply. I want to be told, ‘We can help you to live your life fuller and stay healthy,' and so forth. I don't want to be told I have to comply with anything. I don't think any modern person wants that.”

Collaborate to innovate

This approach is called stakeholder innovation, Skovlund says. “It basically means innovating through collaboration with your customers. We (tend to) look at products based on nurturing short-term relationships with our customers. Then we add a step with a solution that's already packaged for the customer to enhance the relationship and helps to improve customer satisfaction—a truly collaborative approach focusing on customer success.”

Marketers are constantly examining new ways to drive compliance. Bas Op ten Berg, customer manager, DTC, global e-business, at Organon, says US marketers should be thinking about compliance programs like the one that he helped develop for his company's Nuvaring contraceptive in Europe.

The program, in place for the past three years, uses text messaging and has met with success in Europe over

the past three years. Nuvaring patients are sent text messages as a reminder to get refills, which usually drop off after the first prescription. Forty percent of Nuvaring users were reported as participating in product studies, with 80% responding to survey requests in 48 hours. The best part is that “you can observe the patients in real time,” Op ten Berg says.

Another program meeting promising results comes from New Jersey direct marketing company Pharmaceutical Direct, which is promoting a device called “The Smart Cap.” According to Pharmaceutical Direct president Scott Puzia, the device has the capability to increase patient compliance by 35%.

The smart cap is a prescription vial cap with a built-in timer that tells patients how long it has been since they last took their medication.

Pharmaceutical Direct places a letter on the benefits of compliance, along with The Smart Cap, the prescription insert and an instruction sheet on how to use the timer, into a bubble bag that gets sealed and sent to the mail distribution center of the participating drug chain. There, drawing from a list of patients using the specific product, a label is affixed and mailed out. The drug chain then sets up a demographically and numerically equivalent control group that receives no intervention and compares the refill frequency of each group, thus determining the impact The Smart Cap had in patient compliance.

“This gives us an ROI analysis that is right-to-the-penny accurate,” says Puzia, and is easy to budget at just $7 per patient.

Devices sector takes note

The medical device industry is keeping a close eye on pharma DTP marketing and is poised to implement some of the same approaches used by drug manufacturers in reaching patients in years to come, according to Mark Summers, founder and CEO of Threewire, a DTP marketing service for the medical device industry.

“Increasingly, you are going to see programs where device companies are going to be putting patients on the radar screen. It's not happening a lot now, but it's starting to enter the consciousness of a lot of medical device companies. In the next two to three years, I think there's going to be a real increase, and you are going to see a lot of companies doing that.” Summers started Threewire seven years ago and has worked on both the drug and the device side.

“Even four years ago, many device companies weren't interested in DTP marketing, and now most device companies know what DTP is and what we are talking about,” says Summers. “Everybody realizes that consumerism is growing exponentially. In the device industry, historically the sales force went out to the doctors. But that locks out the patients with doctors not using your product. Device companies are realizing this now.”