Direct Marketing Report: connect with color

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Although pharmaceutical manufacturers are hardly stampeding to the internet, at least in terms of marketing spend, most are aware of the advantages and of the imminent necessity of engaging audiences online as part of their direct marketing efforts. And of those that have taken the plunge, many are finding success.

Becky Butler, manager, interactive marketing at Roche, believes the allure of launching an educational direct-to-patient (DTP) initiative online is in the ability to generate effectively scale and reach in a way that simply can’t be done using offline methods alone.

Butler and Roche recruited Google when it embarked on its “At Risk” unbranded awareness campaign targeting Hepatitis C patients.

Worldwide more than 170 million people are infected with Hepatitis C, a potentially fatal inflammation of the liver. The disease is frequently referred to as a “silent epidemic.” Millions have it, but many are not aware of it because they may not experience symptoms for decades.

This presented a unique marketing challenge for Roche, which manufactures the Hepatitis C treatment Pegasys and has four different potential diseases treatments in development. The drug maker needed to reach patients or potential patients who in many cases did not even know they were targets of the disease.

“Google helped us devise a way to pick and choose the sites.” says Butler. “We used the program to help us find some niche sites that were appropriate for our target audience. We were also allowed to make adjustments along the way based on response data.”

Custom approach
The custom approach behind the “At Risk” program required much precision and planning to execute, explains Butler. “[Entire] teams of people are charged with helping our[pharmaceutical] clients come up with strategies that are probably a lot more complex than most people think, in terms of search campaigns, keywords and creative,” says Google’s director of health vertical Mary Ann Belliveau.

For example, a typical meeting between the Google healthcare team and a pharma company brand team consists of questions on brand goals and connections with consumers and/or physicians, depending on whether the effort is for a drug that’s ready to launch, or about to go off patent, or, in the case of Roche, an unbranded awareness campaign. Everything is built around the needs of the campaign.

“It’s really all about clients themselves making sure they are bringing consumers or physicians into an environment that is appropriate and most educational for what they are actually looking for,” says Belliveau.

Site targeting was especially important for the “At Risk” campaign, where the patient audience was highly specific. Roche needed access to the sites that most consumers wouldn’t normally be aware of, or able to think of, Butler says. “The fact that we were able to choose which sites we were able to appear on, with the ability to make adjustments along the way, was really important to us.”

Through targeted sites on the Google network, patients and prospective patients are led to There patients are invited to participate in a free hepatitis C risk profile and sign up to receive  a newsletter offering important hepatitis C facts and links to resources. The site features downloadable patient brochures and serves as a veritable welcome mat where the relationship between the patient or potential patient and Roche begins.

“This trended toward the start of a customer relationship management (CRM) program, says Butler. “The ‘At Risk’ program is the beginning of the funnel for us … Now we are able to come at it from a very targeted perspective in terms of reaching our audience on very niche sites. That is really very effective for us, more so than other tactics.”

Niche targeting
According to Belliveau, many of Google’s pharmaceutical clients are gaining a better understanding of the DTP opportunities by going after the smaller areas of online content that are highly specialized—areas their patients really care about.

“Our clients, in addition to their search campaigns are running both text ads and banner ads and video across the publishing partners that we have. This gives them very wide reach but also lets them reach into areas that were impossible to get to before,” she says.

This type of online DTP marketing is a perfect complement to mass market campaigns, according to Google. “We would never necessarily advise a client to invest in search as opposed to TV or other types of mass market,” says Belliveau. The difference is in the type of relationship marketers are building with patients. “What we find is that the connection, the ability to educate via a search campaign, takes the level of information you can get across to a consumer or to a physician to a much deeper level,” Belliveau says.

Khee Lee, Google’s health vertical manager, says he’s excited that pharmaceutical direct marketers are increasingly realizing the marketing power his firm can provide, even though not everyone is quite ready to test the online marketing waters. “No matter what device it is, no matter what mechanism it is, all Google really cares about is connecting the information that’s really relevant to people,” says.

So what are pharma marketers waiting for? Lee says that most brand managers and directors he has met are still trying to figure out the perfect media mix. “They are just trying to find that balance.”

The other issue, Lee says, is that every disease state is different and that patients are different within those conditions. “There’s no absolute number, but the great thing about online is you can continually test and invest in it with feedback,” he adds. “You get great feedback, not push...  It’s very measurable.”

But what about targeting older patients? Lee reminds the brand managers he works with that this is becoming less of an issue. “I think the fastest growing demographic is those over 65,” he says. “And one has to take note that half the people looking for information online are caregivers. Although a patient with Alzheimer’s may not be online, a consumer taking care of someone with Alzheimer’s may be looking for information [for them]. 

Using innovation for education
AstraZeneca is hoping to seize upon the success of technology to boost its DTP marketing efforts behind its top-selling brand, Nexium. The drug maker is using the popular technology of podcasts with to educate its patients about its blockbuster proton pump inhibitor.

Late in 2006, and AstraZeneca launched a six-part podcast series as part of its Web destination’s “Living with Heartburn” program to educate consumers on how to cope with heartburn and acid reflux disease. The series is featured at and was a first of its kind on the brand.

Each podcast is three to five minutes in duration and hosted by Dr. Mona Khanna, a quadruple board certified practicing physician.

The podcast content was written specifically for the series and produced by and its team of health editors.

Jean Pundiak, senior ePromotions Manager at AstraZeneca says she embarked on the program with knowing that more and more patients are going online for health information, not only to research conditions, but to find treatment options as well. 

“Patients are expecting more and are really looking for trusted sources of information online,” she says. “Knowing this, it’s extremely important for us to provide them with easy, open access to the information they are looking for.”

It is through patient education that AstraZeneca has been able to reach many heartburn sufferers who frequently tolerate the condition for long periods of time but don’t always understand what’s happening to them. “We’ve really been able to use the online channel to help patients become more educated about, and better manage their acid reflux condition,” explains Nexium brand communications manager Dana Settembrino.’s general manager, health, Marjorie Martin, says some of the “Living with Heartburn” program relies on good old-fashioned education “and then some of it on top of that is disease awareness.”

So far the use of podcast technology has paid off for AstraZeneca those involved with the program tell MM&M.

The significant growth in iPod penetration rates combined with the explosion of health information online made the climate perfect for trying the “Living with Heartburn” program, Pundiak says.

“Podcasting has proven to be one of the fastest growing forms of emerging media over the past few years,” Pundiak says. “Therefore, it was extremely important for us to test this format with patients. To us, it’s a great fit, as it allows us one more method to get information to patients, in a way that integrates with their lifestyle.”  

Beyond the podcast
The success of the podcast series has led AstraZeneca to embark on other custom programs on, says Martin.

Another component to the “Living with Heartburn” series is the custom video that was created just for the program, according to Martin.

“One of the things that we like to do with video, which is a little bit different than some other places on the Web, is we are creating video trying to address common questions from users,” Martin says.

Although many DTP efforts have shifted online, Aaron Uydess of Novo Nordisk warns the power of creating effective patient centric campaigns should not rely simply on just doing a podcast or video.

Prior to joining Novo Nordisk, Uydess spent five years as global eBusiness manager at Bristol-Myers Squibb’s ConvaTec unit creating relationship marketing campaigns aligned with the company’s strategy.

Uydess says that while there 80% e-marketing initiatives he was being proposed started out in the “latest and greatest” technology and then worked backward to find out how to get that technology to support the business.

“There’s always that sexiness factor of using the latest technology, but it’s not going to help from a long term communicating the value of what your online channel brings to your company,” Uydess says.

His advice to pharma marketers is “Remember, when planning the use of tactics, if you can’t measure it, you can’t manage it.”

“The power of e-marketing is not in doing a podcast, the power of e-marketing is not in doing a Web cast, the power of e-marketing is your ability to align strategy communicating that online to your customers,” he says. “Whether it’s a healthcare professional or whether it’s a patient.”

Tim Kelly, analyst with IMS Health predicts that the use of interactive tools in pharmaceutical direct marketing in the patient realm will become increasingly important as drug makers try to come up with new ways to reach physicians and other healthcare providers.

“There’s been plenty of evidence to suggest that online is an effective direct-to-physician marketing tool,” Kelly says. “They migrated from the telephones, to sending online invitations, to participating in surveys. Because doctors could do that offline, off hours, when they actually had time to sit down, and do their thinking and their research, you may have marketers asking them to link to a site or two where they can log and really spend time clicking through.”

According to Kelly, some companies have already begun to use technology in an attempt to get a similar ROI to that of using sales forces, with a lot less fixed expense on the pharma company side.

Kelly does not deny there has been a delay in targeting physicians online driven by the conservative stance by a lot of companies and the legacy use of large sales forces as well as FDA guidelines and regulations. There are complicating factors in this industry that are just not there are in some of the other industries according to Kelly.

“I think in this industry some of the other verticals don’t necessarily have to deal with that cause, that tendency to be a little more cautious, a little slower to adopt. That’s why we too are in the midst of the earlier stages of movement toward the DTP stage as well,” he says.

There has also been a significant detailing shift in activity from primary care to specialty care during the past few years, Kelly says.

“I think a lot of the large pharmas are still thinking in primary care terms and what works for the specialists doesn’t necessarily work for the primary care physician and vice versa,” he says.

“I think the depth of information that’s going to be required is more significant than the basic information in primary care driven therapies and markets.”

Build it and they will come
According to Erica Alexander of Manhattan Research, the number of physicians visiting sites owned by pharmaceutical, biotech, and device companies has increased steadily over the past five years and many companies are coming to the realization that offering services via their Web site is an “option” that will happen eventually—like it or not.

Furthermore, visits to a growing cadre of full service “physician portals” owned by pharmaceutical companies has increased in recent years with a growing number of physicians visiting these properties tailored to the needs of a physician audience interested in product, pipeline, and patient education resources.

“Some of the leading physician portals include the ability to order journal articles, product samples, and receive e-mail updates if there is new product information they should be aware of…before their next ‘real’ rep visit,” Alexander says.

SIDEBAR: How traditional direct marketing agencies staying in the game
Are the better-established direct marketing agencies getting left behind as pharma direct marketers focus their gaze and advertising spend online? Don’t bet on it, says Robert Grammatica, practice leader, global director at Rapp Collins Healthcare.

“Interactive is really not new,” says Grammatica, a direct marketing veteran with over 20 years of industry experience. “It’s something that agencies have always been taking advantage of. We’ve always been in the business of going where the customer touch points are.”

There are, however, some major differences be-tween the more established agencies and the newer interactive pureplays, whose main focus is technical execution of online functions.

Well-established direct marketers have experience working with databases and are more steeped in relationship marketing culture, Grammatica says.

“The big issue in the market today is a lot of people are talking the language, and very few can make it happen and pull that through. I think that’s confusing to a lot of marketers. They are buying something and realizing they are not getting it down the road.”

As a pharmaceutical direct marketer you really need to consider the preference of the individual patient, Grammatica adds. “Some still prefer offline. Some still don’t go online. If you are asking the distinction between us and the interactive start-ups, that is the major one. We are really channel agnostic. We can be using direct-response television, direct mail, Catalina, adherence, patient compliance, along with interactive as one of the tools as well as WebMD. We are basically constructed around where the patients come into the process.

 “But we also have a database department, analytics people, and insights people that specialize in relationships, and patient-physician relationships,” he adds. “So, we have a capability and infrastructure that is far beyond that of an interactive pureplay.”

According to Julian Parreño, senior VP, pharmaceutical markets at Harte-Hanks, the database is what allows direct marketers to communicate personalized, relevant information to patients.

“We feel we have an advantage because we offer a totally integrated solution set. From front end, meaning agency, all the way to database and fulfillment on the back end,” he says.

Parreño notes that many of the established agencies are forming alliances or making acquisitions, such as the Publicis buying Digitas recently, because they don’t have a really strong digital piece.

“It is a growing channel, but it’s just one channel,” he says. “We still believe that you have to
have an integrated approach for maximum impact.”

SIDEBAR #2: Forces driving market change
Today we are seeing some dramatic shifts from the previous tactical approaches in response to the changing marketing landscape, according to Lynn Benzing, CEO at Patient Marketing Group.

Some of the top trends in DTP, as identified by Benzing, include:
• More emphasis on disease education
• Tailored messaging
• Growing interest of relationship marketing

Materials today routinely provide disease management information such as activities to help get the condition under control or preventive action. The idea is comprehensive care, Benzing says.
A good example of this is presented in a recent disease education effort for GlaxoSmithKline’s diabetes treatment Avandia.“Multiple waves of communication cover disease management in a comprehensive way—including the caregiver aspect,” Benzing says.

Also, tailored messaging is more personally relevant and therefore, more powerful, according to Benzing. “We are seeing increasing examples of these approaches, although today it is limited to mostly online initiatives,” she says. Benzing reminds marketers that tailoring requires regular information exchange. “The survey process itself requires careful handling,” she says. 

Creating a sense of community is also turning out to be a key trend in the digital age, according to Benzing.

“This sense of community can be a powerful adherence tool—keeping patients connected to sources of motivation, reinforcement and support,” she says.
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