Maintaining successful relationships in life requires aconsiderable investment of time and energy; the same applies todirect-to-patient (DTP) marketing. Realizing that even a minimal improvement inpatient compliance can increase ROI sharply, pharmaceutical marketers are focusedon fostering strong relationships with patients. But to do that, they have toget to know them first.
“The more we know about someone, the more we can tailorspecifically to them to help them reach their goal,” says Melissa Clark,director for Novartis’ BP Success Zone program. “We are trying to really helppatients understand why it’s important to treat their hypertension, reallyunderstanding their mindset and their behaviors as to why they don’t treat orwhy they don’t think they need treatment.”
Customized DTP
BP Success Zone, developed by Novartis and MicroMassCommunications, is a customized DTP approach that uses the patient/healthcareprovider relationship to drive compliance and boost sales of three keyblood-pressure-lowering products: Diovan, Diovan HCT and Lotrel. The program,essentially an overhaul of the previous year’s highly acclaimed Take Action forHealthy BP effort, has met with remarkable results since its launch in July2005, according to Clark.
A satisfaction survey shows 80% of BP Success Zoneparticipants found the program to be important or very important in managingtheir blood pressure, with 77% saying they felt the program has helped themachieve their blood pressure goals. The initiative is initially delivered topatients through their physicians.
“The physician is the person patients trust most in makingtheir healthcare decisions,” Clark says. “So we’ve established very strongrelationships with physicians in the community, and these physicians are alsoon 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 thebest way to go to reach the patient, because it does establish that trust andit helps with the dialogue.”
Clark adds that almost 40% of the people responding to theprogram said that encouragement from a physician was the most frequentlymentioned factor for motivating them to enroll.
As an incentive, BP Success Zone patients initially receivea 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 tovisit the BP Success Zone Web site to learn more about healthy blood pressurelevels and maintenance of their condition.
“We do that with our customized newsletters. People canchoose a specific healthy lifestyle action plan, whether it’s stressmanagement, weight loss, exercise or smoking cessation, there are fivedifferent option plans that people can go through and choose for themselves,
in partnership with their physician, to help them getspecific information about those areas, and tips and tools to help them managetheir blood pressure, not only from a medication standpoint, but from alifestyle modification standpoint. That’s really important.”
What makes BP Success Zone innovative, Clark says, is thatit 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 thatsupports Diovan, Diovan HCT and Lotrel. So it’s different, in that we are notjust trying to push a specific medication. It’s whichever is the physician’sdecision as part of the program,” she says.
The compliance component
The program initially started in April 2004 as Take Actionfor Healthy BP, but Novartis made significant changes for the relaunch. “Thebiggest enhancement to the program is the compliance and persistency patient-educationaspect, because it’s highly tailored and customized to the individual,” Clarksays. “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 likeBP Success Zone, are showing that retention can drive ROI in a way thatacquisition is unable to do, according to Wes Michael, EVP of marketing research company TNS Healthcare. “I think many people have beenseeing that retention—driven by compliance and adherence—can boost business somuch. It only takes a small increase, especially with a chronic condition wherepeople may be taking a medication for the rest of their lives. That has a hugeimpact, and so the question becomes ‘How do you do that?’”
One of the answers lies with the Internet, where almostevery brand is expected to have it own Web site. It’s an environment that hasexpanded the reach of targeted efforts. “You could have your sales force callon 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 meanthere aren’t pitfalls. “You can have the best plan in the world, but if yourmessage isn’t motivating, it really won’t push up the needle. It is verydifficult, especially in terms of increasing compliance,” Michael explains.“With a Web site, consumers are very eager and willing to go there for aspecific piece of information, but it doesn’t mean they are going to come backevery month to develop that relationship to make it a compliance tool. It’s adifficult challenge to get beyond that information-providing side. In terms oftargeting spending, it has to be done. You can’t go to the mass market to havethat effect.”
The customized approach is paying off for Gilead Sciences inits efforts supporting the hepatitis B treatment Hepsera. “Sometimes, just talkinga lot about a disease doesn’t do enough,” says Denton Chase, product manager,community/patient marketing, hepatitis B, at Gilead Sciences. “The reason why atargeted approach works is that within that targeted approach, you have actionbuilt 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 actualdifference. When you take a more personalized approach, you can reallypersonalize the tools and really make a difference to better the lives ofpatients.”
Chase heads up the StopHepB grassroots campaign thatutilizes community partnerships and interactive online education to driveawareness and testing for hepatitis B. A fundamental element of the effort isthe StopHepB.com Web site, designed by Gilead and Ignite Health, to inspirevisitors to become vocal advocates, or “warriors,” committed to fightinghepatitis B by informing family, friends and community groups about thedisease. Web site content is also available in multiple languages, and the sitehas a search tool that helps people find local physicians who specialize intreating hepatitis B.
“It’s just not enough to think about your drug and yourmarket share,” Chase says. “If you are in it for the long run, it’s how do youbetter the lives of your patients? We can all change the nature of the diseasestate for the patient. I do think that this kind of targeted partnershipapproach is the way of the future, because we are already starting to see thatyou can make a difference in the lives of patients.”
Up and running for just over six months, the Web site isaveraging 27,000 pages views a month and reaching 6,000 unique users.
Gilead has already registered almost 150 HepBwarriors—people who have taken the time to go the site, go through educationalsessions and actually start spreading the word actively through face-to-faceinteractions and blogs.
“It’s a commitment, and the fact that we have close to 150HepB warriors say a lot about what you can do with this approach. Sure, Gileadmakes a drug called Hepsera, but this campaign is kind of separate from that,”Chase explains. “This campaign is about trying to work with different communityorganizations and advocates to try to change or basically provide solutions forthe disease state, not so much worrying about the drug. So it’s actually quiteseparate. We believe that physicians will ultimately make the right treatmentdecision. And that’s the way Gilead believes in the science of the products andthe physicians making that choice. But the disease state has some issues evenbefore 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 leanon the Internet, not everyone wants to receive their communications from pharmacompanies online.
“You hear and see that digital marketing is the panacea,”says Julian Parreño, senior vice president, pharmaceutical markets, atHarte-Hanks. “It isn’t. One of the principles of direct marketing is that youhave to offer people the opportunity to respond by channel. To give you theopt-in and tell you how they want to receive communications, you should dothat, not just for the patient, but for the physician as well. The e-channel isa critical channel but not the only channel. We still have the targetedmarketing initiatives—direct mail, one-to-one marketing or telemarketing.”
According to Parreño, the Internet can’t always givemarketers the reach of some of the more tried-and-true methods. “Certainsegments of the population are still not Internet-savvy, [such as] those whotake Alzheimer’s drugs and Parkinson’s medications. The Internet is onechannel. It is a very important channel, but it’s one of many channels. Youstill have to offer the opportunity to communicate with patients the way thatthey want to be communicated with.
“We’ve got to be smarter. It’s the age of what I call smartbombs versus carpet-bombing days where you hoped you hit the target. Now you’vegot to really find out. You’ve got to be more specific and precise. Companiesare under pressure to deliver double-digit earnings growth in light of all ofthese challenges. The marketing model needs to become more efficient. We have alot of waste out there, and when you see a lot of DTC ads on the airwaves, italso doesn’t help pharma.”
However, nobody seems to have come up with an ironcladsolution.
“There’s over $20 billion-plus left on the table every yearbecause of poor compliance,” Parreño explains.
To create compliance, pharma marketers must be aware thatconsumers want to be involved, and they want to be tended to much more, saysSoren Skovlund, senior adviser, manager, corporate health partnerships,
at Novo Nordisk. Skovlund is the manager responsible for theDAWN (Diabetes Attitudes Wishes and Needs) program, a global initiative incollaboration with the International Diabetes Federation aimed at promotingpatient-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’sa condescending word to a patient. They want to be focused on health, to live afull 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 betold, ‘We can help you to live your life fuller and stay healthy,’ and soforth. 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, Skovlundsays. “It basically means innovating through collaboration with your customers.We (tend to) look at products based on nurturing short-term relationships withour customers. Then we add a step with a solution that’s already packaged forthe customer to enhance the relationship and helps to improve customersatisfaction—a truly collaborative approach focusing on customer success.”
Marketers are constantly examining new ways to drivecompliance. Bas Op ten Berg, customer manager, DTC, global e-business, atOrganon, says US marketers should be thinking about compliance programs like the one that he helped develop for hiscompany’s Nuvaring contraceptive in Europe.
The program, in place for the past three years, uses textmessaging and has met with success in Europe over
the past three years. Nuvaring patients are sent textmessages as a reminder to get refills, which usually drop off after the firstprescription. Forty percent of Nuvaring users were reported as participating inproduct studies, with 80% responding to survey requests in 48 hours. The bestpart is that “you can observe the patients in real time,” Op tenBerg says.
Another program meeting promising results comes from NewJersey direct marketing company Pharmaceutical Direct, which is promoting adevice called “The Smart Cap.” According to Pharmaceutical Direct presidentScott Puzia, the device has the capability to increase patient compliance by35%.
The smart cap is a prescription vial cap with a built-intimer that tells patients how long it has been since they last took theirmedication.
Pharmaceutical Direct places a letter on the benefits ofcompliance, along with The Smart Cap, the prescription insert and aninstruction sheet on how to use the timer, into a bubble bag that gets sealedand sent to the mail distribution center of the participating drug chain.There, drawing from a list of patients using the specific product, a label isaffixed and mailed out. The drug chain then sets up a demographically andnumerically equivalent control group that receives no intervention and comparesthe refill frequency of each group, thus determining the impact The Smart Caphad in patient compliance.
“This gives us an ROI analysis that is right-to-the-pennyaccurate,” 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 pharmaDTP marketing and is poised to implement some of the same approaches used bydrug manufacturers in reaching patients in years to come, according to MarkSummers, founder and CEO of Threewire, a DTP marketing service for the medicaldevice industry.
“Increasingly, you are going to see programs where devicecompanies are going to be putting patients on the radar screen. It’s nothappening a lot now, but it’s starting to enter the consciousness of a lot ofmedical device companies. In the next two to three years, I think there’s goingto 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 andthe device side.
“Even four years ago, many device companies weren’tinterested in DTP marketing, and now most device companies know what DTP is andwhat we are talking about,” says Summers. “Everybody realizes that consumerismis growing exponentially. In the device industry, historically the sales forcewent out to the doctors. But that locks out the patients with doctors not usingyour product. Device companies are realizing this now.”
From the June 01, 2006 Issue of MM+M - Medical Marketing and Media
