Large direct-to-consumer ad campaigns have been a mainstay of pharma marketing for some time. But the ongoing shock-and-awe efforts on behalf of Bristol-Myers Squibb’s Opdivo and Merck’s Keytruda, both aimed at a relatively small patient pool, have rewritten the rules. And observers expect their larger impact — for good or for ill — to be even bigger than their ad budgets.

It’s easy enough to measure the success of the two immuno-oncology drugs on the most superficial level: Take a breakthrough drug aimed at a small and possibly desperate patient population, add massive ad spending, then sit back and rake in the revenue. Opdivo’s sales last year rose 31% to $4.9 billion, while Keytruda’s jumped 172% to $3.8 billion.

But the impact of these ad campaigns is much larger than the number of prescriptions written, and the audience bigger than those with these specific tumors. 

“This is big business. These ads are meant as much for Wall Street, investors, and physicians as they are for patients,” explains Mike Rutstein, founder and CEO of Strikeforce Communications. 

“It’s all about optics and perceived differences between these two brands. These ads are meant to influence major investment dollars.” 

Rutstein adds that the math of old-school thinking — that only broad health conditions justify a broad consumer campaign — no longer makes much sense, given the high cost of many groundbreaking drugs. “Because of the lack of highly effective treatments, these drugs can demand higher prices. It’s the cost of innovation,” he continues. “So even though a population is small, you don’t need a lot of patients to pay back the cost of broadcast work. If the average cost of treatment is between $50,000 and $100,000 a year, it adds up fast.” 

While the initial targets of their campaigns are fairly narrow segments of the oncology market, both BMS and Merck are aware they are changing consumer conversations about cancer in a broader sense, acquainting the public with the idea of treatments that don’t involve surgery, radiation, or chemotherapy. Additionally, as both drugs secure approval for new indications, the two brands are constructing a halo effect and a foundation for the future.

“It doesn’t necessarily mean they’ll enlarge campaign spending with each new approval, but they are already building brand awareness,” notes Jon Swallen, chief research officer at Kantar Media. 

DTC as patient salve?
Many see the rise of DTC pharma advertising, which Swallen says has surged to roughly $6 billion in spending per year, as a win for patients. “Lung cancer is the most common cancer and the leading cause of cancer death worldwide,” explains Jill DeSimone, SVP, U.S. commercial operations for Merck Oncology, which markets Keytruda. “DTC advertising provides the opportunity to educate people with lung cancer and their caregivers. Our goal with the campaign is to take a patient-centric approach, raising awareness so patients can have an informed dialogue with their healthcare professional.”
Given the bombshell nature of immuno-oncology, the size of the campaign is defensible, says Howard Courtemanche, who worked on the Opdivo launch before becoming president of Y&R’s healthcare practice. “This was incredible news and a story that needed to be told. The idea that your good cells could fight your bad cells and actually melt tumors? That’s big.”

A drug that extends the lives of the terminally ill is about as inspiring as pharma marketing gets.

Courtemanche says he counts a letter from a patient still alive because of the treatment among his proudest possessions.

Cancer may be the most powerful story to tell, but pharma marketers in all categories are rethinking how to insert themselves into patient conversations.

“Consumers are changing the way they manage their health, and marketers are responding,” explains Julia Phelan, EVP and executive director of FCB Health. “These DTC campaigns are a natural outcome of wanting to inspire engaged dialogue. [Patients] can’t write themselves a prescription, but they can ask the right questions.”

Phelan adds that, while DTC campaigns certainly aren’t the solution for every brand, more clients are considering it in the wake of the shock-and-awe campaigns. And while many doctors don’t like DTC efforts, she says, “They are more accustomed to it and see the value in having a more educated customer.”

But even once brand teams decide DTC is the smartest approach, there’s plenty of debate about how to do it well. Rutstein finds the Opdivo campaign “misleading, even if it is technically accurate. These people are the easiest sell in the world. They’re dying, exhausted, and looking for one more day. They hear, ‘cancer, live longer,’ not ‘this only works on one type of tumor,’” he explains.

Elizabeth Elfenbein, a creative executive who has worked for more than two decades in pharma, isn’t a fan of the Opdivo work, either. While she acknowledges it is both “solid and successful,” she believes the ads “are not that connective. There’s a grandiosity about them, shining light on buildings, [but] consumers, especially those in the sandwich generation, are more open to listening to information about cancer. There’s room for more empathy.”

Merck’s DeSimone says authenticity was “critically important” to the Keytruda DTC work and prompted the brand team’s decision to put a real patient at the center of the campaign. She believes selling hope, in a broad sense, is important. “Consumers are interested in hearing about new treatment options, which may provide them with hope about what is available to them and about the promise of the scientific advances being made across a number of diseases,” she says.

Not just TV

Courtemanche says even the best DTC ads can’t function in a vacuum and have to be supported by intense professional efforts. “Opdivo and Keytruda ads did a good job getting doctors ready to write those prescriptions, because if the doctor doesn’t believe in the drug, DTC doesn’t work. The pump has to be primed,” he notes.

As broadcast TV audiences continue to fracture, there’s also an ongoing debate about where DTC ads can be most effective. For example, Allergan recently said it is looking to aggressively shift DTC spending away from TV to digital outlets.

Elfenbein expects more DTC campaigns to quickly evolve beyond broadcast and toward long-form video, which can live on more devices. “In the context of knowing where ads can be placed, brands can be more engaging and creative. They can even be funny,” she says.

Read more on this year’s best and worst DTC ads

But Swallen doesn’t think pharma brands will step away from national TV, in part because so many drugs target older consumers who are more likely to be watching it on a regular basis. “Pharma will be one of the last categories to turn out the lights on broadcast advertising,” he predicts.

Of course, myriad criticisms of DTC efforts persist. Many doctors continue to categorize the ads as creators of false hope and say they mislead would-be patients about effectiveness.

“I’m starting to hear more and more that we are better than I think we really are,” Otis Brawley, M.D., chief medical and scientific officer and EVP, research at the American Cancer Society, told CNN last year. “We’re starting to believe our own bullshit.”

Rutstein agrees the argument that such ads spark a “conversation” between doctor and patient can be disingenuous, playing on the magical thinking of the terminally ill and their families. “To someone with terminal cancer, the doctor really is God. It is rare to have a patient challenge a prescription,” he notes.

The risk that consumers, regulators, or both will eventually turn on DTC ads likely increases as ad budgets grow. “DTC ads have evoked strong reactions and, at least in theory, there’s a tipping point,” says Swallen.

“The possibility of the public reaching a breaking point is very real, given the amount of money people spend [on prescription drugs] and the critical role prescriptions and their cost play in public health. These ads could start conversations that go beyond individual health and change national policy. That’s pharma’s worst nightmare.”

DTC media trends to watch
Not that anyone expected otherwise, but direct-to-consumer pharma and healthcare marketing continued its evolution into a massive multichannel and multi-environment play during the past year. To make sense of the rapid change, we asked media ace Lisa Healy, a partner at Medical Media Services, to share the trends she has seen in recent months — and the ones she expects to see in the months and years ahead.

The game has changed
“With pharma and health DTC, you’ve always had channel planners and media strategists who oversee them — the strategists take all the different channels and put a plan together. I’m wondering if they’re making changes in how they work. To do your job, you need more meetings with people from each channel and you need to think way in advance how [the channels] can be integrated. Nothing happens in a vacuum.

With Netflix, Hulu, and Amazon, the TV space already looks so different than it did even two years ago. The [pharma] companies that have relied on DTC are going to have to look at other opportunities if they want their dollars to go further.”

Environments expand
“The best of what I saw in DTC this year wasn’t a TV commercial or a campaign per se, but programs that paid a lot of attention to how they’re going to live in different environments. Whatever the message and the content is, you have to plan out how it’s going to live outside TV.”

Social’s status

“We’re seeing more pharma and healthcare in social. One campaign that stands out is the American Cancer Society’s social campaign around Facebook, which aligns nicely with their TV commercials. That matters so much more than the amount they’re spending, because it amplifies the campaign and increases reach and exposure.

And the content itself is really good, with individuals who don’t look at cancer as a death sentence, but fly in the face of the cancer. Facebook Watch is really affordable. That could be a place for pharma to experiment.”

Voices carry
“This is one of the channels everybody is trying to figure out. As you use Alexa — or the Google or Apple devices — how can you incorporate a message from pharma that fits in that environment, saves time, and is fluid?

Right now, voice is really undervalued. It’s not expensive to do. But it’s going to take some time before pharma gets comfortable with it, especially with regulatory [concerns]. You’re going to have to partner with an existing app or information resource.”

A systemic surge
“There’s been some really good DTC work for the promotion of hospital systems. Look at what NYU Langone Medical Center has done, with the ads about everyday athletes and how they can get hurt participating in winter sports. Why haven’t health systems done more of this? These big systems need patients and the space has become so competitive.

But it’s not just about getting patients. With all the partnerships, especially between insurance companies and pharmacies, I’m wondering if places are putting themselves out there more because they know prospective partners may be watching.”

Same players, new playbook
“There’s been a bunch of this in different places. Last year’s United Healthcare ads were about ‘taming the inner Hulk,’ but they added something interesting. At the end of the ads, they had a message along the lines of, ‘When you’re at an appointment, be sure to ask for a particular test [colonoscopy] and it’s free.’

United Healthcare is almost positioning themselves as a provider. They want people to live healthy lives earlier on so that they are healthier down the road. That’s in everybody’s best interest.”