Recently, I’ve been concerned that marketers aren’t worrying enough about how the shift to value-based care and other macro trends are affecting their craft. Eighteen months ago, strategic meetings were full of thinking about formularies and the emergence of Accountable Care Organizations (ACOs), but now, most clients don’t have enough bandwidth to put out day-to-day fires and adapt their operations to a shifting market.

The trouble is that the market is changing much faster than most marketers realize.

We recently did an in-depth review of major trends affecting physician workflow and prescribing behavior today (changes in policy, market access, consumer engagement and technology, etc.), looking specifically at how these trends impact digital engagement and demand for pharma resources. Here are some of the highlights and the opportunities for pharma:

Sensitivity to drug costs is growing among patients and physicians. Fifty-five percent of physicians surveyed for our Taking the Pulse U.S. 2014 study say they are discussing the cost of prescription drugs with patients more often this year compared to previous years. This cohort is more likely to prescribe generics and exclude brand requests from patients, undermining the ability of marketers to drive scripts through branded consumer marketing.

The good news here is that these cost-sensitive physicians are just as likely to use pharma product websites and significantly more likely to use websites on smartphones for work. They are also much more likely to use formulary lookup tools — including those provided by publishers and pharma — on smartphones, making fingertip formularies an attractive platform for provision of copay cards and other cost-mitigating services. Moreover, brands looking to drive copay card use should target this cohort of cost-sensitive physicians, as they are five times more likely than their counterparts to report that they are using co-pay coupons more than in previous years.

Formulary lists and other restrictions are significantly impacting prescribing choice. Physicians say that for almost half of prescribing decisions, they check and follow a formulary list or other restrictive guideline rather than prescribing based solely on their own clinical preference, making this a weak point in even the best-designed sales strategy. One opportunity that emerged from our research here is in providing reliable formulary tools to physicians — especially for mobile devices, as formulary-adherent physicians continue to check clinical resources on websites and apps outside of the EHR.

Patient data and population health already shaping clinical pathways and prescribing decisions. A sizable 18% of EHR users say that they are already performing data mining for patient or practice trends, and that number is likely to grow substantially in the next few years as the technological infrastructure to support data mining evolves and practices pursue Meaningful Use incentives to do so. This calls into question the relevance of marketing messages that rely more narrowly on clinical trials. These early-adopting data miners are immersed in EHRs, but not at the expense of digital resources, and are thus reachable via search, websites and other typical digital channels marketers use.

Moreover, data miners are more likely to use peer-reviewed and other independent sources of clinical information, including decision support tools and guidelines on smartphones and websites for a professional audience (e.g., Medscape), representing messaging and acquisition opportunities for marketers. The recent partnership of Cigna and AstraZeneca around predictive risk modeling for Crestor is groundbreaking in providing a win-win for multiple stakeholders.

Providers and institutions are now investing in the patient engagement movement. Driven by an array of policy incentives, including the HITECH Act’s Meaningful Use provisions and the Affordable Care Act’s push on population health, providers and institutions are investing in patient portals and other health technology to help drive outcomes and quality. Demand for pharma involvement is considerable among healthcare consumers, payers and providers — for example, 41% of physicians surveyed for our ePharma Physician 2014 study said that pharma can play a valuable role in driving progress through provision of adherence solutions. Additionally, our data show that patient support resources can be the tie-breaker for P&T committees deliberating a drug’s formulary status. In our Taking the Pulse Formulary Decision Makers 2014 study, 87% of hospital P&T committee members surveyed said pharma-provided patient support or resources could or have boosted a treatment’s formulary placement. More than two in five P&T committee members for MCOs and PBMs agreed.

The remote care market is gaining momentum. Forty percent of physicians say that they are using remote digital technologies such as email and video conferencing to communicate with patients more now than they did a year ago. To the extent that this disintermediates pharma out of what has traditionally been a key touchpoint, the bricks and mortar point of care, this is a hair-on-fire crisis, as digital continuity of care threatens to push out the marketer through the patient journey. On the upside, enterprising marketers will find digital avenues for reaching patients at key decision-making moments. Mobile is a must right now – our Cybercitizen Health U.S. 2014 study revealed that more than a quarter of online consumers had accessed health information on their smartphones at the doctor’s office in the past 12 months.

Pharma marketers really can’t afford to operate without these trends in mind. The market is shifting quite dramatically, and messaging and customer experience need to follow suit.

Monique Levy is VP of Research for Manhattan Research.