In a year when the COVID-19 pandemic upended most of the health system, telemedicine was touted as a savior, ensuring access to diagnosis and treatment. With the patient journey similarly skewed, being able to see a doctor digitally was also a boon for drugmakers marketing both new and established products. 

And just as telemedicine is expected to play a bigger role in healthcare moving forward, the modality seems poised to become more than just a coronavirus contingency plan for many pharma brands, too. Take the case of Phexxi, a new vaginal contraceptive gel approved by the U.S. Food and Drug Administration in May, that’s aimed at women seeking a non-hormonal form of birth control.

“Many of those women, especially during the height of the pandemic, were basically told to ‘come back when our office is open,’” said Russ Barrans, chief commercial officer for Phexxi’s marketer, Evofem. “So what we’ve done is set up a really comprehensive online experience for them.”

Branded the “Phexxi Concierge Experience,” it allows a prospective patient to text with a prescriber, receive copay and prior authorization support, be connected to a retail pharmacy partner to ship directly to her door and sign up for refill reminders and other support.  

“What I said to my team was, ‘We have to be COVID-proof,’” said Barrans. “We’ve got to find a way that does not dissuade a woman from taking action.”

To make women aware of Phexxi’s launch, the brand launched a fairly aggressive digital campaign. Mass-media DTC, with online and TV commercials, isn’t expected until early next year. 

Telemedicine is integrated with the brand’s marketing assets, and contextual ads drive traffic to the tool. (Credit: McCann Health Engagement)

Meanwhile, telemedicine is Phexxi’s “primary customer acquisition tool,” said Ray Rotolo, chief product officer for Populus Media, the provider behind the service. It’s integrated with the brand’s marketing assets, allowing consumers to connect right out of a digital banner ad or via the brand’s website. 

Driving traffic to the telemedicine tool are contextually placed banner or pop-up ads that appear when a user searches for content related to non-hormonal contraception treatments. Ditto for sponsored postings on Facebook and Instagram, including by spokespeople such as Dr. Charis Chambers, an Atlanta-based OB/GYN physician.

Patients may be seen by a doctor from any number of physician networks (Populus works with several) and are charged a small fee for the consult — about $39, possibly as low as $15 for those who just need to fill out an online questionnaire. The concierge service does not take insurance for Phexxi but does assist with the gathering of insurance details as well as prior authorizations. 

“It wouldn’t be fair to a consumer to give them a consult, find out they’re medically appropriate, maybe even write them a prescription, only to find out that it needs a prior authorization and [say], ‘We refuse to help you out with your insurer.’ That’s just not servicing your customer, and it’s not going to be servicing a brand,” said Howard Seidman, COO of Populus Media.

A copay assistance program for those with commercial insurance is designed for women to pay approximately $30 out of pocket or less, Evofem said on a call with analysts, and in many cases, Phexxi will be covered for no out-of-pocket cost. Copay support is provided at the pharmacy level. 

The ’script can be filled either via a patient’s neighborhood pharmacy or through its mail order pharmacy partner, KnippeRx. The list price for a box of 12 applicators of Phexxi is $267.50, or $1,870 per year. 

Media agency McCann Health Engagement is handling the telemedicine-ad integration for the launch, while W2O Group is AOR for PR/social media and McCann Echo holds the advertising account.

The conversion rate of those people who have gone into the telemedicine platform and progressed to a physician consult and eventually a Phexxi ’script was projected to be about 22%. But since the drug’s September 8 launch, “We’re almost tripling that number,” Barrans reported.

Before the pandemic, regulators were getting friendlier and allowing doctors to prescribe drugs with or without any real-time physician-patient in­ter­­action, enabling online telemedicine services — ranging from Thirty Madison and Kick Health to Nurx, Hims and Ro — to proliferate

By swapping the in-person doctor exam for a video visit or a phone call, or even an online questionnaire, and by eschewing the brick-and-mortar pharmacy altogether, these online drug sellers offer consumers probably the closest thing they can get to an Amazon-like, prescription-drug shopping experience — nearly immediate, discreet and trustworthy. 

So far that kind of experience has been mostly reserved for consumers who are willing to pay out-of-pocket for their medication, though. Ro and Hims do not offer claims adjudication for visits or for the products themselves, which is why they don’t lend themselves to use with pricier drugs.

But with the spike in patients seeking medical care online, combined with pandemic disruption to the patient journey, the direct-to-consumer approach could become appealing to more brands, said veteran pharma marketer Meghan Rivera, who has extensive experience with the platform. 

“Moving forward, [direct-to-consumer telemedicine] will be table stakes for particular therapeutic areas,” she predicted. “It’s absolutely the way of the future in terms of integration between patients and HCPs, especially for products that don’t necessarily require a physical exam.”

A big draw is its potential to consolidate the buying cycle, she explained, especially for consumer-driven brands that would typically advertise on TV. 

“All the data pointed to the fact that it can take up to two years to see ROI on some of those significant [media] investments,” Rivera observed. Virtual medicine “accelerates the path to conversion in a way that appears appropriate, is seamless and doesn’t feel rushed.”

Partnerships between telemedicine firms and pharma usually work best on those drugs that have consumer product-like features. Therapeutic categories such as erectile dysfunction and hair loss, where off-patent pills are plentiful, have been early test cases. 

Since they’re so low-cost, drugs in those areas don’t require copay support or payer coverage. But in the last few years, newer brands have launched with telemedicine/pharmacy integration, or added it in later.

Sprout Pharmaceuticals relaunched female libido brand Addyi in 2018 with telemedicine service courtesy of Populus Media’s predecessor, Firefly XD, which Populus acquired in April. 

“Even before COVID, [pharma was] very interested in this because I think they’ve been looking for alternative sales channels, and digital is where they’re all turning,” said Seidman. 

Previous examples have included AbbVie/Ironwood constipation drug Linzess, as well as a pair of women’s health brands from TherapeuticsMD — Annovera (birth control) and Imvexxy, for treating painful sex due to menopause, known clinically as vulvar and vaginal atrophy (VVA)— all via telemedicine firm PlushCare. Most offer copay support for the medicine at the pharmacy level. 

To be sure, telemedicine as a sales channel doesn’t make sense for every brand. “Even though they pick up all your SG&A [selling, general & administrative costs], meaning you don’t have to spend on sales and promotion, if you can’t turn a profit on not charging much for your product, then you can’t make it work,” said Rivera.

One of the first pharma tele-integrations came in 2016 involving weight-loss drug Contrave, at the time marketed by Orexigen, said Rivera. 

A couple of years later, Rivera, then VP of commercialization for the women’s health division of Amag Pharmaceuticals, partnered with PlushCare on the launch of two Rx brands that, at that time, were part of Amag’s stable. 

The first of these was Intrarosa for VVA. The other was Vyleesi, approved for low female libido, aka hypoactive sexual desire disorder (HSDD). Intrarosa didn’t see much traffic through telemedicine. 

But Vyleesi, introduced more than a year later, did see success through the channel. Rivera attributes the difference to contrasting aspects of the conditions the drugs are designed to treat. In the case of Intrarosa, women who were candidates for the drug often wanted to see their doctor in the flesh to rule out anything of a more serious nature.

“If a condition presents as symptomatic from a physical perspective, there is probably more desire to see somebody in-person,” and thus access via telemedicine is less likely to be viable, she learned.

The $7 billion prescription birth-control market is well-suited to the e-commerce approach. It’s a crowded space, populated by hormonal vaginal rings, patches, injections and intrauterine devices. Some of these need to be inserted, injected or applied at the physician’s office. 

But more than 90% of prescriptions for Rx pregnancy products are for oral hormonal contraceptives, IQVIA data shows. There is a dearth of non-invasive options that are also non-hormonal, other than OTC methods such as condoms, sponges and spermicides. 

Advertising positions female-controlled Phexxi — a bioadhesive gel that’s inserted by a woman into her vagina an hour before sex — to the 47 million U.S. women who use contraceptives as a more empowering lifestyle option in a sea of hormonal products and male-controlled OTC options. 

The brand’s multichannel campaign also includes a sales force of 70 reps (down from 125 previously) targeting about 12,000 OB/GYNs and 14 other tele-detailing reps for those HCPs who are unable to meet in-person. 

Analyst David Amsellem of investment bank Piper Sandler forecasts sales of $320 million by 2027 and, given the vast size of the contraceptive space and the Affordable Care Act’s contraceptive mandate, peak sales well north of $400 million.

Rivera, who is now chief marketing officer and head of commercial for the digital therapeutics company Akili Interactive, said she believes COVID-19 may accelerate the trend of pharma brands — including, eventually, some in the digital medicines space — working directly with online pharmacy/one-stop-shop prescription platforms to integrate their services into brands’ “promotional ecosystem.” But those decisions will remain therapeutic category dependent.

“Is telemedicine going to be a big part of oncology launches? Probably not,” she said. “You won’t get prescribed a chemotherapy over a PC.”

But there are plenty of consumer-leaning categories where it does make sense. And, thanks to generous funding, in some cases from private equity backers, telemedicine startups have been spending a lot on out-of-home and TV advertising to raise consumer consciousness, further boosting prospects for pharma-telemed pairings on both ends of the product life cycle.

Said Rivera, “The more awareness is raised that you can have a clinical conversation and get a prescription in one place, with one experience, all virtually, just helps accelerate adoption of pharma launch brands and even established brands already on the market.”