My second favorite thing about pharmaceutical marketing is the wonderful customer complexity (the first, of course, is that we can use our marketing superpowers for good not evil). The labyrinth of customers, each with different and often contradictory needs, makes Rx marketing a game of three-dimensional chess. That introduces significant challenges, but there are time-tested solutions to engage relevantly with unique customer segments to optimize the sales and marketing mix.
The Three Ps
The three Ps (providers, payors, and patients) have different motivators and barriers and rarely respond in the same way to the same messages and campaigns. For context, it is helpful to consider how these customers think about each other.
- Providers (healthcare professionals) usually resent managed care (payors) because they increasingly limit the prescribing choices HCPs can make. A differentiating treatment can be compelling, but HCPs will prescribe less if access barriers result in a hassle for their already-overwhelmed office staff.
- Payors, of course, want outcomes but at the lowest price. They work hard to reduce costs to employers and are increasingly frustrated with manufacturers offsetting what a consumer spends (via co-pays and bridge programs). That can leave patients unaware of the true cost of their medication, and lacking “skin in the game.” We patients may also want inexpensive or free medication, but that can reduce our perception of its value and negatively impact our compliance.
- Patients and consumers simply want to get better to have a more rewarding life. But we also don’t respond well to high costs or the red tape of confusing payor barriers such as prior authorizations and step edits. If we are frustrated, there’s a risk of switches at the pharmacy or frustrating phone calls with HCPs.
Patients and consumers simply want to get better to have a more rewarding life.
Pharmaceutical marketing’s game of three-dimensional chess means overcoming challenges to create exciting opportunities. As Beth Harmon said in Netflix’s Queens Gambit, “Chess isn’t always competitive. Chess can also be beautiful.” To make smart, strategic choices, brand teams and agencies need to consider the mosaic of customers, stakeholders, and internal structures that can get in the way.
Managed care marketers are usually far removed from brand teams, and brand marketers often do not understand or appreciate the significance of getting insurance and pharmacy benefit coverage. More importantly, they may not recognize that strong access is an important selling proposition. I have seen dozens of research reports on prescribing drivers among HCPs, and access is almost always third after efficacy and safety (and far more important than a unique delivery or mechanism of action).
Many senior marketers in pharmaceuticals are what I call “accidental product managers,” because their experience and passion is in selling to HCPs. The good news is that creates an opportunity for agencies who have cross-pharma experience and can bring best practices and strategic chops if clients are receptive to it. I’ve had clients who are simply “checking the box” in marketing to get to a senior sales position, and I would covertly write the first draft of their brand plans to help them. Because they sometimes face a little “imposter syndrome,” I like to remind them that marketers are simply sales people without as much confidence.
The marketing mix is like a pendulum where a small change in one area can have sometimes invisible cascading effects in other areas. Poor insurance coverage can create a situation where demand generation from HCPs and patients faces a “brick wall” effect. Likewise, a great formulary position doesn’t help if HCPs and patients don’t see the rational and emotional benefits of a treatment. I like to ask peers whether medical claims are a rational or emotional benefit. They are neither. They’re simply “reasons to believe” a benefit.
If a manufacturer is highly siloed, it helps to have an integrated agency that can offset the schism … it can be risky hiring dozens of specialty agencies that bring expertise but fragmentation.
Integrated brand planning: Brand planning across the pharmaceutical industry is highly heterogenous. Some leaders develop processes to ensure that teams are integrated, and strategies are informed by a diverse collection of stakeholders internally and from agencies. That’s easier said than done. If a manufacturer is highly siloed, it helps to have an integrated agency that can offset the schism. Especially with major brands, it can be risky hiring dozens of specialty agencies that bring expertise but fragmentation.
Marketing mix analysis: Budgets are often a zero-sum game, and objective research is the best way to identify the attribution of the full suite of sales and marketing. For instance, for one large pharma client, we could only justify investment in direct-to-consumer once we demonstrated that we were facing a “point of diminished return” with sales representatives (who sampled so aggressively that we would paradoxically see a spike in sales when a district was abandoned).
Objective research is the best way to identify the attribution of the full suite of sales and marketing.
Cross-training executives: The historic career track at manufacturers began in sales then “in-house” for a role in research or training to prepare for a marketing role. As a result, many marketers are good at HCP marketing but lack in-depth consumer or payor experience. Pharmaceutical manufacturers are good at rotating marketers across brands, which helps cross-pollinate learnings and provide a career path. The same approach is important to create well-rounded marketers who have overseen HCP, payor and patient marketing.
Dual customer research: While employed at Johnson & Johnson, I participated in several research studies designed to understand the HCP-patient dialogue. The methodology would simulate an HCP/patient office visit but in a research venue. After observing the mock appointment, we would separate the two and privately ask them about the experience. The results were fascinating and demonstrated that HCPs and patients really experienced separate events. The research is actionable when we test stimuli before these exercises. A marketing message could dramatically improve the conversation. For instance, when I was at Janssen, we worked with HCPs to “offer” an injection to patients living with severe mental illness and who perceived injections as punitive. When I marketed a treatment for male-pattern hair loss, we figured out that we could increase the odds of a patient getting a prescription not by asking for the product or expressing their misery with balding. Instead, we would urge them to convey to the doctor that they had tried over-the-counter medications and they were concerned about inheriting baldness from their father. The result was a 40% increase in the HCP prescribing the product. In one of my most interesting research projects, we created a simulated pharmacy-benefits management team representing chief medical officers, purchasing, and practitioners. It gave us a peek behind the curtain at how they think, behave and influence one another to agree on whether a drug should be on formulary. The insight we learned would not have been possible by interviewing each customer separately.
The results were fascinating and demonstrated that HCPs and patients really experienced separate events.
Blaise Pascal once said that “chess is a gymnasium of the mind,” and that is one of the things that makes pharmaceutical marketing so rewarding. The industry can be complex and difficult with many FDA restrictions. But that complexity and challenge is what keeps the journey interesting as we bring important treatments to patients in this nuanced and changing marketplace.
Kevin Nalty is vice president of strategic planning at Intouch Oxygen.