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Hitting a Mobile Target By Carolyn Gretton “The pharmaceutical industry, in general, is relatively progressive when it comes to finding innovative solutions to its business problems,” says James Carr, Pharm.D., VP of marketing, ARCA Biopharma. “The development may be partly held back by slow electronic adoption by hospitals, doctors, and other parts of the pharma/healthcare field. A general trend seems to be an improvement in integration of data between different systems, and the approach to find a holistic data management solution that saves a company time and costs.” Rodney Spady, head of global interactive marketing and Web officer, OTC global marketing, for Novartis Consumer Health, says integrating interactive and electronic tools into consumer health marketing strategies has been invaluable in terms of improving the dialogue among the company, the consumer, and the healthcare professional. These tools are constantly evolving, and marketers need to keep up with the changes to continue to effectively deliver their messages. “All of the mobile technology that’s available to us is like harnessed energy that we can use to reach out to our target audiences, such as moms who are on the go using their PDAs to keep schedules, to stay on top of emails, and to keep in touch with their family members,” Mr. Spady says. “We can use technology to have dialogues with consumers or professionals and reach out to them with offers, information, reminders, or to solicit feedback.” Busy mothers and commuting office workers aren’t the only ones who depend heavily on their PDAs for communication. According to industry sources, the majority of physicians now rely more on PDA-based information than traditional sources of pharma communication, with roughly half of all U.S. physicians using PDAs or smart phones in clinical practice. Neither sales reps nor traditional media are as effective as PDA-based information in influencing these mobile physicians’ prescribing habits. According to a recent Skyscape survey, 81% of physicians say they have increased their adoption of a new treatment based on clinical information available on their PDAs. In addition, four of five physicians agree that PDA-based information is more influential than traditional media, such as rep visits, journals, and direct mail, as well as other forms of electronic media like brand Websites and e-detailing. Despite this increasing reliance on PDAs, Mr. Spady cautions against the blind adoption of mobile marketing to reach physicians. “It’s all about relevant content,” he says, noting that marketers need to carefully consider whether their messages are pertinent to physicians, and whether the information is valuable enough to share with physicians during the short window of time they have after seeing patients all day. R. Steve Morris, executive VP, Advanstar Life Sciences, Advanstar Communications, agrees that content is key to engaging and tracking physician interest and that in the current promotional environment, pharmaceutical marketers are increasingly challenged to reach high-prescribing physicians or potential high-prescribing physicians in the top deciles. To overcome this challenge, marketers need a better way to target, identify, and engage high prescribers as well as secondary and tertiary audiences. One way to do this is through Websites and online portals for information dissemination, which can bring together a diverse range of credible media sources ranging from healthcare journals to related databases that provide information to healthcare professionals who are looking for instant answers to clinical and practice management questions. (For more information about portals, content, and metrics, please turn to page 28.) “Web-based solutions and browser applications play a more and more important role,” Dr. Carr says. “They are valuable because this is the e-solutions area where developers emphasize usability and simplicity the most and let users contribute to the application development.” “The e-environment is a new frontier, but one that has to be made worthwhile for physicians as well as consumers,” Mr. Spady says. “We have to engage them in a way that’s not overbearing or too intrusive. It’s also critical that they have opted in, because when marketers start using mobile technologies, there may be a cost for the professional and consumer. As marketers, we have to be respectful and protect the privacy of consumers, patients, and professionals.” From Paper to Screen Physicians responding to a Manhattan Research survey report that they will shift a significant amount of time currently devoted to offline professional sources to their online counterparts in the coming years. The 2008 ePharma Physician survey found that physicians conduct 41% of their pharmaceutical research online, but they expect that figure to increase to more than 50% in the near future. Emerging technology channels are giving doctors innovative ways to enhance their professional development by accessing the resources they need on demand, whether by meeting online with a sales rep during office hours or by reading an online medical journal at home. “For marketing/communications, e-solutions have made it easier to connect business to business, and the increase in available electronic databases has facilitated strategic planning,” Dr. Carr says. “It is easier to get an overview of the market we are operating in and find opportunities for partnerships and information about competitors. New electronic solutions for direct-to-consumer marketing is more of a gray area that is not as easy to apply to pharma as other industries. Here, the regulatory limits need to be worked out step by step. The downside to e-solutions is that there can be too much reliance on them for communication; nothing can replace a one-on-one interaction.” Topin & Associates experts also believe that even as technologies continue to change and people continue to connect with one another in ways unimaginable now, there is one thing that will never change — the power of a brand recommendation from one person to another. They say perhaps focus is the biggest challenge facing healthcare marketers when it comes to digital media. Marketers are hardwired to seek out the latest new shiny thing, and the Web is certainly full of those, so it is important that the brand’s touchpoints work together. The product needs to deliver. Reps need to build relationships. Service needs to come through. If any of these fail, digital media ensures everyone will know it — quickly. (To learn about how different audiences are relating to one another in the digital world, please turn to page 26.) Emerging digital channels help sales, marketing, and service teams better align their efforts and facilitate cohesive relationships between physicians and brands. But the key to success lies in determining the optimal mix to reach and influence specific physician audiences. By understanding how physicians currently use and feel about online medical information and their unmet needs for tools and services, brand teams can provide their target audience with a more relevant suite of educational and promotional content and can increase their chance of influencing treatment decisions, experts at Manhattan Research say. “Digital channels have leveled the playing field in many industries, giving sales and marketing groups the chance to make a big impact, even with limited yet targeted resources,” says Mark Bard, president of Manhattan Research. Experts at Kinect Interactive Digital Communications concur, adding that pharma marketers understand the importance of establishing solid relationships with both HCPs and patients. In addition to creating relationships with specific target audiences, keeping these relationships active and engaged is vital. However, to accomplish this goal insight is needed to target the right customers, not only at a program’s onset but also while it is deployed and evolving. These relationships should continue and mature over time, an aspect that many firms forget to take into account. (To learn more about e-relationship building, please turn to page 20.) Online journals and virtual conferences are two other professional resources that should experience spikes in physician traffic in the coming years. The Manhattan Research study found that physicians expect to shift time spent with print journals and live conferences to those online counterparts. The market for online clinical resources has been growing steadily over the past five years, and some companies are taking notice by expanding their interactive offerings for physicians. Marketers also are exploring the relatively uncharted terrain of physician-specific social networking sites, such as Sermo, as well as physician-focused communities created through general networking sites, such as FaceBook and MySpace. Pharma marketers generally have been reluctant to include social networking in their e-marketing plans, in part because of regulatory concerns around off-label discussions and adverse event reporting. Still, more and more companies have become comfortable with reaching out to consumers via social media, and according to a recent report from JupiterResearch, these companies stand to benefit tremendously if they can become part of the conversation with physicians in the social networking space. “Connected online physicians who perform social activities in a work context in general are more engaged with and responsive to online pharma marketing than are unconnected online physicians, signaling an important target segment for marketers,” observes Monique Levy, senior analyst at JupiterResearch. “Marketers must promote word-of-mouth tactics and explore partnerships with professional networks to leverage this growing trend.” Experts at Compass Healthcare Communications agree, stating that social media is transforming the way that people talk about their health and brands. Information is no longer disseminated just by experts or marketers, but can come from anyone who is online. Patients, caregivers, doctors, pharmacists and nurses are using blogs, message boards, videos, and social networks — think YouTube, FaceBook, Twitter — to “talk” about healthcare. Control of information and the message is shifting into their hands. These public, and often large, forums expand the power of these once local and personal discussions. So instead of just relatives and neighbors knowing all about Aunt Millie’s painful arthritis, millions could potentially be aware of her struggle and influence her form of treatment. (For more information about social networking, please turn to page 18.) The report found that one-third of physicians who are online use blogs, professional networks, forums, and message boards to connect with other physicians or content they have created monthly. These connected online physicians are more intense consumers of pharma-sponsored media, with 63% having participated in various pharma-sponsored marketing programs monthly, including online detailing, compared with 53% of online physicians who do not use online networking tools. Connected online physicians were also more likely to use branded Websites and manufacturers’ Websites than were their unconnected counterparts, and they tend to be influencers among other physicians and patients, with two-thirds of connected online physicians forwarding useful content to colleagues and more than half recommending specific Websites to patients. Because the use of the Web to connect and share information is likely to continue to grow significantly among online physicians in terms of both total adoption and frequency, pharma companies that ignore social media could greatly compromise their marketing efforts, experts at JupiterResearch caution. As consumers and doctors continue to demand online access to useful healthcare information, sites that inform and educate remain a staple of pharma’s e-solutions strategy. According to comScore, the health information site category has grown at more than four times the growth rate of the total U.S. Internet population over the past year. WebMD’s site remains the leader in terms of visitors and ad views, but others, such as Everyday Health and Revolution Health Network, are gaining popularity as well. Some companies are using the power of informational Websites in an effort to rehabilitate the industry’s image, which has taken some hits in recent months from regulators, lawmakers, and advocacy groups. For example, Pfizer recently launched an interactive online educational resource, pfizer.com/medicinesafety, designed to provide a centralized resource for information about medicine safety that was previously accessible through numerous but fragmented channels, making it difficult to get a clear picture of the risks and benefits of various treatments. The site’s goal is to provide users, such as healthcare professionals, medical students, and patients and their advocates with a better understanding of the industry’s system for ensuring pharmaceutical safety, and in turn, more confidence when making decisions about appropriate treatment options. “With the population aging and medicine use increasing, information about medicine safety is more important than ever before,” notes Gretchen Dieck, Ph.D., Pfizer’s senior VP, safety and risk management. “Yet surveys of practicing physicians, health policy experts, and the general public have revealed a lack of understanding of the fundamental safety science, processes, and terminology. This can contribute to misinformed decisions by patients about treatment options, which can lead to suboptimal health outcomes.” Another key element of the e-solutions package is the proven strategy of the brand Website. Analysts at Manhattan Research note that product Websites are often one of the first places that physicians visit when researching treatment and prescribing information and updates for a particular product. And a study conducted by comScore in conjunction with pharmaceutical marketing consultancy Evolution Road found branded Websites to be the most effective form of online pharma marketing, resulting in an incremental patient adherence rate almost 20 percentage points higher than among those who did not visit the brand’s site. Brand teams may not be able to control market events, but they can use the brand’s Website to communicate the latest and most accurate product news and updates in a way that serves both brand and patient. (For a summary of 2008’s top 10 pharmaceutical brand Websites in terms of physician visits, please turn to page 11.) “It’s important to realize, though, that visits to a brand Website are achieved through the use of a variety of offline and online tactics, such as online banner ads, search engines, and offline advertising,” notes Bridget O’Toole, comScore executive VP. “This is why it is essential for marketers to develop fully integrated campaigns that not only raise awareness and educate consumers but drive visitation to a site.” Thought leaders at RightHealth believe that because the Web is a more engaging medium than passive TV viewing, it clearly represents the best advertising investment for pharmaceutical firms. Web ads have the potential to reach consumers at precisely the time they are most receptive. And, unlike that of far more expensive TV ads, their impact is measurable. Marketers can track their ROI immediately, allowing them to analyze and alter their campaign almost in real time. (For more information regarding the Web as an advertising medium, please turn to page 24.) But determining the true ROI potential of Websites can be a challenge, say industry experts at Qi, a part of CommonHealth. They say if marketers only measure site traffic, they see only one aspect of a campaign’s performance and they miss out on some truly useful insights regarding what actually influences their target audiences. In some cases, marketers cause behavioral changes. In other cases, changes are out of their control. Because of these multiple channels of influence, synchronizing data analysis has become much more complex. (To learn more about why merging data sets to generate a true ROI is a mix of art and science, please turn to page 22.) The brass ring for all e-marketers is the viral effect, and health companies continue to seek ways to harness its power without crossing any regulatory lines. According to Mr. Spady, useful tools for generating this viral marketing effect include games, videos, and contests, all of which prompt visitors to distribute a link to a Website or to their online network via e-mail or instant messaging. “If the site is engaging enough, marketers have the ability to create a key viral element, that word-of-mouth appeal,” Mr. Spady says. “We want people to share the information, to blog about the site, or e-mail or instant message a friend, to say, ‘Hey, check out this link,’ or, ‘Hey, I’m going to be up on this site, vote for my picture.’ The Website creates its own social networking.” Experts predict the future will become even more virtual as healthcare providers and insurers move more of their functions online and test the feasibility of electronic tools, such as virtual appointments that connect doctors and patients through Web conferencing or chat applications. According to experts at AmerisourceBergen Specialty Group (ABSG), new legislation could possibly provide some relief to both private practice physicians and pharmaceutical manufacturers, all the while promising improvement in patient care. Passed in July 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) allows physicians to receive an additional 2% on Medicare charges by participating in the Physician Quality Reporting Initiative (PQRI). Perhaps more exciting, MIPPA also allows physicians to receive another 2% incentive payment for prescribing patient medications electronically. As a result, interest in e-prescribing has exploded, and the industry is currently waiting for more details to be published related to the operational and process details associated with this new incentive. ABSG executives add that by allowing physicians to submit prescriptions directly to pharmacies, e-prescribing can increase the chance that prescriptions will be filled and refilled in a timely manner. (For more information on the changing e-prescribing landscape, please turn to page 30.) “Again, it comes down to the points of time and mobility,” Mr. Spady observes. “We will continue to deal with a much more mobile society that gives us a short, small window of opportunity to not only get our message across, but to deliver it in a way that educates and guides the audience and calls them to action. It’s a great opportunity that helps to drive us to understand our consumers, our patients, and our professionals.” Dr. Carr predicts that in the next 12 months everyone will be talking about further development toward data cloud management solutions, usability, Web browser applications, thin clients, and a growing importance of e-marketing, as healthcare and medical professionals keep adapting to and upgrading their electronic solutions. On the Clinical Side According to some industry sources, the average cost of developing a new drug now exceeds $1 billion and the time to market is often more than decade. To offset these daunting numbers, pharmaceutical companies need to find efficiencies at all stages of development, and to do so many pharmaceutical companies are embracing e-suites of clinical tools to bring safe products to market faster and at a lower cost. Working with different technology solutions and programs has become a challenge that many manufacturers and CROs are still struggling with in terms of project management. According to experts at inVentiv Clinical, in general, e-clinical allows for proactive and adaptive clinical-trial management, enabling more informed decisions to be made sooner. And even as the next stage of this continuum integrates e-clinical with business processes, seeking efficiencies throughout the entire development plan, including project tracking and accounting, project managers are left asking: “Are things getting done efficiently and on time?” As the pendulum for e-clinical swings beyond the tipping point, the evolution into business processes will become inevitable. With true clinical business process integration, project managers will be able to view comprehensive trial metrics along with cost-accounting reports, reducing the probability for surprises at the end of the trial and ultimately increasing the likelihood for success of the entire clinical development program. (For more information about the evolution of project management, please turn to page 14.) Experts at Medidata Solutions also believe that as multifunctional e-clinical systems become the norm for capturing and managing data in clinical trials, it is vitally important that those using the systems are trained properly. Unfortunately, the training of site staff to use e-systems is still taking place in one-on-one sessions or at investigator meetings. The use of these traditional training methods is often logistically cumbersome and expensive, and can be infeasible for large-scale global trials. Additionally, the benefits of using e-clinical systems can be diminished if investigator/site staff are not adequately trained, which can directly contribute to delays in clinical studies. State-of-the-art e-learning offers a significantly improved solution that can help train site staff on e-clinical systems effectively and efficiently. (To learn more about training in the e-clinical environment, please turn to page 16.) The Food and Drug Administration approved only 17 new drugs in 2007, one of the three worst years for approvals the last three decades. All of these factors make it more important than ever for manufacturers to have patients start on therapy successfully and then maintain therapy as prescribed once they have started. Most agree that because the clinical phase of drug development averages $361 million per drug candidate, it is more important than ever to address the many factors that contribute to rising clinical-trial costs and to embrace e-based solutions to handle the growing complexities in the drug development continuum. PharmaLinx LLC, publisher of the VIEW, welcomes comments about this article. E-mail us at firstname.lastname@example.org. VIEW on E-Solutions October 2008 Integrating interactive and electronic tools into pharma marketing strategies has been invaluable in terms of improving the dialogue between the company, the consumer, and the healthcare professional. Rodney Spady Novartis Consumer Health A general trend seems to be an improvement in the integration of data between different systems and the approach to find a holistic data management solution that saves the company time and costs. Dr. James Carr ARCA Biopharma Digital channels have leveled the playing field in many industries, giving sales and marketing groups the chance to make a big impact even with limited yet targeted resources. Mark Bard Manhattan Research Insights From the Insiders PharmaVOICE asked experts whether the continued advance and adoption of e-solutions has supplanted more traditional pharma industry processes and whether this is a positive or negative development. Empowering Customers Technology’s role — via online marketing programs and services — will, in an era of collaborative healthcare, continue to have a significant and positive impact. From the basics of efficiently delivering a brand’s message to managing complex customer relationships on a one-to-one basis, e-solutions far surpass their traditional marketing counterparts. Our ability to not only segment but proactively reach, acquire and then empower customers to take action simply could not have been achieved five years ago with traditional marketing programs. For specialty products, the Internet has enabled brands to reach patients beyond the doctor’s office — something never achievable before. Now brands can actually acquire these patients and engage them in an ongoing relationship. As physicians shy away from rep contact, print journals, and dinner meetings, the data show they have migrated online. Now brands are able to efficiently reach their targets through e-detailing, physician portals, and other direct means. Looking forward, emerging services such as social media will enable us to engage with and support patients and HCPs. As these platforms evolve, we predict that e-solutions will become ever more central to brand marketing. Peter Nalen President and CEO Compass Healthcare Communications For more information, please turn to page 18. E-Customer Solutions From a multichannel perspective pharma companies have made tremendous strides both strategically and technologically, and have positioned themselves over the past two years to take advantage of true customer-focused communications. More specifically, innovative e-solutions have advanced how they approach customer relationship management (CRM). These advancements include the use of Tablet PC solutions and how they interact with and share customer experience information with today’s more advanced salesforce automation (SFA) systems. Increasingly, campaign management systems are used to assist in the execution of multichannel marketing solutions, helping companies be more media-agnostic in approaching both content development and communications. In the near future, e-solutions will take on a more important role as enterprisewide systems work in concert to provide global automation, and managing customer relationships is based on a truly singular viewpoint. Critical knowledge exchange will improve dialogues with HCPs and patients, and enable companies to provide their customers with more valuable information. In return, pharmaceutical communications with customers will become extremely efficient and effective. This is an important point as most of the top 10 pharmaceutical companies are charged with targeting their most valued customers and leveraging the relationship, including utilizing the social power of Web 2.0, while continuing to increase overall efficiency and return on investment. Ultimately, competitive forces will drive continuing innovation in CRM and how to execute effective two-way communications, with more advanced e-solutions and more traditional processes evolving into a single, more powerful solution. Geoff Melick Executive VP, Interactive and eInnovation Kinect Interactive Digital Communications For more information, please turn to page 20. Online Sensibility As technology has evolved, smart marketers have found creative ways to exploit it. Many traditional tactics have migrated online, resulting in new opportunities to communicate with target audiences. Unfortunately, for every good e-detail, e-CME, or physician portal, we’ve seen 10 bad ones. If pharmaceutical company marketers are planning to move a traditional tactic online, it has to make sense. Specifically, it has to effectively improve the brand’s abilities to meet conversion goals at an attractive cost/value ratio. That’s why brand managers should work with experienced pharma marketing agencies that understand the industry. A good agency provides guidance to the right tactics for a brand, not the tactics that are best for the agency. Remember, every e-solution has a human element that should bring value to relationships. For example, an on-demand Webinar doesn’t replace the sale rep’s relationship with the doctor; it enhances it by making valuable communications more convenient for the doctor. Buddy Scalera VP, Interactive Content & Market Research Qi, part of CommonHealth For more information, please turn to page 22. Two-Way Communications The continued advance of e-solutions is a sign that millions of Americans are taking control of their healthcare. Instead of a one-way communication stream from the pharma industry to consumers, we now have a series of two-way conversations: consumers are using the Web to talk to doctors online and share information with fellow patients. Information about pharma brands spreads virally through e-mail, social networks, online support groups, and chat rooms. As patients use the Web to help manage their health needs, the next step is to simplify the process of finding health information online by aggregating trusted information and making it available to consumers all in one place. In the long run, this is a positive development. Educating and empowering consumers to make informed decisions about their health benefits everyone in the healthcare ecosystem. Pharmaceutical industry players are starting to engage in dialogues with consumers, which in turn strengthens the relationships they have with patients. Experts estimate that two-thirds of all Americans turn to online sources for health information, so smart phama companies are tapping into this as a way to build consumer trust. Anand Rajaraman Cofounder RightHealth For more information, please turn to page 24. Taking a Disciplined Approach For Consistency Supplanted is too strong a word to describe the inter-relationship between e-solutions and traditional promotion. The power of e-solutions is in their ability to enhance and supplement the selling dialogue. We now have the ability to communicate a single promotional message to multiple audience segments at multiple frequencies with the press of a button. This saves time and money in both development and distribution. We can also ask for and receive feedback from our customers and sales representatives almost instantly, enabling us to tailor solutions to meet their practical needs on an almost-individual basis. The drawback to all this? We can implement very quickly, but it can be difficult to keep everyone focused and on track. It takes discipline to maintain consistency when it’s so easy to change just about everything. Developing a printed sales aid often makes us sweat the small stuff because whatever we print stays that way until it’s replaced with a POA later. With a Website, banner ad, e-detail, e-mail, podcast, or Proscape presentation, we are limited only by our “marketing bandwidth”— our ability to manage the communications strategy and the regulatory and implementation processes. Barclay Missen Director of Digital Communications Topin & Associates For more information, please turn to page 26. Top 5 U.S. Health Information Sites by Unique Visitors Total Unique Visitors (in thousands) Site July 2008 July 2007 % change WebMD Health 17,277 16,829 3% Everyday Health 14,703 9,009 63% Revolution Health Network 11,329 4,014 182% AOL Health 11,095 5,913 88% About.com Health 8,682 6,947 25% Total health – information 69,008 56,865 21% Total Internet audience 189,134 180,078 5% Note: Due to the transition of AOL Body to AOL Health in June 2008, the July 2007 AOL figures are for AOL Body, while the July 2008 figures are for AOL Health. Source: comScore Inc., Reston, Va. For more information, visit comscore.com. Incremental Effect of e-Marketing Tactics Over Control on Adherence/Next Fill For Existing Patients Marketing Activity (Patient Group) % Adherence/Next Fill Exposure Only to Online Ads 4.0% Exposure to and Interaction with Online Ads (interactive digital media) 9.5% Visits to Brand Website 19.7% Source: e-Marketing Effectiveness Benchmarks for the Pharmaceutical Industry (2008 Release), comScore Inc., Reston, Va. For more information, visit comscore.com. Best of the Brands Online The best pharma product Websites achieve that delicate balance between effectively delivering the brand message and providing the most up to date news and information about that product, both positive and negative. “This year’s rankings show that market events, rather than just advertising alone, can be critical drivers to brand Websites,” says Meredith Abreu Ressi, VP of research at Manhattan Research. “Pharmaceutical companies need to ensure that brand Websites contain the latest, most accurate content possible and can be found relatively easily by physicians using search engines to research pharmaceutical information.” For 2008, diabetes treatment brand sites from Januvia, Actos, Byetta, and Avandia are among the top pharmaceutical product Websites in terms of primary-care physician visits, according to Manhattan Research’s ePharma Physician study. Also breaking into this year’s top product site list are Actos, Actonel, Amitiza, and Aciphex, which proved successful in increasing physician awareness online. Other brands with sites that made strides in physician visitation are Chantix, jumping from the fourth to third position, and Gardasil, moving up three spots from last year’s list. Key Digital Marketing and Sales Strategies for Healthcare Brands n When maintaining and growing physician customer service portals and other professional resource destinations, understand the tools and content most desired by target physician audiences. Disease-specific information, electronic sampling, and professional education resources are just a few of the features of interest to today’s e-pharma physicians. n Don’t overlook the importance of a product Website’s role in online campaigns. Sites should be kept up to date with the latest product news and information, and search engine marketing and online public relations specialists can recommend strategies for increasing brand visibility online. n Online journals and online conference physician adoption rates have jumped significantly over the past few years and are set to continue growing. Explore the promotional opportunities of these platforms to determine if they are viable ways to reach target audiences. n Many physicians show interest in live video detailing, and the majority of those who already attend sessions with their sales rep report high satisfaction with the experience. Conducting details via online video is an effective way to connect with physicians at their own convenience and also may improve relationships with low-see/no-see physicians. Source: ePharma Physician v8.0 (2008), Manhattan Research, New York. For more information, visit manhattanresearch.com.