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Direct to consumer advertising has received a great deal of attention in the past few years. No other market segment has received as much analysis, scrutiny, criticism, support, and debate as DTC. Along the way, the industry has also had the opportunity to learn a number of lessons to build upon past results. The growth of DTC has been dramatic and ever changing. Last year, CMR reported that branded pre scription products accounted for more than $2.8 billion in adver tising revenue. Yet, in 1990, merely five companies advertised a total of seven products for an annual spend of $44 million, not even a blip on the consumer revenue screen. When the FDA relaxed the standards for pharmaceutical advertising in 1997 and television became a viable option, DTC experienced a large growth spurt. By the end of 1998, DTC had passed the $1 billion mark and overshadowed advertising in all medical publications. In the rush to reach the consumer, we have witnessed numer ous reasons for promotion ranging from the desire to grow a par ticular market all the way to “me too.” We have monitored the introduction of new products with unique selling propositions, and we have observed advertising that said absolutely nothing about the product. On the one hand, DTC has been held to stringent ROI stan dards and on the other hand, no standards at all. Some elected officials would have you believe that directtoconsumer adver tising is the sole reason for the high cost of a drug while other groups contend that it creates abnormal prescribing habits among physicians. Let’s step back and see what lessons we can learn from this short, but hypercharged, experience in consumer advertising. There is general agreement that the major distinguishing fac tor of prescription drugs (other than their impact on quality of life) is the way in which they are sold. For a patient to receive a drug, a prescription must be written by a qualified medical pro fessional. This creates a twostep process. The patient must be seen by the physician/nurse practitioner/physician assistant and must receive a prescription to be filled at the pharmacy. There are lessons learned regarding encouraging the patient to make an appointment with the physician. Once in the office, the patient may decide to choose to ask for a particular medication by name. The physicians will then use their professional judgment based on the nature of the illness, the experience with the brand, and the counterbalancing benefits of fulfilling the patient’s request. Numerous research studies have been conducted to examine behavior triggered by prescription advertising. A national con sumer study by Solucient reports that less than 50% of patients take medication in the manner prescribed by their doctor. This Contributed by Charles Hunt certainly makes a case for the need to increase compli ance for better healthcare. The same study also report ed extensive analyses of those consumers who were “brand requesters.” SEGMENTINGBYMARKETS One of the primary lessons learned in the past few years of directtoconsumer advertising is that the media tools used in consumer package good promotion are not necessarily wellsuit ed for DTC planning and analysis. While there are many segmentation systems available to help businesses distinguish among the various types of consumers of their products, none can be as accurately applied to the health care industry as those designed specifically for the purpose. For example, geodemographic systems such as PRIZM do a good job of identifying neighborhoods with high concentrations of house holds of a certain demographic mix. PRIZM, which was devel oped by Claritas in the 1970s, is a method of linking detailed consumer demographic information (i.e., age, sex, race, income, household size, etc.) to specific geographic locations. But the PRIZM methodology is based on the premise that all households in a particular neighborhood exhibit the same or similar pur chasing patterns (i.e., “birds of a feather flock together”). While the PRIZM approach would be considered an appro priate strategy for identifying new business opportunities in the retail and financial services industries, it falls short of being able to accurately predict healthcare use. Often, on a single block there is a broad mix of young, middleaged and older households, married and single households, households with and without children, etc. Any segmentation system that either ignores these factors or does not account for them at a household level will fail to provide the precision necessary to drive successful healthcare marketing strategies. The ability to identify and target the right patients is depen dent on the appropriate use of a segmentation system that accounts for the key drivers of consumers’ healthcare decisions. There are now segmentation systems that capture the essence of consumer healthcare decisions and are based on factors that are consistent and quantifiable from market to market. Traditional consumer planning systems have been developed with the “cluster” concept in mind. In the same way that phar maceutical brand teams target those physicians who are of great est potential, it is time to apply similar principles to targeting consumers for healthcare. In 1998, brand managers jumped on the opportunity to increase their advertising exposure among consumers. Many CHARLES HUNT D DTC’S LESSON: NEW TOOLS NEEDED FOR PLANNING AND ANALYSIS 72 S e p t e mb e r 2003 PharmaVOICE PHARMA outlet chose to partner with larger consumer agencies to develop con sumeroriented campaigns and leverage an agency’s (consumer) media knowledge. The tools available to the media planner were those systems designed for Diet Coke and Jeep. These are excellent planning systems for consumer package good promotion, with the correct segmentation systems for cluster approaches, but they are not well designed for pharmaceutical marketing. THEDEFICIENCY OFTV Television became the dominant media for DTC, yet it lacks the ability to target prescription products by segment. One of television’s primary strengths is to execute schedules to the most soughtafter consumer segments, 18 to 35 year olds. But, this segment is the least likely target for many of the brands adver tised to the consumer. Few companies have approached the planning process in a way that uses national promotion as a foundation for the campaign or uses an analytical approach to target specific local markets with a high concentration of sufferers. Numerous filters can be applied using specific healthcare attitudes and behavior as well as physi cian support of the brand. For example, the Phoenix market may have a highly desirable content of consumers based on disease prevalence, attitudes toward healthcare, and affinity to seek help. But if the brand does not have the volume of physician support, DTC could drive those consumers to the very physicians primed to write the competi tor’s script. There have been excellent case studies developed that have identified consumers who exhibit specific attitudes, e.g., those who identify their disease state as curable and are actionorient ed to seek innovative therapy. Of the 75 local markets identified by Scarborough Research, perhaps 30 of the markets will have concentrations of those consumer segments of a magnitude that justifies the promotional plan. These 30 markets may be further filtered by the prescribing habits of the physicians within the markets. Prescription brand share and volume may reduce the number of targeted markets to 18. The segmentation analysis should also help the planner deter mine which media are most efficient in reaching the targeted audience. It is at this point that promotion plans can be designed to combine a national campaign in conjunction with local mar ket emphasis to design an effective media mix. Charles Hunt is chief executive of Marketing & Media Strategies, a healthcare media consulting firm based in Tuxedo, N.Y. He can be reached by telephone at 6092735579. PharmaVoice welcomes comments on this article. Email us at firstname.lastname@example.org.