Empowered Patients

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Robin Robinson

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Even before treatment and disease state information became so abundantly available online, empowered patients had begun to take the reins of their own healthcare education, searching for information that would equip them to make better decisions toward improved healthcare outcomes. Today, more than ever, the empowered patient is shaping the way healthcare — and healthcare information — is delivered, and pharma can no longer stand idly by. In an effort to become part of the super patient’s healthcare team, life-sciences companies are expanding their role to include providing valuable information and services that enable better health outcomes all along the patient’s journey. Several companies have begun to create patient education programs, adherence tools, and partnerships with advocacy groups to better inform their patients. Leaders from Janssen Biotech, Sanofi US, and Novo Nordisk describe this transformational role in the industry as a necessity. “Today’s patients have more power than ever before to educate themselves on safety and efficacy of prescription medications, the cost of treatments, and available support programs to access those treatments,” says John Haney, VP, immunology marketing, at Janssen Biotech. “Pharmaceutical companies must spend as much time connecting with their patients as they traditionally have with healthcare providers, with thoughtful dialogues and full transparency.” According to Mr. Haney, Janssen Biotech nurtures a culture that puts the patient at the center of everything it does, and it will continue to make investments in key areas that matter most to its patients: disease education, access services, and treatment affordability. “At Janssen Biotech, our first priority is the patient and his or her overall experience,” Mr. Haney says. “Helping patients and their healthcare teams on their journey not only includes various treatment options, but meaningful services and tools to offer support in managing their disease.” These services and tools facilitate several functions in patient education, including improving patient adherence, improving patient and physician communications, engaging both patient and physician, and creating a greater understanding between all stakeholders. According to Dennis Urbaniak, VP and head, U.S. diabetes patient centered unit, Sanofi US, the industry will be more successful if it involves patients directly in the design and development of the tools that help them improve their health. “Design and education are key opportunities for pharma, and direct patient involvement in the development of these solutions will significantly improve empowerment,” Mr. Urbaniak says. “Also, pharma can help provide better data to patients in user-friendly formats with information on what that data mean in terms of reinforcing good decisions and better understanding trends in managing their health.” At Novo Nordisk, the company has always been based on a patient-centric model and now is taking the next step to engage and motivate its patients, says Christine Sakdalan, director of engagement. “We believe that we can empower patients by providing disease education, engaging with them, and establishing a relationship with them, and more importantly, we need to activate them,” she says. “Activation requires not only education, but ensuring that patients have the tools to act on their knowledge. For example, they need to be able to transfer their knowledge to having more productive dialogues with their healthcare providers.” This is important because patients who fully participate in and understand their treatment choices are more likely to adhere to and therefore realize the benefits of treatment, says Catherine Tak Piech, VP, health economics and outcomes research for Janssen Scientific Affairs. For instance, shared decision-making between patients and healthcare providers is of increasing interest and through the Affordable Care Act has become a national priority for the Patient-Centered Outcomes Research Institute, an independent, nonprofit health research organization. “We believe a collaborative partnership between pharmaceutical companies, providers, and our patients can effectively produce better health outcomes,” Ms. Piech says. For example, there is a great need to improve provider-patient communications and educate patients on the full range of treatment choices available to them, and explore their unique preferences, Ms. Piech says. According to research conducted by Janssen, 55% of patients with immunological conditions who receive subcutaneous medications are not offered the choice of intravenous medications, and conversely 46% of patients receiving intravenous medications are not offered the choice of subcutaneous medications. “This provides an opportunity for the industry to collaborate with providers and patients to create and validate decision aids, as well as formally study the effectiveness of provider incentives to participate in the shared decision-making process has on outcomes and patient satisfaction,” she says. Another crucial part of obtaining the best possible health outcomes is helping patients start and stay on their chosen therapy. “At Janssen Biotech, we are committed to helping patients obtain appropriate access to our medicines and we offer a variety of care-coordination services, including affordability programs, healthcare benefit counseling, disease education materials, appointment reminders, and outreach services,” Ms. Piech adds. Novo Nordisk has experienced success in terms of improving outcomes with its patients through its programs designed to increase compliance and persistence, Ms. Sakdalan says. “We have seen increased education and awareness among our patients through some of our relationship marketing programs and our diabetes education programs,” she says. “These programs have done a lot to improve the outcomes of patients, but we are not satisfied yet, as there are still more patients — and caregivers and healthcare partners — out there who haven’t been reached.” Novo Nordisk has also created an interesting partnership with its patients through a program that gets the diabetes community involved in helping influence legislative policy makers to pay more attention to the needs of patients with diabetes. Novo Nordisk created ACT for Diabetes as an easy-to-use advocacy tool for patients using Novo Nordisk products, their family members, friends, and loved ones; and people at risk for diabetes. ACT for Diabetes stands for “Achieving Change Together for Diabetes” and was designed so that patients can be aware of what is happening in Washington, D.C., in terms of legislation that could affect the lives of people with diabetes and people at risk for diabetes. The program encourages patients to communicate with elected officials to tell them what’s most important in the fight for diabetes awareness, prevention, treatment, and cure. “Novo Nordisk believes that advocacy is essential to achieving policy change and legislation that will help give diabetes the attention it deserves to improve the lives of people affected by diabetes and prediabetes today and in the future,” Ms. Sakdalan says. The program, launched last year, encourages patients to sign up to receive emails from Novo Nordisk on a regular basis. Novo Nordisk notifies participants when there is information of legislative value for the diabetes community or diabetes patient. “The initiative works much like any grassroots political activity program; we highlight particular diabetes-related legislation, but at no time do we ask patients to get involved in the business of diabetes or pharmaceuticals, such as Medicare Part D legislation,” Ms. Sakdalan says. “We only ask patients to write to their legislators on issues that have broad ranging support for the diabetes community.” Mr. Haney says Janssen Biotech also partners with patient advocacy organizations to provide patients with disease education, such as Janssen Biotech’s My Prostate Cancer Roadmap, an educational resource for men with advanced prostate cancer, and Are You Serious, a program that allows people living with psoriasis to share their stories about moments when they got serious about taking control of their condition. While the focus is clearly turning to that of patients, some experts say it’s important not to forget the role physicians and technology are playing in the outcomes paradigm. “The emergence of progressive on-demand intelligence platforms are shaking things up and augmenting traditional healthcare market research practices,” says Michael Marett, senior VP, head of global business development, WorldOne Interactive. “Harnessing technology to create self-service platforms allows targeting global HCPs at speed, creating new channels, and the opportunity to derive crowd-sourced and collective intelligence. Services such as MedLIVE combine global HCP access with communication technology to empower the industry to glean valuable insights anytime anywhere, thereby unlocking HCP opinions and perceptions efficiently to support critical business decisions. Emerging technologies and trends are creating new opportunities to disseminate brand science in differentiating ways. MD-only social networks that can scale and establish trusted environments for clinical conversation represent alternative opportunities to deliver e-resources. Further, newer gamified platforms, such as DocTango leverage the competitive nature of HCPs and create alternative and impactful educational experiences that are fun, social, and engaging. Such powerful and progressive platforms will amplify education, promotion, engagement, intelligence, and forecasting.” Opportunity Knocks There are several ways that pharma can contribute to helping patients become more informed and engaged in their own care. Partnering with advocacy groups, providing patient education, improving physician/patient communications, and offering adherence and compliance programs are all part of its new role in empowering patients. This role will have challenges, but it also brings with it a wealth of opportunity, our experts say. “Pharma companies have the opportunity to change their business models to focus more on connecting with consumers, providing valuable patient education resources, and increasing their transparency,” says Cindy White, creative director, ParkerWhite. “The more pharma companies connect with patients and understand what their needs are, the better they can address their needs, leading to a mutually beneficial relationship for the company and the patient.” Connecting with patients can also bring critical, real-life data that can be used to target unmet needs and better tailor marketing and education efforts. “Patients have a wealth of information about their medical condition and their responses to treatment,” says Brian Loew, CEO, Inspire. “If pharma wants to learn from these data to improve treatment, patients are incredibly willing to go more than halfway.” Patient engagement that enables patients to achieve their goals is critical to long-term therapy success, says Mazen Zahlan, principal, ZS Associates. “Successful patient engagement requires a shift in the industry, one that moves away from a focus on capturing the patient to a focus on maintaining and extending therapy, when appropriate,” he says. Pharma has made some headway in this direction and must continue to invest in developing products, including innovative packaging and labeling, and services that encourage patients to manage their health outcomes. But programs must go beyond information because engaging the patient is more critical than ever in the quest for better health outcomes. “Pharma needs to take the extra step of engaging patients to help them realize their goal of living better; this is a role that the industry must play,” Mr. Zahlan says. “Pharma must not only provide the right high-quality information to the patient through the right channels, but also address patient concerns and emotional barriers to adhering to therapy.” The opportunity to authentically partner with patients will go a long way in empowering them to manage their care. Pharma can play an important role by adding credibility and depth to the discussion, says Brenda Snow, founder and CEO of the Snow Companies. “Building empowering and trusted connections with patients will require a shift that starts with increased transparency and a willingness to partner,” she says. “Patients will view companies more positively once they see and feel their authentic commitment to the community.” Whether it is providing education around product, device, disease state, or prevention, this is clearly a role that pharma must step into, says Susan Collins, senior VP, health education research and development, HealthEd. Another very important role is around the area of health literacy because if patients can’t comprehend the information, it doesn’t do anyone any good. “Nine out of 10 Americans are not proficient in health literacy skills, meaning only one in 10 are,” Ms. Collins says. “There is an absolute need for the communication to be actionable, which also helps support the shared decision making and making sure patients are involved with their providers.” Back to School with Patient ­Education “Many patients want to engage in managing their condition to live life to the fullest, and pharma plays a big part in making this happen,” Mr. Zahlan says. “Part of this philosophy is communicating core product benefits and how they help improve quality of life.” According to Ms. White, the industry needs to provide better patient-centered websites and other patient education materials that provide the resources patients need. Using social media channels to keep consumers up-to-date about product information, case studies, and questions to ask their doctor is one way to connect. Additionally, Dorothy Wetzel, founding partner, extrovertic, says social media offers a quick, cost-effective way to understand unmet patient needs early in the development process. “When patient needs are known and addressed early on, medications and their accompanying support programs have a better chance at helping patients successfully use the products,” she says. Another avenue for successfully educating patients would be medical journal articles that are more readily accessible to the public. For example, companies should consider translating them into layman terms and using digestible formats such as infographics and YouTube videos, Ms. Wetzel says. “Our study of empowered patients in the MS community found that they are information omnivores, with medical journals being rated an extremely important way to get disease information,” she says. The extrovertic Patient Engagement Study: Eye on MS is the first in a planned series of studies examining patient engagement trends within online patient communities. The industry also should look for any opportunity to share information about new treatments, as long as the data comply with FDA regulations, Ms. Wetzel adds. “Our study found that the online MS community has an insatiable appetite for information about new medications,” she explains. “The area of future treatment was cited by more than 50% of the online consumers as one of the top three topics they are likely to discuss with their MS specialist. We are even seeing patient groups like Cystic Fibrosis Unite spring up to bridge the gap between patients and researchers. Pharmaceutical marketers, with their legions of scientists and medical experts, can provide an important value-add to patient organizations. Marketers should also create opportunities to talk with patients directly by organizing face-to-face meetings and online discussions.” According to Mr. Loew, patient education materials will need to be designed to take into account the target audience. As the trend toward more empowered patients grows, the industry will find that some patients will desire extensive scientific information about the treatments they use, while other patients are satisfied with the basic materials typically provided today. “There is more variation among patient interest and education levels than among those of doctors, and thus pharma needs to develop materials that take into account these differences,” Mr. Loew says. “I expect patient education materials to be produced simultaneously at several education and interest levels.” Another factor that will impact patient education materials is the growing need for multicultural awareness and materials in many different languages. According to Ms. Collins, most people assume that the only other language needed is Spanish, but there are many patients from other cultures that need materials designed for their specific needs. A recent HealthEd study, Engaging Patients from Multicultural Backgrounds, determined that half of healthcare providers surveyed don’t have access to education materials in the language they need. “From a patient engagement perspective, providing easy-to-understand patient education in various languages is a really important area for pharma,” Ms. Collins says. “The whole aspect of health literacy also raises another area for pharma to focus on because there is a tremendous need for culturally appropriate content for patient education.” Look Who’s Talking Due to the many challenges facing the industry, from regulatory concerns and slow adoption of digital media, industry-provided information has become less accessible and less actionable to patients compared with information readily available elsewhere. Consequently, patients can only reliably access credible health information when they are in direct contact with their healthcare provider, says Allen Stegall, executive director of strategy, principal, at Scout Marketing. “As a result, the industry must optimize the information transfer process in the interface between the patient and physician or staff,” he says. “Beyond the ordinary patient information brochures and starter kits, an opportunity exists to help physicians communicate key information about specific treatment options in a way that patients can understand and live by.” This endeavor is partly about physician best practices around patient counseling and includes the development of tools that add efficiency to the process so that they fit inside the time constraints of the setting. Mr. Stegall says this can be accomplished in tandem with DTC/DTP efforts designed to raise awareness around specific conditions and prompt empowered patients to query physicians about options. According to Ms. Collins, the industry needs to remember that patient empowerment very much focuses on shared decision-making — in terms of the patient being actively involved with his or her provider in making decisions with regard to treatment options. “These days patients seek to understand the pros and cons and the effectiveness of treatment, and because of this dynamic, the physician is no longer the sole decision maker on what treatment a patient will use,” she says. “Today, these decisions are made by both the patient and the provider going through it together.” Pharma can play a huge role in expanding its focus beyond the physician and the patient. This means including the nonphysicians who are instrumental in a patient’s care, such as health educators and social workers, and making them part of their patient education efforts, Ms. Collins says. Another new role for pharma involves partnering with payers and physicians in supporting Affordable Care Act (ACA) initiatives, Ms. Wetzel says. The ACA aligns healthcare stakeholders on the goal of empowering patients to take a greater role in managing their healthcare. “As payers and HCPs scramble to promote patient engagement, pharmaceutical companies have the opportunity to share their expertise in motivating consumer action that they have developed in more than 15 years of direct-to-consumer marketing,” she says. Getting to the Bottom of ­Outcomes According to Ms. Snow, patient programs prove every day that pharma and patients can partner effectively to improve health outcomes and the result is a win-win for both parties. “Educated, connected, and empowered patients are the best bet for improved outcomes,” she says. “Engaged patients are much more likely to stay compliant on therapy, have strong relationships with their providers, and be advocates for their overall healthcare experience, all of which can contribute to better outcomes.” The best time to start a partnership is very early on in the development process, Ms. Collins says. “There are partnership opportunities starting at the beginning of drug development and R&D, all the way to commercialization and marketing,” she says. Pharma companies should bring the patient and consumer perspective to the table at each point throughout the process, with just as much as weight as they evaluate a provider’s perspective. “In our experience, patient marketing is often the last element to be considered when launching a new drug,” Ms. Wetzel adds. “Some of the orphan drug launches we have studied have engaged patients early in the development process, in some cases two to three years before the product is launched,” she says. “In one case, the first person hired into the marketing department after the chief commercial officer was brought on to work with patient advocacy groups.” The more that brands can provide valuable, credible information and create meaningful relationships that aid consumer research, the better for everyone, Ms. White says. “There are definitely a lot of exciting projects going on in the healthcare space right now,” she says. “Brands are beginning to meet patients where they are, which is online. Brands that are creating patient-centered websites and unbranded communities that are extremely targeted, uniting patients with real patient stories and treatment experiences, along with easy-to-digest information around specific health issues will come out ahead.” There are great rewards for those companies that do support empowered patients, but that requires a few things to be in place first, Mr. Loew says. “First, pharma needs to demonstrate the desire to receive patient-reported information through clear, and easy-to-find channels,” he says. “Next, pharma companies need to be willing to engage in two-way discussions about patient observations and needs. Finally, they need to treat patient information seriously and assign it high value. “Progress to date is not encouraging as we still hear the same reasons why these things are difficult, and regulation is often to blame,” he continues. “But the pharma industry has solved much harder problems than this; the question is whether it sincerely wants to do so.” “Pharmaceutical marketers, with their scientists and medical ­experts, can provide an important value-add to patient organizations.” Dorothy Wetzel / extrovertic “There are great rewards for companies that support empowered patients.” Brian loeW / Inspire “An enormous opportunity exists for pharma to help physicians ­communicate key information in a way that patients can understand.” allen stegall / Scout Marketing “The more pharma companies ­connect with patients and understand what their needs are, the better they can address patient needs. ” Cindy White / ParkerWhite “Pharma needs to take the extra step of engaging the patient; this is a role that the industry must play.” Mazen Zahlan / ZS Associates The Inaugural ePharma Awards IIR created the ePharma Awards to celebrate the accomplishments of innovators in the fields of HCP engagement, consumer engagement, and overall brand planning excellence. The winners are: • HCP Engagement Excellence: Jay Appel, Amgen • Consumer Engagement Excellence: Nancy Phelan, Bristol-Myers Squibb Company • Brand Planning Excellence Craig DeLarge, Merck & Co. Inc. “Collaborative ­partnerships between pharmaceutical ­companies and their patients can effectively produce better health outcomes.” Catherine Tak Piech Janssen Scientific Affairs “Pharma must step into the role of providing education around product, device, ­disease state, and prevention.” susan collins / HealthEd “Direct patient involvement in the development of healthcare solutions will ­significantly ­improve ­empowerment.” dennis urbaniak / Sanofi @Durbaniak and @Diabetes_Sanofi “Pharmaceutical ­companies must spend as much time connecting with their patients as they traditionally have with healthcare providers.” john haney Janssen Biotech “Companies can ­empower patients by providing disease ­education, ­engaging with them, and ­establishing a relationship with them.” Christine Sakdalan / Novo Nordisk “Educated, ­connected, and ­empowered ­patients are the best bet for ­improved health ­outcomes.” Brenda snow Snow Companies Super Consumers Impact Commercialization Strategies The influence of empowered patients is changing sales, marketing, and research models. There are many forces driving changes in sales, marketing, and market research models in the industry, and patient empowerment is one of them. Budgets are shifting, marketing focus is moving from physicians to patients, and the industry is embracing a more holistic view of combining services with product. “The traditional marketing funnel is an artifact of a different time,” says Brenda Snow, founder and CEO of the Snow Companies. “It has been replaced by something that more closely resembles an ongoing loop comprised of many voices, most of which are patients, most of whom are unaffiliated with the brand. Sales and marketing will need to find ways to participate in this conversation in a meaningful and compliant fashion.” According to Dennis Urbaniak, VP and head, U.S. diabetes patient centered unit, Sanofi US, sales and marketing strategies will have to significantly shift from internally created content and pushing it out into the market in a very closed fashion to a fully transparent open model of listening more closely to patients and developing solutions in partnership with patients that truly address their needs. Susan Collins, senior VP, health education research and development, at HealthEd, says she believes sales and marketing models are already shifting from a product-centric focus to more of a services focus that looks holistically at how pharma can support the empowerment of patients. “This model helps support decision-making and self management and the interactions patients are having with their providers and extenders,” she says. “We will continue to see more of that shift, as that is also where providers and healthcare systems are focused.” Budgets are also shifting away from traditional marketing spend and aligning more with patient services. For example, Janssen Biotech’s brands’ budgets are now spent on strengthening support services with a shrinking investment on purely promotional spending, says John Haney, VP, immunology marketing for Janssen Biotech. “We choose to make these types of investments because we understand how treatment adherence and compliance play a role in our patients achieving the greatest possible health outcomes,” he says. “Janssen Biotech is continuously looking to improve the overall patient experience by providing better educational resources that aid in disease and treatment management; we are creating tools that make patients’ access to our products as easy as possible as well as improving overall satisfaction and outcomes through programs like adherence and compliance intervention.” Another major trend will be the shift from share-of-voice business models, which emphasize frequency of calls on physicians, to models that emphasize the value of the interaction to the customer, and the depth of support and information offered to all healthcare practitioners by the salesforce, Mr. Haney adds. There are at least three shifts occurring as a result of the increased influence of empowered patients, according to Mazen Zahlan, principal, ZS Associates. The first change is the increasing move toward a multi-stakeholder customer. Marketing strategies and tactics need to holistically address all stakeholders, not just the healthcare provider as has traditionally been the case. Delivering the right product information to the healthcare provider is key, but it is equally important to provide patients and caregivers with information, advice, and support to achieve successful outcomes. “Pharma needs to enforce the multi-stakeholder mentality throughout their sales and marketing outreach,” Mr. Zahlan says. The second change is in the use of multi-channels, including social media, to address each stakeholder through the most appropriate and effective channel. For the patient, social media will become more impactful, but pharma will have to navigate compliance and regulatory constraints, he says. The third change is in the content forming the basis of the marketing platform. While the industry has been predominantly focused on medical science rather than patient benefits in the past, pharma needs to work harder on translating the medical science more fully into higher order patient benefits, Mr. Zahlan says. “There also needs to be a bigger focus on adherence management through better patient engagement and more reinforcement of benefits,” he adds. “Successful companies will be the ones that embed the multi-stakeholder approach in their culture with the ultimate goal of serving the patient.” Sales and marketing models will also need to change the ways in which they approach physicians. “The whole physician sales model has to change,” says Christine Sakdalan, director of engagement, Novo Nordisk. “Physicians have an impact on what information patients receive, therefore we need to filter the patient education through them, as opposed to ‘here’s our brand message and here’s lunch for your staff.’” At Novo Nordisk, the goal is to become more of a partner with the physician and other aligned healthcare professionals critical to the patient’s care. Office staff, nurses, and pharmacists play a big role in the patient interaction with the physician, Ms. Sakdalan says. “Patients go to a doctor, but they talk more with their pharmacist or the physician’s support staff than they do with their physician, therefore, sales and marketing messaging must include all these stakeholders,” she says. Dorothy Wetzel, founding partner, extrovertic, predicts that the move to a more patient-centric focus will force marketing models to change in several ways. Empowered patients will now evaluate a brand on the entirety of the patient experience. At this point, much of the patient experience is controlled outside the usual marketer scope of responsibility, by departments such as patient services, medical information, and corporate affairs. The increased expectations from consumers coupled with the added pressures from the Accountable Care Act to improve the patient experience will raise the bar for pharmaceutical marketers. The goal of improving patient outcomes will also become the central focus when planning marketing strategies. “Right now marketing planning takes place in three distinct customer silos: physician, payer, and patient,” Ms. Wetzel says. “Tactical plans need to be optimized to drive patient outcomes rather than to meet the separate needs of each customer group.” Marketers will have to think more like a Nordstrom salesperson, doing whatever it takes to satisfy a patient by deploying a strong customer service model that can anticipate and resolve patient problems. “One of our clients exemplified this service mindset by spending an afternoon chasing down an answer for a patient whose product had sat on her doorstep for longer than the specified time period,” she says. “Our client’s actions saved the company money and enabled the patient to take her medication on time. With social media providing every patient with a platform, one negative experience can have massive repercussions.” To meet the marketing challenges of creating relationships with patients and physicians in an integrated manner, pharma will add more patient specialists to both its internal and agency teams. This will involve coordinated programs that include physician education on communication techniques and the development of tools that complement the face-to-face sessions. “We anticipate a shift toward more extensive industry efforts to help physicians employ better, more relatable, more efficient communication techniques,” says Allen Stegall, executive director of strategy, principal, at Scout Marketing. “In other words, companies have to help docs convey the information that empowered patients crave in a way that is credible and satisfying, but in a manner that is very time efficient. “We also anticipate expansion of DTP/DTC programs designed to get patients into professional care, but we believe today’s marketers will be judicious in the use of these more expansive efforts,” he says. “Specifically, we expect programs to be pilot tested and evaluated — including ROI — before there is an expansive rollout.” As patients increasingly take an active role in their healthcare decisions, brands will need to go beyond the medical professionals and have meaningful interactions with patients as well, says Cindy White, creative director, ParkerWhite. “Patients are hungry for information and resources, and pharma shouldn’t be afraid to empower them,” she says. “Patients are hungry for information and resources, and pharma shouldn’t be afraid to empower them. ” Cindy White / ParkerWhite “The new marketing model will ­support patient decision-making and self management and the ­interactions patients are having with their providers.” susan collins / HealthEd “Marketing strategy and ­tactics need to holistically ­address the multi-stakeholder customer environment.” Mazen Zahlan / ZS Associates “We should anticipate a shift toward more extensive ­industry efforts to help ­physicians ­employ better, more relatable, and efficient communication techniques.” allen stegall / Scout Marketing “The whole ­physician sales model has to change.” Christine Sakdalan Novo Nordisk “Sales and marketing strategies will have to ­significantly shift to a fully transparent open model of listening more closely to patients and­ ­developing ­solutions in partnership. ” dennis urbaniak / Sanofi “Janssen Biotech’s brands’ ­budgets are now spent on strengthening support services with a shrinking investment on purely ­promotional spending.” john haney Janssen Biotech “Sales and marketing will need to find ways to participate in ­patients’ conversations in a meaningful and ­compliant fashion.” Brenda snow Snow Companies

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