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“Adapt or Die”
John Lyttle
Oct 2013
Building Patient Partnership for Competitive Advantage or Survival
of the Brand?
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Key Learnings
Patient partnership is the core strategy that must drive everything we do
Patient partnership is todays competitive advantage but may be tomorrows survival strategy
Compliance is history, adherence programmes are tactical, partnerships can provide competitive advantage
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Content
Environmental pressure Early business environment The threat of poor adherence to treatment Present business environment Industry response to the threat
Tactical survival v Strategic dominance Evolving role of the patient Tactical approach not sufficient Plan for strategic dominance
Evolution of adherence the 4P’s (case studies) Presentation driven programmes Pharmacy driven programmes Pharmacovigelence driven programmes Partnership driven programmes
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Environmental Pressures Drive Evolution
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Brand Features, Emotional benefits
Early healthcare business environment
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• IV brands – Patient given drugs in hospital • Oral brands in multiple forms– Focus on gaining prescriptions via the
direct sales approach • High SOV directed at doctors, other HCP secondary • Though leaders are the key • Me-too’s differentiation via emotional branding &high spend
• Complete confidence in randomised phase III studies • Complete freedom to prescribe • Compliance is a patient problem that can be managed by education • Patients trust clinicians and are expected to be compliant
• High degree of trust in doctors • No direct access to pharmaceutical companies • Less understanding of disease and therapies • Less expectation among elderly
• High drug costs accepted • Health economics poorly understood • Clinicians control formulary committees • Negotiation at individual hospital level • Few major drugs available as generics
Early healthcare business environment
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Size of problem Clinicians no better than chance at
predicting poor adherence in patients All studies underestimate non-adherence
Causes of non-adherence Up to 70% is voluntary
Not driven by cost (4-6% increase in adherence when drugs are free)
45% driven by fear of S/E Patients feel better (in denial)
Confusion , poor cognitive function (Clinicians spend < 1% of time with patient
discussing administration of therapy)
Definitions Doctor in control compliance (yielding,
submission accepting punishment) Patient in control adherence/concordance
The threat of poor compliance/adherence
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The threats of poor compliance/adherence
Impact of poor adherence 25% of kidney transplant patients do not take immunosuppressant's as Rx
The global burden of chronic diseases
such as diabetes is growing adherence to long term chronic
conditions < 50%
100% adherence to therapy would prevent 89,000 deaths from
hypertension
Estimated to cost $100 billion/year
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Health care systems cannot afford waste rise of the HTA and real data
IV replaced by oral therapy; Treatment regimens more complex
Higher efficacy balanced by higher risk introduction of the RMP
Patients better informed with higher expectations
40% decrease in sales force heads, reduced access , time, frequency
Present business environment
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98% of management accepts that patient centricity is business critical
3% of current marketing spend on patient support programmes
Industry response to the threat of extinction
Budget allocated to brands not market growth KPI’s direct sales force related – reach, frequency Fear of regulatory/legal challenges Lack of expertise or the need to change the
formulae Not sure how to reach patients Commitment of budget to clinicians Following the herd same as last year vested
interests Centralised marketing limit local control
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Tactical Survival v Strategic Dominance
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Patient centred care
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Evolving role of the patient
Patients have new relationships with HCP including nurses Rx
Patients have greater expectations of QOL and safety
The patients are the decision makers - understand the drivers of choice
New channels are providing access to healthcare information and pharma
Patients are informed networked more active powerful and vocal
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Use of agency templates used in other markets geographies or therapies
Headlong rush into high – tech solutions
Limited consultation with patients and their advocates
Great concept poorly executed no long-term plan
Implemented as a sales force access tool
Tactical approach not sufficient for survival
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Adapt the existing business models – Patient flow
Current volume levers of growth
Potential volume levers of growth
Patients Relevant patient group
Current treatment outcome suboptimal
Patient suitable for therapy class
Recommended for brand
Funding approved for brand
Patient value
}}
Cost per dose
Dose per day
Days on therapy
% Adherence
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Adapt the existing business models – Stakeholder maps
Influences
Regulations & Approvals
Internet, press, nurses physio/T
Published evidence industry support
Guidelines & International KOL’s & industry physiotherapists
Guidelines
Reimbursement wholesaler stock
Gov funding H/E data
Peers Stakeholder
Patient oral anticancer
GPs
Budget holders
Home care services/ Out patient carers
Oncologists Oncology nurses
Advocacy grps
& peers
Pharmacy Pharma
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Planning for strategic dominance
Have a clear long term strategic objective 2017 2016 2015 2014
What drives beliefs across patient types, geographies and pathologies
Segment the patients and customise the key messages to different patient types
Identify unsatisfied patient needs avoid copying competitors
Before implementation build capability (technology, channels, and compliance
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Tactical Implementation of patient support programme
Anticipate updates
Develop and meet SMART
objectives
Deliver key messages via targeted multi-
media (not just digital)
Feasibility study – what can we deliver within time
available
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Evolution of Patient Programmes the 4Ps of Adherence
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Tactical Implementation of patient supportprogramme
Presentation
Pharmacy adherence programmes
P/V driven safety
programmes
PSP
Compliance
Partnership
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Presentation driven adherence programmes
Background Once a day antibiotic for strep throat
Stakeholders GPs and Pharmacists
Drivers of adherence Convenience and simplicity
Pros Kept sales force motivated Uncovered a novel market niche
Cons Assumed brand clinically effective Assumed brand was competitive Assumed GP needs convenience Assumed poor compliance non-
voluntary
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Pharmacist driven adherence programmes
Background GP product with early manageable side effects &long-term benefits Train pharmacists to provide patient education
Stakeholders GPSI in inflammatory disease and community pharmacists
Drivers of adherence Belief in long term safety data Patient education from trusted pharmacist
Pros Motivated patients adherence
improved +ve ROI in areas of high brand
share
Cons Some competitive leakage Non compliant to target high
prescribing regions No impact on poorly motivated
patients Ltd impact on forgetful or patients
with low cognitive function
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Pharmacovigelence driven adherence programmes
Background IV anticancer with a RMP aim to recruit patients to
a proactive telephone support service
Stakeholders Oncologists, nurses and patients
Drivers of adherence Understanding of the RMP Opportunity to discuss side-effects
Pros
Reinforce RMP programme
Relationship building with HCP
Cons Compliance issues with
pharmacovigelence Potential liability issues vary across
Europe Perception that company thinks drug
is dangerous
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Patient driven adherence programmes (PSP)
Background Severity of MS symptoms, complex
administration/monitoring schedules, novel drug side effects and RMP; more empowered patients provided with an online comprehensive patient support package
Pros Patient focused language & approach “Beyond the pill” content
Cons Based within a company website Access via HCP only Ltd use of traditional channels
Stakeholders MSologist, nurses, pharmacists and patients
Drivers of adherence Understanding safety issues Understanding administration & monitoring requirements
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Patient centricity requires organisation change
Organisational change requires strong leadership
Marketing must take the leadership role
History tells us that as with health economics in the 90’s companies that are unable to adapt may die
Look to the future
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Questions and
Feedback