SOCIAL MEDIA AND HEALTHCAREChallenges for Pharmaceutical MarketersAPRIL 2013

Richard A. Meyer

Contributors: Cindy Liu, Christine Bittar

Read this on eMarketer for iPad

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 2

CONTENTS3 The Social Challenge

7 Consumer Behavior

10 Opportunities for Pharma Marketers

12 Conclusions

13 eMarketer Interviews

13 Related Links

13 Editorial and Production Contributors

EXECUTIVE SUMMARY

The Food and Drug Administration (FDA) has yet

to follow through on its years-old pledge to issue

social media guidelines for pharmaceutical marketers

in the US. As a result, some pharma companies

are keeping their distance from the social channel,

preferring to wait out the uncertainty rather than risk

warning letters.

But the size of the social audience, combined with its engagement and demographic profile, has tempted a number of pharma marketers off the sidelines. Paths are emerging for marketers to engage this growing audience without regulatory or legal trip-ups.

This report looks at the intersection of online health seekers and social media. It offers an overview of the size of the social health audience and summarizes consumer attitudes toward health content on social media as well as its credibility and trustworthiness. In addition, the report suggests some practical ways for pharma marketers to address social audiences.

KEY QUESTIONS ■ How many consumers are using social media for

online health information?

■ How much do consumers trust social content about

health issues?

■ Are privacy concerns keeping consumers from using

social media for healthcare questions?

% of respondents

Leading Concerns and Challenges of Using SocialMedia Marketing According to Health and PharmaExecutives Worldwide, Oct 2012

Measuring the effectiveness and ROI of social media78%

Regulatory concerns78%

Legal concerns74%

Need to educate staff about the effective use of social media70%

Compliance concerns67%

Responding to customer comments in social media52%

Integrating the data/analytics from social media into existingdecision support and ROI

48%

Staying up-to-date on the latest technology trends and changes44%

Adverse event reporting41%

Lack of strategy specific to social media41%

Source: Digital Health Coalition, "Executive Landscape Study 2012," Nov 1,2012152859 www.eMarketer.com

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 3

THE SOCIAL CHALLENGE

The social channel poses special challenges for

US pharmaceutical marketers. Uncertainty about

regulatory issues has been a major obstacle,

and there are also concerns about the value of

social media to actually drive brand objectives. In

addition, questions remain about whether people

are actually using social media to make healthcare

treatment decisions.

Data suggests that many online health seekers are indeed including social media in their search for health information. Estimates from Kantar Media and Manhattan Research are at the higher end of the spectrum, with both finding that roughly 45% of US adult consumers used social media for health-related purposes in 2012. Deloitte, GE Healthcare and PricewaterhouseCoopers (PwC) are clustered at the lower end, estimating that less than one-third of US internet users ages 18 and older used social media for health information last year.

The variance in these estimates partly reflects the way the firms posed survey questions. For example, Kantar Media asked those polled about their use of social for health, wellness, diet, exercise and nutrition information, while Manhattan Research asked about the use of social media for overall health, which could include wellness and fitness information. In contrast, Deloitte focused narrowly on healthcare. Meanwhile, the companies also defined social media differently. Kantar Media’s definition, for instance, included newsletters and support groups.

% of respondents

Comparative Estimates: US Adult Consumers Who UseSocial Media for Health-Related Purposes, 2011 & 2012

AdultsManhattan Research, Oct 2011 & Oct 2012

Kantar Media, June 2012

Internet usersKantar Media, June 2012

Deloitte, Dec 2012

GE Healthcare*, Nov 2012

PwC, Nov 2011

2011

45%

45%

57%

-

-

32%

2012

46%

44%

55%

26%

26%

-

Usage

Used in the past 12 months

Ever used

Ever used

Used in the past 12 months

Used in the past 12 months

Ever used

Note: ages 18+; *used to discuss healthSource: various, as noted, 2011 & 2012153304 www.eMarketer.com

Another difference is in the definition of what it means to actually use social media. GE Healthcare’s survey asked US adult consumers about the use of social media to “discuss” health, a focus that might not count passive users who read content on social channels but don’t actively post.

Given the varying terms and definitions, it is difficult to isolate a single number that would describe the total market of internet users who used social media for health reasons in 2012. If a firm narrows the definition to include only those who seek health information—as opposed to general wellness information—while including both active and passive users, it seems reasonable to estimate that the total would be somewhere in the neighborhood of 40% of US adult internet users, based on the available data.

REGULATORY QUESTIONS STILL IN DOUBT The FDA said it would issue social media marketing guidelines for pharma companies more than three years ago, but shifting priorities have postponed the issuance. Via a provision in the FDA Safety and Innovation Act, Congress mandated that the FDA issue social media marketing guidelines no later than July 2014. But as The Pink Sheet, a publication of Elsevier Business Intelligence, noted in March, “The mandate does not specify a comprehensive single guidance, and given the agency’s poor track record of delivering on its promises to issue such a document, a fragmentary approach through warning letters, multiple guidances and a partnership with the Federal Trade Commission seems more likely.”

For the time being, the FDA has taken a “You do it, and we’ll let you know if there is an issue” approach to social media marketing of pharma products. The agency tends to issue warning letters when drug companies use social media in ways that don’t conform to developing guidelines, but that, of course, is a moving target.

The lack of regulatory clarity has led to widespread apprehension about using social media for healthcare marketing when it comes to branded social sites. Some pharma companies have embraced social channels and are building their capabilities via unbranded disease state sites or corporate sites. But most want to avoid risking a violation letter and are waiting for precise guidelines to use social media for specific products and brands.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 4

Whenever the FDA does issue the guidelines, they may become outdated almost immediately, given the rapid evolution of social media.

The fluid nature of social media, combined with marketers’ limited ability to control it, creates special challenges for the pharma industry. Adverse event reporting is a particular concern. The FDA requires US pharma companies to investigate adverse events involving their products. If drug companies had to monitor all social media channels for reports of adverse events, this would overwhelm regulatory and legal staff with paperwork.

Adverse event reporting requires in-depth information from patients, including name, address, a detailed description of the adverse event, physicians’ names and a listing of all other medications the patient takes. Currently, pharma companies are only required to report adverse events that patients post on product sites and sponsored pages.

BUDGET PRESSURES Uncertainties surrounding the social channel come at a time when many pharma companies are cutting direct-to-consumer (DTC) budgets. In fact, US DTC marketing spend in 2012 declined 22% year over year, according to Cegedim Strategic Data, a healthcare market research firm. The declines in spending reflect two key factors: top drugs coming off patent and increased research and development (R&D) costs to get new drugs approved. In addition, the continuing debate on the Patient Protection and Affordable Care Act, or “Obamacare,” is leading to a closer examination of drug prices through Medicare and Medicaid.

millions and % change vs. same period of prior year

US Pharmaceutical Promotional Spending, by Marketing Channel, 2012

Clinical trials

Detailing

DTC

Mailing

Meetings

Print advertising

Samples

Total

Spending

$133.3

$14,997.6

$3,101.9

$1,164.5

$2,143.4

$91.8

$5,722.2

$27,354.7

% change

-13%

-5%

-22%

16%

-2%

-44%

-9%

-8%Source: Cegedim Strategic Data, "2012 US Pharmaceutical PromotionSpending," Feb 15, 2013152649 www.eMarketer.com

Nielsen found a less dramatic decline in DTC spending than Cegedim Strategic Data, but the drop was still significant. According to a Medical Marketing & Media report that cited Nielsen data, overall DTC spending in the US fell 13% in 2012, while DTC internet spending declined 33% year over year. DTC internet ad spending only accounted for 2% of total ad budgets. By comparison, TV and magazine spending represented 91% of total DTC media budgets. However, the internet spending figure does not include nonadvertising marketing expenses such as building drug websites, CRM programs or social media.

Capgemini feels that many executives within pharma companies see a threat in digital transformation and less opportunity than other industries. In fact, the consulting firm classified 33% of pharma companies as digital beginners, which it described as companies that are several years away from realizing the potential of digital marketing. Most pharma companies are currently sticking with mainstream digital marketing, such as product websites, online ads and search engine marketing.

% of total

Digital Maturity* of Companies in Select IndustriesWorldwide, July 2012

High tech38% 25% 21% 17%

Banking35% 23% 23% 19%

Insurance33% 33% 13% 21%

Travel and hospitality31% 19% 50%

Telecom30% 17% 48% 4%

Retail26% 30% 17% 26%

Consumer packaged goods24% 16% 28% 32%

Pharmaceuticals7% 17% 43% 33%

Digirati Conservatives Fashionistas Beginners

Note: read as 26% of retail companies are classified in the digirati categorybased on senior executives' survey responses; numbers may not add up to100% due to rounding; *a quality that describes a firm's current approachtoward using new technologies such as mobile, social media and analytics,and the potential the firm has for using new technologies to enhancecustomer engagement, internal operations and business modelsSource: Capgemini Consulting and MIT Sloan Center for Digital Business,"The Digital Advantage: How Digital Leaders Outperform Their Peers inEvery Industry," Nov 5, 2012153165 www.eMarketer.com

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 5

Indeed, the healthcare segment spends very little on digital marketing on the whole compared with other industries. According to eMarketer’s March 2013 estimates, the US healthcare and pharma segment will spend only $1.2 billion on digital advertising in 2013, considerably less than any of the other eight industry groups. And growth is expected to be scant.

billionsUS Digital Ad Spending, by Industry, 2011-2017

Retail

Financial servicesAutomotive

Telecom

CPG & consumerproducts

Travel

Computing products& consumer electronicsMedia

Entertainment

Healthcare & pharma

Other

Total

2011

$7.2

$4.0$3.6

$3.9

$2.5

$2.4

$2.5

$1.4

$1.4

$1.0

$2.0

$32.0

2012

$8.3

$4.7$4.3

$4.4

$3.0

$3.0

$2.9

$1.8

$1.7

$1.1

$2.1

$37.3

2013

$9.5

$5.3$5.1

$4.9

$3.5

$3.4

$3.2

$2.3

$2.0

$1.2

$2.2

$42.5

2014

$10.6

$5.9$5.9

$5.4

$4.0

$4.0

$3.6

$2.7

$2.3

$1.3

$2.3

$47.8

2015

$11.6

$6.5$6.6

$5.9

$4.5

$4.4

$4.0

$3.1

$2.5

$1.3

$2.4

$52.7

2016

$12.4

$6.9$7.9

$6.2

$4.9

$4.7

$4.3

$3.3

$2.7

$1.4

$2.5

$56.5

2017

$13.3

$7.4$7.8

$6.6

$5.3

$5.0

$4.6

$3.5

$3.0

$1.5

$2.6

$60.4Note: includes advertising that appears on desktop and laptop computersas well as mobile phones and tablets, and includes all the various formatsof advertising on those platforms; data through 2011 is derived fromIAB/PwC data; numbers may not add up to total due to roundingSource: eMarketer, March 2013152949 www.eMarketer.com

Nevertheless, pharma appears to be starting to pay more attention to social. KPMG surveyed US pharmaceutical and biotechnology companies and found that 43% of respondents planned to increase their use of social media with patients, while 7% said use would remain the same. However, 46% of those polled either didn’t answer or didn’t know; social media was the biggest source of uncertainty for respondents.

% of respondents

Promotional Methods that US Pharmaceutical/Biotechnology Companies Plan to Implement, June 2012

Mobile applications

Patient assistance programs

Edetailing

Social media with patients

Patient registries for specificdiseases or devices

Product websites for consumers

Product websites for physicians

Social media with physicians

Medical/science liaisons

Promotion of clinical guidelines as standard of care

Sponsored symposia atmedical conferences

Direct to patient advertising

Call centers

Local media educational events

Sales representatives

More

53%

48%

48%

43%

42%

41%

41%

41%

39%

33%

30%

24%

24%

24%

23%

Same

13%

34%

15%

7%

28%

43%

46%

11%

41%

30%

36%

21%

41%

33%

19%

Less

4%

7%

3%

4%

9%

9%

8%

4%

11%

15%

32%

30%

11%

7%

57%

Not sure/decline to

answer

30%

11%

34%

46%

21%

7%

6%

44%

9%

22%

3%

25%

23%

36%

2%

Note: n=54; in the next five years; numbers may not add up 100% due toroundingSource: KPMG, "Transforming Healthcare: From Volume to Value," Nov 8,2012147924 www.eMarketer.com

However much pharma companies’ social spend increases, it will be growing from a very small base. A December 2012 report from Cegedim Relationship Management showed that half of the US pharmaceutical and life sciences companies polled allocated less than 5% of their marketing and sales budget to social media in 2012.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 6

% of respondents

Percent of Sales/Marketing Budget Allocated toSocial Media Among US Pharmaceutical and LifeSciences Companies, 2011 & 2012

<5%29%

50%

5%-10%20%

21%

11%-20%9%

4%

20%+5%

1%

Don't know37%

25%

2011 2012

Note: numbers may not add up to 100% due to roundingSource: Cegedim Relationship Management, "2012 US Pharma Insights,"Dec 3, 2012148630 www.eMarketer.com

What’s the ROI? Aside from broad budget concerns and the changing business environment, pharma marketers are not unlike marketers at large—they worry about how to measure social media marketing efforts, especially tying the investment in social media directly to brand objectives. More than three-quarters of health and pharma executives surveyed worldwide by the Digital Health Coalition cited measuring the effectiveness and return on investment (ROI) of social media as a leading concern.

% of respondents

Leading Concerns and Challenges of Using SocialMedia Marketing According to Health and PharmaExecutives Worldwide, Oct 2012

Measuring the effectiveness and ROI of social media78%

Regulatory concerns78%

Legal concerns74%

Need to educate staff about the effective use of social media70%

Compliance concerns67%

Responding to customer comments in social media52%

Integrating the data/analytics from social media into existingdecision support and ROI

48%

Staying up-to-date on the latest technology trends and changes44%

Adverse event reporting41%

Lack of strategy specific to social media41%

Source: Digital Health Coalition, "Executive Landscape Study 2012," Nov 1,2012152859 www.eMarketer.com

Bruce Grant, senior vice president of business strategy at Digitas Health, believes that questions about ROI are the main reason pharma companies aren’t using social channels. In terms of adopting new marketing technologies, he said, pharma is years behind other industries. “No pharma marketer has really wanted to just become one voice in a conversation. It’s been a hard new skill for pharma marketers to learn.”

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 7

Signs of Activity

Despite regulatory concerns, budget worries and a desire to see more direct evidence that social marketing drives brand objectives, some pharma companies are experimenting—cautiously—with the channel.

Many have Facebook pages, but they often use them for corporate messaging, rather than engaging with consumers about specific drugs or conditions.

Among the other activities:

■ AstraZeneca uses Twitter to reach out to patients, via the hashtag #rxsave, who have trouble paying for medications. It provides links to prescription savings cards or other sources that can help patients get their prescribed medications.

■ Eli Lilly reaches out to industry thought leaders and consumers via a blog called LillyPad. On the blog, the company tackles challenges the pharmaceutical industry faces, including the development of new drugs.

■ Sanofi US uses Twitter and Facebook to reach out to the diabetes community.

■ Roche sponsors Diabetes Nest, a Twitter-based service that aggregates tweets about diabetes.

■ Boehringer Ingelheim uses Pinterest, which is unusual for pharma companies, to integrate information on the company and healthcare conditions it competes in.

■ Pfizer supports a Flickr page called “Can you feel my pain?” Targeted at audiences in the EU, the aim is to raise awareness of chronic pain conditions.

It’s interesting to note that all of the current pharma activity on social media is around disease state information, not specific brands or products. This reflects continued uncertainty around FDA regulations about how pharma companies can use social media to market to consumers. Some allow posts on their social pages but are required to carefully monitor them or use special software to screen posts.

CONSUMER BEHAVIOR

Recent information has suggested that US consumers

now use social media for a variety of health

information needs—from learning about living with

certain health conditions to reviewing treatment

options, physicians and hospitals.

A May 2012 study from Rodale found that, out of the US social media users surveyed, 55% who used social media for health did so to get more information about a medical condition. Reviews and rankings of doctors, hospitals and medicines were the next most cited reasons.

% of respondents

Ways in Which US Social Media Users Use SocialMedia for Health Information, May 2012

Information about a medical condition55%

Reviews/ranks of doctors38%

Reviews/ranks of hospitals31%

Reviews/ranks of prescription medicines28%

Information about alternative treatments27%

Source: Rodale Inc., "2012 Direct to Consumer Survey, Wave 15," July 18,2012145605 www.eMarketer.com

Respondents told Rodale that general health sites were the most useful for information about prescription drugs. But sites such as Wikipedia and patient community sites—which can both be considered social media—also played a somewhat important role, scoring higher than more general social media sites such as Facebook or Twitter. Only 20% of respondents said they found these general social networking sites valuable.

Rodale’s data stands in sharp contrast with information from Kantar Media, which found that among US internet users who frequently or occasionally used social sites for health, the most commonly cited activity (32.4%) was reading blogs about specific health topics.

The different findings highlight the challenge that users face in sifting through multiple sources of information—and marketers face in trying to decide where to engage with consumers.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 8

GENERATIONAL DIFFERENCES Young users have embraced social media far more quickly and fully than older generations. But their use of social media for health purposes does not necessarily translate into straightforward adoption.

According to Deloitte’s 2012 survey of US internet users who used social media for healthcare purposes, millennial internet users were far more likely than older respondents to use social for “any health-related purposes.” Forty percent of millennial respondents said they did so, compared with 17% of baby boomers.

But when asked about using social media for specific purposes, such as investigating health conditions and treatments, the generational differences were much less pronounced. In fact, millennials were no more likely than online seniors to use social media to learn about prescription drugs.

As search results pages begin to integrate social media content, logic would suggest it could become a bigger part of consumers’ use of online health information.

It’s also interesting to note that all demographic segments appear reluctant to comment about their own experiences using the healthcare system. This likely reflects privacy concerns.

% of respondents in each group

US Internet Users Who Use Social Media forHealthcare Purposes, by Generation, Feb 2012

For any health-relatedpurposes

To learn more aboutspecific illness/healthproblem/injury

To offer motivation orsupport to others battlingan illness/injury/healthproblems

To learn more aboutprescription drugs

To comment about yourown experiences usingthe healthcare system

Note: ages 18+; in the past 12 months; e.g., online community support site,chat room or social networkSource: Deloitte, "2012 Survey of US Health Care Consumers: Five-YearLook Back," Dec 14, 2012150771 www.eMarketer.com

40%

16%

14%

10%

8%

Millennials1982-1994

29%

12%

12%

8%

4%

Gen X1965-1981

17%

8%

6%

7%

3%

Babyboomers1946-1964

17%

11%

5%

10%

3%

Seniors1900-1945

While age plays a role in who taps social media for health, among those who actually do use it, the reasons are fairly consistent across all age groups. A survey by GE Healthcare, which asked US social media users about the benefits of using social to discuss their health, found that roughly one-half of all age groups utilized social media as a source of quick or easy information and recommendations.

% of respondents in each group

Benefits of Using Social Media to Discuss Their HealthAccording to US Social Media Users*, by Age, Oct 2012

Quick/easy way to getinformation/recommendations

Ability to get different opinions/suggestions from a wide range of people

Ability to connect with a like-minded community

Fun way to discuss health

Support others in their diet, health & fitness goals

Ability to engage with brands/companies/organizations withproducts/services related to myhealth needs

Share my health-related successstories/experiences

Other

18-34

47%

45%

40%

36%

31%

25%

28%

17%

35-44

55%

58%

48%

37%

43%

31%

36%

14%

45-54

46%

45%

45%

36%

32%

36%

30%

20%

55+

49%

44%

33%

24%

29%

30%

17%

20%

Total

49%

47%

42%

35%

33%

29%

29%

18%

Note: includes forums, message boards, online communities and/or social media sites; *who have used social media to discuss their health in the past 12 monthsSource: GE Healthcare survey conducted by Harris Interactive, Nov 20, 2012151340 www.eMarketer.com

TRUST AND CREDIBILITY ISSUES While consumers do access social media for health information, many are skeptical about the quality of the information. Deloitte found that only 5% of US internet users trusted social networking sites for health treatment information. This casts doubt as to whether people are actually using information from social media as part of healthcare decisions or just reading what others have to say about their experiences with treatment options or living with chronic health conditions.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 9

% of respondents

Sources that US Internet Users Trust for TreatmentInformation on a Health Condition, Feb 2012

Physician group/medical practice

Academic medical centers/teaching hospitals

Medical associations/societiesCommunity hospitalsPharmacies

US Department of Health and Human Services (HHS)

Independent health-related websites

US Food and Drug Administration (FDA)

State Departments of Health and Human Services

Health insurance companies/health plans

Internet search engines/general reference sites

Pharmaceutical, biotech or medical device/product manufacturers

Employers (e.g., health benefits office, human resources office)

Blogs or websites that address specific health issues or connectpeople with similar health conditions

Social networking sites

44%

38%

37%30%27%

26%

24%

22%

22%

14%

14%

12%

12%

11%

5%

Note: 8-10 on a 10-point scale where 10 is "completely trust"Source: Deloitte, "2012 Survey of US Health Care Consumers: Five-YearLook Back," Dec 14, 2012150772 www.eMarketer.com

Levels of trust also differ depending on the source. A survey of US internet users by Makovsky Health and Kelton found varying levels of trust in pharma companies’ Facebook content vs. pages peers created. Still, trust levels were low across the board.

% of respondents

Types of Facebook Pages that Are Most Trusted forHealth Information According to US Internet Users, by Age, July 2012

18-29

30-39

40-49

50-64

65+

Created by pharma abouta medication

12%

9%

7%

9%

7%

Created bypharma abouta disease state

7%

6%

6%

7%

5%

Createdby peers

10%

19%

14%

12%

8%

Source: Makovsky Health and Kelton, "State of Social Media andHealthcare," Sep 20, 2012151040 www.eMarketer.com

PRIVACY CONCERNS The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established privacy rules to protect patients’ personally identifiable health information and set national electronic security standards for the protected information. According to a GE Healthcare survey conducted by Harris Interactive, the No. 1 reason that US internet users polled did not use social media to share health information was privacy (65%).

% of respondents

Reasons that US Internet Users Do Not Use SocialMedia to Discuss Their Health, Oct 2012

Privacy 65%

Time 14%

Familiarity with resources available8%

Not knowing where to go7%

Ease of use4%

Other 12%

Note: n=1,504 ages 18+ who haven't used social media to discuss health inthe past 12 months and are "not at all" or "somewhat likely" to do so in thefutureSource: GE Healthcare survey conducted by Harris Interactive, Nov 20, 2012151342 www.eMarketer.com

Even young people feel that social media is not the place to discuss health problems. A study cited in JAMIA, a journal of informatics in health and biomedicine, found that most teenage patients did not disclose personal health information on social media as “it is not seen a place to discuss their diagnosis and treatment.”

THE PHYSICIAN CONNECTION When it comes to using social media to connect patients with healthcare professionals (HCPs), data suggests that many patients have privacy concerns similar to those around discussing their health problems and questions via social media.

A study from Russell Herder, a marketing, advertising, public relations and digital communications strategy agency, found that it was relatively rare for US internet users to follow a healthcare provider on social media. Only 11% of survey respondents said they did so. However, younger age groups were almost twice as likely to follow a healthcare provider on social media as those ages 25 and older, an interesting communication opportunity, given that younger consumers tend to not see their physicians as often as older age groups.

Physicians are limited in the conversations that they can have online with patients via social media because of privacy issues and HIPAA legislation. Besides, most physicians don’t have the time to engage patients in social media—and many would want to be compensated for this time, which could take the place of an office visit.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 10

% of respondents in each group

Demographic Profile of US Internet Users Who Followa Healthcare Provider on Social Media Sites, Oct 2012

GenderFemale

Male

Age18-24

25-34

35-44

45-54

55-64

65+

Income$0-$24K

$25K-$49K

$50K-$74K

$75K+

11.3%

11.0%

21.1%

11.3%

11.4%

13.1%

7.9%

3.0%

7.6%

14.1%

12.3%

13.3%

Note: e.g., clinic, hospitalSource: Russell Herder as cited on company blog, Nov 16, 2012149654 www.eMarketer.com

OPPORTUNITIES FOR PHARMA MARKETERS

While potential barriers exist when it comes to using

social media to market pharma products, there are

also opportunities to include it as part of an online

integrated marketing program.

1. OFFER VALUE In a report on social media and healthcare, PwC stated that a majority of US internet users surveyed would find value in drug companies using social media to offer discounts or coupons (68% of respondents) and for customer service (65%). This suggests that consumers would be open to social media communication from pharma companies if the messages are seen as helpful. Given that high healthcare costs are a concern to many consumers, they would likely welcome pricing information and discounts. Pharma companies could use social channels to remind patients that discount prescription cards are available from branded or corporate websites, as well as provide contact information for patients who may not be able to afford prescription drugs.

% of respondents

US Internet Users Who Find Value in Services Offered by Health Insurers and Drug Companiesvia Social Media, Feb 2011

Healthinsurance

Discounts or coupons 67%

Voice complaints/seek customer service 67%

Appointment reminders 67%

Information to find cheapest medication 67%

Treatment reminders 65%Support groups for similar patients 58%

Share positive experiences with other patients 54%Games/contests encouraging healthy behavior

Drugcompany

68%

65%

58%

65%

60%56%

53%42% 42%

Note: n=1,060; "somewhat" or "very valuable"Source: PricewaterhouseCoopers (PwC), "Social media 'likes' healthcare:From marketing to social business," April 17, 2012141357 www.eMarketer.com

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 11

2. LISTEN IN ORDER TO BUILD THE BRAND Listening can be a challenge for marketers, but that’s one opportunity that social media provides.

Brendan Gallagher, senior vice president of emerging technology and channels at Digitas Health, sees social activity not as something separate from the brand, but actually part of it. “The community that surrounds a product’s service offering … may inspire brand preference over time,” he said.

That parallels efforts at Sanofi US. Dennis Urbaniak, Sanofi’s vice president, US diabetes, ties social media into the company’s overall goal of being more patient-centered. “We view social as a great way to listen and build a relationship within those communities that we serve,” he said.

In fact, according to Urbaniak, social channels should not be seen as promotional at all. “Any social media channels are primarily intended for listening, for relationship development and a two-way exchange, but they’re not at all advertising or promotional channels.”

That said, Gallagher noted that AstraZeneca monitors social media for mentions of company products and, when appropriate, responds with pre-approved messaging.

3. PARTNER WITH ESTABLISHED ONLINE HEALTHCARE PROPERTIES One way to get around trust and credibility challenges in the social space is to partner with established online healthcare websites. In particular, nonprofit organizations are likely to be viewed as more credible and trustworthy than for-profit pharmaceutical marketers—and are generally not subject to FDA scrutiny.

4. TAP INTO ONLINE COMMUNITIES One path to developing trust on the social web is to work within online communities. As mentioned earlier, there are high levels of distrust for information on Facebook posted by pharma companies. But Deloitte’s survey showed fairly high levels of trust for physician group and medical practice websites, among other health sector sites, suggesting partnership and communication opportunities.

A survey by WEGO Health and Digital Health Coalition found that 30% of US health activists surveyed, including social media opinion leaders, had positive perceptions of pharma companies that were active in online communities. This could also provide a better channel for connecting with consumers, as well as a great way to reconnect with consumers who are skeptical of marketing claims and establish a level of trust with patients who view pharma companies in a negative light. Still, nearly half of the respondents said they had negative views.

% of respondents

Online Health Communities' Perceptions ofPharmaceutical Companies According to US Health Activists*, Sep 2012

Positive and very positive30%

Neutral23%

Negative and very negative47%

Note: *social media opinion leaders on blogs, community groups,Facebook, online discussion, Pinterest and TwitterSource: WEGO Health and Digital Health Coalition, "Social MediaParticipation: A Moral Imperative (And Good Business)," Oct 18, 2012151062 www.eMarketer.com

Dan Hickey, senior vice president of products at Alliance Health, sees online communities as a means for pharma marketers to engage with users in a way that is not considered advertising. Note that Alliance Health provides community health sites, but the point is well taken. Hickey said that content such as surveys and quizzes allows pharma companies to provide educational material without creating the impression of advertising.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 12

5. DON’T NEGLECT THE PRODUCT/BRAND WEBSITE comScore research has shown that branded pharma websites increase awareness and conversion. While consumers are accessing social media for health information, there is no specific data to indicate they are actually using it to make healthcare decisions. Some marketers are beefing up the content on their websites and treating their brands as a source of information for consumers who want the latest and best information. An updated product website may provide a better ROI than social media, but research that provides insight into audiences’ specific needs is necessary to understand what will affect their decisions when it comes to healthcare.

CONCLUSIONS

While it is clear that consumers use social media

for health information, questions remain about the

marketing effectiveness of the social channel. In

all likelihood, social use for health varies by health

condition and the target audience’s online behavior.

Social media poses both potential risks and opportunities for pharma marketers in the US. The audience size is significant, but trust issues may foil marketers’ attempts to tap the social channel.

The FDA is not scheduled to release regulatory guidelines for social media marketing until 2014. US pharma marketers need to ask themselves if they can afford to wait that long, given the current size of the social audience.

Shrinking DTC marketing budgets may limit social media implementation. Budget pressures could lead many pharma marketers in the US to opt for marketing initiatives with proven ROI.

The most useful websites for general information on prescription drugs are general health and prescription drug sites themselves. US consumers are using social media more for information around specific health conditions rather than prescription drugs.

There are generational differences in how consumers use social media for health. Younger people are more engaged with social media and therefore may seem like a natural target, but this age group is skeptical about the information found on social sites, whether it is created by users or pharma companies.

SOCIAL MEDIA AND HEALTHCARE: CHALLENGES FOR PHARMACEUTICAL MARKETERS ©2013 EMARKETER INC. ALL RIGHTS RESERVED 13

EMARKETER INTERVIEWS

B2B Perspective: How Pharma Should Handle Problematic Comments on Social Networks

Wendy Blackburn Executive Vice President

Intouch Solutions Interview conducted on February 28, 2013

Digitas Health: Pharma Companies Lag Behind in Understanding Social

Bruce Grant Senior Vice President, Business Strategy

Digitas Health Interview conducted on February 22, 2013

Sanofi US Shares Best Practices for Diabetes Patients’ Blog

Dennis Urbaniak Vice President, US Diabetes

Sanofi US Interview conducted on March 4, 2013

Lee Aase Director, Center for Social Media

Mayo Clinic Interview conducted on March 12, 2013

Brendan Gallagher Senior Vice President, Emerging Technology & Channels

Digitas Health

Interview conducted on March 12, 2013

Dan Hickey Senior Vice President of Products

Alliance Health Interview conducted on March 8, 2013

RELATED LINKS

Alliance Health

Capgemini

Cegedim Relationship Management

Cegedim Strategic Data

comScore

Deloitte

Digital Health Coalition

Digitas Health

The Food and Drug Administration (FDA)

GE Healthcare

Harris Interactive

Intouch Solutions

JAMIA

Kantar Media

Kelton

KPMG

Makovsky Health

Manhattan Research

Mayo Clinic

Medical Marketing & Media

Nielsen

The Pink Sheet

PricewaterhouseCoopers (PwC)

Rodale

Russell Herder

Sanofi US

US Federal Trade Commission (FTC)

WEGO Health

EDITORIAL AND PRODUCTION CONTRIBUTORS

Cliff Annicelli Senior EditorKaitlin Carlin Copy EditorJoanne DiCamillo Senior Production ArtistStephanie Gehrsitz Senior Production ArtistDana Hill Director of ProductionNicole Perrin Associate Editorial DirectorAllie Smith Director of Charts