In his meta-analysis, the “Effects of Pharmaceutical Promotion: A Review and Assessment,” Dhaval M. Dave, Ph.D., found that 1) consumer advertising is more effective at expanding the market, driving patients into the doctor’s office, educating consumers and fostering adherence, and 2) physician advertising is more persuasive in nature, helping to drive brand demand.
To help us understand the effects of advertising promotion in today’s evolving pharma landscape, Panorama had the opportunity to speak with Dave on his research findings, the applicability of using traditional and digital forms of advertising today, and how he would advise pharma marketers.
In today’s pharma advertising environment, we’re seeing budgets for DTC advertising cut and reallocated to pursue a digital marketing strategy. Do you think traditional advertising to consumers and physicians would still be effective today and give the best bang for the buck?
How the drug industry promotes its products is undergoing a transition. Pipelines have been shrinking, blockbuster drugs are fewer and farther between, the regulatory environment is evolving, and social media and digital information sources use has grown.
In recent years, DTC advertising has decreased. Part of this trend is related to fewer drug launches and approvals compared to the late 1990s, and an increasing share of new drugs that tend to be targeted at specialist physicians—for instance, cancer and “orphan” drugs used to treat rare conditions. Optimal promotional strategy of such drugs may not include DTC advertising. Furthermore, optimizing strategy also generally requires reducing DTC ads over the drug’s lifecycle. Hence, with the aging of the conventionally heavily advertised lifestyle drugs and with some of them going off patent, DTC ad budgets have been declining.
At least in principle, online or digital advertising may offer a more targeted approach to advertise drugs (both to patients with specific needs and specialist physicians) which are niche drugs or indicated for rare or specialized conditions. As some of the newer drugs tend to fall into this category, it makes sense to include such targeted promotion. As treatments become more personalized, promotion may further rely on more targeted digital advertising. Surveys show that the majority of consumers and physicians turn to online sources of health and treatment information. Hence, it further makes sense to include digital information sources as part of an overall promotional strategy. But, this is a new territory for the industry; firms have limited experience with online campaigns, and the industry is cautious, with good reason, due to privacy and regulatory concerns. There will be a lot of learning-by-doing in this promotional market.
Broadcast DTC ads, on the other hand, probably should still constitute part of an overall promotional strategy for drugs indicated for conditions that are highly prevalent in the population such as cardiovascular, mental health and respiratory conditions. Conventional media will continue to play an important role. The focus of these broader ads may shift, however, as these ads may function along the lines of informing consumers about newer drugs, appropriate use and adherence.
We’re seeing in today’s quickly evolving pharma/patient landscape that patients are becoming more educated about their conditions. Do you think there are any forms of traditional DTC advertising (radio, TV, print, etc.) that would still be effective at targeting educated patients? What about lower income, less-educated consumers?
Research has shown, at least when it comes to conditions that affect some part of a large population, that DTC ads can be effective in informing patients regarding their symptoms, treatment options and facilitating a visit to the physician (who can then complement and provide more information). For these types of drugs (cardiovascular, mental health, some other lifestyle drugs), traditional media still plays an integral role in reaching large portions of the potential market. This may be particularly relevant for new drugs entering the market, of which consumers (and physicians) may be unaware.
Hence, traditional media-based DTC ads inform consumers about newer products. After this point, digital ads complement these efforts, since patients regularly rely on online sources to research a drug. The goal is to build trusting relationships with patients to answer their questions, to provide information, and to “work with” such empowered and informed patients; this can also help to successfully build brand capital. One way to think about this is as complementary ad campaigns and media sources that account for the appropriate market, patient population, underserved areas, lifecycle of the drug, etc.
Less-educated, low-income consumers can also be served by such information sources and DTC ads. Many conditions (high cholesterol, mental illness) tend to be undertreated, providing an opportunity for the industry as well as an impetus from a public health perspective. Part of this may have to do with disparities in healthcare coverage and use. But, some research suggests that some of these populations are exposed to more Rx DTC ads (for instance, due to TV viewing habits, etc.). Hence, a mixed media strategy may also provide a source of information on socio-economically disadvantaged and racial or ethnic minority groups who have a lower prevalence of treatment with pharmaceutical treatments for certain underdiagnosed conditions.
You cited that consumers respond to advertising because it is 1) persuasive, 2) informative and 3) complementary. Which of these views, if not all, are well-received by today’s consumer to drive demand? Why?
Patients today are far more empowered than in the past, partly due to digital information sources. Many turn to online sources first before consulting their physicians. Thus, there is a demand for health information from the patient side. The advertising economic suggests that it can be effective in driving demand for each of the three reasons noted—it can be purely persuasive, it can bridge an informational gap, or it can be complementary to the drug itself—almost as if it were an external attribute of the drug.
Given the large demand for health-related information, prevalence of undertreated or undiagnosed conditions, and failure among a large portion of patients to comply with their physician-recommended drug therapy, DTC ads that inform without being misleading and that encourage patient/physician contact are likely to have the strongest synergies in terms of promoting public health while potentially creating brand capital and resonating positively with the public.
Piggy-backing on the previous question, which view do you think is the best strategy for a pharma company?
The objective of advertising any product is to make a sale and to raise demand. However, with drugs, the logistics are more involved since several prerequisites need to be satisfied. The ad must convince the patient to visit the physician. The physician must determine an appropriate course of treatment, which involves the drug in question, and subsequently write a prescription. And, finally the patient must fill this prescription. This sequence is why promotion needs to be thought of as a series of complementary efforts—DTC ads, provider-directed promotion, targeted ads for certain drugs or populations, and even complementary pricing strategies such as formulary placement.
From the same standpoint, informative consumer ads may be the best bet toward “persuading” them that visiting a physician confers a benefit. This first step in the sequence is key. Ads that inform and remind consumers of the benefits of drug treatment also help toward raising compliance. For newer drugs, ads could play an integral role in informing consumers about a drug and the potential benefits it offers over other treatments. With respect to physicians, promotional efforts that are informative with regards to existence of the newer drug, the incremental benefits over current drugs, indications and counter-indications, etc., may be particularly helpful. Physician prescribing patterns tend to be sticky. Hence, convincing both consumers and physicians of the added value of drugs early on in the lifecycle can have lasting benefits.
In your research, you cite a number of studies that found that DTC spending positively impacts sales and drives high demand. Today, we’re seeing that pharma companies are increasingly using an unbranded campaign strategy in both DTC and DTP ads. In your expert opinion, do you think that there is a difference in demand and sales with brand-specific DTC/DTP ads versus unbranded or general therapeutic class advertising?
There has been limited rigorous research, which has specifically looked at whether, and to what extent, unbranded disease-oriented or reminder DTC ads are effective in raising prescriptions. Some anecdotal evidence (for instance, sumatriptan in the early 1990s, Novartis’ unbranded TV ads in the Netherlands where branded DTC ads are not permitted) suggests that such ads can raise sales. However, in terms of comparative sales effects, it is difficult to say.
Unbranded ads tend to have a specific message geared towards informing patients that a treatment (or a better treatment) exists for their symptoms. Thus, the objective is to get the patient to visit the doctor and facilitate a diagnosis and discussion of treatment options. If the particular drug is the only treatment option, then such unbranded ads could have strong effects on sales. If there are other treatment options, but the particular drug in question is new or innovative and superior to current treatments, then such ads could also cause strong demand effects. Or, if there are multiple drugs in the therapeutic class with more or less similar effectiveness and counter-indications, but the particular drug in question has a preferred position on the insurers’ formulary, then ads that induce the patient to visit the physician may also lead to stronger demand effects. If these conditions are lacking, then it is possible that unbranded ads may have weak or nil effects.
Unbranded ads may also play a more important role in the future, particularly with respect to digital and social media advertising. Some anecdotal evidence suggests that consumer sentiment on web forums, postings and discussions tend to gravitate to the negative, often focusing on side effects and other contra-indications, when it comes to discussing a branded drug.
If a marketing team wants to determine whether their marketing dollars should be spent on traditional DTC/DTP vs. digital advertising/marketing, what would you advise them?
From an economics perspective, optimal allocation requires that the monetary benefit conferred by the last dollar in each type of promotion or medium is equalized. While there is a large literature on DTC and DTP ads, there are virtually no rigorous studies of digital ads in the Rx market to rely upon when determining how and where to allocate the promotional budget. This is still a very new landscape, and will require a bit of trial and error to find the right mix and components. Though, I think it is important to understand that not all types of promotion and media ads would be appropriate for all drugs. For drugs that are highly innovative and confer significant benefits over competitors—and are indicated for highly prevalent and underdiagnosed conditions—DTC and DTP promotion should remain an integral part of the firm’s strategy.
For drugs that are indicated for specialized and rare conditions, a more targeted marketing strategy that relies on digital ads may be appropriate. Though I should also note that digital promotion should not be thought of as simply direct online advertising or maintaining the drug’s web page. Digital promotion should be interpreted more broadly, in terms of empowering consumers and patients, for instance, by facilitating the sharing and exchange of information, encouraging patient groups and forums centered on the drug and/or ailment, providing guides to research and resources for both consumers and doctors, and such. When thought of along these lines, digital advertising no longer needs to be restricted to only specialized diseases and conditions. Taking advantage of the digital media in such non-conventional ways can fully complement the more conventional forms of DTC and DTP advertising.
What is the biggest takeaway you would like readers of your research to walk away with?
From a public health perspective, the costs and benefits of pharmaceutical promotion are not black and white. Pharmaceutical promotion can inform consumers, expand treatment to underserved populations and encourage appropriate use of drug therapy, though there is also a responsibility on the part of firms to present their message in a fair, balanced and non-misleading manner. Informing consumers about newer and better treatments and expanding treatment for undertreated conditions can also help the firms’ bottom line; hence, the goals from a public health perspective and from the firm’s profit perspective can be aligned.