New-to-brand (NBRx) may be a more valuable measure in differentiating between a true new patient—one who has never been on the brand before—and a new prescription.
When it comes to new medicines, correctly identifying physicians who are early adopters of these treatments and building them into regular prescribers is a key to successful, long-term brand performance. A 2009 IMS Global Launch Excellence study showed that fewer than 25% of 4,000 launches significantly improved market share launch trajectory between six months and two years. Traditionally, the total prescriptions (TRx) metric has been a key metric used by the pharmaceutical industry to gauge a medicine’s launch performance. However, this metric lags compared to the new-to-brand (NBRx) metric, resulting in delayed decisions and non-optimal brand performance. IMS research has found that NBRx is a more valuable metric in differentiating between a true new patient— one who has never been on the brand before— and a new prescription (NRx), which in many cases is actually for a patient continuing on therapy. This is good news for brand managers, who can now utilize the NBRx prescription metric to better identify prescribing patterns before they become fixed and target “early adopter” physicians to improve product performance.
NBRX INFLECTION AND PHYSICIAN LEVEL DYNAMICS
Launch inflection identifies when the initial launch uptake phase has ended, as defined by eight weekly data points being flat or three consecutive monthly data points with less than 10 percent month-over-month growth. In an IMS analysis of 150 launches in the U.S. from 2004 to 2010, we found that NBRx uptake inflection, on average, occurs at 14 weeks postlaunch, with 90% of brands inflecting between week nine and week 26. NBRx represents “patients in play” within a therapeutic category—new to therapy, additions to therapy and switch in therapy. Inflection volume is largely driven by switch patients, while post-inflection change is due to dynamics in the patient pool—naive versus switch patients and marketing interventions such as managed care wins, direct to consumer (DTC) initiatives, co-pay cards, etc.
There are several dynamics at the physician level that causes changes in NBRx volume. These include the total number of NBRx writers for a product being dependent on two factors: initiators and adopters. Initiators are composed of physicians who wrote an NBRx for the first time, while adopters are physicians who have written an NBRx in the last two months. For this study, we used a higher-level definition of adopters and we allowed prescribing frequency and productivity to further define the types of adopters.
A CLEAR PATTERN
In our current analysis of 14 launch products there is a clear pattern of early inflection with limited growth post-inflection. In fact, as shown on figure on the adjacent page, NBRx leads TRx performance by approximately seven months. Our analysis examines the correlations between NBRx volume change with initiation, adoption and productivity. Assessment of physician initiation, adoption and productivity provide insights for future launches, including:
• When does physician initiation and adoption
• After initiation, what is ongoing NBRx
• How does NBRx productivity change over
• Does timing of NBRx initiation affect NBRx
frequency and productivity?
• Are there predictable NBRx initiation, adoption and productivity patterns that can be used to inform resource allocation and forecasting models?
Launch inflection identifies when the initial launch uptake phase has ended. Once a brand experiences NBRx uptake inflection, NBRx volume varies post-inﬂection. In our study, ﬁve brands increased an average of 11% from point of inﬂection to 12 months post-launch, while nine brands decreased an average of 21% from point of inﬂection to 12 months post-launch.
NBRx volume at inﬂection and post-inﬂection is driven by physician initiation and adoption; productivity is most inﬂuential on post-inﬂection growth. Expanding the number of NBRx initiators has the largest impact during launch, as building a strong base of adopters will help prevent a decline in NBRx volume. NBRx productivity has maximum effect on NBRx growth post-inﬂection.
TIMING IS EVERYTHING
On average, a launch brand’s rate of NBRx initiation diminishes after month three. Capturing a high-rate of early initiators is critical to establishing a steep launch trajectory. By month four, higher priority needs to be given to establishing a strong base of NBRx adopters with steady productivity. Understanding when to change focus is critical for success.
In building the base of NBRx writers, physicians who initiate during the ﬁrst three months of launch produce more than double the number of NBRx prescriptions than physicians who initiate in months four through eight. Correctly identifying early adopters is a key to efﬁciently using resources and building long-term performance.
Time of initiation matters in terms of prescribing frequency; after NBRx initiation all cohorts erode, with the early initiating cohorts showing a higher frequency of prescribing. Building an NBRx base that prescribes on a regular basis requires ensuring successful trial use and expanding a physician’s ﬂow of ideal patients.
Prescribing frequency is associated with patient ﬂows, meaning the brand team needs to increase patient ﬂow through managed care wins and expanding the patient type that would beneﬁt from the brand.
CONSIDER FREQUENCY ADJUSTMENTS
Peak NBRx productivity occurs in the second month of launch and typically declines throughout the next 10 months. Except for prescribers who initiate in month one and two, segmenting productivity by month of adoption shows that prescribing productivity does not change signiﬁcantly. Brand managers should consider frequency adjustments to later cohorts of adopters. Productivity declines vary by product; products that beneﬁt from pent-up demand and brands that launch with a conversion strategy, such as ﬁx dose combinations (FDCs), typically show large productivity declines due to switch volumes that are not sustainable.
TRx performance is predicated on NBRx, which is determined by the breadth of initiation, adoption and their subsequent productivity. IMS’s NBRx analysis presents key takeaways that will enable brand managers to make better decisions in the months following launch. The results provide insights that should help prioritize sales force efforts, as well as messaging for physician acquisition and trial, physician adoption, and physician productivity. Our analysis quantiﬁes the importance of early adopters and referral networks to allow for deeper conversations on go-to-market strategies and allocation models. Furthermore, a new set of predictive key performance indicators (KPIs) for initiators, adopters and levels of productivity have been identiﬁed that allow brand teams to take corrective action much earlier than with traditional metrics.
When it comes to NBRx versus TRx, each metric tells a slightly different story, but its impact is different on the decisions that brand managers make and when these decisions are made. In the end, it’s about behavior modiﬁcation and NBRx provides a key leg up for decision-making and brand performance.