Thirty years ago, medical marketing history was made with the launch of the first direct-to-consumer (DTC) TV advertising campaign for Marion Merrell Dow’s Seldane. On the heels of the prescription antihistamine’s blockbuster success, medical marketers’ eyes opened suddenly to the possibility of engaging consumers directly to “ask your doctor” about an Rx drug choice.

Armed with this new insight, creative minds within advertising and public relations agencies went to work making patients part of the disease awareness and therapeutic choice wave. If the idea was attention-grabbing and gained sufficient media power, patients would be motivated to ask for a drug by brand name. This formula contributed to awareness around heart disease risks, breast cancer awareness, and HIV prevention. It also created wave after wave of blockbuster prescription brands.

Fast forward to today. DTC remains an important avenue to alert consumers to disease conditions that place them at health risk. Celebrities continue to secure seats on the morning talk-show circuit, fill satellite media tours, and schedule editor desk sides. To many in product management and marketing—despite continued Food and Drug Administration scrutiny—creative ideas and top-name personalities that grab headlines and spur consumer choice and demand remain a proven path to increasing brand visibility and traction.

The Emperor Has No Clothes

The new health economy has thrown a wrench in the “consumer as king” growth engine. Perhaps the current economic realities that put pharma, payer, provider, and patient at odds brings up the question of whether the consumer ever attained royalty status. What king or queen must wait patiently to see a doctor, change health insurance frequently to keep costs in check, or switch primary care physicians to correspond to their payer’s roster of providers? What regal personality receives a prescription for one drug and is denied it because it’s not on their plan formulary?

Data from Finn Futures Health, a 1,000-person national poll, explore how consumers understand and navigate the health system when it comes to relationships with their health insurance plan, primary-care provider, and medications, and looks at the behaviors behind these choices and how their decisions influence marketing communications and investment.

Many in the health marketing community continue to cite “The Consumer as King.” However, royalty—even a monarch from a small duchy—holds ceremonial powers and receives warm regards from their community. In today’s health economy, in which 87% of the population has some form of health insurance, consumers are waking up to the reality that they have little sway—or even ceremonial influence—over a health system that is vital to their longevity. If information is power, American consumers still lack sufficient knowledge of what a health insurance formulary actually is, how and why it is developed, and whether the drugs included address their specific medical needs.

Understanding how the health product system is created and managed will be key to enabling consumers to have greater sway over formulary access. But consumers and the system don’t speak the same language. Payers create formularies to provide their members with care and use competitive market forces to get drug prices in line. Consumers are only somewhat familiar with the terms “prior authorization” and “formulary recommended.” A lack of understanding around balancing care and cost is perceived by consumers as an obstacle to exercising choice.

Americans are evenly split on whether they read their health insurance plan benefits, but those most likely to do so have been with the same plan for six to 10 years. However, data show that most Americans change health insurance plans every three years or less. As plan rates change, employers and private payers go to the open market to find something less expensive. If consumers are healthcare royalty, then their rule is without power.

The force of influence within the health system is not the consumer. Rather, it is consumerism—economic flow among sectors of care. Each of these major health sectors—payers, providers, pharmaceutical companies, and policymakers—are centered on addressing patient needs. All are focused equally on how to provide access to care, offer the best medicines, and secure their own financial well-being.

Consumers Become Their Own Health Historians

Unlike other developed nations such as the United Kingdom, where patients have access to and own their electronic health records (EHR), U.S. consumers are their own health historians. The U.S. healthcare system forces consumers to navigate medical care on their own, putting convenience and cost into the forefront of their decision-making. This fragmentation of information is influencing how people access health providers.

In a recent Harvard Business Review blogpost titled, Speeding Up the Digitization of American Health Care, Dr. David Blumenthal, president of the Commonwealth Fund and former National Coordinator for Obama Administration Health IT, and co-author Aneesh Chopra, co-Founder and executive vice president of Hunch Analytics, and the first Obama Administration Chief Technology Officer, offer a promising view of EHR yet unrealized:

“No more of those infuriating forms to fill out at doctors’ offices: The information is all on the computer. Doctors and hospitals don’t repeat tests you’ve had someplace else—they’re all on the computer. All your caretakers know exactly what medicines you’re on and what you’re allergic to—that’s on the computer. When your elderly mother moves from a hospital to a rehabilitation center, the nurses and doctors there know all about her before she arrives—all on the computer.”

However, the optimistic and practical outlook suggested by health IT gurus is still far off. Dr. Blumenthal and Chopra assume that consumers remain loyal to health providers because that is where their personal health history is archived.

“Patients tend to be loyal to doctors and hospitals at least in part because that’s where they’re known—that’s where their records reside. If that information can travel to another hospital or doctor at the push of a button, patients can more easily leave current providers behind. That’s not good for business.”

Revolving Health Plan Relationships Lead To PCP Disconnect

Results from Finn Futures Health show consumers who change health insurance plans frequently switch their primary care physicians just as often. While consumers cite their primary care physician as the most trusted source for medical information, half of Americans with health insurance have had a relationship with their primary care physician for fewer than three years. Additionally, less than 50% of respondents said they saw their personal physician twice a year, and many only when ill or reminded. This lack of medical provider continuity will soon impact health behavior, disease-awareness engagement, and pharma marketing.

Lack of EHR, health insurance coverage that changes for 50% of the population every three years, and equally frequent switches in primary care providers is creating a new health consumer DNA in the 45—and younger—U.S. population. The 65-plus population covered under Medicare Part D retains a traditional connection to their family physician.

While the primary care physician is still the go-to source for health information (54%) during those infrequent office visits, medical information websites are the second choice (21%) for addressing questions. Yet an important trend is on the rise. Suddenly, alternatives to primary care are gaining favor. More and more of the under-45 crowd saw walk-in medi-merge clinics, pharmacists and telemedicine as a convenient and cost-sensitive health destination. Walk-in clinics and pharmacies are easily accessible, and the latter is a no-cost, credible source.

The diminishing importance of the patient-primary care physician relationship is creating a gap in health information and preventive care. If this trend continues, no longer will there be a point of care reminding consumers to schedule annual check-ups or diagnostic exams.

Physicians are still important to consumers in addressing drug questions. During those visits— whether to a family physician or walk-in-clinic—consumers use that moment to ask about their prescription medications. Yet those visits are so infrequent that consumers are turning more to pharmacies (30% of the time) that are readily available, open at convenient hours, and offer free advice. Pharmaceutical industry drug-brand websites fall a distant third at 8% when it comes to fulfilling patient information needs.

Economics, Convenience, And Cost

The younger crowd has developed an Amazon Prime “convenience and cost” prioritization in consumer-product purchase and access to health needs. Gone are the days of the friendly Dr. Marcus Welby family physician who tended to our grandparents, parents, and even our children. Now the physician relationship is seen as an extension of the co-pay office visit system. If the doctor is not part of their insurance plan, consumers simply shop for a new one.

Using walk-in clinics, consumers shoulder their own health history—including or forgetting background at the varied visits. Health has become a consumer-buying experience. That choice does not make the consumer or patient part of healthcare’s royalty. It does welcome the consumer to participate in this new market dynamic.

That shift in the health economy is not lost on payers and pharmacy benefit managers who are rallying to use consumer pocketbook concerns to support formulary priorities. Now pharmaceutical marketers must reflect on how those economic and consumer decision-making patterns converge around brand-building efforts. Just as consumers are no longer wed to a physician relationship, Finn Futures shows that they are not rooted in prescription brand loyalty.

Retail pharmacists have significant sway as to the final decision on what Rx brand consumers will take home. Though encouraged to “ask their doctor” for a specific medication, once consumers arrive at their pharmacy, formulary is the clear gatekeeper. Pharmacists charged with balancing care and cost will, 67% of the time, recommend an alternative brand to reduce patient out-of-pocket costs.

How does that pharmacy guidance impact the final decision? According to the 1,000 consumers polled in the Finn Futures survey, the majority will accept the pharmacists’ alternative medication suggestion. At this point, the market force—negotiation between pharmaceutical managed market teams, payers, and pharmacy chains—will determine the outcome of brand marketer success. While creative campaigns may drive consumers to see their doctors, words from a trusted medical provider and out-of-pocket costs are playing a bigger part of the final consumer decision.

Pharmaceutical marketers have long sought to address the consumer cost burden by adding “co-pay” cards that pledge to cap the monthly cost of a branded medication: However, only 19% of Americans under age 65 are aware that they even exist. While pharmaceutical companies are ready to address consumer concerns around drug costs, lack of awareness around co-pay savings options and payers gearing up to limit their future use will require new creativity and negotiations with health insurers.

Shift In Power And Influence

Pharmaceutical marketing often operates under the optimistic parameters set 30 years ago with the introduction of the Seldane DTC campaign. If you drive consumers who are knowledgeable about their health needs and a possible solution into their doctor’s offices, they will walk out with a brand prescription. That approach has saved and improved countless lives from the dangers of heart disease, stroke, allergies, depression, and many other life-debilitating concerns. At times, it also failed (e.g., gallstone therapy of the 1990s). However, this approach works! It falls flat at the point of sale—the pharmacy—where payers can influence the choice outcome.

The health economy is now in full swing. Payers and providers are seeking to fulfill their patient care mission and watch their operating costs. They too have become savvy at what patients expect and how to use market competition to balance their bottom line. Pharmaceutical marketing and public relations firms will now have to apply new insight and magic to their creative efforts and a full understanding on how the patient navigates the health system and how economics—consumerism—is the new healthcare environment royalty.

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