In the film Beaches, CC Bloom, Bette Midler’s character, delivers the memorable line: “But enough about me, let’s talk about you… what do you think of me?” I have found in many discussions with brand teams that they view their market pretty much the same way CC viewed the world—unable to look past their brand. Although it is natural for a brand team to focus on its own brand, it is useful, and even necessary, to remove it from the picture for a while: when you take yourself out of the picture you can actually see the scene more clearly. When you are trying to understand how a physician decides on the use of your product, ask first how they decide on the use of any product. Because of the natural tendency to frame everything in the light of your own product, you might completely miss some important aspects of the wider market.

The problem, which I called “inverted focus” in my 1997 book, Elements of Pharmaceutical Pricing, is obviously not new, but it is persistent. When people say they don’t see the problem, I ask them to simply look to the way much marketing research is done: we ask which features of the product are most important, and for how many or what percent of their patients they would prescribe your product. But prescribers don’t start with a product then look for patients; they start with a specific patient and look for the most appropriate product. That’s a distinction with a big difference.

ROUND PEG, ROUND HOLE

Even if your drug is a market leader or the “gold standard” the market does not revolve around it. Your product is a peg that fills a particular hole, and the prescriber starts with the hole and seeks the peg, not vice versa. While doing some recent work for a company with a physician-administered drug, we confronted the challenge of helping them see past their own product and programs. They had implemented a few different programs, such as contracting and patient assistance, in hopes of building more business. They did this because the feedback they got from several physicians was that the drug was great but that it “cost too much.” Assuming that reducing the cost to the physician and the patient would generate more business, they took steps to do that—only to find that their share stayed flat. But why, if you are solving a problem, would that happen?

When asked about the product, physicians said it was costly because that was true—it is the most expensive product in the category. But the “problem” of flat sales was a clinical issue, not economic. The physicians were stating facts but not describing the situation. They were not using more of that specific drug because they didn’t need to: they used it for the patients that needed it and other drugs for different patients. Although there was some overlap in appropriateness of drug choice, for the most part the choices were clear: The physician would examine the patient and order tests to determine which product would be best to use. Instead of focusing on understanding product selection, the brand team couldn’t look past their product —enough about me, what do you think of me?

Another firm with a respiratory product segmented their market into “loyalists” and “spreaders,” and assumed that the “spreaders” just had not yet settled on a preferred product. They established plans around converting these “undecided” physicians into loyal users of their product. Had they taken the time to ask each segment to “tell me how you select a product in this category” they would have found that the “loyalists” selected a product that seemed to work for most patients and referred non-responders to specialists—they were driven by simplicity and ease of use. The “spreaders,” whom the team believed to be undecided, were, in fact, carefully assessing the merits of each product and prescribing for the individual patient. They weren’t randomly assigning different drugs to different patients; they were doing things on purpose. But because the brand team would not look past its own product, rather than asking, “How is the decision made?” they asked, “Why don’t you use my drug more?” Had they taken themselves out of the picture, they would have learned a lot—because they would have seen so much more. When physicians are asked how they select medicines, they don’t start with the drug; they start with the patient. The market isn’t about any one drug or even all the drugs; it’s about their use.

THE PATIENT WORLDVIEW

A similar inverted focus shows up in the way we address patients. They don’t care as much about your brand as you do, and they never will; they want to feel better or stay healthy. A patient is very unlikely to ever have or want a “relationship” with their blood pressure med or chemotherapy, any more than they want a relationship with the Champion spark plug that happens to be firing in their car’s cylinders. They want the drug to be there when they need it, and they would resent having to pay for it. That’s very different from the way they treat their iPhones or even brands of beer. The tendency to focus inwardly isn’t restricted to the brand level; the entire industry tends to view the world through the biopharmaceuticals lens. When the National Institutes of Health published their targets for the first round of comparative effectiveness research (CER) studies, the entire industry (including trade associations) rose in protest and panic. But it turns out that only about 10% of the studies involved drugs, and less than half of those were about individual drugs or categories. More studies aimed at learning how to use drugs more, or better, than evaluated one drug against another. Medicines account for about 10% of healthcare spending, so it is only natural that those trying to improve the system would not focus on drugs (in economics it’s called the ”importance of being unimportant” and helps explain why so many of the “rules” of economics don’t really apply to biopharmaceuticals). Yet the industry still tends to think that CER is all about them. The same applies to healthcare reform: The potential effect on biopharmaceuticals is minor compared with the other aspects of reform.

PHYSICIANS’ REAL CONCERNS

When physicians are asked about their concerns, you won’t hear them talking about the prices of drugs or even their reimbursement for drugs. They might talk about patient costs, because some patients complain about any expense, but physicians’ big worries revolve around the potential for a 20% (or greater) cut in Medicare reimbursement for their services, their ability to collect co-pays from patients, and their reimbursement from insurers. Your drug might not be able to solve any of these problems, but if you don’t understand that this is what is going on with your customers, any marketing plans you put together are bound to miss the mark.

It has been said that “What you see depends on where you stand.” That’s true…and doubly so in biopharmaceutical marketing. Stand in your customer’s shoes for a time, and you will see a lot of new and important things…things that will make your marketing plans and programs more relevant, more targeted, and more effective.

Email your question to Mick Kolassa our pricing and reimbursement expert, for the answer.

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