In preparing this article, I asked several colleagues in the industry to provide nominations for what they thought were the biggest mistakes being made by pharmaceutical marketers today. I received more than 20 nominations, which broke out into two broad areas: traditional marketing activities and pricing/reimbursement activities. The traditional marketing activities (about two-thirds of the nominations) fell nicely into five buckets, which form the backbone for this article. Most of these mistakes have been the topics of previous Marketing Insider columns, and all of them can be traced to two things I have covered extensively: marketers tend to keep doing the same things without seriously questioning them, and they seldom take the time to really understand their markets.
Doing the same thing over and over and expecting different results is, according to the old joke, the definition of insanity. In all fairness, however, it is also an unwritten rule in corporate life. As John Maynard Keynes (the much-maligned economist) once said: “It is far better for a gentleman’s reputation to fail conventionally than to succeed unconventionally.” Most large organizations, regardless of the industry, send out signals that attempting to do things differently is a good way to put your job in jeopardy. Despite appeals for “innovative” or “out of the box” thinking, most large organizations reward people who do not rock the boat. That said, the current state of the industry requires some boat rocking, so let’s look at five things than can and should be done differently—or not done at all.
1. Fear of Segmentation. For all the lip service it pays to segmentation, the pharmaceutical industry, for the most part, thinks of segments as either different classes of trade (e.g. hospitals versus retail pharmacy), different specialties (e.g. PCPs versus neurologists), or differences in intensity of product use (high- versus low-volume prescribers, or different deciles). But segments are only segments if they behave differently and respond differently to the same message. I have heard over and over that product managers don’t really pursue segmentation because they fear being “niched” into a small segment. Frankly, if your product has utility in a broader patient population, you won’t be niched: prescribers will tend to use a product where it works best. If your product can be niched into a small segment, it probably belongs there!
Many products (and even companies) flourish in niches. Even the largest firms are now working to develop orphan and ultra orphan drugs— which, by definition, are niched! If your product is best (or only) suited for a narrow population, then you should embrace that position and price and market appropriately. If your firm is not structured to take advantage of that situation, then have your business development people sell it to someone who can. All markets segment themselves and the product team that fears segmentation or niches is most likely doomed to failure in the coming years.
2. Misalignment of the Product Position with Market Reality. A mistake closely related to the one just discussed, too often we see products that are positioned broadly when they would be better positioned for narrow use, or positioned for first line therapy when they would naturally fit into a second or third line role. The word “naturally” is important here: Juliet Goodfriend, who founded the Strategic Marketing Corporation and has since retired, was a force in marketing research. She once wrote an article on the importance of the natural position of a product—where the product should be and likely will be used as opposed to where the brand team wants it to be. In the years since, I have harkened back to that article many times, because it can usually provide the best explanation for an underperforming product: the company did not understand its natural position.
Unlike most consumer goods, pharmaceutical use is determined mainly by clinical need and appropriateness. Physicians, who determine the use of most medicines, will employ individual drugs where they believe they are best suited, regardless of what your ad or detail piece says. If the market sees a natural place for your product to be used, it is unlikely that any promotion or communications can move them from that— unless your promotion provides new and convincing evidence in support of that use. Although many marketing executives may believe that if they really try hard they can move a product from its natural position, I’m not aware of any who have successfully employed Jedi mind tricks to convince a doctor that “this is the drug you are looking for.” (My apologies to Obi-Wan and Yoda.) If you believe that your product should be used in lieu of other products for a specific area just because it is your product, you are very likely to fail.
Rather than trying to get the market to use a product for something other than what the market wants, it would be better to determine the natural position and then promote it in that way (package insert permitting). The market is often far ahead of the company in understanding the proper use of a product—not always, but usually. Listening to customers usually has a high payback.
3. Relying on “old school” sales force models. Perhaps the most adamant nomination I received was from a very influential sage in the industry. His suggestion was: “Without a doubt, the biggest mistake I see is making the assumption that increased frequency of repetition of the same sound bite of features and benefits, aka the ‘reminder detail,’ sells drugs in 2011.” Although I had not anticipated this as a nomination, I agreed immediately. Physicians commonly rely on a specific selection of drugs for most of their prescribing. Called an “evoked set,” this selection is essentially the prescribers’ “autopilot,” their go-to list for prescribing under specific situations. If your drug is not in that evoked set (and it is often difficult to get into it), simple reminders will not help. If, on the other hand, your drug was once used regularly by a prescriber whose use has dropped off, this provides an opportunity for a discussion and a place where a “reminder” might do you some good—but only when reminding the prescriber of earlier good results.
Reminding a physician who never really adopted your product, even after extensive discussions, is a waste of time, pure and simple. But many firms still place second and third position emphasis on drugs that didn’t make it into the evoked set for all who are targeted with the abbreviated message. Don’t waste your time—if they have already decided not to use your product, then reminding them will only frustrate your sales rep and the physician.
Similarly, reliance on other old methods of sales force allocation appear to result from simply not questioning the status quo. There is a wonderful story of a woman who, after years of following the family recipe for cooking pot roast, finally asked her grandmother why she cut off the end of the roast before cooking it. Her grandmother replied, “I don’t know about you, but my pot was too small.” Although the first generation (grandmother) had a valid reason for the practice, by the third generation the original reason was lost. Only the practice remained—until it was questioned.
For years it has been common to target sales calls to the highest-volume prescribers in a category. In the good old days, it was assumed that the high volume prescribers of statins (for instance) would be more willing to try new statins and would write more prescriptions for your new statin as well. But this is true only when your new statin offers a big improvement over the current products. It also ignores the fact that there are networks or communities, some formal but mostly informal, of physicians, who swap information and influence each other’s prescribing.
Some recent disappointing launches were accompanied by the typical allocations of sales force toward high-volume prescribers of competitive products. As those teams lick their wounds, they should look carefully at what they did: target HVPs with a me-too message. Without real differentiation and a compelling value proposition, calling on relatively satisfied users does not appear to be the wisest move!
4. Assuming that national KOLs influence markets. One of the commandments followed by marketing teams is, “Thou shalt have KOL support.” The problem is that isn’t valid for the vast majority of products. The term KOL is so common in the industry, and the title has been bestowed upon so many different people, that it has become almost meaningless. I recently spoke with an anesthesiologist who proudly announced during the meeting that he was a KOL for several large pharmaceutical companies. This meant he was on their speakers list and that the companies had supported some of his research, not that he ever influenced anyone’s opinion or decisions.
To be an opinion leader requires that someone’s opinion is influenced or shaped by your own. Often, companies seek out KOLs in large academic institutions. These people may be famous, but the degree to which they influence practice is always questionable. These physicians see few patients, and those they do see tend to be the most difficult or interesting cases, not the day-to-day patients seen by the bulk of the market. Most research shows that medicine, like politics, is local—if you want to understand what influences a particular physician’s choices, you should probably limit your search to a 50-mile radius. Local thought leaders are real; national thought leaders are, for the most part, mythical.
5. Assuming that every product needs or benefits from DTC advertising. I’ve saved this one for last, because when I bring it up in conversations I get more objections and pushback than for any other topic. Every single well-constructed academic evaluation of DTC has shown that, in most cases, the most DTC will do is increase the size of the market: it will have no effect on the share of any product. This means that DTC can create disease awareness and drive patients into the physician’s office to seek treatment, but that treatment is still determined by the individual physician. This makes sense: unless there are absolutely no differences among the drugs in a category, the physician will want to use specific drugs for specific situations—we call that “practicing medicine” and it’s something physicians are prone to do. If they were to just prescribe whatever patients asked for, the profession really wouldn’t be necessary—but then, neither would the broad selection of drugs.
Objective research also shows that patients who receive the specific brands of prescription medicines they request as a result of DTC are less likely to be satisfied with the treatment and quicker to abandon it. This also makes sense: patients who request or insist on a specific drug are likely to have higher expectations of positive results than are patients who simply accept what the doctor prescribes.
I don’t mean to say that all DTC is a waste of time and money—anything that drives more patients to seek treatment for their diseases is a good thing. But expectations for the specific brand are often too high. There are specific categories where DTC is important and appropriate for a specific brand. Brand-specific DTC for the phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction and for different forms of contraceptive are not only useful but important; the different features and value propositions of these products address different consumer needs and preferences. They provide different routes to the same clinical endpoint. In cases where your product is the category leader or the only entrant, DTC ads that increase the patient base will, by definition, be to your advantage. But if you are one of several products in a category—whether it is statins, antidepressants, or biological treatments for arthritis or psoriasis—brand-specific advertising will not change market share because the physicians will choose the products to prescribe, not the patient.
You can argue “empowerment” all you want, but in the end it is the physician who makes the decision and bears the responsibility for the use and consequences of that use. That is a pretty powerful dynamic. I believe that a lot of DTC advertising takes place because companies and product teams simply assume they are supposed to do DTC. They see their competitors do it and assume they should do the same. But that’s why the other four mistakes are also still being made as well: people assume it should be done because they see others do it. If you take the time to understand that focusing on what the market wants and needs, as opposed to assuming that they want and need what you have, you can avoid a lot of marketing mistakes.
Email your question to Mick Kolassa our pricing and reimbursement expert, for the answer.