Total global spending on medicines is forecast to reach $1.5 trillion by 2021, according to a 2017 report from QuintilesIMS. That same report forecasts that while the U.S. will continue as the world’s largest pharmaceutical market, pharmaceutical emerging markets will make up nine of the top 20 markets. Meanwhile, PwC’s Pharma 2020 series says that by 2020, the BRIC (Brazil, Russia, India, and China) economies alone will account for 33% of the world’s GDP. So, pharma will continue to have growing opportunities outside of the U.S. To help you learn more about these opportunities, PM360 asked 10 experts:

  • What markets outside the U.S. should pharma companies be the most focused on right now? What are some of the keys to reaching audiences within that country?
  • What emerging markets will become more important for pharma companies in the near future? What marketing tactics should be used to reach audiences in that country?
  • Are there any digital tools, emerging technologies, or other media platforms that are more prevalent outside of the U.S. that marketers should be aware of?
  • When marketing outside the U.S. or preparing for a global launch, what advice would you give to marketers to help them achieve more success within the local market?
  • How do restrictions to DTC and other regulation differences (i.e., social media) affect a marketer’s approach in countries outside of the U.S.?

Jo Ann Saitta

Pharma should be focused on Canada, France, Germany, Italy, U.K., Japan, and the Netherlands. To reach HCPs in those countries, companies must not only understand the regulatory constraints of the market, but also the brand’s strategy, maturity, and current competition in their markets.

Many products are facing stiff competition and need to rethink their messaging and channel mix. Don’t implement the U.S. digital marketing strategy in ex-U.S. markets! While some U.S. campaigns may be more digitally advanced, they are not necessarily the right solution for global markets. Interaction data should not be an afterthought. Data drives great digital marketing strategies, so leverage existing brand data on promotional response and HCP engagement preferences. Validate best practices with local area leaders and understand how/if to apply them to maximize HCP engagement.

Expansion of U.S. Digital Platforms

More penetration of existing technologies and an expansion of U.S. digital platforms is occurring outside of the U.S. than in the past. Cloud-based platforms such as Salesforce.com are prevalent and used to create a customer relationship management database to track multichannel engagements. Veeva is being used for sales force iPad details, while platforms such as MailChimp and Salesforce are used for non-personal marketing automation.

Social and influencer marketing are areas that companies are seeking to execute in global markets, but they are being very cautious. Each market is different based on regulatory restrictions; however, best-in-class tools such as Traackr and Affinio can help companies identify and capitalize on influencer networks.

Pharma companies are implementing content management platforms so they can scale globally through defining content creation standards, implementing digital templates to drive efficiencies, and providing resources for local areas to adapt. Popular platforms are Episerver, Sitecore, and Adobe Experience Manager. Smart companies pull digital data from Google Analytics into visualization platforms such as Tableau, where it is easier to spot trends and further optimize your campaigns and spending.

Markus Saba

My advice: Almost is good enough! What? While that sounds counterintuitive, when launching a global brand, almost right is actually perfect. In fact, if you are striving for perfection when launching a global brand then you will most surely fall short.

In order to maximize your brand’s opportunity globally you need to find synergies across markets, eliminate duplication, and ensure consistency and alignment. If you are trying to find the perfect solution, you will likely make tradeoffs that will optimize one market opportunity at the expense of another.

Find the Commonalities

Every affiliate thinks their marketplace is different and unique. While that is true, at the end of the day they have more in common than not. Patients’ and HCPs’ needs, tensions, and frustrations are more alike than one would initially think. As a global brand director, your job is to find out what are those common insights and then find ways to tap into them to develop solutions that are meaningful. If you aim for 80% correct and then allow your affiliate to customize the remaining 20%, then you are more likely to be successful. You’ll maximize the opportunity while reducing duplication and costs. In addition, you’ll get more buy-in by winning the hearts and minds of affiliate marketers.

One key way to do this is to involve affiliate brand managers early on. Truly listen to their input, engage them fully in the brand development process, have them participate in all market research regardless of country, let them in on the agency selection process, and then work directly with them.

These measures, along with the spirit of inclusion, will allow you to find that 80% overlap—and will ensure that you at least executed that 80% as perfectly as possible. Then, work with your affiliates on the 20% localization and you are sure to build a better brand.

Simon Pickup

Emerging markets have repeatedly demonstrated that a traditional clinical-driven sales force no longer overcomes access and infrastructure barriers. These new frontiers create new challenges and spark innovative digital health and homecare systems, which we see in the Asian and African markets today.

Nigeria has often been described as pharma’s next frontier as the most populous nation and largest African economy. It is predicted to grow 9% year-on-year and by 2026, contribute $2 billion to pharma sales growth—55% from prescription drugs.

Almost half of this potential is concentrated in five cities with much of this growth fueled by the rise in middle class, their increased household consumption, and healthcare spend. This rise in more affluent patients and non-communicable diseases, such as diabetes and heart disease, presents an opportunity for pharma to partner with the government to provide key solutions. Many poorer patients are underserved and suffer from infectious diseases, such as typhoid. Because of these drastically different populations and needs, understanding the various patient journeys is vital to overcome the challenges of access and lack of awareness.

The Opportunity in Nigeria

Most Nigerians visit a retail pharmacist first, rather than a medical professional. This can be a risk considering three-quarters of Lagos’ retail pharmacies are unregistered—often staffed by technicians lacking the knowledge, skill, and tools for effective diagnosis. Hypertension is frequently misdiagnosed as typhoid or malaria, with serious consequences for patients.

In treating hypertension, pharma can leverage their experiences in Asian and Latin American markets to drive patient-specific platforms, increasing awareness and compliance. Education programs can be provided to pharmacists with the necessary blood-kits while prioritizing training staff in screening and diagnostic methods in the cities.

Nigeria’s growing middle class represents a unique opportunity, but to realize it pharma must continue to innovate, reaching audiences through non-traditional channels.

Research provided by McKinsey & Company: Tania Holt, Laura Millroy, and Matthews Mmopi

Brigid Duddy

When preparing for a global launch, a marketing team needs to provide a clear strategy and vision for the brand. Ultimately, a strong and consistent brand presence should be established across markets; however, a successful launch plan also needs to allow some flexibility at the local level. This flexibility helps ensure that the launch tone and tactics are appropriate in each market.

The balance of control and flexibility can be a challenge, but involving local management early in the process can help ease this tension. Their involvement helps twofold: First, it brings local stakeholder insights into the planning process early and, second, it can build internal buy-in and advocacy among colleagues. Both of these factors will help long-term strategy and execution.

Every Market is Different

From a management perspective, it often makes the most sense to group markets by “type.” Bucketing markets makes sense for strategic planning and internal communications, but there are major differences between even seemingly “similar” markets. Local-level insights are necessary to move from planning into successful execution. The local marketing teams understand not just the regulatory atmosphere but also local perceptions, decision-makers, and influencers.

Even after local markets pressure test and adjust the tactical execution for the brand, it is important that the global marketing team remains involved. The team should ensure that—at a high level—the plan continues to fit the overall brand vision and strategy. The global team also should support the local teams—with line of sight to all markets, the global team can help facilitate the sharing of best practices and identify solutions to common challenges. Ultimately, the global team needs to serve as a steward of the brand and as a partner and resource to all markets.

Mark Evans

Culture is much more than just a translation of language. Between the U.K. and U.S., we share much in terms of language but so much of our culture and use of language, use of humor, and use of direct selling versus subtle approaches all differ greatly in our advertising. It is important that we don’t just use a cookie cutter U.S. campaign and translate it around the world and expect success. Our work on recruiting patients for clinical studies in Russia, China, and Japan have shown us that they are different worlds with completely different views on different conditions, approaches, privacy, language, and the role of healthcare. The more effort you spend understanding this, the more success you will have in landing your messaging and approach. Finally, one line we like to repeat is that “the whole world isn’t only on Google and Facebook.” This reminds us that the websites, channels, platforms, and devices that are common place for us are not the same around the world.

The Benefit of DTC Restrictions

DTC is much more difficult outside of the U.S. It is not standard practice to promote medicine, and approaches need to be much more sophisticated when building support and awareness around a pharma brand rather than just direct selling a product.

The good news: It’s proven that longer term emotional brand building activities deliver more effectiveness than the short-term direct selling approaches often favored in the U.S. due to the ability to do so. (To learn more about the proven effects of emotional brand building, go to http://bit.ly/2w8vxYW to see research presented by the IPA, titled “Advertising the Long and the Short of It.”) So, even though the regulations are different, it gives you the opportunity to do things the right way and deliver more effectively.

Olivier Zitoun

Emerging Technology Overseas

Marketers interested in how new technology has an impact overseas should look at Europe, which is leading the VR revolution. There are now more than 300 VR startups in Europe with France being the largest hotbed. Even in healthcare, Euro startups are breaking new ground in the use of VR to manage mental conditions of neurologic disorders. This opens many possibilities for pharma companies, from making new partnerships with young tech companies to leveraging the audience interest in VR at major medical conventions.

Rethinking Global Patient Engagement

DTC limitations and regulation differences are forcing marketers to re-think patient engagement ex-U.S., taking into consideration country-specific requirements while relying more on new channels and technologies. Engagement frameworks should be built to adapt to user flows based on local guidance. Engagement frameworks should be developed by using insights and local regulations to inform local omni-channel communication plans. End-user experience will include mobile app, email/CRM, and SMS. For example, for patient support, Machine Learning can power an all-digital, personalized, frictionless experience, tailored to the country regulations and more importantly, the patient’s journey. The content for the program can be developed centrally, but the delivery and the end-user experience can differ from country to country, and patient to patient. In the planning of these programs’ development, proactive involvement of country managers is a must.

Lane Degenhart

When selecting which emerging markets to focus on, start by considering which markets you can scale and grow in most successfully based on factors such as patient access to the product, levels of income, disease prevalence, and health literacy within the category. Also, analyzing the market dynamics for channel activity and preferred platforms of communication will inform levels of spend and cross-channel needs to reach audiences. This includes considering the country’s technology adoption.

Understanding how well the market utilizes mobile as a channel, for example, versus the effectiveness of traditional print tactics or even the prevalence of out-of-home advertising is key in informing the tactical plan. It’s all about market customization versus a one-size-fits-all approach. Sometimes you should consider tactics that bring your customers closer to you. For example, Biogen used VR to bring their customers into their manufacturing plant so they could learn and appreciate the effort put into their biosimilar development process. That approach won’t fit every need, but it was a unique way to connect with their customers who were sprinkled across Europe.

Popular Platforms Overseas

IM platforms are growing at a significant clip globally. WhatsApp, Facebook Messenger, and QQ Mobile are the top three IM platforms in the world. IM platforms have some pretty significant benefits: They allow for segmentation so you can choose who you share your content with, you can customize messages to increase personalization, you have higher reach with a follower list or SMS subscription, and engagement rates are higher through quality messages that engage customers and produce higher conversion rates. In China, WeChat is the ubiquitous messaging platform used by nurses to reach other nurses for consultation and to reach patients for consultation, updates, answering questions, or scheduling appointments. A platform like WeChat can also be used for B2C opportunities such as updates, promotions, or surveys.

Meghan Oates-Zalesky

Direct-to-Consumer (DTC) ads in the U.S. have become a $5 billion cottage industry since the FDA updated its guidelines in the late 90s. Though DTC ads have increased awareness, they’ve also increased the number of patient questions being asked. Physicians estimate in a recent InCrowd study (http://bit.ly/2vC7gdl) that patients ask three times as many questions now compared to five years ago due to DTC ads.

In the U.S., navigating regulations makes it more difficult for marketers to create compelling and effective DTC ads to engage target audiences. While very few countries allow DTC advertising, with the U.S. and New Zealand permitting DTC ads for prescription medications and Brazil allowing them for non-prescription drugs, it would not be surprising for U.S. marketers to operate with caution in their awareness efforts abroad.

Dealing with DTC Restrictions Abroad

Understanding where patients seek information is important for global marketers when their reach is restricted. An InCrowd study shows that U.S. patients reported they would look to manufacturers’ product sites, among others, for information.

Forty-seven percent of patients say they prefer to receive medical information from their doctors, while a third check online options such as Google/online search, WHO, NIH, and other medical information sites, including manufacturer websites. Though advertising through these channels isn’t an option in most global markets, manufacturer websites are areas in which marketers can make their message clear and communicate relevant details about the medication.

When communicating on a manufacturer’s site, considerations that daunt U.S. restrictions provide good guidance to ensure consumers understand the critical elements of the medication: Indication, side effects, etc. Other key learnings from U.S. DTC regulations are the improvements upon regulated ads that all consumers need: Appropriate reading level, simple message, and relatable images of people.

Jodi Alden

With multiple market variables and pressure to minimize spending to consider, global launch planning is quickly becoming a hot topic. To make your planning efforts easier, consider these fundamental pillars.

Know your local audiences—research, research, research. With different team approaches to treatment, as well as different protocols and regulatory environments, understanding the treatment journey in each local market is imperative. Identifying key audiences (e.g., HCPs, procurement executives, patients, and payers), their pain points, and what value your brand brings is critical insight.

Think globally, act locally. Understanding all relevant market dynamics and using that knowledge to inform the brand value proposition will define your global brand. Even though content isn’t always universal, imagery and messaging needs to resonate in each market to get traction—perform testing in your relevant markets to avoid significant retrofitting costs later.

Collaborate closely. Ensure regional engagement with your positioning and strategic approach early in the planning process to help foster ownership of your brand vision and campaign—fuelling your global brand strength.

Assess the local competitive environment. Perform heat mapping for each market to prioritize launch resources, track activity post-launch to inform future competitive response, and share learning among affiliates.

Provide a centralized hub and roadmaps. Support local affiliates with tools and guidance to enable them to succeed. Establish a centralized digital hub to share assets for minimizing waste and maximizing consistency. Provide a prioritized tactical roadmap—designed to intercept with communications at the right time, via the right channel—and prepare affiliates to prioritize resources for launch.

With the right approach from the outset, global or ex-U.S. launch planning can be seamless so you can focus on connecting with your audiences and encouraging adoption of your brand—locally and globally.

Annalise Coady

In my experience, the hallmark of a successful global launch is whether or not an impact has been made in the local markets—whether they embrace and execute the campaign. Collaborating with local markets from the beginning of a project to get an understanding of their audiences’ specific needs, messages, content, and channel strategy, allows the global team to find the “red thread” of common need across the markets so they can play the critical supporting role in providing consistent, but relevant strategic guidance.

Continuing this partnership to co-create narratives, assets, and training modules, through to launch, goes a long way in shaping a successful program. Importantly, it also gains buy-in so you maximize opportunity and success. The local markets are excited and invested in the campaign, so they are more likely to implement it, as well as measure and share results, enabling better metric evaluation of the overall global campaign.

With No DTC, Focus on HCPs

HCPs and healthcare system influencers play a key role in how we go to market outside of the U.S. due to the different restrictions and regulations. And we have found an insights-based integrated marketing approach works to target these audiences within the different local regulatory environments more effectively.

We use insights from a database of HCPs and global healthcare influencers to map these stakeholders, their networks, and conversations, and overlay our understanding of local market environments and regulations to develop multichannel campaigns that have an impact at the local level.

No country is called global. You have to be able to execute locally to have prescription impact—meaning, collaboration with the local markets in building campaigns is key.

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