Briefing Meeting: 'Effective Use of the Marketing Mix'

If you are about to start strategic and operational planning for your brand, are you unsure as to how best to evaluate the relevant elements of the marketing mix in the new regulatory environment? How do you prioritise those marketing activities that will really work for you?

Held at sanofi-aventis and chaired by Sandy Thomson (Avenue HKM), this PM Society briefing meeting set out to explain what is important in developing a sustainable and differentiated marketing strategy that is meaningful, credible, and motivated. The speakers also discussed the changing NHS structure and the revised ABPI code of practice in relation to implementing strategy, and particularly the significance integrated communications.


Making the right investments in the right place
PIERRE HAZLEWOOD

The world of pharmaceutical marketing is rapidly evolving and the industry must evolve with it. The NHS is undergoing a period of sustained change, moving towards practice-based commissioning, payment by results, nurse prescribing and supplementary prescribing. The customer base is therefore wider and more complicated than ever, with prescribing decisions subject to many more influences (PCTs, NICE, professional bodies, treatment guidelines, patient groups). In addition, healthcare systems are under enormous financial pressure, struggling to keep up with fast-moving technological developments. This inevitably squeezes margins for pharmaceutical companies. The question posed by Pierre Hazlewood was how best to cut through the complexities of the changing marketplace in order to make rational and sensible investment decisions.

The patient-centred NHS
The changes in the NHS are for the benefit of one person - the patient. The patient is now the centre of all treatment, with money designed to follow the patient (payment by results, practice-based commissioning). This means that, as marketeers, we should also focus on the patient by placing the patient at the centre of our market analysis. In assessing where marketing opportunities lie it is essential to understand the changes in the marketplace and how they affect marketing decisions.

Sales can be increased and business generated for a brand in only a finite number of ways: increase the number of patients diagnosed, increase the number of patients treated, and increase choice within your brand. The 'patient flow' therefore becomes the centre of investment decisions. The market can then be segmented, market opportunities defined, strategic levers applied and the tactical implementation planned and carried through.

Within the patient flow the opportunities for market shaping begin with defining of disease populations. At this stage public awareness can be raised to draw patients in to be diagnosed. Once the diagnosis is made then education comes in to play. For patients receiving treatment, GMS support (nurse prescribing, treatment guidelines, patient support etc) can be used to the industry's advantage to provide market access.

These are the elements of brand planning, with patient flow at the centre of all investments in the marketing mix. The individual elements include the medical plan, medical education, PR, stakeholder relations (NHS), public affairs, and salesforce activities. Implementing this process requires company-wide (and agency-wide) expertise, and cross-functional brand teams (i.e. not just marketing) with accountability for outcomes. Once the marketing plan is determined it must be executed with excellence, with targeted investment and monitoring of results.



Creating awareness
Pierre Hazlewood went on to discuss the specific example of Lantus (once-daily long-acting injectable insulin) and a market leader in diabetes. Patients have been shown to view diabetes as a non-disease, and clinicians describe it as a 'light disease', despite its enormous impact on cardiovascular health. Patients' awareness of diabetes is very limited compared to cholesterol and hypertension.

The objectives of the Lantus 'Life's better under 7' campaign in Ireland were to create a disease awareness programme to educate patients and physicians about the importance of the haemoglobin A1c test for blood glucose, and thereby to establish sanofi-aventis as a partner in diabetes care. The campaign, in partnership with the Diabetes Patient Association, comprised television advertising, a KOL support campaign, A1c information packs, an awareness survey via the Diabetes Federation, articles in the medical and lay press, posters in diabetes units and GP surgeries, plus branding items such as lapel pins, pens etc.

The outcome was high campaign recall and awareness of A1c among both healthcare professionals and patients, and high recall of the company among healthcare professionals.

For Actonel (the bisphosphonate risedronate) in osteoporosis the approach was different and focused on patient capture. Osteoporosis a steadily growing but non-dynamic market: it does not feature in the GMS contract and has very limited NICE implementation. Actonel was the second drug to market in this indication and though it captures a consistent market share, the challenge was to obtain more value from each treatment, as well as benefiting the patient and decreasing hospitalisation. The solution in this case was a patient support programme instigated via a registration form on the patient information leaflet. The outcome was an increase in the number of patients remaining on the drug at one year from 60% to 70% and a significant increase in sales.

In summary, to quote the Bananarama song 'It ain't what you do, it's the way that you do it - that's what gets results'. As marketeers we should know our market and understand the environment in which we work. The patient must become the centre of all investment decisions and optimum use should be made of knowledge within the company. Above all, all elements of the marketing mix must be executed with excellence and progress monitored.




Decisions, decisions, decisions - making the right choices
DAVID ROWLEY

Developing a marketing plan is about making choices. The right choice will lead to increased sales and increased success. But, as David Rowley says, with so many marketing options, choice is not always easy. If you make the right choice, the process is relatively logical and straightforward. The difficulty lies in the numerous tactical approaches from which to choose in order to achieve our marketing objectives.

Shifting sands
To make the decision-making process even harder, the rules within which the pharmaceutical industry must work keep changing, The ultimate marketing mix is affected by a number of headline issues:

• NHS change
• New decision makers
• Less product differentiation
• The dawn of 'niche buster' products
• Improved data
• The rise of technology
• New codes of practice

The wide-ranging and ongoing changes in the NHS have already been mentioned. The current focus on patient-centric thinking has had a major impact on marketing activities. As well as disease awareness and direct-to-patient support programmes, the pharmaceutical industry can now support patient choice and the concordance agenda, provide audit programmes to improve patient capture and monitoring, as well as offering better quality patient information.

The changing customer base
The principles of the NHS plan revolve around Trusts earning autonomy by showing that they can improve service and then being rewarded by additional funding with greater freedom and less monitoring. The Department of Health is also setting ambitious targets around the increasing number of supplementary prescribers. Nurses are already increasing their influence with devolved decision making (e.g. in the area of vaccines where the nurse often makes decisions with the practice manager). Through Medicines Use Reviews (MURs) GPs will be tackled about inappropriate prescribing where patients do not achieve national targets (e.g. lipid levels, blood pressure).

While ever more people are choosing medicines, so the sources of influence over choice of medicine are also growing in number. Who has the most influence and how much autonomy each individual customer has in making decisions are vital questions that need to be thought through carefully when establishing the map of influence for a given disease area.

Within the changing NHS landscape doctors' time is increasingly at a premium. They have less time to see pharmaceutical company reps and now obtain information from an ever growing number of alternative other sources, particularly the internet. Whereas in the past reps made 10 or more visits a day, today this is more likely to be 3 5 calls a day, each lasting only a few minutes. At a salary of £80 100K per rep, each call must achieve considerable benefit to repay this financial investment.

Market differentiation
When doctors are able to choose products for themselves, how do they make their choices in a market where there is often very little true differentiation? What can the pharmaceutical industry learn from other industries, for example consumer products (so-called fast-moving consumer goods or FMCG)?

Consumer products develop and evolve to suit the changing market. Differences are created for products by adding value and it is these values that make up the 'brand'. For example, Virgin Atlantic differentiate themselves from British Airways by adding value with limousine check-in and stylish on-board lounges. The pharmaceutical equivalent of Virgin could be a diabetes product with a high quality educational and patient support programme. Effective differentiation of pharmaceutical products (even generics) means utilising all aspects of the marketing mix.

The traditional blockbuster pharmaceutical product represents a high financial risk: if a drug is not first or second to market, it has no chance of success. The pharmaceutical industry is therefore increasingly reliant on so-called 'niche busters': targeted and personalised medicines such as Herceptin (trastuzumab) in breast cancer, and Humira (adalimumab) in rheumatoid arthritis.

When it comes to niche brands, on the other hand, most customers already now about the product before the rep even starts detailing. Detailing must therefore add value and a variety of tools can be utilised. One example is the detail aid in the form of the electronic tablet PC, which as well as including detailing materials can also contain added value services such as clinical papers, meeting reports, information databases, and 'talking heads' of KOLs and patients. In David Rowley's view, the pharmaceutical industry needs to get sharp and embrace sophisticated tools such as tablet PCs, Blackberries, video on mobile and the internet, and integrate them into the marketing mix. This is not always easy, but it can be done.

The industry's image
The reputation of the pharmaceutical industry is probably the worst it has ever been - think of the Vioxx story and the recent highly publicised clinical trial failure. These stories are not going to go away. The climate will get even tougher. Corporate governance therefore needs to be increased and to this end the new ABPI code aims to rebuild the pharmaceutical industry's image.

Despite changes in the marketing environment however, healthcare professionals still choose drugs, they still attend meetings, and they still notice advertising. As pharmaceutical companies learn to embrace innovative marketing solutions alongside the more traditional approaches, order books show that this strategy is working. And this innovation means that the quality of pharmaceutical marketing is better than ever.

Everything comes back to making those all-important decisions. In pharmaceutical marketing we must stay abreast of economic, technical and technological developments, while taking care not to throw the baby out with the bathwater. It is vital to get it tune with our customers and, importantly, their customers. Above all, for the marketing mix to be successful we must ensure that all its individual elements join up.




Talking points
Regarding future technology David Rowley stressed that many of the 'macro' elements, such as demographic changes in our environment, are outside the power of companies to change and have to be worked within. However, certain of the innovative technologies now available need to be grasped quickly in order to gain the competitive edge.

Asked how successful the sanofi-aventis campaigns have compared to those of other companies Pierre Hazlewood noted that this is a very difficult area in which to measure success. One option is to use Dinlink sales data. Patient research is another possibility.

With regard to the tablet PC detail aid, David Rowley was asked how the 'technical sell' fits in with communication of key messages and whether the electronic detail aid means that the doctor is more likely to pursue his or her own agenda. David agreed that the clarity of key messages and focusing of communications remains vitally important. If new technological tools are used appropriately, however, they can still encompass straightforward communications messages but deliver them in a more innovative way. The new tools at our disposal can be used flexibly to great effect.

Asked whether the biggest challenge is access to key customers, David Rowley stated that it is increasingly difficult to identify new channels of communication, such as e-detailing and viral marketing. And once identified, it is equally hard to assess which work most effectively.

Held on: 08/06/2006