1. “Adapt or Die”
John Lyttle
Oct 2013
Building Patient Partnership for
Competitive Advantage or Survival
of the Brand?
2. Key Learnings
Patient partnership is the core strategy that must drive
everything we do
Patient partnership is todays competitive advantage but
may be tomorrows survival strategy
Compliance is history, adherence programmes are
tactical, partnerships can provide competitive advantage
3. Content
Environmental pressure
Early business environment
The threat of poor adherence to treatment
Present business environment
Industry response to the threat
Tactical survival v Strategic dominance
Evolving role of the patient
Tactical approach not sufficient
Plan for strategic dominance
Evolution of adherence the 4P’s (case studies)
Presentation driven programmes
Pharmacy driven programmes
Pharmacovigelence driven programmes
Partnership driven programmes
6. • IV brands – Patient given drugs in hospital
• Oral brands in multiple forms– Focus on gaining prescriptions via the
direct sales approach
• High SOV directed at doctors, other HCP secondary
• Though leaders are the key
• Me-too’s differentiation via emotional branding &high spend
• Complete confidence in randomised phase III studies
• Complete freedom to prescribe
• Compliance is a patient problem that can be managed by education
• Patients trust clinicians and are expected to be compliant
• High degree of trust in doctors
• No direct access to pharmaceutical companies
• Less understanding of disease and therapies
• Less expectation among elderly
• High drug costs accepted
• Health economics poorly understood
• Clinicians control formulary committees
• Negotiation at individual hospital level
• Few major drugs available as generics
Early healthcare business environment
7. Size of problem
Clinicians no better than chance at
predicting poor adherence in patients
All studies underestimate non-adherence
Causes of non-adherence
Up to 70% is voluntary
Not driven by cost (4-6% increase in
adherence when drugs are free)
45% driven by fear of S/E
Patients feel better (in denial)
Confusion , poor cognitive function
(Clinicians spend < 1% of time with patient
discussing administration of therapy)
Definitions
Doctor in control compliance (yielding,
submission accepting punishment)
Patient in control adherence/concordance
The threat of poor compliance/adherence
8. The threats of poor compliance/adherence
Impact of poor adherence
25% of kidney transplant patients do
not take immunosuppressant's as Rx
The global burden of chronic diseases
such as diabetes is growing
adherence to long term chronic
conditions < 50%
100% adherence to therapy would
prevent 89,000 deaths from
hypertension
Estimated to cost $100 billion/year
9. Health care systems cannot afford waste rise of the HTA and real data
IV replaced by oral therapy; Treatment regimens more complex
Higher efficacy balanced by higher risk introduction of the RMP
Patients better informed with higher expectations
40% decrease in sales force heads, reduced access , time, frequency
Present business environment
10. 98% of management accepts that patient centricity is business
critical
3% of current marketing spend on patient support programmes
Industry response to the threat of extinction
Budget allocated to brands not market growth
KPI’s direct sales force related – reach, frequency
Fear of regulatory/legal challenges
Lack of expertise or the need to change the
formulae
Not sure how to reach patients
Commitment of budget to clinicians
Following the herd same as last year vested
interests
Centralised marketing limit local control
13. Evolving role of the patient
Patients have new relationships with HCP including nurses Rx
Patients have greater expectations of QOL and safety
The patients are the decision makers - understand the drivers of choice
New channels are providing access to healthcare information and pharma
Patients are informed networked more active powerful and vocal
14. Use of agency templates used in other markets geographies or therapies
Headlong rush into high – tech solutions
Limited consultation with patients and their advocates
Great concept poorly executed no long-term plan
Implemented as a sales force access tool
Tactical approach not sufficient for survival
15. Adapt the existing business models – Patient flow
Current volume levers
of growth
Potential volume
levers of growth
PatientsRelevant patient
group
Current treatment
outcome
suboptimal
Patient suitable
for therapy class
Recommended
for brand
Funding
approved for
brand
Patient value
}
}
Cost per dose
Dose per day
Days on therapy
% Adherence
16. Adapt the existing business models – Stakeholder maps
Influences
Regulations &
Approvals
Internet,
press, nurses
physio/T
Published
evidence
industry
support
Guidelines &
International KOL’s &
industry
physiotherapists
Guidelines
Reimbursement
wholesaler stock
Gov funding
H/E data
Peers Stakeholder
Patient oral
anticancer
GPs
Budget
holders
Home care services/
Out patient carers
Oncologists Oncology nurses
Advocacy grps
& peers
Pharmacy Pharma
17. Planning for strategic dominance
Have a clear long term strategic objective 2017201620152014
What drives beliefs across patient types,
geographies and pathologies
Segment the patients and customise the
key messages to different patient types
Identify unsatisfied patient needs
avoid copying competitors
Before implementation build capability
(technology, channels, and compliance
18. Tactical Implementation of patient support programme
Anticipate
updates
Develop and
meet SMART
objectives
Deliver key messages
via targeted multi-
media (not just digital)
Feasibility study – what can
we deliver within time
available
21. Presentation driven adherence programmes
Background
Once a day antibiotic for strep throat
Stakeholders
GPs and Pharmacists
Drivers of adherence
Convenience and simplicity
Pros
Kept sales force motivated
Uncovered a novel market niche
Cons
Assumed brand clinically effective
Assumed brand was competitive
Assumed GP needs convenience
Assumed poor compliance non-
voluntary
22. Pharmacist driven adherence programmes
Background
GP product with early manageable side effects &long-term benefits
Train pharmacists to provide patient education
Stakeholders
GPSI in inflammatory disease and community pharmacists
Drivers of adherence
Belief in long term safety data
Patient education from trusted pharmacist
Pros
Motivated patients adherence
improved
+ve ROI in areas of high brand
share
Cons
Some competitive leakage
Non compliant to target high
prescribing regions
No impact on poorly motivated
patients
Ltd impact on forgetful or patients
with low cognitive function
23. Pharmacovigelence driven adherence programmes
Background
IV anticancer with a RMP aim to recruit patients to
a proactive telephone support service
Stakeholders
Oncologists, nurses and patients
Drivers of adherence
Understanding of the RMP
Opportunity to discuss side-effects
Pros
Reinforce RMP programme
Relationship building with
HCP
Cons
Compliance issues with
pharmacovigelence
Potential liability issues vary across
Europe
Perception that company thinks drug
is dangerous
24. Patient driven adherence programmes (PSP)
Background
Severity of MS symptoms, complex
administration/monitoring schedules, novel drug side
effects and RMP; more empowered patients provided with
an online comprehensive patient support package
Pros
Patient focused language & approach
“Beyond the pill” content
Cons
Based within a company website
Access via HCP only
Ltd use of traditional channels
Stakeholders
MSologist, nurses, pharmacists and patients
Drivers of adherence
Understanding safety issues
Understanding administration & monitoring requirements
25. Patient centricity requires organisation change
Organisational change requires strong leadership
Marketing must take the leadership role
History tells us that as with health economics in the 90’s
companies that are unable to adapt may die
Look to the future
