2005 Medical Marketing Association Presentation V1.3

Measuring Promotional Success Optimizing ROI Sponsored by ScienceMedia Become Part of a Greater Body of Knowledge

Table of Contents

Introduction and session objective

Traditional promotion in a changing environment

Historical return on investment summary

eDetailing ROI case study

Maximizing your return on investment when producing digital assets

Introduction

Chauncey Smith – Sr Brand Manager at Glaxo SmithKline Consumer Healthcare

Medical Marketer of the Year 2002

VP elect for MMA – Programs 2005-07

Committee Chair: Medical Marketer of the Year – 2005

The information shared in this presentation has been collected from a variety of sources and reflects my personal point of view of medical marketing and return on investment methods

Every effort has been made to reference all sources and not infringe on proprietary or trademarked work

Michelle Youngers – CEO at ScienceMedia has underwritten this session.

ScienceMedia is a company that uses rich media for the visualization and communication of scientific concepts in marketing and training programs with an emphasis on instructional design .

Overview

Session objective : Stimulate a robust peer to peer discussion about the promotional returns on investment, from several points of view:

Relative and absolute cost efficiency of non-personal selling tactics

Full utilization and amortization of digital assets created to support these tactics

The untapped potential of non-personal selling for medical marketers Medical Marketing Association 2005 Annual Conference

A recent article in Product Management Today proclaims not having sales force support is a product manager crisis! Let’s examine this a little closer

A “historical” perspective helps to start framing our discussion by examining where physicians prefer to get product information is probably useful Source: PERQHCI, June 1998

Promotional Environment Situation Analysis

Physician’s attitudes regarding drug promotion are changing, and although personal selling is preferred method for brands with sales >$100M, the use of non-personal methods are growing

(eg- journal advertising, eDetail, eCME, web based tactics)

The current industry model remains with the status quo, because of the fear of a competitive response

However, clever marketers are testing new promotional alternatives, like eDetailing, with success

Smaller brands are adopting these non-personal strategies at a even faster rate, because of the efficiency of spend

Many small to mid-sized brands can not effectively support the expense of personal selling and recognizes the challenge of a non-personal selling strategy as our way forward

How do we as medical marketers successfully navigate today’s environment and identify “small brand opportunities” into market success?

Personal experience and traditional wisdom have taught us to believe personal selling is imperative for a successful product launch.

But is this tenet still a truth in today’s marketplace with 95,000 pharmaceutical reps clamoring for physician attention?

While the answer is not yet definitive, there is clearly evidence to suggest “detailing” may not be as influential today as in years past, because physicians have more outlets to get their information

Non-personal selling can be an efficient and effective alternative to our traditional wisdom

Although there are more representatives calling on offices, physician face time has remained fairly constant Industry weekly average July 4th Thanksgiving Christmas/New Years September 11 Memorial Day July 4th 45 40 35 30 25 20 15 10 5 0 4/6 4/13 4/20 4/27 5/4 5/11 5/18 5/25 6/1 6/8 6/15 6/22 6/29 7/6 7/13 7/20 7/27 8/3 8/10 8/17 8/24 8/31 9/7 9/14 9/21 9/28 10/5 10/12 10/19 10/26 11/2 11/9 11/16 11/23 11/30 12/7 12/14 12/21 12/28 1/4 1/11 1/18 1/25 2/1 2/8 2/15 2/22 3/1 3/8 3/15 3/22 3/29 4/5 4/12 4/19 4/26 5/3 5/10 5/17 5/24 5/31 6/7 6/14 6/21 6/28 7/5 7/12 7/19 7/26 Syndicated industry report - 11/03 Avg.encounters Avg. details Min/Phys/Week

In today’s crowded offices, more representatives are finding it tougher to break through and have meaningful a dialog with physicians Pharmaceutical Executive Supplement – 5/04 * Out of every 100 attempted sales calls, pharmaceutical reps get 2 or more minutes with physicians less than 10% of the time, and less than 5% is the message recalled

FEWER MEANINGFUL PHYSICIAN INTERACTIONS MEANS FEWER OPPORTUNITIES FOR REPRESENTATIVE LED PRODUCT DIFFERNTIATION Source: Access to high prescribers: The World of Doorknob details, 1999; Scott-Levin; associate ride-alongs and interviews; financial press articles; MD interviews

Only 12 out of 300 (4%) possible details are recalled by physicians

87% of calls last less than 2 minutes

Drop samples off at receptionist’s desk

Leave before receptionist’s desk (i.e., other waiting reps, restricted access signs)

No physician recall

Drop samples off at sample closet

85 reps 100 reps (300 details) 57 reps 20 reps = 20 calls 8 calls ? 12 recalled details** 15 28 37 12

Traditional Medical Sales & Marketing 10 9 8 7 6 5 4 3 2 1 Focus on top recommenders Ignore mainstream recommenders

Traditional Medical Sales & Marketing 2004 Personal Selling Potential Overspend? 50-60% No Contact 70-80% No Contact Good Spend 90-95% No Contact

Integrated Medical Sales & Marketing 2004 Self-Service and self-selected for lower tier ($) Personal Selling Integrated Marketing (1:1) Optimal experiences with heavy recruiting for top prescribers ($$$) Mass-Customized approach with moderate recruiting for mid-tier prescribers ($$) “ Spend in proportion to HCP value, and in alignment with their preferences” Decile 8-10 Specialists Decile 4 -7 Specialists Decile 7-10 PCP NP/PAs in Specialty Decile 1-3 Specialists Decile 1-6 PCP NP/PAs Pharmacists $$$ $$$ $$$ $$ $

An example of an Rx topical steroid 12 months prior to losing exclusivity utilizing a personal selling centric strategy, seems to agree with the premise of diminished rep access and efficiency in changing prescribing behavior Trend line for outside alignment nearly identical to inside alignment, even though substantially (>10x) more investment was made in personal selling and support Source: NDC Health MAT June ‘04

Traditional selling model

Elements of new selling model

New selling model

Steps can be taken to improve the existing model

“ Tightening the screws”

Enhance sales force productivity

Simplify organization strategy

Improve front-line performance management

Maximize DM impact

Ensure technology payback

“ Turbocharging the model”

Develop more sophisticated capabilities for customer knowledge, e.g., segmentation, CRM and KAM

Pilot tailored approaches

Explore new channels

Drive pull through with marketing and managed care

Ensure streamlined, effective technology support

“ Creating a new paradigm”

Create new avenues of access

Reach physicians through multiple coordinated, highly effective channels

Micro-segment and deliver tailored messages and benefits

Provide a solution across networks of physicians and patients

Capabilities must be built in the intermediate term Future paradigm informs intermediate steps The consulting community discussed this rapidly evolving Pharma Selling Model way back in late 2003 Clever marketers are evolving with the market to address the new model’s realities

The old, tried and true media provide a reliable ROI Journal advertising, banner ads for patient record forms have solid track records Tying a direct response mechanism to them can add life beyond the single impression

Journal advertising remains a very efficient non personal selling tactic delivering excellent target reach and frequency Source: IMR Survey of 125 Pharma. Co. Marketing Executives – 999 $2.41 $87,097 $36,140 TOTAL (49 campaigns) $2.68 $67,571 $25,213 Print+Detail $1.95 $19,477 $ 9,988 Detail Only $ 2.39 $ 2,244 $ 939 Print Only ROI (Per $ Spent) Sales Increase ($000) Spend ($000)

The Tuck School of Business recently reconfirmed this dynamic with the publication of the RAPP study Source - ROI Analysis of Pharmaceutical Promotion Study – Ass’n of Medical Publications - 2002 + $0.52 $0.25 $0.19 DTC NA NA $3.56 Medical Ed + $0.88 $2.22 $5.00 Journal Ad + $0.19 $1.45 $1.72 Detailing Margin of error 95% confidence 1997 – 1999 launches (Brand sales of $25-50MM) ROI per Dollar spent (1991 – 99 launches with Brand sales of $25-200MM)

“ Low tech” example of banner ad campaign dampened anticipated erosion Match Period Covariate Period Test Period

Test vs Control NRx Patient Record Banner Ad test Physicians who were using Formedic patient record forms (test group) prescribed 29.4% significantly higher new prescriptions for a new ADHD line extension as compared to the control physicians during the 17 month post-test period. (cl*=99.99%) Note: *cl = Confidence level; if cl >= 90% the program impact is significant, else it is directional. Analysis conducted : ANCOVA.

How about a practical example? Oxistat Case Study Non-personal selling effect on brand prescribing habits of a mature anti-fungal product

Oxistat non-manpower program was designed to examine effects of increase reach and frequency of message vs. personal selling alone

Targeted highest volume Derms, Peds and Pods

Two Main Components directly linked to web site for sample fulfillment

Direct Mail

12,000 decile 7-10 physicians

Four waves (Jan-March ’04) with BRC for premium

26% response rate

Journal advertising

Insertions ran November-December ’03, April-September ‘04

Three pediatric publications

New creative began in July

Total Spend ~ $300M

Very modest compared to personal selling promotion cost

Modest non-manpower promotional investment drove TRx growth outside sales force alignment

So what’s up with all the noise around eDetailing?

Physician Acceptance of Online Detailing*

Physicians are using Online Detailing

206,280 physician participants

109,440 intend to participate in 2004

In 2004, roughly 50% of all physician will participate in an online detail

Current eDetailing Users attended 8.8 programs/physician in past 12 months and expect to increase to 14.8 programs

Physicians who use Online Detailing are high value

physicians

Current eDetailing Users write 193 Rx/week vs. 108 for non-users

Online Detailing is an important channel for keeping

up to date on info

Current eDetailing Users expect to decrease time with reps by 30% and double their time with electronic detailing programs

Physicians access from home an average of 59% of the time

*Source: Manhattan Research

GSK has been testing alternative methods of promotion for more than 2 years now to measure the changing attitudes of physicians 59% of participation time was outside of rep work hours! A GSK product eDetail test - 2003

An early insight to me was that physicians view “e-Details” more like symposia and less like a sales call The implication of this finding may be a driver of future intent of eDetail use

Increasing Interest in Participating in eDetailing Source: Medsite and Industry Research

Overview: Why Physicians use eDetails

Physicians are using eDetails to simplify the information gathering processes required to run their practices and manage their patients more effectively …

Source: Medsite and Industry Research

% Total Survey Respondents

Question: Why do you use eDetailing?

70% physicians complete details outside of office hours

Note:

Access information when and where it’s convenient

Access information when a product is launched or a new indication is announced

Reduce the amount of redundant information received

Follow up to get more information from a sales Rep

82% 74% 54% 52% 41%

Reduce the amount of time I spend with reps

eDetailing has utility throughout the Product Life Cycle High – Medium (varies by cluster) Very High Very High (varies by cluster) Medium High High - Med ROI (depending on volume) Medium – Low High High Med - Low ROI (depending on volume) Med - Low ROI (depending on volume) High - Med Decile Lower Decile Launch / Growth Mature Decline / Harvest General Strategy

Accelerate Adoption

Anchor Key Messages

Integrate with Reps

Protect Relationships through smarter segmentation of customer base…defend market share

Deeper Penetration of customer base…fill in coverage gaps

SFA /eDetail feedback loop

Cushion Erosion

Migrate to low cost promotional / sampling channels

Reported ROI 300% -1500% 200% - 1000% 200% - 400% High - Medium Key Source: Medsite Response ROI

My recent experience with eDetailing agrees with the research

Test Objectives

CH was interested in exploring online promotional marketing to maintain professional relationships with US prescribers (challenge faced with reduction of field sales support)

Focus on two mature dermatology products Aclovate ® and Cutivate ®

Increase interaction with brand message and raise brand awareness

Communicate the use of these products in combination therapy

Creating a low cost solution for developing an online marketing channel

Targets

The program goal was 2,300 completes with 10% high value targets recruited by MedSite based on a target list of 40,000 (MedSite received 8,000 derm & ped targets)

eDetail Aclovate/Cutivate

Program Overview

A 1-wave; 7-minute interactive multi-media program

Includes comprehension and profile questions to keep participants engaged in (and to measure) the program

No honoraria in a channel where pharma companies are offering up to $25 worth of medically relevant gifts

Launched August 26, 2004

GSK owns all assets which can now be redeployed on www.dermprofessional.com

Full amortization of digital assets is must to maximize ROI

The animations used in the eDetail for the mode of action, etc was extracted from a CDDVD based training program

Source files (flash) were sent to the eDetail provider during storyboard phase

Out of pocket expenses were minimal for content development, because the bulk of the cost was absorbed by previous project

Recruiting is key! Participants & Completers – By Channel Physicians may enter site through more than 1 method

Test Case - Program Summary

Program Launched August 26 th , 2004

Cumulative results through March 9 th , 2005

Average time spent in iDetail: 7 minutes

Total Time spent in iDetail: 31,620 minutes

Rx Derm eDetail - Results

Increased Self Reported Intent to Prescribe

Before eDetail 19% self reported prescribing Aclovate

Following eDetail 63% ‘very likely’ (top 2 box rating) to prescribe Aclovate

Before eDetail 22% self reported prescribing Cutivate

Following eDetail 67% ‘very likely’ to prescribe Cutivate

High Marks for Engagement / Completion

1,308 completes in 5 months

82% completion rate

52% completing after business hours

13% visited the web site after the eDetail

Post period analysis shows a TRx change of +25% for brand prescribers, while segment was +3%

Rx Derm eDetail - Results

Increased Scripts

The number of scripts for Aclovate among the targeted physicians who completed the eDetail more than doubled in Q4 ’04 vs. Q1 ’04* (controlling for all other forms of promotion)

Pre eDetail monthly avg. scripts per HCP - 1.372

vs. Post eDetail monthly avg. scripts per HCP - 2.817

There was a 105% increase in total scripts between the two quarters (219 v. 614 scripts written post eDetail)

* Note : the results only refer to Aclovate as Cutivate came off patent in May and the number of scripts actually declined

My eDetail Summary

Key Take Aways

This Interactive Learning Program has proven to be successful

Not having an honorarium slowed the completion rate but has not stood in the way of success

This is a low cost approach to educating HCPs about our products

$44 per completed detail

Drove traffic to the web site and gained opt-in for future communication

This cost per contact may not be easily replicated since it was taken on as a trial by the provider

Scaling up may be to NPs, PAs and other PCPs but high value Derms and Peds have proven hard to reach

My Conclusions

No doubt, Pharma selling model is evolving rapidly as physicians have more channels to access for information

While personal selling may be the “gold standard” of promotional opportunities, there are viable alternatives channels for marketers to consider, regardless of size.

My experience has been with a well known drug in a well established category. This dynamic and opportunity may not be as well defined in emerging or replacement therapeutic categories.

Non-personal selling strategies can greatly increase reach and frequency against category prescribers when compared vs personal selling centric plans

When I combine these industry facts and data with my own experience, I believe it’s possible that small to mid-sized brands can be effectively promoted without personal selling and return a positive ROI for your respective organizations

Acknowledgements for significant contribution to my learning and presentation