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EVOLVING TECHNOLOGIES AND THE FUTURE OF THE PHARMACEUTICAL/HCP RELATIONSHIPFrank Spinelli, MD p ,April 30, 2012

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MY HISTORY WITH PHARMA Pharma-friendly residency (1995) Chief Resident and worked closely with Pharma (2000) Sponsored lunches Grand Rounds Dinners, events, parties, happy hours First practice was Pharma-friendly (2001) Current practice and hospital affiliation are not Pharma- friendly (2010) Many HCPs are witnessing this same evolution

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NATIONAL SURVEY 2001 2004 92% of physicians f h i i 78% received drug received drug samples samples 13% received meals, 83% received food in the th workplace k l tickets to events, free travel 35% received reimbursement for 13% received fi i d financial i l costs associated with or other benefits professional meetings or CME 12% received incentives to participate 28% received payment in clinical trials for consultation, lectures, or clinical trials ti l

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PHRMA CODE 2002 The code states that the interactions between Pharma and HCPs should primarily benefit the patients and enhance the practice of medicine Discourages companies from giving HCPs tickets to entertainment or recreational events, goods that do not g convey a primary benefit to patients and token consulting and advisory relationships that are used to reimburse HCPs for their time travel or out of pocket expenses time,

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AFFORDABLE CARE ACT March 23, 2010, President Obama signed the Affordable Care Act The law puts in place comprehensive health insurance reforms, with most changes taking place by 2014 Changes t note: Ch to t 50% discount for name-brand drugs in the Medicare “donut hole” Expanded coverage for young adults Small business tax credits Pre-existing condition insurance plans

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AFFORDABLE CARE ACT January 1, 2015 - A new provision will tie physician payments to the quality of care they provide Physicians will see their payments modified so that those who provided higher value care will receive higher payments than those who provide lower quality care More preventative healthcare measures

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LOOKING FORWARD It is clear that pharmaceuticals companies will succeed or fail based NOT on how many y drugs they sell but on how well their offer improvement in health outcomes.

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EMERGING TECHNOLOGIES By 2014 all medical practices and hospitals have to convert to paperless electronic medical records Currently, Currently many doctors communicate with their patients via email and text messaging Smart phones, iPads and t bl t are b S t h iP d d tablets becoming more i important in the doctor/patient relationship

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EMERGING TECHNOLOGIESFor example: Patient is away and develops a rash. He calls his HCP but refuses to go to the ER. Patient takes a picture and texts it to the HCP. That picture helps the HCP make a diagnosis p p g and becomes part of the medical record Although there exists codes to bill for these encounters encounters, insurance companies typically do not pay for non-face to face visits.

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Rash

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EMERGING TECHNOLOGIES Consult reports from referring physicians, labs, and x-rays reports can all be linked to patient’s medical record sa ing saving paper and postage Patients P ti t can l on t private access portals f log to i t t l from th i their iPad/tablet, smartphone or home computer to view results Prescriptions are transmitted electronically via the EMR Psychiatrists a eady use S ype tec o ogy for virtual visits syc at sts already Skype technology o tua s ts Eventually, app technology (airlines) will allow pharmacists to scan patients’ device to register prescriptions patients

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EMERGING TECHNOLOGIES Smart phone app - Epocrates, medical calculators and linking apps to CME credits dit Paper prescriptions will be transmitted via apps Electronic medical records will eliminate paper resulting in less time on the phone with a human receptionist Making appointments, new pt registration and prescription renewal requests can all be done through EMR Text messaging services are already set up to send patients reminders about upcoming appointments and the ability to change appointmentsPatients and the government are pushing doctors/insurance companies kicking and screaming into adopting emerging technologies

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PHARMA/HCP RELATIONSHIP Since the PhRMA Code was instituted, the Pharma Rep and HCP relationship has changed Currently they provide: Lunch Samples On-label On label data Invitation to dinners with a contracted medical speaker Facilitate meetings with MSLs What measures can help facilitate a Pharma/HCP meeting?

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PAPER VS IPAD/TABLETS VS.Green environment is Advantages of gpushing toward less iPads/tablets:dependence on paper No paper/nothing to dispose ofPaper has to be disposed Less time to turn on vs. laptopsReps have a shorterwindow of opportunity to Providers are more pronepresent to listen to a detailLaptops need to be bootedup and are combersome

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IPADS/TABLETS Using an iPad/tablet can be interactive and transform the lecture/detail into a dialogue Physicians are more prone to pick up an iPad and if it allows for interaction by clicking and linking to slides and graphics, it has been shown to leave a more lasting graphics impression on the HCP Afterwards, reps could provide HCPs with apps for follow up and companies can track if these apps are down loaded

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ADOPTING APPS FOR PREVENTION As more providers use iPads/tablets, they’ll be more receptive to apps that make their lives easier Alivecor unveiled its ECG app which turns an iPad or app, iPhone into an ECG device Physicians can measure a heartbeat by simply pressing the device against a patient’s chest patient s J&J’s Psoriasis App, designed by Creative Lynx, gives Dermatologists an easy way t calculate PASI scores D t l i t to l l t during patient check ups

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ADOPTING APPS FOR PREVENTION Downloads for apps are comparable for either the iPhone or iPad For th F other clinical apps d i li i l designed b C d by Creative Lynx, iP d ti L iPad download can exceed those for the iPhone Apps are a much better way for a company to represent themselves and communicate through the Internet

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INTERNET AND RULES FOR ENGAGEMENT The Internet will obviously not g away, but it’s y go y, important how you engage it Digital technology and social media are now essential for engagement

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SOCIAL MEDIA Patient to Patient Patient to HCP HCP to HCP

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SOCIAL MEDIA Pharma historically has marketed along two tracks: Driving physicians to prescribe treatment Encouraging patients to request treatment The real opportunity for Pharma is to challenge these modes with digital and social media - providing platforms that extend the doctor/patient relationship, placing value on the dialogue before and after a script is written

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SOCIAL MEDIA Social networks are important for Pharma to understand and consider for communication and marketing strategies Consumers and HCPs are talking about treatment and brands - ranging from usage questions to suggestions to criticisms Talk of brands reflect a need to seek help, feedback, often amendable to information from the manufacturer f f f f

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SOCIAL MEDIACompanies that ignore this approach run the risk of leaving consumers and HCPs feeling ignored and ultimately distancing themselves from their customers

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SOCIAL MEDIA – MY PFO STORY Imagine a relationship that begins in an online community This leads to an office consult where the patient brings their smartphone containing this information found prior to the office visit The patient sits with their HCP, accesses this digital resource about wellness, prevention or disease management In addition to the prescription, patients get a mobile app that facilitate care, monitoring, and adherence The app reminds them of critical lifestyle considerations, such as exercise during detected periods of inactivity, and provides geo- targeted restaurants recommendations tailored to a specific diet t t d t t d ti t il d t ifi di t

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SOCIAL MEDIA “Digital Care Kit” could include a referral to online support groups where patients could track and share their care Physicians could post answers to questions Nurses would be alerted to patients who are lapsing and schedule an online consultation b t h d l li lt ti between office visits ffi i it The possibilities for brands to facilitate this type of engagement are limitless

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SOCIAL MEDIA Bayer launched the WomenHeartStrong@Heart online community on Facebook to encourage awareness of the millions of US women with heart disease (www.facebook.com/pages/WomenHeart-Strong- Heart/62833170782) Children With Diabetes is Johnson & Johnson’s online community for parents, children, adults and families living with Type I Diabetes (www.childrenwithdiabetes.com) Genentech’s Herceptin HER Story Community helps connect women with breast cancer survivors (www.herceptin.com/community)

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SOCIAL MEDIA g g Companies like Boehringer Ingelheim (http://twitter.com/Boehringer) and Novartis (http://twitter.com/Novartis) have Twitter accounts, though most pharmaceutical companies on Twitter haven’t yet used haven t this medium to its fullest potential

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SOCIAL MEDIA Digital resources prescribed as part of care regimens Pharma has to develop and curate reliable, objective information online This information is geared toward optimizing patient/HCP relationships HCPs must contribute to digital resources and participate in online conversations with the goal of starting a dialogue before consultation and maintaining it through the treatment cycle Brands that focus on merging online and in-office experiences will become the most relevant and valuable to both the HCP and the patient

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PHARMACEUTICAL/DOCTOR g Rep visits with the HCP have changed iPads/tablets Apps Social Media – Facebook, Twitter and websites geared to a d disease toward d sease state Human Field Representative?

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IDEAL FIELD REPRESENTATIVE PROFILE Education Does degree or clinical experience matter? Rep vs MSL Core Responsibilities Provide consistent, accurate and balanced scientific information Engage in unscripted scientific dialogue on relevant topics related to disease state and product

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IDEAL FIELD REPRESENTATIVE PROFILE Venue By appointment, in-person visits or virtually as needed? HCPs and institutions are moving towards “no rep access,” so can HCPs obtain access to scheduled virtual visits with MSLs or Med Info to provide unscripted answers? Tools d Resources T l and R Product and disease state information, on-label and off-label (slide decks on iPads/tablets, links to websites, and apps) HCP and patient education material (apps) Literature searches and medical information letters via email

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FINAL THOUGHT g y As the digital world evolves, the physical interaction between Pharma and healthcare providers will diminish. But there is something about the human connection that g transports us in a way that digital media will never do.Until the time when in-person humans are replaced, Pharma in person should seize the opportunity to maximize on this most cherished and dwindling connection. Prepare to become a leader in the technological future. -- Frank Spinelli, MD

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Thank you!