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- 1. “Adapt or Die” JohnLyttle Oct 2013 Building Patient Partnership for Competitive Advantage or Survival of the Brand?
- 2. Key Learnings Patient partnershipis 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
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- 5. Brand Features, Emotional benefits Earlyhealthcare business environment
- 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 Cliniciansno 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 ofpoor 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 systemscannot 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 managementaccepts 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
- 11. Tactical Survival vStrategic Dominance
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- 13. Evolving role ofthe 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 agencytemplates 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 existingbusiness 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 existingbusiness 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 strategicdominance 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 ofpatient 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
- 19. Evolution of PatientProgrammes the 4Ps of Adherence
- 20. Tactical Implementation ofpatient supportprogramme Presentation Pharmacy adherence programmes P/V driven safety programmes PSP Compliance Partnership
- 21. Presentation driven adherenceprogrammes 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 adherenceprogrammes 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 adherenceprogrammes 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 adherenceprogrammes (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 requiresorganisation 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
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