Brand teams have to be increasingly innovative when finding ways to prompt patients and physicians to intervene at the right time. Campaigns such as GSK’s Greatest Season Ever for FLONASE®, implemented last year in the United States which made the decision to prepare for the allergy season easier for patients by linking the proactive purchase of the brand to the start of the baseball season. Providing A Call To Action: We find that examples from within and outside of healthcare can often prompt this innovation. They act as a way of bringing in new perspectives and allowing teams to explore new avenues and new ideas. So, in the spirit of hoping this will prompt some new ideas in your brand team, here are our favourite case studies that speak to the need to provide a call to action.

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© OxfordSM
Selected Case
Studies for Pharma
Providing a call to action

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Learning from Others
1. Providing clarity on which patients
will benefit - XALKORI® (crizotinib) in
ALK positive NSCLC: Pfizer
2. Redefining the disease - FOSAMAX®
(alendronate) in Osteoporosis: Merck
3. Changing the perception of a
”lifestyle condition” - SAXENDA®
(liraglutide) in obesity: Novo Nordisk
4. Innovative Healthcare Technology
Reveal LINQ® system in AF / stroke
prevention: Medtronic
5. Promoting Affordable and Quality
Tests - (IPAQT) across India: Clinton
Health Access Initiative (CHAI)
6. Appealing to younger target patients -
Cervical screening campaign: UK’s
NHS and Red Lippy Project
7. Appealing to children - Sonicare® and
the prevention of tooth decay in
children: Philips
8. Providing a simple trigger for action -
Fire Kills Campaign / UK’s Department
for Communities and Local
Government
9. Responding to disruptive competition
- Waterstones – from bookstore to a
leisure experience
Pharmaceuticals Diagnostics Consumer Healthcare Other Industry

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1. Providing clarity on which patients will benefit
XALKORI® (crizotinib) in ALK positive NSCLC: Pfizer
Source = Pfizer Website, OxfordSM Analysis
Latest Status
Crizotinib has been rapidly adopted as a standard of care for NSCLC patients with ALK+ disease in the
US, with most adenocarcinoma NSCLC patients now routinely tested for ALK status. The brand was
granted accelerated approval in August 2011 and launched alongside the Vysis ALK Break-Apart FISH
Probe Kit (Abbott Molecular). Sales of US$594 million were recorded in 2017, despite just 5% of the
NSCLC population being eligible for treatment.
• Crizotinib was developed by Pfizer for the
treatment of patients with locally advanced or
metastatic NSCLC that is ALK positive
• The brand’s utility in only a small sub group of
patients was recognized early on, and robust plans
to aid patient identification were quickly
established
• Required changes in stakeholder behavior were
identified, and strategies and tactics developed to
help overcome barriers
• Pfizer supported the co-development of a
companion diagnostic, and was able to develop
long term relationships with payers to ensure
access despite a premium price, given the proven
efficacy in a small, readily identifiable patient
population
• Later, disease awareness campaigns targeted at
both clinicians and patients also helped to ensure
rapid adoption of ALK testing and a clear link to
crizotinib use if the test is positive

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2. Redefining the disease
FOSAMAX® (alendronate) in Osteoporosis: Merck
Source = Public domain literature review, OxfordSM Analysis
Latest Status
The FOSAMAX® patent expired in 2008, and immediately a number of generic brands were launched.
Worldwide, FOSAMAX® sales dropped from US$3 billion to US$1.5 billion within 1 year, a reflection of the
attractive, large market built for bisphosphonates. Since then, sales have continued to decline, partly a result
of intense generic competition, but also due to long term safety concerns emerging that suggest a link with
spontaneous femur fractures
• Alendronate was the first bisphosphonate to be launched in
the US for osteoporosis in 1995. At the time of launch there
was a very low awareness of the disease and a focus instead
on its consequences: fractures.
• Prior to launch, Merck worked closely with manufacturers
of densitometry and funded and managed the National
Osteoporosis Risk Assessment program. Low-cost scanners
started to appear in physician offices and osteoporosis
management started to move from the specialist to the
primary care environment.
• At the same time, Merck worked with the WHO to develop
a new definition of osteoporosis, which effectively meant
that around one third of postmenopausal women could
now be diagnosed as osteoporotic
• Merck carefully positioned alendronate for the large
number of low risk patients, building a substantial market
associated with the chronic use of medication
• An ambitious long term vision for the brand was also
established very early, including improving the dosing and
administration, as well as expanding use across a number
of additional indications

5. 5
• The current Novo Nordisk obesity business is built on its
GLP-1 inhibitor, liraglutide, approved for both Type 2
diabetes and obesity (its brand name is SAXENDA® in
obesity, VICTOZA® in T2D)
• However, the number of obese patients actively treated
with pharmacotherapy remains low, at between just 5 and
10%. This is partly due to the perceived lack of efficacy
associated with current brands and the social stigma
associated with treating a, perhaps, self-inflicted disease,
however the key barrier to market growth remains the
restrictions to access widely imposed by payers
• Novo Nordisk is leading the way in changing stakeholder
attitudes about the benefits of effective management of
obesity with a wide-ranging, portfolio based strategy, led
by liraglutide and (shortly) semaglutide, a best-in-class
GLP-1 inhibitor
• The company has invested heavily and boasts a range of
emerging therapies at early stages of development for
obesity with a variety of mechanisms-of-action. Its stated
goal is to look at combining these therapies with GLP-1
agonists to achieve weight loss of >15%
• However, as well as product innovation, Novo Nordisk is
also leading the way by investing in education programs
to engage far more physicians with obesity and improving
access with sponsorship of the “Treat and Reduce Obesity
Act”. It is also raising the status of obesity specialists by
sponsoring academic positions and lobbying for a formal
recognition of the specialty by 2020
3. Changing the perception of a ”lifestyle condition”
SAXENDA® (liraglutide) in obesity: Novo Nordisk
Source = Novo Nordisk Investor Presentation, May 2018, OxfordSM Analysis
Latest Status
Novo Nordisk has stated that its vision is, “to be a world leader in the treatment of obesity”.
Liraglutide was approved for use along with diet and exercise to help manage weight in 2015, and
generated global sales of US$398 million in 2017. Semaglutide, already launched for use in T2D, is
expected to be approved for use in obesity in 2022

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• Reveal was the first insertable cardiac monitoring
system, first launched in 1998, offering long-term
cardiac monitoring that automatically detects
and records abnormal heart rhythms for up to
three years.
• The brand was miniaturized, and later
relaunched as Reveal LINQ®
• Placed just beneath the skin through a small
incision of less than 1 cm in the upper left side of
the chest, Reveal LINQ® is often nearly invisible
to the naked eye once inserted
• One of the conditions it detects is atrial
fibrillation, which if left undiagnosed and
untreated leaves at patient five time more likely
to have a stroke than others
• A series of improvements in its value
proposition, both in terms of technical
innovation and support services have slowly but
surely led to greater uptake. These include
increasing data memory by 20% and improved
algorithms which accurately detect atrial
fibrillation in 98.5% of patients
• The device proved to show progressive thinking
and innovation in healthcare technology, as well
as providing a revolutionary safe way to monitor
patient cardiac activity, and was subsequently
awarded the 2014 Institution of Engineering and
Technology Innovation Award for Healthcare
Technologies
4. Innovative Healthcare Technology
Reveal LINQ® system in AF / stroke prevention: Medtronic
Source = Company website and https://www.theiet.org/factfiles/manufac/medtronic.cfm?type=pdf, OxfordSM Analysis
Latest Status
Reveal LINQ® sales are still growing, with Medtronic predicting peak year sales of up to
US$2 billion. They continue to innovate, now applying AI to their algorithms as their
evidence base grows, and developing longer lasting batteries to enable a single implant to
continue to operate beyond 3 years

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• India accounts for 23% of global tuberculosis
(TB) incidence with an estimated 2.2M cases
reported in 2014.
• Studies indicate that more than 50% of patients
seek care in the private sector, where cheap,
sub-optimal tests with high margins are widely
used. This leads to misdiagnosis resulting in
increased disease transmission, drug resistance,
and mortality.
• Clinton Health Access Initiative (CHAI), in
collaboration with a range of partners, launched
IPAQT, to bring accurate and affordable
diagnostics to the private sector.
• A low-margin, high-volume model that aligns the
interests of test suppliers, private laboratories, and
patients was used.
• First, CHAI worked with manufacturers of quality tests
to extend the 30 -50% lower public-sector pricing to
private sector laboratory partners.
• CHAI then brought together a consortium of private
sector laboratories, providing them access to the
improved supplier pricing on the condition that they
pass on the benefit of this pricing to patients.
• This market pricing was sustained by growing volumes
through medical education efforts to increase test
demand.
5. Promoting Affordable and Quality Tests
(IPAQT) across India: Clinton Health Access Initiative (CHAI)
Source = https://clintonhealthaccess.org/content/uploads/2016/06/Case-Study-India-IPAQT-June-2016.pdf, OxfordSM Analysis
Latest Status
The consortium has grown from five partner labs in 2013 to 121 partner laboratories in 2016,
providing coverage to more than 85% of Indian districts, and by 2016, IPAQT had provided access to
accurate and rapid diagnosis for over 290,000 individuals suspected of TB, up from 75,000 in 2014.
The suppliers and labs maintained profit margins and patients had better health outcomes,
demonstrating that a consortium approach can lead to benefits that could not be achieved by a
single player.

8. 8
• Worldwide, cervical cancer is the most common
cancer in women aged 15–44 years. Nearly 1000
women die each year, yet a cervical screening test
can allow cancer to be detected and treated early.
• In the UK, the NHS introduced a Cervical
Screening Programme.
• Aiming to achieve 80% coverage, the programme
included a population based registry, accessibility
to all women within the screening age range,
systematic call and recall, national coordination
and financial incentives for GPs.
• These measures were highly successful, but there
were some difficult to reach groups, e.g. only one
third of 25-29 year olds attended cervical
screening.
• Awareness raising campaigns by charities
such as the #FlipYourLips campaign,
launched in 2015, aimed to eradicate the
stigma that surrounds cervical screening, so
disliked by the younger age groups.
• A series of creatives were produced, all
using a lipstick theme, detailing how to
make sure you don’t suffer from cervical
cancer. People are invited to spread the
word in a visually arresting, and fun way:
simply adorn your lips in red, take a photo
and rotate it, then share it on social media
with the hashtag #FlipYourLips.
• The easy call to action combined with a neat
visual trick makes it a striking campaign.
6. Appealing to younger target patinets
Cervical screening campaign: UK’s NHS and Red Lippy Project
Source = https://www.huffingtonpost.co.uk/2015/06/15/flip-your-lips-campaign-cervical-screening-awareness-beauty-selfies_n_7583282.html, OxfordSM Analysis
Latest Status
It has been estimated that the incidence of cervical cancer has fallen dramatically due to the
organized cervical screening program and cervical cancer mortality rates have reduced by
approximately half. This clearly demonstrates that well organised programmes by
governments and support from charities can overcome barriers to screening in difficult to
reach populations.

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The gamification of oral care
• More than 40% of kids have cavities by the time the reach elementary school. The oral healthcare expert,
Philips, wanted to help solve this problem in an engaging way.
• Working with technology partner Achtung!, Philips Sonicare® designed an app which gamifies the process of
brushing one’s teeth.
• The app connects with the Sonicare® toothbrush so it knows when kids are brushing and when they are not.
• Launched in late 2015, the app was actually too engaging—kids couldn’t tear themselves away! In response,
the app was altered so that the animated character topples over in exhaustion soon after his brushing
adventure is over.
7. Appealing to children
Sonicare® and the prevention of tooth decay in children: Philips
Source = SAHM review, OxfordSM Analysis
“The app guides the child through the process of properly navigating the mouth and clearing up all the
messy spots. With each proper cleaning, the child is awarded treats or other surprises for their Sparkly
friend. I was pleased when I discovered that even our 12 year old (gamer geek) daughter enjoyed this
new aspect of brushing her teeth! Every day, I hear the girls asking each other what they received for
Sparkly. Sometimes it is a new background or accessories, sometimes food and other times paint to give
the Sparkly a new color. Like any game, the more you play, the more you earn. Since this correlates to
brushing teeth, the phrase “It’s like pulling teeth” doesn’t resonate. There is no coaxing, begging,
pleading or demanding that they brush each morning and evening!"

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• In the UK, whilst most homes have a smoke
alarm, there was evidence to suggest that
people were rarely checking that their alarms
were working, and research had found that
people are at least 4 times more likely to die in
a fire if they do not have a working alarm
• Instead of just thinking that they should test
their smoke alarm, The UK government needed
a campaign to ensure the thought led to action
and actually get people to test their alarms
• The public safety campaign devised created a
new behavioral link between testing a smoke
alarm and the twice yearly clock change
• This made the task feel much easier than
before; the association seemed natural as both
clocks and alarms often require batteries, both
require an effort to reach, both are a chore –
but by doing both together ,it halves the effort
• The campaign was consequently focused
around the 2 specific dates when the clocks
change
• A bold, creative approach was developed that
visually linked the clock change with fire safety
within the context of a real home. It ran over a
fixed two week period across press, tv, radio
and social media, enabled focused spend with a
small budget
8. Providing a simple trigger for action
Fire Kills Campaign / UK’s Department for Communities
and Local Government
Source = OxfordSM Analysis
LATEST STATUS
The campaign was 3 times more memorable than previous campaigns. People who recalled
the campaign were three times more likely to have tested their smoke alarm on clock change
weekend compared to those who did not recall it.
Deaths form fires fell by 16% over 2 years of the campaign, equating to a ROI of £7.12 for
every £1 spent

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• Traditional bookstores were under threat by
both new formats and online Amazon selling
cheaper
• 2007 marked the launch of the 1st Amazon
Kindle which heralded an era of electronic
books. Amazon innovated rapidly - new Kindle
models launched almost annually
• The growth of less costly eBooks exploded,
ensuring a continued revenue stream for
Amazon, while decimating sales of actual books
• Borders Books competed on selection and
price, and lost at both
• Waterstones recognized the need to reinvent
itself – and focused on providing the right
experience to purchase books
• Some of the steps they took:
• Opened W Café in 28 stores,
introducing a more local offer across
Waterstones’ locations
• Opened a flagship 7000 sq. foot store
to enhance & personalise the in-store
experience for book shoppers
• Put store staff in control of their own
shops with local staff selecting their
own ‘ranges of books and offerings
9. Responding to disruptive competition
Waterstones – from bookstore to a leisure experience
LATEST STATUS
• Waterstone’s is moving back to profit as physical book sales are increasing
• In the end, Amazon’s Kindle was removed as sales were too slow!
“Every shop has to become much more individual to
present a personality which is distinctive and local.”
James Daunt CEO

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© OxfordSM
For more information
Mary DeBoos
mary.deboos@oxfordsm.com
+44 7527 425924
Sarah Langan
sarah.langan@oxfordsm.com
+44 1428 683 900