By Taren Grom A 360-Degree Approach to Marketing With the Patient at the Center As budgets start to shift away from mass-media DTC efforts and slick and glitzy advertising, marketers are going old school, in a sense. There is more focus on the healthcare providers, not just as prescribers, but as true providers of care who have their patients’ best interests at heart. Marketers recognize that they need to address the different informational and educational needs of physicians and patients, thus there is a recognition that there needs to be a 360-degree approach to marketing. It’s essential to know which physicians react to which programs and which patient groups respond to what tactics. As such, there is an increased focus on education, because it is believed effective customer education will lead to customer acquisition. There is also a secondary gain that benefits the entire industry: more educational programs likely lead to an improvement of the pharmaceutical industry’s perception among consumers. While marketers can measure the effectiveness of different tactics, the ultimate success of a promotional campaign is dependent upon many components. Marketers agree that there is no single silver bullet solution, which is why it’s important to have a well-thought out and rich promotional media and marketing mix. This mix, for most marketers, is comprised of a wide variety of media, everything from the traditional — fax programs and direct mail for example — to new technologies — Podcasts and highly interactive and targeted online offerings — to sales representatives and journal advertising. Tactics vary by product and physician group, and each brand team needs to consider the approach that has proven most effective for the product in the past and look to how new technologies can be applied to move forward. Some believe that newer technologies will be readily adapted because cutting-edge products require cutting-edge communications and the never-ending quest for newer, faster, and better. Rules and Regulations Since the PhRMA Guiding Principles on DTC advertising went into effect Jan. 1, 2006, marketing campaigns have been altered. Our Forum experts discuss how the guidelines have impacted their strategies. Benecchi. Before January, we weren’t actively involved in DTC marketing, but we were paying close attention to how other companies were reacting as we crafted our approach. Since the release of the guidelines, we have launched a DTC advertising campaign. The guidelines provide clearer direction on DTC TV and print advertising for all companies with respect to what needs to be included to ensure there are informed consumers. For some products these changes may mean moving away from mass media, such as TV, where there are time constraints to engage the consumer. Marketers must deliver a message, present safety or risk information, and ultimately have a call to action. In the absence of TV dollars, the use of other tactics is expected to increase. Arnold. DTC advertising campaigns have become more conservative and concise, meaning they don’t communicate as much information. What is communicated via which vehicle must be taken into account because of the additional cost to include so much fair balance information. Coyle. In general, pharmaceutical companies that launch DTC advertisements for their brands now wait an appropriate amount of time after receiving FDA approval for the product launch. Marketers are building in sufficient time for healthcare providers to have the opportunity to learn about new medications before their patients ask questions. Physicians need to have accurate information to use in responding to patients’ inquiries and in guiding patients to the most appropriate treatment options. In addition, many advertisements have become more disease-state focused to increase awareness about diseases, educate patients about treatment options, and motivate patients to contact their physicians and engage in a dialogue about health concerns. Ads should focus more on healthcare vs. potential outcomes. For example, an ad featuring a physician discussing the disease and/or the potential benefits one may experience from using a particular product, rather than showing people having fun or participating in a sport with the implication that a product will ultimately lead to such outcomes. All advertisements must be accurate and not misleading in any way; they should make claims only when supported by substantial evidence; they must include fair balance to reflect risks and benefits; and they must be consistent with FDA approved labeling. Senyk. The guidelines have been helpful and have helped rein in the DTC campaigns that seemed to occupy every television ad spot available. The high frequency of DTC ads, coupled with the negative perception of pharmaceutical companies, led the public to link DTC with high prices, further harming the industry’s image. While only voluntary, the PhRMA Guiding Principles caused an immediate decrease in television frequency and a shift from overt branding to more subtle messaging. Let’s face it, any company with vast resources can flood the television with DTC ads and pick up some market share. But this is a short-sighted gain since bulldozing does not leverage DTC for its best value, which is to educate the potential patient population and encourage conversations between patients and healthcare providers. Following the Money With branded pharmaceuticals valued at more than $74 billion in annual revenue expected to lose patent protection in the next five years and 80% of that revenue generated in the United States, marketing budgets will be significantly impacted. Our Forum experts discuss how they believe the industry will react to this long-foreshadowed event. Baker. The pressure to develop blockbuster-size replacement compounds for products losing patent exclusivity continues to increase. As a result, blockbuster-potential products are likely to continue to be supported with substantial marketing budgets, perhaps at the expense of smaller products that generate $100 million to $500 million in annual sales. This presents a real opportunity for specialty pharma companies that compete in these areas if they are willing to invest in these products. Benecchi. With the decrease in revenue stemming from branded pharmaceuticals there will be a decrease in budget dollars to market new products. Marketers have to become even better at evaluating the tactics that produce the greatest benefits for the brand. Each tactic will be competing for fewer available dollars, resulting in a shift in spending from TV to more focused tactics, such as the Internet that reach a specific demographic. Patient retention will become an even more vital part of a marketer’s plan. Senyk. The industry has witnessed a shift in money and attention from diverse discovery research to partnering and alliance building. In the short term, this will spread research and marketing risk. Central to the longer-term solution is innovation stimulated by the current market environment, especially the reimbursement/payer component. Innovation will need to come not only from R&D but also from internal operations and processes. Competition and pricing pressures are forcing organizations to increase internal efficiencies, which should translate to the profit line and ultimately pricing strategies. The ensuing period of price erosion as generics come to market also presents agencies and vendors with opportunities to improve their processes, which ultimately would translate to new pricing strategies and savings for their customers, the pharma companies. I believe agencies with this insight would fair very well. Arnold. Marketing budgets tend to be in proportion to the gross revenue generated by the product as well as its importance within the company’s product portfolio and overall profit contribution to the company. It will be interesting to see whether companies with lead products that do not have follow-on compounds will keep investing in brands post-patent loss. I would expect these investments to be in the life-cycle management area, such as a branded generic, although this is starting to be frowned upon; prescription-to-OTC switch; extended-release formulation; or additional indications. With so much control over the branded-to-generic switch by managed-care companies, I don’t believe there will be additional investment anywhere near the same level of investment as during the patent exclusivity time period. If a company cannot extend the patent life, it will switch to the traditional “harvest” mode, which is all about minimizing expenditures. I don’t think companies will just sit back and wait for generics to arrive, but once they do arrive there isn’t much they can do because “DAW” — dispense as written — doesn’t mean much in the managed-care era. Coyle. Once there is generic entry into a market, companies tend to stop spending marketing dollars to promote the branded drug. The managed-care environment is such that drug decisions are typically based upon cost. In addition, the generic manufacturers do not spend money on marketing. So for these products, marketing budgets will definitely decline. Reaching the Masses Our experts discuss how they are preparing to augment or replace branded mass media DTC by initiating more targeted online consumer marketing programs. Benecchi. It’s my responsibility as a marketer to understand our consumers, including the consumers’ media consumption habits. When opportunities arise, we need to have interactive learning that completely engages consumers, regardless of their level of knowledge or experience with the brand. Once we’ve identified our consumers, we must be prepared to have ongoing communications with them as they evolve from information seekers to brand evangelists. Baker. I believe the move to more segmented consumer programs will continue to grow and online consumer marketing is an important means for this to happen. Mass-media DTC is not going away, but public backlash against DTC, the continuing need to show measurable ROI, and the need to move beyond awareness generation will likely push more marketers to shift some of their investment toward online programs that may be more easily targeted to diagnosed but untreated patients or currently treated patients who are at risk of becoming nonpersistent with therapy. Senyk. I always try to connect one form of a campaign, such as DTC or eDTC, to a value-added experience for the physician. This has been effective when using different media. An example would be using direct mail to link an e-patient education program with physicians who are geographically near those patients seeking information about their disease. Arnold. Mass-media DTC is too expensive for most small to midsized companies, and most of the time DTC is effective only if the brand is the market leader. For all of those other products in a class, it makes much more sense to conduct more focused DTC. The only market that is probably somewhat of an exception is the allergy market. In this day and age, the name of the game is segmentation. Targeted online marketing helps marketers reach the segment of the market they are trying to own. Additionally, this makes it more cost-effective and easier to measure the success of online programs. More and more consumers are turning to the Internet for medical information so it makes sense to go where the patients are. The extra benefit of doing online, targeted marketing is avoiding the potential negative fallout from consumers who see big, flashy expensive TV ads and think that is why their prescriptions cost so much. Coyle. DTC is an integrated approach that involves a variety of media: print, TV, radio, online, and offline. Again, it is important to make the messages targeted, but that does not mean companies are forgoing any specific media; they are simply optimizing the ones they use. Online is certainly a very important category as studies have shown that seven of 10 consumers turn to the Internet for disease and drug information. What’s In, What’s Not With marketing budgets undergoing realignment, some channels will benefit from newly found resources while other marketing channels will fall out of favor. Our industry experts take a stab at identifying what’s hot and what’s not. arnold. Tactics that augment the salesforce effort — nonpersonal promotion in the form of direct mail and e-marketing — will increase. Other areas that will have an upsurge include targeted direct-to-consumer or direct-to-patient promotion, particularly Web-based and opt-in programs and journal club types of dinner events. Benecchi. Undeniably, there will be a greater migration of dollars to the Web. As a whole, we’re already witnessing brand budgets going in that direction. While increasing numbers of consumers are accessing information on the Web, marketing dollars have not yet caught up as a percentage of the marketing spend. Web spending will shift from banner advertising and paid searches to more robust, rich media, and niche Websites that are frequented by patients and consumers affected by a specific disease or disorder. Baker. Not surprisingly, e-marketing is likely to see a disproportionate increase in promotional investment as the pharmaceutical marketing community becomes increasingly sophisticated in how to use this channel. Companies that once boldly proclaimed that they would “own the Internet” may become disenchanted when they find that they can’t own it and may choose to reduce their investment in e-marketing. But overall, I expect that there will be continued and steady growth in this area. Coyle. We anticipate that payer marketing is likely to increase. Companies must be able to demonstrate the value proposition of their products so that they gain favorable formulary status. Senyk. To increase attention to medical education, I believe payer/reimbursement and distribution channels also will need increased resources. Educating the PBMs along with physicians is central to success in today’s cost and price-conscious environment. Benecchi. TV and print will experience the greatest decline. Generating awareness isn’t worth the expense if the campaign doesn’t translate into lift for the brand. This includes journal advertising as well. Arnold. Samples won’t ever go away, but the number of days of therapy provided in a sample will probably be minimized since this is usually one of the largest budget items. Journal ads, unless there are new data, will be heavily scrutinized. Coyle. Promotional tactics and exhibit booths at conferences are probably the most likely to show the greatest decline in budget allocations. The effectiveness of these channels is limited. Senyk. Broad corporate awareness campaigns as well as the enormous field forces are being cut. The total number of sales representatives cycles through highs and lows, but over time there has been an overall decrease. Companies understand that the ROI is unattractive for sales representatives to spend greater then 45% of their selling time in a waiting room. Potential Markets There are underserved disease states that could benefit from both more consumer-focused marketing initiatives and physician-directed messaging. Our experts discuss areas where both types of communications could improve patient outcomes. Benecchi. Takeda is studying a few underserved areas very closely, including insomnia, gastrointestinal (GI), and neurology. With insomnia, there has been an increase in marketing to consumers. There new products on the market to treat this condition, but a gap still exists between the 70 million insomnia sufferers compared with the 3 million who are on a therapy for their insomnia. This means there are 67 million people suffering from insomnia who are not being treated. There are also opportunities in the areas of GI, including chronic constipation and irritable bowel syndrome. There are fewer diagnoses made in these areas because patients may be reluctant to initiate a conversation with their doctors about these issues. DTC advertising can communicate that these problems are common and need to be discussed for better health and well being. Baker. Probably most therapeutic classes and disease states are underserved and could benefit from more marketing to consumers. The key question is, can it be done with a better expected ROI than marketing to other audiences? In ADHD, for example, only about 50% of children are treated and fewer than 20% of adults with ADHD are diagnosed and treated. As marketers, we know there is an identifiable target audience — mothers of children with ADHD — who are relatively easy to access, information seeking, and willing to take action. Together, these make the odds good for a decent ROI. Arnold. There definitely are underserved areas. The problem is that products in smaller markets don’t have the budgets to get the word out. Additionally, there are usually fewer products to share the burden of getting the word out. For example, I know of one such disease first-hand — Sjögren’s syndrome — an autoimmune disease that primarily affects women and takes on average 10 years to correctly diagnose. Coyle. Diseases that are associated with a stigma may benefit from having a DTC campaign. Sometimes consumers are afraid or hindered from speaking to physicians about a condition. A good DTC campaign will foster dialogue between patients and physicians for these types of conditions, such as mental illness, erectile disorder, or overactive bladder. In addition, chronic conditions for which there is poor adherence to medication could benefit from more marketing to consumers. DTC can provide encouragement to patients and reinforce the need to stay on medication. Finally, conditions for which there is a breakthrough treatment could benefit from efforts that educate consumers. If there has not been a new option for patients in a long time — or ever — then there is an underserved market with an unmet need and DTC can help communicate the new option. Senyk. Yes, unfortunately, there will always be underserved disease states. And there is certainly an important role to be played by DTC. As marketers, it is essential to continuously improve our understanding of disease states as well as drug properties. Educated consumers are open to treatment options, which leads to improved patient outcomes. There are three areas where I believe DTC to be most effective. The first is alleviating a stigma associated with a disease, such as erectile dysfunction or psychiatric illness. Second, DTC can be used to educate the general public about new disease states or diagnostic classifications, such as overactive bladder and fibromyalgia. Third, consumer-directed promotion can be used to communicate new research findings, such the NCES cholesterol level guidelines or systolic/diastolic guidelines. Ultimately, increased attention to a disease will yield increased research, which feeds a patient’s continuous desire to understand that disease. The quest to uncover and understand disease processes and new treatments is such an important mission for all participants in the healthcare environment that it cannot be understated. And it is far too important a quest to be solely the responsibility of R&D. We all must step up to help improve awareness, which will result in better patient care. Senyk. Some would disagree with me, but I believe physicians are our most important customers. Some companies, such as Bayer, are actively marketing to physicians for some of its OTC products. I think this is a very creative marketing approach to impact the entire healthcare treatment “team” resulting in commercial gains. The PhRMA guidelines reinforce the importance of marketing to consumers without skipping adequate physician marketing. If DTC is part of the marketing plan, then physician marketing should be given more attention, although not necessarily a budget increase. Arnold. Some disease states could benefit from more physician-directed promotion, especially if a more obscure disease can easily be mistaken for common ailments. For example, the reason so many women go undiagnosed with Sjögren’s syndrome is because the disease is routinely mistaken for menopause. The other reason to market to, educate, and remind physicians about these smaller or underserved diseases is to get physicians to think outside the box and not just assume a disease is the “usual suspect” when certain symptoms are present in a patient. Marketing to physicians can motivate them to take the extra time to ask a few additional screening questions during diagnosis that they might not otherwise have considered. Benecchi. There are many nonlife-threatening disorders, such as insomnia, that don’t rise to the top of the list for patients and physicians. These issues may be a marker for greater health and wellness issues that physicians need to know about. Coyle. The goal of most physicians is to save lives, therefore they tend to focus on treating life-threatening conditions such as peripheral arterial disease, which can cause heart attacks and strokes. But there are often very painful, but perhaps not life-threatening symptoms associated with more serious conditions that go untreated. Therefore, these types of situations that impact patients’ quality of life should be brought to the attention of physicians. Another example would be orphan drugs or drugs that are developed and manufactured for diseases that have small patient populations. When a new treatment option becomes available and the FDA gives it the orphan status, it is important that physicians are educated about the potential new treatment. Selling to the Salesforce Marketing materials specifically designed for the salesforces have changed in the past few years. Our experts discuss what works, what doesn’t, and what prompted some of the changes. Senyk. The PhRMA guidelines and cost-conscious customers — physicians — have prompted less glitzy and more science-based selling strategies and visual aids across the industry. Genuine added value to the customer is at a new high. Finally, the concept of marketing to physician customers as doctors and not as prescribers is taking hold on a larger scale than in the past. By this I mean, the provider is more than just an IMS rating. Savvy marketers have always understood this difference. Arnold. Marketing materials tend to take into account the product’s current detail position. Knowing that a third-position detail is going to basically be a reminder, materials are developed with this in mind. They are designed so reps can quickly pull them out of their bags. The visual elements also are considered. For example, perhaps a piece with a patient profile is developed to assist the salesforce with bridging from the lead-detail product to yours. Also, visually and verbally, the directness, importance, and order of the key messages are considered. The stopping power of the images is also something that we pay attention to, because this can assist a rep in initiating a hallway/sample closet discussion with a physician. The images also have to have “campaign-ability” so that nonpersonal promotion can easily and visually tie with salesforce promotion, as this will help augment the salesforce’s efforts. The main reason for these changes is the over-crowding of physicians’ offices with both sales reps and marketing messages. Marketing messages are all about sound bites and visual cues now. Benecchi. Even before the DTC guidelines came out, we recognized that there was a shift in how marketing was being done and how salesforces were being asked to talk to physicians about their products. The guidelines only accelerated the process. There currently is a much more integrated approach across marketing functions, the result being more robust materials in the hands of sales representatives as they talk to healthcare professionals. Coyle. Along with the PhRMA guidelines, numerous other guidance documents have been put in place from the OIG, local, state, and federal governments, and industry organizations to ensure that prescription drugs are marketed responsibly and appropriately; that they are not in any way misleading; that they contain fair balance; and that any claims made are fully substantiated. Because sales representatives have less time with physicians, companies look to develop fewer marketing materials that carry more specific messages to help sales representatives get their message across to physicians more quickly and succinctly. The materials are more clinical in nature and sales representatives receive more training than ever before. And, of course, fair balance is featured more prominently and used more than ever before. Baker. Because Shire now markets two major products — Adderall XR and Daytrana — in the same therapeutic category of ADHD, we have worked hard to simplify our promotional materials to support distinct positioning of the products and to make it easier for our salesforce to promote both brands on the same call. We are creating more cobranded promotional materials. We also provide an extensive amount of general education material on ADHD for physicians to help their patients and reinforce our reputation with physicians as “the ADHD support company.” Finally, we routinely update our promotional materials to be responsive to what we hear from our sales reps through salesforce advisory boards. Searching for the Creative Angle Just as salesforce materials are changing with the times, so too are the other promotional media channels. And these are just as, if not more, heavily scrutinized in terms of regulatory oversight and the creative push is mostly determined by the company and its culture. Benecchi. There are two camps — those companies that are taking a more conservative approach and those that are pushing for more innovative ways to reach consumers. As we evaluated this issue, we realized the approach depends on the company, its culture, and its willingness to try new approaches. The severity of the disorder or disease also plays a part. Finally, the product’s competitive position and the product’s safety and efficacy profile must be considered. New media are going to play a critical role in many new campaigns. Senyk. Creative is a relative term. Currently, marketers must tailor their approach to extremely educated physicians and patient groups. Patients and physicians have more access to information than ever before via the Internet and portable e-devices. I foresee a trend of much more focused and targeted campaigns that use a variety of media. Managing through this tight regulatory environment cycle, while gaining an edge over the competition, requires taking the nonconservative route when others take a conservative stance. Arnold. Marketing campaigns are trying to find innovative media to reach both physicians and consumers. The campaigns are becoming more like packaged goods in terms of segmentation of targets. I wouldn’t say the actual content of the campaigns is aggressively cutting edge because of the regulations. Additionally, because consumers continue to scrutinize pharma companies in terms of high drug costs, pharma companies will go with less flashy TV DTC campaigns, that are more educationally focused. Coyle. Pharmaceutical companies are developing more conservative marketing campaigns. In light of the legal/regulatory environment and the numerous new guidelines that have been put into place, it is in the best interest of everyone — the pharmaceutical companies as well as physicians, patients, and caregivers — that marketing campaigns are executed in a conservative manner, focusing more on education than promotion. Arnold. Yes, marketing programs are more conservative in look and feel. But underlying all of the education is still the goal of trying to find a way to tie the new knowledge about a disease state back to why a particular product is the one to choose. Marketers can never bias the information, but they should always try to choose to educate on treatment option platforms. Marketers may also choose to educate physicians on how to properly diagnose a condition to help expand the number of patients. The main difference is that instead of having the “Madison Avenue” selling approach, there is a logical build from disease-state information to the product. Coyle. It is clear that current messaging does focus more on education, but I also think that companies are not giving up on customer acquisition entirely. It is important to educate consumers as much as possible so that appropriate consumers have the information they need to have a discussion with their physicians. The Print Connection Journal advertising has been part of the marketing mix for a long time. As more journals are going fully online, our experts consider how and when journal advertising makes sense, in print and online. Senyk. Currently, I believe e-journal advertising to be less effective then traditional journal advertising in most cases. But I also believe that e-journal advertising and its effectiveness will only increase as physician comfort and use of e-journals increase. We can infer this by looking at online music as an example, where the target demographic group is 16 to 22 year olds. These highly technically oriented individuals are the next group of physicians and customers for the pharma industry. And just as with computers, online literacy and comfort will only continue to rise with the next generation of medical students, residents, and doctors. E-journal advertising spending will increase as comfort and acceptance with the media increase. Pocket paper PDRs are being replaced by PDAs that have mobile Internet access and interchangeable memory cards that are specialty specific. I predict with confidence that sponsorship of this type of information will yield an outstanding ROI. Coyle. Physicians seem to be a bit slower in adapting to online media. Although there has been an increase in online messaging to physicians, in general we do not foresee any reduction in advertising in print journals. Again, each product team must monitor its various tactics to optimize its specific marketing mix. Arnold. I think there are those who fall in the camp of believing journal advertising is a staple and as such will continue to advertise in this manner. Then there are those who never really believed in using journal ads in the first place and still others — the majority — who only use journal advertising when they have new data or a new strategic initiative they are releasing. While the journals have gone online, I believe there are those who will continue to advertise in the print versions. But I believe journal advertising cannot be considered the sole or cornerstone of professional advertising as it was in the past. Journal advertising has its place and purpose and as such definitely won’t disappear. Benecchi. The shift away from print journal advertising is going to happen more slowly than in other media, such as TV. Physicians still read journals for information. Data will tell us if journal advertising is delivering ROI in print and online, and we will then adjust accordingly. PharmaLinx LLC, publisher of the VIEW, welcomes comments about this article. E-mail us at [email protected]. Complying with regulations is one of the biggest challenges when marketing to physicians. September 2006 VIEW on Marketing Marketing budgets tend to be in proportion to the gross revenue generated by the product as well as its importance within the company’s product portfolio and overall profit contribution to the company. Janice Arnold Daiichi Sankyo Marketing budgets increased or remained the same compared with last year. thought leaders n Janice H. Arnold. Product Manager, Floxin Otic, Daiichi Sankyo Inc., Parsippany, N.J.; Daiichi Sankyo, part of Tokyo-based Daiichi Sankyo Co. Ltd., has a strategic focus on cardiovascular diseases and research and development of new therapies focused in the areas of glucose metabolic disorders, infectious diseases, cancer, immunology, and bone and joint diseases. For more information, visit daiichisankyo-us.com. n David Baker. VP, General Manager, ADHD Business Unit, Shire U.S. Inc., Wayne, Pa.; Shire is a global specialty pharmaceutical company with a sales and marketing infrastructure, a broad portfolio of products, and its own direct-marketing capabilities in the United States, Canada, United Kingdom, Republic of Ireland, France, Germany, Italy, and Spain. For more information, visit shire.com. n Chris Benecchi. Senior Product Manager, Rozerem, Takeda Pharmaceuticals North America Inc., Lincolnshire, Ill.; Takeda Pharmaceuticals North America, a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd., currently markets oral diabetes, insomnia, cholesterol- lowering, and gastroenterology treatments, and through the Takeda Global Research & Development Center Inc., has a robust pipeline with compounds in development for diabetes, cardiovascular disease, and other conditions. For more information, visit tpna.com. n Lauren Coyle. Senior Product Manager, Otsuka America Pharmaceutical Inc., Rockville, Md.; Otsuka America is a fast-growing healthcare company that commercializes Otsuka-discovered and other product opportunities in North America, with a strong focus on and commitment to neuroscience, cardiovascular, and gastrointestinal therapeutic treatments. For more information, visit otsuka.com. n Russell Senyk. Director of Global Products, International Marketing Development, Ranbaxy Pharmaceuticals Inc. (RPI), Princeton, N.J.; RPI, a wholly owned subsidiary of India-based Ranbaxy Laboratories Ltd., is engaged in the sale and distribution of generic and branded prescription products in the United States. For more information, visit ranbaxyusa.com. Medical conferences identified as a major avenue to market to physicians. Probably most therapeutic classes and disease states are underserved and could benefit from more marketing to consumers. The key question is, can it be done with a better-expected return on investment than marketing to other audiences? David Baker Shire U.S. Branded and disease-state Websites are popular tactics to reach mass markets. PharmaVOICE 2006 View on Marketing Survey We asked our survey respondents to rate the challenges they face marketing to consumers/patients on a sliding scale. Not surprisingly, tracking ROI was considered the biggest challenge. Marketing to Consumers Challenge Difficulty on a scale of 1 (least challenging) to 5 (most challenging) Tactic 1 2 3 4 5 Getting the creative right 5% 15% 30% 30% 20% Working with multiple marketing partners 7% 20% 34% 20% 20% Complying with regulations/policies 3% 17% 17% 31% 32% Obtaining a targeted list 9% 33% 32% 16% 11% Achieving a reasonable response rate 3% 16% 26% 38% 17% Completing a campaign on budget 12% 16% 49% 21% 2% Completing a campaign on time 5% 16% 38% 36% 5% Tracking ROI 2% 3% 24% 29% 42% Making campaigns consistent across initiatives 7% 12% 32% 37% 12% In light of the recent guidelines restricting direct-to-consumer advertising (DTC), we asked our survey participants to identify all the tactics they will use to disseminate their messages to patients/consumers and physicians. Consumer Tactic Response % Association sponsorships 67.3% Billboards 9.1% Cable TV advertising 27.3% Community outreach programs 45.5% Consumer magazine advertising 52.7% Direct mail 43.6% E-mail 50.9% Event sponsorships 41.8% Network TV advertising 23.6% Newspaper advertising 21.8% Organic search rankings 20% Paid search advertising 32.7% Patient conferences 34.5% Podcasts 12.7% Public relations 65.5% Radio advertising 20% Sampling programs 32.7% Websites – disease state 78.2% Websites – branded for product 76.4% Note: Statistics are based on responses from 55 individuals Physician tactic Response % Association sponsorships 62.7% Conference sponsorships 76.3% Direct mail 59.3% E-mail 50.8% Event sponsorships 64.4% Journals 71.2% Medical conferences 86.4% Organic search rankings 13.6% Paid search advertising 16.9% Podcasts 23.7% Public relations 57.6% Sampling programs 47.5% Websites – disease state 61% Websites – branded for product 71.2% Note: Statistics are based on responses from 59 individuals We asked the same group to rate the challenges as they pertain to marketing to physicians, again using a sliding scale of 1 to 5. In this scenario, complying with regulations and policies was the biggest challenge identified by marketers, with tracking ROI a single percentage point behind. Marketing to Physicians Challenge Difficulty on a scale of 1 (least challenging) to 5 (most challenging) Tactic 1 2 3 4 5 Getting the creative right 10% 8% 39% 36% 7% Working with multiple marketing partners 10% 25% 24% 22% 19% Complying with regulations/policies 5% 18% 13% 33% 31% Obtaining a targeted list 24% 29% 32% 10% 5% Achieving a reasonable response rate 2% 16% 33% 26% 23% Completing a campaign on budget 12% 33% 33% 16% 7% Completing a campaign on time 8% 27% 31% 25% 8% Tracking ROI 5% 15% 8% 42% 30% Note: Statistics for both charts are based on responses from 64 individuals Because all pharmaceutical marketing is coming under heavy public scrutiny, we asked marketers whether they think companies are doing enough to quell the negative perception. Yes 13.6% No 86.4% Note: Statistics are based on responses from 59 individuals As promotional campaigns move toward a more educational slant, we asked respondents whether they are using outcomes research in their marketing strategies. I don’t know 24.1% No 34.5% Yes 41.4% Note: Statistics are based on responses from 58 individuals The industry has witnessed a shift in money and attention from diverse discovery research to partnering and alliance building. In the short term, this will spread research and marketing risk. Central to the longer-term solution is innovation stimulated by the market environment, especially the reimbursement/payer component. Russell Senyk Ranbaxy Pharmaceuticals Outcomes research is being used more frequently than not in marketing strategies. DTC is an integrated approach that involves a variety of media: print, TV, radio, online, and offline. Again, it is important to make the messages targeted, but that does not mean companies are forgoing any specific media; they are simply optimizing the ones they use. Lauren Coyle Otsuka America Capabilities is identified as the No. 1 criteria when evaluating a marketing partner. Journal advertising remains a staple in marketing to physicians.

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