San Antonio. “The longer you keep a patient on a drug, the higher their lifetime value.”
More than 45% of Americans don’t take medications as directed by their doctors, and 19% don’t even fill their prescriptions, according to American Demographics magazine. Getting patients to refill a prescription is even harder, experts say, proffering this dire statistic: Within the first six months of taking a new drug, about 50% of them drop off.
“That’s a massive attrition after six months,” says Jay Bolling, executive vice president of client services at Roska Direct in Philadelphia. “If you could affect that even a little bit, you’re talking billions of dollars in sales.”
It’s not as if they don’t have to include a response mechanism anyway. The Food and Drug Administration guidelines, finalized in August 1999, require prescription drug ads to list major health risks of a product and include an 800 number or other means for the consumer to find out more about its side effects.
Procter & Gamble Pharmaceuticals markets Asacol directly to patients who have ulcerative colitis (UC). Roska Direct handles these efforts. Because there are so few Americans with the condition – just half a million people – a more focused direct-to-patient strategy makes better sense than a general direct-to-consumer approach, says Rae Ann Mang, brand manager for Asacol. Broadcast or print ads in big consumer magazines were deemed a waste of money since they would reach so many millions who were unaffected by UC. “If you see a minivan on TV and you don’t have a family, it bounces right off [you],” Mang adds.
The disease is debilitating, with symptoms such as abdominal pain and cramping. It often strikes people for the first time in their early 20s. Patients may have a remission, but UC is incurable. Most suffer recurrent flare-ups throughout their lives.
“The central issue is compliance,” points out Mang. “With Asacol, when you take your medication between flare-ups you can lengthen the time between [them]. And that’s the message we desperately want to get to patients.” Most sufferers must take pills two or three times a day.
The Mason, OH-based pharmaceutical arm of the packaged goods giant began promoting Asacol to consumers in 1998, by placing 3-inch-by-5-inch ads in 30 metropolitan newspapers, along with an 800 number to call for more information.
As P&G collected callers’ names, addresses and telephone numbers, it mailed out brochures, which were distributed at doctors’ offices, pharmacies and UC patient-support meeting locations as well. But the Web site (www.asacol.com) has evolved into the central marketing channel. It had 48,000 hits in October – not bad, given the small size of the target audience.
Since the site is listed on major search engines, UC sufferers seek it out in their time of need.
“That’s why [it’s] so valuable,” Mang remarks. “Finding these patients is hard enough, but to find them when they’re in a flare-up is impossible. That’s when they’re most receptive.”
The site features pages of write-ups that detail the importance of taking Asacol regularly, advice about how to manage the disease, and how to deal with other lifestyle issues such as dating and traveling. Visitors can read case histories of others with the disease and link to dozens of pages and sites. Most importantly, early this year viewers will be able to sign up for information customized to them.
Of course, patients can’t keep taking a drug unless they fill their original prescription. Advertising can make them more comfortable approaching their doctors. “Prior to [advertising of] Viagra, only 7% of the men with erectile dysfunction ever discussed it with their doctor,” maintains Dr. Mike Magee, senior medical adviser at Pfizer Inc. in New York. “One year after the introduction of Viagra, 13% [did].”
Plus, advertising works. A 1998 Prevention magazine survey showed that 84% of consumers say their physician complied with their prescription request.
Consumer awareness is the thrust of the D-to-C campaign Otsuka America Pharmaceutical Inc. launched last fall to market Pletal. The new drug treats intermittent claudication, a symptom of peripheral arterial disease, which causes leg pain among elderly people when they walk. Among the 4 million who have the disease, only 1 million have been diagnosed.
The condition mainly affects people age 55 and older. Many of them think leg pain is a natural part of aging – and not worth mentioning to their doctors. In the midst of a multichannel campaign to raise physicians’ awareness, the Rockville, MD subsidiary of Japan-based Otsuka Pharmaceutical Co. began compiling a consumer database through ads in national magazines targeted to this age group, including Modern Maturity and Parade magazines. According to Craig Lewis, senior director of marketing for Otsuka America, it’s pointless to rent lists from database companies that survey consumers about health conditions because those files only identify diagnosed people.
Consumers respond with a business reply card, by calling an 800 number or visiting the Web site (www.pletal.com). The ads contain a “leg pain quiz”: three questions that help the patient determine whether he or she has intermittent claudication.
The questions are repeated in the fulfillment package. “We want to make sure we’re sending the right patients to the doctor,” says Craig Spolsky, vice president and management supervisor at Bates Healthworld in New York. The advertising agency handled this effort for Pletal.
Otsuka collects names, addresses, e-mail addresses and telephone numbers from fulfillment-pack requesters. Web visitors who join the walking club advertised on the site – walking helps the ailment – are also asked to give their age, gender and a description of their leg pain. The company plans to keep in touch with them through the site and a series of brochure mailings.
So far, response to the ad has “exceeded expectations,” says Lewis.
Many firms rely on partnerships with pharmacies or on market research to determine how many prescriptions are filled. But it’s difficult to find out who filled them and whether the patients are taking their medication – unless they admit to it. “People who stop taking medication will tell you” when polled, Roska Direct’s Bolling says. “The return on investment is so great the first year if you can affect behavior; anything beyond that is gravy. With chronic medication, a patient may be worth $300 to $500 a year. They need to take it for the rest of their life.”
The Zyban Advantage Plan (ZAP) is about breaking the cigarette habit. Ten percent of the people who take Zyban – a prescription pill that reduces the urge to smoke – belong to the Web-based membership program.
ZAP gives Zyban’s maker, Research Triangle Park, NC-based Glaxo Wellcome Inc., a way to support compliance and build brand while furnishing the database. People fill out a profile at the Web site (www.zyban.com), which, in addition to name, postal and e-mail addresses, asks when the person will start taking the drug, their quit date and the details of their habit.
In return, members receive a Personal Action Guide, which provides individualized tips for quitting.
ZAP “really helps with the efficacy of the product,” indicates Holly Russell, product communications manager. “Zyban is not a magic bullet. It’s only going to be helpful to someone who really wants to quit.”
Meanwhile, Pfizer and Searle are working together on a CRM strategy for the arthritis drug Celebrex, which they produce together.
Celebrex is a blockbuster drug; First-year sales in 1999 topped $1.5 billion. More than 7 million people have used the product, prompted by mass advertising. But the Web site (www.celebrex.com) is being positioned as a major information destination, vital to the brand-building. “There’s a continuum between awareness and whether people will seek treatment,” says Frank Harvey, Harte-Hanks’ president, group interactive, which is handling the effort.
Web plans call for encouraging a sense of community among visitors, with chat rooms, constantly updated information, a pass-along component and links.
Roughly 41 million adults go online to seek health-related information. Nearly one-third of those who suffer from chronic conditions and visited a condition-specific Web site asked their doctor about a prescription drug, reports Cyber Dialogue Health Practice, a survey and analysis consulting firm in New York.
These health-information seekers must sift through 15,000 to 20,000 health sites to find what they want. Parsippany, NJ’s Aventis Pharmaceuticals Inc. hopes to cut through the clutter for some of them.
Aventis is launching seven disease portals this year; they’ll have links to products that treated the diseases but would mostly offer “rich and deep” information, and tools such as diet calculators and allergy/pollen forecasts, says Lori Kraut, the firm’s director of U.S. commercial communications.
“They increase the probability that the patient will seek medical treatment. Then we could increase the potential that they’ll be treated with an Aventis drug,” she adds.
As necessary as these Web initiatives seem to CRM, most firms in the tradition-laden pharmaceutical industry spend only 5% to 10% of their marketing budgets on Web sites.
Why? “They were trained to focus on the physician,” explains Roska Direct’s Bolling. “They’re five to 10 years behind consumer marketers. So the concept of marketing to consumers and patients is new.” Besides, he adds, the future of CRM is not in Web sites but in e-mail for patient retention – an area in which the industry is just dipping its toe.
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