“Adapt or Die”

John Lyttle

Oct 2013

Building Patient Partnership for Competitive Advantage or Survival

of the Brand?

Key Learnings

Patient partnership is 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

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

Environmental Pressures Drive Evolution

Brand Features, Emotional benefits

Early healthcare business environment

• 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

Size of problem Clinicians no 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

The threats of poor 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

Health care systems cannot 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

98% of management accepts 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

Tactical Survival v Strategic Dominance

Patient centred care

Evolving role of the 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

Use of agency templates 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

Adapt the existing business models – Patient flow

Current volume levers of growth

Potential volume levers of growth

Patients Relevant 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

Adapt the existing business 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

Planning for strategic dominance

Have a clear long term strategic objective 2017 2016 2015 2014

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

Tactical Implementation of patient 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

Evolution of Patient Programmes the 4Ps of Adherence

Tactical Implementation of patient supportprogramme

Presentation

Pharmacy adherence programmes

P/V driven safety

programmes

PSP

Compliance

Partnership

Presentation driven adherence programmes

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

Pharmacist driven adherence programmes

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

Pharmacovigelence driven adherence programmes

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

Patient driven adherence programmes (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

Patient centricity requires organisation 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

Questions and

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