Marketing to Professionals: The Formulary Rebound

LET'S FACE IT: NO BRAND MANAGER WANTS THEIR DRUG LISTED ON THE THIRD OR FOURTH FORMULARY tier. But the reality is that brands often do wind up with low coverage, making them more expensive for consumers. So what should companies do when that happens? Pharm Exec's George Koroneos asks 10 industry experts the question that's stumping most pharmaceutical marketers:

Q: "How do you persuade providers to prescribe drugs that have significant formulary restrictions, or are not reimbursed by managed care organizations?"

CUT COUPONS

There have been examples where managed care plans move a drug from tier two to tier three, and suddenly the patient is paying $25 more a month for medication. In these cases, manufacturers should minimize the payment for the consumer by specifically designing coupon programs that help pay for the managed care rebate differential. Coupons are a great way to help patients stay on the drug, particularly if they're responding well to that agent. Generally, coupon programs do not have incredibly high redemption rates—but it is high enough to bear out a pretty dramatic increase in patients' persistence for our products.

JAY CARTER, senior vice president, director of client services, AbelsonTaylor

FOCUS ON FORMULARY

Sometimes physicians think a drug isn't covered and it is. One obvious marketing strategy is to arm the sales rep with a grid of the formulary positions in their region. Or, if a lot of patients are on consumer-directed health plans like health savings accounts, reps can help show doctors how patients can cover the costs, such as flexible spending accounts using pretax dollars. If you educate physicians that it's not always all out-of-pocket, then they don't feel quite the same guilt [when they prescribe a more expensive brand]. When it comes to sales materials, it's all about showing the overall efficacy.

ANNE STUCHINER, vice president, director of customer segment marketing at DraftFCB

DISCUSS SIDE EFFECTS

Marketers must find ways to make doctors understand that when patients switch brands, they may end up with side effects that are more than a nuisance—they can be really painful and disruptive. There are many co-pay reduction programs that are effective in many categories, particularly in chronic conditions. We are working on a program where a co-pay reduction card is in a kit that the doctor distributes. The patient brings the card to the pharmacy with their prescription and they get a discount off the co-pay to make up for the cost differential.

RISA BERNSTEIN, Flashpoint Medica

IDENTIFY ADVANTAGES

Agencies must identify very clearly what the benefit of the drug is relative to other options. In some cases, depending on the drug, marketers must identify the particular patient population for which it's most appropriate. Marketing an expensive drug is the same as marketing any other—even a breakthrough oncology drug requires a thorough understanding of the unmet medical needs in a category. The patient deserves full disclosure on why a particular drug is on the market, being prescribed, and what is it going to do for them.

JANE PARKER, group president, Grey Healthcare Group Worldwide

SUPPORT PATIENTS

One way to do this is by building a strong patient support system for the drug. This strategy is a differentiator in a category that has a lot of options which can span many different price points, and it is an up-sale opportunity for the sales force, and a value-add for the physician. One support system could be nurse-counseling hotline, which would allow physicians to distribute a phone number that patients can call if they have questions or issues withthe drug. If there is some uniqueness to the delivery method of the product, marketers also can provide doctors with educational DVDs that feature directions on how to use the delivery system.

WILL REESE, vice president of marketing strategy with Cadient Group

PRESCRIBING PROOF

When it comes to lifestyle drugs, companies have to prove the real value of the prescription to the physicians. Marketers have to put the drug into a context of a medical condition that is worth the doctors' attention. In the erectile dysfunction market, we had to show that the condition impacts self esteem, sense of confidence, and the patients' relationships—and in fact, it could be a marker for other medical conditions, such as hypertensive conditions or metabolic issues. The next step is to show that there is a benefit to treating the condition and why it is better than the alternative medications.

SUSAN MILLER, founding partner of the CementWorks

BASE THE SELL ON DATA

Drug companies must differentiate the product from its competition based on data that are relevant, believable, and compelling. The more compelling the differentiation, the more likely providers will prescribe your product, even when faced with formulary restrictions. Differentiation should be established on several levels, the most important of which is the clinical differentiation—but there is also dosing and administration, compliance and persistence, position on nationally-accepted treatment guidelines, and impact of patient quality of life.

ROBERT PAGLIA, senior vice president, managed markets strategic director at Sudler & Hennessey

SEGMENT FOR SUCCESS

Marketers have to focus on segmentation—who are the right doctors and patients to call on? Not everyone is going to be able to pay for the same products. Agencies need to look at the particular area that the doctor is located in. After all, you wouldn't see a Mercedes Benz S-Class marketed to a community where the average income is $50,000. If it's a lifesaving drug then that's a different story, but if you look at lifestyle products—say ED—you are not going to promote it in an area where the people can't afford it.

MICHAEL TREPICCHIO, president of Publicis Healthcare Group, North America advertising

QUALITY OF LIFE COUNTS

In certain situations, clinical evidence and quality of life may outweigh the costs of higher-priced drugs. In such instances—and when feasible—patients should be given the option to pay for a non-formulary drug, especially if it halts the progression of their disease or extends life. It's important to discuss all the options with patients. Choosing a higher-priced drug should always be a collaborative decision between the provider and the patient—let the evidence help them decide.

DANA REGAN, vice president, managing director, Torre Lazur managed markets

PERSISTENCY PAYS

The key is educating physicians and patients about the differences between the brand and alternative products or generics, so they can understand fully the clinical, practical, or emotional benefits of the branded medicine. If physicians and patients perceive the brand as having unique value, they will be more likely to choose it over lower-cost alternatives. Another tool is patient persistency programs. If physicians know that there is a mechanism in place to help keep their patients compliant, they will be more likely to prescribe the brand.

JOHN RACIK, president and CEO, Stonefly Communications Group