Weathering the Storm

A friend of mine is struggling to keep her mother on her blood pressure regimen. "She keeps skipping her medicines because the economy is bad and she wants to save money," the friend says. "But I keep telling her that her health is more important than money, and we'll make whatever adjustments we have to."

Maryann Kuzel

It's not just patients and their families who need to make adjustments—pharmaceutical marketers do, too. In the quarter ending June 2008, the number of prescriptions filled dropped nearly half a percent, according to IMS. It was the first time that number failed to rise in the 12 years IMS has tracked it. And in a Kaiser Family Foundation poll conducted last October, 36 percent of respondents said they or a family member had put off needed care, compared to 29 percent in a similar poll the preceding April. Certainly some of these people are in actual financial trouble. But there's a contagion of consumer sentiment that is affecting even those who are able to make financial adjustments, such as my friend's mother.

Twenty-nine percent of respondents to a November 2008 Futures Company OmniPlus survey said they were worried about job security, and a Gallup poll from February 2009 reports that more than 80 percent of consumers expect the economy to get worse. The Futures Company report says that those with severe economic anxiety—more than half of adults—are most likely to exhibit poor health behaviors.

As anxiety causes an increasing number of consumers to risk their health and quality of life by turning away from therapy, what are pharma companies to do? Here are four key considerations.

Get Inside Your Customers' Heads

When consumers engage in what may seem like irresponsible behavior regarding their health, it's important to understand their motivation. For many people, health is not a high priority. As the economy worsens, many people become focused on putting food on the table or keeping a breadwinner's job.

A consumer's financial condition may be stable, but as they see friends and colleagues lose jobs and retirement savings, stress levels skyrocket. Anxiety leads patients to lose their sense of control, and that can be bad for adherence to a treatment regimen. In times of economic difficulty, stress and anxiety can cause patients to "forget" to take their medication, lose sight of their medication's value in maintaining health and helping them achieve personal goals, and lose their commitment to treatment, especially if they weren't keen on it from the start.

Nonetheless, times of anxiety for patients can be an opportunity to show that you support them. Brands and companies that connect with and partner with patients will reduce the impact of a down economy on brand sales in the short term, and be rewarded with brand loyalty in the long term.

Be Relevant in All Communications

It is important to acknowledge customers' most pressing concerns, and show how your brand fits into their lives. We urge our clients to use language that focuses on values. For example, "When the economy is down, your health is the most important resource you have to bring the best to your family and your job."

Whenever practical, tailor your communications to the individual by asking questions like, "What is your level of economic anxiety?" The economically anxious have a higher risk of dropping or reducing their medications. You can diminish this risk by offering them extra financial incentives and/or messages that urge them to stay on their medication regimen.

Novartis Oncology, in connection with its drug Zometa (zoledronic acid), asks attitudinal questions and delivers tailored content to users as part of its Bone Health Program. (See graphic, next page.) This is a proven and powerful way to improve medication adherence and brand loyalty.

Help Patients Financially

Pharmaceutical companies have long provided financial assistance to patients who cannot afford their drugs. AstraZeneca, for example, has offered patient prescription-assistance programs for 30 years, and actively promotes its AZ&Me prescription savings program. AZ goes even further with some of its prescription brands, such as Symbicort, for which it offers a Measures of Success program that bundles adherence programs, reminders, and money-saving coupons.

As an increasing number of consumers run into financial difficulties, many for the first time, they may be unaware of these programs or be too embarrassed to seek help. It's our job as marketing professionals to help direct distressed patients to programs that will help them maintain their health—and their loyalty to our brands.

A word of caution: Pay close attention to the tone of your financial assistance copy. It can be a touchy subject with patients, and it's easy to make mistakes. Here are two examples taken from the Web sites of major pharma companies:

• From Schering-Plough "Schering-Plough believes that the pharmaceutical industry needs to address the challenges facing low-income, chronically ill, underinsured and/or other uninsured people who cannot access the prescription medicines they need to improve their health."

• From GlaxoSmithKline "Healthcare costs are an issue—for all of us. Getting sick carries with it a lot of concerns. Will I feel well again? Will I miss work? What about my family? How much will it cost? As healthcare costs have gone up, some patients feel that they have to do without medicines they need. That's why we offer savings programs and coupons in addition to the many programs available elsewhere."

Sample Decisional Balance Tool

While Schering-Plough addresses financial assistance as if it's a public policy issue, GSK addresses it as a personal concern using warm, understanding language. Patients will appreciate this empathy, and be more likely to raise their hands and take advantage of the offer—which in turn will make them more loyal to the brand.

Enable Healthy Choices

Usually, patient education takes a top-down approach. Patients struggling with chronic disease, however, tend to tune out even the best advice. To reach them, marketers can't simply issue instructions. Instead, the patient must feel empowered. After all, while the brand is the expert about the product and the disease, the patient is the expert on his or her life.

One proven, effective, and very simple tool to empower patients is a "decisional balance tool"—a graphic presentation that helps patients balance the pluses and minuses of various health decisions, and understand the trade-offs they are making. For example, a decisional balance tool created for the American College of Sports Medicine compares the benefits and costs of regular exercise with those of inactivity. (See chart, left).

The power of these assessments is to highlight the often strong dissonance between patients' actions and their highly cherished values and goals, which helps motivate them to take action.

When patients feel stressed and vulnerable, as they do now, the opportunity is ripe for pharmaceutical brands to benefit by partnering with patients to help keep them healthy through the hard times. Those patients will thank you with their loyalty and their adherence to their medications.

Maryann Kuzel is president of Star Healthcare. She can be reached at kuzelm@starhealthcare.com