Digital channels and pharmaceutical promotion

For those of you who follow the news on that subject, every day offers new publications on this very popular topic. Published numbers and data are often contradictory and seldom presented in a rigorous way. Yet it is possible to pinpoint solid information, which allow us to draw primary operational conclusions.

Promotion and digital channels; focus on a popular concept

What are promotional digital channels?

From a technical point of view, it is clear enough: it concerns all means of communication and all tools on a digital support, “off” or “on” line, allowing for interaction with a specific audience. In this article, we will purposefully restrict our discourse to health professionals, and more precisely to clinicians.

Here is a non-exhaustive list of these channels :

  • e-mail
  • website, public or with restricted access
  • pages, articles and posts on social networks
  • mobile apps, specialised or not
  • download portals (for example of the FTP category)

 

Trends, and how they reflect the eternal race for performance

A few years ago, the trendy term was « Sales Force Effectiveness » or SFE, which soon was ennobled into “Sales Force Excellence” – more elegant indeed. SFE is now well established in the commercial organisations of pharma labs, to the point of having SFE “VPs”, Vice Presidents, alongside the sales and marketing departments. Today the spotlight is on digital channels: a token of constant promotional efficacy in an increasingly binding and restrictive regulation environment due to:

  •  Limitation of the number of calls per prescribers
  • Access restrictions within hospitals
  • Pre-approval process for all promotional messages
  • Strict management of hospitality and events such as scientific symposiums, conferences etc
  • Cumbersome transparency requirements, as for the Sunshine Act
  • Taxes on promotional expenses including sales force costs

 

This non-exhaustive list cumulates elements from various countries or geographical zones; yet all markets today are impacted in various degrees by these measures.
In such a context, the democratization of these new digital media truly represents a real opportunity to maintain the level of commercial efficacy of pharmaceutical laboratories and other health industries impacted by all these measures.

Why is the pharmaceutical industry the most eager about these new communication channels?

The 80s and 90s, and ballistic marketing

ballistic marketing

In those years, pharmaceutical marketing consisted in investing massively in the launching phases –loading the powder-, in choosing promotional messages carefully in order to hammer them better –the shooting angle– while hoping to place the new product on stationary orbit –market share-.
Most of the new specialties during that period of time, whether innovative or not, targeted  wide populations of patients and prescribers, and this approach has triggered success for many companies, though with unfortunate collateral excesses and disorders.

The years 2000s and the emergence of selective marketing

Three independent factors have deeply transformed marketing techniques in health industries, and more specifically in the pharmaceutical industry :

  1. the shift of therapeutic innovation from mass affections to more and more specific diseases
  2. the growing restraints and limitations of the promotion of reimbursed and/or regulated pharma specialties
  3. the availability of flexible and efficient managing tools with new generation CRM (Customer Relationship Management) systems

It would clearly be a gross mistake to consider these new channels of communication and promotion as a simple consequence of technological progress and web democratization. Interest for their use illustrates the ongoing mutation in terms of marketing for pharmaceutical specialties and medical devices.

 

The race for press releases and the lack of strategic vision

The growing, and justified, interest for these new promotional and communication channels is illustrated by a continuous flow of press releases, white papers and other articles on the topic. Unfortunately, their content is often so superficial that it can be difficult to draw valuable information from them.

 Medical promotion : digital channels have little impact on French health professionals

This is the attractive title of a Cegedim Strategic Data press release from January 8th, 2015.

And yet a careful look at the document reveals numerous approximations, at least in the presentation of numbers and the phrasing of comments.

“The share of digital channels is most important in Japan (34%), followed by the United States (24%) and Poland (20%). The United Kingdom and France are placed equal 5ths, with 13%, and 5% in Germany.”

It is quite curious to see such a respectable company communicate in such a way, based on percentages and without a single reference to the context of each of the cited countries. What do the 34% of Japan represent in absolute value, compared to France’s 13%? Are there regulatory factors in these countries which might impact the use of new promotional channels? Without an analysis of such elements, the communicated data is perfectly useless.

Learned conclusions and misleading demonstrations

Christopher Wooden, Vice-President of Cegedim Strategic Data, declares :

“Commercial teams are invited to favor the use of digital channels, but are facing both technological and cultural difficulties – both within the company and with the customer. The results of this study validate the idea that personal interaction remains the best way of influencing prescription choices”.

Such a general conclusion, could not be further from the truth unfortunately, and is supported by averages which have never been able to account for the extreme diversity of situations according to country, specialty or type of exercise. If a prescriber is absolutely inaccessible to the sales reps, or if his or her choices are entirely determined by formularies and other procedures, what is the value of C. Wooden’s conclusions?

Another observation by the same author :

“Japan has opened the door to the digital, but it has to be pointed out that this was not illustrated by a significant diminution of the salesforces size in the country”.

Now here is an interesting information – according to this study from Cegedim Strategic Data, the share of digital channels in Japan rises to 34%, the highest number among the countries observed. Yet the real information is elsewhere: the important use of new promotional channels is not associated to a significant decrease of the salesforce size in the country. Should we not even point out the lack of definition of what is “significant”, still we can regret the lack of effort to identify causes, whether they be:

  • a cultural or societal issue, as the Japanese are famously very attracted to and great consumers of new technologies?
  • a change in the regulations restricting access to prescribers?
  • new regulatory requirements for exception drugs and their risk management plans?

 

And what about the assertion : « The results of these studies validate the idea that… »

Where is the demonstration? What is this new concept of validating an idea? What was the initial assumption? What are the methodological limitations of the study?

Using pseudo-scientific vocabulary to comment the results of an interesting but superficial survey, cultivates the illusion of a final demonstration; decision-makers in the pharma companies and similar domains must resist this “intellectual fast-food”.

 

Repeated press releases and contradiction

To illustrate this point one needs only compare two recent press releases from the same company:

Four months later, comments on the French market diverge quite sensibly.

In the field of promotional digital channels, it is impossible today for a decision-makers in the industry to make up his or her mind based on the sole press releases, posts, articles and other tweets.

 

Real answers lie in the detail

The main motivation for using « new » digital channels quite certainly is the decrease of the prescribers’ accessibility through traditional promotional means and more specifically sales reps calls.

 

To illustrate this point, one can refer to the ZS Associates article « If physicians aren’t listening to Sales Reps, what are they listening to? » published in July, 2014. It clearly states that the percentage of “accessible” doctors for a rep’s call greatly varies according to medical specialties, with dermatologists being the most accessible, and psychiatrists the most restrictive.

Accessible prescribers

Source ZS Associates

Another valuable information: this accessibility varies according to the geographical zone. The ZS study was conducted in the United States but one can easily apply these conclusions to other countries and markets.

The same ZS Associates article contains another indirect proof of the influence of the type of medical specialty on prescribers’ accessibility.

Sales Force size and physicians access

Source ZS Associates

Indeed, there is a clear peak in favour of mid-size sales force (between 500 and 2000 reps, in this case in the US), the lowest number being associated with the larger sales force of more than 2000 sales reps. One just needs to compare this data with the size of “specialists” and “general practitioners” sales force to understand that the type of actively promoted product strongly impacts the efficacy of traditional promotional media and consequently the opportunity to substitute or complement them with digital medias.

Paradoxically, the profitability of the physician office visit is improving

ZS Associates has estimated the cost of “infeasible calls” (if a best-in-class rep can’t deliver it). The numbers (US) are mind-blowing, with a waste of 1.4 billion US dollars in 2014. For the record, in 2008 the same costs amounted to 2.9 billion.

Cost of infeasible calls

Source ZS Associates

This evolution perfectly illustrates the transition from ballistic to selective marketing as described earlier: the spared sums being redirected, at least in part, towards new media and digital promotional channels.

The Black Hole of the Sunshine Act

There is no data about the impact of the Sunshine Act and of other equivalent regulations on budget expense levels for promotion, information and medical education. Yet it seems obvious that redirecting budgets allocation towards new means of promotion, mainly the famous digital channels, largely accounts for the current enthusiasm for these alternate methods to traditional promotion.

 

A new kind of Sales Rep; the “Orchestrator Rep”

Reading the excellent paper “Conducting the Sales Symphony: How the Orchestrator Rep Addresses a Restricted-Access, Multichannel World” by ZS Associates, allows us to identify interesting leads to understand current evolutions.

Rep interactions drive up to 20% of brand website traffic

Drivers of Brand Website Traffic

Source ZS Associates

In this study, a dedicated website is a «single product» or «single specialty» site, as opposed to a “corporate” site, which function tends to evolve into that of a portal. This is a very common practice in the United States but is still confidential in Europe and notably in France.

If we do not consider the traffic driven by paid search, almost 30% of the visits on the site are initiated by sales reps.

It is most surprising to note that one third of the traffic comes through paid search, quite probably of the Adwords type. It is even shocking if one adds the fact that these are “dedicated” websites, which mean that they are specific to one brand, one medical product. In such a case, using these paid searches seems hardly justifiable; unless it is a way to spend one’s budget to feel reassured.

 

Quantity vs quality of the traffic; the bounce rate

There is one important oversight in the data communicated by ZS: the quality of the visits according to the referring sources and channels. Indeed, what are 100 more visits worth if 95% of them last a few seconds because the user doesn’t find what it is looking for?

It is very easy to monitor this parameter (or “metric”, the correct analytic web term). Unfortunately, no mention whatsoever is made of the “bounce rate” in this article.
This oversight underlines the low requirements of pharmaceutical laboratories as far as analytic web is concerned; nobody would dare communicate as superficially and approximately about truly competitive markets; e-commerce, on-line financial services, on-line reservations for example.
This shows how to this day, most of the decision-makers in these companies are left in the dark by their partners.

Google Analytics and the pharmaceutical industry

The analytic service of Google, just as the other equivalent platforms such as Xiti or Piwik, are the main missing element in this type of article and analysis. It hard to believe that this should be a deliberate omission in order to lighten the content of these communications. It easily illustrates at best the ignorance of the possibilities offered by these platforms on monitoring and analysis of the traffic of a website or mobile application. In the worst scenario, which we cannot exclude completely, this reflects the absence of a real intention to precisely measure the impact of the undertaken digital promotional actions.

Classical sales reps calls as a support for digital channels (and not the other way around)

Among the many quality pieces of information one can find in this survey, is the positive and spectacular impact of e-mail personalization.

taux d'ouverture des emails

Source ZS Associates

 

E-mails sent by sales rep will be read by the doctors in almost 30% of the cases, more than twice as much as the opening rate of e-mails sent directly from the pharma lab. This shows the complementarity of traditional, salesreps calls, and digital channels, in this case e-mails.

Work done by ZS Associates shares a few other examples which confirm what one could easily suppose – the complementarity of all promotional means and channels available today.

The key question of top management sponsorship

The article mentions that the “buy-in from senior management” is one of 5 critical success factors of such an approach.
Nothing new indeed – and yet, are the management teams still able to apprehend the issues, to evaluate associated risks and costs, and finally to set up objectives and clarify direction?
One would tend to say no – because the multiple responsibilities and obligations of the decision-making teams are rarely compatible with the level of understanding and, above all, of command required by these new digital tools. All one has to do is randomly question a Marketing Manager to observe that in 90% of the cases, he or she has never seen a Google Analytics screen (or anything equivalent). A few years ago, every layer of the management chain could read GERS or IMS reports.

Small steps rather than big-bang

An essential point is made in the conclusion : “Start small”.
This advice is sheer common sense and underlines the experience of the authors. It is also advised to work closely with “first-line management” – the interest of which is triple:

  1. test and develop solutions rooted in the daily life of the reps who will have to apply these solutions
  2. insure the support and the involvement of the first-line managers
  3. identify the critical issues of implementation to adjust training and deployment programs.

 

To draw a conclusion, the integration of new digital promotional channels is an important evolution for the health industry, particularly for the pharmaceutical labs; yet it is not the revolution some have so clamorously announced.

Such a transition, which one can compare to the deployment of the early modern CRM at the end of the 1990s, has to go through a few essential steps, starting with the implication and insightful sponsorship of the senior management teams.