The changing face of pharma’s customer engagement

Sarah Rickwood looks at five key trends in the new customer model

It is easy to be distracted by the latest revolutionary therapy and miss the broader revolutions which proceed more slowly but also change the industry more fundamentally. Two such revolutions occurring in the period since the mid-2000s have profoundly changed pharma, and have also changed pharma’s customer engagement model beyond all recognition.

One of the key divisions in the type of prescription medicines developed by the industry is between primary care products and specialty ones. Traditional, primary care pharmacotherapies are prescribed by GPs and family doctors and treat common, chronic conditions and diseases – the leading areas being type II diabetes, asthma, COPD, hypertension and dyslipidaemia.

Up to the early 2000s, primary care blockbusters ruled the world, driven by large primary care sales forces focusing on one group of healthcare professionals, the family doctors and general practitioners, and one metric – share of voice. Life, commercially speaking, was simple, even if we did not appreciate that at the time. In the 15 years since 2004, the share of world prescription medicines market value that is specialty has risen from 15% to 39%, growing on average at twice the pace of the global market.

This specialty value is also concentrated – more than 80% is generated from the US, Europe and Japan, meaning that for many countries in these developed regions, specialty products are already more than half of all prescription market value. The most commercially successful launches up to the mid 2000s used to be primary care blockbusters, used in the first line treatment of conditions where the patient populations numbered in the hundreds of millions to billions, globally. Now, the most commercially successful launches are still blockbusters, but they are specialty products, often multi-indicational, often later line use, and for conditions or patient segments with global prevalence in the sub-100 millions, sometimes as low as tens of millions.

Launches are evolving beyond the simple dichotomies of primary care/specialty and small molecule/biologic. More exotic types of pharmacotherapy are pushing beyond the simple division of biologic and small molecule, with cell therapies, gene therapies and other advanced therapies. The question of what primary care is and what specialty is, is challenged by the new biologic therapies entering later lines of treatment for asthmatics and migraine sufferers who are not managing their conditions effectively on conventional medication.

Throw into this mix the possibility that new therapeutics may not even be based on a molecule any more – they could be a prescription digital therapeutic – and you are forced to conclude that what the pharmaceutical industry commercialises is changing, fast.

It immediately follows that the customer model – the customers and stakeholders, the approach to their engagement, and the execution of commercial strategy – will see comprehensive change too. There’s one last complication: pharma companies will have to undertake this radical change of their customer model – embracing new technologies, ways of working and new audiences – without significant growths in budget. Slowing overall pharmaceutical market growth and increasingly intense focus on rebating and discounting below the list price mean all product opportunity is realised in the context of budget limitations.

The industry is currently in a highly productive phase in terms of new product approvals, but the increased number of launches are largely concentrated both by therapy area and by geography, and the maths is simple and brutal – incremental market value will not grow as fast as the products competing for a piece of it. There will be losers as well as winners. To be the latter, companies will need the most integrated, sophisticated and responsive customer model possible. This article covers five key trends in the new customer model powering the industry’s adaptation to that change.

The changing customer audience

In specialty, pharma faces audiences smaller in number but much more complex in nature.

Specialty medicines are used to treat cancers, autoimmune conditions, rare diseases, and hard to treat patients with severe forms of otherwise common conditions such as asthma or migraine. All will have a complex, interconnected web of stakeholders and customers. Multiple healthcare professionals will be involved in the treatment of a patient, serially or simultaneously, and they in turn will be part of a complex web of influence which will extend internationally. Patients, their carers and advocates, and patient groups, play a particularly important role for many of these conditions. Rare diseases and cancers are also politically high profile, poster children for much of cost benefit debate, and therefore payers, health technology assessors, healthcare system administrators and politicians are all key audiences in the customer mix.

This concentrated but complex audience is often the focus of huge competition for engagement by pharma, because they are hotspots for innovative launch. Oncology illustrates the dilemma: in the five years to 2017, in the US, EU 5, Japan and China, the number of oncologists grew, with CAGR of 2.5%. However, the number of cumulatively approved oncology products/indications (with customer facing teams and important messages to communicate behind them) saw a CAGR of 8.7% in the same period.

More products, more messages, more noise. How can a company cut through this with the key messages for their product?

The changing nature of the customer-facing team

The customer-facing team has come a long way from the monadic focus on sales reps, with other functions strictly siloed away elsewhere. The traditional rep, reduced in numbers, is now one part of a far more integrated, multi-functional team, including Medical Affairs, Nurse and other patient support program roles, payer liaison, digital engagement and key account managers. Promotional and non-promotional roles must communicate and work together, even as the boundaries between medical affairs and promotional engagement are strictly respected.

The traditional sales team was a classic, pyramidal “command and control” structure, where messages flowed down from the top. Today’s multi-functional team has a much more complex challenge: messages must be orchestrated across different functions and to different audiences; information must be shared across multiple roles in an appropriate and compliant fashion.

For the new customer facing team to truly work, the individuals as well as the structure must change. Team working is now a vital skill. Knowledge of the broader landscape into which their own goals and tasks sit is crucial – reps must understand the work of market access, patient support and of medical affairs, for example. For all functions, but especially for those directly engaging with healthcare professionals, embracing the multichannel environment is a necessity.

The rise of multichannel and the digital tipping point

When talking about multichannel, it’s important to talk direct about what it is not – it is not digital channels of communication alone. Multichannel implies the ability to choose between channels, to orchestrate the channels of communication by audience and over time in the most effective way. Digital is an absolutely necessary part of that, as without channel choice there is no multichannel, and as healthcare professionals have increasingly restricted time in the real world, the main opportunity to reach them may come from the virtual.

Thus, use of digital channels in a sustained and sophisticated manner is a marker of multichannel maturity, although not an end in itself. By this marker, the developed countries have reached a tipping point, as Europe passes 10% of all volume being digital promotion directly focused on a specific healthcare professional, and so moves closer to the US and Japan in the volume of engagement pharmaceutical companies have with healthcare professionals that is digital in nature.

Widespread use of digital channels is only the beginning. Japan is the market with the highest volume use of digital promotion in the world, but the rapid growth of digital channels was accompanied by an equally rapid commoditisation, as volume was prioritised over quality of engagement. The next multichannel challenge will be to ensure that quality content that healthcare professionals value and seek out is delivered across all channels, the medium being a question of preference and effectiveness. On this, there is still a considerable way to go.

The rise of Medical affairs

The cutting edge of pharmacotherapeutic development is about increasingly sophisticated therapies entering increasingly complex diseases. With this trend, the importance and nature of Medical Affairs is changing. While Medical Affairs is a long-established function – Abbott trademarked the term Medical Science Liaison (MSLs) in the 1960s – its role has been siloed, supportive and reactive in the past. No longer. Medical Affairs is growing in importance from early launch planning throughout the launch preparation and execution, playing a strategic as well as a tactical role. MSLs are vital to the stakeholder landscape assessment, country by country, which is the basis of building the launch plan. MSLs no longer play a single role – as with the whole of the customer facing team, there’s a diversification of roles, and we see MSLs focused on clinical trial liaisons, clinical trials specialists, health outcomes liaison, digital engagement enablers, and clinical educators.

The development of patient support programmes

Patients are pharma’s ultimate and most important customers, and the importance of patient support programmes is rising, driven by the growing ownership by patients of their own care, the increasingly complex needs that patient suffering serious and rare diseases will have, and the complexity of pharmacotherapies.

Patient support programmes are a vital element of the customer model, and need to make full use of innovative approaches and digital technologies, but combined with a strong element of human interaction. It’s estimated that only two out of ten Europeans and one out of ten Americans are what could be termed “health literate” – that is, they are able to use information and advance effectively to take control of managing their condition. Pharma, therefore, must address the remaining eight to nine out of ten patients who, to receive full benefit from their treatment are highly likely to require coaching, support, and a programme tailored to individual needs and to the way in which that patient learns most effectively.

Any effective patient support programme is, therefore, going to be multichannel, because some people learn best by reading material, some by talking to a healthcare professional, other visually by watching a video, still others by a process of hands on experimentation. You don’t choose which patients will use your product and their learning styles- you must cater for all. Designed carefully, used effectively and measured and calibrated from learnings in use, patient support programmes are an asset not just in terms of engagement and customer satisfaction, but also to competitive edge and revenues.

One of the clichés of successful business is that you follow the customer. It’s over-used, of course, but at present the pharmaceutical industry is seeing its direction in terms of products and customer model mirroring each other. As the focus of innovative value becomes more segmented, complex and sophisticated, so customers have become more complex and yet more interconnected and the customer model, while downsizing in absolute numbers of people, is more multifunctional, interdependent, and technologically sophisticated.

The early 20th century department store magnate John Wanamaker was the originator of the famous quote “half of the money I spend on advertising is wasted – I just don’t know which half”. This quote’s enduring appeal reflects the underlying concern all businesses have about customer engagement – are they investing in the right people, technologies and channels?

As companies redefine their customer model, they will require an approach built on a solid bedrock of “one customer view” master data, powered by AI/machine learning to make sense of vastly increased data flows and support the most effective decision making, and a customer facing team that has the skills and processes to work as an integrated team with an orchestrated approach to customer engagement.

About the author 

Sarah Rickwood has 26 years’ experience as a consultant to the pharmaceutical industry, having worked in Accenture’s pharmaceutical strategy practice prior to joining IQVIA. She has wide experience of international pharmaceutical industry issues, having worked most of the world’s leading pharmaceutical companies on issues in the US, Europe, Japan, and leading emerging markets, and is now vice president, European thought Leadership at IQVIA, a team she has run for eight years.