7 principles in marketing to the new NHS

pharmafile | May 28, 2008 | Feature | Sales and Marketing |  NHS, healthcare, marketing 

Developing a successful market access strategy has become the Holy Grail for brand teams across the UK pharmaceutical industry.

The sustained and significant NHS reform of the past few years has created a customer climate to which the industry has been slow to respond. But as the market has evolved and the picture has become clearer, companies have begun to redefine their commercial models to suit the needs of the new environment. Pharmaceutical companies across the industry are restructuring and, as part of this widespread operational change, a focus on robust market access strategies has emerged.

In the past few months, Pharmafocus has been exploring the principles of market access and how it can help brand teams achieve true, measurable sales and marketing effectiveness. In this, the final instalment of our three-part series, we take these principles a stage further and offer real-time insights into how the approach works, both from the marketers' perspective, and crucially, from the customers' perspective as well. Their views offer up some valuable lessons for sales and marketing professionals seeking to develop market access strategies.

Lesson 1: Understand NHS policy and how the reform agenda affects you

Undoubtedly, the need for a change has been driven by the wholesale reform of the NHS. This has precipitated the redrawing of the industry's customer road map, but has also had a dramatic effect on primary care – a market where the industry has traditionally focussed much of its promotional effort.

Companies are being forced to re-evaluate their markets and make critical decisions about whether to focus their efforts in primary or secondary care. To succeed in primary care, where generic prescribing has become the rule rather than the exception, branded products need to demonstrate much more than clinical effectiveness.

"There are now two different types of market scenario," says Mark Lawson, Bonviva brand team leader at Roche.

"Primary care has been heavily impacted by what has happened in the NHS, while specialist markets are more affected by what happens at NICE. If you look at therapy areas such as osteoporosis, cardiovascular, diabetes and respiratory, you can see that all the major primary care markets are pretty much satisfied. Generally, the biggest gold standard products in those markets are now generics.

"Guidance supports this very strongly. Therefore, for branded products to succeed in such an environment, marketers need not only to develop a clinical rationale, but also to influence the guidance agenda between primary and secondary care. Historically, companies have managed to use secondary care referral as a means to overcome that guidance, but that balance has switched and is now much more in line with payers. Marketers must now develop a strategy which enables them to manage holistically influencers across the whole total care environment – payers, policy makers and, of course, clinical decision-makers."

Lesson 2: Understand funding and your product's place in the market

An understanding of where a new product could potentially sit in the market is essential. The notion of service redesign presents major opportunities for pharma and, if such propositions are aligned with local and national health objectives, can yield real benefits for all parties. Once again, in such cases, long-term market access plans are vital.

A good example of this is in the area of new anticoagulants for the prevention of DVTs and, subsequently, the treatment of atrial fibrillation. Companies working in this area are faced with the challenge of preparing the market for a product which can be delivered at home rather than predominantly through warfarin clinics in the community. This brings with it huge issues around service evolution and redesign, and accelerates the need to engage with new customers two to three years prior to launch.

Speaking to commissioners and medicines management teams, as well as service redesign people (if they are not already within those groups) will be critical to ensure the planning and execution of market access is optimised. New stakeholders will start to emerge, and though they may not be traditional customers, they will be absolutely vital. The market has changed significantly – it's no longer simply a question of proving clinical effectiveness. Prescribing freedom and independence has greatly reduced, and the old approach of focusing on targeting independent decision-makers such as GPs or physicians, and encouraging them to adopt your new technology, may no longer be sufficient. In addition the varied customer base is now interested in having value provided as a service-offering rather than just a product.

Lesson 3: Develop customised messages for individual customer groups

The shift away from all-out assault on traditional customers brings with it new challenges. How do you find them? How do you access them? And, crucially, how do you get to understand their needs adn objectives so that once you actually get in front of them you enjoy a mutually beneficial engagement? Shaping the environment is pivotal to market access, but without sufficient understanding of your marketplace and its key stakeholders and influencers, developing messages to suit your customers' needs becomes impossible. The challenge for the marketer, however, is to develop a customised approach that matches the priorities of individual health economies – a one-size fits all approach will not work.

It may be more challenging for a Product Manager to develop a plan of action for a product on a national basis, given the significant inter-individual variability of PCTs and other local health economies in the UK. Diagnosing PCTs, for example using a balanced scorecard approach to determine the "net company value opportunity" may be one way forward in amalgamating a national strategy for local implementation. Strategy now needs to be more individualised. Sales and marketing not only needs to work more closely together through visible 'traction activities and accountabilities', but brand teams need to acquire new skill-sets.

Success depends upon being able to treat each locality as a separate account and taking a much broader view. Finding out who the key decision-makers are and how the decision-making process works is critical. Then, engaging effectively with your customers and working out new ideas as to how to take the business forward.

Lesson 4: Engage with payers and develop your non-clinical arguments

Clearly, focusing greater attention on non-clinical opinion leaders is essential. As such, Continuing Payer Education programmes are emerging as a central component of market access strategies as companies seek greater insights into the mindset of payers. Of course, what influences these customers will depend on specific local health priorities and will differ from PCT to PCT. However, there are general principles that are consistent across all payers' roles, and these may provide clues as to how best these vital customers should be approached.

Alison Tennant is head of a medicines management team in Dudley, West Midlands and a specialist in pharmaceutical public health. The medicines management work gives Alison an operational involvement in GP prescribing budgets, while her public health role has a much wider remit. In combination, it is possible to draw parallels with individuals who operate in similar roles and gain valuable insights into the challenges they face and identify where the industry may be able to offer support.

"The idea of the Public Health role is that we look at population impact," says Alison. "I look at two elements; what value for money are we getting from our current prescribing budget in terms of health gain, and what new innovations are around the corner that may help improve it. The latter is classic horizon scanning. For example, when we knew that we had to implement NICE guidelines for Herceptin, we didn't just look at the cost of the drug, we looked at the change that was going to need to happen to services in order for the drug to be used."

Lesson 5: Focus on developing an additional service

Making such assessments is critical to whether or not a product will succeed, and the industry has a major role to play in helping NHS professionals reach that decision. The key is to look beyond developing traditional clinical messages and instead to provide information in the currency of the non-clinical customers who can unlock funding for the product – evidence of budget impact. "Traditionally, a new drug comes out, and we issue prescribing guidelines that advise GPs on how to use a product – or not to use it at all," says Alison. "More often than not, we have to base those decisions on clinical data. What we are trying to get drug companies to look at is what impact their drug is going to make on the whole health economy. For example, some drugs for osteoporosis have meant a large investment in the prescribing budget but a lot of savings elsewhere. The improvements are actually seen in the social care budget through reduced hip fractures."

Dinah Roy, GP and chair of a Practice-based Commissioning (PBC) Group in Sedgefield Borough, County Durham, has different priorities in her role but sees similar value in industry provision of services and data beyond the clinical arena. "There are eleven GP practices in the Group and each has a responsibility to conduct PBC. Our aim is to facilitate that and to do it as a group, in negotiation with the PCT. Our function is to determine the local health need and develop plans to meet it" she says.

"This is a different responsibility from that of a Primary Care Trust. A PCT has a larger population and although the health needs identified by the director of public health are usually in line with the things you want to do locally, there are often additional things needed locally that are not integrated with the wider PCT plan. One of my main challenges is to improve that way of working to help practices understand about population needs and create commissioning plans based on the profile of their individual populations."

So where can the pharma companies help? Well, with current emphasis on 'world-class commissioning', it seems the NHS is ill-equipped to develop the materials required to develop business cases and models to support their commissioning intentions. Largely speaking, local practices possess neither the resource or expertise to craft robust business plans to underpin their ambitions. "For example, a practice may come forward and nominate a peripheral vascular disease detection service that would be good for its population, because they know that there is a high level of cardiovascular disease risk," says Dinah. "At this point they need to come up with a pathway and a business case for the service to be commissioned. But there is a huge deal of confusion around this.

The PCT needs to see a 'commissioning intention' – a robust plan that outlines why a service needs commissioning and the likely impact it will have. These commissioning intentions have to integrate with the PCT commissioning plan – and there should only be one plan – and only once this is agreed can a practice switch hats and become providers and develop business cases to provide those services.

"This is where the pharmaceutical industry can help. Recently, I had contact with a representative who came to speak to me about a drug for peripheral vascular disease. In one sense, the drug was of no interest to me at all, but with him he had already prepared validated guidelines, validated pathways and examples of how services could be constructed to help identify appropriate patients. We started to get into the area of service redesign. This was really helpful. It's easy to have good ideas about services – in fact it's overwhelming and there's too much of it – but to have support and information that is validated, and information about what has been done elsewhere is invaluable."

Alison Tennant agrees. "Drug companies need to focus on the outcomes that improve the health of the patients their product targets. Where is the evidence that it works? Where is the evidence that the improvement it makes is important to the patient?

"If it's about reduced side-effects, how many patients currently experience those side-effects and to what extent does it bother them? And critically, what are we going to get out of this drug in terms of reduced appointments, improved compliance and benefits elsewhere? I always look for a budget impact model – these are getting better and are very useful. For example, a company contacted me about an inhaler that was looking at reducing admissions to hospital with COPD. They had data which showed that patients using the drug went into hospital less. This is extremely valuable as this kind of modelling helps us give robust advice to GPs trying to manage PBC and their prescribing budgets."

Lesson 6: Adopt a cross-functional approach internally

The nature of discussions between medical representatives and NHS professionals is, of course, restricted by the constraints of the ABPI Code. The code requires the separation of promotional and non-promotional discussion with customers. However, marketers have a responsibility to research their markets in such a way as to capture intelligence that will help develop services to meet customer needs, and share them internally to drive sales and marketing effectiveness.

Marketers are starting to recognise that they need to engage with non-clinical influencers to prepare the market for their product. Understanding the need to communicate through the sales team how your product might bring value and meet not just their objectives, but also their patients' and, of course, your company's goals too. In the process, it becomes a much more mature engagement than simply selling to an individual as a customer's objectives may not be entirely measured on their own activities but on those of a team.

In fact, you may not necessarily discuss product for quite some time, but could instead be talking about issues such as service redesign, or working in partnership to implement NICE guidelines – which may not have a direct bearing on any of your current products at all. What it is doing, however, is helping shape the market for your product later on and, in the process, paving the way for your sales team when the time arrives.

The battle for marketers, however, is actually managing to get in front of these influential customers. Non-clinical preceptership programmes are an essential tool in capturing such market intelligence, and this is an approach that is being widely endorsed across the industry, with marketing teams at the forefront of their development. How such information is shared internally is crucial.

"You need to conduct research in a cross-functional way," says Mark Lawson. "Understanding PCTs up to Strategic Health Authority policy level is vital – either to validate or challenge what you are doing internally. You also need to know who you have to influence to change a treatment protocol in a local environment. Who do you need to see? What influence do they have on other stakeholders? And what type of messages do you need to develop to move forwards? Ideally, this should be mapped with the customer-facing sales force and, separately, with the internal brand team. The ultimate goal is to pour all of your insights about customer needs into the brand team so that you understand it and can augment your key messages to suit the different customer groups."

Such an approach is a move away from the silo mentality that has historically plagued sales and marketing strategy in pharma. Cross-functional research, along with thorough understanding of stakeholders and influencers, is at the heart of an integrated market access strategy and a huge step towards sales and marketing effectiveness.

Rather like the 'government of all talents' prime minister Gordon Brown promised when he came to power, a successful brand team should be cross-functional. "If you want to be a good marketer, you need a base pyramid of expertise that involves managing top-tier hospital KOLs, managing policy and payer decision-makers and an understanding of how to sell effectively to the traditional groups of jobbing GPs and hospital consultants," says Mark. "A successful brand team will combine experience and expertise in healthcare management, tactical promotion and selling into different environments. Having a separate healthcare management group and separate functions that manage sales and marketing will not give you the integrated solution required in the modern market."

Lesson 7: Adopt a multi-disciplinary approach externally

Despite the growing influence of non-clinical decision-makers, the value of approaching traditional customers has not diminished entirely. There remains a great need to engage with clinical customers as, in many cases, they can themselves exert influence on payers and policy-makers. "Important information can reach us via GPs and there are many examples of where such exchanges have led to instances of service redesign," says Dinah Roy. "For example, we recently designed and commissioned a different pathway for patients with DVT.

Two companies who provide different types of subcutaneous heparin contacted a GP and gave information for redesigning the service in a way that allowed us to anticoagulate patients in the community at the point they presented with symptoms, while they awaited their results. The doctors realised this was do-able and it really motivated them to support the idea. The reason to continue contact with individual GPs is because if they think something is going to work and help them, they will do it. In general, they don't like theoretical information, but if they get the sense that an idea is workable and they can do it in their practice, it really appeals."

And so it's clear that the voice of the GP is not necessarily being minimised in the newly reformed NHS. In fact, the route to the traditional GP remains as important as ever. Equally certain, however, is that success in the modern market depends upon developing value propositions that take into account the perspectives of both clinical and non-clinical stakeholders. This multi-disciplinary approach will ensure that all of your key messages resonate with customers across the influencer/decision-maker matrix.

The overriding lesson, of course, is that an integrated market access strategy is the optimal way to achieve sales and marketing effectiveness in the modern healthcare environment. This involves developing a thorough understanding of your market and where your product sits within it, and creating a robust value proposition that takes into account the needs of all the key stakeholders, both internally and externally, that will influence its success. Making it all knit together is the ultimate challenge. It's as well not to do it on your own.

Richard Morton is managing director and Simon Dawson is a management consultant at WG Consulting. They can be contacted on 01494 470760 or e-mail enquiries@wg-group.com

Related Links

Market Access Review part 1:

What can I do to change your mind?

Achieving commercial success in the modern market depends on changing beliefs not only among an expanding customer-base, but also within the pharmaceutical industry itself.

Tuesday, January 15, 2008

Market Access Review part 2:

Why should we listen to you?

Marketers must not only engage more with non-clinical stakeholders, they also have to demonstrate value and overcome scepticism

Wednesday, March 12, 2008