Mutual medicine

pharmafile | November 18, 2004 | Feature | |   

From developing strategy for a product at the earliest pre-launch phase to promoting older, established products the pharma industry has always worked closely with clinical advocates. These experts, who are often referred to as key opinion leaders (KOLs) provide valuable input and feedback to the pharma industry to support the marketing process. In fact, the industry could not supply the right products, information or educational materials to the medical profession and patients without a close working relationship with them.

KOL endorsement and support for a therapy area, class of drug or particular product is an absolutely essential part of the successful marketing of products in the pharma industry.  Successful working relationships with KOLs can result in a wide range of benefits including appropriate credibility and endorsement from experienced experts.

It is absolutely essential, however, that KOLs maintain their independence in order to stay credible to their peers (your target audience) and not be seen to be supporting only one brand or company. Achieving the right balance between developing a positive working relationship with KOLs whilst they maintain a comfortable distance between themselves and 'commerce' is one that needs careful planning and excellent communication skills.

What makes a good KOL?

As we have touched on above, KOLs are specialists who have specific expertise in a particular area of medicine and who are influential and authoritative in their particular field. In the past, KOLs were traditionally, influential, senior healthcare specialists, usually based in academic units or prominent teaching hospitals.  

However, in the ever changing NHS there are now an even wider range of stakeholders who are influential in the prescribing process, who need to know what different therapeutic options are available for their particular area of interest.   KOLs, therefore, come in many different guises, from the eminent Professor of Urology, GP prescribing lead, a chief executive officer of a PCT to a senior nurse prescribing advisor at the RCN or media GP.

How do you therefore establish the right network of KOLs who will speak at a meeting, write an article or support a local formulary application? How do you find the right people who are credible and highly respected in the field who will be able to provide appropriate, third party support for your product? In other words how do you find the most appropriate brand advocates and who are they?

How many KOLs?

The type and number of KOLs needed is dependent on the product or company's current marketing position. If you are preparing to launch a new product into a new therapeutic area your needs will be very different from launching a new product into an established therapeutic category. Maybe you have a new therapeutic indication for an existing product or want to increase your product market share in an existing market? Another important area is finding the right person to help manage a crisis?

Who do you need?

Firstly, you need to assess the current position of your KOL programme. If you are entering a new therapy area there is obviously a lot more work to be done. The key product related messages and identifying the key stakeholders who need to hear them will help to determine the number and breakdown of KOLs needed to support your communications programme.

The key messages will be delivered much more effectively if the right delivery channel and voice is used.  

How will the key messages be delivered?

What are the elements within your planned communication programme and where will the appropriate KOLs fit in to provide the support and endorsement you need?

Communications programmes will have a diverse range of activities that require KOL input to make them relevant and correctly positioned: from clinical research; membership of specialist advisory boards for pre-launch or post-launch strategy development; development of interesting and relevant international and local speaker meeting programmes, plus providing support and advice with crisis management programmes.  

Media coverage of new and existing treatment options is also an important part of the communication plan. By providing relevant and up to date information and briefings to KOLs who  write features and are involved in broadcast media, they are able to review the information and, where appropriate, include coverage of your product, raise the profile of a therapy area or raise issues independently that provide exposure and a platform for discussion to a wide range of readers and ultimately prescribers.  

No one person will have the right skills for all of these activities, so developing open working relationships with a broad range of personalities and healthcare professionals will be necessary to support your communication plan and help deliver appropriate elements of your programme effectively to all relevant stakeholder groups.

How do you get started?

Initially, an audit of existing KOL relationships you have in the relevant field needs to be undertaken together with a wish list of any stakeholder groups you may need to develop new contacts in, to help support your communications programme.  

There are a number of different ways this can be done. Some pharma companies coordinate this process internally, developing and retaining personal KOL relationships. Other companies who may be launching a product in a completely new area will use the skills of a professional communications company who work with KOLs on a daily basis to support them in this process. Often a partnership between the company and the communications agency works well with a combination of contacts from both parties being developed to form the core KOLs for a specific programme.

A search can be undertaken in a number of ways in order to draw up your required shortlist. Peer reviewed journals and conference/symposia programmes can provide you with the experts who are credible in a given therapy area and who have undertaken clinical trials with specific drug classes which may include your product.

Salesforce input and clinical trial investigators may also provide you with key company and product-specific contacts who may have experience and knowledge in the therapy area. It is also important to identify KOLs who have knowledge and experience of your competitors' products at this stage and who may be advocates of them. Other sources include membership of editorial panels on relevant journals; those who have involvement with patient groups and any other relevant NGOs or those particularly vocal at national speaker meetings or in the medical and consumer healthcare press.

In addition to established KOLs, it is important to identify younger 'up and coming' people who may become the KOLs of the future. Trainee groups at specialist societies, such as the TiGs (Trainees in Gastroenterology Group) at the British Society of Gastroenterology (BSG) can sometimes present those younger Specialist Registrars who have a specialist interest.  

One way of building relationships might be to support key groups or individuals via educational grants or sponsorship to attend relevant congresses where they might not have the opportunity to attend. This will enable them to keep pace with medical advances, a daunting challenge for today's physicians.

Whether the education sponsor is a pharma firm, independent provider, professional association or medical school, medical education's goal is the same: to enhance medicine practice.

Time spent with these individuals at the development stage of their careers and exposure to senior colleagues helps to support career development. This often shapes positive relationships for the future where dialogue between the industry and individuals is open and opportunities for developing essential abilities such as presentation and media skills may be relevant.

The next steps

Armed with your shortlist (or long list!) of the KOLs you are currently working with, those who you would like to be working with and also a list of people you know are supportive of alternative therapies, the next step can be taken.

This list needs to be refined to identify the level of KOL development you will need to undertake in order to meet your communications objectives and assess the levels of advocacy you need and from whom. Depending on the expectations you need to ask yourself a number of important questions such as:

Therapy area support:

• Are they interested enough in the therapy area?
• Do they support the role of your class of products in an appropriate treatment regime?
• Do they know the clinical supporting data and evidence base?
• Do they have established credibility from their peers in this area?

Specific brand support:

• Have they contributed to research with your product?
• Do they know YOUR clinical evidence?
• Can they position it appropriately versus the competition?
• Do they speak for the competition? Or do they specifically support your product's evidence?

And coupled with all these:

• Competency and credibility
• Are they credible and highly respected in this field by their peers?
• Are they a competent and appropriate speaker? Are you looking for a clinical guru or an entertainer?
• Have they received media training can they competently handle the objections?
• Can they communicate effectively to the target customer audience?
• Are they right personality and face for broadcast media?

How to work with KOLs

Once you have identified which KOLs you would like to work with, understanding what issues there may be and what level of information you will need to provide is one of the first things required before the programme is implemented. Communication is key and individuals with sound interpersonal skills and a thorough understanding of the product strategy and communications plan are essential to the success of the KOL development programme.  

Depending on the company set-up and resources available to the pharma company, this team may work internally or expertise may be outsourced to an external agency. First impressions count when making contact with KOLs and from the initial contact to working with them, the ability to communicate effectively and appropriately is essential.

Establish what level of advocacy is required from each individual KOL – before making contact decide what you think are their particular skills and how best they might be able to support elements of your communications programme. From research already undertaken you will have a good idea who will work well in an advisory board setting. Who might be the most appropriate person to support with training? Who has the skills necessary to support an extensive media programme? When an approach is made to the KOL be well prepared, know what you want to ask and be completely open with them in order to establish trust, beginning the relationship on the right footing.

A written proposal and agreement is sometimes helpful in confirming what you are expecting from your KOL, managing expectations from all parties.  

It is important to be specific and understand what they are happy in doing for you. Do not ask them to be overtly promotional as this would threaten their independence and damage their reputation.

Always remember that it is essential that your KOL's credibility and integrity are preserved, otherwise their impact as independent opinion leaders will be eroded.

Have realistic expectations, but it is important to be assertive and discuss what you want to achieve. Although you might be talking to a world expert, they need to be clearly briefed, and understand the data and what is required of them. This open dialogue from day one means trust is built and an open and positive long-term, two-way relationship started.

Ongoing development

Continuing discussions with your KOLs is important as the communications programme and product development are likely to be fine-tuned as your campaign progresses. Regularly ask them for advice and discuss how any changes to the campaign or messaging may affect the communication routes to the target groups. They are the experts and will know what information needs to be presented to which groups to enhance best practice.

They can provide information on how stakeholder groups think about issues; feedback on the quality of your data and how it is perceived by their peers; and help identify how your product might best be positioned, amongst many other things.

Remember not to rely too heavily on any one KOL. Different stakeholders require different spokespeople and whereas the 'top down' approach does work in some instances, hearing your peers' opinions and comments is important too. The credibility of a KOL could also be questioned if he or she is seen to be acting as a company spokesperson. This is not beneficial to you or your product and their integrity and independence must also be maintained.

There are many target groups to address, with very different messages so make sure you have considered each area. Remember, just when you think you're getting there you've answered all these questions and have a broad base of supportive advisors the environment can shift: a competitor launches a new indication or a landmark trial is published. It's a dynamic progress – KOLs are only human like the rest of us – and based on new data and products their opinions can and will change too!

The ongoing role of KOLs

The role of advocates also changes during a product's lifecycle: at the beginning you need confidence and strong messages around the evidence base. This may be the first time prescribers hear about your product so it needs to be impactful!

As time progresses, more persistent, subtle messaging is required to maintain awareness and support in the absence of new clinical data.

Then a new competitor launches and the advocates need to consistently communicate your clinical advantage often against loud, strong messaging and high levels of customer interest in the competition.

Coupled to all these changing dynamics ensure every opportunity is taken to equip the KOLs with relevant information, evidence and support.  They need to be kept up to date with product developments where relevant and regular contact should be maintained even when a specific project or activity has been completed to maintain their interest and support.

Advocacy is integral to the marketing strategy – strategically and operationally, nationally and locally. And across all levels of influence. Just remember the 'young guns' of today could be the national advocates of tomorrow!

Overall, throughout the development programme, the integrity and independence of the KOLs need to be maintained. Open and transparent working relationships are essential and will ensure all parties are comfortable with what is expected and maintain a focus on the most important objective – improved patient care.