Orphan and rare disease marketers: are you armed for success?
pharmafile | March 8, 2010 | Feature | Business Services, Sales and Marketing | Orphan
Many marketers are currently unfamiliar with the specific approaches required in orphan and rare disease (ORD) brands, but will need to familarise themselves with the challenges of such products as they become an increasingly important element in pharma portfolios.
Lower commercialisation costs in these less competitive and highly motivated markets, combined with significant unmet needs, means ORD products offer a less risky and more attractive solution to broadening the revenue base. However, despite being attractive in some ways, these markets offer distinct challenges when compared to more mainstream areas of pharma marketing, notably:
• Orphan and rare disease markets by their nature are small, and given the few occasions when a small, highly specialist group of clinicians actually get the opportunity to prescribe your brand, it becomes all the more essential that you are their preferred option. Particularly as there isn’t much opportunity available otherwise.
• The diversity and level of clinical and market information available is very different in ORD markets. For instance, given the severity of most orphan and rare diseases, many clinical trials conducted use less robust methodology (e.g. RCTs can be unethical given survival rates) and have to be accepted as best practice. This often makes clinical comparisons difficult, resulting in a lack of consistency in therapeutic management. And when conducting market research, given the small number of target customers that have probably been interviewed several times already, it becomes much harder to obtain unbiased insight. As a result, commercial decisions can become more of an art form!
• Disease management tends to be inconsistent and fragmented as ORDs are rare, and many clinicians will be unaware of any referral infrastructure or how to diagnose appropriately. For many patients this results in delays to diagnosis and treatment.
• Finally, a key barrier for all brands regardless of market is access to product, usually because of formulary or distribution challenges. For ORD brands, which tend to have very high unit costs, access is even more challenging. Access decisions are often made on a case by case basis, each requiring their own business proposition, which makes it a constant battle to convince the different influencers involved in the decision. Imagine going through a formulary process everytime you wanted to get a patient on your drug!
So the ORD marketer must ensure that their brand is always front of mind, using diverse and limited information in a market which is likely to be underdeveloped, whilst overcoming significant access barriers.
How the ORD marketer addresses these challenges
To be successful, ORD marketers need to approach things slightly differently, and with an open mind.
To entrench the brand as the preferred choice on those few occasions that the small number patients will receive a therapy, the ORD marketer must own the relationships in the key centres and prevent the competition building better rapport or stronger relationships.
Unlike other more mainstream brands, if you don’t win with these key opinion leader (KOL) prescribers there really is nowhere else to get the business.
In addition to building the rapport, the brand will not be the preferred choice unless the ORD marketer can clearly communicate a significant value over other therapeutic options – and not just to the prescribers – but also to those holding the purse strings involved in the case-by-case assessment. The good news here is that given a lack of clinical concensus and the more personal nature of these markets, there is a better opportunity to build value for a brand through the non-clinical aspects – particularly from support services and positive relationships.
Another area in which the ORD marketer has to be skilled is in overcoming the diverse and limited data. Because of the limited but very dynamic nature of the clinical data in the market, an ORD marketer will need to be a knowledgable and creative scientist who is on top of the most recent and relevant clinical information as customers will expect materials to include the most current abstracts. And in addition, to get the most from the very small market research sample, ORD marketers need to consider creative and innovative ways of gaining market insight.
For example, have you ever considered video interviews including tours of the clinic?
A likely priority for the ORD marketer will be improving patient diagnosis and referral by supporting the development of a disease management infrastructure. This is usually managed through a mutually beneficial partnership with both KOLs and NHS managers.
So unlike their more mainstream colleagues, the ORD marketer needs to understand that brand success and the allocation of their resources requires a very different emphasis when compared to more classical pharma marketing.
The small disease management community, although sceptical, will be more likely to want to work in partnership, so to gain their trust and maximise the benefit for the brand, the ORD marketer (and the ORD organisation) must have the expertise, skills and confidence to negotiate with NHS infrastructure builders, as well as understanding where the most return will be for supporting clinicians.
How do they do this?
For the ORD Marketer to ensure success for their brand, they need to approach several key areas in different ways:
•Increasing and making the most of customer intimacy
•Maximising the increased value of the non-clinical benefits associated with the brand
•Having an efficient organisation in which individuals have the breadth of skills to match the diverse audience.
Getting close to customers
For all pharmaceutical brands we need a clear picture of our key customer behaviour and drivers. But given the critical importance of each individual prescriber in ORD markets, the ORD marketer needs to generate a much deeper understanding of what it is that drives individuals, i.e., their personal motivations and aspirations.
Why do we need this information? So we can ensure that our medical marketing and sales activities, conversations and support are all aligned – thus fulfilling the customer’s (and our) goals.
In so doing, you are sure to create an unassailable relationship – a true partnership – and crowd out the competitors to retain that essential first place.
We already have a reasonable level of information on our key centres and our KOLs, but there is always room for improvement. So how can we do that?
We need a very detailed picture of the market which combines quantitative metrics such as centre sales performance, a picture of where referrals are coming from, and current clinical trial / Investigator Initiated Research (IIS) involvement.
In addition, we need to overlay individual qualitative aspects of the accounts, such as the level of influence of the KOL, the aspirations of the centre and what is behind any prescribing barriers.
This picture helps us prioritise where and who we are going to work with, as well as identifying what we should be doing with them.
We would usually leave this level of detail and customer management to the local rep, however given the increased importance of each customer, the whole organisation becomes responsible for ensuring this is optimised and implemented.
Maximising increased value of non-clinical benefits associated with the brand
As with all pharma markets, we need to align our most valuable product benefits with clinicians and fundholder’s key needs so that they are motivated to choose our brand over other options. The difference here is the value, importance and aspects of our brand – other than simple claims of clinical efficacy.
Less consensus on clinical superiority and the increased customer intimacy of ORD markets, offers a greater opportunity for ORD marketers to use these non-clinical benefits of their brands.
Building the benefits of strong longer term personal relationships, along with demonstrated commitment to making the disease management easier (with relevant financial support) over and above simple clinical efficacy messages – will increase the customers’ emotional attachment to the brand, and help to provide a rationale for much higher product costs.
To do this we really need a detailed understanding of what clinicians or fundholders are thinking when they choose what to do with appropriate patients.
What is their motivation behind selecting our brand and what are their perceptions of the competitive benefits of different therapeutic options?
Are there specific attributes that they are looking for from a product, over and above the usual requirements of efficacy, safety and tolerability?
Then it becomes a question (once we understand the product differences) of what services or support we could offer to improve the competitive perception of our brand.
For instance, do we need a dedicated nurse team to provide support or even potentially, specialist skills at initiation?
Should we be financing extra clinician time in the clinics to help the specialist centres increase their capacity for the increasing volume of patients?
Finally we need to wrap these benefits together in a compelling and motivating story and provide it to our small and expert community in a conversation, and tone accordingly – tailored to their individual needs and their role as much as possible. Should we really spend so much on producing beautiful detail aids or could the money be used more profitably supporting a group of registrars attending and presenting at a European congress?
Individuals with a breadth of skills to match the diverse audience
For most marketers, being involved in defining the relevant structure of the organisation for the brand is unlikely to be a major part of the job role. However, in ORD there is generally more scope to have input into the decision around having the right capabilities.
With the different market challenges and a (necessarily) small organisation serving a diverse group of customers, the balance of skills that individuals in teams require is different to the more classic secondary care sales approach.
The team you have will need to be able to do it all: being expert in the most advanced clinical science with a Professor one minute; then selling health economic value to Commissioners the next.
With a critical emphasis on owning the relationships in the key centres, there needs to be demonstrable commitment to developing a long term partnership across the whole team.
So the level of turnover seen in more mainstream sales teams would not be suitable for ORD teams.
To understand what capabilities would be most suitable for the success of the brand we need to overlay our brand aspirations and priorities on our customer needs, whilst also taking into account the potential future of the market.
We will already be clear on the aspirations and priorities of our brands and should be aware of the critical customer needs – so what we then need to understand are the future implications of the chosen organisation.
By using scenario planning we can uncover key themes of some prospective scenarios to draw enough of a picture to understand what skills we need to build upon, in order to continue to succeed.
A checklist for where we need to focus
In light of these key areas of success, chances are we can clearly see distinct areas of improvement, and you can carry out a check by asking, “Am I entirely confident that…”
1. We fully understand in detail, the internal dynamics, team aspirations and motivators within each of our key centres.
2. We are absolutely clear on what really motivates each of our KOLs, e.g., leading the development of shared care or writing national guidelines and concensus, congress trips or speaking internationally, plus maybe aligning strategies/activities to ensure that we support them in this.
3. We are communicating the most compelling value for our brand, using not just the usual competitive clinical data statements, but also clearly communicating our commitment to the development and evolution of the disease area, through all of the other services and projects that we currently support.
4. We have built the most efficient infrastructure with the right balance of capabilities to suit our priorities and customer needs now, and for the foreseeable future.
Summary and conclusion
As an increasing number of organisations choose to market profitable ORD brands, it is likely that you will at some stage have to work in this highly specialist area.
Because of the small and specialist nature of the market it becomes even more essential for ORD brands to be front of mind at the moment of prescribing – because there is limited room for No.2.
In addition with inconsistent and fragmented clinical management, it is likely that developing the disease infrastructure in partnership with KOLs and health service managers will be a priority.
So to deliver brand success as an ORD marketer you will need to acquire a broader personal expertise, confidence in your clinical knowledge, a willingness to be involved creatively in the wider commercial aspects of the brand, and a desire to be managing across the internal teams.
Michael Craig is a Consultant at the MSI Consultancy and can be contacted at mcraig@msi.co.uk or visit www.msi.co.uk for further information
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