Why should we listen to you?

pharmafile | March 12, 2008 | Feature | Medical Communications, Sales and Marketing |  industry relations, marketing, stakeholders 

Last month, Pharmafocus showed how market access can be a platform to build a cohesive strategy that brings together sales, medical and marketing. Being 'customer-centric' is central to a market access-led approach and, for pharmaceutical marketers, not only is the external customer-base expanding, but internal customers such as the salesforce carry equal significance.

That means communicating to all stakeholders that may influence the uptake of a product is essential to any market access strategy.

Despite overwhelming evidence that the decision-making power in PCTs is moving away from clinicians, it seems that much of the pharmaceutical industry remains chained to a traditional approach that ranks the GP as its key target. To compound the issue, actually getting in front of these customers is becoming more challenging – access rates in the UK are now among the lowest in Europe.

Even more worryingly, the amount of time marketers spend with customers is remarkably low. The sales force is, of course, the industry's largest customer-facing body and despite the decline in access, this is unlikely to change. However, in order to develop messages that resonate with key customers and that can be delivered with confidence by sales professionals, marketers need to understand all the stakeholders in their given therapy area, and identifying the pressures they face.

Non-clinical stakeholders

For the traditional marketer, time spent with external customers normally occurs at congresses or advisory boards. This takes place, at best, probably three or four times a year. Such 'key opinion leader development' is regarded as a central component of any marketing plan and, branded as Continuing Medical Education (CME), continues to command a significant chunk of the marketing budget. Yet whilst such activity is worthwhile, in truth it focuses on just one aspect of the customer-base: clinicians. The focus on non-clinical customers – chiefly payers such as prescribing advisers and commissioners – is conspicuous by its absence.

So who are these customers and how do you identify them? "Most of the important non-clinical customers can be termed as payers – they have influence over the drugs used. However there are also customers such as business managers within a hospital – these customers may not actually have direct responsibility over a drug budget, but may manage the budget for delivery of certain services," says Simon Dawson, management consultant at WG Consulting. "If, for example, an IV infusion service is required for the delivery of your drug then you are going to need to influence that person to try to secure space in the infusion service for your drug to be delivered. Determining who your key influencers are will depend on the type of drug being delivered and where it is administered."

As a marketer, take a look at your marketing plan and ask yourself the following questions:

1. How have insights from non-clinical stakeholders helped to shape your strategic plan?

2. How often have you accompanied your Healthcare Team in seeing non-clinical customers?

3. How have you used the insight into the roles and responsibilities of your non-clinical customers gained from your non-clinical preceptorship (Payer Preceptorship) programme to shape your strategic plan and drive brand success?

4. What approach have you taken to engage non-clinical customers in potential clinical trial design and early market access?

For many, insufficient attention is paid to these areas when developing a marketing plan. In the modern market, developing an approach that incorporates the pressures and priorities of the entire NHS customer-base is essential to success. In the past 18 months, the need to communicate to customer groups beyond the clinician has accelerated. This has been driven by the increased powers of PCTs allied to a reduced level of clinician insight into the funding processes and business cases that are increasingly required to support the use of the drugs that they want to prescribe.

To compound their lack of budgetary control, clinicians' prescribing decisions are increasingly guided by NICE (and other HTA) guidance. Clinicians rarely understand how to secure funding for products during the pre-NICE period – yet another reason for marketers to target a wider group of non-clinical customers with appropriate value propositions that will drive product uptake. Despite these factors, the industry focus still remains heavily weighted towards the clinician.

"Marketers plough a lot of money into CME with a view to bringing in clinical KOLs on an ongoing basis. They don't do anything comparable with payers," says Rick Morton, managing director at WG Consulting. "We have identified an emerging requirement for Continuing Payer Education (CPE) that could be used to help marketers to understand the roles and responsibilities of their key payer influencers. A CPE programme could be used to build strong relationships with non-clinical stakeholders that will help development of an appropriate brand strategy for this important customer group. It's a huge area that marketers could tap into, but they don't."

Understanding your market

Marketers currently undertake a heavy amount of clinical preceptorship work to understand disease areas and clinical profiles. But this exercise is rarely replicated for non-clinical customers. "It is common practice for marketers or sales professionals to spend time doing preceptorship work with clinicians," says Simon Dawson. "They spend time with them in clinic and in surgery, and follow them through their day of work. This allows them to understand what they do and to empathise with the pressures they face on a daily basis. This insight helps promote their products in a way that will address those needs. The challenge for marketers is to arrange to spend similar time with a payer in a PCT, and get to see and understand the daily challenges they face."

There is much to be gained from such an insight into the non-clinical mindset; the beliefs these customers have about your brand will ultimately influence the prescribing decisions made by clinicians. With such a clear current focus on clinicians, it is likely that marketers' understanding of non-clinical customers is poor. "Marketers should ask themselves: how much do you understand funding flows? How clear are you on the non-clinical issues that may impact upon bringing a product to market in your disease area? Do you know what a commissioner's priorities are? Gaining an understanding of the non-clinical mindset and the beliefs that exist about your brand can be used to generate a 'value map'. This value map will enable development of appropriate messages that will resonate with non-clinical stakeholders and provide market access for the drug you are trying to promote. Only by spending time with these important stakeholders will you be able to understand the challenges of their role and achieve true non-clinical brand impact," says Simon Dawson.

Payer attention

While non-clinical customers are not limited to prescribing (or pharmaceutical) advisors and commissioners, these two roles are perhaps the most significant for pharmaceutical marketers. They are, however, two entirely separate positions with different remits, responsibilities and priorities. As such, they each require a different approach.

"One of the core measures of the effectiveness of many prescribing advisers is how well they plan and manage their drug budget. Their responsibility is to determine how a new or existing product will impact their annual drug budget when compared with other alternative products in the market, taking into consideration the dreaded 'prescribing creep' that exists for products with multiple indications," says Rick Morton. "A commissioner is not measured on the management of a drug budget, but considers the impact that a drug will have on the delivery of a service, for which he/she commissions and is ultimately measured against in terms of cost effectiveness and quality. For example, if a new product on the market can demonstrate that it will reduce the number of bed stays in a hospital, the prescribing advisor may not necessarily be interested (N.I.M.B.D.I.M – Not In My Budget Doesn't Interest Me) – the money saved will not be of direct benefit to the management of an accountable drug budget. It could, however, benefit the commissioner and so his interest and influence may be needed to mobilise clinicians and prescribing advisers to consider reviewing the prescribing strategy in that area (initially this may be for a defined cohort of patients). Having the right value proposition (key message with functionality) for the right customer at the right time introduces an energy and momentum into the influencer/decision-maker matrix. The marketer's role is to support the sales teams in understanding this matrix and also to have ongoing interaction with the clinical and non-clinical stakeholders to understand how this influencer/decision maker matrix evolves over time."

Clearly, success rests in developing key messages and value propositions that are appropriate for each customer. By engaging with non-clinical customers, marketers will gain a better understanding of the value propositions needed for their brand.

Demonstrating value and overcoming scepticism

The challenge for marketers, therefore, to spend more time with these key customers, gain internal support and identify a framework for engagement. The problem, however, is that prescribing advisors and commissioners are largely very sceptical about marketing and its purpose. So how do marketers overcome this?

– Acknowledge

– Support

– Engage

"The key is for pharma companies to communicate their messages to payers in a way that helps payers achieve their daily and longer term goals," says Simon Dawson. "If you can show how both the PCT and the payer might benefit from meeting, the current scepticism of marketing would quickly erode. Effective models of non-clinical engagement can really ignite the market access influencer/ decision-maker matrix to drive brand success."

The early bird

The real trick is to garner enough information early in the development of your marketing strategy in order to put your brand on the front foot. Too often, limited access to non-clinical stakeholders forces marketing departments to be reactive and reliant on information from the field. This results in demands on marketing for 'non-clinical issues management' solutions. Commonly, information reaches managers from the field force – normally through Healthcare Development Teams – but all too often, the kind of information that filters back is the bad news, for example, a PCT has blocked the funding of a drug. If marketing can engage with both clinical and non-clinical opinion leaders during pre- and post-launch marketing plan development, the likelihood of nasty surprises from PCTs post-launch can be significantly reduced.

Payers and clinical trials

When considering products in the early development phase or where seeking new data to support differentiation, informed payer input even at the clinical trial design stage could be hugely beneficial. "Nowadays, many clinicians and non-clinicians have become experts in clinical and cost-effectiveness. A core factor for cost-effectiveness is in the trial design, and what information is collected," says Rick Morton. "Generally, non-clinicians are not involved with clinical trial design, yet this is a good way of integrating non-clinical customers with medical and marketing teams. The multi-disciplinary approach works best. If you have a group of non-clinicians who sit alongside clinical KOLs, they can identify areas of cost impact that are evident in clinical study design and help propose how resource data could be collected in a way that will support the assessment of cost-effectiveness as well as clinical effectiveness. It is a radical approach and it would require a significant mindset shift from the industry – but it would be extremely valuable."

The way forward

So in addition to using traditional clinicians, marketers need the input of non-clinicians in shaping their marketing plans. Non-clinicians can be instrumental in helping develop a managed entry plan if you are launching a new product, or in shaping your strategic plan if your brand is already on the market. Understanding the influence that non-clinical stakeholders can have on your brand is the best way to identify opportunities and the 'market space' that could be filled by your product.

Undoubtedly, marketers need to secure increased involvement with non-clinical stakeholders. In addition, they need to better understand what non-clinical customers require from marketers and how such customers can help add value to the differentiation of a product, whether it is in early-stage development or has been on the market for a long time. "Proactive engagement with non-clinical stakeholders, can give marketers a different perspective on how they can create value and build a broader value proposition," says Rick Morton. "Historically, value propositions have been created for clinicians not payers. This approach has limited effectiveness in the influencer/decision-maker matrix. To succeed, ask yourself two simple questions: Does your marketing plan have true value propositions? Have your value propositions been developed in conjunction with non-clinical customers?

If you cannot answer 'yes' to both questions, the chances of success are limited and you may have to pay the price of investing heavily in non-clinical issues management solutions. If you can, you'll find that when the sales force takes your messages to market, the barriers to entry will be lowered. In the process, you will have addressed a key aspect of sales and marketing effectiveness, and, furthermore, developed a market access plan that works and you never know, you may be the first marketer to have a non-clinical KOL strategy."

Box: Rules of Payer Engagement

1. Gain an understanding of the roles and responsibilities of the non-clinical customer.

2. Identify where that customer sits with other clinical and non-clinical customers. Who are the other stakeholders that the customer interacts with? And what level of influence does that customer have with those other people? Gather information to enable you to draw a stakeholder map around the person and an influencer map with them in it. Who influences them and who do they influence?

3. Establish the local and national issues impacting on them and their role? What are their priorities and can your brand help them address them? This might be at disease level or at service level.

4. Identify the core value factors for that customer in your market space. How does the customer measure and ultimately value your organisation in your market space?

And always pay attention to what constitutes effective engagement-

5. Always conclude with a call back. How are you going to go back and see that customer? How are you going to keep the momentum going so you can demonstrate that you add value and are worth building a relationship with?

Richard Morton, managing director and Simon Dawson, management consultant, at WG Consulting.