Listening to Patients:A Novel Concept in Medicine?

Daniel J. Feldman, Ph.D.17 September 2011

Agenda

Patient Journey as a Unique Methodology

Case Study: Finding the Differentiator

Removing the Barrier

Patient Journey as a Unique Methodology

Group Discussion

“The pharmaceutical industry has been slow to adopt analytics, compared to consumer packaged goods, telecommunications, financial services.”

In five minutes, discuss reasons why you think that might be so …

Include a rationale that includes how pharmaceuticals are different from other industries …

The pharmaceutical industry has been slow to adopt analytic innovations:

1)that, until recently, the margins in pharmaceuticals were so healthy that analytics were not as necessary,

2) the number of influencers in the purchase decision were too complex for traditional modeling techniques (not just consumers but patients, physicians, and payers, let alone caregivers, nurses, and regulatory agencies),

3) the sheer amount of secondary data that have been available for tracking demand have paralyzed the analytic arm (try to think of another industry where each purchase is recorded and reported in such detail for regulatory reasons – gun sales might be the most comparable)

4) considering that pharmaceuticals are “negative goods,” (that is that given a choice, people would rather to not have to purchase or take drugs) traditional marketing research may not apply in the same way as telecommunications or consumer packaged goods (“positive goods” – everyone wants an iPad!!)

5) in addition to regulatory challenges, there are complex scientific and ethical considerations when marketing pharmaceuticals or medical devices that limit the ability to apply some market research recommendations.

More than 75% of research is focused on Physicians

The remainder is split between patient and payer research.

But come on! How much influence does a patient REALLY have in a prescription decision?

So, what IS a patient journey?A systematic review of a

patient’s experience with disease and treatment – uncovered by qualitative interviews or ethnographic research – to identify leverage points or unmet needs.

• Planning for disease• First symptoms• Decision to seek help• Information-seeking• Interactions with physicians,

allied health, payers, and pharmacists

• Treatment experience• Relapse and Disease progression• Non-compliance• Financial management• Discontinuation• Restarting Therapy

What kind of decisions are informed?

Product Development and Planning

Commercialization

Access Strategy

For each leverage point, there should be an identifiable commercial tactic, repositioning opportunity, or plan for product development.

Case Study

Finding the DifferentiatorRemoving the Barrier

Market: Multiple Sclerosis – Oral Agent(for illustration purposes only)

Slow onset; some familial genetic riskSymptoms can be mild for years, even decadesOral agents have been in the market for less than a year

Attribute Product Competitor

Relapse Rate 50% of placebo 40% of placebo

Side effects 10% nausea/vomiting1% risk of lymphocytopenia

12% nausea/vomiting2% risk of lymphocytopenia

Dosing 100 mg once per day

50 mg twice per day

Restrictions No grapefruit Fasting 2 hrs before and 2 hrs after dose

Price per day $55 / day (copay $1/day)

$50 / day (copay $1/day)

Group DiscussionIn five minutes, list all of the waypoints

along the patient journey: decision points or events for patients. (These are not people or places, just events). Make at least 10 rows …

Journey Waypoints

Influencers Tactic or Development Opportunity

Likelihood of Influence

Group Discussion

Did you include some of the following journey waypoints?

Planning for high-risk MCO plan Information gathering during treatment

Decision to seek help Ongoing support for disease

Information gathering at onset Follow-ups and disease progression

Experience of side effects Decision to use walking assist

Purchasing prescription Decision to enter hospital

Changing benefit design Missing a dose

Incorporating dosing into lifestyle Getting MRI results regarding disease progression

Group DiscussionIn five minutes, for each of the waypoints

list all the key influencers with whom the patient will interact. These can be persons, places, or things. Have at least 10 different influencers …

Journey Waypoints

Influencers Tactic or Development Opportunity

Likelihood of Influence

Group Discussion

Did you include some of the following influencers?

Employer Caregiver/Friends/Family

Pharmacist Online support group

Office manager Payer

Nurse Product or Disease Websites

Primary Care Physician Patient Advocacy groups

Neurologist FDA (for approval)

Gastroenterologist Hospital

Group DiscussionIn five minutes, for each of the influencers that you can,

indicate a marketing tactic or a development opportunity that might have benefit for your brand. Have at least 10 different tactics total … Indicate likelihood to influence with that tactic (High, Medium, Low, None)

Journey Waypoints

Influencers Tactic or Development Opportunity

Likelihood of Influence

Group Discussion

Did you include some of the following tactics?

Web banner Alignment with advocacy groups

Unbranded disease and treatment education MSL studies for identifying impact of non-compliance on disease progression and relapse

Product website Hospital care kits

Coupons or discounts Marketing campaigns around food (including DTC)

Compliance programs or diaries Formulary discussions with MCOs to remove financial barriers

Reimbursement tools for physician/office managers

Sampling programs

Nurse programs for recognizing lymphocytopenia or relapse, dealing with nausea

Caregiver support tools

Group Discussion

Put a * next to tactics with competitive advantage/disadvantage

Journey Waypoints

Influencers Tactic or Development Opportunity

Likelihood of Influence

Market: Multiple Sclerosis – Oral Agent(for illustration purposes only)

Slow onset; some familial genetic riskSymptoms can be mild for years, even decadesOral agents have been in the market for less than a year

Attribute Product Competitor

Relapse Rate 50% of placebo 40% of placebo

Side effects 10% nausea/vomiting1% risk of lymphocytopenia

12% nausea/vomiting2% risk of lymphocytopenia

Dosing 100 mg once per day

50 mg twice per day

Restrictions No grapefruit Fasting 2 hrs before and 2 hrs after dose

Price per day $55 / day (copay $1/day)

$50 / day (copay $1/day)

Group Discussion

Did you include some of the following tactics?

Marketing campaigns using food or pointing out minimal disruption to sleep or other schedules: website, DTC, hospital care kits

Alignment with advocacy groups around side effects or treatment options

Unbranded disease education about relapse or expecting nausea

Compliance programs or diaries

Planning for disease if sibling or other family member has MS: benefits, identifying symptoms

Reimbursement tools for physician/office managers

Coupons or discounts Nurse programs for recognizing lymphocytopenia

Next steps

Now that the patient journey is mapped, market research to follow will explore …

• Reasons for under- or missed diagnosis

• Validation of journey waypoints• Missing journey waypoints• Establish true role of influencers• Missing influencers• Characterizing interactions with

physicians, allied health, payers, and pharmacists

• Non-compliance

• Other components of treatment experience – unmet needs (focus on behavior vs. stated)

• Emotional drivers and barriers associated with waypoints

• Financial concerns or opportunities• Factors in discontinuation or

restarting• Ability for certain tactics or

messages to have impact

Questions?