From John Guarino, SVP, Managed Markets & Payer Strategy, Palio

More and more in the healthcare space, the success of a brand depends on having an understanding of managed markets.

Nearly all business in our industry is managed. In some way, third party payers, be they commercial or government organizations, are affecting most use of drugs. Manufacturers can’t afford to be unsuccessful in this critical part of our business. How often have you seen excellent marketing executed into the physician/nursing/pharmacy space, only to have a reimbursement hic-up derail that prescribing process and set back your efforts in that practice?

The managed markets space is critical to pharma/biotech success for two reasons: 1) it represents the goal line of patients actually receiving their prescriptions and them being paid for, and 2) payers are becoming institutional decision makers that drive physician use through the payer preference.

Companies tend to address the need of managed markets marketing by either making their efforts part of the overall brand strategy driven by the business unit responsible for sales of a specific product, or by carving out managed markets as its own entity, usually within the corporate accounts space, focusing on the entire portfolio. Each approach has advantages and disadvantages. What is critical to success is understanding what is different about marketing to these customers.

Conversations in the payer space look different than they do for health care providers. They revolve around not only clinical differentiation but also the value associated with those outcomes. FDAMA 114 (the section of the regulation guiding pharma marketing to “formulary decision makers”) requires a unique understanding of what types of data paint the value picture best. Companies will need to address what “directly related to” the drugs indicated uses are as well as what “competent and reliable” means for claims data analysis. Internal regulatory and compliance organizations struggle with these definitions, and a clear understanding is important in helping manufacturers find their voice.

The payer buying process is different than that of physicians. Coverage reviews and decisions can vary by customer and they may be triggered by new products, generic entrants, competitive proposals or just a desire to ensure appropriate use of the drugs they pay for. They generally tend to make decisions by committee, with many stakeholders chiming in. Their frame of reference is to allow enough alternatives to satisfy need, but to avoid excess cost. They have to think in terms of patient populations where physicians are making decisions on specific patient cases. Good marketing in this area ensures holistic approaches to messaging –– not only to pharmacy and medical staff within the plan, but also to financial decision makers, quality directors, physician opinion leaders, hospital system partners of the payers and even patients.

Patient payer benefit design often reflects increased patient cost-sharing, premiums, and OOP costs. This move will shift care more towards consumerism. Large institutional decision makers will have to consider how shifting cost will impact members, and manufacturers will have decisions to make about where best to place their advocacy dollars, and how to advocate for patients in a compliant and legal way.

The Patient Protection and Affordable Care Act (PPACA) or healthcare reform, will have a profound impact on the payers and how they run their business. Fixed medical loss ratios, the excise tax on insurers, and benefit design restrictions are just a few areas that will challenge the payers’ profitability, and they, in turn, will challenge manufacturers to make value a linchpin issue in their marketing messages. Comparative Effectiveness Research is a health care reform initiative that manufactures need to help drive, or they will suffer whatever other stakeholders produce. You can think of this as National Committee for Quality Assurance (NCQA) initiatives combining with health economics research.

Things like market access, reimbursement, effective pull through, and contracting profitability are all areas in which expertise is necessary. If your organization doesn’t have strength here you need to develop it… and fast! The market is moving towards these customers becoming more important, not less. An understanding of the differences and similarities between traditional marketing and payer marketing will help deliver the strategies and tactics that ensure access and reimbursement success so critical to the success of the brands you’re managing.

From Michael Boggs, Account Director, Palio

From nature’s perspective, the crow is one of the most intelligent birds. Part of what makes the crow unique is that they are known to employ tools in order to help forage for food – they use almost anything they come across in the wild. What’s more is that they will take what they find and tailor it to suit their needs – be it sticks, leaves, wires or other things that modern life has put at their disposal. They aren’t born with this skill set, they learn how to use tools over time. The crow’s problem-solving skills are what set them apart from other birds.

And therein lays the correlation to our everyday agency lives. As marketing experts, we also use all of the tools at our disposal to solve problems. But the challenge becomes how to incorporate all of the new tools that technology has put at our disposal.

Take for example some of the new technologies that have been recently developed. Quick Response (QR) codes. Ever hear of them? I’m sure you’ve seen them. They’re little matrix bar codes that can be used for a variety of applications.

In places such as Asia and Europe where they’re more widely used, you might see one on a movie poster. If you thought the movie looked interesting, you could scan the QR code with your Smartphone, which would then direct you to a web site where you could buy a ticket for the next show. Keep an eye out for an upcoming post from our own Chau Ho on this new technology being used as a flexible marketing tool.

The lesson here isn’t that the US is behind the times (which we are when it comes to QR codes), the lesson is that this is an example of a tool that is underutilized and can be put to use for our clients. Could drug reps have QR codes on their business cards that automatically dial the rep’s phone number? Could we provide doctors with a QR code for ordering more co-pay coupons or samples? Scan a QR code on a physician detail piece to visit a microsite for more information?

Here’s another one: How about the ability to serve information to Web site visitors based on where they live? Let’s say you’re promoting a flu drug. The flu and flu season are different if you live in Florida vs. Chicago. In Chicago, flu season could be in full swing in November – accompanied by snow and winter conditions, whereas in the South, flu season might be a bit later in the year while it’s still sunny and warm. The more relevant the content you serve consumers, the more likely they are to think that you can relate to their version of the flu.

The point of all this is that while it’s difficult to keep up with the rapid pace that technology is evolving, we all have a responsibility to both ourselves and our clients to use the tools at our disposal – and to use them in new and innovative ways. Not only will doing so help you do better work for your clients, but it will also help reinforce your agency’s USP. Having said that, I’d be willing to bet that with all of the focus and energy that we’re putting behind technology, we’ll continue to see plenty of educational seminars to learn more about the latest tools.

So be the crow. Look for any opportunity to wisely use the tools around you to help make your clients’ campaigns more effective.

From Bob Rath, Associate Creative Director, Palio

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From Mike Myers, President, Palio

There isn’t a week that goes by in recent months that a client or media publication doesn’t reach out to us to discuss social media. It’s the new “thing,” and everyone wants to make sure that they aren’t missing an opportunity to use social media to effectively market and manage their brand.

Surprising to some, social media isn’t that “new.” It’s been used in various ways for years. Yes, social media on the Internet.

Forbes Magazine put out a great article last week reviewing their analysis of the Top 20 social media campaigns. We thought it was well done and very interesting. A quick review will show you how clients and brands have been creating buzz and engaging customers for well over 10 years using the “latest rage.”

We’ve taken the original Forbes list and commentary, placed it into PowerPoint for easy review, provided a set of worthwhile and interesting links, and embedded it here via a SlideShare plug-in for WordPress.

If you’d like to download it for yourself, here is the link.

From Alan Steele, VP, Director of Studio Services, Palio

A review of: Going Visual - Using Images to Enhance Productivity, Decision Making and Profits, by Alexis Gerard and Bob Goldstein

This book, which is in Palio’s creative resources library, proposes that images are the best new tool to significantly improve business. Using the analogy of a Bach concert in 1500, the authors argue that, although we have a surviving music score, information about audience reaction, the look and feel of the concert space, the sound of the instruments, and the interaction between orchestra members is lost. The limitations of the written word as a descriptive tool are clear.

Humans, the authors point out, process the world visually. We have significantly more nerve fiber connections between our brain and optic nerve than between our brain and our other senses. However, we need a technology to capture and share images. There are three variables to image capture/sharing: skill level, time requirements, and audience reach. Through most of human history, up until still photography, skill level and time requirements were very high and audience reach was very low. Think of a highly skilled Renaissance oil painter and his courtly audience. With film photography, then digital photography and digital video, skill level and time requirements are low and audience reach is high. Think of you with a point-and-shoot digital camera and a quick download to your Facebook site.

The authors cite five case studies where images are incorporated into business process. A facilities management firm uses images to show where property needs repair. A self-employed sales rep takes photos of products from her 150 manufacturers and shares them with clients instead of lugging around the physical products. An SVP of merchandising for a chain of retail stores travels globally, photographing unique products. Designers also send her digital photos of concept renderings. An outdoor advertising company tags images with information making them “smart.” For example, the metadata attached to a billboard in Los Angeles includes a specific location, the advertiser, expiration date of the contract, etc. The company can “pre visualize” a property by superimposing a billboard on a proposed site. A project manager for an international entertainment company uses videoconferencing so globally dispersed team members can be together. There is less travel, tighter contact, and quicker business decisions.

There are five future directions for images in the business environment – 1) Imaging ecosystem: reducing the barriers to seamless image communication, ensuring that images flow freely across devices, software, and networks, 2) Visual mobility: the mobile phone is just the beginning, “real-time business” captures and communicates information instantly regardless of where the sender and receiver are located, 3) Automatic imaging: CCTV, web cams, reconnaissance satellites are examples of continuous, unattended, network-connected imaging devices, 4) Vivid imaging: a “long” picture of 1 to 10 seconds enables the viewer to feel part of an environment (a 360° view of a home is an example), and 5) Personalized authoring: video editing software that creates different videos for different audiences from the same content.

From Amanda Murphy, Senior Copywriter, Palio

Erin Rossi, Palio Art Director extraordinaire, and I recently attended a conference sponsored by The Big Money: Untethered 2010: Profitable Media in the Tablet Era, where some pretty prominent folks from companies like Condé Nast Digital, Sony, HealthCentral, Zagat Survey, Simon & Schuster, Google, Razorfish, and one of the guys responsible for a little campaign known as Apple “1984” sat on stage and spewed their feelings about the iPad and its potential effect on their business. Feelings that left it obvious as to who thinks the iPad is just another me-too device and who thinks it’s the sliced bread, peanut butter, AND jelly all rolled into one sparkling, shiny package.

All in all, the content was noteworthy. The speakers were impressive. The new Blio software for e-readers was snazzy. The mini cupcakes were mini.

But the most fascinating point to me was this quote from Shiv Singh, Vice President of Razorfish (forgive me if I butcher this, Shiv. I’m not a journalist): “The average time a user spent on the GQ iPad app was 62 minutes.” Wow. 62 minutes? And just the other day, I read on Adrants that ads on the iPad perform 6 times better than on a desktop. Double wow. In advertising, where you’re thrilled if a user spends more than a few seconds on your site, or you somehow achieve a 2% click-through rate from e-mail, this is big. Maybe the reason for these statistics is due to the novelty of the iPad, but methinks it’s much more.

Imagine an app created solely with your client’s brand and target in mind. Let’s take diabetes for example. With one app, patients could monitor blood sugar levels, keep track of their eating and exercise, set up reminders to take their medication, learn all about the product being promoted, etc. Sound just like a regular ol’ Web site? Re-read that GQ statistic, my friend, and think again.

Or, what if you could score for your client a single-sponsorship on an app relevant to their brand? Wait. Forget single-sponsorship, any amount of advertising you can land where users are spending an hour plus with their eyes and fingertips glued to the iPad just tapping and browsing and interacting is mind blowing.

This is incredibly exciting news for advertisers, because it means we get to experiment with the latest and greatest whiz bang device and expand our capabilities to gain new clients. (And ideally, it also means we get to play with the devices that create the whiz bang.) But, advertisers, this is equally exciting news for you. It means the chances for your ad to be not only read but acted upon, increase exponentially—by 6 times, to be exact-ish.

So, yeah, the iPad really is changing everything from turning flat content into a truly dynamic, user experience to showing us marketers how to take advantage of that content without crowding the marketplace.

Now that we’ve got the question of making media on a tablet more profitable all figured out, the only thing left to learn is just how this iAds works.

From Ian DeMeritt, Senior Medical Writer, Palio

In what may be the first DDMAC letter to focus on Facebook, Novartis Pharmaceuticals was just warned that its use of Share Widgets on the Tasigna (nilotinib) Web site was illegal and that it misbranded the drug. Tasigna is “indicated for the treatment of chronic phase and accelerated phase Philadelphia chromosome positive [Ph+] chronic myelogenous leukemia (CML) in adult patients resistant or intolerant to prior therapy that included imatinib.” The Tasigna PI contains a boxed warning and the FDA required a REMS program for Tasigna to educate healthcare providers and patients about proper dosing strategies to avoid serious risks.

The Tasigna Web site contained several Share Widgets. By clicking on these icons, visitors were able to quickly and easily share information about Tasigna on Facebook, Twitter, or other social media sites. A short description of Tasigna (including its indication) and a link to the Tasigna Web site would then appear on the user’s Facebook page visible for all of his or her friends to see. Although users were unable to edit the Novartis-generated text, they could include comments along with the post.

While I applaud this use of social media by Novartis, there was only one problem with this approach that anyone familiar with recent DDMAC communication in this area could predict (except, apparently, the Novartis regulatory team): no safety information was included on the Facebook pages of visitors who shared the link. Even though a link to the Tasigna Web site was present, DDMAC has made it pretty clear over the past couple of years that when it comes to social media, it doesn’t recognize a so-called “one-click rule.”

To my knowledge, this issue was first addressed by DDMAC in the 2008 untitled letter regarding banner advertisements for Diovan; this letter was also issued to none other than Novartis. That letter clearly stated the need to include safety information in on-line communications, and that a link to safety information is insufficient to communicate risk information:

“The [Diovan] banners, however, entirely omit all risk information, including the warnings, precautions, and the most frequently reported adverse events from the PI. We note that a link to the PI and Patient Product Information (PPI) is included at the bottom of the banners. However, this does not mitigate the misleading omission of risk information from the banners.”

Not surprisingly, DDMAC’s position hasn’t changed in the past 2 years. The following wording from the latest letter is nearly a direct copy-and-paste from the letter issued in 2008:

“We note that the shared content contains a hyperlink to various Tasigna product websites, which do contain risk information. However, the inclusion of such a hyperlink is insufficient to mitigate the misleading omission of risk information from these promotional materials.”

Given the previous communications between DDMAC and Novartis, I find it curious that they continue to test the “one-click rule.” Whether this latest misstep was intentional or not, it highlights the fact that the issue of pharmaceutical advertising in social media is not going away. Until DDMAC releases its guidance on social media these issues will continue to surface and DDMAC will continue to issue letters to companies who fail to comply.

Until then, I wonder if DDMAC will accept my friend request.

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From Mike Myers, President, Palio

We’re big fans of Michael Gass’ ‘Fueling Ad Agency New Business’ blog. He regularly posts interesting insights that are worthy of a read regardless of your position or industry.

Michael recently wrote a blog post entitled “52 Facts About Social Media for Ad Agency New Business” that drew from a blog post by Danny Brown.

This summary is directly drawn from the content that these two published. We found it interesting, timely, and worthy of passing along.

From Rafael Holguin, SVP, Director of Design, Palio

It would be unfair of me to write about the design of medicine labels and brand identity in pharmaceutical products without looking back. After researching, I was amazed by the artistic quality and fascinating shaped bottles, typographic labels, interesting ingredients and elegant color palettes. In those days elixirs, liniments, syrups, pills, extracts, tonics and balms were produced and distributed by doctors themselves!

Until around 150 years ago, anyone could call themselves a chemist or druggist. The first steps in regulating the profession came in 1842 with the founding of the Pharmaceutical Society.

Some of the substances prohibited today were legally available in the past. Interestingly, the world-famous soft drink, Coca-Cola, was initially made from a syrup that listed as an ingredient, coca. John Pemberton (1831-1888), a pharmacist from Atlanta, Georgia sold many tonics and elixirs, and among them was Coke syrup known to have a medicinal or sedating effect. At that time, the addictive and harmful qualities of cocaine were not known and it wasn’t illegal in the U.S. It isn’t surprising that we won’t find this historical fact in the Coca-Cola website. It’s fascinating to me that one of the largest consumer brands in the world has such a direct link to the pharmaceutical industry.

Looking at the early 1800’s medicine vintage labels you would appreciate the exquisite handwritten and typographic treatments, printing techniques, and shapes and paper stock of the labels — some of them very simple and straightforward, others more ornate combinations of serif and sans serif typographies.

Very early on, physicians and marketers realized the importance of design in providing differentiation. Soon, greater competition began fueling more creativity. Nothing has changed in principle since then except that there are more regulations and controls designed to protect the public. For instance, when designing the brand identity of a pharmaceutical brand today, the generic name must appear below the product name at 50% of the height in size of the tallest character in the brand logotype, and legibility is extremely important.

It’s the same when choosing the color palette and symbols for a brand — the FDA regulates all aspects of advertising graphics to avoid confusion among products. This is very important to prevent the misuse of medicine by physicians, pharmacists, nurses and patients. It’s mandatory now that all pharmaceutical communication for both professionals and consumers is reviewed and approved by the FDA. This process is very strict. In addition, none of the visual and verbal branding elements can convey information that makes claims not supported by data.

Therefore, there is some creative limitation that could begin to genericize the marketing expression of a brand if we don’t seek to use the most artistic originality possible within our constraints. Adding to the difficulty are the rushed deadlines and then the focus-group factor that can hinder the good old-fashioned craftsmanship that produces truly great work.

Design innovation is imperative to produce breakthrough branding within these established boundaries. We can only do this if we carve out the proper amount of time to educate ourselves about the product profile, MOA, market dynamics and unmet needs of the audience and we don’t truncate the creative process. Obviously, it’s a lot easier to default to the typical expressions of the triumphant “jumping for joy” figure, the meaningless “swoosh,” or something so abstract or generic that it becomes completeley meaningless and non-differentiating.

However, there are some pharmaceutical brands that have achieved high design standards — like Nexium (the purple pill). Astra Zeneca’s Nexium managed to own the color purple in the mind of the world; purple is a “cool” color very appropriate for a medication prescribed to treat the symptoms of acid reflux and heartburn. Creating “the purple pill” was brilliant. Advair has followed this example with “the purple disk” and Pfizer’s Viagra did the same with “the blue pill.”

Of course, there are other famous pharma branding cases; Bayer aspirin is surely one. In 1897, chemist Felix Hoffmann, at Bayer in Germany, chemically synthesized a stable form of ASA powder that relieved his father’s rheumatism. The compound later became the active ingredient in aspirin, which took its name from the “a” in acetyl, the “spir” from the spirea plant (which yields salicin), and the addition of “in,” a common suffix for medications. In 1899, Bayer distributed aspirin powder to physicians to give to their patients, and it soon became the number one drug worldwide.

In branding, the biggest sign of success is when your product becomes synonymous with the category. People worldwide always refer to aspirin when speaking of medicine for headaches. Non pharmaceutical examples are Scotch tape, Xerox, FedEx and Google. I‘m convinced that great strategy and well designed brand names, colors, logotypes, symbols and concepts go a long way to ensure a brand’s memorability and acceptance… perhaps as much as fundamental factors like quality and efficacy.

From Tiffany Ryan, VP, Account Services, Palio

It’s the “tagline” of one of my favorite shows, Survivor. I’ll admit it’s not quality TV, but it is entertaining, and each season I enjoy watching to see which player’s strategy will win in the end.

It’s a motto that serves marketers well, especially today. Budgets are tighter. Physicians are harder to see. We are facing an uphill battle, and those that reach the top, the lone survivors, will be the ones who outwit, outplay, and outlast. Is your brand ready for the “lone survivor” title? Consider this:

Are you outwitting your competition, or are they outwitting you?

Is your brand reactive or proactive? Do you find yourself constantly trying to “catch up” with the competition? Is your focus on blunting competitive messages instead of focusing on the steps needed to develop advocates? If so, your brand is reactive, not proactive.

Developing a proactive brand requires planning, foresight, and ongoing maintenance. It’s not about developing materials for POA cycles, it’s about launching with a smart, strategic plan. One  that not only takes into account what your reps need, but anticipated market events, expected publications, and competitive intelligence that fuels key insights. A strong plan that accounts for future changes in market place dynamics. Should something unexpected arise, it should require tweaking your initiatives – not overhauling them.

Are you outplaying your competition?

It’s no secret that physicians are getting harder to see. Evaluate your tactics. Does your tactical plan feel like it’s dated? Is it the same plan you had five years ago? Frankly, if it is, it’s outdated – time to refresh, to dig deeper. Think smart phones, mobile apps, social media, tablet PCs…if you haven’t thought about them, it’s time to consider them. Regardless of your technical readiness, your efforts today may need to be disseminated through technology tomorrow.

Remember the last time you said “I need to advertise (here) because my competition is.” Or, “I noticed they launched (X), we need to do that too.” Now, forget those phrases – FOREVER. Don’t play where your competition is playing. Think about new, unique things that can set your brand apart. Take a risk – a calculated one to stand out.

Are you outlasting your competition?

When the doctor is with the appropriate patient and it’s time for a brand choice, is yours first on his mind? Evaluate your message. Is it relevant? Compelling? Does it give the physician a reason to care? Too often we sit behind the glass and have physicians rank messages based on how compelling and believable they are. It becomes a game of “which was least offensive” vs. “which was most impactful.” I could go on and on regarding what’s wrong with that approach, but I think that requires a whole different blog post. How about a different approach: Talk to your physicians, ride with a rep, uncover the needs of your target. Really understand them. Then, evaluate your messages and align them with those underlying needs. Meet your customer at their point of need with something (message, program, initiative) that really makes a difference for them.

Let’s face facts. The pharma world is no longer about who screams the loudest, spends the most, gives out the most samples. I’d argue that it never really was, but I’m sure some would disagree. It’s about being smart marketers. It’s about having the right vision for the right product, appropriately aligned to your customer needs. Outwit. Outplay. Outlast. Not outspend.