Understanding the new prescribing influences

Tom Haskell and John Moran of IMS’ Innovation Lab discuss how to evaluate new factors driving prescribing decisions.

What new factors are affecting prescribers' medication choices?
Tom Haskell. The list is growing exponentially, but we can classify them into three general categories: those that are managed-care driven, patient-driven and technology-driven.

The influence of managed care extends beyond the use of generics to include the impact of tier position in drug choice and of noncompliance caused by prior authorization requirements. A more educated patient population has a strong voice in therapy and medication decisions. And physicians are relying more heavily on the internet through electronic medical journals, e-detailing and physician networking sites. These new influences will differ in the degree and duration of their impact and sort out the high-value activities from the 'trendy' ideas is the challenge.

How have these new channels complicated things for manufacturers?
John Moran. Companies are increasingly moving to regional commercial models and figuring out how best to use traditional channels differentially across regions, which is complex enough. If not done well, adding new channels to the mix could make the process unmanageable for a regional business unit. Also, these various influences do not impact healthcare practitioners uniformly. Figuring out the rate and pace of impact regionally and by specialty poses an opportunity to maximize brand performance in the near and long term.

What is the role of headquarters, versus each region in adopting these channels?
TH. It is up to the headquarters' commercial analytics and market research functions to vet new influence sources, qualitatively and qualitatively, and then to give specific deployment recommendations to regional units (and even the national franchise). Of course, recommendations should be made in conjunction with the regional business unit's strategy and operating approach. For example, a region focused on obtaining preferred status for second-line therapy will benefit most from deploying channels that education healthcare practitioners and payers on patient flows and treatment patterns.

Determining how much to invest in which channels involves asking, 'Which influences act where, what level of support should be reallocated from traditional channel and how should investment performance be measured'? These types of questions are strategic, rather than quantitative, and can only be answered with customer insights.

Do these new channels represent any opportunity for manufacturers?
TH. Most definitely. To the extent that companies can select and deploy local activities in these channels, they can drive stronger customer relationships, optimize their P&L through more efficient brand spending and improve brand usage. Companies that understand the rate and pace of a channel's impact regionally and by specialty can maximize brand performance in the near and long term.

How can companies assess the impact of these new channels? 
JM. In general, there are three types of measurement methods that can be used, although there isn't one right way to assess the impact of an influence channel. Often, multiple models are required to best explain the impact on prescribing. First, there are analyses at the healthcare practitioner level that compare the prescribing behavior of test and control groups. This is only possible, of course, if you can identify through secondary or primary research which practitioners have been exposed to the new influence.

The second type is regional-level modeling, which includes a strategic framework for understanding the future impact of influences that are working together. This entails modeling the influence's contribution to sales, gathering sentiments from participants, obtaining a perspective from the field, and then deploying the activity selectively and tracking its actual impact. The third type is channel-level assessment. With this, primary research is integrated with new-to-brand prescribing metrics and value assessments to identify how the influence affects HCP satisfaction, loyalty and prescribing. The results are used to prioritize program efforts or to implement region-specific programs that increase customer value in lagging geographies.

What specific metrics can be derived from these research methods?
JM. Traditional metrics such as brand share and volume can be applied to some, but not all, new influences. Others require new performance metrics such as penetration, treatment rates, disease intervention rates and patient compliance/adherence. We're testing research questions now, but have identified some 'givens', such as brands operating under new commercial models must have a way to regularly assess the strength of the prescriber's relationship to the brand and the corresponding value it delivers.

Also, the believability of the brand's message should be measured in light of other influences that either support or contradict the brand's value proposition. Particularly in today's highly connected environment, companies must be attuned to how an influence supports or undermines corporate communication and education efforts. Finally, measures should address the dual drivers of cost containment and comparative effectiveness. While measuring the impact of a pharmaceutical brand on patient outcomes and cost is still in its infancy as a commercial business practice, new metrics of cost and value are taking shape. 

Can you give an example of a measurement of a new influence that produced surprising results?
TH. Often models produce results that aren't intuitive. In one study of coupon usage among patients in a specialty-focused disease area, IMS found that certain coupon types and offers significantly influenced the follow-on adherence of patients. It was reasonable to assume that couponing would have an impact on new patient share, but an impact on patient adherence was a surprise. This finding has significant by accounting for the 'lifetime value' of the patient brought into the franchise.  

What must companies do to adopt appropriate, new performance metrics? 
TH. First and foremost, they need to develop a richer dialog with their customers through a combination of primary research and rep interactions. Fortunately, they can fund such research by migrating other, more traditional primary research activities, such as awareness, trial and usage studies, to secondary data sources.  A good starting point for using new metrics is to apply them initially only to new influences. Eventually, they can then be extended to traditional promotion and education activities.

What other tips do you have for companies as they focus on new influence factors?
JM. The first step is to expand or redeploy research activities so that companies can measure the extent of practitioners' exposure to new influences and the resulting behavioral change. Brand managers should then look for gaps between the research findings and their brand plan. Each year, they should incorporate a few promotional 'R&D' elements into the brand plan so that they can keep on top of new channels. Once influences are identified, prioritized and included in the brand plan, tracking and assessment can begin. The organization will have to add a few key performance indicators, such as brand penetration, productivity and adherence, to the brand dashboard to monitor the spread of an influence and to track how the brand is responding. 

Tom Haskell is Director, US Innovation Labs for IMS Health. In this role, he directs the development of new, creative solutions for pharmaceutical and biotechnology clients in the R&D, clinical and commercial spaces. Haskell is a graduate of Harvard University, majoring in Applied Mathematics and Computer Science.

John Moran leads the US Innovation Labs for IMS. He serves as an advisor to pharmaceutical clients across a range of commercial disciplines, designing and structuring solutions to meet clients' key commercial challenges. He holds a BS in Chemistry from Carnegie-Mellon University and an MBA from the University of Pittsburgh.