Optimizing the Biopharma Client Relationship

Laurie Gelb, MPH

Health decisions: uniquely complex• No “typical” physician or sufferer to study, but rather a spectrum

of evolving beliefs that link behavior across organizations and individuals

• Specifiers (HCPs), purchasers (payors) and consumers (patients) differ most of the time

– High stakes: wrong decisions can impair, disable or kill

– Yet future outcomes are seldom completely predictable

• Ongoing re-evaluation of rx decisions– Patient can stop taking rx or start/stop OTC without notice

– Prescriber can switch or discontinue treatment

– Payor can change costs, access to agent

– Extreme: FDA can reinstate a withdrawn drug!

Life on the brand side: a full table

• Who’s on the team?

– Depending on the occasion, forecasting, regulatory, medical affairs, finance, scientific pubs, industrial ops, PR, HO, Marketing, market research, pro-ed, third party agencies, consultants; sometimes senior management sits in

– Tele or videoconferences common, send slides around beforehand if want to ensure receipt given dial-in issues; may use Web to go through slides

• Life is largely reactive – go to meetings, review drafts, answer questions, travel as needs arise, address milestones (like next quarter’s message) as time passes

• Budgeting: few projects split because of accounting constraints – usually one check writer but many kibitzers

No life of leisure

• Bombarded by weekly, monthly, quarterly and yearly data/reports; but booked for so many meetings that reading anything requires taking it home, coming in early, staying late or reading on the road

– E-mails: patient, script, promotional tracking and ad hoc studies. Excel spreadsheets. Slide decks with lots of graphs and tables.

– Occasionally, you try to match these up with what you really shipped to wholesalers, what advertising you really bought, etc. But mostly, everything’s apples and oranges and it changes daily anyway.

– Other e-mails: issues blown out of proportion due to grandstanding, important issues ignored because no one wants to stick her neck out or contradict someone important

• Endless travel – to ad boards, clinical meetings, co-promos, agency get-togethers, thought leaders, preceptorships, internal team meetings/ retreats, global meetings, market research viewing

Life on the brand: sell, sell, sell

• A brand team sells every day to:

– Payors, coalitions, employers, think tanks, oversight agencies

– Health care professionals, including research sites and academic institutions

– Sufferers and patients; advocacy and support groups

– Sales management and reps: “This quarter, we need to focus on patient convenience…”

– Senior management: “We’re doing great. Can we have more money? And when do I get my promotion?”

• So question must be, “How will this help revenues?”

– Revenues come from units x acquisition cost for strength/formulation, so units are not the whole ball game

Life can be good…

• Marketing crafts the optimal messages for reps to take out each quarter

• Sales management gets and keeps the reps pumped up

– Sales hit forecast, so there are no production issues

– Wall Street analysts make note of the drug’s success

• Medical Affairs and Health Outcomes implement post-marketing studies that further establish the drug’s benefits and ultimately expand the label

• Trialists turn into loyalists, key thought leaders come on board, formulary access is maintained through refinement of dossiers, relationships and the data (not to mention savvy contracting)

• Pharmaceutical Executive does an interview with the brand leader

– The agency on the campaign collects awards

…but the honeymoon always ends

• One day (maybe a month after launch) a competitor launches or goes generic, publishes a new paper, gets a new claim; treatment algorithms evolve, etc.

• Management starts questioning the value of its investment in your compound

• Very rarely is your brand unchallenged until the generic (Coumadin an exception)

• The LA Times reports that eleven patients taking your drug suffered hepatotoxicity and Public Citizen files an FDA petition to remove your drug from the market

Listen and learn…

• Don’t take client feedback literally

– I may or may not speak for my team

– I may or may not believe what I’m saying

– Biopharma is a political snake pit and vendor projects are frequently used as pawns, or diversions to draw fire

• What if you’re told more than you want to know?

– Listen politely--knowledge never hurts

– “How can we help?”

– Keep focused: what is the problem? A solution? Talk about approaches, not people

– Help a client garner compliments, and you have a relationship

One simple rule

• Bring the person to the table that knows the most about the topic/function/dz state

– Territoriality may be a rule of life in pharma, but has no place on our side

– Clients do not want to be used as the beta test, the first draft, the opening act

– Put your team’s best foot forward from day one!

• Will multiple experts confuse the client?

– Never, if their roles are clear – and their expertise should speak for itself

– But, bring no one to the table who has nothing to add

Deskwork is more than a lit search

• Trial data, especially pre-launch, is often not published [in essence, first pub is the PI]. Look for IR presentations, often on own Web site [Google/cached]

• Also look at Trends in Medicine, PR Newswire, biospace, drugs.com, F&C, emedicine.com, PBM sites

• Do not presume that the PI, esp. for mature brands, represents use in practice. Off-label use and non-sponsored trials are very common to advance indications, dosing, combo tx. Check the literature and peer-to-peer chat to see what’s really recommended

…but not on the client’s dime• Do the pre-work before you write the proposal or show up for the kickoff

• How is this disorder treated? How are the client’s brand and others positioned clinically—are there inherent differences? Is there a major competitor on the horizon?

• There is really no recovery from a stupid question or draft, or a meeting that lacks client-perceived value [Lunch & Learn trumps Meet & Greet]

– Lack of therapeutic insight and understanding what really goes on at a P&T table, exam room, ER, etc. eliminates many vendors without even trying

– Use knowledge management to leverage resources

• Ask about what the team knows more than you: the brand’s marketing

– What we know and don’t, what’s changed, near-term priorities and long-term plans, previous research, post-marketing studies, treatment-centered market research, etc.

What do humans want?

• Solutions, not problems

• Answers, not questions

• To feel that we are building, not re-doing, what has gone before

– And that our previous efforts count for something

• To keep our jobs and grow our salaries

• To know that we are getting fair value

• To feel confident in our choices

• To be re-validated as a professional <marketer/scientist/clinician/whatever>

What do clients want?

• To feel good about their decisions, and to be validated as they go

– The better you look, the better they look

• To be able to report tangible project progress when someone stops them in the hall

• To be able to clearly link project deliverables with product success

• To be able to depend on you time and again, without the dreary process of finding and orienting new vendors

• To say confidently, “These results are as good as we can get for this level of project.”

What do clients (and you) want to support?

• The right pt gets the right dose of the right agent for the right duration at the right time for the right indication, with optimal results

– Which is no more than Marketing 101: exchange theory says equal value received by both parties (need to have a need)

• Whether you call this “evidence-based marketing” or “applied HOR,” it should increase the probability of achieving a beneficial clinical outcome for a given pt

• So there is not any “fundamental divide” between HOR and marketing, clinical research and marketing…other than common sense regulatory and budgetary divisions

Clients don’t want to be your…

• Project coordinator

– They want to direct the project, not baby-sit

• Scribe, recorder or clerk

• QC manager

• McDonald’s customer

– “Do you want fries with that?” [“Do you want any patients excluded?” What do we recommend, based on the objectives?]

• Therapeutic expert [that’s what we sell ourselves as; they’re supposed to be the product expert]

• Trainer [“our drug is not indicated for that”]

What clients don’t want to hear

• “You’ll have that in an hour” [then it takes two]

• “We’ll do our best,” instead of “you’ll have that by X” or, simply “sure”

• “I don’t know why that was in the proposal”

• “Oh, yeah, I forgot we took that out last meeting”

• “We’ll get back to you on that” [when it’s something basic]

• “Hi, it’s Marla” [5 minutes after the telecon was scheduled to begin]

• “What did we decide about that?” [what happened to your notes?]

Using proprietary data from a client on another’s project

Sharing proposals, projects, prices or stories among clients, prospects or intermediaries, including any firewalled corporate unit

Disclosing individuals’ or organizations’ identities or attributable comments without consent

Concealing or withholding non-proprietary methods, honoraria, instruments, etc

“Bait and switching” – exaggerating level of senior staff involvement; database size, plan relationships, revenues or any other asset

Wherever our projects go, our clients are in the same boat!