September 2015 Edition Vol.11, Issue 9

Beyond the Peak: Four Levers to Address Quickly Plateauing Oncology Drug Sales

Beyond the Peak: Four Levers to Address Quickly Plateauing Oncology Drug Sales (continued)

How do Oncology Marketers Need to Adjust?

These changes in science, competition and landscape do not alter the fact that manufacturers still need strong launch strategies, but demand the adoption of a new mindset to generate steady, sustained growth using four actionable levers.

Sounds obvious, but getting the right message to the right clinical decision-makers is increasingly complex. Achieving the full potential of an indication requires sophisticated insight into the target patients and physicians.

Recently, one pharmaceutical company with a broadly indicated breast cancer drug noticed that while adoption rates were high, its supply team data showed doctors only prescribed the drug to the most severe cases. Armed with this information, the pharma company moved to better communicate the opportunity for broader use to physicians.

This company pursued and achieved a label amendment to better support the effort. As a result, the company experienced 10 percent growth over six months by treating patients with less severe cases who could still benefit from this breast cancer drug.

Examples such as this bring two simple yet powerful questions that must be answered — not only when launching an oncology drug, but also when looking to grow your drug’s potential:

• Who is my patient?
• Where do individual physicians fall on an adoption continuum?

Who is my patient? Market maps and strategic planning provide a great sense of the target patient populations before launch. But success sustaining oncology sales growth today often requires an ability to provide physicians a clear space for actual trial and early positive experience, with deliberate strategy for expansion into the targeted breadth of patient types.

We mentioned previously that with the increasing number of treatment options for certain cancers, oncologists seek guidance on patient types. If manufacturers do not provide oncologists a starting point, oncologists create their own patient segments, and an innovative product’s broad indication may not be maximized.

One key to maximize adoption in an eligible patient population is a clear understanding of how a product is used immediately after launch. Companies that integrate and analyze sources such as custom patient chart audits and specialty pharmacy supply data can better track use and adapt quickly. This enables them to move quickly from “Who is my patient?” to “Who should be my patient?”

Where are physicians in adoption? Though a classic marketing question, it was easy to overlook in the era of blockbuster oncology. Today, most oncologists will initiate trial of a new drug fairly rapidly after a launch. However, oncology product trial today is nuanced, and understanding that nuance provides marketers new insight into how best to promote for sustained use and deeper adoption.

Several recent launches of oncology products with multiple dosing options have seen patients prescribed lower doses than indicated to proactively manage toxicity. This can have longer-term effects on overall efficacy perceptions and decrease length of therapy. Physicians may also make judgments about loading doses or length of therapy, or discontinue use near the ends of chemotherapy courses – despite clinical benefits from continuing treatment. It is good practice for manufacturers to understand their physicians and their behaviors early to maximize all aspects of use.

In the past, oncology treatment decisions were more predictably based on clinical evidence – primarily efficacy, tolerability and safety. Today, non-clinical factors such as cost and even habit play increasingly stronger roles, and marketers must be willing and able to adjust.

The most prominent non-clinical driver today is value – in particular, cost of regimen and out-of-pocket costs. While there is limited cost transparency to oncologists today when prescribing, more reference points are arising in the form of frameworks from organizations such as ASCO and NCCN. With increased patient cost sharing and high-deductible plans, oncologists take on some financial stewardship in decision-making by considering cost when making treatment decisions.

But there are important intangibles, including emotion and habit. ZS has seen on multiple occasions a product indicated for a niche patient type not prescribed to all eligible patients who would benefit because oncologists developed pre-existing attachments to other therapies.

The intangibles are more important in areas of increasing competition. The emergence of immunotherapies is a prime example where marketers must engage customers more deeply than the clinical argument. Today there are six PD-1/PDL-1s in mid- to late-stage development across five manufacturers. Clinical comparison among them may be complicated given the diagnostics being developed. So how will oncologists choose? Can later to market immunotherapies deliver that simple but emotionally compelling rationale to drive use beyond those first to market? And what about manufacturers of targeted therapies – can they effectively compete with the legend and promise of immunotherapies?

In these situations, carefully crafted and complex clinical stories commonly will not change behavior. Oncologists must be engaged in a holistic and humanistic way. Traditional patient journeys offer some insights, but deeper insights from beliefs, habits, decision processes and cognitive behavior models are critical. The value proposition to the prescriber must include a strong but simple clinical argument and a meaningful emotional connection, reinforced by a seamless customer experience. 

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