Beyond the Peak: Four Levers to Address Quickly Plateauing Oncology Drug Sales
By Sean Walter and Maria Whitman
With the oncology market estimated to soon reach $100 billion, it is no wonder biopharma manufacturers hold high expectations for their cancer pipelines. However, many oncology products that launch today face the new challenge of quickly plateauing sales. Brands now reach peak sales as soon as 12 to 18 months after launch. This is counter to conventional expectations of high growth for at least 36 to 48 months. With sales plateauing faster at potentially lower levels in these launches, marketers must question what they know about historical launch success and adopt new mindsets to drive long-term organic growth.
What is Driving the Change in Time to Peak?
The change is being driven by a combination of the science, the competition and the evolving oncology landscape.
The science. Oncology has seen incredible advances in drug discovery in recent years, especially in targeted and biomarker-based therapies. The number of clinical trials that included a biomarker in 2014 more than doubled from 10 years earlier. These therapies provide specific, identifiable patient populations a better chance of response and therefore, improved clinical outcomes.
The majority of an eligible patient population receives a new biomarker-based therapy rapidly following launch, particularly if it is first-in-class. These therapies spike in sales, and then plateau quickly. As a result, manufacturers and marketers need to focus on incremental growth and the pursuit of new indications or other product launches to reach a product’s full potential.
The competition. Non-targeted therapies also face significant sales challenges to growth, due to competition. Zydelig launched in July 2014 as a first-in-class therapy and the only approved PI3-kinase inhibitor for chronic lymphocytic leukemia (CLL). Zydelig launched into a space that was already highly competitive – only four months after Imbruvica approval, two months after an Arzerra label expansion and one week before an Imbruvica label expansion, all in CLL. Further, Gazyva received a label expansion in CLL in January 2015. Looking at the pipeline, there are at least 21 PI3Ks in active phase 2 and phase 3 developments for a wide variety of indications (Figure 1). Though not all will compete in CLL directly, oncologists clearly will have multiple treatment options in addition to Zydelig, within and outside the class. And let’s not forget – in spite of significant innovation in categories such as CLL – oncologists still consider “watch and wait” a viable treatment strategy.
This pace of innovation is a boon to patients and gives oncologists more options. However, this also means manufacturers face a significant risk that unless marketers can adequately convey the patient and usage scenario, oncologists could limit treatment choices to manage complexity.
The landscape. This dynamic means marketing communication to oncologists is more important than ever, yet changes in the health care landscape raise barriers to conventional promotional tactics.
ZS’s AccessMonitor™ report, which examines sales rep access to over 400,000 U.S. physicians, identifies oncologists as specialists with very restrictive access: Seventy-three percent of U.S. oncologists restrict time with sales representatives. This limits the ability to deliver the right messages about the right patients for the right products. Add to this the continued consolidation of oncology clinics and more aggressive adoption pathways, and manufacturers are left to target an increasingly concentrated layer of treatment decision-makers who may not be reachable through conventional promotional channels.
 "Cancer drug market looms toward $100B, thanks to costly targeted therapies," FiercePharma, June 8, 2014.
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.
Beyond the Peak: Four Levers to Address Quickly Plateauing Oncology Drug Sales (continued)
Even with a strong positioning and compelling value story, companies must ensure the story reaches oncologists and resonates.
ZS's AffinityMonitor™ report shows non-personal promotion (e.g., digital communication channels) can especially help manufacturers reach traditionally access-restrictive oncologists. Companies that coordinate these communication channels between marketing and field sales see personal and non-personal promotion as complementary, not competitive (Figure 2).
For example, emails to customers sent by sales representatives are opened two to three times more often than corporate emails. To maximize growth, companies can develop the capability to capture these kinds of insights, and then execute customer engagement models driven by customer-centric, multichannel strategies.
Essentially, they must become not only “customer-engaged,” but also “customer-led.” Marketing departments plan and leverage support systems to answer the question, “What do customers need from us now, and in what ways, to ensure the next eligible patient gets our product?” Is it engagement with a nurse specialist to help train the practice? A reprint they received in the past, but is timelier now? Discussion of insurance and Medicare coverage? Marketers who have the mindset, systems and tools to orchestrate responses to these questions will enjoy key advantages in future launches (Figure 3).
The commercial model in oncology is shifting from “all oncologists are the same” to “every oncologist is unique.” This requires not only changes in strategy but also improvements in infrastructure to enhance commercial agility and flexibility.
Marketers need new capabilities to capture and act on emotional drivers of customer behavior with a coordinated, flexible and targeted plan to maximize engagement. Thoughtful, coordinated marketing tactics across channels at the speed of launch require access to rich, multidimensional data sets, the ability to integrate diverse sources to gain a holistic perspective on the customer and new ways of modeling to achieve deeper insights.
Success in this arena requires marketers to access “always on” analytics developed with a data science mentality. Insights could come from anywhere, and data proliferation opens a Pandora’s box of possibilities for assessing the situation.
For example, one company segmented customer accounts into three groups based on high, medium and low share. Thinking of the customer base in terms of three segments would have led to three segment-level strategies.
However, the original segmentation misrepresented the reality. By integrating primary research on what drove high, medium and low share, ZS could see that, in fact, there was no true medium-share segment. These accounts were comprised of a mix of doctors with high and low share.
Agility is especially critical as industry continues to consolidate. With more stakeholders influencing protocol, purchasing and contracting decisions with large customers, marketers must adapt quickly to account-level behavior changes and shifting influences on contracting decisions.
This level of agility is especially important in defining and executing a key account management (KAM) program. The KAM role manages a network of stakeholders, determines the impact of decisions at the account level and then manages the account with that in mind – including key account strategy and marketing. Empowering KAMs with tools to support driving complex, multidimensional engagements with customers is critical to ensure products follow a compelling growth path.
Net-Net: Success Driven by Agile Operations, Organic Growth
Faced with the challenge of quickly plateauing drug sales, pharmaceutical companies must continue to evolve their approach to oncology marketing and execution.
Those that continue relying on traditional oncology launch models and strategies will likely stagnate and struggle to grow. But companies that work to gain a detailed understanding of patients and physicians, adapt to non-clinical drivers, integrate sales and marketing tools, and deploy analytics and technology will position themselves to achieve sustained, long-term growth.
About the Contributors
Sean Walter is a Principal with ZS and can be reached at firstname.lastname@example.org.
Maria Whitman is a Managing Principal with ZS and also leads ZS’s Oncology and Specialty Therapeutics Practice. She can be reached at email@example.com.
ZS is the world’s largest firm focused exclusively on improving business performance through sales and marketing solutions, from customer insights and strategy to analytics, operations and technology. More than 4,000 ZS professionals in 22 offices worldwide draw on deep industry and domain expertise to deliver impact where it matters for clients across multiple industries.
ZS’s Oncology Practice combines deep expertise and innovation to tackle growing market complexity. In 2014, ZS completed more than 1,600 engagements in Oncology for more than 60 Oncology manufacturers. This work spanned 65 countries and over 40 issue areas. ZS recently adapted its innovative Customer-Centric Marketing solutions to Oncology. This includes an Orchestrator Representative solution to improve access and enhance the customer experience by enabling coordinated multichannel customer engagement at the intersection of marketing, sales and technology.