Two audiences, one goal
Editor’s note: James E. Heasley II is a principal of Evolution Marketing Research LLC, Blue Bell, Pa.
The marketing of any product begins with the identification of a need. That is, marketers seek out a place for the brand - a position that will differentiate it from the other possible choices available to the customer through the fulfillment of a need that is currently not being met by competitors. This is the fundamental goal of all marketers, including those attempting to sell their products to physicians and patients in the pharmaceutical marketplace.
Once one or more unmet needs have been identified, marketers can then tailor their efforts toward describing their product’s benefits in a way that fulfills those needs. This process, however, is not a simple one and requires developing a careful understanding of both physician and patient behavior that can then be built into an actionable strategy and a set of supporting tactics for the product.
One of the key weak points in these efforts is rooted in the clarity with which a given brand’s benefits are linked to the identified unmet needs. This process is especially difficult for marketers when physicians are the target audience. Physicians represent a unique challenge for marketers in that, unlike other consumers, they are making a choice for other people rather than themselves. Thus, marketing teams must focus on multiple sets of potential needs (the physician and the patient) and then find the most effective way to communicate their product’s benefits in that context. The goal of this article is to describe how to enhance this linkage of benefits to needs through improving the way that marketers communicate to their customers.
A bit of a misnomer
In the pharmaceutical industry, the buying process is, at its heart, a way to characterize physician behavior with regard to how decisions are made when diagnosing and treating patients. The term itself is a bit of a misnomer given that physicians do not buy products but rather prescribe drugs (and other treatments) for their patients who are the ultimate consumer. The term has, however, persisted as part of the common industry lexicon and is used to reflect both the decision-making process used by physicians and, in some cases, needs communicated by patients.
The only way to effectively characterize the buying process is to engage in marketing research with the customer. While this is done through both qualitative and quantitative methodologies, the former allows for a more in-depth and meaningful assessment of how and why treatment decisions are made at various points in the process. Regardless of the specific methodology used to gather the data at hand, all buying processes employ a similar series of questions to gather data that are utilized to populate a decision-tree model. The key goal from the marketer’s point of view is to identify explicit or implicit factors that influence decisions about if and/or how a given product might be utilized. These are often characterized as points of leverage where unmet needs among either or both the physician and patient population in question are marked on the evolving treatment map.
A buying process decision tree will often start with a description of how patients typically present to the physician with the condition in question and then move through the diagnostic and treatment process. This will differ according to what type of specialist is involved, especially since the presentation of the undiagnosed and treated patient to the primary care physician is often quite different than the presentation to a specialist. Some of the more advanced methodologies will also include a similar evaluation carried out with patients and then melded with the physician-based model.
Figure 1 shows the fundamental flow of the physician buying process at a very basic level. Note that there are multiple points at which physicians will make decisions about treatment selection - the primary opportunity for which will often be at the time of diagnosis and at points where treatment is adjusted according to the development of new symptoms, disease progression, side effects related to specific agents or other factors. The ultimate complexity of an actual model is entirely dependent on the disease state in question. It may involve multiple specialties, treatment pathways and other factors unique to that particular situation.
Exploit areas of unmet need
Capturing the basic buying process allows brand teams to exploit areas of unmet need, also referred to as leverage points. Once these areas have been identified, common practice is to seek out the points of “best fit” for a particular brand. This is usually done through the explication and linkage of the brand’s benefits to the unmet needs uncovered at various points within the buying process. Dosing, for example, is often a focal point of unmet need. In the context of an oral product for a disease state where agents are typically dosed with a frequency of two or more times per day, reducing that frequency to once-a-day might well be a key unmet, assuming all else is equal among the competing products in that category.
The key facet of this approach is the assumption that a set of product features/benefits can be identified and sold to physicians in a way that allows them to simply plug the new drug into their treatment algorithm at one or more of these leverage points. The fundamental problem with this approach, however, is that physicians do not necessarily “buy” drugs for their patients based on a set of particular product-related attributes. Rather, they individualize treatment according to their assessment of a patient’s condition and then select the agent they consider to be the most appropriate for the circumstances at hand. In this way, the profile of the individual patient drives the selection and use of the treatment rather than a list of drug benefits that physicians would otherwise be forced to find some way to incorporate into their perception of when to use Product A versus Product B.
Pharmaceutical marketers know this to varying degrees and they often attempt to couch the benefits of their particular product in terms of a patient type, but this is often done as a last step rather than as an integral part of the overall product positioning and message development process. As a result, physicians are often left to make their selection among various options based on one or more perceived product benefits that do not always clearly match the perceived needs of individual patients. This is an obvious disadvantage when there are multiple similar agents within a class all vying for the same patient. A well-designed patient profile that is developed and evolved throughout the creation of a brand’s marketing strategy (positioning) and tactical implementation (messaging, creative concept, visual aid, etc.) can package a drug’s benefits to highlight exactly where and why one product should be used instead of another.
Portrait of a patient
The ideal patient profile contains a portrait of a patient that clearly identifies that individual (and therefore all others with similar characteristics) as a good candidate for the agent in question. It is created through a process that starts during or soon after the brand’s positioning development and may be evolved during the creation of the drug’s core messaging and subsequent tactical marketing materials. Currently, many profiles used as part of detail aids and other sales materials are often hasty constructions created after the fact during the “creative process” (e.g., created by the ad agency with little or no input from actual marketing research). Unfortunately, it is unusual that such profiles are developed and evolved as fundamental to the positioning and messaging phases of the process, thus wasting a unique opportunity to weave the patient profile into what becomes the ultimate brand image.
In practice, most teams/agencies use patient profiles to highlight the benefits of their product by simply showing a picture of a “patient” and highlighting some facet of their illness that the product in question is seen as treating most effectively (e.g., the chronic obstructive pulmonary disease [COPD] patient with frequent exacerbations related to a product indicated for the reduction in exacerbations). However, this offers only a minimally-effective approach since it merely highlights the indication for the brand in question and does little to specify a fit for the product within the overall buying process. Thus, it does not take the most effective advantage of previously identified leverage points. A further downside to this type of patient profile development is that customers eventually become dismissive of the overly generalized profiles, which reduces their effectiveness as tools for communicating how and where to use the product in question.
It is understandable, however, that both marketers and agencies often favor these more general profiles. There is an embedded concern that by developing what they perceive to be more narrow profiles, marketers may well be leaving other patients - and opportunities - up for grabs by the competition. While this may be a real concern in some instances, it is often driven by a lack of understanding regarding how effective patient profiles can become part of the brand’s positioning and messaging rather than mere descriptions used as part of the final detail aid or other promotional materials.
Built through discussion and feedback
Both qualitative and quantitative research can be employed in the effort to test and refine effective patient profiles. Overall, the qualitative process is usually key since profiles are built through discussion and feedback from physicians rather than from data gathered from quantitative surveys. This is especially important during positioning, where brand teams are exploring which product features represent potential benefits versus potential liabilities. As the benefits are identified as important to physicians, it is possible to determine the core outline or sketch of the patient type or types who would be likely candidates for the product. Ongoing research is then used to fill in the sketch and develop a full profile that may consist of one or more “patients,” each of whom can be used to characterize a particular facet of a drug’s benefit or provide direction for linking the benefit to different leverage points/unmet needs in the buying process.
An actionable patient profile typically consists of at least three fundamental characteristics. First, the profile must identify a patient with real and recognizable disease attributes that reflect the realities of treatment within the given disease category. It cannot be a vague snapshot that does not coincide with the type of patients that physicians commonly see in their practice (e.g., a COPD patient profile should not be based on a 45-year-old mother from the suburbs who appears otherwise healthy in an image). Likewise, it must contain enough information about the patient’s history of treatment so that the physician can fully understand where the patient stands within the overall treatment flow.
Second, the profile should be consistent with describing the disease characteristics in such a way that the benefits of the drug in question fit with the apparent needs of the patient.
Third, the profile should provide clear direction to physicians so that they quickly understand the link between the patient, the product and when it would be most appropriate to use that drug instead of another possible choice at specific point in therapy - in other words, during the detail it should prove immediately apparent to the physician that the product in question will prove beneficial to the patient in the manner desired by the brand team (the leverage point).
The baseline profile should begin to emerge during positioning research and this ought to be used during message development as a way to guide the creation of the brand story. This is not to say that the product story should rely on the profile but rather that the two should be interwoven and act in a mutually supportive way.
Once the baseline messages have been created, initiate a specific qualitative study focused solely on creating the profile or profiles that will be used as part of the brand’s marketing materials. The best-case scenario for this type of research is a dual-phase process that includes a first-phase brainstorming session using small focus groups (four to six physicians) followed up by a second phase of individual depth interviews.
In this second phase, the profiles are refined in combination with the product story and the process may be somewhat similar to a white-card visual aid test. The output from this research is then converted into various marketing materials, such as a detail aid, which are pressure-tested in research once again to produce the final, finished product.
This scenario is the most useful because it affords the team time to explore options for understanding the specific attributes of patients fitting the leverage points identified in the buying process. Time is, of course, the enemy of all marketers and it is often necessary to use a shorter version of the process (such as dropping the brainstorming groups). If the team has taken to heart the value of developing profiles, however, there should be plenty of opportunity to incorporate some elements of the process in later stage research.
Outline for a product profile
The following provides the basic outline for a product profile that is created and evolved during the development phase of brand positioning and messaging. Although it is a hypothetical example, it is based on real-world experience in developing such models.
The product: A new biologic agent for the treatment of chronic lymphocytic leukemia (CLL) that is similar to several others on the market but with a somewhat different mechanism of action (MOA). The agent shows an adverse-event profile similar to other first-line biologics but does not appear to cause serious infections. Phase III clinical trial data suggest that the product might prove effective for those patients who have progressed after first-line therapy with a regimen containing one of the similar agents (the study patient population contained a range of patient types, including a number who had been treated with prior regimens containing one of these agents).
The supposition: Based on the trial data and potential leverage points identified from the buying process, the brand team believes that the agent could be a viable second- or third-line agent, especially given that the FDA indication is not entirely clear on its placement in the overall treatment paradigm.
Physician response to the product: Hematologists/oncologists exposed to the product profile, positioning and messaging, however, seem to believe that the new agent could be of value in a “salvage” setting when few other choices are available. There is some concern about using an agent with a similar MOA following the failure of another agent in the same class. They further note that the Phase III trial population was not entirely made up of patients who were exposed to one of the other similar biologic agents, thus somewhat devaluing the idea that the agent would be an appropriate follow-on therapy.
The patient profile: Through qualitative marketing research with physicians, several possible patient profiles are developed that very specifically highlight characteristics of the disease and subsequent treatment. Particular attention is paid to understanding what physicians would need to see in a product used in the second and third line and the specific patient or drug characteristics that would assuage their concerns regarding following agents with a similar MOA. When combined with the brand’s messaging, the profiles guide physicians toward thinking about the new agent as a useful choice in the second or third line following the failure of the similar agent used in the first line. The profiles in Figure 2 represent an example of the level of detail that is often required to achieve a close fit with a given product (especially in complicated treatment areas such as oncology).
Considered integral
The development of actionable patient profiles should start as early as possible in the marketing process and be considered integral to positioning and messaging so that the profiles themselves become a part of the brand story. While simplicity is often desired in the marketing process, a fully-formed patient profile, or set of profiles, that speaks to the physician in their own language will often go a long way toward selling the benefits of a product in a way that maximizes its potential market share.