Real-Time Response - Pharmaceutical Executive

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Real-Time Response
Armed with the right data, marketers can quickly react to changing prescribing trends.


Successful Product Manager's Handbook


Physician behavior chages rapidly
Last year, the industry spent a record $30 billion on physician and consumer marketing. But the question remains: Are pharma's promotional initiatives hitting the mark? Few executives know—or at least know in time to do anything about it. That's why marketers should use cutting-edge, real-time data that better reflect the prescribing environment and help improve their company's bottom lines.

This article reviews the metrics companies currently use and introduces new tools that offer marketers a real-time understanding of physicians' prescribing behavior. Armed with that knowledge, they can measure the effectiveness of their promotional tactics and respond accordingly.

Old School: Track the Score

Precise measurement of a promotion's impact requires targeted physician Rx data and the ability to track the right metrics. Fortunately, the quality of the data used by pharma marketers to track not only their own promotional activities but those of their competitors has dramatically improved since the 1980s. At that time, all that was available were defined daily dose (DDD) data, which provided a historical measure of aggregated sales, but didn't allow companies to track prescribing by geography or physician specialty.


Physician behavior chages rapidly
In the 1990s, both total (TRx) and new (NRx) dispensed prescription data became available, first at the pharmacy level and later at the physician level. While TRx tracks all prescriptions, NRx tracks new prescriptions—that is, all scripts written except refills. However, the NRx also includes renewals—the script patients get when they run out of refills. Depending on the therapeutic category, renewals can comprise a large percentage of NRXs. The availability of such data represented an enormous advance, allowing marketers to analyze sales across therapeutic class, by micro-geographies, and by physician specialty and rank. " Companies now consider TRx and NRx to be gold standard metrics in tracking "the score"—how much has been sold by whom. In particular, marketers watch NRx share to indicate new business, shifts in market share, and prescribing behavior. Nevertheless, relying on NRx share for these purposes is fraught with problems.

The inclusion of renewals in NRx data distorts our understanding of the promotion-sensitive segment of the market: new patients and those switching therapies. Renewals represent the historical response to promotion, and since they can represent a large percentage of NRx volume in many therapeutic classes, they mask the impact of current promotion on physician prescribing behavior. This often makes it impossible to adjust marketing activities in time to make a difference in share trends.

NRx data are at least a month old. Many marketers think that time lag isn't significant because they believe physician behavior doesn't change very rapidly. But, with newer, more sensitive metrics, it is now possible to detect changes in prescribing in the "new Rx" segment of the market in real time. Recent examples of successful marketing events and promotional campaigns demonstrate that, in fact, contrary to most marketers' beliefs, physician behavior often does change rapidly—and not always as one assumes.

New School: Real Time


After the super bowl
Pharma executives can now use a metric called "new written prescription" (NWRx) share, which only measures the new prescriptions written by physicians, rather than those dispensed at the pharmacy.

Dispensed NRx data is great for tracking actual sales and projecting revenue, but NWRx is better at measuring promotion response, because it captures current information about what physicians actually prescribe. The data are different from dispensed prescriptions data because many scripts written by physicians are never filled by the patient—about 15 percent, according to the Ipsos Insight Survey 2004—or formulary restrictions require substitutions. Some real-world examples illustrate how rapidly physician prescribing can change in response to market events and promotions.

PROVE-IT. In the spring of 2004, the results of Bristol-Myers Squibb's PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) trial shook up the highly competitive statin market. The trial compared BMS's Pravachol with Pfizer's Lipitor and found that Lipitor provided greater protection from death and cardiovascular events.

All major media outlets covered theresults, presented at the annual meetingof the American College of Cardiology (ACC) in March. The impact on the statin market was immediate—a matter of days and weeks instead of months.


What youre missing
Share of new scripts for Lipitor, measured by NWRx data, surged in the week following the ACC meeting: 40 percent of new statin scripts written by primary care physicians were for Lipitor, up from 27 percent before the media blitz. That was not a surprise. The real shock was that while Pravachol's share held relatively steady, another statin directly lost out to Lipitor's gains: Crestor (rosuvastatin).

Other news surrounding Crestor compounded the blow. In March, the advocacy group Public Citizen petitioned FDA to pull Crestor from the market because of its concern over potentially life-threatening side effects. Within days, new scripts for Crestor fell from 28 to 17 percent—representing 75,000 lost patients and nearly $80 million dollars in patient lifetime revenue.

With so much at stake in that market, knowledge of the immediate impact of unpredictable scenarios offers brand teams the chance to respond quickly and regain valuable market share.

Erectile dysfunction DTC. Ad-vertisements for erectile dys-function treatments Cialis (tadalafil) and Levitra (vardenafil) made their Super Bowl debuts on February 1, 2004. Market leader Viagra (sildenafil) abstained from the DTC battle, generating water-cooler buzz and an interest among pharma marketers in the effect of those brands' campaigns on patient requests and new prescription share.

In the week preceding the Super Bowl, patient requests for Levitra and Cialis were neck and neck, at 25 and 23 percent, respectively. (See "After the Super Bowl.") In the days following the game, more ED patients asked for Cialis than Levitra. Based on ImpactRx data, 34 percent of the new patients requested Cialis compared with 21 percent for Levitra. Viagra earned 45 percent of patient requests, without any Super Bowl advertising, but that was a drop from 52 percent the week before.

As these case studies illustrate, the impact of market events and promotional campaigns can affect physician behavior in a matter of days. With the right tools to measure the effect of unpredictable market changes as well as the effect of internal and competitive promotional activities, product managers can capture real-time, crucial data about changes in prescribing right where it happens—inside the doctor's office.

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