Pfizer might be aggressively cutting costs on its sales side, but plans for big consumer rollouts--including for the much-anticipated diabetes drug Exubera--are full-steam ahead.

With least 20 percent of the sales force on the chopping block, Pfizer appears to be substituting brains for brawn--educating patients (and, to some extent, doctors) through direct-to-consumer methods.

It's no longer uncommon to find doctors barring their doors against perky, pretty reps bearing freebies of all kinds. In fact, the Street started seeing a "rash" of sales force cuts in 2004, according to Michael Zbinovec, a pharmaceutical analyst at Fitch Ratings. "They're following a bit," he said about Pfizer. "I think they're the last holdout in cutting down the primary care sales force."

But Pfizer's products won't sell themselves--especially those in hotly competitive categories (like Lipitor) and those with questionable risks (like Celebrex). At the company's recent analyst meeting, Ian Read, president of worldwide pharmaceutical operations, outlined some of the plans Pfizer has for its biggest growth drivers.

Most significantly, consumers will see the first promotion efforts for Exubera, the inhaled-insulin breakthrough that has been slow to get off the ground since studies raised concerns about its long-term lung safety. For that reason, Pfizer has opted for a phased approach, focusing on specialists before introducing it to general practitioners.

"What you will see in 2007 is a full-court press," said Read, who admitted, "The initial marketing and educational challenges relating to Exubera were more time- and resource-focused than we expected."

Newly diagnosed diabetics delay insulin therapy by an average of more than eight years, according to Read. "They see [insulin] as the end of the road," he said. Working with diabetes educators, the campaign will focus as much on emphasizing the importance of early treatment as on the benefits of inhaled delivery over standard injections in order to highlight how Exubera could increase compliance.

Exubera needs such a value pitch, since insurers have been slow to embrace the hype. The drug was the most heavily promoted product to managed care plans in the third quarter of last year, according to Cognet-X, which conducts weekly surveys of managed care executives.

Pfizer is also gearing up to launch a consumer campaign for its designer anti-smoking drug, Chantix (varenicline), aimed at nothing less than changing the entire mindset of smokers, doctors, and insurers. In what may be a clue to the company's tactics, Read called nicotine addiction a "chronic, relapsing medical condition."

Marketers will be using these four buzzwords to persuade physicians that smoking is less a lifestyle than a physical problem--and it requires long-term use of a prescription drug rather than a quick OTC nicotine patch. Pfizer will also be driving home this message to patients with personalized Web sites, a cravings hotline, and interactive workbooks. To be successful, Pfizer needs to get around what Read calls a "lack of understanding" about the quitting process. "We recognize that these are early days for this medicine, and challenges still lie ahead," he said. Not least among the challenges are the many surveys that suggest that smokers who quit cold turkey have the highest rate of success.

The company is also ramping up consumer outreach for its promising anti-cholesterol, anti-hypertension combo drug, Caduet (amlodipine/atorvastatin), where initial promotion helped contribute to a 39 percent increase in prescriptions since November, and for Geodon (ziprasidone), where a "Know the Facts" campaign alerts patients to the risks of diabetes and metabolic syndrome.

Other brand teams on the "go" list include marketers both for Lipitor (atorvastatin), who are pitching its greater efficacy in the face of growing damage from generic simvastatin, and for Celebrex (celecoxib), who are talking openly about heart concerns in a "CV Safety First" effort to counter widespread fears of COX-2 inhibitors.

Articles

Drug giant's new style features brains over brawn.

Pfizer Debuts 2007 Marketing Line

Opening arguments have begun in a closely watched lawsuit regarding whether states have the authority to shield doctors' prescribing data from drug companies. The law restricts the ability of drugs reps to tailor their sales pitches to individual physicians--and makes it harder to judge whether their tactics had any impact.

New Hampshire's Prescription Confidentiality Law--also dubbed the "Prescription Restraint Law" by industry--bars pharmacies, PBMs, and insurers from selling doctors' prescribing histories to medical data-mining companies like IMS Health and Verispan, the two companies that filed the suit. Info by zip code or specialty is still available.

But the law's target isn't these third parties but the drug industry itself--and the sales reps who use this data to hit up high-prescribing docs with their sales pitches. Although New Hampshire represents only about one percent of data, the danger is a domino effect across states that could undermine how IMS and Verispan--and in turn drug marketers--do business.

"Perception [of the drug industry] is a very important part," said Jody Fisher, vice president for product management at Verispan. But, he added, "You're not actually getting at the pharmaceutical industry--you're targeting a tool that they use."

IMS and Verispan--as well as the industry in general--favor a voluntary measure from the American Medical Association, which allows individual physicians to opt out of sharing their prescribing histories. Yet that program has been slow going, with only about 7,000 (or less than one percent) of the country's practicing physicians signing up since it went into effect July 1.

It's not clear what the poor showing means. Many doctors may be unaware of the program or too busy for the sign-up process. On the other hand, the low numbers may suggest that as much as physicians grumble about sales reps, they do appreciate certain aspects of the interaction, like drug samples.

A summer poll from Maritz Research found that about half of physician respondents think it is appropriate for drug companies to use their prescribing histories to prepare patient education sheets or provide drug samples. About 21 percent also saw no problem using this information for sales and marketing activities.

"At the very least, it's choice," Fisher said about the AMA's program, which is modeled on the National Do Not Call Registry for telemarketers. "It's not a draconian measure."

State Rep. Cindy Rosenwald, who drafted the bill and is married to a cardiologist, said she saw firsthand the tactics drug reps use to promote their products to doctors. "We saw two problems--one was privacy, one was money--and we thought that they were linked," she said, adding that, over the past five years, the per-capita cost of drugs has risen 84 percent, increasing Medicaid costs by 65 percent despite only a 20 percent growth in population.

In their lawsuit, IMS and Verispan argue that New Hampshire is preventing the exchange of truthful information, or "free speech," in order to accomplish something only tangentially related--controlling drug prices. The state disputes that the data is speech, and likens the restrictions to those placed on a company undergoing a "quiet period" before an IPO.

The companies also argue that the data serves important non-marketing purposes--from alerting high-prescribers about new drug warnings to academic studies on how public health efforts impact prescribing habits. If it can't be sold to pharma, however, there will be no economic incentive for it to be collected in the first place, the companies assert.

"It's a multifaceted issue," said Randy Frankel, vice president of public affairs at IMS. "Any way a judge looks at this, he will recognize that the data is necessary."

Rosenwald dismisses that idea, arguing that zip code level data remains valuable enough for the industry to pay for its collection. She noted that the state hasn?t ruled out other laws for holding down drug costs. "Many states pursued those alternatives," she said. "This just seemed to be very reasonable."

Physicians still slow to restrict prescribing data from sales reps as New Hampshire case goes to trial.

Fighting for Access

King Pharmaceuticals is bravely betting on the Super Bowl to kick off a $5 million unbranded campaign called "Heart Attack" to boost sales of its blood-pressure drug, Altace (ramipril). The drug company is the first to publicly announce that it is buying time during TV's most coveted four hours, when advertising gets almost as much coverage as touchdowns and field goals. With pharma's marketing budgets under heavy scrutiny--both inside and outside company walls--most marketers are passing on next Sunday's razzle-dazzle.

"All eyes are on the Super Bowl," Rebecca Sroge, executive vice president and managing director of Publicis agency Glow Worm, which created the spots. "It had to be appropriate and it had to be entertaining."

While the hypertension category is packed with products both branded and generic, drug makers still insist that it has room to grow. Lacking telltale aches and pains, many people with high blood pressure remain either undiagnosed or noncompliant with their treatment--which means that the next frontier is establishing the seriousness of the condition with patient education about the toll that hypertension takes on the heart.

Ninety million people watch the Super Bowl each year, and about 30 percent of all Americans have high blood pressure--and many don't even know it. "There's a large crossover," said Steve Andrzejewski, King's chief commercial office.

In "Heart Attack," an unsuspecting Heart Man is assaulted by a gang of heart-disease risk factors: High Blood Pressure, High Cholesterol, Overweight, and Diabetes. The tag line: "Is your heart at risk for an attack?"

"When someone's told they have high blood pressure, they don't necessarily think it's bad for their heart," Sroge said. "It's almost like a mugger--we heard that in market research. We took that idea and ran with it."

The company's two TV spots--one 60 seconds, the other 30--steer viewers to www.BeatYourRisk.com, a Web site created with the American Heart Association (AHA) as part of a three-year partnership around high-blood-pressure awareness. The site, which also goes live on Super Bowl Sunday, features a risk-assessment tool and encourages users to discuss their results with their doctors.

With close to $472 million in sales in the first three quarters of 2006, and 16.7 percent growth over the same period in 2005, Altace is one of the most commonly prescribed Ace-inhibitors. King is also supporting prescription uptake with data from its HOPE study, which suggests that patients on Altace had a decreased risk of heart attack, stroke, and diabetes.

"The ultimate goal of the campaign is to get people to take action," Andrzejewski said. "It's unique and exciting." The campaign, which will be reinforced with print and online ads, builds on branded spots created in 2002 featuring professional golfer Jack Nicklaus, an Altace patient. "We don't have plans to revive the branded advertisements for Altace at this time," Andrzejewski said.

Other companies so far seem to be steering clear of the Super Bowl hype. The hefty cost of airtime is a sticking point not only for firms hell-bent on cutting costs but also for their critics, who take issue with spending big bucks to mass-market products that may carry health risks.

"The question is, is it right for the context of the Super Bowl--high profile, high entertainment?" said Loreen Babcock, chairman and CEO of ad agency Unit 7, which did not work on the campaign. "In today's environment, would it be seen as irresponsible?"

Babcock described the AHA's involvement as "highly unusual," but also gives King the leeway to have fun with the creative. "Education is valuable," she said. The marketing component "won't be as in-your-face."

Unbranded campaign with American Heart Association kicks off with much fanfare.

Pharmaceutical Executive-01-31-2007

Pfizer Debuts 2007 Marketing Line

Fighting for Access

King of Super Bowl Sunday