EVOLVING TECHNOLOGIES AND THE FUTURE OF EVOLVING TECHNOLOGIES AND THE FUTURE OF THE PHARMACEUTICAL/HCP RELATIONSHIP

Frank Spinelli, MDp ,April 30, 2012

MY HISTORY WITH PHARMAMY HISTORY WITH PHARMA

Pharma-friendly residency (1995)

Chief Resident and worked closely with Pharma (2000)Sponsored lunchesSponsored lunchesGrand RoundsDinners, events, parties, happy hours

First practice was Pharma-friendly (2001)

Current practice and hospital affiliation are not Pharma-friendly (2010)

Many HCPs are witnessing this same evolution

NATIONAL SURVEYNATIONAL SURVEY

200192% f h i i

200478% received drug92% of physicians

received drug samples13% received meals,

78% received drug samples83% received food in th k l13% received meals,

tickets to events, free travel13% i d fi i l

the workplace35% received reimbursement for

13% received financial or other benefits12% received

costs associated with professional meetings or CME12% received

incentives to participate in clinical trials

28% received payment for consultation, lectures, or clinical t i ltrials

PHRMA CODE 2002PHRMA CODE 2002

The code states that the interactions between Pharma and HCPs should primarily benefit the patients and enhance the practice of medicine

Discourages companies from giving HCPs tickets to entertainment or recreational events, goods that do not gconvey a primary benefit to patients and token consulting and advisory relationships that are used to reimburse HCPs for their time travel or out of pocket expensesHCPs for their time, travel or out of pocket expenses

AFFORDABLE CARE ACT AFFORDABLE CARE ACT

March 23, 2010, President Obama signed the Affordable Care Act

The law puts in place comprehensive health insuranceThe law puts in place comprehensive health insurance reforms, with most changes taking place by 2014

Ch t tChanges to note:50% discount for name-brand drugs in the Medicare “donut hole”Expanded coverage for young adultsSmall business tax creditsPre-existing condition insurance plans

AFFORDABLE CARE ACTAFFORDABLE CARE ACT

January 1, 2015 - A new provision will tie physician payments to the quality of care they provide

Physicians will see their payments modified so that thosePhysicians will see their payments modified so that those who provided higher value care will receive higher payments than those who provide lower quality care

More preventative healthcare measures

LOOKING FORWARDLOOKING FORWARD

It is clear that pharmaceuticals companies will succeed or fail based NOT on how many y

drugs they sell but on how well their offer improvement in health outcomes.

EMERGING TECHNOLOGIES EMERGING TECHNOLOGIES

By 2014 all medical practices and hospitals have to convert to paperless electronic medical records

Currently many doctors communicate with their patients viaCurrently, many doctors communicate with their patients via email and text messaging

S t h iP d d t bl t b iSmart phones, iPads and tablets are becoming more important in the doctor/patient relationship

EMERGING TECHNOLOGIES

For example:Patient is away and develops a rash. He calls his HCP but refuses to go to the ER. Patient takes a picture and texts it to the HCP. That picture helps the HCP make a diagnosis p p gand becomes part of the medical record

Although there exists codes to bill for these encountersAlthough there exists codes to bill for these encounters, insurance companies typically do not pay for non-face to face visits.

RashRash

EMERGING TECHNOLOGIESEMERGING TECHNOLOGIES

Consult reports from referring physicians, labs, and x-rays reports can all be linked to patient’s medical record sa ingreports can all be linked to patient’s medical record saving paper and postage

P ti t l t i t t l f th iPatients can log on to private access portals from their iPad/tablet, smartphone or home computer to view results

Prescriptions are transmitted electronically via the EMR

Psychiatrists already use Skype technology for virtual visitssyc at sts a eady use S ype tec o ogy o tua s ts

Eventually, app technology (airlines) will allow pharmacists to scan patients’ device to register prescriptionsto scan patients device to register prescriptions

EMERGING TECHNOLOGIES EMERGING TECHNOLOGIES

Smart phone app - Epocrates, medical calculators and linking apps to CME ditcredits

Paper prescriptions will be transmitted via apps

Electronic medical records will eliminate paper resulting in less time on the phone with a human receptionist

Making appointments, new pt registration and prescription renewal requests can all be done through EMR

Text messaging services are already set up to send patients remindersText messaging services are already set up to send patients reminders about upcoming appointments and the ability to change appointments

Patients and the government are pushing doctors/insurance companiesPatients and the government are pushing doctors/insurance companies kicking and screaming into adopting emerging technologies

PHARMA/HCP RELATIONSHIPPHARMA/HCP RELATIONSHIP

Since the PhRMA Code was instituted, the Pharma Rep and HCP relationship has changed

Currently they provide:Currently they provide:LunchSamplesOn label dataOn-label dataInvitation to dinners with a contracted medical speakerFacilitate meetings with MSLs

What measures can help facilitate a Pharma/HCP meeting?

PAPER VS IPAD/TABLETSPAPER VS. IPAD/TABLETS

Green environment is Advantages of pushing toward less dependence on paper

giPads/tablets:

No paper/nothing to

Paper has to be disposeddispose of

Less time to turn on vs. laptops

Reps have a shorter window of opportunity to present

laptops

Providers are more prone to listen to a detail

Laptops need to be booted up and are combersomeup and are combersome

IPADS/TABLETSIPADS/TABLETS

Using an iPad/tablet can be interactive and transformUsing an iPad/tablet can be interactive and transform the lecture/detail into a dialogue

Physicians are more prone to pick up an iPad and if it allows for interaction by clicking and linking to slides and graphics it has been shown to leave a more lastingand graphics, it has been shown to leave a more lasting impression on the HCP

Afterwards, reps could provide HCPs with apps for follow up and companies can track if these apps are down loadeddown loaded

ADOPTING APPS FOR PREVENTIONADOPTING APPS FOR PREVENTION

As more providers use iPads/tablets, they’ll be more receptive to apps that make their lives easier

Alivecor unveiled its ECG app which turns an iPad orAlivecor unveiled its ECG app, which turns an iPad or iPhone into an ECG device

Physicians can measure a heartbeat by simply pressing the device against a patient’s chestdevice against a patient s chest

J&J’s Psoriasis App, designed by Creative Lynx, gives D t l i t t l l t PASIDermatologists an easy way to calculate PASI scores during patient check ups

ADOPTING APPS FOR PREVENTIONADOPTING APPS FOR PREVENTION

Downloads for apps are comparable for either the iPhone or iPad

F th li i l d i d b C ti L iP dFor other clinical apps designed by Creative Lynx, iPad download can exceed those for the iPhone

Apps are a much better way for a company to represent themselves and communicate through the Internet

INTERNET AND RULES FOR ENGAGEMENTINTERNET AND RULES FOR ENGAGEMENT

The Internet will obviously not go away, but it’s y g y,important how you engage it

Digital technology and social media are now essential for engagement

SOCIAL MEDIASOCIAL MEDIA

Patient to Patient

Patient to HCP

HCP to HCP

SOCIAL MEDIASOCIAL MEDIA

Pharma historically has marketed along two tracks:Driving physicians to prescribe treatmentEncouraging patients to request treatment

The real opportunity for Pharma is to challenge these modes with digital and social media - providing platformsmodes with digital and social media providing platforms that extend the doctor/patient relationship, placing value on the dialogue before and after a script is written

SOCIAL MEDIASOCIAL MEDIA

Social networks are important for Pharma to understand and consider for communication and marketing strategies

Consumers and HCPs are talking about treatment and brands - ranging from usage questions to suggestions to criticismscriticisms

Talk of brands reflect a need to seek help, feedback, f f f foften amendable to information from the manufacturer

SOCIAL MEDIASOCIAL MEDIA

Companies that ignore this approach runCompanies that ignore this approach run the risk of leaving consumers and

HCPs feeling ignored and ultimatelyHCPs feeling ignored and ultimately distancing themselves from their

customerscustomers

SOCIAL MEDIA – MY PFO STORYSOCIAL MEDIA MY PFO STORY

Imagine a relationship that begins in an online community

This leads to an office consult where the patient brings their smartphone containing this information found prior to the office visit

The patient sits with their HCP, accesses this digital resource about wellness, prevention or disease management

In addition to the prescription, patients get a mobile app that facilitate care, monitoring, and adherence

The app reminds them of critical lifestyle considerations, such as exercise during detected periods of inactivity, and provides geo-t t d t t d ti t il d t ifi di ttargeted restaurants recommendations tailored to a specific diet

SOCIAL MEDIASOCIAL MEDIA

“Digital Care Kit” could include a referral to online support groups where patients could track and share their care

Physicians could post answers to questionsPhysicians could post answers to questions

Nurses would be alerted to patients who are lapsing and h d l li lt ti b t ffi i itschedule an online consultation between office visits

The possibilities for brands to facilitate this type ofThe possibilities for brands to facilitate this type of engagement are limitless

SOCIAL MEDIASOCIAL MEDIA

Bayer launched the WomenHeartStrong@Heart online community on Facebook to encourage awareness of the millions of US women with heart disease (www.facebook.com/pages/WomenHeart-Strong-Heart/62833170782)

Children With Diabetes is Johnson & Johnson’s online community for parents, children, adults and families living with Type I Diabetes (www.childrenwithdiabetes.com)

Genentech’s Herceptin HER Story Community helps connect women with breast cancer survivors (www.herceptin.com/community)

SOCIAL MEDIASOCIAL MEDIA

Companies like Boehringer Ingelheim g g(http://twitter.com/Boehringer) and Novartis (http://twitter.com/Novartis) have Twitter accounts, though most pharmaceutical companies on Twitter haven’t yet usedmost pharmaceutical companies on Twitter haven t yet used this medium to its fullest potential

SOCIAL MEDIASOCIAL MEDIA

Digital resources prescribed as part of care regimens

Pharma has to develop and curate reliable, objective information online

This information is geared toward optimizing patient/HCP relationships

HCPs must contribute to digital resources and participate in online conversations with the goal of starting a dialogue before consultation and maintaining it through the treatment cycle

Brands that focus on merging online and in-office experiences will become the most relevant and valuable to both the HCP and the patient

PHARMACEUTICAL/DOCTOR PHARMACEUTICAL/DOCTOR

Rep visits with the HCP have changedg

iPads/tablets

Apps

Social Media – Facebook, Twitter and websites geared toward disease stateto a d d sease state

Human Field Representative?

IDEAL FIELD REPRESENTATIVE PROFILEIDEAL FIELD REPRESENTATIVE PROFILE

EducationDoes degree or clinical experience matter?Rep vs MSL

Core ResponsibilitiesProvide consistent, accurate and balanced scientific informationEngage in unscripted scientific dialogue on relevantEngage in unscripted scientific dialogue on relevant topics related to disease state and product

IDEAL FIELD REPRESENTATIVE PROFILEIDEAL FIELD REPRESENTATIVE PROFILE

VenueBy appointment, in-person visits or virtually as needed?HCPs and institutions are moving towards “no rep access,” so can HCPs obtain access to scheduled virtual visits withso can HCPs obtain access to scheduled virtual visits with MSLs or Med Info to provide unscripted answers?

T l d RTools and ResourcesProduct and disease state information, on-label and off-label (slide decks on iPads/tablets, links to websites, and apps)HCP and patient education material (apps)Literature searches and medical information letters via email

FINAL THOUGHTFINAL THOUGHT

As the digital world evolves, the physical interaction g ybetween Pharma and healthcare providers will diminish.

But there is something about the human connection that gtransports us in a way that digital media will never do.

Until the time when in-person humans are replaced, PharmaUntil the time when in person humans are replaced, Pharma should seize the opportunity to maximize on this most

cherished and dwindling connection.

Prepare to become a leader in the technological future.

-- Frank Spinelli, MD

Thank you!