Where Does DTC Go From Here?

  • View

  • Download

Embed Size (px)


Updated presentation from Defined Care 2004 summit on the role of rx drugs in society with implications for marketing, managed care and disease management.

Text of Where Does DTC Go From Here?

  • 1. Dont Worry, Be Happy Where Does DTC GoFrom Here?Laurie Gelb, MPH

2. The views expressed in this presentation do not represent the views of any other person, company or industry organization. 3. This deck is an update of a presentation to Defined Care 2004, sponsored by Managed Care On Line. The author is nowPrincipal, Profit by Change 4. Healthcare background

  • Hospital PBX, lobby receptionist, admitting rep
  • Researched patient, nurse, AHP, physician satisfaction and developed market-driven strategy for Texas hospital/health system clients
  • Managed MD Andersons Biomathematics department
  • Moved into rx, with vendors, then in biotech, then in big pharma; later in managed care (outcomes research)
  • Publish/present on e-marketing, decision models; blog at Managed Care On Line and examiner.com

5. Feeling good or feeling better when do needs differ from wants? Luxury Survival need Means to end Self-contained Massage therapy? Allergy meds? Rx/OTC/ACM is unique Higher education Employment Entertainment Leisure travel Home electronics Fashion clothing Upscale housing Housing Food Warm clothing Acute rx/tx 6. Definitions

  • The right treatment is [your definition here, incorporating clinical efficacy, safety, cost, logistics, compliance/persistency]
  • The right way to take rx is following label cautions, incorporating other modalities for maximum benefit, dosing consistently, etc.
  • The right patient is s/he for whom a drug is indicated
  • The right time is as soon as the drug will achieve significant benefit

7. Our goal: the right synergy We want the right patient to take the right drug at the right time, the right way, for the right reason, and therebyaddress a medical need 8. Were lonely at the top,becausethe stakes are high Resentment Ignorance Poverty Denial Fear 9.

  • External sources daily assert:
    • Evil drug companies are withholding lifesaving drugs from the poor and elderly here and in the Third World, wasting millions in marketing to the insured
    • As a wealthy society, we use rx to improve mood, allergies, sex lives, etc. when we should be attacking root causes through natural healing/prevention, less conflict, less pollution, etc.
    • You should take as few drugs as possible, except for

Thinking about rx means Generalizations are tempting 10.

  • When you see Mr. Clean in someones kitchen, there is a wink-wink component of humor and exaggeration
    • Is that tone appropriate to DTC? Does it facilitate rational decision-making?
  • HCPs, payors and biopharma all have a stake in conveying that pills are not commodities that the rx decision is a serious one

A possible failure to communicate the righttone? 11. Fear & loathing in the headlines, risking suboptimal decisions 12.

  • Drugs can heal, disable and/or kill
  • Nor is the ultimate position on the pleasure/pain continuum as predictable as with other goods
  • Thespecificdrug as benefactor spurs antipathy and resentment who wants tohaveto think about, take or depend on rx?
  • The consumer can at once fear, live with and cherish:
    • The drug itself; having to consider it at all
    • What the drug does
    • What the drugdoesntdo
    • Not knowing what benefits/risks will actually apply

No rx guarantees, so attachments always conditional 13.

  • Im not as energetic/happy as I should be [expectation gap]
  • I feel pain/weakness/fuzzy/numb [active concern]
  • My doc says I weigh too much/have high blood pressure/have diabetes [physicians attribution]
  • My boss says I look tired all the time [peer observation]
  • I had chest pain when I played football with my son last week [isolated event]
  • I just want to stay healthy as long as possible [goal-setting]
  • My aunt died last week and she was only 61 [benchmarking]

Contexts breed expectations 14.

  • Understand how DTC/DTP exposures affect consumers, with every word
    • Freeze frame methodologies stop and reflect
    • Explore real-world mediators of calls to action, not just likelihood scales
    • Probe how problems perceived; with whom discussed; recommendations made; never presume that DTC exposures are evenprocessed
  • Explore the duality of rx
    • Allow consumer/patient to want to take responsibility because now s/he understands how, and to makerationaldecisions
    • Never stop reinforcing the rx decisions importance to thepatient
    • The more conscious decision-making, the happier we will all be; decisions based on emotion may not last

Consider the contexts When/why does the right thingseemright? 15. The capsule has two faces

  • See drug exteriors; inside is mystery
  • Endless reading, but rarely discussions
  • Hear drugs are risky/not; trivial/not; the cost of modern living/the bane of civilization
  • Most patients charged considerably less than retail but often believe they overpaid
  • May take drugs daily, feeling insecure every time
  • Seldom is the consumers objective to buy more rx, (this is not got milk ?) but besieged by messages pointing to specific drugs and disorders

16. Rx: seldom wanted in the abstract

  • The consumer: Iwantthis only becauseIneed it(we do not generally follow the rx leader)
  • We seldom ponder whether towantthe benefits from a prescription drug, as opposed to a DVD player
    • But may ask if we really need a drug, an opportunity to ensure that therighthands are reaching for the right benefits
  • HCP: What youneedis
  • Marketers: You shouldwantour class/brand (since you need it)
  • Counterproductive to convey that some rx decisions should be easy, no-fault and others not


  • Rx access entails multiple costs, e.g. financial, emotional and opportunity costs for care-seeking, transactions, reimbursement
  • Layered on concerns about professionals, processes and payors
    • My physician just wanted to get me out the door, so he wrote me this prescription [is there a better but slower option?]
    • My insurance company sends me letters about disease management, and Im not even sure if the drugs Im on are the right ones [should I be re-evaluated]
    • The pharmacist asked if I had any questions. I have a lot, but I dont know who should be answering them [Im not yet fully satisfied with the decision(s) I made]

Rx access costs more than money 18.

  • A drug can be personalized: I cant sleep without my pills and we warn consumers not to share rx
    • Yet formularies, generics, Internet pharmacies, re-importation and pricing debates/magazine spreads imply drugs are interchangeable commodities
    • As those in need beg, borrow and steal drug from the living and dead
  • The same molecule can be a veterinary or human formulation, with a different route of admin/ color/shape, and priced differently by channel
  • Physical product generally loses value over time, but investment may gain value, e.g. years of controlled vs. uncontrolled dz

How personal an investment is rx? 19. Knowledge actualcontrol, but can increaseperceivedcontrol

  • Survey analysts frequently confuse needs for control and knowledge with attitudes. Some consumers may assume the worst, rather than relinquish perceived control

Knowledge Intervention Decisions Health decisions are continually re-evaluated, entailing changes in modalities as well as rx My drugs keep me in balance. They give me control over how I feel. [ severely ill pt ] Control 20. When does realismfatalism? Mike Twohy,New Yorker,6/10/2002 21. Consumersdontnecessarily want all the ramifications, but they

  • Often cant presume that health care players have only their interests at heart
  • Assume personal responsibility to the extent of clear benefits, though stillreluctantto believe that:
    • Health is a direct function of money spent
    • Unwise spending can endanger health
  • Want to believe that if drug companies are working with HCPs/payors, its for their own good, though increasingly afraid that its not


  • You may have a problem [can be oblique, e.g. ED]
    • You to feel better, address the issue and/or lower your risk
    • This drug can help you achieve the above
    • Ergo, you should take this drug, presuming you have this problem
    • You can do other things to help yourself, too
  • Issues: