Contents:

EXECUTIVE SUMMARY 3 Key findings 3 Poor patient compliance represents lost revenue potential for the pharmaceutical industry, at a time when companies are under pressure to rationalize promotional costs. Addressing non-compliance is therefore key, but the complexities of the drivers of compliance limit the effectiveness of a one size fits all solution 4 Current DTCA campaigns do not address compliance effectively. Companies must develop a marketing continuum to better support patients for the duration of treatment 6 CRM is an under utilized compliance tool. Companies should invest in CRM to enhance patient understanding and build better Pharma-patient relationships 8 CHAPTER 1 OPTIMIZING PATIENT COMPLIANCE TO MAXIMIZE REVENUE OPPORTUNITIES 21 Scale of the problem 22 Cost to patients 23 Cost to pharmaceutical companies 24 Types of non-compliance 25 Unintentional non-compliance 25 Intentional non-compliance 26 Compliance evaluation: Identifying key candidates for compliance management 28 Asthma therapy 32 Diabetes therapy 32 Hormonal contraception 33 ADHD therapy 33 Anti-dyslipidemics 33 Pre-launch initiatives: Identifying compliance concerns before they arise 34 Post launch initiatives: Tailoring DTC and CRM strategies to address compliance 36 The role of CRM 37 The role of DTCA and DTPC 38 Reactive strategies of limited use in boosting compliance 38 The role of branding 39 Cost-effectiveness considerations 39 CHAPTER 2 ASSESSING THE IMPACT OF PATIENT MARKETING ON COMPLIANCE: DTC AND BRANDING 41 Best practice recommendations 42 DTCA to raise awareness as the first step in compliance 44 Targeted DTPC to enhance compliance 44 Branding to add value for patients and enhance loyalty 46 Key recommendations 47 DTC: any evidence supporting use as a compliance boosting tool? 49 Does increased compliance contribute to the ROI of DTC? 49 Usefulness of DTC in compliance varies by therapy area 52 CNS Therapies 57 Respiratory Therapies 60 Antifungal Therapies 63 Lifestyle Indications 65 Cardiovascular Therapies 67 General conclusions: DTC and compliance 69 DTCA: role in compliance secondary to driving new prescriptions 70 Suitability of DTCA in compliance: an industry perspective 70 Impact of DTCA on compliance: a physicians view 72 DTCA in practice: is applicability limited to unintentional non-compliance? 73 Educating and empowering patients 74 Creating responsibility for own health 76 Improving the patient-physician relationship 78 Reminding patients to take medication 79 DTPC: a more effective compliance tool? 81 DTPC in practice: range of options addresses varying compliance issues 82 Disease awareness/ understanding programs (unbranded) 83 Patient support programs 85 Public relations 92 Patient information leaflet 92 Online information portals 95 The “other” DTP: Pharmacist and Physician involvement essential to compliance 100 Physicians 100 Pharmacists 101 Caregivers 101 Branding as a compliance boosting tool 103 Branding in practice: a continuation of the patient comunication process 104 Product branding 106 Franchise branding 106 CHAPTER 3 TARGETING PATIENTS FOR LONG-TERM CUSTOMER LOYALTY: THE VALUE OF CRM 108 Best practice recommendations: using CRM to boost patient compliance 109 Maximize understanding and satisfaction of patients 110 Tailor CRM to suit stage of product lifecycle and therapeutic area 110 CRM and the product lifecycle 111 Applicability of CRM across therapeutic areas 112 Develop brand loyalty 112 CRM in practice: untapped potential? 113 The current perspective on CRM – a short sighted view? 113 CRM in theory: potential drivers of use in patient compliance? 114 Effective customer identification and targeting 117 Patient identification 117 Personalized patient targeting 118 Providing added value to patients 121 Developing a brand value 122 Directly targeting barriers to compliance 124 Boosting patient retention across a product’s lifecycle 125 Challenges in implementing CRM in compliance 127 APPENDIX 131 Research methodology 131 Participants to Patient Compliance 2004 Survey 131 References 131 Authors Details: Neal Hansen, Lead Analyst – Strategic and Competitive Intelligence 137 Linda McNamara, Managing Analyst – Strategy 138 Andrew Jones, Senior Analyst – Strategy 139 Johannes Inama, Strategy Lead Consultant 139 How to contact experts in your industry 140 LIST OF TABLES Table 1: Top 50 DTC promoted drugs, 2003 54 Table 2: Pfizer/ RxRemedy study indicated that exposure to DTCA has positve impact on patient compliance 75 Table 3: The public tend to overestimate the risk of experiencing side effects 93 LIST OF FIGURES Figure 1: Drivers and resistors of patient compliance 5 Figure 2: Industry ranking of factors likely to improve the ROI of DTC compliance initiatives 6 Figure 3: CRM in the pharmaceutical industry 8 Figure 4: Tailoring patient communication strategies based on product and patient specific drivers of non-compliance 8 Figure 5: Perceived factors driving patient non-compliance 27 Figure 6: Drivers and resistors of patient compliance 28 Figure 7: Evaluating product specific compliance issues 29 Figure 8: Evaluating patient specific compliance issues 31 Figure 9: Compliance boosting interventions used by survey respondents 35 Figure 10: Tailoring patient communication strategies based on product and patient specific drivers of non-compliance 36 Figure 11: Companies must consider the cost per patient of compliance boosting interventions 40 Figure 12: Targeting of DTC interventions within treatment cycle 43 Figure 13: Industry ranking of factors likely to improve the ROI of DTC compliance initiatives 45 Figure 14: The impact of Elidel DTC on new prescriptions (2002-2003) 50 Figure 15: US prescription growth and DTC spend for Elidel, 2002-03 51 Figure 16: Industry perception of therapy areas facing compliance problems, and of usefulness of DTC in addressing compliance in these areas 53 Figure 17: Zoloft US product website promoting the “Knowing More” program to new patients 57 Figure 18: Excerpt from Strattera support brochure “Parents: What Should I Expect with Strattera?” 58 Figure 19: Prescription growth and DTC spend for selected US antidepressants, 2001-03 59 Figure 20: Prescription growth and DTC spend for selected US allergy treatments, 2001-03 60 Figure 21: Allegra’s US product website targets new and existing patients 61 Figure 22: Prescription growth and DTC spend for selected US asthma therapies, 2001-03 62 Figure 23: US prescription growth and DTC spend for Lamisil, 2001-03 64 Figure 24: US prescription growth and DTC spend for Xenical, 2001-03 66 Figure 25: US prescription growth and DTC spend for selected statins, 2001-03 68 Figure 26: Industry ranking of effectiveness of DTCA tools in targeting compliance 70 Figure 27: Physician perception of impact of DTCA on patient compliance 72 Figure 28: Physician perception of impact of DTCA on patient attitudes to healthcare 76 Figure 29: Industry perception of relevance of various patient information services 78 Figure 30: Physician perception of impact of DTCA on patient behavior during medical consultations 79 Figure 31: Industry perception of relevance of various patient information services 81 Figure 32: Pfizer’s UK disease awareness program “ChoLESSterol” 84 Figure 33: Xenical New Zealand product website, promoting access to patient support materials 86 Figure 34: NuvaRing product website offers medication reminders for patients transitioning from once-daily to once-monthly therapy 87 Figure 35: Pfizer UK’s Viagra patient support program gathers information from patient in order to tailor the content they receive 88 Figure 36: Novartis’s “Take Action for a Healthy BP” campaign integrates awareness raising DTCA with extensive patient support initiatives 89 Figure 37: MSPathways.com provides access to extensive support services for patients undergoing treatment with Betaseron 91 Figure 38: US PIL for Taxotere 94 Figure 39: Levitra’s product website offers patients the option of filling prescriptions online, overcoming the “embarrassment factor” that may prevent some patients from filling prescriptions 96 Figure 40: Abbott’s unbranded disease education program for rheumatoid arthritis discusses the available treatments, but provides prominent links to Humira.com 97 Figure 41: Novartis’s SimplyStated campaign to provide patients with independent information, within a few clicks of its branded sites 98 Figure 42: Pfizer sponsors the patient information portal VisionConnection, raising awareness of glaucoma 99 Figure 43: Schering-Plough’s Intron A site encourages caregivers to take an active role in boosting compliance with therapy 102 Figure 44: Industry perception of applicability of branding methods to patient compliance 103 Figure 45: Improving sales: the influence of branding on patient retention throughout a product’s lifecycle 105 Figure 46: Pfizer’s online women’s health portal: tailoring brand image for a specific target group 107 Figure 47: Areas where CRM can influence patient compliance 109 Figure 48: CRM and the product lifecycle 111 Figure 49: CRM in the pharmaceutical industry 113 Figure 50: ‘The Virtuous Circle’ offered by CRM to improve patient satisfaction with a prescribed product 115 Figure 51: Factors perceived to drive use of CRM in boosting patient compliance 116 Figure 52: Factors perceived to increase effectiveness of DTC communication in boosting compliance 118 Figure 53: Xenical: adherence with and without the support program 121 Figure 54: CRM can extend a product’s lifecycle through better retention of patients 125 Figure 55: Product ROI and patient numbers over time 126 Figure 56: Perceived barriers to use of CRM in patient compliance 127 Figure 57: AXA Assistance (UK) Telephone Support Model 129