ONCOLOGY MARKETING PERSPECTIVES · content lab, mm&m 4 the marketing playbook a dtc: oncology takes...

ONCOLOGY MARKETING PERSPECTIVES

eBook

Delve into one of the most dynamic periods for oncology marketing, from brands’ embrace of DTC to the development of checkpoint inhibitors, to value-based care and what’s next for the cancer sector

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In this eBook, we’ve scoured the best of our medical and commercial trend reports and added new commentary to bring you the key oncology marketing and science highlights of the past five years, along with trends in 2018 and projections beyond.

And what a dynamic five years it has been. The global oncology market is riding a steady growth trajectory, with little sign of stopping. Oncology drug spend soared to $107 billion worldwide in 2015 and is projected to reach $150 billion by 2020, according to figures from IQVIA.

Science-wise, the oncology sector has been hitting it out of the park with solutions promising improved survival with lower toxicity for some patients.

One of the biggest challenges for all participants is keeping up with break-through oncology therapies.

These products — both hopeful and approved — arrive with a splash of new data, guidelines, and clinical trial infor-

mation that inundate HCPs, patients, and caregivers.

Recognizing these participants are also consumers, oncology marketers are retooling their outreach strategies and embracing tactics such as DTC, digital, and even social media.

Market access is also undergoing ma-jor transformations, with some cancer therapies now managed similarly to other chronic diseases, and value-based care entering the mainstream as a must-have strategy amid cries over treatment cost.

A growing need to capture and analyze data from a dizzying number of streams parallels scientific advances and offers the promise not only of better marketing, but also better patient outcomes. No matter what your area of focus in oncology mar-keting or oncology drug development, the past five years have been a fasten-your-seat-belt ride. How’d we get here, and where are we headed? Read on for some much-needed perspective.

THE ONCOLOGY LANDSCAPE TRANSFORMS

JOANN WHITCHER, SENIOR PRODUCER, CUSTOM CONTENT LAB, MM&M

4 THE MARKETING PLAYBOOK

A DTC: ONCOLOGY TAKES TO THE AIRWAVES

B PATIENT ENGAGEMENT BECOMES AN AREA OF FOCUS

C HCP ENGAGEMENT: BRANDS MOVE BEYOND DIRECT SALES TO REACH ONCOLOGISTS

10 ADVANCEMENTS

IN TREATMENT: A TIMELINE OF CHECKPOINT INHIBITORS

13 MARKET ACCESS MARCHES TOWARD VALUE-BASED OUTCOMES

15 THE DATA CRUNCH

17 PEEKING INTO THE CRYSTAL BALL: WHAT CAN WE EXPECT MOVING FORWARD?

20 PARTNER PERSPECTIVES


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“DTC CAN CREATE A TIGHTER BOND BETWEEN BRANDS AND PATIENTS IF IT ASSISTS IN FACILITATING A BETTER BRAND EXPERIENCE FOR PATIENTS”MICHAEL PARISI, GUIDEMARK HEALTH

DTC: ONCOLOGY TAKES TO THE AIRWAVESBefore 2013, when the first Provenge DTC ad aired, it was unheard of for brands to use DTC advertising for oncology drugs. DTC was a marketing play for the blockbuster consumer brands, the Lipitors and Viagras of the world.

Oncology brands now have permission to play in the DTC space. That permission was granted, notes Michael Parisi, CEO of Guidemark Health, “because the consumerization of healthcare, cancer, and personal cancer stories has become mainstream. Cancer is such an individual and personal experience.” Patients expect to have similar experiences with brands involved in their cancer treatment as they do with retail.

DTC, adds Parisi, can create a tighter bond between brands and patients if it assists in facil-itating a better brand experience for patients. As cancer is managed like a chronic disease, with patients on treatment for an infinite amount of time, “brands are looking to find meaningful touchpoints in the patient journey, and to stay relevant at different points in time,” he says.

DTC oncology ads don’t just reach patients. Oncologists and care partners are consumers, too, and are seeing the same programs as patients and getting those same messages.

Oncology brands are increasingly promoting on the airwaves. Bristol-Myers Squibb launched

the first DTC TV ad for Opdivo, called Longer Life, in September 2015.

Merck’s campaign kicked off more than a year later, on January 30, 2017.

From June 2013 to February 2017, pharma companies spent an estimated $223 million

THE MARKETING PLAYBOOK

Eli Lilly worked with artist John Magnan on the Hero’s Journey art project to raise awareness of research


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on more than 42,000 airings for DTC commer-cials for Bristol-Myers Squibb’s Opdivo, Merck’s Keytruda, Dendreon’s Provenge, and Amgen’s Neulasta, according to iSpot.tv. At least half of that spending was for Opdivo spots that aired during the past year.

Total investment in DTC advertising for prescription cancer medications more than tripled from $163 million in 2015 to $505 million in 2017, data from media intelligence firm Kantar Media shows.

The Keytruda and Opdivo spots were just the beginning. In May 2018, Eli Lilly debuted its first TV ad for Verzenio, dipping its toe into DTC with its first oral cancer drug.

Immunotherapies represent some of the most innovative cancer advancements of the past decade, and with as many as 44 active PD-1 combination drugs in development, if more make it to market, we could see a further rise in national TV ads for new cancer meds.

Large health systems looking to recruit cancer patients are also splurging on DTC. When you look at some of the largest spenders in cancer markets, you will see cancer cen-ters are major players, reveals Parisi. To wit: Houston-based MD Anderson uses TV to advertise its services to a New York audience.

DTC is often the go-to strategy for the drug with the most to gain, such as when brand teams try to create awareness of a new market or new type of drug, or if the therapy has a stronger clinical profile than its competitors.

The prevalence of DTC ads promoting some of the new I/O drugs also has its detractors, with some critics assailing the companies for overly hyping, given the drugs work for a fraction of patients. Whether or not this criticism slows down DTC spending remains to be seen.

PATIENT ENGAGEMENT BECOMES AN AREA OF FOCUS Five years ago, treatment decisions within the oncology environment were typically HCP-driven. Patients deferred as a matter of course to the doctor’s expertise. But patients are now more empowered, armed with information acquired through the internet along with involvement with advocacy groups.

“We are more focused on the overall patient experience across their entire clinical journey,”

says David Cooney, senior consultant at Blue Latitude Health. “This doesn’t just mean paying attention to the way treatments are chosen. We also want to ensure the best outcomes for patients and their carers. These results aren’t just measured clinically, but also in the patient and carer’s quality of life.”

As patients live longer with cancer, the patient-brand relationship is lengthened and deepened. Patients may be on a treatment for years, not months, or may experience a series of treatments. Depending on where they are in their journey, they will require additional support and resources.

So, while patient adherence to treatment is a much discussed challenge, brands are now recognizing adherence is only part of the journey. To that end, marketers are infusing welcome kits and brand websites with materials to help patients cope better, communicate more effectively about their needs, and manage the impact cancer has on their self-identity.

Oncology patient support programs are going beyond basic nurse call centers and traditional messaging-based approaches to incorporate psychosocial strategies such as mindfulness and cognitive behavioral techniques, says Meredith Terry, Ph.D., lead behaviorist, innovation and practice, MicroMass Communications.

“By addressing the psychosocial factors of patients, you strengthen the bond between the patient and product,” she notes. “The patient maintains a more positive mindset. It builds resilience and reinforces the patient’s strengths to endure treatment.”

There’s also been a shift to incorporate caregiver and partner offerings into patient oncology services. Pharma recognizes caregivers play a critical role in a patient’s ability to stay on treatment, with evidence suggesting when caregivers have what they need, there is a significant impact on patient adherence.

“Oncology marketing materials must continue

“WE LOOK TO IDENTIFY PEOPLE WHO HAVE A VOICE AND THEN PROVIDE A ‘MICROPHONE’ ... TO PROMOTE THOSE ADVOCATES WHERE THERE IS A SYNERGY.”DAVID MUSTALISH, M.D., INTOUCH SOLUTIONS

The top three spenders in DTC are Merck (for Keytruda), Bristol-Myers Squibb (for Opdivo), and Cancer Treatment Centers of America

Total DTC advertising spend for cancer medications has steadily increased since 2015SOURCE: KANTAR MEDIA

2015: $163.4M

2016: $273.5M

2017: $505.0M


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“WE STILL APPROACH CLINICAL TRIAL MARKETING WITH MICRO-CAMPAIGNS FOR EACH INDIVIDUAL STUDY, AND SOMETIMES A SMALL PORTFOLIO OF STUDIES”

ANGELA RADCLIFFE, PULSEPOINT

to become more diversified to align with different patient needs,” says Terry.

To the point patients are also consumers, marketers are exploring innovative use of digital and social media to reach and engage with them.

In a recent campaign by skin cancer nonprofit Melanoma Know More, the advocacy group teamed up with marketing agency Doner to bring attention to melanoma using the ubiquitous period (as in the end of a sentence).

The campaign launched in late August in partnership with lifestyle website Popsugar and ran through September.

Doner’s team did some interactive coding to turn periods into tiny awareness videos when readers hover their mouse over them. The enhanced periods appeared on all of Popsugar’s health, wellness, and beauty articles. When readers rolled over the periods, a video popped up sharing one of five tips for detecting melanoma with a link to the Melanoma Know More website.

“One of the more forward-thinking digital tactics by an oncology organization was by Novocure for its glioblastoma, or GBM, cancer treatment Optune,” explains Jeff Greene, VP, digital strategy and insights, DRG Digital. The brand’s use of Facebook Live “was an impressive example of a company applying social and video best practices in a narrow disease state,” he says.

Deemed a success by Novocure, another Facebook Live event is already in the works. The marketing teams measured traff ic increases from Facebook on several pages of Optune’s website. One page received a more than 1,900% increase in traffic month over month after the Facebook Live event. Within 48 hours, the video had more than 12,000 views.

To promote the broadcast to the relatively small GBM community, which sees about 12,000 new diagnoses each year, Novocure partnered with patient advocacy groups to amplify the live event and promote it on its corporate and Optune social profiles. Its Facebook page has 80,000 followers.

“It’s important to test the boundaries so no matter how the end user is looking for info, it can get to them,” notes Novocure chief commercial officer Pritesh Shah.

Despite Novacure’s success, social media remains a tricky proposition for pharma marketers in the oncology space. To avoid possible pitfalls, oncology brands looking to

leverage social are connecting with consumers through patient advocates.

For oncology clients, Intouch Solutions looks to identify “people who have a voice and then provide a ‘microphone’ to that voice,” says David Mustalish, M.D., VP, group medical officer. “We don’t control the dialogue, but instead look to understand where those channels of communication exist, then promote those advocates where there is a synergy.”

These patient advocates are making sure drugmakers, payers, and providers are listening to their needs. Some are even going beyond social media.

Diagnosed with Stage IIB/IVA Hodgkin’s lymphoma in September 2014, Jonno Boyer-Dry, with his wife Allison, created CancerChatbot by CSource. CancerChatbot is designed to listen to the newly diagnosed patient speak to his experiences and feelings, then to provide info helpful to a newly diagnosed patient, something Boyer-Dry wished he had when he was diagnosed.

Clinical trialsNot typically thought of as a facet of patient engagement, which may be part of the problem, clinical trial units in oncology continue to struggle with a range of recruitment and access issues. There’s widespread agreement the space is in need of new thinking and tactics.

While the amount of clinical trials has exploded, participation is still less than 10% among patients. It is way below where it should be, says Parisi. “We have to listen to patients, allow them to help design clinical trial studies, and remove barriers.”

To that end, some companies have recently begun partnering with ride-sharing services Lyft and Uber to provide free transportation to the clinical research site.

The industry has expended significant effort to reduce complexity, bust myths, and provide

According to the NIH, based on growth and the aging of the U.S. population, medical expenditures for cancer in 2020 are projected to reach at least $158 billion (in 2010 dollars) — an increase of 27% over 2010.

70% of people use the internet to figure out what condition they may have before visiting the doctor52% use the internet to understand what they need to discuss with the doctor84% use the internet to learn about treatment options after receiving an initial diagnosis61% use the internet to learn about treatment choices and side effects

DRG DIGITAL, GOOGLE CONSUMER STUDY 2015 AMONG ONLINE PATIENTS

CLOSE TO 60% OF U.S. cancer patients say their health expenses have increased relative to two years ago

MORE THAN 8 OUT OF 10 U.S. cancer patients think pharma companies care about profit more than patients

SOURCE: DRG DIGITAL 2018


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more patient-centric perspectives, yet the needle for recruitment rates has barely moved. “We still approach clinical trial marketing with micro-campaigns for each individual study, and sometimes a small portfolio of studies,” says Angela Radcliffe, GM of clinical trial solutions at PulsePoint. “We usually create a study website with a survey pre-screener and a set of creative. These micro-campaigns come and go with minimal impact.”

One brand seeking to change the status quo is Eli Lilly, largely the result of the efforts of Joe Kim, senior adviser, patient experience and design innovation at Eli Lilly.

His brainchild, the Hero’s Journey art project, is a way for the company to thank clinical trial participants. Wood bricks are sent to trial participants. The recipients customize the bricks with words or art, then return them to artist John Magnan, who creates the sculptures. The first sculpture was unveiled during 2017’s South by Southwest and was on exhibit at the Livestrong Foundation HQ in Austin.

“The idea was to raise awareness of research in an authentic way, but also pay homage to the people participating,” Kim says. “We sometimes forget how intense this is for them.”

PulsePoint’s Radcliffe thinks the industry needs to go further. “We cannot thank clinical trial participants enough,” she says. “Free medication upon trial approval provides participants stock. Precaution must be taken to eschew coercive participation, but we know too well the story of participants unable to afford the medication they helped bring to market.”

HCP ENGAGEMENT: BRANDS MOVE BEYOND DIRECT SALES TO REACH ONCOLOGISTS

There are numerous ways to share info and communicate with HCPs and patients, but this has detracted from the meaningful relationships reps built so successfully, says Cooney.

“In the past, the strategy centered on the brand story with the e-detail or visual aid, and the pharma rep was the center of competitive comms,” he says. “However, new regulations have reduced the amount of interaction pharma reps have with doctors. Meanwhile, the number

of channels for sharing info has increased tenfold.” Access to oncologists continues to shrink, with some studies showing as many as 73% of oncologists are currently labeled as “access-restricted.”

But oncologists are hungry for info, and DRG’s research shows once a rep does gain access, oncologists are more engaged than other HCPs. “They need to be on the cutting edge and are more interested in hearing what’s new from pharma relative to their peers,” Greene reports. “Of all of the specialties we cover, oncologists are near the top in their interest level in engaging with pharma.”

Why aren’t more rushing to meet with pharma reps? Often the info delivered by the rep is stale or not relevant. Oncologists, like HCPs, “have an increasing intolerance to straight up promotion,” adds Greene. “They are hungry for science-based info.”

With protocols for cancer still being created and new treatments coming fast and furious, “if you think the rep will offer something of value, you’ll want to take that meeting,” he says.

“With so many new products and paradigms of care entering the therapy area, oncologists are looking for answers,” agrees Cooney. “The challenge is to provide customers with relevant answers rather than data and continue to build relationships between industry and providers.”

“The future for sales reps is less about, ‘How can I see a doctor?’ and more about providing the full spectrum of sales and marketing info to doctors via their preferred method of communication to increase engagement,” says Pratap Khedkar, managing principal at ZS Associates. “Even if certain physicians are ‘rep-accessible,’ they could limit access in the future. Sales reps who orchestrate all communication channels — including digital — to supplement sales interactions and cater to the physician’s preferences will experience the best results.”

“IN THE PAST, THE STRATEGY CENTERED ON THE BRAND STORY WITH THE E-DETAIL OR VISUAL AID AT THE CORE OF OUR PLANNING, AND THE PHARMACEUTICAL REP WAS THE CENTER OF COMPETITIVE COMMUNICATIONS”

DAVID COONEY, BLUE LATITUDE HEALTH

TWO-THIRDS OF U.S. oncologists say they’re more likely to visit a pharma website if it has scientific and educational resources

ALMOST 80% OF U.S. oncologists use physician websites weekly, about 13 percentage points higher than all U.S. physicians

80% OF U.S. oncologists have participated in an online conference, 11 percentage points higher than all U.S. physicians

SOURCE: DRG DIGITAL


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Brands need to offer oncologists a seamless follow-up process, where oncologists can go online to various resources or participate in an online conference to receive the rest of the story.

While in-person visits remain the most effective method for sales reps to communicate with doctors, pharma companies can no longer rely on these visits alone. Instead, they must personalize and coordinate new, alternative communication channels.

A strong, multichannel, digital campaign is a must, from peer-to-peer social networking opportunities such as online roundtables and podcasts to optimized sites to email programs.

Non-personal promotion is being made more effective and engaging through the use of multichannel marketing such as eblasts and quick-hit emails with a singular focus and call to action, notes Thomas Ferrara, associate creative director, Calcium. “It’s about building relationships over time without having to be face to face,” he notes.

The key is ensuring non-personal promotion is mobile-friendly. Because like other consumers, oncologists will surf the web on smartphones.

The trend of practice consolidation means companies are looking beyond just targeting individual oncologists, adding institutions and practices to their list of targets, with some adopting a “key account manager” approach to engaging large centers. John Strapp, cofounder and chairman of The Kinetix Group, says selling to large health systems is actually a B2B sell.

Password-protected sites and apps are also trending. Intouch sets up advisory boards for some of its oncology brand clients, and while there is an initial meeting, often at a conference, follow-up interaction is often through these closed social media sites.

“The board can engage in a safe environment,” explains Mustalish. “It allows clients to respond immediately to market development and keeps them connected throughout the year.”

The rise of influencersMedical oncologist Dr. Jack West has a modest online presence. He is followed by 13,000 people on Twitter, while his TEDx Talk, originally published in June 2011, has been viewed on YouTube just short of 5,600 times through late July 2018.

Although those stats may seem low by consumer standards, for drug companies

looking to engage with doctors, West is an A-list influencer. Along with his fellow connected opinion leaders (COLs), he represents a burgeoning opportunity.

While pharma companies have long partnered with key opinion leaders (KOLs), there is a new player emerging: COLs. It’s not that traditional KOLs have waned in influence. But where KOLs were once the sole tastemakers in medicine, they’re now joined by physicians who are savvy on social media and whom other clinicians enjoy reading for concise takes on trends, research, or new products.

“Five years ago, pharma didn’t know what to do with these people,” says Kilian Weiss, GM of Veeva Oncology Link, a subscription

database of oncology KOLs. “Now, they’re learning.” Over the past few years, Weiss has noticed an uptick in the number of pharma companies actively building relationships with clinicians and including them on advisory boards because of their digital followings. It seems social media presence has fully evolved from a drawback to a draw.

At the same time, some traditional KOLs, including Dr. Eric Winer, a medical oncologist at the Dana-Farber Cancer Institute, have grown interested in engaging with users online. Winer posts videos on YouTube with titles such as “What is HER2-positive breast cancer?”

Marketers are using social media listening to look across platforms and see who oncologists are connecting with.

“Five years ago, we began using a nuanced analytics approach, looking at how these influencers communicate with each other,” says Mustalish. “We are able to map out social connections, and use social metrics to see who the key thought leaders are, not just nationally, but regionally, as well.” •

“OF ALL OF THE SPECIALTIES WE COVER, ONCOLOGISTS ARE NEAR THE TOP IN THEIR INTEREST LEVEL IN ENGAGING WITH PHARMA”

JEFF GREENE, DRG DIGITAL


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Advancements in treatment:

A TIMELINE OF CHECKPOINT INHIBITORS

Immunotherapy’s modern era began in the early 2000s, according to Jeffrey Weber, Ph.D., deputy director of the Perlmutter Cancer Cen-ter, when Bristol-Myers Squibb began testing CTLA-4 antibodies in patients. Since then, pharma companies have alighted on a category of drugs that target an even more promising checkpoint: PD-1 and PD-L1 inhibitors.

Following the first anti-PD-1 therapy approval in 2014, the class of drugs has racked up 12 additional indications — melanoma, bladder, and head and neck cancer, among others — and more than 30 label expansions. Leading the pack of drugs by a notable distance: Keytruda (pembrolizumab), which is made by Merck, and Opdivo (nivolumab), which is manufactured by BMS. Both are PD-1 inhibitors.

The two pharmaceutical companies have been neck-in-neck for approvals, one gaining

an advantage only to have the other also be greenlit by the FDA for the same indication.

At the moment, Merck has the edge in non-small cell lung cancer (NSCLC), a big market. In 2016, Keytruda was approved as a monother-apy in the first-line setting for PD-L1 positive NSCLC patients. Opdivo, notably, failed as a first-line treatment.

And in 2017 Keytruda, in combination with chemotherapy, was approved by the FDA as a first-line treatment in all NSCLC patients, irrespective of PD-L1 status. This gives Merck an advantage, as more physicians are growing familiar with the drug, says Andrew Merron, Ph.D., executive director, oncology and biosimilars at Decision Re-sources Group. The more comfortable they become, the harder it will be for Opdivo to unseat Keytruda’s dominance. — Laura Entis CONTINUES ON NEXT PAGE


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EARLY 2000s Bristol-Myers Squibb begins testing CTLA-4 antibodies in melanoma patients. While promising in melanoma, they do not show activity in other tumor types.

MID-2000s BMS begins early-stage trials of PD-1 and PD-L1 inhibitors.

Unlike CTLA-4 inhibitors, they show activity in a variety of tumor types. “For the first time, you had a drug that seemed to have activity in more than just melanoma,” notes Weber.

Shortly after BMS, Merck begins devel-oping Keytruda, its own inhibitor that used a PD-1 antibody acquired in the company’s 2009 purchase of Schering-Plough.

MARCH 2011 BMS’ Yervoy (ipilimumab), which targets the checkpoint CTLA-4, is approved by the FDA for the treatment of patients with inoperable or metastatic mela-noma. It is the first checkpoint inhibitor to be greenlit by the agency.

SEPTEMBER 2014 Keytruda is approved by the FDA for malignant melanoma, becoming the first PD-1 inhibitor approved by the agency.

DECEMBER 2014 Opdivo quickly follows suit. It also receives FDA approval as a treat-ment for malignant melanoma.

MARCH 2015 Opdivo is approved by the FDA as a second-line treatment for patients with advanced squamous non-small cell lung cancer, making it the first checkpoint inhibitor approved for lung cancer.

SEPTEMBER 2015 BMS receives approval from the FDA to market a combination of Opdivo and Yervoy as a treatment for advanced melanoma.

OCTOBER 2015 The FDA approves Keytru-da as a second-line treatment for patients with squamous and non-squamous non-small cell lung cancer whose tumors express a protein called PD-L1, following chemotherapy.

AUGUST 2016 The FDA approves Keytruda for patients with recurrent or metastatic head and neck squamous cell carcinoma.

OCTOBER 2016 Keytruda gains a label expan-sion for PD-L1-positive NSCLC in the first-line setting, based on its significant overall survival and progression-free survival benefits over chemothera-py. Keytruda becomes the first immune checkpoint inhibitor to be approved as a first-line treatment for NSCLC patients, giving it a significant commercial advantage over its competitors.

NOVEMBER 2016 Opdivo receives FDA ap-proval to treat patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

MAY 2017 The FDA grants Keytruda a label expansion: It is now approved, in combination with chemotherapy, as a first-line treatment for NSCLC patients, irrespective of PD-L1 status.

Keytruda receives an accelerated approval for patients whose tumors have specific genetic features — MSI-H or dMMR — regardless of cancer type, marking the first time the agency has approved a cancer treatment based on biomarkers.

APRIL 2018 In a study presented at the American Association of Cancer Research’s annual meeting, risk of death among patients who received Keytru-da in combination with chemotherapy was reduced by 50% after a median of 10.5 months compared to patients who received chemotherapy alone.

Meanwhile, in a separate study presented at the same conference, Opdivo in combination with Yervoy reduced the risk of progression or death by 42% compared to chemotherapy in first-line advanced NSCLC patients whose tumors had high tumor mutational burden (TMB).

However, the data was too immature to show an overall survival benefit, and TMB is an unestab-lished biomarker.

JUNE 2018 The FDA accepts Bristol-Myers Squibb’s application to market Opdivo plus Yervoy for the treatment of first-line advanced non-small cell lung cancer in patients with high TMB. A deci-sion is expected in February 2019. •

Advancements in treatment:A TIMELINE OF CHECKPOINT INHIBITORS Below is a timeline of checkpoint inhibitors, including highlights in the approval battle between Merck and BMS.


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In 2012 Memorial Sloan Kettering Cancer Center refused to put Sanofi colorectal cancer drug Zaltrap on its formulary because it cost thousands more than a competitor’s product while delivering similar results to the incum-bent treatment.

That may have well been the start of a value-based sea change in the oncology land-scape, which until then was treated with a hands-off approach by most payers and providers.

“You are starting to see this more and more,” says Intouch Solutions’ David Mustalish. “Sloan Kettering has the authority to push those bound-aries. Once a large health system refuses to put a drug on its formulary, it softens the way for other centers to make similar decisions.”

The provider marketplace has also shifted dramatically. “In the past, the emphasis was on community oncologists delivering care. Today more and more treatment is delivered

in a large health system through an integrated delivery network (IDN),” notes Scott Du-litz, SVP enterprise strategy and corporate

development at TrialCard. “It’s tougher for community oncologists to survive in today’s reimbursement environment. Many are being acquired by hospital systems and IDNs.”

MARKET ACCESS MARCHES TOWARD VALUE-BASED OUTCOMES

“IN THE PAST, THE EMPHASIS WAS ON COMMUNITY ONCOLOGISTS DELIVERING CARE. TODAY MORE TREATMENT IS DELIVERED IN A LARGE HEALTH SYSTEM THROUGH AN IDN.”

SCOTT DULITZ, TRIALCARD


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Five years ago, the industry operated under the assumption payers were not going to man-age oncology treatments. Fast forward to 2018 — there is hardly an oncology agent that isn’t managed in some way. “No one wanted to end up on the front page of The New York Times be-cause grandma died from the insurance company denying her care,” observes Peter Weissberg, VP of market access at Intouch Solutions.

It’s a fundamental shift on the ground. Also, while there were a lot of me-too drugs

in diseases states such as diabetes before 2013, that wasn’t the case in oncology. Now, depending on the cancer, there isn’t as much differenti-ation among the drugs, experts say. Having undifferentiated drugs clinically gives payers the ability to manage. There are choices as to which treatment goes on formulary.

The rise in oral drugs has also contributed to the shift, allowing payers to more easily manage the formularies from an operational standpoint.

“These two developments mean oncology management is much closer to mass market cardiovascular and diabetes than it ever was five years ago,” says Weissberg.

“When you think about the oncology land-scape five years ago versus today, the amount of clinical innovation in the space has been off the charts,” notes Dulitz. “Just look at the targeted medications that have hit the marketplace — the cell therapies, CAR-T technologies, and other targeted therapies such as RET or PARP inhibitors.”

As personalized medicine and gene therapy emerge, there may well be friction as payers and hospitals look to implement a value-based

“MARKET STRATEGIES NEED TO BE APPLIED THROUGH THE LENS OF CHRONIC DISEASE”

PETER WEISSBERG, INTOUCH SOLUTIONS

care approach to treatment. “We are at a true inflection point in the use of value-based care, especially in the oncology space,” explains Stephanie Stadlin, principal, DRG Consulting.

“There is a lot of provider interest in value- based care,” agrees Dulitz. “There are over 500 provider practices that have registered to participate in the CMS oncology care model. As more and more commercial payers follow suit with those types of reimbursement arrangements will it become a standard for reimbursement in the government?”

Also gaining traction are more regimented and systemic plan processes across a broader array of tumor types.

“Pathways are a tremendous opportunity for significant management in oncology,” notes John Jaeger, partner, DRG Consulting. “We are starting to see a roadmap that leads to enhancement management in oncology.”

“Perhaps the big takeaway is you can’t launch a product now if you don’t get the insurance companies as a partner,” explains Mustalish. “You have to make your justification that you’re cost effective.”

Changes in market access also have broad implications in how oncology drugs are mar-keted. Five years ago, oncology was thought of as existing in its own universe. There was every other disease state, and then you had oncology.

Marketers are now realizing oncology can in some respects be treated similarly to other chronic disease states. Market access strategies need to be applied through the lens of chronic disease, says Weissberg.

“With some patients living for many years after a cancer diagnosis, market access realities such as open enrollments and the patient hit-ting their deductible are becoming much more relevant,” he notes.

Tactically, this means brand managers, who want the patient to stay on their drug long-term, must take a different approach to marketing. One engages differently with a patient if they are going to be on the drug for three months versus three to five years and more.

“As complexities increase, payers might look back at this point of time as the golden age of their ability to manage,” says Weissberg. •


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Healthcare professionals and patients expect a brand experience comparable to their experi-ence with Amazon or Netflix. “Although we are not meeting this expectation today, we are making measurable progress,” says Hans Kaspersetz, president and chief strategist of Arteric.

In the past five years, there has been substan-tive change in the quantity and quality available to pharma brand marketers and their partners. A wealth of analytic methodology and tech has been developed since 2013, including AI and machine learning.

In 2014, firms allocated 29% of their mar-keting budgets to online channels, reports Kaspersetz. In 2018, online marketing accounts for 41% of marketing budgets. This percentage is predicted to increase to 45% by 2020. “This increase bodes well for marketers because dig-ital tactics collect data nonstop,” he explains. “Brands that know how to mine their data and test their insights will make decisions that are measurably better than their competitors’.”

The wealth of data is arriving in boatloads from pay-per-click programs, search data, patient sup-port programs, medical information department inquiries, surveys, CRM programs, and deeper customer segmentation, to cite a few sources.

“The challenge continues to be how to use the data that is now available,” says DRG’s Stephanie Stadlin. “That is where AI will come in,” she says.

The industry has taken impressive strides in its use of data: unpacking the value drivers of personalization, organizing customer and clinical data, making advances in insights-based creative development, and adopting technology platforms for personalized marketing. “Data and analytics enable healthcare marketers to radically personalize healthcare consumer and clinician messaging to provide relevant and timely mes-sages congruous with and tailored to what their recipients need at that stage of their healthcare journey,” notes PulsePoint’s Angela Radcliffe.

Data-driven programmatic advertising is growing exponentially, the result of its ability to accurately target HCPs, including oncologists, says Justin Fadgen, chief corporate development officer at BulletinHealthcare.

The ongoing challenge is when teams fail to store, integrate, and liberate to their marketing

partners sufficient raw data to enable the depth of analysis required to personalize the experience for HCPs and patients, says Kaspersetz.

“These advances are functionally and organi-zationally siloed across agencies, data companies, and reasearch and technology firms,” says Rad-cliffe. “Challenges lie in data access limitations across those siloes and bridging the gaps with patient privacy sensitivity.”

Data is also helping to drive the use of real-world evidence, which extends beyond marketing to impacting treatment outcomes. In December 2016, President Barack Obama signed the 21st Century Cures Act into law, changing the way we view real-world data generated through touchpoints between oncology brands, patients, and HCPs, explains Blue Latitude Health’s David Cooney. “The use of real-world evidence, a direct result of this legislation, means we can analyze actual behavior and decisions around drug uti-lization and patient feedback, and can measure how real patients experience a drug,” he says.

“Compare this to the previous decade of data collection and analysis, where so much of our customer insight was from reported sources, sales,

and regulatory black boxes, and it’s clear this is a huge step forward for keeping the industry connected with the needs of the market in a more genuine and timely manner,” he adds. AI and machine learning were but a blip on the radar in the oncology landscape. “Now, we are beginning to see AI not only as an info aggregator, but also as a support structure of oncologists as they are thinking about treatment plans, given the rapidly changing clinical and commercialization envi-ronment,” says DRG Consulting’s John Jaeger. •

THE DATA CRUNCH

“IN 2018, ONLINE MARKETING ACCOUNTS FOR 41% OF MARKETING BUDGETS. THIS INCREASE BODES WELL FOR MARKETERS BECAUSE DIGITAL TACTICS COLLECT DATA NONSTOP.”

HANS KASPERSETZ, ARTERIC


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Peeking into the crystal ball:

WHAT CAN WE EXPECT MOVING FORWARD?

For the past five years, marketing and science developments, such as the growth of PD-1 and PD-L1 inhibitor drugs Keytruda and Opdivo, have dominated headlines. Here are a few predic-tions on what might be coming down the pike.

EHRs TAKE CENTER STAGE “Based on the data we are collecting, oncologists are looking to gain insights into population data to gain more information,” says DRG Digital’s Jeff Greene. “In the near future the electronic health record is poised to become the nerve center of the practice. Tomorrow’s EHRs will offer more than just access to patients’ records and will act as recommendation engines that make suggestions to physicians based on a wider data set than the oncologist has access to.”

Calcium’s Thomas Ferrara agrees. “Lever-aging advances in linked EHR technology, pharma marketers can meet oncologists’ data needs with real-world information for a clearer picture of the patient journey,” he explains. “For example, targeted email communications can be triggered by changes in the linked EHRs of patients with breast cancer. This could be based on events such as starting new medications, completing a medication cycle, or combining with another medication. So oncologists can receive marcomms — such as eCoupons and customized reports — that are most pertinent to their patient population and the challenges they


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face.” Taking this tech a step further, pharma companies can move beyond the typical “push” marketing that sends out waves of communi-cations to an interactive “pull” model. “This enables oncologists to choose or even request the type of information that is most pertinent to their practices,” says Ferrara.

CAREGIVERS MOVE TO THE FRONT Look for ongoing interest in the caregiver role in determining oncology patient outcomes, and the recognition that caregiver can mean any number of people in a patient’s life.

The assumption is caregivers are romantic partners, but they can be parents, adult chil-dren, or even non-romantic friends. Whoever is considered the caregiver, they will have more responsibilities because of newer, oral therapies. Their loved one won’t see the HCP as frequently.

CHANGING THE TRIAL PARADIGM How can brands move the needle in clinical marketing trial recruitment? “Content market-ing enables us to attack root-cause problems inhibiting clinical trial participation, including health literacy,” informs PulsePoint’s Angela Radcliffe. “An engaged, educated clinical trial participant is a retained participant. The head-lines, images, and content with which patients electively interact teaches us their needs and stage in their journey and tells a story.” This story better informs the patient journey, ex-posing new ways to empathetically approach the clinical trials and their potential.

PROMOTING BETTER OUTCOMESWith AI and machine learning leading the way, the industry will witness deeper investments in collecting and analyzing patient-care data to determine what patient types — not tumor types — perform well on a certain therapy. The idea is to see how a cancer patient’s genetics affects the success of a particular therapy. Upfront genetic testing may help patients understand which ther-apies they will be responsive to, and even be used to help determine clinical trials, says TrialCard’s Scott Dulitz. In fact, TrialCard is working with a diagnostic manufacturer that develops lab tests specific to oncology. “We are looking at genetic testing on the front end that can refer patients to commercially approved products or clinical testing based on biomarkers,” he explains.

WILL VR FINALLY HIT ITS STRIDE?Oncologists are poised to increase their use of VR for education and training, explains Greene. There is low use now, but very high interest to use VR to help patients manage the physical and emotional stress of chemotherapy, he adds.

For example, in the U.K., there is a project set to create VR lifesize or lifelike reproductions of tumor cells the physicians can rotate, look at, and explore.

As a method training, it is inspiring younger physicians to think differently about the mech-anism of cancer and treatment.

“There will be VR suites in cancer treatment centers where patients will go for mental and emotional support in addition to receiving their chemo biologic,” Greene predicts.

VR will become part of the therapeutic regimen, and may even extend life while cutting costs.

Pharma and cutting edge agencies are look-ing for ways to improve the patient experience using VR to improve the patient quality of life.

THE RISE OF PERSONALIZED MEDICINE “Personalized medicine aligns with what we call modern marketing,” says InTouch’s Peter

Weissberg. As mass marketing gives way to an approach that highlights personalized expe-riences, there is an interesting parallel on the clinic side, with the drugs themselves mirroring the progression toward personalized medicine.

“Maybe the old world way of marketing and approach to chemo — everything, everywhere, without really knowing if it was going to work — is disappearing,” muses Weissberg.

“Looking to the future, the drugs are going to be precise and personalized, and marketing needs to be, too.” •

“LEVERAGING ADVANCES IN LINKED EHR TECHNOLOGY, PHARMA MARKETERS CAN MEET ONCOLOGISTS’ DATA NEEDS WITH REAL-WORLD INFORMATION FOR A CLEARER PICTURE OF THE PATIENT JOURNEY”

THOMAS FERRARA, CALCIUM

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PARTNER PERSPECTIVES

Fred BassettCofounder and head of strategy, Blue Latitude Health

Oncology, like so many areas of medicine, is constantly evolving, and few therapy areas have benefit-ed more from advancements in genomics than cancer. Now, these innovations are starting to reach patients, and this means the way we differentiate products and deliver exceptional customer experience is changing, too.

The FDA’s novel breakthrough status has led to rapid approval times and faster regulatory, payer, and guideline adoption, meaning for a launch to be successful, speed to market has to be a priority.

The movement from volume to value focuses the industry on better patient outcomes, which are fueled by complex diagnostic tests and will drive healthcare profes-sionals and patients to request more specific information. To serve this need, greater collaboration between medical and marketing functions will become integral.

Meanwhile, significant numbers of products are entering the market simultaneously, reducing the length of time a novel agent remains novel.

On the one hand, this is great news for patients who deserve pric-ing competition. On the other, the role of a brand’s competitive strat-egy will change. It will be applied earlier in the product development process and will have a greater impact on the clinical development program before it reaches the mar-keting and sales stage and fulfills its traditional role.

At Blue Latitude Health, we’re experts in operating in novel spac-es. As a creative marketing consul-tancy, we combine the commercial focus of a consultancy with the creativity of an agency. This, cou-pled with our expertise in precision medicine and immuno-oncology, ensures we can provide the end-to-end support our clients need to transform patients’ lives.

For additional information, please contact [email protected] visit bluelatitude.com

Garth McCallum- KeelerManaging partner and chief strategic officer, Calcium

A common mantra within oncol-ogy marketing has been that it is ‘different’ and requires skills distinct from those used in other pharma categories.

While that opinion is debatable, it’s true the rise of sophisticated and highly targeted oncology therapies has made oncology more closely re-semble ‘specialty’ and orphan drug marketing. As with those disciplines, today’s oncology marketing must be holistic and unified while addressing the distinct needs of various stake-holders, including HCPs, patients, caregivers, patients, and advocates.

To be effective, oncology market-ing needs to be highly customized, responsive, and integrative.

This trend has already started with diagnostics-driven prod-ucts extensively leveraging direct-to-patient communications. The rationale for this is clear, since the potential treatment effects of these therapies is so significant, patients have a tremendous incen-tive to be actively engaged in the decision-making process.

As both HCPs and patients are activated and inspired by the ben-efits gained through personalized therapies, a much more dynamic en-vironment is created where dialogue and debate should be embraced as indispensable to better health and business outcomes.

Companies will be most suc-cessful when they are transparent in their comms and participate more as members of communities — genuine participants and stake-holders, rather than just marketers or communicators.

The advance of science has been exponential, and now is the time to advance our approach of engaging with treaters, patients, and commu-nities in more organic ways.

For additional information, please contact Garth.McCallum@ CalciumUSA.com or visit CalciumUSA.com

Meredith Terry, Ph.D. Lead behavorist, innovation and practice, MicroMass Communications

In today’s healthcare environment, real-world outcomes and patient experiences are critical to a brand’s success. Conventional pharma solutions that focus solely on driving brand awareness and adoption through data and messaging are not enough. These information-based approaches fall short of driving lasting changes in patient and provider behavior. In fact, research shows that at best, only one out of five patients are influenced by information-based approaches.

Pharma should address both the clinical and behavioral factors that drive oncology brand success. Clin-ical factors such as efficacy, safety, mode of administration, process of care, brand benefits, and quality measures are important. However, behavioral factors have as much of an impact on brand success as clinical factors.

Prescribing inertia, patient adherence, and patient reluctance to escalate therapy are factors that can impede or accelerate brand success. These cannot be changed with only the use of typical messaging or info-based persuasive approaches.

Evidence-based behavioral approaches are key to unlocking better oncology outcomes. These approaches aren’t about providing tips or persuading patients to make changes. They are fundamentally different because they engage patients and providers in a way that changes behavior.

Proven techniques from health psychology and behavioral science can change patient and provider behaviors and lead to improved outcomes for your brand.

For additional information,Please contact [email protected] visit MicroMass.com

Derek EvansSVP and GM, commercial effectiveness/brand analytics, Symphony Health Solutions

Significant amounts of data gener-ated by the proliferation of person-al medical devices, social media, and electronic medical records have the potential to transform the life sciences industry — but only if companies translate it into actionable insights.

The challenge lies not in col-lecting this data, but in harness-ing, curating, and analyzing it to create competitive intelligence. Patients, caregivers, providers, and manufacturers have more options via mobile technologies to better understand and engage each other to improve outcomes. And all the health data collected from these technologies creates new sets of data that can have meaningful impact on patient treatment.

For example, research identi-fied the BRCA1 gene, which lead to the establishment of targeted therapies to treat breast cancer and kicked off research which has now identified more than 2,000 variants whose impact on the disease are still being researched. This research led to the develop-ment of more directed therapies, which when applied to the tar-geted patient population has seen the five-year relative survival rate increase to 90%.

As precision oncology therapy continues to develop, healthcare companies need to understand how to best take advantage of the explosion of information to get the right therapies to the right patients to improve outcomes while decreasing development costs and increasing speed to market.

For additional information,Please contact [email protected] visit SymphonyHealth.com

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