40% of launches fail and then stay below forecast. Now that’s scary. What’s a launch to do?

Kudos to Mark Tosh at the Medivo blog “Beyond The Pill” (http://pharmainsights.medivo.com/)  who calls out a must-read: McKinsey’s paper on pharma drug launches. Thanks, Mark for your analysis! And thank you, McKinsey Team for crafting an excellent piece. But let’s build on what they wrote. Mistakenly, I had thought the focus was going to be on “how to launch”; they focused instead on the different types of launches (based on strong data) not how to launch.  We will get to that. Check out this chart of launch performances on McKinsey.com/insights, publications for late March.     McKinsey on failed launches     This report broke their framework into four main insights:

  • Go for gold. Roughly one in four launches involves drugs that are strongly differentiated from competing products and treat diseases with a high perceived burden. Examples include Zytiga, Johnson & Johnson’s prostate-cancer treatment, and Januvia, Merck’s drug to lower blood-sugar levels in people with type 2 diabetes. Such launches run a substantial risk of companies believing that the product’s high quality guarantees high sales volume. Capturing their full potential still requires shifting substantial resources from in-line brands to finance the launch. Companies must avoid the “good data trap” by seeking out possible barriers to prescription and focus on capturing the potential as quickly as possible by creating maximum early exposure to the product, closely monitoring launch uptake, and correcting course if necessary.
  • Stand out from the crowd. At the other extreme, more than half of upcoming launches are of moderately differentiated products in well-established disease areas, and the priority is to find a way to stand out from the crowd. These launches must find or create an edge that will allow the drug to be positioned effectively for particular patient segments and create clear differentiation from existing competitors. This requires innovative approaches to unveil insights into stakeholder needs and behaviors that competitors do not have. Finally, product pricing is another means for creating differentiation.
  • Category creator. For roughly 15 percent of launches, the priority will be to establish unmet needs effectively to ensure access to a well-differentiated treatment for a targeted population. We call these launches “category creators.” Gardasil, launched in the unestablished human papillomavirus market, is an example. Companies must ensure they quickly understand the market’s unmet needs, make sure they don’t underinvest, and be prepared to react and course correct.
  • Market shaper. The remaining 8 percent of launches will face the substantial challenge of launching an undifferentiated product in an unestablished disease area. Once the decision to market such a product has been made, the priority for these market-shaping launches will lie in securing access for the product and effectively establishing unmet needs.

That is the core of the articles synopsis. Many insights and themes emerge. But I think the most shocking fact is in the pie chart: 40% of launches fall below forecast, never recover and keep dropping…anything in orange would scare me as a Brand Director.   No matter what type of launch you have of the four named above, you might still be in that 40% and Down Club. I have seen a lot of product launches.  By-the-pharma-playbook, DTC-heavy, the multi-channel dance, obsessed with audience needs, hyper-targeted orphan campaigns, or doing something breakthrough to make noise. When you look at two specific, incredibly complex categories like diabetes or oncology you see that rules of how to launch are more a mashup of the four categories listed above. Given the evolution of the science involved, you have a nearly blank Road Map.   In both categories, the explosion of science and different treatments just seem to pile on top of each other — how do patients and doctors keep it all straight? How does one PD-1 work for melanoma versus another? Invokana versus Victoza for glucose control? Well, if you are doing me-too marketing, if it feels non-authentic and you have not hit all the points of differentiation based on insight, then you will fall into the “noise” category of what might be a unique product with a message not getting through. McKinsey has an interesting conclusion — they basically advise not to try and get everything right for a launch, but focus on what you do best and really stress those strategies/strengths. They advise compromise, but I would look back at that orange part of the chart and say: go for authenticity, differentiation, pricing and the empowerment of science to drives sales and more cogent conversations between doctor and patient.   And as Mark Tosh would advise, go “Beyond The Pill” in serving the needs of all stakeholders. I leave you an example of what was a “Go for the Gold” but had at least 2-3 launches to get it right: Gilenya, the first oral for MS. Now that was big! But the drug had a REMS profile and some bad press and mediocre creative before it’s competitor, Tecfidera came along. Now, Gilenya has an amazing online presence…but is it too late? In 2013, Gilenya did over $500 million in sales; Tecfidera did over $800 million. I wonder if Gilenya is in the orange chart but using very strong patient community engagement to drive patient-driven demand.   Gilenta. 2nd page  3.24.14

Impacting Doctor’s work in the coming years? A lot more than medicine! Where does one start!

Someone recently asked me: how do you think doctors will learn new things over the next few years?

I was puzzled by the question, because I think another bigger question precedes it: what is influencing how doctor’s practice medicine, taking up what little time they have and  how will that impact how they learn over the next few years? Reality is, doctors are learning new things every day — and not just medicine! It’s not learning that is the issue, it is how they evolve in the face of such tumultuous changes and still stay on top of their medical news.

The list of what is consuming a doctor  is pretty daunting, and I will illustrate the complexity of the following issues by using infographics to give some dimension.

The issues seem clear (and though I list several that I view as hugely influential, this is not exhaustive, though the topic is exhausting!)

1. HUGE practice pressures doctor’s have never seen before. Wolters Kluwer put out some disturbing findings from a bi-annual HCP attitudinal study (http://www.wolterskluwerhealth.com/News/Pages/Survey-Physicians-Reveal-Top-Challenges,-Financial-Management-Concerns-and-Focus-Areas-for-Next-3-5-Years-.aspx):

Physicians were also asked about likelihood to leave their current practice in the next one to two years. Findings show that 34 percent said they are very or somewhat likely to leave. The top reason is that it is hard to make their practice profitable, as cited by 29 percent of physicians. Another 15 percent say the field is no longer rewarding.

Among other findings:

  • 83% of physicians find it challenging to keep up with the latest research
  • 80% at least sometimes use browsers such as Google and Yahoo for information, coming in as the second top physician information source after professional journals (84%)
  • 55% of physicians use both smartphones and tablets in their daily practice
  • Primary uses of smartphones are accessing drug information (72%), communicating with nurses and other staff (44%), accessing medical research (43%) and accessing evidence-based clinical reference tools at the point of care with patients (42%)
  • Mobile apps are the most heavily used digital/social media channel for physicians, used by 24%

 

2. Practice Technology/EHR: the shift from a human to technology-based practice. The looming Meaningful Use 2 guidelines, which will make information transparent (Meaningful) but the User Experience difficult (Use). And of course, when I bring up UX, the implication is that people will want to have an easy experience with their records across all devices/screens:

101-on-eye-tracking-how-your-eyes-move-on-a-website-infographic (2)

 

3. Becoming patient-centric: patients are being legislated to have more influence and control over their medical choices (despite lack of transparency, poor health literacy and FDA over-regulation of Communications.) What is more seminal is that patient-centricity will alter the current imbalance of the patient-physician dialog which is too fast, highly scripted, emotionally charged and not satisfying, and leaves patients with more questions than answers. Not that there aren’t a thousand good reasons for this imbalance, i.e. practice pressures, but it a reality that needs to, and will, change. Just read from Verilogue how dominant the physician is. Gee, wonder why almost 25% of Rx are never filled and adherence is low.

 

 drug abadonment

 

4. Patient Empowerment: Doctor as equal to patient, not the authority figure. This trend addresses this patient-doctor dialog imbalance — one that clearly impacts patient health. Ask patients how “transparent” they want their EHR Notes (specifically, their doctor’s unfiltered notes) to be, and this is one survey results:

 

 opennotes-infographic1 patient centricity

 

5. ACA/Outcomes/Adherence: while 7 out of 10 doctors blame ACA for rising costs, the fact is, costs are not rising, but pressures are.  But perception is reality. Now that the entire healthcare system shares one metric — “patient outcomes” — this brings a host of challenges to a model that always focused on new diagnosis and treatment but was abysmal with adherence, which of course has a direct impact on outcomes. Doctors will become deeply involved in adherence through EHR’s and other digital tools.

 

6. Mobile-Society: this seems like a technology challenge/issue but it isn’t. Mobile is about communication, it is our fastest form of satisfying our information needs. Doctors are incredibly adept now at moving between devices and are using them to squeeze in research time. Meanwhile. more and more patients are using mobile as a platform to search for health information, track their own health and seek peer influence from Social Media.

 

Google HCP Search behavior

 

Unlike my typical blog post, I have avoided making my usual number of insights, judgments and recommendations. This was a context post.  Letting the visualized data tell the story of a doctor’s struggles in a time of tumult is important if we are to understand the new stresses on doctor’s and how we still need to give them time to actually practice their craft.

We are in the middle of “turn-healthcare-on-its-head” time. To that end, I finish with a future-forward infographic that shows what lies ahead for patients and doctor’s and how the challenges the patient-doctor partnership face in the future will force a new — and hopefully better — dynamic relationship between the two:

 

doctor-infographic 4.17.14 MEDICAL_infographic_final