Humira A Historical Marketing Perspective By Emery James Baker December 10, 2011 This case study is a snapshot snapshot in time. That time period being the release of Humira in 2003, with market and sales preparations occurring occurring in 2002. The Arthritis market in general was estimated to be a 15.5 billion dollar market overall. overall. The 15.5 billion dollars dollars would encompass Osteoarthritis (OA) as well as Rheumatoid Rheumatoid Arthritis (RA). The RA sub market share in 2003 was approximately 4-5 billion dollars according to Emory Medical University and Drugchannels.net market data. Humira was in a good position to capture a large portion of of that market. Market capital estimates for RA were at that that time and even today hard to qualify. RA is difficult to properly diagnose and often left to the very specialized subset of physicians that ch oose to peruse arthritis as a specialty. Of ten RA specialists were undervalued undervalued and not as well compensated for their their expertise in the market. RA research and treatment in 2003 was not as widely accepted and therefore not as attractive to new physicians as some other form of study. It is important to note that the driver for any m arket values is fundamentally the result of research and treatment in that area. The proliferation (from a marketers/ marketers/ salespersons point of view) of an aliment directly influences i nfluences treatments available from the pharmaceutical industry. Therefore it is in the best interest of the drug companies to educate decision makers and physicians on the proper diagnose and treatment of disease in order to build a thriving market for their product. The number of individuals affected by RA i n 2002 -2003 numbered approximately 4.3 million worldwide with the American populous populous accounting for 2.8 million suffers. suffers. The demographic breakdown of the time is fascinating. fascinating. The bulk of the potential market lie between between 35 and 60 years of age stated as 63 out of 100,000 reported. 75% of those cases would be women. women. Worldwide population in 2003 was approximately 6 billion. The quoted statistics of the time claim that 1 percent or more of all women would develop RA over the course of their lifetime. Humira was in a position to capture anywhere from 1 to 2 billion dollars in market share during the first year of of release. Current market values have seriously changed over 2003. Rheumatoid arthritis accounts for a lions share of the the 16 billion dollar market. Arthritis suffers now number in at close to 50 million patients. We can clearly see that education education in the field and the ability ability to properly diagnose the condition condition has changed. Todays market cap for Humira is nearly 5 billion dollars according to Abbot Laboratorys annual annual report. This means that Humira accounts accounts for
32% of all RA sales and accounts for a very large percentage (6.5 billion) of abbots 36 billion dollars in annual net sales. In 2003 the Rheumatoid Arthritis market was much different than it is today by far as discussed above. RA treatment has changed dramatically as well. well. Abbot Labs stated their their approach to developing a market place for their product clearly in the case and by the end result review in 2010 we can see that the approach was very effective. The Abbot approach was not not groundbreaking but it was insightful. The fundamental fundamental concept is to educate and drive decision makers. This type of market development development is not restricted to to Pharmaceutical sales and marketing but it is more difficult in this field. Disease-State Education was defiantly appropriate. As a contrast Onglyza from Bristol-Myers faced a similar issue and did not prep their market, failure ensued ensued during Bristols launch. launch. Abbot educated the prescribers, payers and patients as to the severity of the disease and the methods of treatment in preparation to the Humira launch. The FDA has little tolerance for for drug marketing before approval however Disease education education is not constrained. Abbot made good use of of this opportunity. From our studies I can see opportunities for improvement using m odern technology in modern day terms as well as a limited subset of tools in 2002-2003. Our own course materials teach us that the application of interactive technologies opens new and exciting learning opportunities for the decision makers that drive the the entire RA market. Looking at E-Detailing and how these these tools can be applied we see with Telephone Detailing Services, Video Conferencing Services, Detailing-specific Web sites Physician Portals Web sites all can be applied to preliminary preliminary education efforts. The development of the Abbot Scholar program as well as the SONORA study was an outstanding idea. By driving the educational and career interest interest of physicians at the the early stages of Abbots release of Humira they drove later sales. It was not just Abbot and Humira that benefited, it can be argued that by driving education and the promotion of Rheumatoid Arthritis care Abbot brought much needed attention and development to an underserved community of patients. The additional of modern technology such as interactive presentation presentation and learning tools, web sites designed to educate and inform physicians as well as mobility tools for the sales force (principle contact for the physician and researcher) further advancements could be made. In the course curriculum we were exposed to new approaches to SFA and CRM, the use of these tools are principle to the efficient and up to date discrimination of quality information to caretakers worldwide. The more advanced and encompassing the means of delivering delivering needed information to physicians and consumers the greater the benefit to all. Personaly I would not have perused and sales and marketing model that promoted all patients with RA. The reasoning behind this this decision is simple and outlined within the the case itself. There is a protocol that is to be followed in the prescription of a Humira class medication. Also there is a certain combination of lesser lesser compounds that may be introduced with each each protocol. To rush
through the protocols and begin prescribing a level 4 RA treatment is not only questionable but may have serious adverse effects to the patients and ultimately the market itself. RA patients are usually lifelong suffers. suffers. The long term treatment will include a number number of levels 1-4 medications and the combination of these treatments in order to find the right treatment for an individual at that point point in time. To introduce Humira to early in the patients discovery process may very well lead to insufficient insufficient exposure to the medication. medication. Short exposure to treatments generally does not bring effective results. The outcome of rushing to level-4 treatment would undoubtedly be the abandonment of the treatment due to a lack of fast eminent results. DMARDs can take up to several months before before influencing the course of the disease. They can have se rious side effects, so blood and urine tests are used to monitor potential po tential effects on blood producing cells, the kidneys and the liver. People vary in their response to these medications, so the physician works with the patient over time to find the DMARD that is most effective. In addition humans become become less affected but medications over over time. This would result in the the abandonment of Humira as a treatment for that individual faster than if the protocol were to progress at a more normal rate. Sometimes long term care solutions are not not arrived at as quickly as sales divisions would like however they are prescribed for longer periods of time resulting a greater dominance in the market place; think of this approach as No drug left behind. With caution and in accordance with proper trials and fillings with the FDA additional research was definitely warranted in 2002. 2002. Several RA medications are prescribed for for non RA conditions. Actually the use Biologic DMARDs amongst psoriasis psoriasis sufferers. Later testing and advances advances for the treatment of Crohns disease were pursued. pursued. At the time of the product launch the the focus was the RA community. The FDA approval approval was for this treatment. treatment. Off label marketing would have had detrimental results for the the Humira launch. We learned in this semester the devastating effects of off label litigation and the sanctions imposed by the FDA that can result However even in 2002 2003 2 003 the possible benefits for Psoriasis and Crohns patients were known, this knowledge drove additional R&D for Humira and now the medication is well sold in both areas adding to its overall financial success for Abbot. Fundamentally the Humira marketing marketing campaign would emphasize a return return to normal life. A family of RA suffers (and to other degrees Psoriasis and Crohns Cr ohns Disease suffers) have become separated from their family members. members. In the case of RA the disease is severely life life altering, a Humira protocol can help the afflicted return to a more regular lifestyle and rejoin their families in the simple day to day activities activities that define their lives together. I would emphasize a welcoming back to common life li fe to these families.
I would have developed a digital digital marketing strategy of its own. Often online based digital campaign tools are added to a traditional marketing campaign, i.e. television, radio, print. Whether the message is educational in general or part of a DTC campaign, new media is often seen as a lesser add on. on. The time period was just post internet bubble, bubble, well within the peak of Gartner hype curve for digital development. development. There were a lot of young technology savvy people on the market looking for new but but stable opportunities. Web development and new media tools were raising businesses. Based on e-marketing techniques as seen in our course lectures well as Pharmaceutical Sales & Marketing Technology, the answer is digital sharing. Its hard to argue with the facts. 2/3 of physicians that made use of online portals and informa tion sources have changed their prescribing models. Broadband internet use use by doctors is rising at a tremendous rate and by every account those who drive the market want information at their own pace and schedule. Online education programs are complimentary to the steps Abbot took with the ACR announcements and Scholar programs; it would not be hard to justify Continuing Medical Education (CME). My digital marketing campaign would m ake use of all of the E -Marketing tools to various degrees, Pharmaceutical-sponsored drug information web sites for Drug information and treatment research. Physician Portals for clinical trial information when appropriate and sample re-orders if available. available. But the application of new tech does not stop there. There are so many ways to bring attention grabbing relevant data data to physicians. In addition live events such such as lectures with interactivity are possible. possible. For Humira direct patient contact contact through distance learning portals is appropriate for questions and follow on discussions via desktop tools. I do promote the use of Direct to Customer marketing. Lets face facts the modern day patient patient has a great deal to say about their care, they have proverbial skin in the game. As a modern day patient people often are under the impression that t heir care is too often decided by accountants rather than interested interested parties. This is the result of the modern day insurance model and the rise of HMOs. DTC fills the need need for information by the individual. individual. DTC precludes middle men and and as a result has the image of truth (at east east on the surface). With DTC the patient feels somewhat in control and at least a voice in their prescribed care.
Figure 1 Biologics for Rheumatoid Arthritis: Challenges and opportunities in tackling this crippling disorder Date Published:
20 Jul 2004
In the case of Humira Quality is the message message as well as a real solution here and and now. Humira is a pure human antibody not not a combination of human and mouse. Humira is very effective in its bonding characteristics and can be said t o have a higher degree of effectiveness and quality over its competition (although that margin is small and unqualified). That claim can be question and is subjective. One claim that is not subjective is the lack of availability of some of Humiras competition. There is a market opportunity opportunity for Humiras campaign. A real quality solution Here and Now. If we look back at the time period with modern day knowledge we can state observe the change in market dominance from Enbrel to Humira, being available to consumers at the right time has very long term advantages?
Figure 2 2009 Trends Trends Saurabh Aggarwal Nature Biotechnology http://www.nature.com/nbt/journal/v28/n11/full/nbt1110-1165.html
Yes very important. Humira pre-launch information gathering gathering made the perceptive determination that the product quality would be its strong point. We learn from the case study that value is the result of perception. That perception is the balance of Quality and Price from the payers point of view. In this case as in many cases the payer and the consumer are not for the most part, the same. First step in any pricing exercise is to determine determine who will be responsible for for actual payment. In the case of Humira that would fall upon upon the insurance carrier. The statistics from the case indicate that 80 90 percent of the actual drug revenue would be sourced from health care insurance. Insurance providers view product value from the perspective of quality quality over pricing. In the case of Humira the drug quality was determined to be slig htly higher than its leading competitor (Enbrel) but not overwhelmingly overwhelmingly so. Pricing Humira well below Enbrel Enbrel would undoubtedly undoubtedly capture the market and the favor of the health insurance provider but at what cost? Years earlier Hoffman La Roche attempted to corner a MS drug market with sub market pricing only to destroy the market. Price increases later in treatment protocols protocols are not well tolerated and significant changes in price are likely to force prescription changes, at the bequest of the payers. Humira also had another hurdle to overcome and that was the Medicare reimbursement patients. Medicare has strict guidelines for for RA treatment reimbursement the hinging hinging of which is mandatory physician or treatment center administration. Humira is self-administered and and
would not meet the guidelines. guidelines. Abbot combated this this issue with a free program to help Medicare recipients: Projhealth. Com January 13, 2003
Abbott Laboratories recently announced the launch of the Humira Medicare Assistance Program, an unprecedented drug access program that will provide its newly approved rheumatoid arthritis (RA) drug, Humira (adalimumab) at no cost to Medicare-eligible seniors without prescription drug coverage until a Medicare drug benefit is enacted. The Humira Medicare Assistance Program ensures that Medicare-eligible seniors in need of a biologic treatment for RA who do not have prescription drug coverage will be able to receive Humira at no cost until a Medicare prescription prescription drug benefit is enacted. Seniors interested in the program should talk with their health care provider. Eligible seniors will receive Humira directly from their health care provider, and access will continue as long as they continue to meet the eligibility criteria
Many drug companies help patients remain on their protocol with subsidies; Abbot Laboratorys program for Humira treatment was exemplary. Lobbying for Medicare Medicare changes are also an alternative and happen on on a regular basis not just as they apply to RA treatment. treatment. Final pricing for Humira was set slightly above a comparable Enbrel treatment. In order for the use of technology to be complimentary we need to decide on what market we will be servicing. In the time period that this this case was originally released Humira was approved for the treatment of RA. In modern time on label marketing can be done done for the treatment of RA, Plaque Psoriasis, and Crohns Disease. For RA whose main target market falls between the ages of 35 to mid-sixties, any use of technology for a DTC campaign may differ slightly from say a Psoriasis oriented DTC or even Crohns disease awareness campaigns. campaigns. The reasoning for the shift shift in approaches lies with the target age groups and genders. More common ground can be found in the use of technology as it pertains to educating specialists on the benefits of a Humira based protocol. The market has turned Social. Social media and supporting tools tools have dominated the space in very recent years. In years past, conferences, conferences, symposiums, were where industry professionals professionals would gather to discuss trends, trends, successes and new ideas as well as products. products. That is why I would leverage modern technology through Social Media as my platform for Humira marketing as well as traditional methods. Within the Sales Force Compliance article by Robin Robinson we clearly see the acknowledgement that digital methods of marketing deliver results. Social Media, audio and video streaming sources as well as those services that combine entertainment content with social grouping to produce powerful results. For DTC campaigns using modern technology I see social media playing a large role in this space as well. The best way to reach the market appears to be in those areas that capture and keep the customer within a framework. Enbrel Enbrel is one example, there are others. others. Facebook is no longer about Facebook its about the experience and support by third parties holistically. My
campaign will start with the communities and leverage all the new media methods such as in app advertising and streaming content opportunities Our submissions within this class during week 3 and week 4 explored Social Media as a platform for DTC. We looked at what the social media marketing marketing groups have chosen chosen to focus on. on. The best method to reach the new market is not just Soci al Media or Streaming Content or even in app advertising for DTC but a combination of all three. For physician and educators, sales organizations have a significant interest in social CRM, although not many have developed social CRM as a viable business tool. Soon, gone will be the Legacy Technology packages as we discussed discussed in Assignment 10. Progressive solutions including slate presentation platforms are becoming the new sales interface (IPads are receiving real consideration from sales organizations as mobile device alternatives to laptops). Opportunity management in a SFA tools ar e integrating Social Media (community portals, as well as public solutions such as Facebook). My approach would be to make the best of community components so I would make Opportunity Management a key component in my selection and marketing case for Humira. I would then turn the focus to field support and the mobile platform support each solution offers. In SFA tool selection for the sales force is simplicity is extremely important or the system simply will not be used appropriately. Finally tool integration and data sharing with CRM as well as sharing amongst the sales force is my next focus. The greater the sharing of data the more effective the SFA tool wil l be in increasing sales footprint per per agent and reducing wasted effort. Its not just about hardware, without the proper CRM, SFA and Social Media platforms the hardware tools are just baggage.
References:
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Stevens University Class Notes and Lectures Lectures MGT 672, Professor Elby Nash PHD
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World Population Monitoring http://www.un.org/esa/population/publications/2003monitoring/WorldPopMonitoring_2003.p df
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Abbot Labs annual Report http://www.abbott.com/static/content/microsite/annual_report/2010/index.html
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2002 RA Market Share http://managedhealthcareexecutive.modernmedicine.com/mhe/data/articlestandard//mhe/04 2004/82645/article.pdf
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Nature Biotechnology Online http://www.nature.com/nbt/journal/v28/n11/full/nbt1110-1165.html
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Abbot Helps Medicare Recipients Pr oHelath.com http://www.prohealth.com/library/showarticle.cfm?id=616&t=Arthritis
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CRM Vendor Market Guide for Software as a Service, 2011 Published: 30 March 2011 | Robert P. Desisto Michael Maoz Kimberly Collins
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Selecting the Right Smartphone Platform for Sales Force Automation Published: 10 June 2009 | Michael Dunne
