Does DTC Marketing Work?

  The industry has considered the effectiveness of patient marketing since 2002. The results are conclusive. DTC marketing works. In its early days, the emphasis was on TV and print advertising. DTC was being used mainly for drugs with very big budgets. ROI on this advertising was quite remarkable. Some brands were seeing awesome returns on their investments.  The lesson was that DTC is a "no brainer."

Companies That Resisted Using DTC Marketing Learned A Hard Lesson

And yet, some companies shied away from patient marketing. While we worked with the Nexium team, watching brand sales propel upward, their primary competitor, Prevacid, stalled. Its patient marketing efforts were no match for Nexium's. So, Takeda decided to save the money and pull Prevacid off TV. The effect was devastating. Nexium advanced, stealing even more of the share from Prevacid. If they did not pay attention before, Pharma companies were now forced to carefully consider patient marketing. The lesson was that if brand performance could be substantially impacted by consumer input, you needed to pony up the stakes. Even small brands with limited budgets found ways to get their brands on air. However, after the heady days when any DTC advertising could sell, with more brands advertising, it became more difficult to break through. DTC was confronted with marketing clutter. Certain laws of marketing now came into play, particularly developing awareness and moving this toward information delivery. We have found that there is a minimum amount of spend needed to develop awareness and a maximum level (somewhere above $100M), where a positive ROI is unlikely. Still, prevailing wisdom continues to be that if you can get on TV, then by all means do it.

Are Current DTC Television Ads Effective?

With a substantial marketing budget, Nexium showcased the turbocharging potential of awareness. Adopting the "purple pill" moniker, originally developed by the parent brand Prilosec, proved to be an iconic move for DTC branding. When patients inquired about the "purple pill," HCPs almost always prescribed Nexium. In contrast, another AstraZeneca brand, Crestor, faced challenges in the cardiovascular category against Lipitor. Despite a sizable DTC budget, Crestor struggled with patient awareness due to unremarkable early marketing. Sales relied heavily on HCP influence. It was only able to break through with patients leveraging information from the Jupiter clinical trial.  This trial showed that Crestor helped patients with atherosclerosis.  That terminology was difficult for patients to recall.  So instead, Crestor referred to "plaque build-up."  The message was a hit!

How Can Brand Break Through the Clutter?

Fast forward—we need to consider current marketing, where no brand has an iconic image (like Nexium), and most brands are like Crestor, lacking a clear point of differentiation. The challenge now is breaking through.  For example, in the highly contested migraine category, a large number of brands are using TV advertising and competing for eyeballs, attention, and awareness. They are also looking for that magic formula to trigger an HCP discussion. It seems that nobody has taken the high ground yet among patients.

Heavy Competition in the Migraine Space

While several of the migraine DTC campaigns show definite promise, we are not convinced that their TV efforts are paying off for them. A new survey from Phreesia Life Sciences offers discouraging news about the impact of DTC marketing in the migraine space.  Nurtec just struck gold with FDA approval that it both "treats and prevents" migraine headaches. However, this message is not getting through. A wide array of medications is available for treating migraine headaches, ranging from OTC options like Advil and Aleve to prescription solutions.  These include generic triptans and the promising CGRP medications. However, overall awareness of migraine medications is low. In a July 2021 poll of 4,000 migraine patients, there was minimal awareness of how newer therapies compared to older ones. Surprisingly, the most recognized brand was Topamax, approved by the FDA for migraines in 2004.  Newer medications are medications are falling short in educating patients about their benefits compared to older therapies.

How to Use DTC Marketing Effectively?

Figure 1: NURTEC ODT 75 mg is the first and only migraine medication to be approved for both acute and preventive treatment.
Marketers, lacking evidence of DTC effectiveness in the migraine space, might think about giving up. However, we've learned that giving up in a competitive category is not advisable. For brands aiming to build awareness with a budget, TV is the obvious choice. However, it's a broad approach with low targeting. Advertising Nurtec on TV was likely justified as it offered clear clinical advantages over other branded medications. Nurtec's exclusivity makes it highly probable that if patients notice the ad, they will inquire with their doctor about the brand. In this category, both Nurtec and Ubrelvy heavily use celebrities in their ads. Testing indicates positive patient responses to both celebrities and non-celebrities like "Ellie" in the above advertising. Both brands could potentially save money on celebrity endorsements and redirect it to emphasizing their benefits in marketing.

Get Them Through Digital and On Your Website

  Our research clearly indicates that effective DTC marketing prompts patients to initiate a series of investigations. If a patient is interested in learning more about Nurtec, they will visit the website to gather information.  This information becomes the basis for a conversation with their HCP. Among all patient groups, over 40% find internet information and websites highly valuable sources of information. Notably, a small percentage (4%) consider TV a good source of such information. When patients seek brand awareness on the Internet, a significant percentage of them inquire with their doctors. Think of the TV effort as a howitzer, aimed at achieving maximum awareness impact (although often not easily targeted). The less flashy multimedia activity is often the work that genuinely drives sales.  Some of the greatest opportunities come with digital marketing.

We All Know that Pharma is Slow Getting to the Digital Party

It will come as no surprise to anybody that Pharma is dragging its feet when considering Digital/Multi-Channel marketing. A new report by MediaRadar shows that even in categories where digital can be used very effectively, there is little movement of budget toward this channel. This runs counter to the marketing approaches used in all other industries outside of Pharma. It really seems like deja vu to the early days of DTC marketing when teams had to be convinced that it works. Our works shows without a doubt that digital marketing works.
There is always a brand that will be brave and buck the trend. Among the wide range of DTC brands, this is CABENUVA (HIV PrEP medications), which increased digital spending to 28%, up from 12% the year before (while other therapy areas were allocating between 5% and 16% of their budget for digital advertising). A large percentage of Cabenuva spending is going to YouTube, which is which is highly targeted. Cabenuva knows that its patient population is looking for information—and can find it through their marketing efforts online. They are nailing the demographic. And YouTube has many advantages over network TV.

Adapting to The New Environment and Choosing the Right Channels/Tactics

Years ago, some in the industry predicted the demise of network TV advertising.  TV was clunky and annoying, with long commercial breaks. However, those predictions did not come true, and TV marketing is alive and well.  Especially the latest variation of CTV. Even still, clients should focus on being nimble and highly effective within their categories, utilizing multi-faceted approaches. Brands with smaller budgets can compete effectively by getting the message and channel mix right. In the past 20 years, since brands like Nexium, Crestor, Viagra, and Cialis used TV to drive patient response, a lot has changed. The ROI of TV advertising is not as impressive now.  And yet, there are many additional ways to reach and trigger patients. For example, examine the marketing for Xiaflex and Krystexxa. These brands are achieving impressive results. It doesn't take much to be brave in this new environment.  DTC marketing is often effective, even in categories with a small patient population. If patients play a vital role in therapy selection, DTC marketing should be considered, as it is definitely effective.

Insights From Research Is The Cornerstone of Great DTC Marketing

AIM works with clients to provide insights that result in great DTC marketing.  When the client clearly understands the mindset and needs of patients, they can develop advertising that will "speak" to the patient.  Driving action.  That is the goal of our work.