Is DTC TV Really Effective? Really?

Studies have been conducted about DTC effectiveness since 2002.  The results are conclusive.  DTC marketing is effective.  In the early days of DTC, the emphasis was on TV and Print advertising.  DTC was being used mainly for drugs with very big budgets.  Prozac was the pioneer followed soon by Nexium, Lipitor and Viagra.  ROI on this advertising was quite remarkable. In our experience, these brands were seeing awesome returns on their investments, sometimes on the order of 5:1+.  Even brands with less than stellar efforts were seeing positive returns.  The learning was, DTC is a "no brainer".

Companies That Resisted Using DTC Marketing Learned A Hard Lesson

And yet, some companies shied away from DTC Marketing. While we worked with teh Nexium team, watching brand sales propel upward the primary competitor, Prevacid, stalling.  Its DTC efforts were no match for Nexium.  So Takeda decided to save the money and pull off TV.  The effect was devastating to the brand.  Nexium advanced stealing more share from Prevacid. If they did not pay attention before, Pharma companies were now forced to carefully consider DTC marketing. The learning 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 positive ROI is unlikely. Still, prevailing wisdom continues to be if you can get on TV, by all means do it.

Are Current DTC Television Ads Effective?

With a huge marketing budget, Nexium demonstrated how awareness can be turbo charged.  The brand decided to pick up the "purple pill" moniker which was developed by the parent brand, Prilosec.  This iconic moniker is perhaps one of the best ever delivered by a DTC brand.  When patients asked HCPs about the "purple pill" they almost always got it.   The impact was breathtaking.  Even after Nexium went off patent, patients continued to ask for it because they wanted a "purple pill".  And while sales certainly suffered, Nexium continued to sell well above LOE expectations. Another brand at AstraZeneca did not fare as well.  Crestor was launched to compete in the CV category against Lipitor.  Already Lipitor had established good awareness in the category and was fueling sales with strong DTC efforts.  AstraZeneca had learned from the Nexium example, so from the start Crestor had a large DTC budget.  However, patient awareness of the brand was not good.  Its early marketing was not noticeable and there was no image that patients could remember.  Thus sales were sluggish, mainly relying on HCP influence.  Crestor would not see strong sales growth until it released information from it Jupitor trial and was able to use strong clinical data about "plaque build-up" in its marketing.   With better awareness and this differentiating information, Crestor was then able to increase sales. 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 eye balls, 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. To start with, there is a very wide array of medications that can be used to treat migraine headaches.  Of course many patients will start with the OTC medications like Advil and Aleve.  For those with more severe symptoms, they will move toward Rx solutions.  And there are a lot of those.  From generic triptans used to treat pain to the latest CGRP medications which show a lot of promise for patients.  These are the medications that can become block blusters. Overall awareness of migraine medications is poor.  When polling 4,000 migraine patients in July 2021, none said they couldn’t recall a single brand name that could prevent migraine headaches. Patients had next to no awareness of how the latest therapies compared to older line therapies. The most recognized brand in the category? Topamax, which won FDA approval for migraine way back in 2004. Just as depressing, fewer than 1 in 10 patients remembered the newer brands, which have entered the market in recent years. The bottom line here is that these medications are failing to educate patients on their benefits compared with older line 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.
Lacking evidence that DTC is working in the Migraine space, marketers might be tempted to throw their hands in the air.  If patients are not paying attention, maybe they should stop trying.  When thinking this way, return to the Prevacid example.  In a cluttered category, giving up on DTC marketing is generally a bad idea. Returning to brass tacks of marketing, we know that TV is at the top of the funnel, best able to deliver awareness.  Because so many drugs are advertising, it may be very difficult for patients to remember any brand name.  However, because Nurtec has a clear clinical advantage it probably makes sense for that brand to turn its focus almost exclusively onto that advantage.  Television advertising should hammer that one clear idea.  Because it is exclusive to Nurtec, when a patient asks an HCP about the idea, they will almost certainly get Nurtec. In the category there are two brands using heavy TV advertising, Nurtec and Ubrelvy.  Both have decided to use celebrities in their advertising.  When testing both ads, we found that patients respond positively to these celebrities.  However, they also respond very favorably to the non-celebrities like "Ellie" shown in the advertising above.  Both brands can probably save the money spent on celebrity endorsement if they can apply it to more emphasis on their benefits in marketing.

Get Them Through Digital and On Your Website

Our work shows conclusively that the best DTC marketing initiates a sequence of investigations by the patient. Should the patient be interested in learning more about Nurtec, they will go to the website and gain the information they need to trigger the conversation with the HCP. Within all patients groups, over 40% consider internet information and websites very valuable sources of information. It will not surprise you to learn that a tiny percentage (4%) consider TV a good source of such information. And if patients search for awareness about brands on the Internet, a very large percentage of them will ask their doctors about them. Consider the TV effort a howitzer, used to have maximum awareness impact (but often not easily targeted). The multimedia activity, which is less sexy, is often the work that truly drives the sales.

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 from 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 people in the industry predicted that Network TV advertising would go away. They noted that it is clunky and annoying, with long commercial breaks. Who would put up with it? Those predictions did not come true and TV marketing is not going way.  However clients need to identify ways that they can be nimble and highly effective within their categories, using multi-faceted approaches.  Even brands competing with a smaller budget can compete effectively if they get the message and channel mix right. A lot has changed in the past 20 years since brands like Nexium, Crestor, Viagra and Cialis used TV top drive patient response. The ROI's of  TV advertising are certainly not so impressive (check MR analytics on this). And there are so many additional ways to reach and trigger patients. If you want a few examples, take a look at the marketing for Xiaflex and Krystexxa.  Using a much larger tool kit, these brands are achieving very impressive results!  It should not take much to be brave in this new environment.  To conclude, in many cases DTC marketing is effective.  Even in categories where the patient population is small.  If they patient plays an important role in the selection of therapies, DTC marketing should be considered.  It definitely is effective!