Managing multiple conditions and a variety of medications has become something that many patients face every day, and this will be even more common as our society grows older. But it’s not just the elderly that are affected. Early intervention into a variety of conditions can help prevent symptomless health problems like high LDL cholesterol or hypertension from progressing into more serious medical events such as a heart attack or stroke, but this means that even middle-aged, active and otherwise healthy people can be taking multiple medications for many years. The result is that this is becoming the normal situation when communicating with patients.

The first thing that patients taking multiple medications want to know is often, “Will these drugs play nice together?” Hopefully the patient’s physician has taken this into account, but often patients are cared for by a variety of providers who may not communicate with each other, much less the patient, about the various medications they are prescribing. This is where the patient’s pharmacist can play a vital role in care, both by checking for interactions but also in counseling the patient. For this reason, many experts believe patients are best served by having all their medications supplied through a single pharmacy provider (generally a single store or more commonly, any location within a single pharmacy chain), a view I also share. When that is the case, it opens up a wealth of options for communicating with a patient, and multiple medications can actually mean multiple opportunities for communication to occur. But this must be done with careful planning and with a long-term view, and as much as practical and possible, messages should be tailored to the needs of individual patients.

The role of pharmaceutical brand teams (the client) in patient communication is to support the patient’s therapy by working with health care providers and carefully selected solutions providers to deliver information that supports the patient’s care. These messages are different than traditional DTC in that the brand team isn’t trying to generate general awareness and initial interest across a wide consumer audience; instead, and if conducted appropriately, these messages support the patient’s treatment by providing and funding information that the patient might otherwise not receive. Goals often include keeping the patient adherent to a prescribed therapy or, in some situations, informing a patient about additional ways their condition might be managed (such as the availability of a CRM program, additional information sources, or even an additional medication that they might want to discuss with their physician). To best serve the needs of the patient taking more than one medication, keep these principles in mind:

• Create Relevance through Segmentation Every marketer knows that audience segmentation is important, but think about WHY: because it allows you to speak to individual audiences in unique ways and with unique messages that matter to them. Patients taking multiple medications create many unique, addressable audiences with specific information needs based on the specific combinations of medications they are taking. Technology allows many of these segments to be easily created and addressed (for example, patients taking statins alone compared to patients taking a statin, an anti-hypertensive, and a medication for diabetes) with unique messages that will resonate with the individual patient because they offer information that speaks to their unique situation.

• Walk With the Patient Patients taking multiple medications often start each of those medications at different times in their life, and most have at least some apprehension with each new drug added to their therapy. Again, technology allows us to know when a new drug is added to therapy, and what drugs the patient is already taking. Instead of delivering the same message to every patient regardless of how long they’ve been taking your product, think about addressing the concerns of a patient just starting therapy differently than those of a patient that has been on the product for many months or years. If you combine this element of time with the segmentation mentioned above, you can create messages that really address the concerns a patient is likely to be having at a given point in their therapy. And don’t just speak to patients in the first few months of therapy! Although patients just starting on a medication may have special needs and be at somewhat higher risk of discontinuing therapy, there is proven financial value to maintaining ongoing support for a patient taking your product, in addition to the value it can bring the patient in their treatment. I like to call this process of addressing patient needs no matter where they are in their therapy, “Walking with the patient.” It can pay incredible dividends to the patient, their health care providers, and the supporting brand.

• Adapt, Change and Grow with Patients Don’t think that you can just create a series of messages, hand them off to your promotions manager and solutions provider, and be done with it. You probably aren’t doing that with your DTC campaign or the messages you deliver to your physician audience, so why would it be any different for communicating with your patients? When something changes in the patient’s world, think about how your message to them needs to change. New audience segments are created every time a new product comes to market, and sometimes those changes are occurring outside your immediate therapeutic class. Anticipate the needs of your most important audience segments and tailor your messages to meet those information needs. One example that might surprise some brand teams is the economic concern created by the recent financial crisis and the effect this can have on patients taking multiple medications. I’ve noticed some thoughtful (and smart) brand teams stepping up communication about their copay assistance programs to these audiences, which is a great example of adapting to the needs of the patient in a way that both helps them and prevents the brand from losing a valuable, long-term revenue source if the patient lapses from therapy.

• Know and Respect Boundaries I’ve heard product managers complain that they can’t address the needs of their patients unless the patient signs up for their CRM program, or “opts in” to a special program. That’s just not correct. Technology allows for the creation of audience segments, message sequencing and timing, and other factors that address and customize programs for patients – even those taking multiple medications – using de-identified patient data. The patient’s identity can be known to only the health care provider (such as the pharmacy) for many effective programs, and brand teams should take advantage of these technologies. Patients should be invited to join well-designed CRM programs and similar offerings that may require the patient to share at last part of their personally identifiable information, but don’t think you must know this to offer effective programs that meet the needs of specific patient groups, or even specific patients.

Patients taking multiple medications, even for multiple conditions, do have more complex information needs than patients taking only a single medication. But pharmaceutical brand teams can effectively meet those needs in a variety of ways if they keep these points in mind, work with their solutions providers to plan and update their communications on an ongoing basis, and above all, keep the patient’s needs top of mind as they design and implement their communications programs.

Have you ever seen the Seinfeld episode where Elaine’s friend has an ugly baby? Everyone is repulsed except the proud and smitten parents. Some brand managers are just like that;  they can’t see that their brand isn’t cute enough to be on TV.

When exploring whether DTC advertising is right for a brand, you have to see beyond the market opportunity and ask, and answer the the hard question, is my brand attractive enough to entice a customer in 60 seconds or is a “get to know you” brand? Frankly, if your brand is a “get to know you” brand then DTC advertising can force you to  expose the brand’s weaknesses without giving you an adequate opportunity to put its superficial flaws into context.

All Pharma brands have side effects and managing the communications of those side effects is one of the most important aspects of protecting your brand, especially to the public. Two cases in point are Xenical® and Viagra.

Example 1: Xenical­ – Huge opportunity with weight loss. Who doesn’t need to shed a few pounds? But are you willing to risk a humiliating and potentially career-threatening bout of “explosive diarrhea”? I think not.

Xenical is a “get to know you” brand and DTC advertising for Xenical was a crippling mistake and probably not necessary. The market research sized the market for weight loss products at $6 billion in the US – a potentially  huge windfall for Roche if Xenical® succeeded. Unfortunately, the mandated fair-balance was not very consumer-friendly and made it an easy target for Leno, Letterman, and Saturday Night Live. Years in prelaunch mode must have desensitized the marketing team to the impact of required warnings for Xenical, which should have been carefully considered before investing in DTC advertising.

Fast-forward to today’s Web-connected world. If Xenical launched with a non-branded DTC campaign coupled with extensive PR, targeted grassroots events, comprehensive physician education, and offered a weight-loss support group to ensure compliance, that would have been a successful approach.Today, through one-to-one marketing, each consumer can be qualified as a potential candidate, receive education on the pro’s and con’s of the Xenical, and get tips on how to manage the side effects to ensure success and avoid humiliation. Through customer selection, education, and constructive patient and physician dialogue, the benefits of Xenical could be put in the proper context.

Last year, GSK launch a low-dose Xenical by the name of Alli. Marketing expenditures were an impressive $150 million in the first six months. The campaign theme? Isn’t it time for a little honest talk about weight loss? Still, the product attracts a lot of criticism for understating its side-effect risks. Although 4 million have reportedly tried Alli, those in the know say that its commercial performance has been disappointing. Maybe a prescription medicine that shouldn’t be promoted DTC shouldn’t go OTC?

Example 2: Viagra – big brand, big dollars, small ads. I worked on Viagra personally and it was a great lesson on what works and what doesn’t. Marketing Viagra was unlike anything else in my experience.

Top-of-mind for every Pfizer marketer and agency member were two questions; will this improve the perception of the Viagra brand and what effect will it have on the credibility of the Pfizer organization? With all its overnight success, Viagra was a meticulously managed brand internally and externally. Perception was king.

The Viagra team excelled at managing perceptions. And despite the fact that every late-night talk show host used Viagra as a punch line in their opening monologue, the Viagra image was never tarnished.

Pfizer knew that combined with the general stigma of ED, the side effects of Viagra might keep a majority of potential customers from trying the little blue pill. The Viagra team very successfully used all DTC advertising channels like no one had before. Brilliantly, Pfizer used a 5-pronged DTC strategy: unbranded and branded DTC, events, sponsorships, and spokespeople. All of this was directed at removing barriers to discussion and building Viagra into a mainstream brand.

To achieve this, the Viagra team leveraged and carefully nurtured its number one asset – brand awareness. The drug’s novelty and newsworthiness put Viagra on the world stage and raised its awareness to a level that rivaled Coca-Cola. In a market research study, Viagra had 97% awareness globally and Coca-Cola had 99%. Viagra didn’t need to tell anyone what is was indicated for … it just needed to remind people it was available and acceptable.

Pfizer had a three-step DTC plan: De-Stigmatize, Define and Demand.

Step 1: De-stigmatize. Everyone remembers Bob Dole as Viagra spokesperson. The fact is, he wasn’t. He was a spokesperson for Pfizer Men’s Health, but from the onset, Pfizer and Viagra became synominous, so we exploited that. We used the credibility of Bob Dole to legitimize ED as a real and serious medical condition, unbranded. This was important groundwork for the rest of Pfizer’s DTC plan.

Step 2: Define. To help broaden the definition of ED and create demand for Viagra, Pfizer used a combination of educational events and brand assets to power the brand. NASCAR was a great success on the track and off. Supremely masculine, NASCAR helped solidify Viagra’s acceptance as a mainstream brand on the track. In the pits, the Pfizer Men’s’ Health trailer screened, educated and helped redefine ED as a condition commonly associated with high blood pressure, diabetes, smoking, etc. Simultaneously, Pfizer launched its non-branded “Faces of ED” campaign that helped broaden the target audience and further destigmatize ED, moving away from the Bob Dole heritage and moving towards an everyman’s problem.

Step 3: Demand. The luxury of being the only marketed drug for ED afforded Pfizer a great deal of flexibility. Importantly, they recognized it and took advantage.

Getting a man to seek treatment required great care and tact. We couldn’t understate the problem of ED, but we had to preserve the man’s masculine self esteem. Successfully, Viagra brand stood for confidence, virility, and life. Anything that countered that would jeopardize the preceding efforts. That’s why Pfizer strategically used 15-second reminder advertising to enhance its awareness and build appeal while minimizing the negative perception of such side-effects as hypotension, visual disturbances, and erections lasting four hours or longer. That discussion would be handled where it should be, in the doctor’s office.

The Viagra brand had sex appeal and Pfizer knew it. It is the definition of a “love at first site” brand.

As I mentioned earlier, DTC is evolving and for better or worse, many of the tactics employed by Pfizer would not stand the scrutiny of FDA’s current guidance. Nevertheless, brand managers must realize that their side-effect profile may be a serious liability in DTC advertising. Instead, the use of digital DTC advertising, mobile, for example, can help consumers engage in a dialogue with a brand, become better educated, and have a productive discussion with their healthcare professional. In today’s healthcare environment, with the increase of biologics and the increase of government scrutiny, I believe there will be more “get to know you brands” than “love at first site” brands. I believe, these brands will need to use broadcast DTC sparingly and online DTC intensely.