April / May 2017 by Healthcare Sales and Marketing Magazine

™ APRIL/MAY 2017

the publication for healthcare sales & marketing leaders™

THE TOP 50 BIOTECH COMPANIES IN THIS ISSUE Roundtable: Improving the Sales/Marketing Partnership CEO Benson Smith Explains How Teleflex’s Value Grew 4x in 6 Years The Orphan Drug Outlook Astellas, Otsuka and GSK Execs on the Consumer Revolution A Pulitzer Winner on How to Change Your Habits A Healthcare Marketer at the Oscars Helping Marketers Think Like Advocates

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the publication for healthcare sales & marketing leaders™

TABLE OF CONTENTS

Publisher’s Letter..............................................................................................................................................4 Editor’s Letter.....................................................................................................................................................5 Editorial Board....................................................................................................................................................7

ARTICLES Executive Spotlight: CEO Benson Smith of Teleflex..............................................................................9 Roundtable: The Sales/Marketing Partnership.................................................................................... 15 The Top 50 Biotech Companies................................................................................................................. 25 Orphan Drug Report 2017............................................................................................................................ 31 Pulitzer Winner Charles Duhigg on Changing Habits......................................................................... 39 By The Numbers.............................................................................................................................................. 43 The Consumer Revolution: Astellas, Otsuka and GSK Execs Comment...................................... 45 Motivideos........................................................................................................................................................49 Obesity, Allergies and Oscars.................................................................................................................... 53 To Be a Marketer, Think Like an Advocate............................................................................................ 57

3 | HS&M APRIL/MAY 2017

Publisher’s Letter

The Biotech Sector Continues to Impress From the immense activity in biotech, it’s obvious that healthcare is tilting in this direction to bolster the industry. At the same time, analysts of all types are cautiously optimistic about what’s happening here. Perhaps the best headline is that 70% of the companies on this list saw an increase in revenue over 2015, while 30% declined. Despite the fact that the IPO market didn’t perform well, biotech still was ahead of other sectors of the industry. It enjoyed three quarters of the healthcare deals, signifying how hot this territory is. Nevertheless, on the Nasdaq Biotech Index it still dropped by 21%. CARI KRAFT

There are encouraging signs in 1Q 2017, though. Biotech stocks have regained half of that loss, and we are looking to see further growth. Similarly, IPOs are showing some positive signs for this year, given the announcements of AnaptysBio, Jounce Therapeutics and ObsEva SA. On the downside, however, the Visterra and Braeburn deals didn’t come through. For 2016 as a whole, revenues for the top 50, at $264B, increased only at 4%. This compared weakly with the 2015 increase of 18%. And most of that went to the top ten companies. Combined, with at least $10B for each, their numbers comprise three quarters of the total for the top fifty. For a complex sector that has to spend more in development and take longer to get to market than traditional therapies, biotech is showing continuing energy. Although many of its products don’t make it from lab to shelf, those that do typically pay off in a big way. We look forward to seeing where the potential of this sector leads us in the next few years. And always, please keep the feedback coming. It all goes to making the magazine better for all of us.

Cari Kraft, Publisher CLICK HERE TO GET TOP 50 BIOTECH COMPANIES

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HS&M APRIL/MAY 2017| 4

Letter from the Editor

And Now, the Good News I could list all the complaints and anxieties we have in the industry today. But not in this column. For now, let’s look at the other side of the cloud. We continue to reduce the death rates from many cancers. And people are more likely to survive at least 5 years after being diagnosed with those cancers. And, despite the wailing about healthcare costs—which, admittedly, are higher than in other NEIL GREENBERG industrialized countries—our total nationwide spending is slowing, according to the Kaiser Family Foundation, which expects it to maintain a slower rate than we have experienced in recent years. Millions more people are insured. Medical advances in many specialties continue to make headlines regularly. Just since the middle of the last century, we have turned infectious disease deaths (which used to total over 100,000 a year) into treatable or preventable disorders. Most of the 1.25 million Americans who suffer heart attacks every year—who just a few decades ago had no thrombolytic drugs, beta blockers, stents or bypass grafts to depend on—can now return to relatively normal lives, with a more optimistic prognosis for their futures. In addition, we’ve become much better at heading off those heart attacks, with statins and other medications (not to mention a better understanding of lifestyle factors) to reduce the risk. The treatments for high blood pressure have significantly reduced the rates of kidney failure and stroke. More recently, we’ve almost miraculously turned HIV from a certain death sentence into a manageable chronic condition. We have also leapt forward in developing anti-psychotics that offer the prospect of reasonably normal living to people who formerly would have been institutionalized. Not to mention the progress that has been made on neurological diseases such as Parkinson’s, MS, and ALS therapies, which hold a promise of being reliably treated in the near future. And, as much as it has presented a high hurdle to the industry, the FDA has served a significant purpose in increasing the safety and efficacy of our products. We are not the only industry with regulations—and we are the one people depend on most. Here’s to us. And to the progress ahead. As always, we continue to look for the value of your contributions. Let us know if you have an idea for an article—the people we write for are the people who write for us.

Neil Greenberg, Editor To become an HS&M contributing author or provide feedback, please email me at ngreenberg@hsandm.com.

5 | HS&M APRIL/MAY 2017

THERE ARE SOME THINGS PEOPLE JUST WON’T TELL YOU BUT THEY’LL TELL US IN CONFIDENCE. AND WE’LL TELL YOU. There are a lot of opinions people never offer you about your company. What the pain is. What you could be doing better. What they think of your competition. How to talk to them effectively. Big corporations get these answers through expensive research. Small to medium-sized companies don’t have that luxury. That’s why we created the Private Process . It’s a quick, cost-effective way of compiling information that people will offer us in complete confidence. Then we assess the results and give you the insight you need to adapt your sales and marketing messages accordingly. ©

For details on how the Private Process works, and the kinds of answers you can get, contact us now at ngreenberg@hsandm.com.

™

Editorial Board

the publication for healthcare sales & marketing leaders™

Publisher Cari Kraft Editor Neil Greenberg Creative Director Hedy Sirico Digital News Rick Cataldo Digital News Chris Manning Sales Director Andrew McSherry EDITORIAL BOARD: Kristen Sharron-Albright Head of Marketing at Noven Pharmaceuticals Chris Bergstrom Associate Director, Digital Health Expert at Boston Consulting Group Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Lewis Chapman Vice President, Global Commercial Operations AllCells, LLC Maria Finlay, MBA Associate Director of Oncology Marketing, Teva Oncology Nick Gurreri Vice President New Products at Alexion Pharmaceuticals, Inc. Bob Roda VP and General Manager at BD © 2017 CL Media Inc., Philadelphia, PA CL Media is not responsible for any unsolicited contributions of any type. Unless otherwise agreed in writing, CL Media retains all rights on material published in HS&M for a period of one year after publication and reprint rights after that period expires. Email ckraft@hsandm.com.

To advertise in HS&M, please contact Andrew McSherry at amcsherry@hsandm.com

7 | HS&M APRIL/MAY 2017

Chris Bergstrom Associate Director, Digital Health Expert at Boston Consulting Group Chris brings almost two decades of commercial expertise as an entrepreneurial executive at large medical device and high-growth digital health companies, and he provides “on the ground” advice for implementing digital health solutions. He currently serves as the expert on digital health at The Boston Consulting Group (BCG). Before joining BCG, Chris was the chief commercial officer (CCO) at WellDoc, a pioneer in digital health. He also held progressive roles at P&G, Roche, and Becton Dickinson. Chris was a senior advisor to several digital health innovators, including MyOwnMed, LiftOff Health, HelpAround, Heart Beam, iSageRx, and Alere Home Monitoring. He also advised the Leona Helmsley Charitable Trust and the Saatchi & Saatchi Wellness Board. Chris holds two digital health patents and has won multiple awards.. Chris holds a Bachelor of Science degree from the Kelley School of Business at Indiana University and earned his MBA from Columbia University.

Sebastian “Sebby” Borriello Vice President, Chief Commercial Officer SK Life Science Sebby is currently service as the Vice President, Chief Commercial Officer at SK Life Science. Sebby’s career has included executive sales and marketing positions at Cempra, Mentor Worldwide LLC, Johnson & Johnson Healthcare Systems Inc., Ethicon, Inc. and OrthoMcNeil Pharmaceuticals, Inc. Sebby received his B.A. in Public Administration from St. John’s University in ‘81, and received his M.S. in Organizational Dynamics from the University of Pennsylvania in 2001.

Maria Finlay, MBA Associate Director of Oncology Marketing, Teva Oncology Maria has over 20 years of commercial marketing, sales leadership and operations experience. She has led multiple sales, women’s leadership, and cross-functional teams at Johnson and Johnson, AstraZeneca, and Teva Oncology. Maria has experience collaborating to launch and grow small and large molecule products across seven different specialty therapeutic areas.

Bob Roda

Editorial Board

VP and General Manager at BD Bob Roda is a Senior Commercial executive with extensive experience in delivering business growth and profit in the Medical Tech and Diagnostics Industries. He currently serves as VP and General Manager at Becton Dickinson where he is responsible for the global infusion therapy business. Prior to his role at BD, Bob held a variety of roles of increasing commercial responsibility within the MD&D sector at Johnson & Johnson. His diverse background included positions in Sales and Marketing at Johnson & Johnson Medical, Inc, Ethicon, Inc and Ortho-Clinical Diagnostics. While at J&J, Bob also served as the Executive Sponsor of the Commercial Leadership Development Program as well as the Chair of the VP Marketing Council for all of MD&D. He has a proven track record of delivering results and leading teams in competitive and diverse business environments. Bob is a highly respected and successful global leader. Bob holds a Bachelor of Arts degree in Economics from the University of Rhode Island.

Lewis Chapman Vice President, Global Commercial Operations, AllCells, LLC Lewis Chapman is currently the Vice President, Global Operations at AllCells, LLC.Â He has spent over thirty years in health care management. He served as VP of Global Strategic Marketing at BioMarin Pharmaceutical from 2007 to 2012, where he was responsible for strategic marketing and product portfolio analyses, and implemented medical education, brand enhancement and sales support programs on a worldwide basis. He oversaw the global launch of Kuvan, which in the U.S. was 112% to budget in 2008, the first year on the market.Â Previously, he worked with Alpha Inntech Corporation as Vice President Global Sales and Marketing, where global sales grew 26% in 2004 and 22% in 2005 under his leadership. Lewis started his career with Eli Lilly & Company, with roles at Syntex and Genentech, where he was responsible for the global commercial launch of Activase (t-PA), the largest biopharm product launch in the history of the industry up to that time (first year sales $187 million).

Nick Gurreri Vice President New Products, Alexion Pharmaceuticals, Inc. Nick Gurreri is a business leader and General Manager with over 25 years of consistently achievinghigh performance and profitability through strong leadership and cohesive team building in the biopharmaceutical and medical device industries. Nick has held executive positions at Medgenics, Insmed, Pfizer, Pharmacia and Bristol-Myers Squibb. Nick received a BS in Mechanical Engineeringfrom the University of Delaware, and also acquired a Master of Science in Information Assurance at Carnegie Mellon University.

Kristen Sharron-Albright Head of Marketing, Noven Pharmaceuticals Kristen Sharron-Albright, the current Head of Marketing at Noven Pharmaceuticals, was until recently VP Sales and Marketing, Anti-Infective Marketing and Institutional Sales Specialty Care Business Unit at Pfizer. She is an experienced business leader with 20 years of experience in the pharmaceutical and biotechnology industries. She has a strong track record of delivering results in highly competitive and complex markets. Starting her career in sales at Eli Lilly, she then held positions of increasing responsibility at Lilly, Neurogen, and Pfizer, where she was responsible for sales and marketing in a franchise business model. In her spare time she volunteers, serves on the leadership committee for her church, and enjoys hiking.

HS&M APRIL/MAY 2017| 8

EXECUTIVE SPOTLIGHT

How Teleflex Grew its Market Value 4x in 6 Years CEO Benson Smith details the Teleflex success story By the end of 2010, Teleflex was near the end of transitioning from an industrial conglomerate to a pure play medical device company. Its stock closed in 2010 at $53.81 a share, not much better than the anemic performance it had shown for the previous five years. To facilitate the transition, Teleflex’s board of directors asked Benson Smith (at the time a director himself) to take the helm and become CEO. Today, its stock is north of $190, about 4x the 2010 number. What happened in the interim? Although he credits his team for much of the progress, the leadership medal goes to Smith. Let’s take a look at his journey and how he brought Teleflex to its current status. 9 | HS&M APRIL/MAY 2017

In the 1970s Benson was in med device sales at Davol, which was later acquired by CR Bard. Early evidence of his talent was proven by his quick rise to president and COO of the company. Although Bard had bought Davol only for the foley catheter and intended to divest the sales force, they changed

their minds after viewing Benson’s process for re-structuring the sales force. When he came to Davol, Benson saw that the sales people fit the profile of the era: IBM-style men in tailored blue suits, with winning personalities. But obviously there

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EXECUTIVE SPOTLIGHT was a more complex equation to being a top-notch rep. The proof was that turnover was high, and overall performance wasn’t impressive. That all changed after Benson became intrigued by the work of psychologist Don Clifton at SRI1, who had developed a different kind of interview process, based on certain personality traits. Benson explains more about the process here. Ultimately, it was so successful at attracting better personnel that Bard used it throughout the organization.

One interesting side effect of these interviews was that they changed not only the quality of sales personnel, but balanced the gender mix as well2. Apparently, once you identify the right talents, you get a more diverse staff overall. Benson later went to Teleflex as a director, and ultimately became chairman, president and CEO, using the successful process he had developed earlier. He says “In 2011 we had a very poor reputation for our service levels. It became one of our top priorities to improve those. We even put the goal on our 2011 coffee cup. Consequently, everyone knew we had to get better at this. Under normal circumstances, it 11 | HS&M APRIL/MAY 2017

might have taken years. We managed to move much more quickly. As a coffee cup priority, everyone at all levels of the company chipped in. We made investments in inventory, and followed up routinely with our progress. By the end of the year we were named as the best supplier for the largest GPO in the US.” We asked Benson what contributed most to their commercial success. He indicated that there are four key strategies:

HIRING FOR A PROVEN SALES PERSONALITY

CUSTOMER ADVOCACY

BUILDING ON STRENGTHS

A UNIQUE MANAGEMENT PROCESS

1. THE SALES PERSONALITY One key area of focus was the sales team. Benson observes that “Only 3% of the population has the right personality for sales. Most companies not only don’t hire for the right traits, but they hang onto low-performing people even when they negatively impact the com-

pany’s progress. There’s too much focus on keeping these people from failing completely. The process that SRG (Sales Research Group) developed to identify the best sales people has two main stages, each designed to address the unique needs of a particular company. (Every company has its own profile for the right people, depending on what kinds of products and customers it has and what sales techniques contribute to success.) The first stage finds the top 25% of the sales force for the last 2-3 years, and the bottom 25%, and administers a TalentProfilerTM survey for all of them. This looks at 124 known traits, which are ultimately condensed into five categories key to performance. The five categories are Motivation, Trust, Asking, Organization, and Understanding. “It’s often a surprise to management when they find out what traits really make a difference,” Benson says. This leads to the development of an interview process for future hires, usually 60-75 questions that result in a score of A, B+, B or C. It starts with general questions (like “Are you reliable?”) and then probes further to reveal the accuracy of the interviewee’s personal assessment. Then, over time, the people hired (typically the A or B+ candidates) are re-assessed to evaluate their performance. This gives the company even more detailed insight into which are the prime traits they’re looking for. Prior to using this approach Teleflex tended to rely heavily on the candidate’s past experience and almost exclusively hired people with previous medical device backgrounds.

Unfortunately, past experience is not a very good predictor of future success. By shifting its focus to hiring people with the right matching personality characteristics, Teleflex expanded the window of candidates it is willing to hire. 2. CREATING CUSTOMER ADVOCACY We often take comfort in customer satisfaction scores. But that isn’t the measure we should be looking at: it’s customer engagement that counts, because it leads to customer advocacy, and hence to sustainable growth. In an article he wrote even before joining Teleflex, Benson explained it this way. The real goal of a publicly traded company is to achieve sustainable growth, the most reliable driver of shareholder value. High customer satisfaction scores do not necessarily link to this sustainable growth. Gallup Organization researchers William J. McEwen, PhD, and John Fleming, PhD, found that there was a difference in financial outcomes when they isolated customers who were both extremely satisfied with the company and emotionally connected to the company. They say that “Satisfying customers without creating an emotional connection with them has no real value. None at all.” But customer engagement scores have a very strong relationship with sustainable growth. Emotional connections are hard to create on the basis of a product or service alone. The sales force can make a significant difference in creating customer engagement— one that is exceedingly difficult for competitors to mimic. And engaged customers are much more willing to act as advocates by referring others to your company’s

product or service. Simply put, engaged customers help companies get other customers. Engagement derives from the relationship that develops between customers and the people who take care of them. But sales managers often look at how much a particular rep is selling; few know or understand whether their reps are actually increasing customer engagement each year. While product, service and people are all important, people make the biggest difference in advocacy. There are big differences from sales territory to sales territory where the product and the company are the same, but the salesperson is different. They’ve also noticed great sales people were more likely to ask customers to be advocates. “Doctor, would you mind writing a letter to the purchasing department asking for the product?”

“We found that the top 25% of the sales force was responsible for more than 90% of the customer advocacy that was being created,” says Benson. “The bottom ten percent were actually destroying consistent customer advocates.” To provide a key example, Benson pointed to Vidacare, a unique Teleflex product. “When patients need an immediate, high-volume fluid line—say, after a heart attack or auto accident—you often can’t use a standard IV line, because the veins are collapsed. Vidacare builds a small hole in the shoulder

that allows blood to be administered, even in a moving ambulance. It’s a one-of-a-kind product, which of course gives us a marketplace advantage. We’ve doubled market share in the three years since we’ve acquired it,” he says. “But, even with that kind of product superiority, that level of growth wouldn’t have been possible without the kind of sales personnel who inspire customer advocacy.” Those customer advocates in many ways acted like an extension of the sales force and often will interest their colleagues in using the product as well. 3. BUILDING ON STRENGTHS The next segue is to how the best sales people make these connections. “We found that they create advocates by building on their own strengths—the qualities that make them better and different.” Most companies spend a lot of time trying to identify weaknesses and correct them. “It turns out that this is exactly the wrong way around,” Benson explains. “The key to enhancing talent is to drive strengths. As the person’s strengths grow, their weaknesses become irrelevant.” Not surprisingly, weaknesses are easy to spot but focusing on improving weaknesses rarely yields positive results. An astute manager, on the other hand, who takes the time to understand what inherent strengths an employee has, will generate far better outcomes. This is related to what best-selling author Malcolm Gladwell explains as the “10,000 hour success rule”: “An extraordinarily consistent answer in an incredible number of fields... you need to have practiced, to have apprenticed, for 10,000 hours before you get good.” Where HS&M APRIL/MAY 2017| 12

EXECUTIVE SPOTLIGHT does that logic lead? No one is going to devote 10,000 hours to something they don’t like or are failing at. Benson remembered an incident from early in his career. “One high-performing sales person at Davol wanted to up his game. So he invited a regional sales manager to accompany him on calls and make suggestions. The sales manager was actually surprised to find that the rep’s presentation was, to him, rather bland, despite the extraordinary numbers. It turned out that, especially in his West Texas territory, a slick IBMstyle approach was not needed. What made the difference was how much customers believed him— and believed in him. That’s what led to customer advocacy. Two years later, that guy was named Salesperson of the Year.” As mentioned above, every company has a particular selling style that works best for them. 4. A UNIQUE MANAGEMENT CONCEPT Managers often feel they have laid out clear expectations—but studies show that employees don’t always agree. When they know what’s expected of them in explicit terms, they typically perform better. This is what Benson calls the Work Planning and Review System (WPRS). It’s best described in another article Benson co-wrote in which are outlined five key areas of focus that result in salesperson results, and subsequent customer loyalty: • Frequency: Great managers talk about expectations constantly, 13 | HS&M APRIL/MAY 2017

almost in every conversation. “Expectations are not static,” Bill G., one of the interviewed managers, told them. “They are dynamic. The less you talk about something, the less important people think it is.” • Clarity: Average managers tended to be vague, “Do the best you can.” The best managers discussed tangible, measurable outcomes. “Sell $1 million in new business this month.” Outstanding managers also ranked their expectations by defining excellent, good, average, and unacceptable performance in readily understandable terms. • Priority: Sales goals sometimes seem to conflict. Is growing the sales line more important than protecting gross margins? Is adding new business more important than preserving existing customers from a competitive threat? Great sales managers give unambiguous direction, and are also careful to set expectations about only the most important outcomes. • Consequences: Expectations without consequences quickly become meaningless goals. The best managers tend to focus more on the positive consequences that result from meeting or exceeding expectations, but they are also clear about what will happen if employees fail to meet those expectations. • Individualizers: People learn and respond differently. The best managers set expectations depending on the employee involved. Some sales reps want to be actively involved in setting goals; others would rather leave this to managers. Some are more productive if managers frequently follow up on

their progress. Some want help or advice. Pay attention to what best helps each individual salesperson succeed, and set expectations accordingly. As an example of the above, Benson explains that at Teleflex, annual performance reviews have been substantially eliminated. No one particularly liked them anyway. In place of that, managers have regular six-week meetings (frequency) with employees, and set an agenda for what needs to be accomplished in next six weeks (priority, clarity, consequences). Then they examine what resources or support are needed to achieve that agenda (individualizers). At the end of the year their annual review is basically the sum total of those six-week meetings identifying the employees’ accomplishments. In very dynamic business environments, where priorities can shift considerably during the year, this approach helps make sure that employees’ priorities are re-focused throughout the year on accomplishing the most important tasks. THE RESULTS The proof of Benson’s strategies for choosing the right employees and managing properly is in the hard numbers: Teleflex revenue grew from $1.4B in sales in 2011 to a projected $2.1B this year. This also makes a difference in their image as a company: T. Rowe Price, Fidelity and other Wall Street firms rate them highly. In the book Discover Your Sales Strengths, which Benson coauthored with Tony Rutigliano, talent is described as “a pattern of thought, feeling, or behavior that

can be productively applied,” and they describe 34 theme names that describe different traits salespeople can embody (Achiever, Command, Empathy, Fairness, Self-Assurance, Strategic, etc.), including a salesperson’s top five dominant, or Signature Themes. By defining a clear vocabulary of sales strengths, leaders, managers and salespeople can talk knowingly about their strengths. Benson has an analogy that sums up his approach to the best management style. “The next time you’re in your seat waiting for a plane to take off, consider how many things have to come together to ensure that the time is right. The pilot and crew have to be in place; the mechanics have to sign off on the craft’s readiness; the passengers have to be properly seated; the weather has to cooperate; the runway has to be clear. It’s incredibly complex,” he says. “Well, a business isn’t much different. Product, service, management, sales and other elements all have to be tuned up and working at their optimum to ensure success. It’s that confluence of competence that predicts where your company is going.” • To learn more about how SRG’s behavioral assessments can drive breakthrough results for your sales organization, visit salesresearchgroup.com and request a demo. SRI was Don Clifton’s company at the time. It eventually bought Gallup. SRG is a spinoff company founded by ex-Gallup employees 1

This is similar to the effect major symphony orchestras experienced when they started auditioning musicians behind a screen. The inherent prejudice that women couldn’t play certain instruments as well as men disappeared, and the gender balance changed significantly. 2

Benson Smith CEO, Teleflex Mr. Smith was named chairman, president and chief executive officer of Teleflex Incorporated in January 2011, after serving on the Teleflex Board since 2005. Prior to 2011, he was the founding partner of Sales Research Group Inc. (SRG), a talent assessment and behavioral science research and consulting firm where he originally developed TalentProfiler™. From January 2000 to December 2005, Mr. Smith was a speaker and an author at The Gallup Organization. He also served as the leader of Gallup’s Global Sales Force Effectiveness Practice. Prior to that, Mr. Smith worked for C.R. Bard, Inc., a company specializing in medical devices, for approximately 25 years. At C.R. Bard, he held various executive and senior level positions culminating as president and chief operating officer until 1998. He also served as a member of its board of directors. He was previously on the board of Rochester Medical Corporation and chairman of the board of Zoll Medical Corporation until its sale to Asahi Kasei Group in April 2012. Today, he serves on a variety of academic and health-related organizations. Teleflex is a global provider of medical technologies designed to improve the health and quality of people’s lives. They apply purpose driven innovation—a relentless pursuit of identifying unmet clinical needs— to benefit patients and healthcare providers. Their portfolio is diverse, with solutions in the fields of vascular and interventional access, surgical, anesthesia, cardiac care, urology, emergency medicine and respiratory care. Teleflex employees worldwide are united in the understanding that what we do every day makes a difference.

COMMENT HS&M APRIL/MAY 2017| 14

ROUNDTABLE

How Sales and Marketing View the Partnership And how these professionals can work together more efficiently

With moderator NEIL GREENBERG Editor, Healthcare Sales & Marketing

Our panel of experts: JOANNA BEEMAN

HENRY LEVY

VP, Content Director precisioneffect

Chief Strategy Officer Veeva

VRAHRAM KADKHODAIAN

BRIAN PETERS

CEO Prolifiq

15 | HS&M APRIL/MAY 2017

Vice President of Marketing Medac Pharma

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ROUNDTABLE Sales and marketing are on the same team, but often not on the same path. Given the same goals but different tasks, they sometimes don’t mesh as well as they might. Do sales people use marketing messages in the way they’re intended? Do marketing people provide the tools that help the sales division meet its targets? What is the world view of each? For this roundtable, we purposely turned to a panel with varied backgrounds to get a look at different perspectives into this landscape. To get take a mix of viewpoints we looked for input from creative, strategy, commercialization, and early stage pharma. Read on for their point of view—and send us yours if you have other wisdom to add!

What are the challenges to sales and marketing based on the current healthcare landscape in the U.S.? BRIAN PETERS: Increasing regulatory challenges, the impact of pricing pressure, the constant need to develop innovative products in highly competitive markets, and tightening budgets all have an impact on sales and marketing teams across the industry. VRAHRAM KADKHODAIAN: Healthcare has been a late adopter when it comes to technology in general. They are competing with increased regulation, constantly changing reimbursements and competitive pressures. Sales and marketing teams are going to market with technologies they used 10 years ago and expecting unrealistic results. These technologies are not designed, nor set-up for the success of their people or organizations. JOANNA BEEMAN: The combination of a complex market and diminishing access to HCPs makes 17 | HS&M APRIL/MAY 2017

it rough out there for sales specialist. Half the time they can’t see a doc, and when they can, they’re taking two of their three minutes of your call to explain their indication. There is so much innovation, so much data…HCPs are in a bit of an option overload, and it’s causing some to stick to their prescribing habits. Unless we make it simple for HCPs to understand a brand’s value, can we really blame them for doing that? HENRY LEVY: Today’s innovation is being fueled by the shift to specialty medicines and more precise treatments that are customized for rare diseases and individual patients. The focus on precision medicine coupled by changing expectations of HCPs is having transformative implications on the life sciences industry. With more specialty drugs and treatments, manufacturers have a greater obligation to educate and inform providers for the benefit of their patients. Most life sciences companies aren’t structured to operate in an environment with less

access to doctors, a broader ecosystem of varied stakeholders, and an insufficient response to digital transformation. For the doctors, uncoordinated experiences with companies can lead to inconsistent messages and information, creating risks of regulatory compliance. All of this is prompting the industry to make the leap to digital and take advantage of new commercial engagement models. So, as the shift to specialty medicines accelerates, digital transformation in life sciences will not only be inevitable, but also drive new levels of operational efficiency and speed. Winning companies in the digital era will fully reimagine their sales and marketing operating models, leverage disruptive, innovative technologies. What are the differing world views held by sales and marketing? VRAHRAM KADKHODAIAN: They have the same intentions and goals, but different vantage points. They don’t necessarily understand each other’s challenges, which makes the relationship very difficult to navigate. Also, adding to the complexity, they aren’t aligned on technology or process, making for an awkward relationship in most cases. BRIAN PETERS: At Medac Pharma, there’s not much difference in the views between sales and marketing, as we truly all have a shared goal of driving our brand to be successful. We try to have everyone working in harmony. Our corporate culture encourages respect for one other and establishes processes and technologies

PRICING PRESSURES LIMITED HCP ACCESS SHIFT TO SPECIALTY MEDICINES

DIGITAL TRANSFORMATION

that support open collaboration so teams aren’t working in lonely siloes. Certainly, there are prejudices that exist in some organizations, and I’ve seen examples of these at different times and in different places during my 28-year career. For example, if sales’ view of marketing is innately antagonistic, then they might just reduce the work of brand teams to that of “making pretty pictures that don’t help us reach our goals.” Alternatively, if marketing has an antagonistic view of sales, then they argue that the sales teams are being difficult and “refuse to leverage our materials, causing a lack of consistency in messaging.” What are sales’ priorities? VRAHRAM KADKHODAIAN: Sell value, sell compliantly and collaborate effectively with internal and external teams. They are in a tough spot, because they

have overwhelming administrative and reporting demands from HQ, but nobody in HQ is focused on how to actually help them sell and collaborate more effectively. Plus, they are all competing for the same mindshare with respect to the customer and must sell in a highly-regulated industry. BRIAN PETERS: Sales teams want to drive product sales—it’s really as simple as that. They need the tools to develop strong relationships with their customers continuously over time. They also require the tools and technologies to act efficiently, like having the right customer reference and account data that’s always up to date so they can have the right conversations with the right healthcare professionals. What are marketing’s priorities? BRIAN PETERS: Marketing teams’ top priorities are to increase

brand awareness amongst the target audience and create offerings that have value for customers. At Medac Pharma, we strive to establish consistent messaging across all channels. So, whether our customer interaction is in person via a sales rep in the field or through non-personal engagement via digital channels, we work to ensure consistency to ensure the best possible customer experience with our organization as a whole. VRAHRAM KADKHODAIAN: Content creation, approval, version control and sales alignment. How do they get effective messages out quickly, compliantly and effectively? Marketing is challenged with many competing priorities, none more costly than infrastructure (technology) and compliance (FDA, HIPAA, etc). They have to ensure they, and their sales teams, go to market leveraging the approHS&M APRIL/MAY 2017| 18

ROUNDTABLE priate content that not only helps them differentiate their unique value proposition, but also keeps them sheltered from legal exposure. How can we get over the hurdles? HENRY LEVY: The key is to unify teams and strategies around centralized information and harmonized engagement practices. By taking a look at foundational processes and systems, companies can break free from the limitations of previous models in order to deliver the consumer-like experience healthcare stakeholders have come to expect. One important change that life sciences companies can make in an effort to unify commercial teams is to establish a common understanding of who all key stakeholders are, and their history with the organization as a whole. This is foundational to an effective customer experience but challenging today with so many silos between sales, marketing, and increasingly crucial medical teams. Just knowing that an interaction took place—without any sensitive details—can provide a foundation for more informed commercial engagement. For instance, knowing a stakeholder has progressed to the point of engaging in scientific exchange with a medical science liaison can indicate a shift in clinical beliefs. Often, increased customer interactions with medical affairs can indicate greater affinity with the brand’s value proposition. Visibility to this information enables commercial to refine alignments, excluding high-priority medical stakeholders from broader communications. 19 | HS&M APRIL/MAY 2017

VRAHRAM KADKHODAIAN: People, process and technology. Too often, organizations throw people at the “hurdles” to solve issues, instead of taking a step back and looking at all three. Some organizations have the people and good process, but very few leverage their people with good process and technology to solve their endto-end go-to-market challenges. BRIAN PETERS: I agree. At Medac Pharma, we work in a culture of collaboration whether that is between sales and marketing or regulatory and manufacturing. We respect one another, and that resonates from the top down, across markets and across functional areas. I think this is particularly crucial for a smaller organization. Medac Pharma succeeds because we take full advantage of all the great minds and talent at our disposal regardless of each person’s title or function. Technology, however, is the enabler of this culture of collaboration. The cloud brings people and processes together to allow easy, automated, fast information sharing enterprise-wide. Specifically, cloud technology makes it very easy for marketing to know what sales is doing and vice versa—and this not only creates significant business advantages but it also fosters mutual respect. For example, we leverage a cloudbased multichannel CRM that it tracks all the multichannel nonpersonal promotional efforts so that sales know what marketing is doing and vice versa. Thanks, in part, to our integrated data solution, we maximize our touch points with our HCP, pharmacy, and payer audiences.

What shifts have happened as a result of the focus on patient centricity and the doctor/patient relationship? VRAHRAM KADKHODAIAN: Information gap. Patients need more information and different types of information than physicians and clinicians. We are in an “information overload” society right now, with many different resources as consumers to get information. Healthcare firms, especially medtech, need to get much better at differentiating on value and providing relevant content in the manner patients and physicians are expecting to consume it. The digital/social landscape of healthcare is very real. It’s real in every other aspect of our lives and the organizations that understand that, and invest in it, will be better positioned to benefit from it. JOANNA BEEMAN: What is notable is a more earnest effort to communicate the emotional benefit that an HCP will get out of offering a product to a patient. There’s a shift toward arming the HCP with the hard and soft data of a brand— of course the clinical outcomes, but also the emotional value a product plays in support of the patient’s goals. Amgen’s Aranesp comes to mind — “An Opportunity to Intervene.” And Opdivo as well — “A Chance to Live Longer.” These are not just campaign headlines; they’re words a doctor can use with the patient. There’s incredible utility in that—in teaching an HCP how to introduce a product in such a way that the patient is bought in to the treatment experience. Patients today want real conversations because they are approaching

medical intervention as consumers. So the most exciting shifts are the ones in which brands are responding to that with conversation guides, point-of-care tools, and digital offerings that support the HCP in having a productive, transparent dialogue. What has changed for sales and marketing in terms of the regulatory atmosphere? VRAHRAM KADKHODAIAN: Everything. This is very complicated and process and technology need to be evaluated regularly to meet this changing landscape. Organizations need to partner with the right vendors to ensure they can keep up with the demands that aren’t predictable. BRIAN PETERS: I think risktaking has gone down. Overall,

the pendulum has clearly swung towards being more conservative. JOANNA BEEMAN: Turbulence in the regulatory climate probably has most of us a little leery. Any time there’s a new administration that brings in new FDA appointments, there’s a little bit of a feeling-out period for our industry. Yes, we’ve heard some hyperbolic statements about how “easy” things will become, but what does that mean in terms of our obligation to existing FDA guidelines and respective MLR teams? I think we can only stray so far in the spirit of exploration. What has worked at your company or others to bridge the gap or create a streamlined salesmarketing team? JOANNA BEEMAN: It is always

preferred to work directly with sales specialists when we’re in discovery for a major marketing piece, like an eCVA. We work with marketing to find one or two specialists who will be our point persons want to hear about their experience with the current tools first hand. We want to see their beat-up, dog-eared, and markedup CVA to understand how it really aids their communication first hand. Then we engineer that flow into a digital construct and prototype. We take it back to those same reps and say “How does this feel to you? Is it intuitive?” We need to keep in mind that the reps will become power users of any digital piece, so they don’t need (or want) fancy intro animations. They want smart content choices offered to them in one to two taps. When

Moving Forward ENHANCE COLLABORATION

COMMUNICATE EMOTIONAL BENEFITS

INCREASE PARTNERING

HARMONIZE DIGITAL PRACTICES

HS&M APRIL/MAY 2017| 20

ROUNDTABLE the sales team is brought into development of a marketing piece like this, they become champions of the piece. They’re in their NSM helping to train on the piece, and everyone gets on board. VRAHRAM KADKHODAIAN: We need to be more agile, nimble and relevant every single day to stay competitive. Organizations that can’t change, or don’t want to change won’t be here ten years from now. We have to make the jobs of sales and marketing teams easier, not harder. Less focus on “call reports/meetings” and more focus on how productive was your “call/meeting.” BRIAN PETERS: At Medac Pharma, I have incorporated members of the sales team, sales management, and managed markets team into the marketing planning process early on. By involving these groups in the planning process from the start, including input into the tactical plan, we have created a real sense of ownership within the sales force when the tactics are rolled out. Furthermore, this comes with the added benefit of gaining additional champions of the marketing plan. Sales managers and members of the sales force can then promote the plan to their regions so everyone rallies around it. I’m also a big proponent of field advisory boards. I am always looking for feedback on field-based issues and how we can address these challenges through creative and

21 | HS&M APRIL/MAY 2017

smart marketing. We interact on a fairly regular basis. We’ve also had success integrating the managed markets team into the mix. Using their expertise to help the sales force better understand the ever-changing payer environment, assisting them in targeting their customers based on formulary/payer status, and utilizing tools such as MMIT to customize our payer messages has paid off tremendously for us. How are sales and marketing different at small vs. large healthcare companies? VRAHRAM KADKHODAIAN: Very. They have different business models in pharma and medtech and small/large, but they are the same because they all need to create compliant content, they need to present a competitive differentiator and value with respect to their therapies, and they all need to coordinate with internal and external teams to be successful. They also face the same regulatory pressures and challenges when it comes to sales and marketing. BRIAN PETERS: I have spoken at industry meetings on this topic several times, most recently at a channel optimization conference. Small pharmaceutical companies need to create synergy across all channels and be more targeted and laser-focused in our resource allocation. The common phrase I say to my agency/vendor partners is “spend our money like it’s your

own.” Unlike larger organizations, we have to be more prudent with our resources. How can you best typify the sales-marketing collaboration situation? JOANNA BEEMAN: The best way to align sales and marketing is to have members of the marketing team go on rep rides. Do it quarterly, and do it every time there’s a label update or a new market entrant. A little bit of empathy goes a long way in our world. BRIAN PETERS: I always refer to this graphic when talking about the alignment of sales and marketing:

This gets back to what that optimal relationship needs to be—in any industry, you cannot be successful unless marketing and sales are working together in unison. We are a one-product company right now, with 52 employees, operating in a large and competitive therapeutic area. About nine months ahead of us, a direct competitor launched their product, but because of synergistic efforts between sales, marketing, managed markets, trade, and IT, we passed

the competitor in monthly prescriptions at just one year after our launch. Despite that nine-month head start, we surpassed the other company to which I credit not just our great product but also our great commercial launch. We went to market with unified messaging and a strategic launch plan developed with cross-functional teams that each had equal involvement in the launch planning process. We see it as not just sales and marketing but sales, market access, customer service and marketing. This coordinated effort and data exchange allows for more targeted customer interface and a better customer experience. What changes have you seen in the industry with regard to sales training and techniques or marketing strategies? BRIAN PETERS: I started my first marketing product management job in 1991, and my sole focus was on creating new materials for each Plan of Action (POA) to support the sales force. Now, I have many more stakeholders to consider— consumers, payers, HCPs, office staff. And, we have many more channels to consider and allocate funding towards—social media, email, digital channels…the list goes on. Life sciences marketers clearly have to be more diverse today. VRAHRAM KADKHODAIAN: Processes and people aren’t changing as fast as information-worker’s requirements. This has a lot to do

with technologies and methods not aligning with sales’ and marketing’s expectations on what it takes to be successful in their industries. More progressive organizations understand this and double down on these new realities. What will the commercial business model look like in 3-5 years? VRAHRAM KADKHODAIAN: Information will become much more available and less dependent on the traditional “sales rep.” People will have access to more information about everything. They already have 80% of their mind made up before they speak to anyone. How do you influence the consumers’ decision-making, before you even know they are a potential customer, patient, target audience? This will be the big question every organization should be solving for right now. HENRY LEVY: We are in the golden age of life sciences. If 2016 is any indication, the industry will continue to thrive and push new frontiers in scientific breakthroughs that improve the quality of life for people around the world. As innovations increase and the landscape becomes more complex, there will be greater pressure for companies to modernize commercial operations for the digital age. In the next few years, we expect cloud technology to drive five major changes to the commercial landscape.

1. Industry collaborations like Align Biopharma and others will increase and make things easier for shared customers. 2. Life sciences will continue to shift to cloud-based, unified solutions to address inefficiencies, enable end-to-end processes, and streamline commercial operations. In the cloud, commercial teams will move to a single platform to deliver a more coordinated, valuable customer experience across many touch points. 3. A new channel—online meetings—will open between life sciences companies and healthcare professionals. Digital engagement will be easier and compliant with integrated applications built to meet the industry’s unique requirements and regulations, making this efficient way to engage “face-to-face” feasible. 4. Life sciences companies will prioritize improved collaboration between medical and commercial teams, with the goal of developing a deeper, more accurate understanding of their relationships with healthcare decision makers. 5. Data-driven actions will come of age. The growing volume of data has created tremendous opportunity for life sciences, but delivering contextual insights and making it easy for sales teams to take action is challenging. Advancements in cloud technology will make it easier for companies to deliver relevant insights, when and where commercial teams need it, so they can take immediate action.

HS&M APRIL/MAY 2017| 22

ROUNDTABLE

MEET OUR PANEL OF EXPERTS

VRAHRAM KADKHODAIAN CEO Prolifiq

JOANNA BEEMAN VP, Content Director precisioneffect

Previous to her work at precisioneffect, Joanna was VP, Creative Director at THREAD, a pioneering mobile healthcare research development agency who launched one of the first ever mobile clinical research trials. Joanna also served as Creative Director at Palio+Ignite. Joanna.beeman@precisioneffect.com precisioneffect is the only healthcare advertising agency devoted to working with companies who are changing the standard of care. For nearly 40 years, they’ve honed an expertise in understanding why clinicians cling to the status quo and what it takes to accelerate the evolution from skepticism to evangelism. Their core competency is the use of communications to help drive the adoption of innovation.

23 | HS&M APRIL/MAY 2017

Vrahram joined Prolifiq in September 2016 as Chief Commercial Officer and transitioned into the role of CEO in February 2017. He is responsible for driving the company’s continued growth by building upon Prolifiq’s longstanding legacy of innovation, customer centricity, and passion for solving complex business challenges. Vrahram has spent over a decade in Executive Sales Leadership positions working for organizations such as Wells Fargo, CDC Software (Pivotal CRM) & SalesForce.com where he has been responsible for not only customer acquisition & customer success, but go-to-market strategy and distribution locally and internationally. He specializes in solving complex business problems leveraging technology in regulated markets such as financial services and healthcare, with an emphasis in medical device and pharmaceuticals. Follow Vrahram on LinkedIn Prolifiq helps regulated companies create and deliver content and enables sales teams to execute on their go-to-market plans without the headaches. Their end-to-end compliant content management and sales enablement cloud platform provides the final mile to complement and extend the value of other enterprise systems such as: customer relationship management, product lifecycle systems, and enterprise resource planning. They serve many of the world’s largest and most innovative medical technology and pharmaceutical companies because they focus on solutions for marketing and sales teams to go to market faster and more effectively.

HENRY LEVY

BRIAN PETERS

Chief Strategy Officer Veeva

Vice President of Marketing Medac Pharma

Henry has been working to transform the way the biopharmaceutical industry improves patient health for 23 years. Prior to Veeva, Henry was chief commercial officer for PPD, where he defined new models for the biotech and biopharmaceutical industry to partner with contract research organizations. These new models brought down the cost and improved the speed of drug development. Prior to PPD, Henry led Accenture’s life sciences research and development practice, helping the industry improve through consulting, technology, and outsourcing solutions. In his role, Henry worked with 90% of the top 20 biopharmaceutical companies and provided Accenture leadership to industry groups like TransCelerate and Hever. Henry has published multiple articles on clinical development and technology trends, and is a frequent speaker at industry forums. henry.levy@veeva.com Veeva Systems Inc. is a leader in cloud-based software for the global life sciences industry. Committed to innovation, product excellence, and customer success, Veeva has more than 375 customers, ranging from the world’s largest pharmaceutical companies to emerging biotechs. Veeva is headquartered in the San Francisco Bay Area, with offices in Europe, Asia, and Latin America. For more information, visit www. veeva.com.

Brian brings 28 years of both client and agency experience to his current role. Prior to Medac Pharma, he was Director of Marketing at Cornerstone Therapeutics and previously led the launch efforts for Letairis® at Gilead and for Axona® at Accera. At Searle, he directed the first unbranded and branded DTC campaigns for Ambien®. On the agency side, he worked at Klemtner, KPR, and MedThink Communications. bpeters@medacpharma.com Medac Pharma, Inc. is a privately held specialty pharmaceutical company based in Chicago, Illinois. Backed by medac GmbH, a global pharmaceutical company that has been operating in 70 countries for over 40 years, it is independently and aggressively building operations in the United States, focusing initially on the development and commercialization of treatments for autoimmune diseases and oncology. By forming new partnerships and leveraging its parent company’s strong product pipeline, it has the opportunity to make significant medical advancements that can help patients live better lives.

COMMENT

HS&M APRIL/MAY 2017| 24

BIOTECH

CLICK HERE TO GET TOP 50 BIOTECH COMPANIES

BIOTECH COMPANIES

BIOTECH IPOS UP, MARKET DOWN, REVENUES FLAT: THE TOP 50 Biotech continued its ups and downs in 2016. While the overall IPO market was weak, biotech led the healthcare sector, with over 75% of the healthcare deals (26 of 34). Valuations, however, did not fare as well. 2016 was a tough year for the biotech market sector, with a decline of 21% in the Nasdaq Biotech Index. As of today, one quarter into the year, stocks have currently regained half of that market value, but we still have a way to go. The 2017 IPO market is off to a good start with AnaptysBio, Jounce Therapeutics and ObsEva SA, but there are some questions as to where it will go, since the next expected IPOs - Visterra and Braeburn—were pulled. Total 2016 revenues for the top 50 increased at a rate of 4%, for a total of $264B, down from the 18% increase in 2015. Revenue is still dominated by the top 10 companies, which make up over 75% of the total. Each of them contributed at least $10B. 25 | HS&M APRIL/MAY 2017

Growth is still the mainstay for biotech, with 70% of the companies on the list experiencing an increase in revenue from 2015 and 30% of the companies experiencing a revenue decline. Here’s a snapshot of where the Top 50 (based on revenue) were at year’s end. Companies are ranked by their 2016 revenue as furnished by their annual reports, earnings press releases and publicly available sources such as Edgar and Morningstar stock information websites. Figures of non-U.S. com-

panies who did not report earnings in U.S. dollars were converted to U.S. dollars based XE currency data as of 12/31/16. Companies with fiscal year end dates in 2016 that are prior to 12/31/16 have their revenue listed as 2016 revenue. Additional company-specific notes for the compilation include: Salix was purchased by Allergan; Allergan was purchased by Actavis; Medivation and Anacor were purchased by Pfizer; Aegerion was purchased by Novelion; and Baxalta was purchased by Shire.

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Companies are ranked by their 2016 revenue as furnished by their annual reports and publicly available sources such as Edgar and Morningstar stock information websites. Figures of non-U.S. companies were converted to U.S. dollars from various currencies.

BIOTECH COMPANIES

CLICK HERE TO GET TOP 50 BIOTECH COMPANIES

RANKING COMPANY LOCATION

2016 REVENUE IN US$B

ROCHE

Basel, Switzerland

49.691

GILEAD SCIENCES

Foster City, CA, USA

30.390

AMGEN

Thousand Oaks, CA, USA

22.991

NOVO NORDISK

Bagsværd, Denmark

15.817

MERCK KGAA

Darmstadt, Germany

15.808

TEVA

Petach Tikva, Israel

15.411

ACTAVIS

Parsippany-Troy Hills, NJ, USA 14.570

BIOGEN

Cambridge, MA, USA

11.449

SHIRE

Basingstoke, England, UK

11.397

CELGENE

Summit, NJ, USA

11.229

VALEANT PHARMACEUTICALS

Laval, Quebec, Canada

9.674

CSL BEHRING

Victoria, Australia

6.129

REGENERON

Tarrytown, NY, USA

4.860

UCB

Brussels, Belgium

4.396

GRIFOLS

Barcelona, Spain

4.260

SUN PHARMA

Mumbai, India

4.078

7 8

9 10 11

16 17

ENDO INTERNATIONAL

Dublin, Ireland

4.010

ALEXION

New Haven, CT, USA

3.084

ACTELION

Allschwil, Switzerland

2.418

ILLUMINA

San Diego, CA, USA

2.398

DR. REDDY’S LABORATORIES

Telangana, India

2.274

NOVOZYMES

Bagsvaerd, Denmark

2.001

VERTEX PHARMACEUTICALS

Boston, MA, USA

1.683

IPSEN

Les Ulis, France

1.668

UNITED THERAPEUTICS

Silver Spring, MD, USA

1.599

19 20 21

22 23

27 | HS&M APRIL/MAY 2017

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BIOTECH COMPANIES

CLICK HERE TO GET TOP 50 BIOTECH COMPANIES

RANKING COMPANY LOCATION

2016 REVENUE IN US$B

JAZZ PHARMACEUTICALS

Dublin, Ireland

1.488

BIOMARIN

Novato, CA, USA

1.117

INCYTE

Wilmington, DE, USA

1.106

HORIZON PHARMA

Dublin, Ireland

0.981

ALKERMES

Dublin, Ireland

0.746

SOBI

Stockholm, Sweden

0.573

AMAG PHARMACEUTICALS

Waltham, MA, USA

0.532

ACORDA THERAPEUTICS

Ardsley, NY, USA

0.520

EMERGENT BIOSOLUTIONS

Rockville, MD, USA

0.510

BIOCON

Bangalore, India

0.507

SEATTLE GENETICS

Bothell, WA, USA

0.418

IONIS PHARMACEUTICALS

Carlsbad, CA, USA

0.347 0.341

35 36

37 38

CHINA BIOLOGIC PRODUCTS

Beijing, China

PACIRA PHARMACEUTICALS

Parsippany-Troy Hills, NJ, USA 0.278

MIMEDX

Marietta, GA, USA

0.245

PDL BIOPHARMA

Incline Village, NV, USA

0.224

PHARMAMAR

Madrid, Spain

0.190

THE MEDICINES COMPANY

Parsippany-Troy Hills, NJ, USA 0.168

GENMAB

Copenhagen, Denmark

0.168

NEKTAR THERAPEUTICS

San Francisco, CA, USA

0.165

SCICLONE PHARMACEUTICALS

Foster City, CA, USA

0.160

46 47

GALAPAGOS

Mechelen, Belgium

0.159

NOVELION

Vancouver, BC, Canada

0.152

SPECTRUM PHARMACEUTICALS

Henderson, NV, USA

0.146

BAVARIAN NORDIC

Kvistgaard, Denmark

0.143

29 | HS&M APRIL/MAY 2017

TOP LISTS the publication for healthcare sales & marketing leaders™ This issue begins HS&M’s series of Top Company Lists. The Top 50 Pharmaceutical Companies will be in the next issue, followed by the Top 50 Medical Device Companies, and culminate with the consolidated Top 100 Healthcare Companies of the year. Per your requests we are making last year’s lists available below.

PHARMACEUTICAL COMPANIES CLICK HERE TO RECEIVE YOUR COPY OF THE TOP 50 PHARMACEUTICAL COMPANIES

MEDICAL DEVICE COMPANIES

CLICK HERE TO RECEIVE YOUR COPY OF THE TOP 50 MEDICAL DEVICE COMPANIES

HEALTHCARE COMPANIES CLICK HERE TO RECEIVE YOUR COPY OF THE TOP 100 HEALTH CARE COMPANIES

HS&M APRIL/MAY 2017| 30

PHARMACEUTICAL

EvaluatePharma® Orphan Drug Report 2017 Celgene, BMS and Novartis set to dominate by 2022 For the last few years, Evaluate Ltd, a life science market intelligence firm, has been assembling their annual EvaluatePharma® Orphan Drug Report.

31 | HS&M APRIL/MAY 2017

Based on their coverage of over 5,000 of the world’s leading pharmaceutical and biotech companies, the Orphan Drug Report 2017 highlights trends in prescription sales for orphan vs. non-orphan drugs, US revenue per patient, orphan designation analysis in USA, Europe and Japan, product and company performance and the most valuable orphan drugs in development. The following is a summary of details from the fourth edition of this report on the expected performance of the orphan drug market between now and 2022. The full report can be found here.

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PHARMACEUTICAL It’s important to understand what defines an orphan drug, a pharmaceutical product aimed at rare diseases or disorders. In the U.S., rare disease populations are defined as having less than 200,000 patients (<6.37 in 10,000). To classify as an orphan drug, the medication has to meet certain criteria. For instance, the first indication approved has to be for an orphan condition. Also, the product has to generate more than 25% of sales from orphan indications—which excludes drugs like Avastin, Enbrel, Humira and Remicade, because the orphan designations for those products don’t reach the 25% threshold. ORPHAN MARKET DRIVERS Why is there a current upsurge in the sector? Mainly because “orphan” is not such a diminutive term anymore. The Orphan Drug Act of 1983 financially incentivized the development of orphan drugs. Companies developing these medications receive a 50% tax credit on R&D costs. Before the act was passed, only 38 orphan drugs were approved. Since then, 425 indication designations covering 347 drugs have been approved. The success of the original Orphan Drug Act in the US led to it being adopted in other key markets, most notably in Japan in 1993 and in the European Union in 2000. And there are significant financial incentives. In the U.S., a company receives seven years of marketing exclusivity from approval. The market exclusivity blocks “same drug” recombinant products. Indeed, large pharma groups finding orphan indications for some of

33 | HS&M APRIL/MAY 2017

their biggest sellers mean that seven of the ten top companies by orphan indications are global majors, and the likes of AbbVie are trying to ensure their seat at the big table through acquisition. The Chicagobased group is now in the top 20 companies by orphan sales, thanks to its acquisition of Pharmacyclics. The enduring appeal of orphan drugs remains grounded in a variety of factors, including the lack of alternatives for patients, lower R&D costs, easily defined patient populations, and the prices that the drugs are able to command. So far orphan drug developers have managed to defend the cost of these life-changing drugs, due to the relatively small patient populations they serve and the continued paucity of options for sufferers. MAJOR FINDINGS What has changed in the last 12 months is the increased scrutiny of the price of these lifesaving products. There is little doubt that insurers will continue to cover orphan drugs, due to the fact they are frequently the only option for patients and, for now, remain a relatively small part of overall budgets. But according to the findings in this year’s report the market will carry on expanding rapidly, with sales growth forecast at 11% per year, more than twice the rate predicted for conventional drugs. In fact, sales of orphan drug are expected to almost double between 2016 and 2022, to hit $209B. This rapid growth and current willingness of payers to stump up for the huge price tags are two of the main reasons why the sector has become more and more attractive to some of the industry’s biggest players.

The image of the plucky small biotech striving to develop treatments for the rare diseases largely ignored by big pharma is long gone. Instead, this year the report finds big pharma dominating the sector. Seven of the top 10 companies by orphan drug sales are global industry players, who have won approval for their biggest products in various niche indications. However, some see big pharma’s interest in this space as a potential problem, claiming that these groups are taking unfair advantage of the lower R&D cost, speedier approval times, favorable patent life and pricing incentives for developing orphan products. And the pricing incentives are substantial. According to this year’s report, of the top 100 drugs in the US the average cost per patient per year for an orphan drug was $140,443 in 2016, compared with $27,756 for a non-orphan. In what might spell trouble for the industry, payers and politicians are taking note. Exondys 51 and Spinraza—both treat rare and fatal childhood illnesses—might have won broad approvals from the US regulator, but some payers are insisting on much narrower interpretations of their clinical effectiveness.

Orphan drug chart 1

• Opdivo (nivolumab) will be the No.1 orphan drug in Europe in 2022 • Orphan drugs are forecast to account for 55% of the cumulative value of the European pipeline to 2022 • Axicabtagene Ciloleucel (Kite Pharma) is the most valuable R&D orphan drug • The first decline since 2012 for FDA orphan designations was in 2016 with 333; A record number of applications made to the FDA for orphan designation in 2016 WORLDWIDE ORPHAN DRUG SALES (2000-2022)

Note: Industry sales based on Top 500 pharmaceutical and biotech companies. Sales to 2015 based on company reported sales data. Sales for 2016 based on available company reported sales data. Sales forecasts to 2022 based on a consensus of leading equity analysts’ estimates for company product sales and segmental sales. In February, Republican senator Chuck Grassley announced that he would be starting an investigation into potential abuses of the Orphan Drug Act. President Donald Trump has also expressed his concern over drug pricing; whether this will spill over into orphan drug pricing is unknown but not impossible. As such, if the orphan drug industry is to continue to thrive it must continue to generate innovations that justify the huge cost of these life transforming treatments. Highlights from the report include: • Worldwide orphan drug sales forecast will total $209B (CAGR 2017 to 2022:+11.1%); approximately double overall prescription market growth

• Orphan drugs set to be 21.4% of worldwide prescription sales by 2022 (excluding generics) • Median cost per patient differential is expected to be 5.5 times higher for orphan drugs compared to non-orphan • Celgene is set to climb to number one position in orphan drug sales to 2022 • Shire will be the largest company by sales in the orphan nononcology space in 2022 • AstraZeneca, Abbvie and Johnson & Johnson are set to march up the orphan drug sales ranking table

Worldwide Orphan Drug Sales Forecast to Total $209B (CAGR 2017 to 2022: +11.1%) which is Double the Overall Rx Market Growth. Orphan Drugs Set to be 21.4% of Worldwide Prescription Sales by 2022; (excluding generics) The market for orphan drugs, based on the consensus forecast for the leading 500 pharmaceutical and biotechnology companies, will grow by 11.1% per year (CAGR) between 2017 and 2022 to $209B. The growth of the orphan drug market is more than double that of the overall prescription drug market, which is set to grow by 5.3% over the period 2017-2022. Orphan drugs are set to account for 21.4% of global prescription sales in 2022, excluding generics, up from 6% in 2000. In 2016 orphan drug sales increased 12.2% to $114B vs. 2015, while non-orphan drug sales increased by 2.4% to $578B. [See orphan drug chart 1]

• Revlimid (lenalidomide) will be the No.1 orphan drug in 2022 HS&M APRIL/MAY 2017| 34

PHARMACEUTICAL Orphan drug chart 2

TOP 100 USA DRUG COST PER PATIENT PER YEAR 2012-2016 Average Orphan Drug Cost to Patients $140,443 in 2016; Median Orphan Drug Cost $83,883 The average cost per patient per year in 2016 for an orphan drug was $140,443 versus $27,756 for a non-orphan drug. The average drug price has increased year on year for both orphan and non-orphan drugs since 2012. The median price differential between an orphan and non-orphan drug in 2016 was 5.5 compared to 9.8 in 2012. The median price of orphan drugs and non-orphan drugs has increased by a factor of 1.3 and 2.3 since 2012 respectively. [See orphan drug charts 2 & 3] 2016: USA REVENUE PER PATIENT PER YEAR FOR TOP 20 SELLING ORPHAN DRUGS

Orphan drug chart 3

Note: Cost per patient is an estimate for the retail cost of a drug to a patient, for a given year, based on a 100% compliance to the treatment guidelines outlined in the FDA label. Does not include off-invoice discounts. The Top 100 orphan and non-orphan drugs were ranked by USA sales for 2016. Prices for products in the US are sourced from Medicare Part B, NADAC, FSS and Medicaid. Availability of a price point determines choice of source. The source is kept consistent across years to reflect a clear trend in pricing.

Soliris will be the Highest Revenue Orphan Drug in 2016 Revenue per patient for the Top 20 USA selling orphan drugs is correlated (R2 = 0.77) to the number of patients treated in 2016. A similar analysis of the Top 10 selling orphan drugs that treated fewer than 10,000 patients confirms a closer correlation (R2 = 0.94). This analysis confirms industry perceptions that smaller patient groups allow a pricing premium to be achieved versus non-orphans. Products such as Gleevec support the notion of an innovation premium for drugs that create a step change in treatment options and therapy outcomes. Soliris confirms the pricing power resulting from indications with the fewest number of patients. [See orphan drug charts 4 & 5]

35 | HS&M APRIL/MAY 2017

Orphan drug chart 4 WORLDWIDE ORPHAN DRUG SALES IN 2022: TOP 20 COMPANIES Celgene to be Number One in Orphan Drug Sales in 2022 with BMS and Novartis in Second and Third Place. AZ, Abbvie and J&J Set to March up the Orphan Sales Ranking Table. It is expected that Celgene will overtake Novartis as the world’s number one orphan drug company in 2022, climbing two places, and pushing Novartis down to number three.

Orphan drug chart 5

One product contributes the majority of orphan sales for two of the top four; Celgene (Revlimid, 80% of sales ) and BMS (Opdivo, 68% of sales). Seven of the Top 10 companies by orphan drug sales in 2022 are forecast to be Global Majors. The Top 5 companies in 2022 are forecast to account for almost one third (30.6%) of the orphan drug market. 2022: TOP 20 SELLING ORPHAN DRUGS IN THE WORLD

Note: Sales represent company reported sales where available, otherwise based on an average of equity analyst estimates. USA sales represent sales for all indications. EvaluatePharma® analysed the Top 10 selling USA drugs which treated fewer than 10,000 patients in 2016. *Revenues per patient: An estimate of the dollar ($) revenues per year received, by a company, per patient for a drug in the USA market. This takes into account the cost per patient (average mg per year multiplied by the cost per mg), off-invoice discount and patient compliance. Prices for products in the US are sourced from Medicare Part B, NADAC, FSS and Medicaid. Availability of a price point determines choice of source. The source is kept consistent across years to reflect a clear trend in pricing.

Revlimid (lenalidomide) will be the No.1 Orphan Drug in 2022. EvaluatePharma® finds that Revlimid will be the world’s largest orphan drug in 2022, with sales of $13.6B for all indications. Revlimid from Celgene was first approved in December 2005 for the orphan treatment of myelodysplastic syndrome. Revlimid is also approved for the orphan indications Non-Hodgkin’s lymphoma and multiple myeloma and remains in development for a number of other HS&M APRIL/MAY 2017| 36

PHARMACEUTICAL Orphan drug chart 6

orphan conditions. Bristol-Myers Squibb’s Opdivo approved for multiple myeloma & Hodgkin’s lymphoma, and designated for hepatoma, glioblastoma, small cell lung cancer and oesophageal cancer is set to be a distant second with $9.1B in worldwide sales. [See orphan drug charts 6 & 7] 2022: TOP 20 ORPHAN R&D PRODUCTS BASED ON NPV Axicabtagene Ciloleucel will be the World’s Most Valuable R&D Orphan Drug

Orphan drug chart 7

Kite Pharma’s Anti-CD19 chimeric antigen receptor (CAR) T cell therapy in development for NonHodgkin’s lymphoma, is the world’s most promising R&D orphan drug, with an NPV of $7.9B. The top three ranked products account for 19% of the total orphan NPV. Of the products in R&D, eight are classed as being developed inhouse or having been in-licensed. The remaining four products were acquired through a company acquisition. [See orphan drug charts 8 & 9]

Note: * Forecast based on a single broker model. Sales represent company reported sales where available, otherwise based on an average of equity analyst estimates. Worldwide sales represent sales for all indications. All sales analysis based on EvaluatePharma®’s clean “Orphan” sub-set of products, as defined above in Methodology on Classifying an Orphan Drug.

37 | HS&M APRIL/MAY 2017

Orphan drug chart 8

Orphan drug chart 9

Evaluate is the trusted provider of commercial intelligence including product sales and consensus forecasts to 2022 for commercial teams and their advisors within the global life science industry. It helps clients make high value decisions through superior quality, timely, must-have data and insights, combined with personalized, expert client support. Evaluate comprises EvaluatePharma®, EvaluateMedTech®, EvaluateClinical Trials® , EP Vantage and Evaluate Custom Services. For the full report, click here.

COMMENT Note: Sales represent company reported sales where available, otherwise based on an average of equity analyst estimates. Factor VIII products for haemophilia A & B classified as orphan drugs. * Forecast based on a single broker model.

HS&M APRIL/MAY 2017| 38

SALES

Great Advice from Great Minds: Habits Can Be Changed ...If we understand how they work, says Pulitzer Prize winner and NYT best-selling author Charles Duhigg By Jill Donahue, Managing Director, EngageRx

When you woke this morning, what was the first thing you did? What habits helped or hindered you? It’s the small habits over time that decide your future.

Now think about what habits of healthcare professionals help or hinder patient outcomes. What habits can you help them change to create optimal patient outcomes? “But it’s hard to change habits!,” you say. And I couldn’t agree more. There is a science to it. Charles Duhigg has studied how habits work and how to change them in ourselves and others. He is a Pulitzer Prize winner and author of two New York Times best-selling books: The Power of Habit and Smarter, Faster, Better. Habits are not easy to understand, but by drawing on hundreds of academic studies, interviews with over three hundred scientists and executives, and

39 | HS&M APRIL/MAY 2017

research conducted at dozens of companies, Duhigg illustrates why habits exist and how you can change them. We had a chance to sit down with him to ask him how his lessons apply to us in healthcare.

“In the end, by helping improve patient outcomes you will achieve greater sales. We call this patientcentered engagement—the necessary evolution of the old sales habit.” While Duhigg admits that changing habits might not be fast and is certainly not easy, he believes that with time and effort, almost any habit can be reshaped. Habits cannot be eradicated but they can be replaced. His Golden Rule of Habit is to keep the same cue and same reward but replace the routine.

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SALES The key element is the craving. Marketers at Proctor & Gamble studied videos of people making their beds. Why? They were trying desperately to figure out how to sell Febreze, a product which seemed to have tremendous benefits but was on track to be the biggest flop in company history.

“This is how new habits are created: by putting together a cue, a routine and a reward, and then cultivating a craving that drives the loop.” ~From “The Power of Habit” Suddenly, one of the researchers detected a subtle yet important pattern. After people sprayed the room, they stopped and seemed to enjoy the smell of their newly cleaned room. The reward was the smell. The marketers made some adjustments, and Febreze went on

to earn a billion dollars a year. Think of your efforts to change your own habits (anyone else struggling to break their afternoon cookie habit?) or the habits of healthcare professionals. How could you dissect the habits? What is the cue, routine and reward of the habit you most need to break? As an industry, the one habit we desperately need to change is the traditional sales call. Let’s apply Duhigg’s four steps to help us:

1 Identify the routine. The old

habit is sitting down in front of a doctor, telling him/her what you know, then checking the box of one more call completed.

2 Experiment with different

rewards. Rewards satisfy cravings. But the tricky part is that we are often not conscious of the cravings that drive our behaviors. The sales reward typically has been achiev-

ing reach and frequency goals. That drives the traditional routine described above. That approach worked for many years in pharma selling—but not anymore! Imagine if we adjust that reward. How would the routine be changed if your reward from a call was determined by how much you helped the doctor treat patients (who are helped by your product or device)?

3 Isolate the cue. What is the

goal you have in mind when you get in your car in the morning? What are you thinking the moment the doctor says “What’s new?—I have one minute.”?

4 Have a plan. Decide exactly

what you will think and do when the cue appears, then follow your plan. In your old habit, you thought about how quickly you could rhyme off your features and benefits to check the box of one more call complete. In this new habit, your mindset will be on how to help the doctor become more effective at improving patient outcomes. You will ask great questions, listen and respond to the doctor’s needs. You will get more time. You will be more engaging and inspiring.

How would the routine be changed if your reward from a call was determined by how much you helped the doctor treat patients? 41 | HS&M APRIL/MAY 2017

See more from Charles Duhigg in this video interview.

In the end, by helping improve patient outcomes you will achieve greater sales. We call this patientcentered engagement—the necessary evolution of the old sales habit. We have seen incredible results when people feel rewarded by helping the doctor help patients. Empowering our people with their purpose may be the most significant thing we can do to evolve our out-dated and ineffective sales-call habits. In the video interview with Charles, we find some of his top insights: • His #1 tip for pharma reps to change habits of HCPs to make better choices for patients: creating rewards in advance that the doctor will respond to • Help physicians reflect on the choices they make. Ask questions that will reveal the rewards they perceive or expect • Who is the best person to make a decision about a treatment path—

the doctor, nurse, PA, med tech? It’s the person closest to the problem • The relative benefits of multitasking vs. focused contemplation: stop and think • How to prioritize your agenda and be better at meeting stretch goals and smart goals: have a system! • Why busyness and productivity are NOT the same thing • His biggest take-away from writing his book—the most productive

people aren’t the ones who work hardest, or go to the right schools or work for the largest companies, but those who balance their agendas. • DEEPER DIVE: Read the Actionable Books summary of Duhigg’s books: The Power of Habit and Smarter, Better, Faster

Jill Donahue, HBa, MAdEd is on a mission to lift our industry, building purpose-driven, influential people. Through her keynote talks, workshops and award-winning mobile-learning programs, she is helping pharma people build trust, open doors and make a bigger impact. She trains people why and how to engage instead of sell.

COMMENT HS&M APRIL/MAY 2017| 42

BY THE NUMBERS Compiled by Cari Kraft, Jacobs Management Group, Inc.

78% Consumers want virtual health In a survey of more than 1,500 consumers, Accenture found that consumers are willing to use a wide range of virtual health services. Interestingly, only 21% have actually tried it. Source: Accenture Consulting, “Virtual Health: The Untapped Opportunity to Get the Most out of Healthcare,” 2015

$74B

Venture capital device and biopharma investment in 2016 Venture capital firms invested over $74B in the device and biopharma sectors last year. The past two years saw nearly double the investment activity compared with 2011-2013. Source: “Trends in Healthcare Investments and Exits 2017,” Silicon Valley Bank, based on PitchBook, NVCA and SVB proprietary data.

COMMENT

43 | HS&M APRIL/MAY 2017

2011-2013

77% Percent of hospitals that say developing value-based payment models is a priority over the next 12-18 months 78% of physician practices are participating in value-based payment models, and participation among facilities is 91%. This includes Medicare quality incentives, pay for performance, ACOs and bundled payments. Source: Availity study “Provider Outlook on Value-based Payment Models,” April 2016

2014-2016

Biotech revenues mixed, generally up Growth is still the mainstay for biotech, with 70% of the companies on the list experiencing an increase in revenue from 2015 and 30% of the companies experiencing a revenue decline. Source: Healthcare Sales & Marketing, April/May 2017, “Top 50 Biotech Companies”.

46%

Portion of global healthcare market held by U.S. in 2016 The U.S. continued to command over 46% of the global pharmaceutical market in 2016, up slightly from both previous years Source: Statista, Statistics and facts about the Pharmaceutical Industry in the U.S. 2016

RX GENERICS OTC

244

$244B

U.S. sales of Rx drugs in 2016 The patent drug market in the U.S. was $244B, 70% of the total. Generics came in at $70B, 21% of the total, and OTC sales were $19B, 6% of total. Source:â&#x20AC;ŻU.S. Snapshot: Pharmaceutical sales, Pharmaceutical sales per capita: Centers for Medicare and Medicaid Services (CMS), Consumer Healthcare Products Association (CHPA), BMI

$700M GSK/Verily investment in bioelectronic medicines GlaxoSmithKline and Alphabetâ&#x20AC;&#x2122;s Verily Life Sciences have announced a plan to invest $700M over the next seven years in Galvani Bioelectronics, a joint venture focused on bioelectronic medicines. This is a new modality that complements small- and largemolecule drugs on the biopharma side and traditional devices on the medtech side. Source: Pulse of the Industry: Medical Technology in 2016, EYGM Limited HS&M APRIL/MAY 2017| 44

PHARMACEUTICAL

The Consumer Revolution How Astellas, Otsuka and GSK execs see the coming changes By Hugh Gosling, Chief Editor, eyeforpharma

As the industry truly starts to listen and react to the voices of the people who take its medicines, a more nuanced and insightful picture is emerging about what patients want from pharma and its medicines. Words have power. Words can move mountains. Words matter. We know this instinctively when we listen to a moving speech or when we hear hate speech. We know how it feels to be on the wrong end—or the right end—of powerful words. 45 | HS&M APRIL/MAY 2017

“Patient” is a word of power for the pharma industry. In fact, it’s transforming companies, turning everything on its head. Yet, for an increasing number of the people we are using this term to describe, the word itself leaves a sour taste in the mouth, with many preferring “person” or “consumer”. For

them, a “patient” is the passive recipient of care but a “consumer” is an active seeker of the best products and services. “Patients are tired of being called ‘patients’,” says Margaret Long, Vice President, Business Communications and Stakeholder Engage-

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PHARMACEUTICAL ment, at Astellas Pharma. “Recently, we’ve heard from the patient community that they want to be MARGARET LONG recognized as someone’s mother, sister, father, brother. Some may be dealing with a chronic illness for the majority of their lives, so they simply cannot consistently think of themselves as a ‘patient’ and they want other people to start recognizing that they are more than a ‘patient,’ that they are people too.” Understanding that people are both patients and consumers is essential, adds Cheryl MacDiarmid, SVP and Business Unit Head US Primary Care at GSK. “On the one hand, a patient who is suffering from a health condition lives with the feeling of not being well every day, and approaches their healthcare journey with an ‘I need help’ mindset, relying on others for information to help them feel better. On the other hand, patients are always consumers, searching for information just as they do in any other part of their lives. They are more demanding and more purposeful in their search, and they do not rely as heavily on others to provide them with information. There is a dance between the behaviors of ‘patients’ and ‘consumers’ and it’s quite important that we, as an industry, understand both.” GIVING UP CONTROL Yet making decisions about your own healthcare is not as simple as buying a car or booking a vacation. 47 | HS&M APRIL/MAY 2017

“Healthcare is incredibly complex and it would be naïve to suggest that anyone is entirely capable of fully informed decision making alone,” says Long. “We have to think about the patient holistically and ensure that we consider what is important for them. We need to recognize that we may not always be the deliverer of the message and understand that supporting the patient means doing it across the entire continuum, every time they, their family, their caregivers are touched by healthcare.” However, medicines are only one element in the equation, says Kabir Nath, President, North AmeriKABIR NATH can Pharmaceutical Business, Otsuka America, Inc. “The medicine is a small part of the patient journey. A schizophrenic patient, for example, has an extraordinarily complex relationship with the healthcare system and with society at large. We have to acknowledge where we sit in the overall scheme of people’s interaction with their healthcare system.” For Nath, the days of most patients as fully empowered and independent “consumers” are some way off. “The reality is that the majority of people do not even manage the non-drug interventions that provide for their better health, for instance, the lifestyle and diet changes that would help prevent or manage chronic disease more effectively. We’re talking about a subset of patients who are deeply

interested [in their healthcare]. The idea that patients en masse are going to take control of their health any time soon is simply unrealistic. Yes, patients, their families and caregivers want more information, yes, they go to the internet for that, but I’m not sure the majority are ready to abandon professional guides any time soon,” he says. In addition, millions of people are making decisions about their healthcare based on financial pressures. “Right now, people in the United States are making healthcare choices, for instance, choosing generic over branded medicines because of access issues such as copays. That economic decision is already here, unfortunately, and it is far from clear how this will evolve over the coming years. While the premise of the Affordable Care Act was to bring some of the 43 million uninsured in and widen the pool, so potentially lowering costs for everyone, in practice, because of some of the design and execution elements, in some cases choice has fallen and costs risen, for example, through high deductibles and copays,” says Nath. IT’S GOOD TO TALK— AND LISTEN As some patients struggle to find their place in the healthcare continuum, how can pharma companies CHERYL support them? MACDIARMID “People want amazing medicines,” says MacDi-

armid. “They want us to be unbelievably transparent around the qualities of the medicine, and the safety and side effects. They want us to help them make the right decisions. They want responsible pricing and access to our medicines.

“This is about having a highquality, honest conversation around a medicine. Historically, this used to be quite oneway, with information coming at them from pharma or via their HCPs. Today, they want the same high-quality information but they’re looking for it in digital ways. Patients are also looking for more dialogue when making a choice about a medicine, they want far more information on the experience of taking the medicine and information on how to access it, including help with challenges they might have around payment. We are on a journey towards much greater dialogue and conversation with patients.” Everything starts with understanding patients’ needs, says Astellas’ Long. “We recently launched a new department called Patient Experience, a group focused on ensuring that we really understand the patient experience and that we, as a company, meet patients’ needs. For example, are we providing support materials that are easily understood by the patient community? This new department, along with our stakeholder engagement function—

the company’s face to the patient advocacy community—are aimed at better aligning the organization around what patient experience means to Astellas.” For GSK’s MacDiarmid, pharma companies need to learn new tricks. “We are working very carefully to understand the exact pain points in the patient journey and then be able to use innovative thinking and technologies to ease them. The pharmaceutical market is evolving at a fast pace, so there is a need to be faster and more agile to stay ahead. Within GSK, we are adapting to this ever-changing environment and there is real receptivity to being different and to trying something new.” Listening to and engaging with patients on an individual level can be very helpful in understanding the patient experience, says Long. “We always start our quarterly Town Hall meeting with a patient speaker, but recently our speaker was also an Astellas employee, so it was doubly impact-

ful. He said something that really resonated with everyone in the audience—that, as he was going through cancer treatment, he saw no distinction between improving the quality of his life and saving his life. His treatments were so difficult that, at times, he was struggling to make it to the next day. We often think we understand the struggles of our patient but to hear it from a patient’s mouth definitely puts a different perspective on it. He also shared that a friend said to just live to the next day, because you don’t know what ‘they’ will come up with next. We are the ‘they.’ Our commitment to innovation and advancing the science is critical but when you hear it from a patient, it is so enlightening that it changes your view.” • KABIR NATH AND CHERYL MACDIARMID WILL BE SPEAKING AT EYEFORPHARMA PHILADELPHIA ON APRIL 20-21.

Hugh Gosling Chief Editor, eyeforpharma A trained journalist and editor, Hugh Gosling has more than 20 years’ experience in healthcare. In addition to being editor of industry magazines PharmaTimes, Pharmaceutical Marketing and European Pharmaceutical Executive, he has been a freelance journalist and worked in-house at Merck and Pfizer. HGosling@eyeforpharma.com

COMMENT HS&M APRIL/MAY 2017| 48

MOTIVATION

MOTIVIDEOS By Cari Kraft, Jacobs Management Group Ideally, you get to the office, ready to start a day with renewed energy. But not everyone on the staff will feel the same way. So here are some caffeinated videos that we hope will give everyone ideas, change the way you approach things, and generally make your day ultimately better. Coaching for Noâ&#x20AC;&#x2122;s

Imagine If

Getting a positive or a negative response largely depends on how we frame a situation. Since we are wired to focus more on the negative, it takes practice to accentuate the positive. This is a great one for any manager or to use at a meeting.

Everyone who will ever make a presentation should take the time to watch this simple concept from Simon Sinek. We all know it, but here he clearly explains why we should pay attention to what we know.

Thinking Backwards

We work in this industry for a reason. For many of us it is to create moments like these.

An interesting approach to take when pursuing a product launch or a client sale. This is a great way to change up thinking at the beginning of a meeting on a product or a client situation.

New Hands

Submissions are welcome. If you have one you like, email a link to me at ckraft@jacobsmgt.com.

Cari Kraft leads a team of master level recruiters at Jacobs Management Group, celebrating 20+ years of executive recruiting in the healthcare (pharmaceutical, medical device, biotechnology) and high-tech industries, nationally. Â Prior to joining Jacobs Management Group, Ms. Kraft has held positions as a Senior Sales Executive, Director of Business Development and Director of Marketing. She also has deep knowledge of the technology/startup fields, having been in the industry through the rise of the Internet. Ms. Kraft is a University of Pennsylvania/Wharton alumnus holding a degree in economics and decision sciences. Cari can be reached at ckraft@jacobsmgt.com.

COMMENT 49 | HS&M APRIL/MAY 2017

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MARKETING

Obesity, Allergies and Oscars How a healthcare marketer found himself at the biggest awards show of all By Peter Kenney, Founder and Partner at DiD Healthcare agencies are always looking for newer, better ways to help their clients amass the eyeballs and loyalty of target demographics. Today we talk mostly about high-tech strategies involving data analytics and the multiplicity of digital platforms available—getting the right messages before the right people with exacting precision. But all of that expertise is pointless without compelling creative that grabs the audience from the first few seconds of exposure. This is still the secret sauce that makes certain campaigns rise above the rest. The shorthand we often use to describe this creative genius is “storytelling”— something akin to what attracts TV and movie audiences to hits. No one understands this better than Peter Kenney, co-founder of DiD. Not only has he helped create winning campaigns for DiD’s clients, but his love of a good story has led him in other directions as well. Here’s his story about how a healthcare marketer wound up at the Academy Awards ceremony this year.—Ed. When Rick Sannem and I formed DiD, one of our goals was to use marketing as a way to tell stories that would reach and inspire people to take steps towards better health. Along the way, a former film school classmate, Kahane Cooperman, told me about a movie she was making. The subject matter was intriguing: a 91-year-old Holocaust survivor hears about a music school in Manhattan in need of instruments, and decides to donate his 70-year-old violin, rescued from the horrors of WWII. But it’s the connection between Joe and Brianna, the girl who received his violin, that makes the story so 53 | HS&M APRIL/MAY 2017

heartbreaking. I jumped in as Executive Producer. The film, titled Joe’s Violin, went on to win six Audience Awards and two Grand Prizes at numerous film festivals, an Oscar nomination for best short documentary, and accolades across the media spectrum. So, what’s the connection between what we do at DiD and my passion for helping get Joe’s Violin made? Storytelling is an overused term. Simple product pitches are said to be stories. But to truly work as a story it has to connect on a deep level with people. This deeper connection is what gets someone to talk to their doctor, to change

a behavior, to follow through on purchasing and taking a medicine. The secret to generating this connection is empathy. You need empathy both in developing your story and in presenting it to your audience. In Joe’s Violin, Brianna’s enormous empathy for Joe’s experience is really what makes it unique and touches a chord with audiences. At DiD, we create the full range of video from scientific MOA animations to 30-seconds TV spots. Our best efforts, however, are when our stories reach you emotionally. We see this in patient and consumer as well as professional-facing video work. For a surgical client, we actually created a series of videos documenting one person’s journey through the process of bariatric surgery. We created it because research told us that, besides cost, the biggest thing that kept eligible patients from following through on surgery was anxiety about being able to succeed. After someone learns that they qualify for weight-loss surgery, there is sometime an extended process (up to six months) where the patient loses weight, adjusts their diet and learns about the

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MARKETING

Ultimately, she did have successful surgery and we captured the excitement and exuberance of her new self.

Dana

The campaign was created as a non-branded way for bariatric centers to connect with and motivate potential patients. Initially each episode was delivered via email to patients at each stage of their process. Empathy was also critical in a developing a successful TV spot for a natural eye drop. The client, Similasan, had been communicating the features and benefits of their naturopathic eye drop. Here the focus was on its origins in Switzerland and the freshness of the mountains. From research conducted with a previous client we realized that our opportunity was with a more customer-centric, empathic approach.

The Landscape Architect

We had previously done ethnography research to determine how eye care products are used in household and discovered that eye drops were purchased when they were in greatest demand and to meet their greatest challenge. Efficacy was essential. “Natural” ingredients just meant you can take them more frequently.

details of the actual procedure. Throughout this pathway qualified patients are known to drop out and not follow through with what could be life-saving surgery. With this client, we decided to create a series that would address the emotional barrier patients would 55 | HS&M APRIL/MAY 2017

have in each phase of this presurgery journey. Dana’s Story was a five-episode documentary series that followed this young woman to appointments, through exercise classes, telling her friends and family of her decision, organizing the finances, etc.

This spot told story of a landscape architect with allergies who needs the most efficacious eye drop to keep working. The natural, preservative-free aspect came through because of how frequently they used it. Because of our deeper customer research, we were able to deliver a spot that increased yearover-year same store sales by 25% over previous spots. This effect lasted through the seasonal run of the spot. Today doctors often work by algorithms. Not fully appreciating

the people sitting in their clinic, hospital ward or OR. For an Rx client with a product that improves quality of life for end-stage liver disease, we are currently putting the “care” back in “healthcare.” Generating empathy is one of our prime objectives.

Joe’s Violin

We were able to deliver a spot that increased year-over-year samestore sales by 25% over previous spots. Quality of life (QOL), of course, is a highly emotional issue. In the end stages of certain diseases, it becomes all that patients and caretakers can focus on. For one client we have begun to make a series of short videos helping physicians along the treatment pathway to better appreciate the importance of quality of life to patients and their caregivers in the end stage of their disease and better value their Rx decisions. Here, empathy is not just an aspect of creative development but the communication objective itself. Storytelling—that is, awakening doctors to the inner lives of patients through powerful marketing—is an effective way of engendering this kind of empathy and a more refined approach to treatment. Like Joe’s Violin, storytelling is about bringing people closer to each other’s world, improving understanding. In theory, doctors and patients are more in synch than a Holocaust survivor and a young inner city violinist would be, but sometimes it takes a story to evoke the humanity in their relationship. That’s what we try to do every day. •

Peter Kenney is an advertising executive, producer and a founding partner at DiD, a health and wellness agency that counts Tylenol, Bausch & Lomb, Salix, Ethicon and Hologic among its clients. In business for over a dozen years, DiD now has 120 employees at three offices, in Ambler, PA, Center City, Philadelphia and Healdsburg, CA. Prior to starting DiD, Peter was a writer and creative director in healthcare advertising at Medical Broadcasting Company, in Philadelphia, and worked in documentary television and interactive media in Los Angeles, where he was a founding partner of Digital Ranch, a TV production company. He has served on the Board of Trustees for The Philadelphia School. DiD is a professional and consumer advertising agency committed to helping people discover and experience great health and wellness brands. It focuses on building connections that drive results for its clients and their customers, with tenacity, precision, and grace. DiD delights through service; work with passion, courage, and mutual respect; and is agile in thinking and action. Its people are authentic and humble; hunger for personal excellence and improvement; and never forget the people their brands help.

COMMENT HS&M APRIL/MAY 2017| 56

PHARMACEUTICAL

To Be a Marketer, Think Like an Advocate Hearing the voices and learning the lessons A conversation with Ramana Sonty, MBBS, PhD, Director of Strategy, Janssen Global Medical Organization

Leaders from Janssen, Bristol-Myers Squibb and Sanofi recently participated in a panel on patient-centered leadership at an eyeforpharma Patient Summit. This is adapted from Ramana Sonty’s participation on that panel. The primary topic was how companies can become aware of patient concerns and address them properly—not only for the benefit of the patients themselves, but for the efficiency and intelligence that ultimately make healthcare’s sales and marketing initiatives more successful. Ramana Sonty is in the Global Medical Organization of Janssen at Johnson & Johnson, working on several different patient engagement and patient-centric activities, which is the mission of the office of the CMO. He says “most prominently I’ve worked in the expanded access space. Access in investiga57 | HS&M APRIL/MAY 2017

tional medicine is something that we’ve been working on for the past couple of years and has brought us into the sphere of patients.” On this topic, he reported that he remembered back in the initial AIDS crisis in the mid-80s that patient voices became very impor-

tant. “These were either dying patients or seriously ill patients and the existing treatments didn’t work for them and they weren’t eligible for trials. I think the voices went to crescendo after social media came in.” He recalled the story of a small boy

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PHARMACEUTICAL who was likely to die very soon. It was very clear that he was fading and his physician said that there was a particular drug that was being produced by a small company that did not want to provide access to that drug. The parents worked with lawyers and then the social media folks, who mounted a very intense campaign. The result was the drug was provided to the child and he recovered. “We all want access to these treatment options,” said Ramana. “When those voices came forward, one of the things that we discovered was that we engaged with patients and patient advocates. What they wanted were simple things, a single point of contact in the company. Where can we find more information, what drugs do you have, what is the process to apply, what is the decision criteria? None of this information is available on any kind of consistent basis.”

“One of the things we’ve heard from patients is a frustration about that they don’t know who to approach. Second is that there’s always the sense that there’s implicit bias—that you’ll get a better reception based on who you talk to.”

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In his role, he expanded access through improving the company website and providing the education with videos and other materials, gaining insights from patient advocates and trying to engage patient voices. “They certainly also asked for legislation to help them and they also asked for more innovative solutions and then we came up with a partnership with NYU.” Ramana was reminded of specific changes he has seen. “One of the things we’ve heard from patients is a frustration about that they don’t know who to approach. Second is that there’s always the sense that there’s implicit bias—that if you go to the CEO you’ll get a better and warmer reception than if you go to the medical information line or just catch a security guard and ask him for the drug. And certainly we wanted to quell that kind of feeling among the patients so that they understood it’s a very fair process.” He pointed out that trust is lacking because patients think the industry has interests contrary to those of the people being treated—that the primary concern is not necessarily medical evidence or treatment protocols. “So to address all these pieces very tangibly over the past year we’ve gone ahead and built several principles based on which we set our policy. One of those principles is equity, so we’ve communicated that whether you’re a patient who is a king of a country or someone coming off the street, you’ll go through the same review process and you’ll be applying in the same place.”

“We’ve communicated that whether you’re a patient who is a king of a country or someone coming off the street, you’ll go through the same review process and you’ll be applying in the same place.” Second, he explained that it’s not just the internal company people who make that decision. There’s an initial screen of the application to look for issues on safety, or appropriate clinical trials, or a cohort program that the patient can go into. If that’s not available, they have a collaborative effort with NYU, an expert party independent of Janssen. It’s a group called CompAC, Compassionate Advisory Committee of NYU, that’s led by one of the world’s first and highlyregarded medical ethicists, Art Kaplan. The requests that come in after the initial screen are sent to NYU and they’re the ones that advise the company about whether this particular patient is an appropriate candidate and this one is not. What’s impressive about all this is that it’s not something mandated by any regulatory body, and it’s an additional expense and screening process for Janssen. But they consider it a benefit overall, because it provides them with vital information that they might not get through traditional examination channels.

Ramana spoke of anecdotes he had heard about patients. “It was just very gratifying. Even being completely in the thick of it and designing the process and implementing it, I never for one day expected the kind of response that came back from the patients—that they were so grateful to us for doing this. In fact, one of the first responses that came back was about a family that had lost a husband and father. The son put up a campaign on social media trying to get medication for his dad, and unfortunately the father passed away because he couldn’t get access to the drug. The father’s widow wrote a letter to us saying ‘Thank you so much [for our programs]. I wish there was something like this when my husband was still alive.’ I think that’s an example of a very tangible change that we’ve made.” This points to a sea change that has happened in just the last few years at companies. It forces everyone to think differently about their jobs, to change perspective, actions and programs. At first, there was a perception—probably true—that patient advocacy groups had a somewhat skeptical or even contentious relationship with the companies who make the drugs and devices. We now see that changing significantly: both are working toward the same goals, and therefore can operate in concert. The industry has never considered itself at odds with patient concerns, but it took a major shift in perspective to understand the gap between patient point of view and company point of view.

“We just assume everybody knows certain facts. It was amazing that [the patient advocacy groups] were not aware of some of the policies that we had in place and the changes that were taking place in the landscape.” Ramana said “It’s very interesting because you get so many insights from the advocacy groups. I’ve been working with some of them in the mental health area. As you know, depression is one of the areas that affects the most people, so this particular group had was training mental health professionals across the country. When it came to certain simple things about what pharma companies do, it was astonishing to see the level of awareness of things that we consider in our daily language, in our daily culture, that we just assume everybody knows certain facts. It was amazing that they were not aware of some of the policies that we had in place and the changes that were taking place in the landscape.” In that case, it wasn’t even that the policies and programs weren’t available, but that even the patient advocates didn’t know about them. The company wasn’t aware of the education gap, and had to address that. Health literacy and education has to go hand-in-hand with the benefits provided by the companies.

“This is one of the areas where the patient advocacy organization can let us know about the kinds of needs they have and the kind of insights that we can bring forward for them,” said Ramana.

Patients and professionals recognize the mutual benefits…and provide resources for each other. In other words, it’s a partnership, and that’s the new era we’re in: patients and professionals now recognize the mutual benefits of an ongoing conversation. They provide resources for each other: on the one side, information about disease states and therapies, and on the other side insights about what is understood or unknown. Access to each other is the bridge that makes this possible, and it’s the responsibility of healthcare companies to open the door to access. For instance, companies can help advocates organize their thoughts and formulate a plan of attack with a particular payer issue, or can align with them on things that are not branded. Ramana said “One of the things I heard from the advocacy organizations was often times the advocacy organization will start with a very sick family member, and this person starts off a grassroots effort. It’s really teaching the advocacy organization how to advocate for themselves. So you really get them off the ground because we have a lot of experience that we can share HS&M APRIL/MAY 2017| 60

PHARMACEUTICAL and they can start representing a broader patient community. Very often they don’t know how to do that, but it’s just that they have unlimited passion because of a certain tragic story that they try to bring forward and help others in that space.” It’s in this spirit that people like Ramana and many others have shown that, because we are all patients, we must also all be advocates. Not a difficult bridge to cross, and one that more companies are traversing every day. •

Ramana Sonty, MBBS, PhD Director of Strategy Janssen Global Medical Organization Ramana is a leader on the J&J Pre-Approval Access Task Force in the Office of the CMO. The Task Force has delivered a new Janssen preapproval access policy, a new SOP and implemented global tracking processes for expanded access/compassionate use requests. In addition, he has led engagement with multiple external stakeholders and is part of the team that launched an innovative compassionate use pilot with NYU, called CompAC, in 2015. The pilot has been featured in articles in Nature, JAMA and other publications. He has presented the work of the task force to diverse national and international audiences. Ramana has trained in medicine and neuroscience. RSonty@its.jnj.com

COMMENT

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