THE EMERGING ROLE OF INTEGRATED
MARKETING IN THE PHARMACEUTICAL INDUSTRY
AN EXAMINATION OF DIRECT-TO-CONSUMER PRESCRIPTION DRUG COMMUNICATIONS
As prescription drug manufacturers increasingly target consumers through integrated marketing com-munications strategies, questions of ethics inevitably arise. Anne Gibson explores the role pharma-ceutical companies’ direct-to-consumer IMC campaigns play in this highly regulated industry.
Confronted with a changing marketplace, pharmaceutical compa- biotechnology and consumers’increasing accessibility to information
nies are embracing and leveraging marketing and branding strate-
about medications and treatments. Biotechnology has revolutionized
gies.Traditionally, the public views major pharmaceutical companies
the industry as it increases the number of potential new drugs. The
as strong research and development institutions.Today, these compa-
recent mapping of the human genome and the increased accessibili-
nies also boast robust marketing arms with practices that rival tradi-
ty to technology that utilizes DNA potentially augment drug inno-
tional marketing efforts of consumer goods companies such as Nike,
vation targets (illness or disease treatments) from 500 to 10,000
(Barents Group LLC, 1999), leading to an abundance of new
A variety of factors have led to a rise in direct-to-consumer pre-
biotechnology ventures and firms. Pharmaceutical companies, under
scription drug campaigns. One major factor is the aging of America.
the pressure of patent expirations and decreasing revenues, increas-
By 2010, 50 million Americans are expected to be over the age of 60.
Between 1998 and 2010, the market for 54- to 64-year-olds will
AS MORE CONSUMERS SEEK
increase by 59 percent, making the baby boomers the pharmaceuti-
INFORMATION REGARDING THEIR
cal companies’ largest growing market. Comprising the industry’s
HEALTH, A CONSUMERISM MOVEMENT
most profitable and reliable market are those aged 55 and over, agroup that accounts for 58 percent of all healthcare spending. An
IN THE PHARMACEUTICAL INDUSTRY
average person over the age of 65 fills 14 to 17 prescriptions per year
(Business and Industry
, 2002) compared to a middle-aged individual’sannual consumption of five prescriptions.
ingly enter into drug licensing agreements with biotechnology com-
Although the target market is growing, pharmaceutical companies
panies. Under these agreements, the big pharmaceutical companies
are facing increasing competitive pressures, most notably mergers and
have evolved into the marketing arms for the new drugs of the
patent expirations. Recent mergers and acquisitions, such as the $60
billion acquisition of Pharmacia by Pfizer, are consolidating the com-
Consumers in today’s marketplace are informed customers, even
petitive landscape. Adding to the pressure are the blockbuster drugs
in healthcare.As more and more consumers seek information regard-
with established brand names that are near to or have met their patent
ing their health and wellness, a consumerism movement in the phar-
expiration dates. Large pharmaceutical companies could lose up to
maceutical industry has evolved. Consumers are able to play a more
$40 billion in revenues from patent expirations over the next five
active role in their treatment decision-making with information
years (Investors Chronicle
, 2002). Upon expiration, the drug companies
readily available through the Internet, dedicated health publications
face cannibalization of their most popular and profitable brand names
as other companies introduce generics. Generic drug manufacturers
As a result of these factors, the pharmaceutical industry is under-
realize revenues at the expense of the pharmaceutical companies’
going a tremendous transformation. It is now commonplace for
research and development investments.
pharmaceutical companies to directly market prescription medicines
Also changing the pharmaceutical landscape are the advances in
JOURNAL OF INTEGRATED COMMUNICATIONS
TRADITIONAL PRESCRIPTION DRUG MARKETING
advertising. The 1997 ruling also dictated that direct-to-consumer
Historically, major pharmaceutical companies marketed their drug
advertising state that health professionals can provide more information
offerings to patient gatekeepers — physicians and healthcare professionals
and use an additional medium (a company’s toll-free phone number or
— since the Food, Drug and Alcohol Administration (FDA) prohibited
web site address) for consumers to obtain detailed information and a
advertising prescription drugs to consumers. Companies used sales repre-
drug’s product labeling (Barents Group LLC, 1999). In spite of these
sentatives to "detail" doctors by educating them and promoting prescrip-
FDA requirements, pharmaceutical advertisements began to have the
tion drugs. Busy doctors relied on the major pharmaceutical companies
same commercial feel as consumer products’ advertisements.
A PHARMACEUTICAL MARKETER’S TOOLBOX INCLUDES:
• Television commercials and radio spots
• Billboards and public transportation advertising
• Print advertisements in newspaper health sections, niche mag-
• Public and patient education regarding diseases, illnesses and
THE INTRODUCTION OF DIRECT-
• Contributions to patient-advocacy groups (i.e. the National
Kidney Foundation and American Cancer Society)
• Physician sales calls, educational seminars and marketing
• Survey results for product efficacy and perception
• Sales promotions through coupon dispersements
commercials became common discussion around the company water
Direct-to-consumer advertising of prescription drugs became more
cooler. Internationally,Viagra features Pele, the Brazilian soccer phe-
prominent in 1997 when the FDA issued less stringent guidelines.
nomenon, in its advertising and public relations campaigns.
Pharmaceutical companies were able to make their advertisements
Other pharmaceutical companies have also hired celebrities to pro-
more media-friendly and hold consumers’ attention.Although the FDA
mote its products, such as Dorothy Hamill for Merck’s osteoarthritis
still prohibited misrepresentation or false claims, it required only a brief
drug,Vioxx. A public relations approach utilizes celebrities through the
summary of the major side effects needed to counterbalance the drug’s
television talk show circuit. Amgen hired New York Yankees Manager
benefits in place of the previous mandate for detailed information in all
Joe Torre to discuss his battle with prostate cancer. Although Torre did
JOURNAL OF INTEGRATED COMMUNICATIONS
not discuss a drug directly, Amgen hoped that his story would create
Changes in Major Pharmaceuticals’
dialogue between patients and physicians, ultimately increasing the use
Consumer Marketing Expenditures
of its own revolutionary prostate cancer treatment. Pharmaceutical
companies use this public relations tactic to increase awareness of unfa-
miliar medical conditions (Wall Street Journal
, April 22). Today, it is not
uncommon to turn on “Entertainment Tonight” and see a celebrity
Merck & Co.
Bristol Meyers Squibb Co.
As the use of celebrity campaigns became increasingly common, so
too did music, athletic and event sponsorships by pharmaceutical drug
companies for a particular brand.Typically, the sponsorships are closelyaligned with a celebrity.Viagra is an active sponsor of a heavily male
showed that 69 percent of patients who inquired about utilizing a
watched sport, NASCAR and has its logo painted on a racing car (For
drug by name ultimately received a prescription for it (O’Connell,
more information on marketing Viagra, please see the article "NASCAR
2002). The industry embraced a strategy similar to that of any con-
Sponsorships: Putting Your Company in the Driver’s Seat" in this issue
sumer good: brand the product so it is asked for by name or easily
Interactive and new media supplement traditional marketing tactics.
recalled and leverage the brand to create a competitive advantage.
AstraZeneca is leveraging futuristic marketing trends as it utilizes new
AstraZeneca has successfully branded its acid pump inhibitor drug,
technology for a campaign promoting Zomig, a migraine treatment.
Nexium, as the "purple pill" through its frequent airing of catchy
The company is pairing up its broadcast commercials with interactive
commercials, its dedicated web site named purplepill.com and its
television, through which interested individuals can request informa-
print advertisements, all of which focus on the physical attributes of
tion and be connected to the brand’s web site.Viral email campaigns
the product. Using IMC, in which advertising, public relations, direct
are increasing in popularity and depend on grassroots efforts of con-
marketing and other tools are utilized, the drug companies have been
sumers to communicate the existence, benefits and results of a new
able to convey clear and consistent messages to consumers and doc-
prescription drug product. Finally, online games and drawings offer a
pharmaceutical company an opportunity to collect information oninterested individuals, which is used to develop a marketing database.
THE FINE LINE OF PHARMACEUTICAL MARKETING
(Please see the Schering-Plough case study on page 28 on the integrated mar-
The industry’s direct–to-consumer marketing expenditures have
keting communications campaign for the company’s new brand, Clarinex.
led to increased regulatory scrutiny of its consumer-targeted market-ing approach in conjunction with other factors, including the ever-
THE PROOF IS IN THE NUMBERS
increasing costs to consumers, insurers and companies for prescrip-
Major pharmaceutical companies have increased their direct-to-
tion drugs and the aging population. Large corporations that insure
consumer ad expenditures, most dramatically after the 1997 FDA rul-
their employees, including Ford and General Motors, state and feder-
ing. In 1991, the industry spent $55 million. In 1998, that number
al legislators, health insurance companies, and lobbying organizations
increased to $1.3 billion and to $2.5 billion in 2000 (Barents Group
such as the American Association for Retired Persons (AARP), close-
LLC, 1999). More recently, these companies have allocated 30 percent
ly monitor the industry and its companies.
of their overall budgets to advertising, outspending all other costs. In
Pharmaceutical companies face a unique environment in the mar-
2000, Pfizer spent $160 million on direct-to-consumer advertising for
keting of prescription drugs. Like any other company, they seek to
Vioxx, which is more than Pepsi ($125 million) and Budweiser ($146
establish distinctive brand identities that own a certain part of con-
million) spent in the same period. In fact, the "seven most heavily
sumers’ mind share. However, these companies also provide an essen-
advertised drugs beat out Nike’s ad budget of $78.2 million for its top
tial service through their products: the improvement of a person’s
shoes" (American Marketing Association, 2002) during 2000.
health and well being. Since pharmaceutical companies are in the
In 2001, pharmaceutical companies spent $175.2 billion on drug
business of healing and improving the quality of life, the standards for
promotions.A closer look at three of the largest pharmaceutical com-
marketing these products are higher than that of consumer goods. At
panies in the following chart displays their most recent marketing
large, the public views the receipt of correct medications not as a
choice, but as a fundamental necessity. Some organizations and law-
Establishing a drug’s brand through direct-to-consumer marketing
makers view drug marketing as the exploitation of a critical and
reaps rewards for the pharmaceutical businesses. A 2002 FDA study
complex product by appealing to consumers’ emotions. No matter
JOURNAL OF INTEGRATED COMMUNICATIONS
what one believes, it is crucial for the pharmaceutical companies to
industry. Before it conducted the Prozac Weekly marketing cam-
comprehend the environment they are operating in and practice eth-
paign, Eli Lilly & Co. should have asked itself the following questions:
• Was this a participant opt-in campaign (i.e. did consumers
Ethical marketing involves conducting one’s branding and pro-
approve the use of their personal information)?
motional campaigns in a manner perceived as moral by the public.
• Will consumers feel as if the company breached their security
Before a company embarks on a campaign, it must question if a
patient’s privacy, confidentiality or security — universal consumer
• Is there an unacceptable risk that this letter and consequently the
concerns for healthcare marketing — are potentially jeopardized. If
drugs will get into the wrong hands, possibly causing harm to the
any doubt exists, the company should discard those marketing tactics.
In the cases where patients and consumers can opt into mailing lists
• Does this marketing tactic align with and enhance the compa-
or share their medical history, the drug companies should give par-
ticipants guidelines detailing what the information will be utilized
• Will the court of public opinion support this marketing campaign?
for, security precautions and what happens to the information if one
A negative answer to any of these questions raises ethical ques-
chooses to opt out. The pharmaceutical companies must not only
tions. Eli Lilly & Co. would have answered negatively to at least one
abide by the current regulatory standards, but also meet the public’s
of these questions; thus it should not have run the campaign.
demand for high standards. Each company must act as its own watch-
This is not to say that the building of brand equity does not
have a place. It does. Umbrella corporate marketing can support anorganization’s overall mission and company promise. When thecorrect message is conveyed, it adds credibility and trust to a com-
WITH THE ABILITY TO NOW USE A
pany’s individual products. Product-specific pharmaceutical mar-
COMPLETE MARKETING ARSENAL, THE
keting can continue to tout a drug’s effectiveness and benefits,
PHARMACEUTICAL INDUSTRY HAS
ensure a brand name is creating "buzz" in the marketplace and val-
EMBRACED INTEGRATED MARKETING
idate it with the public. There is a place for truthful consumer
Pharmaceutical companies take on too much risk when they act as
A major objective of direct-to-consumer prescription marketing
consumer product good companies. Eli Lilly & Co. is under investiga-
is to encourage patients to be educated about their treatment options
tion for a Florida-based direct mail campaign in which free samples of
and to open the dialogue between patients and physicians. In fact, the
Prozac Weekly were sent to previous Prozac users and consumers of
industry should be a strong promoter of patient-physician discus-
other antidepressant medicines. Irate consumers, shocked that the
sions. Pharmaceutical companies should also support the notion that
company knew about their medical history, have filed invasion-of-pri-
the end treatment decision lies with a doctor and is made solely with
vacy suits against Lilly. Medications are not simply a consumption
product; when misused or abused, they can potentially cause seriousharm. Eli Lilly & Co. placed its own reputation and the public at risk
when it sent unsolicited free drug samples.The medications could have
As the pharmaceutical industry undergoes tremendous transforma-
reached an unintended individual or have been consumed by a child
tion, pharmaceutical and biotechnology firms are evolving their mar-
believing it was candy.The industry must prioritize public health and
keting tools. Customer-centric brand communications play an
individuals right to privacy over brand building.
increased role in securing a market category for a company’s drug.
The negative publicity and public outrage over Eli Lilly & Co.’s
Integrated marketing campaigns allow these companies to convey con-
actions make it a moot point whether the company will be found
sistent and powerful messages to all stakeholders, especially to patients.
guilty under Florida’s Deceptive and Unfair Trade Practices statute
However, drug marketers have a responsibility to the public to act
(Wall Street Journal
, July 8, 2002) since repairing the company’s repu-
in an ethical manner.The healthcare industry is simply different from
tation could be more costly than its potential fines. For most busi-
other consumer good businesses. As direct-to-consumer marketing
nesses, the court of public opinion decides its fate, its perception and
becomes more prominent for healthcare products, pharmaceutical-
whether or not consumers will continue to buy the company’s prod-
related companies need to embrace and address consumers’ universal
ucts. For pharmaceutical companies, public opinion significantly
healthcare concerns. By taking this approach, the pharmaceutical
influences the amount of pressure placed on lawmakers to regulate an
companies realize a win-win situation as legislators, regulatory agen-
JOURNAL OF INTEGRATED COMMUNICATIONS
cies and lobbyists support those companies that put consumers first.
Than Journals." Sacramento Bee
. 5 April 2002.
In today’s climate, responsible customer-centric actions resonate
5. O’Connell, Vanessa. "Drug Requests Are More Specific." The
6. Otto, Alexander. "Healthy Living: A Pill By Any Other
Name…." The Atlanta Journal and Constitution
, 23 April 2002.
1. Allison, Wes. "Ad Blitz On For Claritin Alternative." St
7. Rubin, Rita. "Claritin Going OTC;Will Heir Be a Prescription
, 17 April 2002.
For Success?" USA Today
, 23 April 2002.
2. American Marketing Association. . "Putting It In Context."
8. "Rx Meets Boomers’ Demands." Business and Industry
, 13 May
3. Barents Group LLC. "Factors Affecting The Growth of
9. "Who Gains When Pharma Patents Expire?" Investors Chronicle
Prescription Drug Expenditures." The National Institute for Health
Care Management Research and Educational Foundation.
Washington, D.C., 9 July 1999.
ANNE GIBSON is a 2001 graduate of Northwestern’s integrated
4. Drug Industry’s Big Army Doctors Rely More On Salesmen
JOURNAL OF INTEGRATED COMMUNICATIONS
INTEGRATED MARKETING IN SCHERING-
PLOUGH’S LAUNCH OF CLARINEX
Schering-Plough Corporation’s patent for its blockbuster allergy
medicine, Claritin, is expected to expire in December 2002.
Generating $3.2 billion globally and accounting for approximately one-third of Schering-Plough’s 2001 sales, Claritin is a crucial productfor Schering-Plough Corporation (Otto, 2002). As the blockbuster allergy medicine’s patent is expected to expire in December 2002, thecompany has shifted its hopes of future profitable sales to Claritin’s offspring, Clarinex. Clarinex is a modified version of Claritin as it con-tains a more potent version of its most active ingredient.The FDA approved Clarinex for prescription drug sale and patent on December21, 2001.
At stake for the pharmaceutical company is a 50 percent to 75 percent loss in revenue in the first year alone of Claritin’s patent expi-
ration due to the introduction of comparable generic remedies. To hold onto its revenues, Schering-Plough hopes to switch its currentClaritin users to Clarinex.Yet, Clarinex has come under scrutiny by physicians who do not recognize a clinical difference between the tworemedies. The drug manufacturer has turned to consumer marketing to achieve its goal: "to make Claritin the premier over-the-counter(OTC) allergy medication while making Clarinex the leading prescription brand" (Allison, 2002).
The company is leveraging a large investment in the established brand name (note the similarities between Claritin and Clarinex
names), making it almost foolproof for a patient to forget the name of the new drug. Clarinex can claim that it is a treatment for indooras well as outdoor allergies. Thus, the company is able to tout the drug as a "new and improved" version of its trustworthy and popularClaritin, which was advertised as an outdoor allergy medicine.
The company removed all Claritin ads so only Clarinex is marketed. In March 2002, Schering-Plough began running Clarinex televi-
sion advertisements to inform consumers that the new drug can relieve "any allergy, anywhere, any time." Print ads and billboards soonfollowed. Clarinex is a major sponsor of Major League Baseball; advertisements featuring New York Mets’ catcher Mike Piazza frequentlyair on nationally broadcasted MLB games and the brand logo is prominently displayed on the All-Star Game player selection ballots andballpark walls. It is estimated that Schering-Plough will spend $60 million on Clarinex DTCA.
Schering-Plough leverages the Clarinex web site to create a marketing database. The web site offers a free week supply (with physi-
cian’s prescription) coupon for the product. To receive this coupon, patients must complete a personal profile, which includes one’s con-tact information and personal allergy information. Users are encouraged to return to the web site after using the medicine to complete asurvey regarding its efficacy; again, information is collected on each visitor. In return, participants are given a free 10-day supply of Clarinex(with prescription).
Schering-Plough utilizes the collected user data to present physicians with its findings on the drug. Its intent is to re-emphasize the
drug’s efficacy and present patients’ positive perspective.Though the company is directly targeting consumers, it also recognizes the impor-tance of doctors in Clarinex’s success. ImpactRx, a pharmaceutical promotion research organization, reports "90 percent of doctors decideto embrace or discard a new medicine within the first six months of the drugs release" (Sacramento Bee
, 2002).These doctors are a crucialtouch point with consumers. Clarinex replaced the distribution of Claritin samples. The price of Claritin, approximately 17 percent lessthan Claritin’s price, should please both consumers and physicians.
It is too early to state the results of Schering-Plough’s integrated marketing efforts for Clarinex.The company has publicly stated that
it is happy with the results to date for new users and Claritin switchers. Claritin, the replaced drug in this campaign, was one of the firstdrugs to leverage direct-to-consumer marketing. Its success was profound. Schering-Plough spent $110 million to market the drug eachyear in 1999 and 2000 (Allison, 2002). Claritin was the third largest selling prescription drug in 2000 (Rubin, 2002). As an OTC drug, thecompany can leverage Claritin’s established brand name and loyalty while generic drug manufacturers will have to compete at a similarshelf price (Investors Chronicle
JOURNAL OF INTEGRATED COMMUNICATIONS
Almeida JPM, Carnide C, Sousa R, Pereira-da-Silva D Review Article/Artigo de Revisão Pregnancy after breast cancer: dream or reality? Gravidez após cancro da mama: sonho ou realidade? Joana Palmira Martins Almeida*, Cátia Carnide*, Rita Sousa**, Daniel Pereira da Silva*** Serviço de Ginecologia do Instituto Português de Oncologia, Coimbra, Portugal Abstract Pregnancy afte
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