プライマリー/セカンダリーケアでの医薬品処方機会

Overview

Introduction

Key findings indicate that pharmaceutical promotional campaigns have to be aligned with physicians' exact information requirements if engagement and persuasion is to be increased. Consequently, the factors that feed into the decisions prescribers make when choosing one drug over another potential competitor have to be the core component of any targeting strategy

Scope

• Identification of the major impacting factors on physician prescribing behavior, based on results from a survey of 85 doctors in the US, Europe, Japan
• Assessment of physician perception of the effectiveness of components of the pharmaceutical promotional mix
• Investigation of prescription behavior in the epilepsy, depression, dyslipidemia, gastrointestinal ulcers and asthma primary care in the US and Europe
• Discussion of prescribing opportunities in secondary care, illustrated by reference to the arthritis and oncology sectors

Report Highlights

Detailing is proving to be the least effective component of a product's promotional mix. Companies have to better address prescribers' exact information requirements if buying is to be increased.

All physicians would normally prescribe the best-perceived treatment for an indication, despite its cost. For secondary care prescribers, however, the challenge is to justify the cost of an efficacious drug if payers disagree.

US-based physicians believe that the recent Medicare law changes will not enhance but only complicate current prescribing practice. Pharmaceutical marketers have to capitalize on any reimbursement opportunities that minimize prescribing indecision.

Reasons to Purchase

• Understand why one drug is always prescribed over another, and how promotional activity can provide the 'right' information to the physician
• Determine the effectiveness of detailing at influencing physicians' prescribing behavior in both primary and secondary care markets
• Identify high growth specialist disease markets that offer greater product margins for long-term portfolio growth

TABLE OF CONTENTS

EXECUTIVE SUMMARY

• Action points
• Detailing is proving to be the least effective component of a product's promotional mix. Companies have to better address prescribers' exact information requirements if buy-in is to be increased
• The best perceived treatment for the respective indication would be prescribed despite its cost. Companies have to position a product's comparative benefit-risk ratio and patient compliance rating to persuade prescribers
• Main dilemma facing secondary care prescribers is justifying the cost of an efficacious drug if payers disagree. Buy-in is best optimized by ensuring costs are rationalized through effective disease management support
• US-based physicians believe that the recent Medicare law changes will not enhance but only complicate current prescribing practice. Pharmaceutical marketers have to capitalize on any reimbursement opportunities that minimize prescribing indecision

CHAPTER 1 MAXIMIZING A PRODUCT'S PRESCRIPTION VOLUME

• Primary versus secondary care: working with physician detailing being a zero-sum game
• What truly influences the prescribing decision?
• Factors that impact on a physician's prescribing process
• Factors that influence the prescribing decision making process
• Conclusion: optimal targeting strategies

CHAPTER 2 PRIMARY CARE: ASCERTAINING THE PRESCRIBER'S DECISION MAKING PROCESS

• The high cost of primary care promotion
• Understanding the key influencers on primary care provision
• Influencing primary care prescribing
• Driving factors for choosing a particular drug
• Resisting factors to choosing a particular drug
• Impact of key factors on the decision to prescribe
• Therapeutic considerations
• Conclusion - what drives PCPs to prescribe one drug over another
• Epilepsy, depression, dyslipidemia, GI ulcers and asthma: main therapeutic considerations are...
• Influencing secondary care prescribing
• Driving factors for choosing a particular drug
• Resisting factors to choosing a particular drug
• Impact of key factors on the decision to prescribe
• Identifying high growth specialist markets
• Dilemma in secondary care: paying for innovative therapies

APPENDIX

• Supplementary data for Chapter 1
• Supplementary data related to Datamonitor's Physician Prescribing Survey 2004
• Research methodology
• Primary care datasets
• Secondary care datasets
• Supplementary data related to the analysis of primary care prescribing (US and Europe)
• Rationale for using the prescription data of five indications
• US
• France
• Germany
• UK
• Italy
• Spain
• Datamonitor's Product Valuation Index
• Supplementary data for Chapter 2
• Supplementary data for Chapter 3
• Diovan: key facts and events in its lifecycle
• Overview of the global ARB market
• Other general information related to report content
• References to Datamonitor Healthcare reports
• Other references not detailed in the report text
• Glossary of general terms used in the report
• Datamonitor Healthcare's pharmaceutical strategy capabilities
• About 21st Century Insight
• About eHealthInsight
• Datamonitor's strategic consulting expertise
• Key strategy team members
• How to contact experts in your industry
• List of Tables
• Table 1: Healthcare expenditure* of the US, France, Italy, UK and Spain, 2001-02
• Table 2: US and France: top five anti-epileptics prescribed in primary care, (US data: Q3 2000-Q3 2003 and France data: Q2 2000-Q2 2003)
• Table 3: Germany and the UK: top five anti-epileptics prescribed in primary care, (Q2 2000-Q2 2003)
• Table 4: Italy and Spain: top five anti-epileptics prescribed in primary care, (Q2 2000-Q2 2003)
• Table 5: US and France: top five anti-depressants prescribed in primary care, (US data: Q3 2000-Q3 2003 and France data: Q2 2000-Q2 2003)
• Table 6: Germany and the UK: top five anti-depressants prescribed in primary care, (Q2 2000-Q2 2003)
• Table 7: Italy and Spain: top five anti-depressants prescribed in primary care, (Q2 2000-Q2 2003)
• Table 8: US and France: top five anti-dyslipidemics prescribed in primary care, (US data: Q3 2000-Q3 2003 and France data: Q2 2000-Q2 2003)
• Table 9: Germany and the UK: top five anti-dyslipidemics prescribed in primary care, (Q2 2000-Q2 2003)
• Table 10: Italy and Spain: top five anti-dyslipidemics prescribed in primary care, (Q2 2000-Q2 2003)
• Table 11: France: top five anti-GI-ulcerants prescribed in primary care, (Q2 2000-Q2 2003)
• Table 12: Germany and the UK: top five anti-GI-ulcerants prescribed in primary care, (Q2 2000-Q2 2003)
• Table 13: Italy and Spain: top five anti-GI-ulcerants prescribed in primary care, (Q2 2000-Q2 2003)
• Table 14: US and France: top five anti-asthma products prescribed in primary care, (US data: Q3 2000-Q3 2003 and France data: Q2 2000-Q2 2003)
• Table 15: Germany and the UK: top five anti-asthma products prescribed in primary care, (Q2 2000-Q2 2003)
• Table 16: Italy and Spain: top five anti-asthma products prescribed in primary care, (Q2 2000-Q2 2003)
• Table 19: Product's characteristics: key influencers on prescribing
• Table 20: Healthcare payer's guidelines/stipulations: key influencers on prescribing
• Table 21: Patient's and/or healthcare professional's preference: key influencers on prescribing
• Table 22: Pharmaceutical product promotion: key influencers on prescribing
• Table 23: Drug characteristics - key issues considered when prescribing
• Table 24: Therapy area or indication specific - key issues considered when prescribing
• Table 25: Local regional concerns - key issues considered when prescribing
• Table 26: Product's characteristics: key influencers on prescribing
• Table 27: Healthcare payer's guidelines/stipulations: key influencers on prescribing
• Table 28: Patient's and/or healthcare professional's preference: key influencers on prescribing
• Table 29: Pharmaceutical product promotion: key influencers on prescribing
• Table 30: Drug characteristics - key issues considered when prescribing
• Table 31: Therapy area or indication specific - key issues considered when prescribing
• Table 32: Local regional concerns - key issues considered when prescribing
• Table 33: Top 15 global blockbusters, 2002
• Table 34: Prescription trend data - input classifications/codes used in IMS Health data
• Table 35: US: top five anti-epileptics prescribed in primary care and associated marketing companies, Q3 2000-Q3 2003
• Table 36: US: top five anti-depressants prescribed in primary care and associated marketing companies, Q3 2000-Q3 2003
• Table 37: US: top five anti-dyslipidemics prescribed in primary care and associated marketing companies, Q3 2000-Q3 2003
• Table 38: US: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 39: France: top five anti-epileptics in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 40: France: top five anti-depressants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 41: France: top five anti-dyslipidemics prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 42: France: top five anti-GI-ulcerants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 43: France: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 44: Germany: top five anti-epileptics in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 45: Germany: top five anti-depressants in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 46: Germany: top five anti-dyslipidemics prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 47: Germany: top five anti-GI-ulcerants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 48: Germany: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 49: UK: top five/six anti-epileptics in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 50: UK: top five anti-depressants in primary care and associated marketing company, Q2 2000-Q2 2003
• Table 51: UK: top five anti-dyslipidemics prescribed in primary care and associated marketing company, Q2 2000-Q2 2003
• Table 52: UK: top five anti-GI-ulcerants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 53: UK: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 54: Italy: top five anti-epileptics in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 55: Italy: top five anti-depressants in primary care and associated marketing company, Q2 2000-Q2 2003
• Table 56: Italy: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Table 57: Italy: top five anti-GI-ulcerants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 58: Italy: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 59: Spain: top five anti-epileptics in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 60: Spain: top five anti-depressants in primary care and associated marketing company, Q2 2000-Q2 2003
• Table 61: Spain: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Table 62: Spain: top five anti-GI-ulcerants prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 63: Spain: top five anti-asthma products prescribed in primary care and associated marketing companies, Q2 2000-Q2 2003
• Table 64: Criteria and points for the Product Valuation Index (PVI)
• Table 65: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-epileptic to be prescribed in primary care
• Table 66: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-depressant to be prescribed in primary care
• Table 67: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-dyslipidemic to be prescribed in primary care
• Table 68: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-GI-ulcerant to be prescribed in primary care
• Table 69: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-asthma product to be prescribed in primary care
• Table 70: Diovan: key facts
• Table 71: Global sales of the leading branded ARBs, 2002
• List of Figures
• Figure 1: Detailing and advertising are not effective at persuading prescribers
• Figure 2: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-epileptic or anti-dyslipidemic to be prescribed in primary care
• Figure 3: Medicare Part D benefit proposal: the $2,850 'doughnut hole'
• Figure 4: Specialist physicians placed greater emphasis on peer and literature support for a prescription product
• Figure 5: Prescribers are unlikely to choose non-formulary drugs
• Figure 6: Peer physician opinions are most persuasive on the prescribing decision
• Figure 7: Detailing is the least effective component of pharmaceutical promotion aimed at persuading physicians to prescribe a particular product
• Figure 8: A product is chosen primarily on the basis of its benefit-risk ratio and effect on patient compliance
• Figure 9: Physicians will choose the product that is expected to meet its clinical expectations
• Figure 10: A drug's reimbursement status is an important consideration when prescribing
• Figure 11: US: total marketing spend 2002
• Figure 12: The impact of local regional issues on primary care prescribing
• Figure 13: A key influencer on prescribing is patient adherence to treatment
• Figure 14: Persuading physicians: influencing the 'crowd' not just the 'individual'
• Figure 15: Key influences related to meeting payers' requirements: length of treatment and formulary guidelines
• Figure 16: Key influence related to product characteristics: ongoing support for the product made evident from the clinical setting
• Figure 17: Least influences from the pharmaceutical promotional mix on prescribing: online banner advertising and verbal promotion from a sales rep
• Figure 18: Three product characteristics that affect prescribing choices - cost, clinical efficacy and side-effect profile of a drug
• Figure 19: Determining the relative cost of the prescribed therapy: methodology applied1,2,3,4
• Figure 20: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-epileptic to be prescribed in primary care
• Figure 21: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-depressant to be prescribed in primary care
• Figure 22: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-dyslipidemic to be prescribed in primary care
• Figure 23: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-GI-ulcerant to be prescribed in primary care
• Figure 24: Cost of therapy versus clinical value: a quantitative review of the likelihood for an anti-asthma product to be prescribed in primary care
• Figure 25: Support by peer physicians is a key persuader for specialists to prescribe a particular drug
• Figure 26: Further importance placed on peer and literature support: positive long-term product history is more persuasive on the prescriber
• Figure 27: Adherence to formulary guidelines is a key influence on the secondary care prescriber
• Figure 28: US secondary care prescribing is heavily persuaded by the reimbursement status of the drug
• Figure 29: Patient compliance is best demonstrated by a product's high benefit-risk ratio and is a key influence on the prescriber
• Figure 30: Indication specific needs are an important consideration when prescribing choices are made in secondary care
• Figure 31: Specialist physicians' opinions: a visit from a sales rep is not always welcomed
• Figure 32: Performance of the blockbuster market (2000-03) and taking a look into the future (until 2008)
• Figure 33: 2002 estimates: arthritis, respiratory diseases and cancer are the new blockbuster breeding grounds*
• Figure 34: 2003 estimates: oncology, thrombosis, arthritis and respiratory diseases are forecasted to experience the strongest growth*
• Figure 35: US: emergence of specialty pharmacies to optimize pharmacy distribution channels
• Figure 36: US: top five anti-epileptics prescribed in primary care, Q3 2000-Q3 2003
• Figure 37: US: top five anti-depressants prescribed in primary care, Q3 2000-Q3 2003
• Figure 38: US: top five anti-dyslipidemics prescribed in primary care, Q3 2000-Q3 2003
• Figure 39: US: top five anti-asthma products prescribed in primary care, Q3 2000-Q3 2003
• Figure 40: France: top five anti-epileptics prescribed in primary care, Q2 2000-Q2 2003
• Figure 41: France: top five anti-depressants prescribed in primary care, Q2 2000-Q2 2003
• Figure 42: France: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Figure 43: France: top five anti-GI-ulcerants prescribed in primary care, Q2 2000-Q2 2003
• Figure 44: France: top five anti-asthma products prescribed in primary care, Q2 2000-Q2 2003
• Figure 45: Germany: top five anti-epileptics prescribed in primary care, Q2 2000-Q2 2003
• Figure 46: Germany: top five anti-depressants prescribed in primary care, Q2 2000-Q2 2003
• Figure 47: Germany: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Figure 48: Germany: top five anti-GI-ulcerants prescribed in primary care, Q2 2000-Q2 2003
• Figure 49: Germany: top five anti-asthma products prescribed in primary care, Q2 2000-Q2 2003
• Figure 50: UK: top five/six anti-epileptics prescribed in primary care, Q2 2000-Q2 2003
• Figure 51: UK: top five anti-depressants prescribed in primary care, Q2 2000-Q2 2003
• Figure 52: UK: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Figure 53: UK: top five anti-GI-ulcerants prescribed in primary care, Q2 2000-Q2 2003
• Figure 54: UK: top five anti-asthma products prescribed in primary care, Q2 2000-Q2 2003
• Figure 55: Italy: top five anti-epileptics prescribed in primary care, Q2 2000-Q2 2003
• Figure 56: Italy: top five anti-depressants prescribed in primary care, Q2 2000-Q2 2003
• Figure 57: Italy: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Figure 58: Italy: top five anti-GI-ulcerants prescribed in primary care, Q2 2000-Q2 2003
• Figure 59: Italy: top five anti-asthma products prescribed in primary care, Q2 2000-Q2 2003
• Figure 60: Spain: top five anti-epileptics prescribed in primary care, Q2 2000-Q2 2003
• Figure 61: Spain: top five anti-depressants prescribed in primary care, Q2 2000-Q2 2003
• Figure 62: Spain: top five anti-dyslipidemics prescribed in primary care, Q2 2000-Q2 2003
• Figure 63: Spain: top five anti-GI-ulcerants prescribed in primary care, Q2 2000-Q2 2003
• Figure 64: Spain: top five anti-asthma products prescribed in primary care, Q2 2000-Q2 2003