In the past decade, the combination of high unmet patient need and revenue potential has attracted companies of all sizes to the oncology space, creating fierce competition as more and more “copycat,” non-clinically differentiated assets vie for attention in the same space with high prices.
This has made the customer experience that oncology manufacturers deliver more important than ever. Consider a key finding from research that ZS conducted at the end of 2019: Oncologists prescribe 70% more products from companies that deliver a positive experience than from companies that deliver a negative experience.
And then comes COVID-19, which has upended pharmaceutical companies’ established ways of operating and put further pressure on their traditional business models and performance. That’s the bad news. The good news is, the global pandemic has created an environment in which pharmaceutical companies can think and act more boldly and creatively when it comes to the experience they deliver. It’s such a massive disruption of the established order that it presents a unique opportunity for pharma to change things they might not have been willing or able to change in the past—to try new things because customers are open to engaging in different ways.
Pharma companies need to seize this opportunity to rise above the inertia many have long felt and move past the mistaken belief that product performance alone is sufficient to be considered by physicians. In doing so, they should pay particular attention to three areas that have been profoundly affected by COVID-19 and, thus, are important candidates for a new approach to customer experience: clinical trials, biomarker research, and promotion and support.
According to TrialTrove, the top 20 pharma companies sponsor more than 2,000 trials in oncology in the United States alone and more than 3,000 globally. Yet these trials are not necessarily uniformly positive experiences for those involved. Our 2019 research found patients’ and providers’ experience was largely negative, irrespective of the clinical program’s scale. This means that spending more in research or running many more trials doesn’t lead to a better experience, which suggests there are plenty of ways to improve how trials are designed and executed.
Fast forward to 2020, this is truer than ever, as COVID-19 has shut down, delayed or slowed a significant volume of clinical trials. In fact, oncology trial enrollment has dropped by half since last year, affecting more than 1,000 trials, according to ZS research. In some countries, such as the United Kingdom, COVID-19 trials have assumed top priority, which reduces the resources available for in-progress or planned oncology trials.
One of the biggest worries for providers beyond staff safety has been protocol deviation, given the relatively strict rules around trials and data collection. For their part, oncology patients are looking for a delicate balance between effectively fighting their cancer and avoiding exposing their immunocompromised bodies to additional risk. Patients can’t wait—the disease has likely been progressing while trials are on hold and they need to regain access to trials as quickly as possible. But in the current environment, a patient’s traditional weekly visit to a provider for a blood draw isn’t practical or safe. Unfortunately, while the FDA is adapting its guidance for COVID-interrupted trials to help companies ensure the data is useful, patients looking to get on trials are finding their options limited.
The question for pharma looking ahead is, how do we design trials that not only are scientifically valid but also reduce the burden on providers and patients? The bottom line is pharmaceutical companies still need to be able to collect data, but they have to do that in a way that doesn’t put patients or providers at risk.
At a base level, pharmaceutical companies need to inject more flexibility into their trials in response to COVID-19’s impact, moving away from the standardized “supply chain”-type approach to one that recognizes and is tailored to the specific needs of patients and providers. The big opportunity here is in data collection.
As mentioned earlier, TrialTrove has recorded 2,000 in-progress trials in the United States, most of which don't currently rely on any convenient data collection mechanism. They still require patients to visit providers which, as we’ve noted, is far less safe and practical for both parties in the COVID era. In fact, ZS research found that 65% of cancer patients said they delayed their visit to their oncologist. What if pharma companies used this time to completely rethink their clinical trial protocols to reflect a world where on-site visits for data collection are rare or even non-existent? If a patient can’t go to a provider in person, what could that mean for how a company collects data in future trials?
For example, patients could be outfitted with connected wearable devices that could enable pharma companies to still collect data without making patients visit providers. Benefits include greater convenience and safety for patients, a potentially larger sample size (because it’s easier to recruit patients remotely), possibly more accurate and objective results, and less time spent by providers. Wearable devices can pose several challenges, including regulatory concerns and logistical issues. But because of their big potential upside, they certainly bear serious consideration.
Growing use of different forms of technology to digitalize various aspects of clinical trials is enabling pharmaceutical companies to gradually decentralize certain elements of their trials, with the potential to move to fully “site-less” trials in which all elements are decentralized. A few actually have taken the big step of going completely virtual. ZS research has found that nine in 10 U.S.-specific ongoing decentralized oncology trials incorporate such tools as artificial intelligence, machine learning, digital interventions, ePRO, mHealth, wearables or biosensors, and web-based systems.
Irrespective of the trial’s design, pharmaceutical companies may also want to look at how they can continue treating patients in trials—even if they might not be counted in the final analysis because their data wasn’t usable—on a purely compassionate basis. Many patients would likely see this as the right thing to do, and consider this a truly great experience.
As we continue to move toward precision, personalized medicine, many new diagnostics and biomarkers will likely be launched. For example, in lung cancer alone, more than 20 mutations or biomarkers are in clinical development today. Historically, markets have largely operated on an “if you build it, they will come” philosophy when it comes to biomarkers. However, according to our research, not all biomarkers are equally accepted, and they can be a barrier to treatments reaching patients. In fact, providers in our research indicated there are a number of keys to success that aren’t related to clinical value—including how to get the test, how it fits in with existing infrastructure, how to interpret test results and how patients are reimbursed.
COVID-19 has injected further complexity into the biomarker landscape. In the short term, it has stunted biomarker research by commandeering scarce testing resources. In the longer term, pharma companies will need to consider the fact that a meaningful portion of the population (currently 4 million and counting) will have been exposed to the virus. The people who have been exposed and have other comorbidities likely will respond to biomarker tests differently, and might need different interventions. But COVID-19’s long-term impact is still emerging and won’t be known for decades. Even the interventions themselves have long-term implications: for example, the rise in secondary acute myeloid leukemia (AML) a decade after chemotherapy treatment for breast cancer.
As pharmaceutical companies take a fresh look at biomarkers in development, they’ll need to consider biomarkers as well as prior exposure to COVID and other comorbidities. Single biomarker treatments are valuable and have helped patients considerably. But by including COVID and other scenarios in their efforts, pharmaceutical companies can begin evaluating solutions in the context of the full patient.
And as the market heads toward more comprehensive testing, pharmaceutical companies will have to determine the right mix of access, cost and utility to give patients a personalized solution. For example, the rapid scaling up of serology testing for COVID-19 demonstrates the value of diagnostic testing and modalities that are less burdensome, less costly and more efficient.
In other words, pharmaceutical companies should focus on making comprehensive testing (of which, our research shows, customers don’t have a positive impression) as accessible to patients as the single-point tests and in-house IHC (which customers do view favorably, according to our research). A big turning point this year in that regard has been the Centers for Medicare and Medicaid Services’ decision to cover tests using next-generation sequencing for patients with germline (inherited) ovarian or breast cancer.
PharmaForce has found that, traditionally, pharma companies have supported new drug launches by adding more sales representatives to get the drug in front of providers. However, more than 6,000 sales personnel already work in oncology. Do companies really need more for their next launches? The answer is likely no, for a few reasons. First, the market’s not asking for them. According to our research, in the drive toward precision medicine, providers see diagnostic support personnel as more important than sales reps in addressing their needs. Moreover, our research shows that providers perceive pharmaceutical companies with a stable or non-disruptive sales force—despite adding new products—as delivering a much better “people” experience. So, longer-lasting and richer relationships matter more than the size of the force.
COVID-19 has further redefined the shape that promotion and support should take. Our research shows that 50 to 80% of sales reps weren’t able to make in-person visits with oncologists for a significant portion of their providers while travel restrictions and lockdowns were in place. Furthermore, many industry conferences that have served as connection points for pharma companies and their customers have gone virtual, limiting potentially valuable interactions. And things aren’t likely to ever go back to “normal.” A group of providers in our research don’t expect to see any pharmaceutical company personnel in person in the future, and many more will restrict access in some ways. The result is a significant promotion and engagement gap that’s forcing pharmaceutical companies to take a harder look at the value of their interactions with providers.
On top of this, our research found that providers aren’t overly enthusiastic about the support they’ve received from pharma companies during the pandemic. Only 35% of oncologists and 17% of administrators said they’re very satisfied, with the remainder being mostly neutral. This suggests that pharma companies have some work to do to understand and deliver what their customers are looking for.
Pharma’s single-biggest investment in commercialization (beyond drug development costs) has been the field force. But the efficacy of and need for that team is in question, especially now. The market is looking for the right personnel at the right time to access life-changing therapies, and the importance of reimbursement personnel and diagnostic liaisons in that mix is growing. As a result, many pharma companies are reconsidering their long-term strategies for how they engage with providers.
A big issue companies are looking at is what to do with the vast army of sales reps on their payroll. With most providers both expecting far fewer in-person visits from sales reps and increasingly relying on other roles for education and support, many pharmaceutical companies will have to redefine the sales rep’s role. That includes identifying new metrics by which to gauge reps’ performance when traditional measures, such as the number of times a rep has visited an oncologist, is no longer relevant. Some companies are also looking at all their roles, including non-commercial ones, to ensure they’re a good fit for today’s environment.
The channels pharma companies use to engage with providers also must change. Most obviously, the digital channel has assumed far greater importance in a post-COVID-19 world. Just as many people in the general population have gone from in-person to online dating, pharma needs to learn to move beyond the in-person channel to meeting customers virtually. Training is critical for sales reps and support personnel to understand how to use and get the most out of digital tools.
But the digital channel can’t be simply the replacement for in-person visits. Digital should be part of a mix of multiple channels—including emails, phone calls, video conferences and, yes, the rare in-person visit—that’s focused on interaction quality, not quantity. The explosion in digital engagement has meant more noise to cut through, and the pharmaceutical companies that recognize the context of the provider and adjust their approach and support to meet their unique needs will have a far greater chance of connecting with doctors. Similar to how we consume news today—via everything from TV and newspapers to Instagram and Twitter—there pharma companies need to offer multiple channel choices to fit the context of the customer (who might engage on different channels at different points of the day).
For example, according to our research, oncologists who anticipate a return to normalcy within the next several months are most likely to look for pharma companies to help create unbranded collateral on COVID-19 and provide telemedicine resources support. Conversely, oncologists who expect the current conditions to drag on for six months or longer said that co-pay or other financial support and transportation services for medical care visits are the best ways pharmaceutical companies can help. Treatment fulfillment support is also important for both groups.
The experience of customers and patients has always been key to pharma companies’ sustained success. Our research has revealed, for example, that companies that create positive experiences have fewer restrictions on customer access and have two to three times stronger digital engagement. We also found improving the customer and patient experience could drive an incremental $50 million to $75 million per $1 billion in revenue for most oncology companies. This was true in 2019 when we ran our research, and it’s still true today. The difference is that the context has changed—thanks to COVID-19—and the opportunities to trigger improvements in the experience delivered have multiplied as a result. With countries and regions continuing to experiment with different approaches to managing their COVID response, it’s a good time for pharma companies to explore with customers what they’d like in this new reality.
The fact is, as providers, patients and institutions recover from the initial shock of COVID-19 and get a clearer understanding of the long-term consequences, the customer and patient experience becomes more important than ever to competitive differentiation and growth.