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  Prescribing Drugs a Healthy Future   Prescribing Drugs a Healthy Future  Edwin Colyer  
Prescribing Drugs a Healthy Future Rebranding is part of everyday life. Our favorite drinks get "improved," airlines change their signature colors, and even stores change their names, or at least their livery and layout, once in a while. We expect rebranding to happen. Sometimes we like it, sometimes we don't.

"But consumers are fickle," says Jon Parton, director of global branding at pharmaceutical company AstraZeneca. "If your product is not the newest and the best, then consumers will try something else. The market expects innovation and companies don't have to prove their new claims. If you don't keep up with new improved formulas and fashionable logos, then you will lose customers.

"In medicine this doesn't seem to apply," Parton continues. "To be better than the competition you have got to prove it with clinical studies and scientific data. There is not much an old product can do to compete with drugs that can prove their superiority."

This is Parton's way of saying that drug rebranding tends to be a bad idea. "You can't just do a 'bit of branding,' " he says. "Good branding must involve time and money. The idea that you could do some branding and squeeze out some extra revenue is wrong, especially at the end of a product's lifecycle when it faces competition from both generic products and newer prescription compounds."

Nevertheless, Parton concedes that brands must be maintained, adapted, and adjusted throughout their lives. "Marketers try to predict and respond to the environment that the product is competing in. For example, if a competitive product comes out and threatens it, you may have to change what you say and change what people think about your positioning. Or you may get approval for a new indication and that may completely alter what you say about your drug."

The osteoporosis drug Fosamax, for example, was originally marketed to specialist physicians who could prescribe it to post-menopausal women diagnosed with osteoporosis. However, in 2000, the FDA approved a once-a-week drug that could be used for the prevention of the disease. Fosamax's focus then moved from treatment to prevention; the main marketing audience became the primary care physician. The brand's messages had to change.

Mike Rea, managing director of pharmaceutical marketing firm IdeaPharma, argues that these kinds of "brand changing" events can be predicted and planned for. "You have to plan ahead. The alternative is not to—and wait for your marketing to turn around and bite you. Clearly you never know everything, but you can identify areas where you don't know enough and plan for various scenarios. For example, you may realize that some indications are not ready for your drug and you may need to do some market shaping well in advance of any launch."

Rea points to Lipitor as one of the best examples of a well planned brand. The world's top-selling statin (a drug used to lower cholesterol) was actually first approved for patients with a rare, often fatal disease called familial hypercholesterolemia. "It was a small commercial opportunity, but a real stepping stone," says Rea. "The halo effect was tremendous and helped Lipitor's success. I'm sure that they always intended leap-frogging to a 'mass market' product and the Lipitor brand must have been developed with this in mind. With all the additional supplementary approvals for Lipitor, the branding and messages have never really changed."

Rob Dhoble, president of DAS Healthcare, says that the branding issues that arise at the end of a drug's life can certainly be planned well in advance. "There are two main routes you can take to extend sales at the end of a drug's patent-protected life. One way is to couple the product to an additional patent, for example a novel drug delivery technology. Otherwise you can transfer the product to the over-the-counter space, where it becomes more like a consumer product. In the latter case this depends on the proven safety of the compound."

Dhoble says that the branding work to extend the cholesterol drug Zocor's life began more than seven years before its patents ended. Merck identified the drug as a candidate for over-the-counter (OTC) switching. After several failed attempts to switch to OTC status, the drug (now branded as Zocor Heart-Pro) was finally approved for OTC sales in the UK in 2004.

But according to Dhoble, all the while Merck was waiting for OTC approval it was undertaking extensive branding work. Zocor's main claim as a prescription product was that it lowered "bad" cholesterol. But how can you demonstrate this for an OTC product unless customers take blood tests? Zocor Heart-Pro was also targeting a population of people that had a moderate risk of a cardiovascular event (heart attack or stroke)—people who today feel fine and tomorrow are whisked off in an ambulance. "Merck knew that it had to find a role for physicians and pharmacists with this drug despite it going OTC," says Dhoble.

A large part of the branding work actually targeted pharmacists, now the front line decision-makers and gatekeepers of Zocor Heart-Pro. They needed to engage with the brand and be educated about typical "at risk" populations who would supposedly benefit from taking the OTC drug.

Unsurprisingly, the OTC marketing tends to focus more on aspects of the treatment that don't need blood tests to measure. The message on McNeil's (the Johnson & Johnson company which manufactures Zocor Heart-Pro) website is clear: Zocor Heart-Pro helps to prevent heart attacks. "If you are at moderate risk (that's a one in ten to one in seven risk of a heart attack in the next ten years)," the site copy reads, "you should be able to buy Zocor Heart-Pro from your pharmacist. It's great news for everyone who wants to take control of their heart health. After all, it is the single biggest step you can take without a prescription to lower your bad cholesterol and protect a healthy blood flow to your heart."

McNeil offers training and education materials for pharmacists and leaflets for patients. Patients are also invited to engage with the brand by joining the "Healthy Heart Program" and monitoring any adverse events.

Despite this shift in emphasis, however, the Zocor Heart-Pro brand also remains loyal to its origins. In the US, where the drug remains a prescription-only medicine, the brand also promises to save lives: "Zocor does more than just lower cholesterol," it says on the US product website. "Zocor helps save lives."

"Even if a drug does not go OTC, but is modified with a drug delivery system, the branding challenge is not small," says Dhoble. "You want familiarity between the old and the new, but you don't want them to be equivalent. Unless you do a good job, the product will not be approved for reimbursement or make it onto national formularies."

But while the end of a drug's life can be anticipated, AstraZeneca's Parton points out that accurately mapping its entire lifecycle is far removed from laboratory science. "Long-term strategic planning is what we aspire to do. But the further out we get from the present the more likely we are to be wrong. We are confident with the short-term, but anything over five years is almost impossible to predict."

Dhoble blames much of this unpredictability on the way the industry is so heavily regulated. "While there's a lot of wisdom in long-term branding based on a full clinical development plan, there are so many variables that the certainty of what such a plan represents is diminished," he says. "In the pharma world the decisions are not your own. If a big food company wanted to bring out an active nutrition bar for men over 50 it could probably launch one within six months. Pharma companies have to go through scientific trials, then regulatory scrutiny. It is all about safeguarding public health, and there are no certainties at any step."

So sometimes, inevitably, the branding experts are called in to troubleshoot, says Dhoble. "Branding consultants can breathe life into a brand which hasn't changed from a product point of view. It tends to happen where a product represents a large proportion of a company's turnover, or several products are considered as a group."

"If you know that you are not connecting with your audience, it would be foolish to keep banging the drum in the hope that it will eventually work," adds Rea, of IdeaPharma. "It is a hard call, but it does sometimes make sense. If you see the product going in the wrong direction or not breaking through and there is no apparent reason for that, then the only thing to change is the messaging and branding. And there is no better time to do it than now. People should bite the bullet, say they got it wrong and change it straight away."

Rea points to Seroquel, an antipsychotic: "Five years ago this was an awful brand. It has been turned around. They didn't play around with the imagery, just got the basics right, clarifying messages and making sure that promises were delivered."

But he argues that this kind of rebranding should not need to happen. "The best brands in the pharmaceutical world are those that do not change from five years pre-launch to long after patent expiry," he says, "but this is only possible if the brands are actively monitored and managed. Branding is usually considered pre-launch and if it doesn't do well, then companies think about doing some more three to five years in. Often there is no active process to manage the brand."

This is why brands begin to drift. They stray from their core values, or they do not address unforeseen changes in the market. "When brand performance is ignored you may have to resort to rebranding. Then high level changes are always risky and could just as easily fail," says Rea. "Low level changes may just be mere tinkering, giving someone in marketing something to do between 9 and 5."

Dhoble says that pharma companies need to see their relationships with branding experts in the same way that they consider their advertising agencies. "It is better for a client to have a continuous branding operation in place with contingencies built in and 'what ifs' accounted for. Instead of wondering whether one branding agency could give something that another agency didn't, pharma companies should look at building ongoing relationships." Active brand management, he suggests, could avoid the need for much of the troubleshooting and keep pharma brands looking healthy for the whole of their lives.     



Edwin Colyer is a science and technology writer based in Manchester, UK.

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