I remember it like it was yesterday. I was a regional marketing manager at Pfizer in the early 2000’s, and I spent a large portion of my time and marketing budget focused on our cardiovascular (CVD) disease portfolio. Although I was largely focused on CVD at the time, the lessons learned can be applied across all disease areas. Statin class cholesterol lowering treatments were enjoying tremendous growth with solid patent protection runways for years to come. I learned that I would have the privilege to work on Lipitor in my region in the Southeastern United States. At the time, Lipitor was clearly the superior treatment in lowering LDL cholesterol and Triglycerides, while raising HDL. It was number one in the U.S. in market share by a large margin, with shares in the 50s and 60s in some markets.
Nevertheless, Lipitor’s storybook launch and adoption came up short in the Southeast, and this cost the brand millions of dollars annually. Furthermore, the Southeast was and still is infamously known as the “Stroke Belt” with the highest per capita incidence of cardiovascular disease and the highest per capita volume of new (NRx) and total (TRx) cholesterol prescriptions. In fact, the markets in the Southeast trailed the rest of the country by 10 to 30 market share points. While regional and local market interventions could “move the needle” a little bit, they were never sufficient to close the glaring gap between the Southeast and the rest of the U.S.
So, what happened?
Lipitor won the affections and support of global and national ThoughtLeaders (also known as Key Opinion Leaders or KOLs). The terms “ThoughtLeader,” “TL,” “Key Opinion Leader,” and “KOL” may be used interchangeably. These KOLs were respected cardiologists and their opinions and prescribing behaviors held tremendous influence over primary care physicians (PCPs). The brand also won over regional and local KOLs across the country, but inadvertently overlooked the truly important regional and local KOLs in the Southeast.
Regional and local ThoughtLeaders may not value the opinions of global and national ThoughtLeaders.
So, one might think that the ThoughtLeader cardiologists in the Southeast were irrational. Were they irrational? I will address this hypothetical question later. When I joined our sales representatives on sales calls with KOL cardiologists and “high-writer” primary care physicians, I consistently heard the same message from them. Our competitor, Zocor, had outcomes data. Physicians readily conceded that Lipitor lowered LDL cholesterol, total cholesterol and triglycerides more than Zocor, but the outcomes data gave them “confidence” that Zocor might have “other benefits” Lipitor didn’t. Ironically, Lipitor was feverishly working to generate outcomes data. After all, Zocor had enjoyed more time to produce its outcomes studies. When Lipitor did finally produce positive outcome studies, KOLs simply stated that Zocor’s studies were more robust and covered longer time periods. Of course they did. Even PCPs who were sympathetic to Lipitor’s efficacy messaging, were very difficult to turn. They would often say, “whenever one of my patients has a heart attack or a cardiac event or receives stents, the cardiologist sends them back to me on Zocor.”
Interestingly, as a regional marketer, I sponsored and attended numerous speaker events with cardiologists and PCPs, where I always asked this question: “If your mother had high cholesterol, what would you prescribe for her?” The response was 80% to 90% “Lipitor” every time!
Let’s revisit our question. Were KOLs being irrational?
I don’t think so. They were out of step with three-quarters of the United States, but they really weren’t irrational. They routinely told me they used Zocor for their “run of the mill” high cholesterol patients, and they saved Lipitor for their really difficult patients, where Zocor couldn’t achieve their cholesterol goal. Lipitor was their “elephant gun” for the really difficult patients… not their “go to” for the majority of their patients. Being the “elephant gun” in the Southeast cost Lipitor 10 to 30 share points, depending on the market and millions of dollars every year.
Once these informal treatment algorithms were established and ingrained, no amount of sales, marketing or new data could turn the tide. Small market share gains were achieved behind very focused sales and marketing efforts, but the large gap remained. Lipitor was very successful, but the brand missed reaching its full potential.
How can pharma brands preparing to launch find and engage the right global, national, regional and local KOLs?
This can be a real challenge. Treatments need buy-in from the bottom up as well as from the top down. This is true across all life sciences brands and disease states where ThoughtLeaders play a role. Brand perceptions in different localities can vary widely, particularly when treatment needs differ, and if a KOL or clinician has not been adequately engaged by medical affairs prior to launch – and therefore may not have fully understood the science underlying a treatment – they may fill in the gaps themselves. Furthermore, they will often create their own arguments for where a brand fits in their formal or informal treatment algorithms. Some may decide they should prescribe only for patients with the most severe symptoms, or patients who are most engaged with their treatment, or patients at the latest stages of disease.
At the same time, competitors are vying for their share of mind. They will be all too happy to take advantage of a lack of brand awareness on the ground or the opportunity to position your brand into a niche.
So, it is vital for commercial launch and medical affairs teams to map out not only the global and national networks of ThoughtLeader influence, but also those in every locality the treatment is prescribed. It requires more time and more resources, but those costs are far outweighed by the risk of ignoring the physicians who can break your brand in meaningful pockets or regions of your market.
What is a proven approach for pharma brands to identify and engage the right KOLs prior to launch?
MDOutlook’s Lumineer™ platform can be the difference-maker for commercial and medical affairs teams preparing for a treatment launch. Lumineer™ is a global platform and precision tool that maps and highlights connections between global, national, regional and local KOLs and the clinicians they influence. It also supports rapid research, engagement and peer-to-peer programs, helping brands achieve full potential by reaching the right KOLs and clinicians with the right message at the right time. Lumineer™ brings the power to see the physician landscape clearly, so launch brands can leave nothing to chance.