Prepared for

Soumya Roy, PhD. | Hall & Partners Health

Andrew Nelson | Precise

Let’s get straight to the point … Does social media matter to patients?

Should pharmaceutical marketers care?

Our World is More Connected Than Ever

Physicians and patients have immediate access to information that influences choices

CHANGING FROM PRODUCT & BRAND FOCUS TO PATIENT-CENTRIC

R&D and sales driven –

huge sales force, products

sold based on the strength

of clinical attributes

2008

Transactional sales model,

based on direct delivery of

product information

Product-driven

Marketing driven –

marketing and sales focused

on physician loyalty and

building ‘big’ brands

Focus on emotional benefits

along with clinical; big

blockbuster brands

Brand-driven

Customer driven - from pills

to solutions; putting the

customer voice at the heart

of everything

2014

Putting customers at the heart

of everything – including

patients and physicians;

personalized, targeted therapies

Customer-driven

The pharma world is embracing customer centricity

1 in 4 internet users who experienced a health crisis

in the past year sought others like them online (Fox,

2011)

1 in 5 US adults have consulted online reviews of

particular drugs or medical treatments (Fox, 2011)

59% of US adults say they looked online for health

information within the past year (Fox, 2013)

35% of U.S. adults say they have gone online

specifically to try to figure out what medical condition

they or someone else might have. (Fox, Duggan, 2013)

Patients emerging as a key customer

Access to unlimited information and influencing their treatment options

“I’ve been lurking for several months and

thought I’d finally introduce myself. My Dad

was diagnosed stage IV in May of last year at

age 64… Your posts have been an invaluable

resource to me!”

— Daughter of stage IV cancer patient

• Passive Lurkers: patients who visit and

read disease specific social sites

• Active Members: once confident, some

take the next step and contribute

• Advisors: over time, some take on an

advising role and may be even be brand

advocates

“The internet has made our small disease

larger and we are able to educate many

more people now.”

— Jordana Holovach

The Jacobs Cure

Patients influence their own treatments and others

Online peer-to-peer healthcare is transforming how people feel, think, and act in

disease management

In Diabetes Forum

Members

As of 25

Jul

Members

As of 28

Aug Time/Day

US Alexa

Rating

diabetesforum.com 27,607 28,007 2.48 mins 118,248

diabetesdaily.com 99,361 99,862 2.38 mins 52,653

diabetesforums.com 45,782 46,273 2.39 mins 113,632

My Alli (GSK) -- -- 2.08 mins 131,192

Children with Diabetes (J&J) -- -- 4.37 mins 134,970

For every active member who posted a comment or reply, there are another 100 Lurkers viewing the discussion* - so

pharma should care & utilize this growing social momentum

Increasing activity suggests that social media does matter with an impact on how patients feel, think and act

* From a random sample of 15 threads across these diabetes sites, there were 482 replies with 53,689 views suggesting a Member to Lurker ratio of 111

1. Assess the full

patient experience

including the challenges,

drivers, barriers

3. Enable them with better

education, support, and

relevant promotion

2. Understand the

drivers, barriers and

challenges in-context,

in their social space

4. Help build true

empowerment (with right info),

engagement (disease and

lifestyle management) and

compliance (with treatments)

Patient

HCPs

Payers

Caregivers

Being patient-centric involves enhancing the patient’s digital experience

How can pharma give rise to a patient centric digital experience? Mary’s digital experience:

Understanding her journey with

diabetes

Diabetes forum = Senior Member, joined 25th March 2013

Diagnosed: February 2013

40 year old female

Medication taken: Metformin, Synthroid & Vitamin D

Total posts: 2,755, Avg posts per day:17

Likes received 1,592 (every 1.7 posts)

Mary is a very active member of the diabetes forum community. Being new to the world of

diabetes, she starts with concerns about diet, food, self management and measurement.

She thinks of it as a number’s game with ups and downs. With confidence and control over

her BS levels, she is now an emerging advisor with detailed account of her experience that

others appreciate. Her long-term goal is to be meds free and, while initially impatient,

she now accepts her disease and know it will take time.

Her digital experience broadly falls in 3 time periods: before treatment initiation, starting

treatment and adjusting to it, and continuing treatment

Meet Mary

What does she do? Based on forum feedback, Mary seeks a second opinion. She finds

another doctor. She downloads bloodsugar 101 to her kindle.

Bread…has anyone ever found a

successful substitute?

- Mary, March 29th

Okay…so let’s hear your opinion

on the whole numbers issue.

- Mary, March 31th

Small amounts of carbs, still high

numbers. Suggestions?

- Mary, April 8th

“If a doctor is stuck with the thinking that

180 is okay, then he/she is not doing a

good job of educating a diabetic. It has

been PROVEN that BG over 140 cause

damage. So, why take the advice of a

doctor who probably doesn't have

diabetes himself and is very lax in his

recommendations. After all (to quote

Jenny Ruhl of BS101) "it's not the doctor's

eyes, feet, kidneys...“

- Senior Member (66), T2D, Dx 2010

Before treatment

Mary feels impatience with a growing sense of lack of control. Her thinking is

muddled with confusion jumping from food to numbers:

Mary feels hope in lowering her numbers, but concerned about taking a pill. Her

thinking revolves around numbers and a series of questions.

What does she do? Takes steps towards self-management (is this control again?) --

works with her doctor to assess accuracy of her BGM.

She recommends Bayer ACI over ReliOn.

“Why the building up of the dose? If I see

my BS come down in week 3 for instance,

should I still build to the 4 per day dose?”

“Does metformin ER always mess with

everyone's stomach?

If so, how long does it take to go away? Anything else you

can tell me about the best way to take it? Any right or

wrong way? I know he said ideally with the largest meal.”

“Do I have to worry about low blood

sugar? Should I keep carbs on hand just in

case I go below 70?”

Starting treatment

What does she do? She actively searches information at other blogs,

forums and sites. She finds Jenny Ruhl’s blog to be a valuable source and

recommends to others.

“Since I've been on it (1550 mg Metformin)

for three weeks now, combined with a

continued LCHF diet, I'm actually seeing

lower numbers and I am so

excited!!!”

Starting treatment – seeing results

Mary feels excitement and positive energy as her readings go down.

Her thoughts are still focused on numbers - a tangible way to measure progress.

“Last week, there were 3-4 days where I

didn't take my full metformin dose.

I took 1500 mg. instead of 2000 mg. I was

totally in a slump, low on pills, hadn't been

out, and had a lot going on with diabetes

anger and depression. Then, I decided

to cut my dose (stupid, I know), for

3-4 days. I then put it back up to 2000

mg. I've been fine, except for today. Now

today, I have been high all day long. (Was

normal yesterday.)”

So, what does she do? She makes inquiries about herbal alternatives -

berberine, guava leaf tea, aspirin therapy, milk thistle. She seeks advice

about skipping doses. She becomes non-compliant for 3-4 days before she

goes back to her regular dose.

“I am starting to see really nice

numbers finally… I have been on 2,000

mg. for about 8 weeks now. If I am eating

LCHF and on metformin, I don't

understand how I can eventually go off of

it and maintain stable BS. Someday, I

want to be off it and control just

with diet and exercise. If I have to

have metformin to bring me to a good

range, could I ever live without it and still

control my BS?”

Mary, continuing treatment

Mary has been seeing positive results for a while.

Mary feels confidence and then complacent – the need to control her own destiny.

“Mary, I did the same thing you did.

I was on a great streak with my BG

and so decided I'd try to cut

back on my metformin

(actually a combo drug - Janumet),

after I successfully eliminated

insulin. Nope, it didn't work. Had

about the same experience as you.

So right back up to my

prescribed dosage.”

- Senior Member, Dx 2005

I would not worry about it, and in

fact would wait a month or so and

try it again to see if it happens again!

I experiment with my meds a lot, with

results ranging from "aha!" to ... "okay,

okay, just kidding!“

- Senior member, Dx 2009

A patient’s desire to regain control, reinforced by misleading information online, can lead to non-compliance

What does she do? She is compliant. She offers advice to newly diagnosed

and confused members.

“Has your doctor suggested

increasing your metformin?

You're not on the maximum

dose. I would watch my

carbs and increase my

metforim to 2,000 mg. a

day, if it were me”

“Just as food for thought, I didn't

feel like metformin did anything

substantial for me, until I was on

the highest dose. Since then, I

have seen really nice

improvements. At 1,000 mg.,

it did really nothing to bring me

down. Just something to

consider.”

Today’s Mary: continuing treatment and compliant

6 months into her journey; her BG is controlled at 106.

Mary’s complacence has evolved into a tempered confidence.

Identifying patterns in Mary’s journey leads to an overarching model From an individual journey to

an EXPERIENCE FRAMEWORK

to engage and empower the

patient digital experience

A patient experience framework to impact the digital experience

The patient experience can be classified

into 3 distinct phases:

● Diagnosis-treatment initiation;

● During treatment;

● After treatment initiation-continuing

treatment

At each phase, patients

● Feel,

● Think, and

● Do

● Differently offering opportunity to add

value with differential engagement

strategies and tactics

Quantitative research to validate patient experience framework

5 minute online survey

● Assess how patients feel-think-do

differently through the 3 phases of

Type 2 Diabetes experience

● Perceptions of usage of social media

and pharma online resources

● How pharma can provide useful

information through digital media

Respondents

● 13% before starting treatment

● 23% at treatment initiation

● 64% continuing treatment

Before treatment initiation , patients seek information on disease, lifestyle, and treatment options

How can

pharma sponsored sites

be useful?

Base: All Respondents Before Tx Initiation (n=21)

Q10. Now thinking about your T2D diagnosis, how can a pharmaceutical company help you to better understand and deal with

your diagnosis? Please rank your top three answers.

Help me learn about

lifestyle choices I can

make (76%)

Help me learn about

Tx options (67%)

Help me understand

my diagnosis & what

it means (67%)

How can

social media sites

be useful?

Help me learn about

lifestyle choices I can

make (57%)

Help me understand

my diagnosis & what it

means (52%)

Help me learn about Tx

options (43%)

When starting treatment, patients are more focused on drug characteristics -- safety information and unbiased assessments

Base: All Respondents Before Tx Initiation (n=21)

Q10. Now thinking about your T2D diagnosis, how can a pharmaceutical company help you to better understand and deal with

your diagnosis? Please rank your top three answers.

Provide me information

on the safety of various

treatments (45%)

Help me evaluate

treatments in an

unbiased way (32%)

Educate me on the kind

of questions I can ask

my doctor (32%)

Help me learn about

lifestyle choices I can

make (45%)

Help me understand my

diagnosis & what it means

(39%)

Provide me information on

the safety of various

treatments (37%)

How can

pharma sponsored sites

be useful?

How can

social media sites

be useful?

After initiating treatment, patients are more interested in learning about new treatments & connecting with others like them

Base: All Respondents Before Tx Initiation (n=21)

Q10. Now thinking about your T2D diagnosis, how can a pharmaceutical company help you to better understand and deal with your diagnosis? Please

rank your top three answers.

Help me connect with

others who have this

condition (44%)

Help me learn about

lifestyle choices I can

make (34%)

Help me learn about

new treatment

options (28%)

Help me learn about

lifestyle choices I can

make (37%)

Help me understand

my diagnosis & what it

means (37%)

Help me learn about

new treatment

options (31%)

How can

pharma sponsored sites

be useful?

How can

social media sites

be useful?

Feelings are much more positive among those continuing treatment

0 0 0 Negative Feelings Neutral Feelings Positive Feelings

Feelings about diagnosis - NET scores, top responses

Before Starting After

Worried,

sad,

shocked,

overwhelmed

Concerned,

vulnerable,

confused,

surprised

Optimistic,

curious,

secure,

energized

Base: All Respondents, Before Tx Initiation (n=21); Starting Tx Initiation (n=38); After Tx Initiation (n=105)

Q6. Thinking about your feelings about your T2D diagnosis, which of the following words would best describe the way you feel about your T2D diagnosis?

29% 14% 14% 5% 19%

29%

52%

29%

5% 24%

32%

34%

55%

63%

74%

17% 14% 14%

15%

35%

53%

54% After

Starting

Before

Discussed with

family and

friends

offline

Own research

at non-

pharmaceutical

websites

Own research

at sponsored-

pharmaceutical

websites

Own research

participation

in social

media sites

Discussed with

family and

friends

over social

media

Engaged with

online support

groups

Diabetes

advocacy

groups

None of

the above

Activities, however, are much more prolific when starting treatment

Base All Respondents Before Tx Initiation (n=21); Starting Tx Initiation (n=38); After Tx Initiation (n=105)

Q4 Besides your doctor, what are some sources that you have utilized to better understand and/or learn about your T2D diagnosis?

Actions taken by patients - % used

Confidential & Proprietary. Not For Public Distribution. Do Not Copy. 24

Utilizing an Experience Framework to provide a patient-centric digital experience Identifying opportunities for pharma to enable, engage and empower patients along their disease experience

Think

Do

Feel

HOW THEY FEEL-THINK-DO HOW TO ENGAGE

Shock/ denial followed by

Impatience/ Frustration

• Support services/tools to

deal with psychological

implications

• Remove stigma/self-blame

Confusion: what do the

numbers mean? what should

my diet be?

• Education focused on

diagnosis, lifestyle changes,

disease management -

simplicity

• Unbiased information re

drugs

Search/research,

Talk: question/gather

• Provide adequate online

resources and tools to help

with queries

• Enable easier navigation and

simpler content

Before treatment initiation

http://www.youtube.com/watch?v=DaEyuicY_nM

PR Week US June 22, 2010

Will Janssen-

Cilag's ADHD

YouTube

Video Go

Viral and Win

an Award?

Pharma Marketing Blog

July 20, 2010

Janssen-Cilag

ADHD

YouTube

video attracts

worldwide

attention.

PR Week US

June 22, 2010

Hugely successful social media campaign

● The video is now one of the most viewed pharma videos in Europe, with

more than 132,500 views in only six months

● The campaign was named Best Digital Patient Communications at the

2010 PM Society Awards

● The campaign received two nominations at the 2010 APA International

Customer Publishing Awards: Best Use of Video and Best Specialist

Communication

● Thousands of people shared the clip among their peer groups, amplifying

the brand message and campaign cut through

● Most importantly, helped improve perceptions and understanding of the

condition.

Starting treatment initiation

Think

Do

Feel

HOW THEY FEEL-THINK-DO HOW TO ENGAGE

Most vulnerable, Concern,

Seeking connection/ needing

reassurance

• Tools, apps to alleviate

concerns

• Tools to connect (CML Earth

from NVS)

Seek anchors: metrics;

Learn treatments

Tolerability/safety

Convenience

• Tools to teach adequate

usage of treatments

(injectibles, infusions, etc.)

• Simple, tangible guidelines

to measure progress

• Simple explanation of

disease and how treatment

works (MOA)

Acts to regain control: search

for the right doctor, right

treatment, right information

• Easier access to product

(help them with treatment

plan; coordinated care)

• Help find doctors

After treatment initiation

Think

Do

Feel

HOW THEY FEEL-THINK-DO HOW TO ENGAGE

Complacent, confident,

acceptance (can be resigned

or peaceful)

• Tools to emphasize and

address compliance

• Enable connection with

advocacy groups

Risk-averse, questioning,

valuing personal knowledge

and experience

• On-going FAQs re

compliance

• On-going tools for

answering questions about

disease management/

switching/nutrition (AZ

customer portal)

seeking agency,

experimenting, questioning,

gathering

• Easy access to new

products/pipeline products

• Financial support

• Patient advocacy group

• Clinical trial enrollment

Key takeaways

● Utilize social and digital media to impact patient experience of disease

and brand, beyond simple advertisements

● Use social media monitoring + primary research to learn how to better

tailor their patient engagement strategies and tactics

● Provide enabling tools that are entertaining and relevant (e.g. entertain

with games that tap into a different part of the brain) but also make it

relevant to the phase in their journey

● Measure effectiveness of social media initiatives and apply strategic

listening to evaluate campaigns along with traditional research

● Utilize social media to inform different teams, not just marketing;

include patient support teams, product development, etc.

● Don’t put your customers into a “digital bucket” just because their

conversations are in social; involve and integrate qualitative and

quantitative primary research – we still have to ask questions

to get to the “Why’s?”

Confidential & Proprietary. Not For Public Distribution. Do Not Copy. 32

Questions?

Soumya Roy

Managing Partner, Health

Hall & Partners

s.roy@hallandpartners.com

Andrew Nelson

Healthcare Director

Precise

andrew.nelson@precise.co.uk

Todd Grossman

Managing Director, Americas

Precise

todd.grossman@precise.us.com