Customer experience in the pharmaceutical sector: Getting closer to the patient
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Customer experience in the
pharmaceutical sector:
Getting closer to the patient
Health Research Institute
November 2013
Customer
experience series
This report is the third in
a series of publications
that focus on the customer
experience in healthcare.
As patients exert
greater control over
their healthcare, drug
makers need to master
the complexities of
consumer behavior.Table of contents Executive summary 1 An in-depth discussion 3 A more sophisticated customer segmentation model 3 Appetite for personalized information and real-time feedback 5 Active participation in care and treatment 7 Focus on convenience and on-demand services for busy lives 9 Value-hunting through comparison shopping 10 Getting closer to the patient 11 What this means for your business 13 Conclusion 14 Acknowledgements 16 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient
Executive summary
Consumers have a habit of reshaping industries at inconvenient and unexpected times. Their expectations
and demands may initially appear irrational, faddish, or impossible. But over time, a dance begins to
evolve from a series of uncoordinated movements as industry responds to consumer demands. Today, the
retail, banking, and travel industries are in step with their customers, making their moves based on a
real-time understanding of consumer behavior. Rapid feedback and a focus on the customer becomes the
lifeblood of the company.
Hospitals and insurers have been The rise of high-deductible insurance Today, many drug makers still have a
slower to follow suit, nudged plans places more financial burden clouded vision of a patient’s healthcare
along by competition and payment on individuals and families. In the journey. The same old customer
systems that now factor in patient past five years, patient out-of-pocket segmentation studies on which they
experience. For the pharmaceutical costs for prescriptions have climbed typically rely aren’t enough. Consumers
sector, the economic implications of by 250%.2 As they increasingly spend are willing to offer feedback that
consumer behavior are more complex. their own money, consumers are no informs who they are, how they
Prescription drugs remain a highly longer passive players in treatment behave, and how existing biases impact
regulated business with physicians selection and usage. They’re customers their behavior. Drug makers that tap
prescribing the product. At the same with unique priorities, expectations, into this feedback will reach a new level
time, insurance companies and and demands. of success.
employers bear much of the cost.
Customers are reacting with PwC’s Health Research Institute (HRI)
While consumers have limited veto increasingly high expectations of the identified four defining elements of the
power over the choice and price industry shaped by experiences in next generation patient:
of prescriptions, they nevertheless other sectors. For example, TripCase,
1. A
ppetite for personalized
have strong views on the industry, a mobile travel app, provides real time
information and real-time feedback
its products, and expectations for a travel updates and nearby deals for
positive customer experience. American Express business travellers. 2. A
ctive participation in care
The app knows precisely where and treatment
Just as change is sweeping across
travellers are and pushes pertinent 3. F
ocus on convenience and
the rest of the healthcare landscape,
information throughout their journey.3 on-demand services for busy lives
the pharmaceutical sector is shifting
The pharmaceutical industry’s
as well. Drug makers today must 4. V
alue-hunting through
challenge is to create similarly
increasingly prove that the “value” of comparison shopping
meaningful experiences across the
their products goes beyond established
patient journey.
measures of safety and efficacy.1 To do
that, they need help from patients—
the individuals best positioned to
provide real-time insights into how a
product works.
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 1In spring 2013, PwC’s Experience • Almost all Experience Understanding customer behavior isn’t
Radar team surveyed more than Radar respondents said that a one-time event. Rather, it should
700 US consumers to understand pharmaceutical companies did not cover the full life cycle of a drug. Some
their preferences and behavior in play a role in their diagnosis and next-generation consumer approaches
drug treatment selection and use, treatment decisions, suggesting are coming from outside pharma.
segmenting respondents into distinct that current pharma education Device makers, technology, and
groups. Key findings include: and communication has had wellness companies are all in the mix.
limited impact. Higher-income They are devising ways to continuously
• Consumers are seeking the same
Gen Xers spending more than $100 engage consumers through education,
convenience they experience in
of their own money per month self-motivation, and progress
other settings. In general, they are
on medications were 20% more trackers for treatments and disease
willing to pay 19% more for a “no
likely to seek advice from a doctor management.
wait time” prescription. Affluent
than other sources and prefer the
baby boomers and Gen Xers with For their part, more consumers want to
interaction to be in-person.
chronic conditions are willing to be actively engaged in their treatment
pay 52% more. Baby boomers with Some of these findings initially appear decisions. Quality of life, side effects,
multiple chronic conditions are to be outside a drug company’s and cost can influence those decisions
willing to pay 21% more for home- traditional scope. However, to meet to varying degrees across therapeutic
delivered medications. the needs of the next-generation areas. Drug makers have a ripe
consumer, manufacturers must opportunity to embrace the many
• Treatment costs are the top reason
consider where in the patient facets of the emerging consumer who
people stop taking medications. An
experience they can deliver greater is increasingly at the core of our health
estimated $213 billion is lost each
value. To start, pharmaceutical system’s success.
year in the US due to wasteful or
companies can identify the
unnecessary treatment resulting
partnerships and resources needed to
from lack of adherence and
deliver value.
medication mismanagement.4
Drug companies have a rich history
• Baby boomers with multiple
of attempting to speak directly to
chronic conditions demonstrate
patients. In 2012 alone, the industry
less medication adherence than
spent over $3 billion on direct-to-
average, but they’re willing to do
consumer marketing out of $27 billion
something about it. Some 41% want
in total promotional spending. But
do-it-yourself pharmacy health
as new drugs aim for more targeted
screening stations and 37% want a
populations, companies must go
mobile app to monitor their vitals
beyond focus groups and mass market
with contextual understanding of
advertisements to better exploit the
their prescriptions.
complex and highly relevant real-world
experiences of individual patients.
2 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patientAn in-depth discussion
A more sophisticated Behavioral economics principles Pharmaceutical companies can
customer segmentation commonly used in the retail sector go beyond the one-way mirror in
model shed light on consumption by analyzing consumers, delving into
adding emotions and biases into the their behavior and motivations.
Many pharmaceutical and life sciences purchasing calculus. One consumer Consumers want their medication
companies have relied on traditional energy management startup, OPower, experience to be personalized and
techniques of using demographics makes detailed consumption data meaningful. If their expectations are
such as gender, insurance status, age, available to its customers, revealing met, they’re more likely to follow the
and health condition to parse out the how neighbors use energy and proper course of treatment for longer.
types of patients best suited for their sharing conservation tips. Influenced Whether a consumer is starting a new
products. But too often that approach by this impromptu social network, therapy, managing a chronic condition,
to customer segmentation misses consumers have lowered their energy or juggling multiple treatments,
individual attitudes and behaviors, consumption, creating a positive evaluating their needs throughout the
resulting in an incomplete picture of ripple effect. patient journey is critical to delivering
the consumer. experiences that resonate with the
patient (Figure 1).
Figure 1: PwC’s Experience Radar uncovered four customer segments based on their medication behavior and desired experience
Basic Bob Motivated Monica Invincible Izzie Routine Ron
Self-reliant and rarely ill, though Well-off but dealing with several Much younger and rarely ill, A little older, also suffering from
he is older. When he gets sick, he chronic conditions. She puts a lot despite her unhealthy lifestyle. several health problems, but
doesn’t want high-tech gadgets of time and effort into managing But when she does have a managing them at home, as he
or advanced treatment. He just her health. And while she likes condition, she prefers to research always has. Like Monica, Ron
wants affordable options with convenience, she values face-to- it online and manage her own relies on others for help and
no extras, to take care of his face advice from experts even treatment. This is quick and support—but he prefers friends
symptoms and get him back more. That’s why she always convenient—two qualities and family to experts.
to normal. picks up her medication from the she values.
pharmacist in person, so she can
talk about it.
Who views experience as a differentiator
Most
Least
Source: PwC 2013 Customer Experience Radar Research
Note: Please see the companion Experience Radar study for additional details about each of these segments
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 3Aside from demographics and health To understand the value of experience, Interpreting willingness to pay in the
conditions, the Experience Radar team participants evaluated a variety of pharmaceutical landscape is a new
analyzed elements of behavior and features ranging from information frontier, as patients in the US rarely
lifestyle such as: support, prescription pick-up options, shoulder the full cost. It’s not always
reward and savings programs, and clear who benefits from willingness
• Strength of social networks
additional services such as health to pay. Manufacturers can explore
• Stress and healthy habits screenings. The results reflected a novel roles or partnerships to
• Extent of self-reliance or range of willingness to pay for these capture value from these desired
community reliance services (Figure 2). features. In the new value-based
health economy, pharmaceutical
• Willingness to share experiences Individual segments such as socially
companies must tap into the
with others connected Gen Xers who are proactive
unique characteristics of the next-
about their care exhibited much higher
• Trust in information sources generation consumer.
willingness to pay for experiences such
as time with medical experts and fast
medication pick-ups.
Figure 2: Consumers place varying value on a range of health-related
Figure 2: Consumers place varying value on a range of health-related services as measured
services as measured by demand and willingness to pay
by demand and willingness to pay
Higher 19%
18%
Pickup Time
Prescription No wait time
Script
Electronic script,
pharmacy
Demand
6%
Reward Programs
Medication
savings program
1%
Pickup Options
Drive through & walk in
Medication Services
Screening stations & clinic services
Support Groups
Lower Online & in person expert support
Lower Willingness To Pay Higher
Source: PwC 2013 Customer Experience Radar Research
4 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient1. Appetite for personalized information and real-time feedback
While parts of the health system Consumers are embracing their A majority of respondents (57%)
struggle to integrate new data, “quantified selves,” using sensors, preferred online medication support,
consumers are charting their own software, and devices to measure such as disease and prescription
digital course (see Sidebar on next multiple aspects of their health and education websites. Most millennials
page). The popularity of services such well-being. Few consumers today (ages 18-24) valued online medication
as 23andMe, a $99 genetic test, and think pharmaceutical companies play support more when it included
AliveCor, a smartphone-connected a role in their diagnosis or treatment interaction with health experts. One-
echocardiogram, fuels the quest decisions, according to the Experience third of seniors preferred in-person
for more knowledge. Online chat Radar results. This is a significant events in conjunction with online
forums also serve up a constant flow opportunity for manufacturers, which information. High-income Gen Xers
of information. have so much to share about disease spending more than $100 per month
and treatment choices. on medications were 20% more likely
to seek advice from a doctor than
other segments and prefer in-person
interactions.
“The biggest unmet need for patients is still
When making a drug purchase
education, information, and active self- decision, insurance coverage (89%)
management support,” said Jeremy Shepler, and physician recommendations (74%)
director of patient-centric strategy and solutions were primary factors influencing
at Novo Nordisk. consumers (Figure 3). However,
Figure3:3:Although
Figure Although insurance
insurance coverage
coverage and physician
and physician recommendations
recommendations are the mostare the most
important important
purchasing f actors, consumers are also
purchasing
using factors, consumers
online information are also
and testimonials using
to guide online information and testimonials to guide decisions
decisions
Choose and rank the five things that are most important to you when
purchasing prescription or over the counter medication.
89%
74%
29%
17%
12%
8%
Insurance Physician Additional online Patient Mobile Healthcare and
Coverage recommendations medication testimonials application lifestyle coaching
information
Source: PwC 2013 Customer Experience Radar Research
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 5almost one-third of respondents Informed patients form social networks online and off
reported that they sought additional
Today almost every drug manufacturer has a presence in social media, but
information about their medications
few successfully engage with patients and establish their sites as a destination
online—and in many instances they
for disease- and treatment-focused conversations.7 A majority of Experience
said the online information influenced
Radar respondents (57%) say they want online medication support, and 21%
their choice of treatment.
want online interaction with experts along with that support. But consumers
Empowered consumers seek consistently report scepticism about information supplied by insurers and drug
information beyond insurance companies. Rather, they place greater value on the experience of their peers.
coverage and physician
“Consumers are forming networks of micro-experts about their own treatment
recommendations. They’re looking
experience,” said Dr. Roni Zeiger, CEO of Smart Patients, an online community
at drug reviews and rating systems,
of cancer patients. “It’s almost a new form of peer review.” They’re also paying
which evaluate value for money and
attention to online patient testimonials regarding costs and side-effects prior
often recommend alternatives to
to purchase. As patients build their peer networks, they equip themselves
branded medications.5
with better tools and information, and their voices gain traction within
WebMD, a ubiquitous site for health their networks.
information, hosts thousands of user-
These rapidly evolving peer networks in which consumers share health
submitted reviews of prescription
information are not just confined to the dominant social networking sites
drugs. Each drug is rated on three
such as Facebook and Twitter. In HRI’s analysis of treatment conversations,
dimensions—effectiveness, ease of
Topix.com and Reddit.com, neither of which is health-specific, were top online
use, and satisfaction, with additional
discussion sites for health issues. Disease-focused sites such as PatientsLikeMe
user comments. Like online retail sites,
and Smart Patients go even further, merging user input on symptoms,
consumers can read the most helpful
treatments, and experience to create valuable information for patients,
reviews, as determined by other
clinicians, and researchers.
consumers, first.
Since discussion forums constitute a large volume of internet chatter,
Consumer Reports, a popular
companies may want to pay closer attention to the dialogue and sentiment
information source, recently ranked
expressed on these sites. HRI evaluated the cyberspace discussions regarding
three generic diabetes medications as
ten frequently prescribed drugs and found that the volume of that chatter
“Best Buy” drugs. The report advised
can vary widely. Consumers’ online sentiment about treatment options,
that newer branded drugs are not safer
medications, and side effects is largely negative, regardless of the drug being
or more effective, and side effects tend
discussed. While companies may have a patient communication strategy for
to be less well-known.6 As these trusted
top social networks, they can also learn from discussions in other broader
sources continue to host consumer
consumer forums. Such forums are easy to dismiss due to the volume of the
opinions and influence patients, drug
informal chatter that takes place there. But when enough people participate
makers should pay closer attention
in a discussion, consumers tend to give more authority and weight to the
to the information these sites
conclusions participants make.
make available.
Companies are beginning to tap into these grassroots networks. To better
understand how bloggers are discussing patient and caregiver needs,
AstraZeneca recently convened a summit of breast cancer bloggers at its
headquarters in Wilmington, DE, gaining insight into online advocacy for care
and treatment options. Sanofi maintains a diabetes Facebook page with about
8,000 likes.8 Patients, caregivers, providers, and the public can comment on
the frequently updated postings. But pharma companies still trail significantly
behind technology companies in online consumer engagement. FitBit, a
healthy lifestyle device and application, has 126,000 likes.
6 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient2. Active participation in Table 1: Prescription drug consumer behavior slang
care and treatment Drug holiday Omission of medications on three or more sequential days
Today’s patient is moving from a White-coat Improving medication adherence within a period around a
passive recipient to an independent adherence doctor’s appointment
decision-maker (Figure 4). During Trail mix Casual and inappropriate mixing of prescription drugs
the past two decades, industries Doctor shopping Visiting multiple doctors until a preferred prescription is filled
such as banking have recognized the Pill splitting Splitting medication in half in order to double the length of
increasing power of the consumer, and prescription, share with family and friends, or save money
as a result banks have evolved from 9-5
brick-and-mortar locations to always-
available mobile and online presences. Adherence challenges remain Boehringer Ingelheim and Eli Lilly
Physicians, health systems, insurers, took on the challenge of medication
Customers expect the same focus
and drug makers have grappled with adherence by teaming up to engage
on their personal preferences from
medication adherence issues for a patients with My Well Planner, a
pharmaceutical companies. Some
long time. One-third to one-half of program launched in 2012 that targets
pharma companies have taken into
patients frequently miss doses or Type 2 diabetes patients. Based on
account patients’ desire to participate
even completely ignore taking their a behavioral change approach, it
in their care and treatment decisions,
prescriptions.11 “Drug holidays” offers personalized information that
leading them to create predictive
(taking a break from medication) adjusts to patient use. The program
measures and behavioral interventions
and pill-splitting are also common allows patients with type 2 diabetes to
that can improve outcomes.
(Table 1). Adherence is complex and partner with clinicians to set modest
One such measure, patient activation, multi-faceted, requiring approaches lifestyle goals at their own pace,
determines an individual’s skill that can change a patient’s behavior. building toward bigger goals. A scoring
level, knowledge of their health, But companies still lack an intimate mechanism gives the patient a sense
and confidence in managing their understanding of patient actions in the of accomplishment and momentum
health.9 Patients who score higher “mystery zone” between doctor visits, rather than just indicating compliance.
on the activation scale and feel perpetuating this age-old problem. In another example, McKesson, a
that their healthcare professionals
Consumers have behavioral biases health technology service and drug
include them in decisions exhibit
that affect their medication usage. distributor, uses call centers to keep in
better health behaviors, including
Many tend to brush aside future touch with patients and nudge them to
medication adherence.10
repercussions if they’re feeling good take medications. Trained personnel
Figure
Figure 4:
4: Patients
Patients become
become partners
partners in
in care
care today. Others get over-confident in take personal information provided
and
and treatment
treatment when
when information
information is
is provided
provided their ability to master their health by patients to encourage them to
condition. They also struggle to stick to their medication schedules.
manage complex routines and For example, they may urge elderly
dosage regimens. But strategies for patients to adhere to their medications
overcoming these difficulties need not to be healthy enough to attend a
be overly complex. grandchild’s birthday. This helps
81%
patients focus on achieving their own
Recent research points to a range of “real-world” goals.
techniques for overcoming behavioral
biases, from blister packs that make “Research shows adherence to therapy
Want an equal say in increases when patients are more
care decisions with pills easier to track, to reminder
their care provider calls, to waiving co-payments.12,13 engaged, and that patients want
Technological solutions can be simple personal one-on-one support,” said
Source: “Partnering with patients to drive shared decisions,
better value, and care improvement,” Institute of Medicine, 2013 too. A large majority (75%) of survey Amanda Rhodes, director of client
respondents preferred text message strategy and solutions at McKesson.
reminders compared to advanced “It’s a two-way relationship, so if we
monitoring apps or other devices. can develop trust over the phone or
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 7across the pharmacy counter, there’s However, patients still feel like much about time commitment to manage
a better chance of uncovering real of their medication is trial-and-error. medications, and encouraging
barriers and helping that patient be Companion diagnostics that identify compassion from front-line
more adherent.” which patients are likely to be the professionals can help a lot.
most responsive to a given treatment
Some consumers will be more The Experience Radar results
option can overcome these attitudes
receptive to interventions and support underscore challenges for drug
and improve the prospects for success.
than others. Baby boomers with manufacturers and consumers alike.
Nineteen drug-diagnostic partnerships
multiple chronic conditions are less Experience Radar respondents
have been approved by the FDA.
adherent, but they’re willing to do reported long wait times, unexpected
Genetic and other biomarker testing
something about it. Some 41% want costs, unfriendly professionals,
are other tools that can indicate that a
do-it-yourself (DIY) health screening and difficult medication regimens
certain drug may have a higher chance
stations, and 37% want a mobile app to as common frustrations with their
of success in specific individuals,
monitor vitals. treatment experience (Figure 5).
boosting patient engagement.
“DIY doesn’t mean consumers don’t Expectations of meaningful
Frustration is a slippery slope that
need you anymore,” advises Dr. Josh information, outcomes or support
can eventually lead a patient to
Riff, medical director at Target. “They evolve over time especially as an illness
give up—on medications, care, and
want the right partners helping them progresses. Patients understand a
treatment. Although some sources of
make their health decisions.” Pfizer cure is often not available, but they
frustration are out of a drug maker’s
embraced DIY with its haemophilia want their quality-of-life improved in
control, opportunities exist to improve
population. Its mobile app, HemMobile, the course of treatment. This includes
patient engagement. For example,
helps patients find local treatment mobility, ability to continue working,
being transparent about total expected
centers and allows them to share their participate in key life milestones, and
treatment costs, setting expectations
medication injections. physical appearance.
Figure5:5:
Figure Cost
Cost andand
sideside effects
effects dominate
dominate consumers’
consumers’ top frustrations
top frustrations regarding
regarding their treatmenttheir treatment
experience experience
Which part of the treatment experience is the most frustrating for you?
High treatment costs 44%
Dealing with side effects 41%
Long wait times 25%
Unexpected treatment costs 24%
Unfriendly healthcare professional 18%
Difficult medication regime 13%
Confusing medication information 13%
Difficult payment/reimbursement 10%
Inconvenient pharmacy hours 7%
Lack of social/ 1%
emotional support
Source: PwC 2013 Customer Experience Radar Research
8 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patientFigure 6: Consumers find many opportunities to abandon their
3. Focus on convenience treatment
Figure at critical
6: Consumers points
find many duringtothe
opportunities disease
abandon life cycle
their treatment at critical points
and on-demand services for during the disease life cycle
busy lives
Missed screenings
In 2013 Pfizer launched a website for or vaccinations
consumers allowing them to purchase Skipped lab tests
Ignore preventative
Viagra directly from the company. The care advice
move simultaneously addressed male
Missed checkups
reluctance to purchase the medication and routine exams
in public and a rampant online
counterfeit marketplace for the drug.14 Risk Detection
At the same time, the company tapped
into consumers’ desire to manage their
treatments as easily as they could order
a book online. Fifteen years after the Disease Diagnosis
Recurrence life cycle
initial launch of Viagra, Pfizer created
a distribution channel for consumers Multiple
that offers a new sales path for other visits to the
emergency room
drug products. Management Treatment
Offering consumers convenience Medication holiday
is important. They have the same Religious restrictions
low tolerance for inconvenience in Prescription costs
Psychological barriers
acquiring medications as they do in
Unfilled prescriptions
other retail settings. Patients consider
long wait times a serious problem Source: HRI analysis; SJ Weiner, et al. Patient-Centered Decision Making and Health Care Outcomes:
across the health system, especially in An Observational Study. Annals of Internal Medicine. 2013 Apr;158(8):573-579.
emergency rooms.15 One respondent
described his problems waiting for
Poor service is one of the fastest ways prescription. Affluent baby boomers
medications this way: “I purchased
to lose customers. Consumers will and Gen Xers with chronic conditions
medication online. I had to fill out
always find an exit from slow and are willing to pay 52% more, according
prescription forms and find a fax
inconvenient experiences. Patients to the Experience Radar survey.
machine to fax that information in.
desert their treatments because of Baby boomers with multiple chronic
Then I had to wait several weeks to get
psychological and logistical barriers, conditions are willing to pay 21% more
my prescription while I had run out.”
or they simply ignore the advice of for home delivery of medications.
physicians (Figure 6). Or they’ll leave
Large drug retailers such as Walgreens
a pharmacy if they look at a line of
have taken notice, creating 400 “Well
customers and cannot tell how fast it is
experience” stores in urban areas that
moving. Overall, consumers are willing
provide streamlined pharmacy services
to pay 19% more for a “no wait time”
paired with cafes that serve sushi and
other healthy options.
“Our guests have told us that one of the
things they most value is time”
–Dr. Josh Riff, medical director, Target
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 94. Value-hunting through Drug cost is so important because more return, drug makers hope to remove
comparison shopping people today juggle multiple health out-of-pocket cost as a barrier and
conditions that can last for decades. increase brand loyalty. One study of
Pharmaceutical companies and
The Centers for Disease Control and 2,800 patients found improved clinical
pharmacies increasingly offer an array
Prevention (CDC) estimates that 26% outcomes and medication adherence
of rewards, perks, and other programs
of Americans have multiple chronic rates 4-6 percentage points higher when
to entice and retain customers. But
conditions, up from 21% a decade ago. copayments were completely eliminated
what do customers want? Today’s
for heart medications.19
consumers, whose pocketbooks are The survey results reflect fiscal realities.
increasingly stretched thin after years One in five consumers has trouble “We recognize that cost isn’t the only
of recession, predominantly associate paying medical bills, according to the barrier to adherence; it’s a piece of the
value with lower cost. CDC.16 Consumers have weathered puzzle,” Rhodes told HRI. “When we
prescription drug price increases provide patients with a co-pay card,
HRI found that saving money is a top
averaging about 3.2% per year since we can help them to better afford
issue for a majority of consumers.
2005, according to the Consumer Price their medicine, and when we partner
Almost half of survey respondents
Index. For diseases such as cancer, the co-pay card with live support to
(46%) preferred some sort of
average US cost has doubled from assess additional barriers, we have the
medication savings program over
$5,000 to $10,000 per month.17 ability to address adherence barriers
either no program, or a combined
over time.”
savings and well-being rewards Today most drug makers offer discounts
programs, irrespective of income or financial assistance programs McKesson pairs its co-pay card with
(Figure 7). Even senior citizens who to increase access. One popular patient interventions that help
have some prescription drug coverage consumer website has hundreds of patients with financial and disease
through Medicare voiced similar cost drug coupons available, organized management issues. “Affordability,
concerns. Among survey respondents by brand name.18 While the practice complexity, and cost are the greatest
over age 65, 42% preferred medication is not viewed positively by insurers, challenges patients face when it
savings over other programs. consumers happily use the coupons. In comes to their medications,” says John
Helfrich of McKesson. “Patients with
debilitating diseases like cancer often
Definition: Well-being rewards are motivational incentives, financial
and non-financial, awarded to consumers for pursuing healthy lifestyle have difficulty navigating through
choices. These choices include a wide array of activities, from eating drug options, costs, and the healthcare
healthy and exercising regularly to adhering to medication regimens and system. Care Advantage staff are
staying on top of medical checkups. available to assist the patient.”
Figure 7: Consumers prefer medication savings program across household incomes
Figure 7: Consumers prefer medication savings program across household incomes
51%
48% No program
43% 42%
Medication
savings program
33%
29% 30% Wellbeing rewards
27% 27% & medication
25% 24%
savings program
20%
$25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 and above
Source: PwC 2013 Customer Experience Radar Research
10 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patientGetting closer to the patient Case Study: Propeller Health improves respiratory
New payment models and rising disease management
patient demands are prompting Asthma is taking a toll on the United States. More than 25 million suffer from
existing healthcare players and the chronic condition, triggering 10 million physician office visits, two million
new entrants to focus on the rich ER visits, 500,000 hospitalizations, and 3,000 deaths each year. The disease
opportunity of improving individual costs the nation about $56 billion a year in medical costs and lost productivity.
patient outcomes. Drug makers can Poor patient adherence is one contributing factor—up to 50% of patients do
learn much from new players who not take medication as prescribed.20
are more adept at gaining customer
Patients can avoid attacks if they know how to manage the condition and avoid
mindshare. Opportunities for drug
certain triggers. In the past, patients were asked to keep daily written logs of
product and service partnerships also
symptoms, frequency of attacks, and reaction to therapy. Patients had difficulty
exist, with technology helping fuel
sticking with the system, leading doctors to question the reliability of the data.
greater consumer participation.
But patients using an electronic diary showed consistently higher adherence in
Innovation floods in from one recent study, suggesting patients were eager for a more convenient tool.21
outside pharma
Propeller Health is hoping technology can fill the gaps. The company received
Outside the pharma industry,
FDA clearance in 2012 to market its device for respiratory diseases, including
companies are recognizing the
asthma and Chronic Obstructive Pulmonary Disease (COPD), to patients,
opportunity to connect with patients
doctors, and hospitals. Some insurers and public health agencies are smoothing
managing their conditions and
the way by enabling access to the devices for patients with asthma.
medications (see Case Study). Many
non-pharmaceutical companies Propeller is a small, portable device that fits on top of inhalers. It uses GPS,
are making inroads catering to Bluetooth-enabled sensors, and a mobile app to help patients and doctors
patient needs. manage asthma through accurate trigger and symptom tracking. Text messages
and popup alerts via smartphones remind patients to take their medication and
For example, technology company
log their symptoms.
Glooko has devised an FDA-approved
data cable and mobile app that records Automating the chore of tracking medications, symptoms, and other data
glucose measurements as well as self- could be a game changer. Propeller keeps track of medication use by taking a
reported moods and eating habits. digital snapshot of the time and location of inhaler use. The system shares this
The tool lets users discover cause- information with physicians. Propeller Health also offers ongoing educational
and-effect patterns in managing their outreach through email, text, mobile apps, and phone calls with certified
diabetes—such as eating low glycemic asthma educators.22 Physicians can remotely monitor asthma symptoms and
foods. The results give patients clear, how well their patients are sticking to their medication schedule. Physicians
meaningful information to discuss and can also set up customized alerts if a patient’s condition deteriorates.
share with their physicians. “One of the biggest challenges for patients with asthma is the cost of their
OMsignal, a developer of bio-sensing medications,” said Dr. Alan Leff, professor emeritus at University of Chicago
clothing, created a shirt with sewn- Medicine and a pulmonary specialist. The cost of asthma medication can easily
in sensors to measure heart rate, exceed $1,500 per year.23 Costs climb higher for patients who fail to control
breathing, activity, and emotional their disease. Propeller Health estimates that its approach can reduce annual
state. While still in its early stages costs $4,000 to $6,000 per member, making it attractive to health plans.24
of development, OMsignal allows Amerigroup Florida, a WellPoint plan, recently invited a targeted group of
patients to monitor their vitals and post members to participate in a new asthma management program with the
automatic health updates for friends Propeller tools.25
and family. Being connected to this New medical technologies always take time to diffuse into patient and provider
information daily heightens consumers’ acceptance. Propeller Health’s approach improves patient awareness of
awareness of their health, which can triggers, is more convenient for the patient, and has the potential to lower other
lead to early intervention, prevention, medical costs.
and better health outcomes.
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 11The HopeLab Foundation develops Phase III is the most costly and time- Novartis launched an ad campaign
technology-based products to improve consuming step of clinical trials, partly focused on early diagnosis of MS in
the quality of life of young cancer because finding eligible patients is younger patients, relying largely on
patients. The non-profit created two difficult. Pfizer sought to overcome Internet play and social media. Their
video games, Re-Mission and Re- this challenge by employing online product, Gilenya, was the first oral
Mission 2, in which players travel tools to recruit patients with overactive therapy available and also one of the
through the bodies of fictional cancer bladders for a trial that did not require costliest. Based on overwhelmingly
patients, destroying cancer cells proximity to trial sites. The company positive real patient stories, the ads
and managing cancer-related side obtained patient consent online and are bolder than traditional pharma
effects. Patients learn that sticking to shipped investigational drugs directly advertising and feature a mix of real
their treatments helps fight cancer, to trial participants’ homes. patients and actors sticking their
resulting in a positive shift in attitude tongue out (with said pill on the
This approach promises lower costs,
around chemotherapy. tongue) taking a stance against the
more access, and lower administrative
disease.29 Several Gilenya patients have
HopeLab manages to unlock the burdens. But companies must still
posted videos on YouTube describing
mystery of adherence—engaging overcome trust deficits from consumers
their experience.
patients, increasing motivation, and hesitant to share personal health data
providing enjoyment. One study of with companies online. Health professionals create new
Re-mission demonstrates that this customer touchpoints
Other pharma companies are turning
type of video game intervention As healthcare continues to decentralize
to the technology sector to get help
can significantly improve treatment away from the hospital, retail
recruiting trial participants. Genentech
adherence and subsequently pharmacies, minute clinics and
recently partnered with 23andme
reduce cost.26 telemedicine are playing bigger roles.
to use voluntarily provided genetic
Engaging the patient at information to identify eligible The two largest pharmaceutical
every stage patients for metastatic breast cancer retailers are expected to have at least
treatments. The consumer-oriented 1400 retail clinics nationwide in 2013.
Pharmaceutical companies that begin
genetic testing platform allows patients Drug makers should consider the
to engage patients at every stage of the
to share their genetic data and take shift away from a traditional doctor’s
product lifecycle can create longer-
surveys to evaluate their eligibility for office and its impact on marketing,
lasting patient relationships and
large-scale clinical studies. education, and communication. What’s
improve chances of product success.
clear is that large gaps still exist in
Clinical trials, the most expensive In a sign that regulators see the value a consumer’s understanding and
component of drug development, in patient participation, the FDA awareness of their treatments.
often get delayed for lack of qualified is encouraging the submission of
patients. Only 3% of cancer patients patient reported outcomes such as Front-line healthcare professionals
participate in clinical trials.27 self-reported symptoms and quality- are already positioned to create
of-life measures. As the amount better medication experiences for
In the Experience Radar study, one-
of patient-reported information the consumer. Survey respondents
third of high-income Gen X women
builds, industry and regulators will identified pharmacists as a key
with chronic conditions wanted more
need to agree on acceptable ways to resource for treatment information
information about clinical trials,
communicate results. other than their physicians. However,
signalling an unmet demand.
national patient experience surveys
Drug makers are also tapping into conclude that 37% of the time,
patients’ desire to “own” their providers do not tell patients what
condition. AstraZeneca created a their medicine is for and the possible
new advertisement for its 10-year old side effects.30
product, Crestor, which illustrates
a “super fan” patient with high
cholesterol as passionate about his
medication as his favorite sports team.28
12 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patientWhat this means for your business
Pressure test customer Align real-world patient Patients are anxious for answers to
models against the evolving expectations and the questions that most meaningful to
healthcare consumer. corporate strategy. them. When beginning a drug therapy,
Pharmaceutical and life sciences For pharmaceutical companies, they want to know, “Will I have to take
companies have long tried to segment making treatment easier for the off work for this?” and “What side
and target their customers. However patient should be the new recipe for effects will impact me the most?”
traditional efforts may not be enough product success. Companies that have Creating a community in which
to help them understand the next- succeeded in the past with outdated patients feel comfortable expressing
generation consumer. Whether strategies may be skeptical about ideas about the information they
stretching beyond the bounds of new approaches. Leadership must receive and the support they need
segmentation and demographics or proactively communicate the vital role over time is important, especially as
increasing the focus on behavioral that the consumer plays in determining disease states change. Frequent and
insights, the industry must find a company’s future. robust conversations with patients and
a way to tap into its customers’ their caregivers throughout the patient
A customer–centered business
nuanced lives to offer an enhanced journey helps companies generate the
model requires collaboration that
personalized experience. right evidence.
breaks down organizational walls.
Patients managing multiple chronic For example, encouraging R&D to Make it personal, make it precise.
diseases don’t take a single drug in work with product launch teams to
Consumers want to know that the
isolation. Drug makers can get a better engage the patient early on may spur
treatments they’re taking are right
understanding of their consumers by fresh ideas for patient education and
for them. In the absence of better
collecting feedback on how patients’ communication. Becton Dickinson’s
information, they turn to friends,
experiences measure against the leadership team rallied behind an
family, and wider social networks to
specific outcomes they hope to achieve, effort across the organization—from
compare experiences. It’s common
and by understanding the influence of developers to sales—to incorporate its
for millennials to text a photo of a
social networks along the way. customers’ perspectives into product
sudden skin condition to a friend
development. As a result, the company
And while marketers are accustomed before a physician. These networks are
forged stronger two-way relationships
to analyzing by brand, companies can increasingly powerful and are quickly
with its customers, creating new
maximize a customer’s “lifetime value” becoming more common. Regulations
business opportunities.31
by pressure testing consumer profiles make it difficult to host or participate in
across multiple therapeutic areas Create a permanent seat at the these networks, but pharma should find
and product lines to deliver a unified table for patients. ways to work in tandem with regulators
customer experience. While only a If companies box patients in as to educate and clarify the value they
handful of companies have a portfolio clinical trial subjects or focus group can bring to patients.
extensive enough to cover several participants, they don’t have a true Besides physicians, pharmacists are
conditions, those who do not should customer-centered model. For starters, the other health professionals who
consider partnering with others that companies can strengthen patient have direct, personal contact with
offer complementary products. input in clinical trials—from study consumers. In the past, the level of
inclusion criteria all the way through to interaction between a pharmacist and
communicating trial results. patient was limited to brief discussions
about the dispensed medication.
Because of this, drug manufacturers
targeted pharmacists with product
messaging and education, resulting in a
lackluster business impact.
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 13Changes in the marketplace are As pharmacies offer more care and Embrace DIY consumers
prompting an increased focus on services, they are becoming a good determined to control
coordination of care among patients, place to alert patients of clinical their conditions.
physicians, and pharmacists. As the trials, disease support networks, and Consumers are looking for better
pharmacist’s role expands and more technology tools that can help patients ways to manage their medications
retail pharmacies become full-service better manage their conditions. Drug and associated costs, and many prefer
health centers, pharmacists have makers should rethink the quality to do it themselves. Technology
greater opportunity to enhance the and robustness of their pharmacist that gives consumers more control
customer experience and influence relationships, especially where retail over their lives, suggests healthy
behavior by integrating care. California, clinics and pharmacy consulting decisions, and avoids unnecessary
for example, now allows pharmacists services are available. medical appointments can bolster
to provide additional services such patient empowerment and improve
Targeted biologic medicines and
as preventive care, chronic disease outcomes. Apps focused on retail
molecular diagnostic products are
management, medication therapy shopping, investing, and personal
routing patients to treatments more
management, immunization delivery, finance management already do this
tailored to their genetics or other
and wellness screenings.32 particularly well. Building on these
specific biomarkers. Companies
with these products can proactively industries’ successes, the healthcare
communicate the role and purpose of a industry must determine how to
companion diagnostic to strengthen the provide patients with tools that can
personal connection to consumers. achieve desired results.
Conclusion
The next generation of consumers is Other players such as health
reshaping the pharmaceutical industry technology companies are not standing
much as they have transformed other idle. They offer products and services
industry sectors. Customers want their that engage the patient in disease
preferences and behaviors understood management, influence healthy
and acted upon. As consumers take on behaviors, improve convenience, and
more risk and responsibility in their provide better health information.
healthcare, they’re migrating from a
Drug makers and their retail
passive recipient to a joint participant
counterparts must find new ways
in drug purchase and usage decisions.
to create meaningful experiences
and relationships with the ultimate
stakeholder. In essence, a customer
experience for pharmaceuticals.
14 PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patientEndnotes
1. “Unleashing value: the changing payment landscape for US pharmaceutical industry,” PwC Health Research Institute, 2012.
2. “Declining medicine use and costs: for better or worse?” IMS Institute for Healthcare Informatics, May 2013.
3. See Sabre.com
4. “Avoidable costs in U.S. healthcare,” IMS Institute for Healthcare Informatics, June 2013.
5. “Scoring healthcare: Navigating customer experience ratings,” PwC Health Research Institute, 2013.
6. “The Oral Diabetes Drugs: Treating Type 2 Diabetes,” Consumer Reports Best Buy Drugs, 2012
7. In December 2011, the FDA issued draft guidance on off-label information requests through social media channels.
8. B. Paynter, “How Sanofi is Writing the Social Media Rules for Big Pharma without Running Afoul of the FDA,” Fast Company,
August 2012.
9. J. Hibbard and E. Mahoney, “Toward a Theory of Patient and Consumer Activation,” Patient Education and Counseling 78, no. 3
(2010): 377–381.
10. M. Parchman, J. Zeber, and R. Palmer, “Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate
Clinical Outcomes in Type 2 Diabetes,” Ann Fam Med. 8, no 5 (2010): 410–417.
11. L. Rosenbaum and WH Shrank. “Taking Our Medicine—Improving Adherence in the Accountability Era.” The New England Journal
of Medicine 369, no. 8 (August 22, 2013): 694–5.
12. M. Viswanathan et al., “Interventions to Improve Adherence to Self-Administered Medications for Chronic Diseases in the United
States,” Annals of Internal Medicine 157, no. 11 (2012):785-95.
13. NK Choudhry et al., “Full Coverage for Preventive Medications after Myocardial Infarction,” The New England Journal of Medicine
365, no. 22 (December 01, 2011): 2088–97.
14. See Viagra.com, Buy Real Viagra.
15. See knowledge.wharton.upenn.edu, “Losing patience (and patients): wait in line, or decide to bail,” June 19, 2013.
16. R. Cohen et al., “Problems Paying Medical Bills: Early Release of Estimates from the National health Interview Survey, January 2011
– January 2012,” Centers for Disease Control and Prevention, June 2013.
17. H. Kantarjian et al,. “Price of Drugs for Chronic Myeloid Leukemia (CML), Reflection of the Unsustainable Cancer Drug Prices:
Perspective of CML experts,” Blood 121, no. 22 (2013): 4439-42.
18. See internetdrugcoupons.com, Accessed October 1, 2013.
19. NK Choudhry et al., “Full Coverage for Preventive Medications after Myocardial Infarction,” The New England Journal of Medicine
365, no. 22 (December 01, 2011): 2088–97.
20. A. Gillisen, “Patient’s adherence in asthma.” Journal of Physiology and Pharmacology 58, Supple 5 (2007): 205-22
21. H. Jiang et al., “Patient compliance with assessing and monitoring of asthma,” J Asthma 46, no. 10 (2009): 1027-31
22. See chcf.org
23. Aetna website
24. Propeller Health website
25. http://finance.yahoo.com/news/asthmapolis-partners-amerigroup-enhance-asthma-124500379.html
26. P. Kato, “A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults with Cancer: A Randomized Trial.”
Pediatrics 122, no 2 (2008):e305-17
27. P. Lara Jr. et al., “Evaluation of factors affecting awareness of and willingness to participate in cancer clinical trials,” Journal of
Clinical Oncology 23, no. 36 (2005): 9282-9.
28. See azhealthconnections.com, R. Wooten, “Astrazenica takes a new advertising approach to engage and educate consumers,”
October 1, 2013.
29. See gilenya.com, Hey MS Campaign.
30. “Summary of HCAHPS Survey Results. Hcahpsonline.org/HCAHPS_Executive_Insight. [October 2011 to September 2012
Discharges]. Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed October 2, 2013. “
31. F. Gouillart and D. Billings, “Community-Powered Problem Solving”, Harvard Business Review, April 2013.
32. See amcp.com, “California Grants Pharmacists Provider Status”, October 2013.
PwC Health Research Institute | Customer experience in the pharmaceutical sector: Getting closer to the patient 15About this research
The research for this report included 24 in-depth interviews with executives in the
healthcare industry. PwC also conducted an Experience Radar online survey of more than
700 US consumers in spring 2013. These consumers were 57% female, at least 18 years
old, insured, and they had filled at least one prescription or purchased an over-the-counter
pharmaceutical within the past two years. Eighty percent of respondents reported having
one or more health conditions.
Acknowledgements
Marissa Addalia Lina Eliasson, PhD Amanda Rhodes
Senior Vice President, Clinical Strategist Director, Client Strategy
Business Engagement Atlantis Healthcare and Solutions
Health Ed McKesson
David Van Sickle, PhD
Rajinder Arora, MD Chief Executive Officer Jeremy Shepler
Director, Pediatric Pulmonology Propeller Health Director, Patient Centric Strategy
La Rabida Children’s Hospital and Solutions
John Helfrich Novo Nordisk
Liz Austin Director, OncologyRx
Associate Director, Interactive Care Advantage Jennifer Sigaud
Patient Marketing McKesson Specialty Health Managing Director
Genentech Atlantis Healthcare
Judy Hibbard, PhD
Ed Banfe Professor Emerita, Erica St. Angel
Director, Consumer Marketing Senior Researcher Chief Marketing Officer
Bristol-Myers Squibb University of Oregon Propeller Health
Bob Brooks Alan R. Leff, MD Ken Thorlton
Executive Vice President Professor Emeritus of Medicine Senior Vice President,
WEGO Health University of Chicago Medicine Creative Director
Health Ed
Joshua Cohen, PhD Heather Morel
Senior Research Fellow Vice President & General Manager Laura Wilson, MEd
Tufts Center for the Study of Health Informatics
Drug Development Reimbursement, Access & Jessica Wong
Safety Services Group Product Manager, Patient
Stuart Davis McKesson Marketing BioOncology
Associate Director, Brand Genentech
Marketing Patient Centric Strategy Peter Pitts
and Solutions President Roni Zeiger, MD
Novo Nordisk Center for Medicine in the Co-founder & CEO
Public Interest Smart Patients
Chris Delaney
Chief Executive Officer Josh Riff, MD
Insignia Health Medical Director
Target
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