Adaptive Strategies to Account for Impact from Non-Promoted Competitors/ Competitive Dynamics
Why do we need to think differently about competitive challenges stemming from non-promoted treatment options as a competitor?
In the context of today’s rapidly evolving competitive landscapes, the key to long-term success lies in a brand team’s ability to anticipate and adapt to change. (Adaptive Strategies) And while teams are often familiar with future-proofing their strategy against a more traditional competitor set (e.g., in-class competition, newly launching MOAs etc.), a formidable and often overlooked threat can also stem from non-promoted treatment modalities and the dynamics that drive their prescribing.
This raises the question – how can we better prepare for a broad range of threats from competitor types of all shapes and sizes? And what are key success factors when incorporating our understanding of prescribing behaviours associated with these notably different competitors into our competitive readiness planning and cross-functional strategy development?
But before we think about how we account for non-traditional competitor threats within our strategic planning, it’s important to better understand what these competitor types are and the key dynamics that influence their utilisation.
Adaptive Strategies: What are the key dynamics that drive the prescribing of various types of non-promoted competitors?
When thinking about drivers of prescribing for non-promoted competitors, there are three distinct categories to consider: those driven by a belief in the clinical value of a product, economic considerations (budget constraints, profitability measures etc.) and emotional factors, often firmly rooted in long-standing physician beliefs and behaviours. Now, let’s consider an industry example that illustrates the complexity of navigating the launch of a branded product into an established market with several non-promoted treatment options, and how in this environment, we see a number of these prescribing dynamics play out.
A company launched a branded topical treatment indicated for a commonly occurring skin condition that can lead to skin cancer but is easily detectable and treatable. Prior to its approval, multiple treatment modalities, including office-based procedures (cryosurgery, laser resurfacing etc.) and at-home options (prescription topical creams, gels and ointments) were available. Often treating PCPs/Dermatologists prescribed a combination of medical procedures and topical treatment.
At time of market entry, its direct pharmacological competition consisted of two other branded topical treatments nearing loss of exclusivity (with little differentiation beyond dosing frequency), as well as a generic topical treatment with legacy use. The new entrant boasted a dual MOA that enabled a much shorter duration of treatment compared to its topical competitors, and thus a reduced burden of treatment and improved patient adherence. Based on this key point of differentiation, the launching company’s goal was to displace the branded competitors and become the new topical treatment of choice.
Clinical Value of Non-Promoted Competition
When the term non-promoted competition is used, often the mind associates this with generic products. And while price can be a key motivator for generic use, physician rationale for usage can often be rooted in their belief in the clinical value of the genericized product, rather than patient affordability and access alone.
- Belief in the clinical value of the generic product can be driven by:
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- Proven efficacy of the originator drug, often supported by a wealth of clinical dataset and real-world experience/ evidence
- Resonance of market-shaping activities by the originator company; excitement/ hype for the product once created by the originator, if executed well, continues to drive prescriber belief in the active ingredient following genericization
- Continued academic interest in the active ingredient keeping the scientific dialogue/ podium presence alive despite pulled back investment from the originator; data generation can continue beyond LOE, fuelled by large-scale studies funded by globally/ nationally recognised research institutions
In our example, while patient compliance was a key unmet need, physicians felt they already had effective topical treatments at hand. In the absence of head-to-head data against the on-market topical treatments, the new branded entrant struggled to differentiate on a clinical basis. Added to that was its relatively unknown real-world safety profile, compounding physicians’ hesitancy to adopt.
Furthermore, physicians had at their disposal in-office procedures that guaranteed compliance and immediate results. Beyond the initial investment in equipment, cryosurgery and laser devices were not actively promoted by the manufacturing company, and in this sense, a different type of non-promoted competition the launching company also needed to contend with.
Budget-Conscious Prescribing Behaviors
In certain environments\markets physicians may be designated an individual or practice-level budgetary target set by local health authorities or institutions.
- Where budgetary constraints are at play, prescribing effective, low-cost treatment options for easily treatable conditions can:
- Afford greater budgetary flexibility for physicians to treat patients with more serious conditions under their care with innovative products
- Enable physicians to meet overall budgetary targets and avoid penalties
- Limit the need to seek special authorizations often required for use of more expensive branded products
In our case, this resulted in the use of branded products for this skin condition typically reserved for patients who could not tolerate generic topicals. The launching company therefore needed to navigate physicians’ tendency to pre-position its product in select patients, where perhaps adherence was a particular challenge.
Additionally, with the anticipated loss of exclusivity of the two on-market competitor branded products, most physicians expected to switch to an all-generic protocol for this condition moving forward. Physicians were encouraged by the knowledge that effective options they had experience with were earmarked to become more cost-effective, allowing them to utilize these treatments in a greater number of patients while meeting their targets.
Economic/Practice Management Considerations
While physicians prioritise patient well-being as their utmost priority, they often face the challenge of balancing this with the practical considerations of practice management. There are two important factors that drive prescribing behaviours in this complex interplay:
- Finding the delicate balance between financial viability and the provision of optimal patient care
- Navigating operational efficiency dynamics, where oftentimes a significant administrative burden is imposed on physicians within the practice in addition to their responsibility to provide patient care
Unpacking these considerations reveals a nuanced dynamic that significantly influences prescribing behaviours, as physicians must navigate the intricate intersection of fiscal responsibility and the imperative to provide quality medical care.
Fiscal responsibility
Depending on country market dynamics, where products may be perceived to be clinically undifferentiated, financial incentives may become a secondary factor in driving physician preference for one branded product over another. Unlike when budgetary targets are in play where prescribing habits often form to avoid negative financial consequences, prescribing preferences can also be influenced by positive practice economics that can go towards helping meet a medical practice’s profitability goals. Practice profitability can be influenced by a number of factors including:
- Billing for in-office administration of pharmaceutical products that allow the practices to get reimbursed for both drug and service, and for in-office procedures, reimbursement for multiple services related to a single procedure
- Physicians can be invited to participate in honorary-based speaker programmes to provide peer-to-peer education on the benefit of one branded product vs. other on-market options, often drawing from their own prescribing preferences
- Thought leaders can provide advisory services to companies under consulting contracts
- Practices can become a clinical study site for sponsoring companies with pipeline products and be compensated for patient recruitment, screening, randomization, study drug treatment and tracking.
Now let’s apply this to the non-pharmacological competition mentioned earlier in our example. Cryotherapy provided an immediate improvement in the condition that offered patients visible and emotional assurance and unquestionable adherence for the physician. In addition to providing patients with an effective treatment, physicians also made a profit on each cryotherapy procedure performed in-office and patients who returned to their clinic at regular intervals for repeat procedures became an important revenue source for their practice. The financial benefits that came with utilising this clinically effective procedure added another layer of complexity to the competitive environment the new entrant had to take into consideration for launch planning.
Operational Efficiency
The administrative burdens imposed on physicians, ranging from paperwork to navigating evolving healthcare policies can often introduce a strain on operational efficiency and put time constraints on clinical practice. This higher administrative burden and less face time with patients can lead to:
- Less effective communication between the HCP and patient around disease outcomes
- Sub-optimal frequency of outcome assessment is typically required for an HCP to make informed treatment adjustments
- Limitations on time spent staying up-to-date on the latest evidence-based guidelines
- Reluctance to switch patients to different treatment options that require additional time to monitor severe adverse events, recommend the involvement of larger multi-disciplinary treatment teams, or increase the administrative burden in a significant manner
If we consider our example, these time constraints can mean a physician who is familiar with and consistently prescribing the branded topical agents or office-based procedures may be less likely to switch to the newly launched dual MOA topical agent. As physicians in this situation are time constrained, they may have less bandwidth to discuss outcomes/adherence patterns with their patients and more reluctant to choose a new therapy which requires managing an entirely unfamiliar set of adverse events.
Emotionally Driven Prescribing
Within the realm of medical decision-making, the notion of emotionally driven prescribing is an important one to consider as it accounts for the impactful role of physicians’ emotions and patient connections in shaping prescribing practices. This emotional influence can often lead to clinical inertia, a hesitancy to modify treatment plans—which may pose challenges to achieving the highest standard of patient care. Consider again our same dermatology patient that may see moderate efficacy from their current therapy (e.g. cryotherapy combined with topical agents) but starts to consistently present with increasing flare ups. In this case, an HCP’s failure to consider alternative therapies or escalate treatment to the next generation therapy with proven efficacy is an example of clinical inertia. This phenomenon often manifests in conservative treater physician types, who are more likely to maintain patients on an existing treatment for longer owing to:
- A preference for familiar options, opting to wait for further real-world evidence to inform their decision to adjust treatment plans
- Risk aversion, with particular caution around initiating patients on a new therapy with limited insight on outcomes and safety signals outside a randomised controlled trial setting
- A patient-centred approach, which in the context of a conservative treater could mean HCPs are less comfortable suggesting changes their patients might be uncomfortable with despite evidence suggesting a new therapy could lead to better outcomes
Overcoming clinical inertia requires physicians to seek out ongoing education to stay up-to-date with current guidelines and research and a willingness to adapt treatment plans based on evolving evidence and patient needs. As clinical inertia can manifest in several ways, it’s important to better understand how we account for these beliefs and behaviours (and how they influence prescribing of non-promoted therapy options) within our competitive strategy exercises.
What is best practice when accounting for these prescribing dynamics and competitor types within strategic planning exercises?
Although important, it’s not enough to simply recognise the various dynamics that drive the prescribing of non-traditional competition; it’s essential to translate this awareness into true planning insights that inform a customer-centric strategy, one that truly resonates with our target stakeholders. This requires a deep understanding of these fundamental beliefs and behaviours that shape product utilisation among stakeholders and the ability to identify priority challenges these might present to the brand or portfolio. And while these insights should be seamlessly integrated into cross-functional strategic planning processes at a global level, teams also need to take into account regional and local variations in stakeholder perceptions and clinical practices to tailor the approach effectively.
In an ever-evolving competitor landscape, the path to sustained success lies in our ability to anticipate and adapt to a diverse array of threats, both visible and hidden and create adaptive strategies. Embracing these notably different competitors in our competitive readiness planning and cross-functional strategy development is key to staying ahead in a rapidly changing market. For more information on proactive strategic planning, including how to incorporate non-traditional competitor types into your strategic planning exercises, don’t hesitate to contact us
