Hi everyone – Jodi here and for this month’s edition of Junkie I’m talking to Dr Alex Grey, Chief Medical Officer about what happens when we take a well-positioned new medicine out into the real world (and when things go wrong). I have asked Ines Dieringer, Junior Consultant, to join us because she brings some great post-launch insights with her market access background. Let’s go!
AG: Alex Gray; JL: Jodi Lewis; ID: Ines Dieringer
JL: Alex, you have hundreds of positioning projects under your belt, you’ve developed patented methodologies to mine the known and the unknown. When we get called in to do the early positioning piece, really what we’re doing is opening things up, looking at all possible futures of an asset. What’s at the beating heart of early-stage positioning?
AG: Fundamentally it’s about finding the purpose for your product because nobody ever launches a molecule. It's everything else, beyond the molecule, that matters in the way that it gets used at the other end. To help the patients who use it, the way the physician is going to feel about it and believe in it, or not believe in it and for those paying for it.
JL: To live long and prosper, across the entire lifecycle. So, we must ask the right kind of questions early on.
AG: Absolutely. What do we believe this molecule might be capable of delivering? What is the breadth of possibility that exists for it? Within one disease space? Within multiple different disease spaces? Then we can start to unravel where might be best to send it on its journey, or it might be multiple parallel journeys or sequential journeys, different journeys that we could take it on. It’s absolutely critical to think about the front end, so you can plan an approach that speaks to the whole of the lifecycle of the product moving forwards, rather than just the first point of launch.
JL: Right, and you can easily see how purpose can translate into value throughout the healthcare ecosystem. Because then, everybody gets what the product is there to do and the benefit it brings.
JL: Ines, talking of the wider ecosystem, are we going to see more approaches to regulators with this kind of mindset – with more clearly differentiated products?
IG: I think some companies are doing this really well and others still have a way to go. When it gets to this stage, to be successful you must supplement your positioning by doing your homework. Knowing your drug’s introductory environment, strong and evolving competitor intelligence. Asking who is there? What was the first market? How is the market saturation going? What hurdles are you going to find once you’re on the regulatory side? How strict are they in terms of reimbursement once you get through the initial marketing authorisation? All these things might sound obvious but there are companies out there that aren’t putting two and two together. If we think of a saturated market, like flu vaccines. How far really are you going to get with any flu vaccine?
AG: There is a fitting example of this from history, which was flu drugs - Tamiflu being one example. When they did their clinical programmes, they looked at very minor average benefits in broad populations in which there was no interest. There was no value to society in getting lots of people back half a day early to work, for example. That’s not a value proposition that is ever going to exist, as opposed to saving the lives of the elderly or immunocompromised, which is largely where they ended up in many markets. If you go back to, not just the molecule and what it was capable of doing versus saying ok, it needs a development programme that is aligned with what people were interested in and end goals. That was a totally misaligned set of propositions, poor positioning, poor development programme, that they then had to revisit to find the value in their product, as opposed to designing it from the front end.
JL: Ah yes, and they made it onto our Top 30 positionings list of all time – number 26 in the end. Because they pivoted?
JL: I’m from a comms background and I can tell you it’s a fallacy to expect the media to pay attention to a product that isn’t well differentiated or seen to have ongoing potential. Because these journalists, quite rightly, are asking the same question as their readers – who are prescribers, analysts, payers … what’s different, who are the patients benefitting, where’s the so what?
IG: Exactly. If we take the example of Microsoft and Apple, already the two titans, are you really going to introduce a third broadly similar competitor brand? So why do we keep barking up that tree in pharmacology?
JL: Let’s track back to positioning and timing. In an ideal world, it should take place as early as possible, right? A mere twinkle in the eye. But what happens when the proverbial train has left the proverbial station, which is also a terrible mixing of metaphors, sorry everyone. In this example, say we find ourselves in late Phase 2, awaiting read out. What are the key things one could do to optimise the development journey?
AG: We often get asked to position products in Phase 3. There isn’t necessarily a pure line of sight between what’s being studied and what they are going to get utilised in the marketplace, but there is still an opportunity to do something at that point. I would break this down as, there is the launch piece and the wider consideration around lifecycle. There is obviously opportunity with lifecycle, there are more studies that can be done, there is more data that can be achieved, and you can look more broadly at what the assets are able to deliver, or deeper within the space it is already operating in. All of that stuff can be extremely helpful to course correct, reposition, or go in a chosen direction as opposed to just a vague launch and allowing the market to position your drug.
AG: Even within the launch space, this is what I always think about: if I’m the sales rep or MSL sitting in front of the physician and they say ‘ok, you’ve got this new product but who is it for and what I am going to get back out of it?’ If I can’t answer those questions in a very straight forward way, which is: who would I give this to first? Is it the next guy through the door, do you have to be left-handed? What defines who I should be giving this to? If I can’t answer those basic questions, I have failed. So, whatever we do at that point, we must be truly clear on why they should use this product, in whom and what will be different from using what they are already using. In some cases, that can be obvious but more often, that’s not the case.
JL: So, understanding those sweet spots for the products …
AG: Yes. Going back to that basic positioning mantra of who, what, why and really understanding our alignment between our molecule, the data, what it can deliver and specifically in whom it can deliver it. So, we can answer that question that the doctors pose with clarity. That allows us to get from the vague to the accurate and position the product. Even if we can’t rerun their phase 3a, within the way that the drug has been studied, we are still able to find the sweet spots for it.
And we’re at word count folks. I hope you enjoyed the conversation and discovered something new. Look forward to hearing what you think. Let us know if you’re facing any tricky conundrums, you’d like us to tackle in next month’s Junkie, we’d love to hear from you.
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