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Ehrlich on Creative

It’s On-Amgen on Health Disparities

August 13, 2020 0
Covid-19 has raised a major societal issue on health disparities in America. In many diseases, minority populations suffer more and get less treatment. This is not a new finding, but Covid-19 along with the Black Lives Matter protests on discrimination have given rise to new possibilities of addressing health disparities.

Is this the time that health disparities will be taken on? Most drug companies have some efforts related to minorities. The reality, however, is that DTC budgets do not usually allocate significant spending towards these communities. This is interesting given that traditional DTC efforts under reach these audiences, and most minority groups over index in digital, social, and mobile. I expect that will change as big Pharma realizes they are missing an opportunity to contribute to the disparities solution. It will be good business to devote more resources to minority health. A Biden victory would add to the impetus to deal with health disparities through both disease education and special branded efforts towards minority communities.

As I searched for those doing minority efforts now, I was impressed by a campaign on Multiple Myeloma done by Amgen. This digital campaign targets African-Americans with unique creative. Amgen has a drug, Kyprolis, and decided to do a separate education effort to African-American patients leveraging both disease education and branded content. This is not just showing African-Americans as part of a general vignette ad. Instead they created, along with their agency EMCAY, a dedicated branded campaign to address key needs of this important segment. The site www.multiplemyelomaitson.com is rich in African-American focused content and a dedicated place for consumers to share their stories. They also use quotes around the photos of patients, from leading African-American historical figures and authors to inspire the fight against the disease.

The campaign, “Its On”, highlights the treatments available to fight Multiple Myeloma, which includes Kyprolis. The educational component is excellent as to risk factors, an explanation of how the disease affects blood cells, discussion guides with your doctor, and patient trackers for labs and doctor visits. The “It’s On” theme covers patient (It’s on You) and drug company/caregiver (It’s on Us). Clearly the site was well-developed with relevant language that emphasizes spirituality and community. That is not something you see on general sites.

The need for special outreach is because health discussions within communities can vary greatly by race, ethnicity, and economic status. The clinical journey is at times widely different. African-Americans frequently consume health information differently and have unique health issues, such as higher prevalence of co-morbidities like diabetes and hypertension. The site encourages African-Americans to be part of the treatment process and reduce some of the gaps.

The “It’s On” campaign tries to understand and talk to these unique needs. Amgen and EMCAY recognized that special efforts are going to get better results among African-Americans than just assuming the general effort is sufficient.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

Ehrlich on Creative

My Favorite Fowl

August 6, 2020 0
Hmm, Aflac or Chantix. Duck or Turkey. What a feast! I have written about the Chantix Turkey when it launched. I liked it then and like it now. I said then that I did not see the use of the turkey as a long term campaign. Apologies to Pfizer and their agency VMLY&R. They have extended the campaign with numerous new executions.

Starting with Turkey by the pool in early 2019, Chantix has added Turkey camping, sightseeing, ice skating, snowball fighting, lounging at home, at a local carnival, and at the beach. The theme has stayed the same. The Turkey represents not having to quit smoking cold turkey. 

This campaign is quite interesting and innovative for DTC. It is a far cry from patient testimonials and actor Ray Liotta, which were done earlier and also well done. I have no data on its success versus the earlier approaches. I can say with certainty that Chantix ads are memorable, likable, and unique.

“Once you land on a great strategy, you can’t shy away from it. We were certain that offering smokers a gentle alternative to cold turkey would motivate them to try quitting again. The Slow Turkey character is really just the most natural expression of that idea,” John Bollinger, Executive Creative Director at VMLY&R, told DTC Perspectives.

Use of a cute character has its limits. It really depends on the therapeutic category. It is hard to imagine using a Turkey for cancer ads. No, the cute character needs to stay within categories we do not consider immediately life threatening. Of course smoking can lead to heart disease and death, but not imminently like stage four cancer. Cute characters have worked for toe fungus, urinary incontinence, gastrointestinal ailments, and dry eye. Lamisil (Digger), Myrbetriq (walking bladder) and Xiidra (eye critter) are examples where levity was considered useful.

Chantix apparently decided that a cute character would help break through the DTC clutter of testimonial, lifestyle, vignette type ads that dominate drug advertising. I think it certainly does that well. Whether the Turkey can endure much longer is up for debate. Chantix has proven me wrong that the Turkey can be extended to numerous situations. Clearly in other categories, characters have lasted for years and have not shown any viewer fatigue. The Geico Gecko and Aflac Duck have had staying power.

Chantix has the benefit of a relatively simple selling message. You can stop smoking over time with Chantix. No need to go through the withdrawal going cold turkey. With that simple message, Chantix can focus on a memorable creative device. Many drug ads have so much information to convey that they need to be more straightforward in their presentation and use real patients or doctors, or actor portrayed patients or doctors, to recite multiple points. Chantix had the luxury of being able to focus on stopping power since the message can be nicely conveyed through the voice over.

What is very interesting about the campaign is the lack of print ads. The campaign is over 90% television with the rest digital. I would think the Turkey would make a nice visual in full page ads. That said, Chantix knows what works and has their reasons to eschew print for television. Good job Pfizer and VMLY&R for trying something very unique among DTC ads that have a tendency to look the same.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

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Xiidra and Their Critter

July 29, 2020 0
Sometimes an Rx Drug is also competing with many OTC alternatives. In that case, their DTC ad frequently is more OTC-like than most typical DTC ads. Xiidra is a perfect example of the near OTC ad. It treats dry eye and is the only FDA approved treatment specifically indicated for the signs and symptoms of dry eye disease. Other approved drugs are indicated to increase tear production which I assume may also have the effect of reducing dry eye signs and symptoms. Restasis is the most well known of those.

Xiidra is now part of Novartis, after its deal to buy the brand from Takeda in June 2019. Takeda acquired Shire which owned Xiidra in January 2019 but quickly divested it. Novartis decided to create a new campaign for its newly acquired brand and thus a new creative approach was born.
Their new creative uses a little devilish critter to represent the symptoms of dry eye. He sits at a console where there are controls to cause ache, grit, itch, and burn levels. He is sinister but in a humorous way. Reminiscent of the “Digger” toe fungus character which represented the disease, the Xiidra controller is meant to be memorable without overpowering the core message. 

You would not ever use these characters for life saving or life altering drugs, such as cancer, as even a little humor would not be appropriate. In cases where the conditions are annoying but not life threatening however, the use of disease representative characters is fine. People with toe fungus and dry eye are not laughing about their conditions, but can still accept ads that are lighter in tone. 

The Shire launch campaign for Xiidra was very different from the latest Novartis execution. It was an animation of two balls representing the eyes on a track and a play on the double “i” letter in the name. A voice over announcer described the symptoms and Xiidra treatment. The branded campaign was launched after the much publicized Jennifer Aniston eye-love disease education campaign.

I assume Xiidra under new ownership decided that to compete with all the OTCs, they needed to get a more attention getting device and the critter was born. Their web site also features the critter on the landing page. I also like the use of the critter in print where so many DTC ads are similar with headshots of patients. The critter in the print ad is an attention grabbing visual enhancement. It looks like it is being used only for physician publications to date but I am sure it will appear in consumer publications soon.

Does the use of critter diminish the efficacy message or create negative reactions from potential users? That is unlikely given the nature of the disease being annoying but not life threatening. Patients have a sense of humor, too, and creating a memorable character helps Xiidra get attention in a category that is underdeveloped in the Rx arena.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

Ehrlich on Creative

Flu Season

July 23, 2020 0
One of the most timely and fascinating areas of DTC will be for flu this year. Usually flu advertising is limited in timing and spending. This upcoming season, when America will be dealing with Covid-19 and the flu concurrently, flu advertising has some new opportunities and challenges.

As we hear regularly from Dr. Fauci, the combination of flu and Covid-19 poses diagnostic confusion for doctors. Therefore the CDC and other health care agencies will be pushing widespread flu vaccination this year to reduce the number of cases of seasonal flu so our hospitals and testing centers are not overwhelmed.

There are only a few flu vaccine and treatment makers in the United States. Sanofi Pasteur (Fluzone) vaccine and Genentech (Xofluza) for treatment are the companies who advertised in 2019. The flu market is large with 45% of adults getting vaccinated. We can suspect this percentage will rise in 2020 as receptivity should grow as no one wants to risk both the flu and Covid-19. Therefore we should expect significant DTC for both flu vaccines and treatment this season, perhaps at higher spending levels.

Unfortunately, the percent of population vaccinated has been only between 40-45% for the past decade. CDC estimates that a 5-percentage point increase would reduce hospitalizations by up to 11,000. This year, when ICU bed utilization may be at or over capacity with Covid-19 patients, any reduction would be critical. We also see clear evidence of health disparities as 49% whites are vaccinated, while only 39% of African-Americans and 37% of Hispanics get the flu shot. This may be the year for a special DTC effort to narrow the gap.

Fluzone will need to add to their normal messaging given the Covid-19 situation. They will have to motivate people to get the flu vaccine at a time patients may still be reluctant to see a health care provider out of Covid-19 contagion fear. It will be interesting to see if masks are added to the actor patients.

Vaccines are going to be a major area of ongoing government focus as the world needs to prevent another pandemic. We will always be at risk for the unknown pathogen but given the massive cost in lives and destruction of national economies, it is reasonable to see increased investment. Pharma companies will also ramp up R&D recognizing the enormous potential of new vaccines. All the basic work being done on Covid-19 will lead to possible vaccines for other similar viruses.

What will Covid-19 vaccine makers do with DTC if they get approval this fall? That depends how many vaccines are available. Clearly if we have only one approved vaccine, then government and the media will give that drug massive free publicity. On the other hand, the first approved vaccine will benefit from building up brand identification to prepare for multiple competitors. A non-branded campaign would make sense to sell the public on safety and efficacy as that will be a strong concern given the speed of approval.

An approved Covid-19 vaccine will be seen as the biggest medical news in years. I will be thrilled to review that DTC campaign.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

Ehrlich on Creative

HIV – The Fight Continues – Descovy

July 15, 2020 0
Those of us who remember the emergence of HIV in the early 1980s are awed by the progress in fighting the disease. There have been many drugs to treat HIV, but recently the category introduced prophylactic drugs to be taken if there is risk of exposure. Gilead has been a leader in HIV treatments and added to their mix with Descovy. 

The category of drug is called PrEP (pre-exposure prophylaxis) and Descovy got this indication late 2019. There are about 40,000 new HIV cases annually. Descovy is the second drug in the category after Truvada. The FDA says Descovy was similar to Truvada in effectiveness. Both are from Gilead and Descovy uses the same combination but at lower concentrations which could improve its side effects profile. 

The Descovy campaign is basically using television with limited consumer print. The ad is lively and upbeat using the theme “Step Up, Prep Up.” We are exposed to vignettes of singles and couples telling viewers to step up and prevent HIV. The selling copy runs about 35 seconds of the 90-second ad. Fair balance is then run for about 40 seconds, with a return to the reminder of “Step Up, Prep Up” lines in the remaining 15 seconds.

The background music is a drum mix, with one of the vignettes showing five drummers. It has a nice contemporary feel and the beat adds to the positive outlook of using a drug to prevent HIV. Gilead has switched advertising from Truvada to Descovy for a solid business reason. Truvada will go generic as early as late 2020.

The limited print campaign ties well to the television using the headline “Step Up, Prep Up” and shows scenes of the actors featured in the television ad. The digital also integrates well using these themes.We have come a long way from the heartbreaking days of HIV/AIDS of the early 80s. It is gratifying to see HIV presented first as treatable and lately preventable with drug treatment. 

Earlier HIV ads were largely print. Like many other limited incidence categories, television seems to be accepted as a worthwhile investment. Clearly the emotional element can be best used on television. The DTC payback comes from the fact that Descovy is priced at about $2,000 a month. Getting a few thousand new patients means potentially tens of millions in sales. These sales are also recurring since this is used to prevent the disease and will be taken indefinitely.

It has been a remarkable 40-year journey from almost certain death to a manageable or preventable condition. 
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

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DTC without TV? – Saxenda

July 8, 2020 0
It is rare to find a big budget DTC campaign that does not use TV as a part of the total plan. Saxenda, a weight loss drug from Novo Nordisk is one brand that excludes TV. There are several interesting things about this campaign.

First is the amount spent on print with no TV. According to MediaRadar, Saxenda spent an estimated $89 million on print in the latest 12 months. Given typical discounts big companies get, this might be a high estimate. That budget, even if less, is certainly large enough to do TV. The obesity category has high incidence and that is where TV is largely used. Yet Saxenda sticks with print. They have been advertising to consumers since April 2017 so after three years they must be satisfied print is effective. They clearly target women given the magazine title selection led by Better Homes and Gardens, Good Housekeeping, Women’s Day, and People, among other popular female-targeted books.

The second thing that is notable is the creative consistency. Most Saxenda ads are headline oriented and have been that way throughout. Currently they use “Losing Weight and Keeping it Off” as the headline in a 2-page spread. The earlier ads have the words “Will” and “Way” boldly featured and also have small type to fill out the expression: where there is a will there’s a way. I like creative consistency and Saxenda has been very patient running basically the same style of ad.

Thirdly, we see creative that equally pictures both sexes. This is interesting given the majority of titles are women’s publications, although there is Men’s Health and Golf magazine among the media titles used. That said, women are the primary target. I assume Saxenda believes that women who show interest will tell husbands and other males who are overweight about Saxenda.

I do not know why Saxenda avoided television. Obviously, they probably concluded that print alone got them the awareness they wanted at the budget they had. Their choice of print could have to do with the fair balance. There is a fairly lengthy list of risks and side effects in the print ad. This is not unusual for DTC, but it may have required a 75 second television ad, and that length may have convinced Saxenda that print more efficiently communicated benefits and risks.

There are currently very few big spending campaigns that avoid television completely. There are some that spend in the $10-30 million range that only use print / digital; Aubagio (MS), Imvexxy (Menopause), Imfinzi (Lung Cancer), and Steglatro (Diabetes) are among the few.

Of 28 DTC campaigns that spent over $10 million on print in the past year, only five did exclusively print. The trend has been to use television as part of the media plan even for highly targeted drug categories. What matters most, however, is achieving the brand media objectives. Most DTC studies show combined print and broadcast optimize a plan, but each brand is unique. Saxenda has chosen what it believes works best. In a DTC world where television reigns, it is interesting to see some brands go a different direction.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

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The Rx Available Without A Traditional Prescription

July 2, 2020 0
The opium overdose antidote Narcan (naloxone) is a very interesting DTC case. Naloxone is widely used by EMTs and first responders to counteract opioid overdoses. States have recently made Narcan from ADAPT Pharma available to the general public to use on those in the home who overdosed. Narcan is a branded nasal spray version of naloxone.

The interesting development is this is a prescription drug that most states (42) make available from the pharmacist without requiring a doctor to write a script. The new television campaign is an Rx DTC campaign explaining why Narcan should be stocked in households where opioid painkillers are used.

The ad is a :60 second spot that looks like a typical Rx DTC ad. We see a scene with a teenager who injured himself playing sports and is now on an opioid pain killer. The theme is for parents to be ready to deal with an accidental overdose. I assume that Narcan is also widely used to help opioid drug abusers. This ad only deals with prescribed pain use, not illegal drug use, but the idea is the same. Narcan can save a life by reversing the effect of an opioid which has depressed the breathing or induced unresponsive deep sleep in affected individuals.

This is a very serious drug and risks and side effects are discussed just like all DTC Ads. Narcan is running digital ads as well. These ads state that 40% of opioid overdoses are prescription based used for legitimate purposes. The goal of the ad is for every opioid using household to keep Narcan handy. Prescription opioid use is a hot topic in every state because of addiction and abuse. Lawsuits against opioid makers has resulted in large judgements because of over marketing. About 25% of adults have used a prescription opioid in the last two years. According to the CDC, 168 million prescriptions were written in 2018.

Narcan is highly effective and can quickly reverse the effects of opioid overdose. Much like EpiPen, Narcan is something many households should have ready in emergencies. The ad says opioid overdose can happen at any time. The premise is that parents can reduce their anxiety by knowing Narcan is in the house. As a nasal spray, Narcan is easier to administer than an emergency injection, which many people might be reluctant to use.

There is obviously a big market for Narcan given the widespread use of opioids for pain. The DTC effort likely makes financial sense given the sales potential of stocking opioid containing households with an emergency antidote. Like most people, I thought of Narcan as something EMTs and first responders carried rather than a drug we all could keep ready in the household. This DTC campaign, which was developed with help from FCB NYC, hopes to change that.
Bob Ehrlich, Chairman
DTC Perspectives, Inc.
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Bob Ehrlich

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To The Point-Ubrelvy

June 24, 2020 0

I like ads that are clear and get to the point. Ubrelvy, a new migraine drug from Allergan, now part of AbbVie, does clarity well. In what I would call a near OTC ad, Ubrelvy intro only took 45 seconds to tell its story. It is positioned as “The Anytime Anywhere Medicine”. That is an OTC like slogan. 


I had to watch this television ad several times to make sure it is a prescription drug. Fortunately for Ubrelvy, the side effects and risks are few and that allows for the 45-second time frame compared to 60 seconds or longer for most DTC. Ubrelvy also has a new 30-second ad and to do that, they cut the section about discussing the drug with your health care provider or using telemedicine as an option. From a messaging perspective, the 30-second ad delivers the selling points just as well as the 45-second spot.


Creatively, Ubrelvy uses a print ad like headline approach with on-screen graphics of the selling messages over scenes of migraine sufferers shown at different times of the day. It is shot in black and white with some color in the supers. The key selling point is ease of use as it is one pill that can stop migraines within two hours. 


There is no consumer print yet which is interesting given this headline approach adapts well to print. The digital approach is clear and concise as the website mirrors television. The website has more information on price support and disease education. It also can connect the patient directly to a telemedicine provider and get a prescription. There is a fee for that service that goes to the telemedicine service.


The consumer media plan is basically 98% spent on television with the rest digital. The new 30-second spot extends the efficiency compared to most DTC ads in the category which are 60 seconds. Ubrelvy is the perfect broadcast brand as the fair balance section needed only eight seconds compared to 25-30 for most brands. Ubrelvy has focused on a memorable slogan and has an easy to understand benefit. Many DTC brands are more complex and require more detailed explanation. Ubrelvy has the benefit of a category well established in consumer expectations for a treatment; that expectation is quick relief in an easy to use form. Simple, clear, and concise was Ubrelvy’s goal and that was accomplished in this campaign.

Bob Ehrlich
Chairman
DTC Perspectives, Inc.

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Bob Ehrlich

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Taking on Supplements-Vascepa

June 18, 2020 0

It is interesting when you contrast the regulations for benefit claims for prescription drugs and OTC supplements. We all know the unproven health claims made for most supplement brands. They often have a tiny super on screen that says these claims have not been evaluated by FDA. Contrast that with prescription drugs which are regulated where every word is parsed over by regulators.


It is rare a prescription drug takes on the supplement industry directly. Vascepa is a drug that treats high triglycerides. Many OTC fish oils make claims about heart health. Amarin, the maker of Vascepa, offers a highly purified fish oil that did clinical studies on triglyceride reduction. In their latest Vascepa campaign, they are aggressively taking on the fish oil supplements for effectiveness.


The first campaign in 2018 did not compare Vascepa to competitive OTC supplements. The launch ad just introduced Vascepa and referenced that there are unapproved competing supplements. Vascepa must have seen data that showed consumers and payers needed more convincing that a prescription is needed instead of an OTC. Hence the latest Vascepa campaign talks the negative effects of some OTC fish oils that can raise bad cholesterol. It is a good strategy to show that OTC fish oil may actually be harmful to heart health if bad cholesterol increases.


Vascepa is contrasting its capsule by showing the purity of its drug as evidenced by the clear liquid vs. the yellowish fish oil. Amarin references its extensive R&D and clinical studies to contrast with fish oil supplements unapproved by FDA for triglyceride reduction. The patients are shown in a super modern looking clinic discussing Vascepa with their doctor. This is done to add emphasis to the cutting-edge science of Vascepa.


The regular price of Vascepa is not mentioned in the ads. This is a potential issue with consumers once they get a prescription and go to the drug store to fill it. Vascepa is expensive versus OTC alternatives. The retail cost is about $2.50 a pill versus $.05-.20 per pill for most OTC products. Insurers are likely reluctant to cover Vascepa fully given the hundreds of cheap OTC alternatives. The DTC ad probably helps Amarin get formulary coverage as insurers know patients and doctors will be requesting reimbursement. They do have a price support deal for new customers.


The latest DTC campaign is designed to basically say that when it comes to reducing triglycerides, go with a brand you can trust, one that has been researched fully, and had claims validated by FDA. This is a very interesting case study of how to take on OTC supplements which compete across many Rx categories.

Bob Ehrlich
Chairman
DTC Perspectives, Inc.

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Bob Ehrlich

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Embarrassing Conditions? Endo talks Peyronie’s Disease

June 10, 2020 0

One of the benefits of DTC advertising is making it easier to talk to the doctor about conditions patients may find embarrassing. Viagra was a pioneer in talking about erectile dysfunction (ED). This created an opportunity for many men to deal with what was often a condition not treated. Since ED could be indicative of blood vessel blockage, what was embarrassing could also create a discussion that saved a life.


Some other examples of conditions patients are often reluctant to discuss are toenail fungus, urinary incontinence, low testosterone, and depression. DTC has been very helpful in making those conditions easier for patients to raise with their health care provider.


One of the potentially hard to discuss diseases is treated by a drug from Endo Pharmaceuticals. The disease is called Peyronie’s Disease (PD) which is a bend in the penis when erect. Endo, which makes a treatment called Xiaflex, has been running a non-branded campaign since 2016 starting with print and digital. The firstTV campaign started in 2018 and was designed to introduce the idea of abnormal curvature. Using the “curved below the belt” line was a way to discuss the penis and erections without mentioning those terms in the ad. The ad told men that there are thousands like them who have abnormal curvature.


In the second 2018 campaign Endo got more bold. They explicitly mentioned erection curvature and from then on, added more facts that directly addressed the possible causes. The first-year campaign used fairly standard visuals of men lookingconcerned while the voice over addressed the condition. In recent executions, Endo became creative visually with representations of a bent penis. Using fruit and vegetables we see cucumbers, carrots, and bananas standing in for the penis.


Endo has a very good explanation about the causes of PD on its website. Xiaflex as a treatment option is explained as an injectable that can break up the plaque which forms from an injury to the area. In fact, we learn on the site there are millions of men who have this disease. The degree of curvature is used as an assessment tool on the site to determine whether treatment is needed.


Interestingly, we also see Xiaflex used for another common condition called Dupuytren’s Contracture which is a rigid bend in the finger joint. Endo has a separate campaign on air for this condition. This is clearly something patients may be less reluctant to discuss with physicians.


Critics of DTC Ads should recognize that educating patients about hard to discuss conditions is one of the unheralded benefits of DTC. I am sure discussing a bent penis is not something men would generally find easy. Having an educational campaign that says it is common and treatable makes many men more likely to discuss it with physicians. The fact that Endo has been running a PD TV campaign for over two years indicates they are seeing increased PD related urology visits. It is not easy to do a DTC campaign on sexually related conditions and Endo has done that well across multimedia platforms.

Bob Ehrlich,
Chairman
DTC Perspectives, Inc.

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