Oct. 23, 2018
There's
a reason the Trump administration wants to require drugmakers to include list
prices in advertisements for prescription medicines on TV: It's
where the money is.
In
recent years, direct-to-consumer advertising has touted to consumers
prescription medicines for relatively common ailments like high cholesterol or
impotence. Think Lipitor (atorvastatin) or Viagra (sildenafil). While pharma
has never liked the idea of price disclosure, the cost of drugs previously most
familiar to the American public are nowhere near the cost of the most commonly
advertised products today.
Patent
expirations, along with the rise of specialty drugs and biologics, have shifted
the line-up of drugs consumers are likely to see hawked on TV.
In
2018, a traditional 60-second spot is likely to come from one of a handful of
large pharmas and feature a specialty medicine approved for sale in the past
five years. Gone are the twin bathtubs and little blue pills, replaced instead
with promotions for new psoriasis biologics and cancer drugs.
Spending,
though, remains high. Through the first nine months of this year, pharma
companies have spent more than $2.8 billion on TV drug ads, up from around $2.5
billion through the same time period last year, according to analytics firm
iSpot.tv.
Here
are five common themes among the top ranks of pharma TV advertising:
A
handful of drugmakers account for the lion's share of drug ads on TV
In
proposing to mandate inclusion of prices in drugs ads last week, the Department
of Health and Human Services estimated its rule would
affect roughly 25 drugmakers that air about 300 commercials a quarter.
Data
from iSpot.tv, though, shows that the number of pharma companies putting up
serious money on television drug ads is an even narrower group.
Spending
by Pfizer, Eli Lilly, AbbVie and Bristol-Myers Squib, for example, represented
about 40% of the $2.81 billion spent on TV drug ads through the first nine
months of 2018, according to an analysis of iSpot.tv numbers
AbbVie's
investment in promoting its blockbuster drug Humira (adalimumab) made up 8.5%
of the total just by itself.
Top 5 spenders on TV drug
ads, first nine months of 2018
|
Company
|
TV ad spending for top drugs
|
Drugs advertised
|
Number of ad spots
|
|
Pfizer
|
$481 million
|
Lyrica, Xeljanz, Ibrance and
Eucrisa
|
24
|
|
Eli Lilly
|
$318 million
|
Trulicity, Jardiance, Taltz and
Verzenio
|
15
|
|
AbbVie
|
$236 million
|
Humira
|
15
|
|
J&J
|
$113 million
|
Xarelto
|
4
|
|
Celgene
|
$104 million
|
Otezla
|
2
|
Note: Pfizer's figures above don't include
Eliquis, which it co-promotes with Bristol-Myers Squibb SOURCE:Data from
iSpot.tv
All
told, 12 drugmakers were behind the top 20 brands by ad spend, and those
products accounted for three-fifths of overall investment in television DTC.
Given
the sums involved, it's not exactly surprising that large pharmas invest the
heaviest. Still, there's a reason that it may seem the same drug ads keep
coming up in TV programming.
Advertising
is heaviest for brands locked in battles for market share
Drug
companies argue that direct-to-consumer advertisements are an important tool to
raise awareness among patients that treatment options exist. Commercials can
also act as a push, reminding consumers to ask their doctors about whether a
drug might "be right" for them.
Critics
say drug ads overweigh the benefits while consigning risks to rushed voiceovers
at the end of the ad. Some research has backed the concern
that doctors may be more inclined to prescribe drugs patients ask for — whether
they are necessary or not.
While
the pharma industry does invest in unbranded "awareness" marketing,
the most heavily advertised brands generally are in competitive markets.
For
example, J&J's Xarelto (rivaroxaban) and Bristol-Myers Squibb and Pfizer's
Eliquis (apixaban), two competing anticoagulants, were both in the top 10
brands by TV ad spending so far this year and in the top 15 last year.
A
twist on this general theme are drugs nearing the end of their patent
protection. Drugmakers tend to ramp up DTC spending ahead of patent expiry,
before sharply cutting back after generics enter the market.
Pfizer,
for instance, has spent over $200 million this year on TV spots for its nerve
pain treatment Lyrica (pregabalin), the principal patent for which expires this
year.
Most
top advertised brands are considered specialty medicines
Unlike
the blockbuster drugs of the 2000s, many of the top drugs both by revenue and
ad spending are considered specialty medicines.
While
the definition varies, specialty drugs typically are more expensive, prescribed
by a specialist rather than a primary care physician or treat more complex
conditions. Many are biologics.
In
2017, specialty medicines accounted for nearly half of per capita net spending
in institutional and retail settings in the U.S., data from Iqvia shows.
That
increased utilization is reflected in which drugs are advertised most heavily,
too. Humira, Trulicity (dulaglutide), Otezla (aprelimast) and Keytruda
(pembrolizumab) were all among the top 10 brands by ad spend, according to
iSpot.tv. numbers.
"We
are moving away from the old way in which specialty pharmaceutical
manufacturers thought they had to only talk to the health insurers and the
physicians, and then they would drive it to the patients," said Sam
Cannizzaro, an executive creative director at the Syneos Health-owned GSW
Advertising, in an interview with BioPharma Dive. "I think that model is
evolving."
*Trulicity was
approved through a Biologics License Application
Credit: Ned
Pagliarulo / BioPharma Dive, data from iSpot.tv
DTC
advertising for specialty medicines can also make economic sense. While a
condition like rheumatoid arthritis might affect fewer people than high
cholesterol, an expensive marketing campaign for a drug costing thousands of
dollars a year can generate substantial returns on investment by boosting
prescription uptake.
Still,
top advertised brands mainly target broad indications
Pharma
and biotech companies are investing more and more R&D dollars into rare
diseases. Technologies like gene and cell therapy are putting a wide range of
inherited disorders within reach of treatment, spurring buyouts and pipeline
investment.
Given
the smaller patient populations, though, rare disease drugs don't make a great
case for wide-reaching advertising. More targeted digital technologies could
offer a better channel for pharma advertisers but, for TV, DTC marketing
campaigns mostly focus on broader indications like rheumatoid arthritis,
diabetes and psoriasis.
One
exception is cancer, where specific targeted therapies might only be approved
for a narrow group of patients with a specific genetic mutation, for example.
Even
there, though, advertised brands tend to be aimed at cancer types with higher
incidence. Merck & Co.'s Keytruda, for instance, is approved for nearly a
dozen indications, including non-small cell lung cancer, one of the most
prevalent types in the U.S.
Cancer
drugs are making the airwaves more often
DTC
advertising for cancer drugs comes with its own set of challenges and
controversies.
Patients
with cancer can face a deadly prognosis, and aren't as well-positioned to weigh
the risks and benefits presented in a drug ad as those with other, less fatal
diseases. Even for drugs with impressive clinical promise, ads that trumpet
"a chance to live longer" can spur backlash.
Which
type of cancer a patient has typically isn't established until after testing,
too, making the kinds of "ask your doctor" prompts in ads more
spurious.
More
and more though, cancer drugs are showing up in TV ads, mirroring the rise of
immuno-oncology and a broader boom in cancer research.
This
year, Keytruda, Pfizer's Ibrance (palbociclib) and Eli Lilly's Verzenio
(abemaciclib) were all in the top 20 most heavily advertised brands. In 2017,
Bristol-Myers' Opdivo (nivolumab) was also among the top ranks.
Data
from both iSpot.tv and Kantar Media show that DTC advertising for cancer drugs
has increased sharply in recent years. Through the first nine months of 2018,
pharma companies spent $268 million on TV ads for cancer medicines, up 18% from
the same period a year prior, according to the iSpot.tv figures.
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