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For Switch Success, Dive Deeper Into Consumer Behaviour

Executive Summary

Behavioral insights can help companies make a success of Rx-to-OTC switches, explains Hamell’s managing director Fiona Hammond, in an exclusive interview with HBW Insight. 

Prescription-to-OTC switches have more chance of success if companies understand the deeper, behavioral drivers of self-care, according to behavior change agency Hamell Communications Ltd.

Pharmaceutical companies must look beyond consumers’ own interpretation of their symptoms and stated reasons for wanting to manage their own health conditions, urged Hamell’s managing director Fiona Hammond, in an exclusive interview with HBW Insight.

Not only consumers, but also pharmacists and doctors had deep-seated attitudes to self-care which must be considered by OTC companies when evaluating the feasibility of a potential switch, she warned.

“To understand the behavior of all these key stakeholders, we need to do much more than just ask people what they will do or intend to do and what they think about it,” Hammond insisted.

“What we say we will do or intend to do is known to be a poor predictor of our future behavior, something that has been demonstrated repeatedly when new products fail to get the sales they anticipated,” she explained.

To really understand and accurately predict how consumers and healthcare professionals would behave in relation to a potential switch, she recommended companies use different techniques to get beneath what people say in market research and advisory boards to enable them to understand “what is driving behavior at an intuitive, unconscious level.”

Companies needed to understand how powerful default behaviors were, Hammond suggested, why people do “what they have always done” when they have a health problem – go and see the doctor, for example – and what rewards maintain these default behaviors.

Generating and activating a “behavioral intent” for consumers and pharmacists to purchase or supply an OTC product respectively was essential for the success of prescription-to-OTC switch, she continued.

“We need to know how and when to use social norms to influence and motivate consumers to seek help or pharmacists to start supplying a switched product,” she added.

Maloff Protect, An Example Of Understanding Behavior

Hamell’s aim was to work with companies to assess the feasibility of Rx-to-OTC switches and to develop successful commercialization and marketing strategies based on these behavioral insights, Hammond explained.

The Rx-to-OTC switch of Glenmark Pharmaceuticals Ltd.’ antimalarial treatment Maloff Protect in the UK was a recent example in which Glenmark’s enthusiasm for understanding and predicting the behavior of their stakeholders led to Hamell applying its behavioral insights approach, she pointed out.

After a successful public consultation, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) in July 2017 approved the prescription-only (POM) to pharmacy (P) reclassification of Maloff Protect, which contains 250mg atovaquone and 100mg proguanil hydrochloride.

Indicated to “prevent malaria in adults aged over 18 weighing more than 40kg travelling to areas where malaria is widespread,” MHRA approved the switch on the condition that consumers tell their pharmacist the countries they would be visiting, as it was essential that the antimalarial taken was effective in those areas.

With the Maloff switch, Hammond said that Glenmark had worked closely with Hamell in the development of their switch strategy, conducting behavioral research with the relevant consumer population.

This research uncovered three distinct potential target populations with different behavioural drivers, beliefs, biases and defaults in relation to malaria prophylaxis, Hammond noted.

Reflecting on the lessons from this switch, she explained that consumers “needed different messages and strategies to successfully activate them to seek and use Maloff Protect and pharmacists “needed training to successfully engage with each group and communicate the key safety messages in a way that resonated with them.”

Glenmark’s “cost-effective, impactful creative campaign” for Maloff – driven by Hamell’s behavioral insights, Hammond pointed out – stormed the 2018 OTC Marketing Awards, winning the ‘Most Innovative New OTC Product’ and ‘Best OTC Pharmacy Training’ Awards and being shortlisted for three others.

“Maloff Protect addresses a clear need from on-the-go consumers for accessible, affordable and effective malaria protection,” one judge wrote.

“The availability of Maloff Protect without prescription will help to save increasingly limited National Health Service resources,” another judge noted, adding that the product also “has the potential to save lives.”

The campaign also won the Effectiveness Award for Promotional Brand Campaigns at the 2018 PM Society Digital Awards, with judges noting the importance and innovation of using the behavioral insights in driving the campaign.

Overcoming Switch Skepticism

While generating behavioral intent among consumers and pharmacists was crucial to the success of companies’ reclassification strategies, Hammond also pointed to attitudes among doctors and regulators that created potential behavioral barriers to Rx-to-OTC switch.

“Doctors are often concerned about safety, especially for more complex medicines or chronic conditions,” she explained. “They think about their clinical population and whether it would be appropriate for them to be managed by a pharmacist,” she continued.

However, the target population for switched OTC products “is usually one with earlier or less severe disease with fewer comorbidities or complications,” Hammond pointed out.

If companies didn’t understand and engage with the behavioral tendencies behind these objections, switches could hit a brick wall, she warned.

The first “true” global Rx-to-OTC reclassification of sildenafil with Adamed’s MaxOn Active erectile dysfunction treatment in Poland in 2016 was an example of a clinical community lobbying to reverse a switch, she argued.

Although this attempt was not successful, Polish switch-conservativism won the day a year later with the reverse-switch of HRA Pharma’s ulipristal acetate-based emergency contraceptive Ella One, which had been granted OTC status via the European Union’s centralized procedure in 2014.

In the case of EllaOne, it was an ultra-conservative Polish government that came in and rolled back the Europe-wide liberalization of emergency contraception.

However, Rx-to-OTC switches could also fall foul of conservative regulators, Hammond said, who worry too much about safety risks without balancing these risks with the wider benefits of increasing access to effective drugs.

“From the regulators’ perspective, their key responsibility in relation to switches is safety and therefore assessing the risks associated with making medicines available without a doctor involved in the process is an essential activity,” she acknowledged.

However, a better understanding of consumer behavior – in terms of what beliefs, experiences and expectations determine their use of medicines and therefore the risks they might “wittingly or unwittingly take” – can help companies reassure regulators that switched medicines would be used appropriately, Hammond insisted.

“Key to managing the risks is getting the right consumers to use the product correctly,” she explained.

This was “not always straightforward,” Hammond conceded, but could be achieved by using behavioral insights to “predict consumer behavior and put measures in place to address it.”

“Having this understanding and knowledge of predicted behavior in the target population enables the risks to be appropriately quantified and risk management plans (RMPs) and risk minimization measures (RMMs) to be designed to minimize the risks,” she said.

By conducting behavioral research during the preparation stages of OTC companies’ switch applications, Hamell had in many cases created data that had allowed regulators to avoid imposing potential supply restrictions for switched products, Hammond pointed out.





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