Frank Spinelli, New York City's Cabrini Medical Center - Speaker at the marcus evans PharmaMarketing Summit 2012, held in Wheeling, IL, April 30 - May 2, 2012, delivered his presentation entitled A Doctor’s Perspective on the Future Role of Pharmaceutical-Doctor Relationships and How They Are Evolving through Technology

1. EVOLVING TECHNOLOGIES AND THE FUTURE OF
THE PHARMACEUTICAL/HCP RELATIONSHIP
Frank Spinelli, MD
p ,
April 30, 2012

3. MY HISTORY WITH PHARMA
Pharma-friendly residency (1995)
Chief Resident and worked closely with Pharma (2000)
Sponsored lunches
Grand Rounds
Dinners, events, parties, happy hours
First practice was Pharma-friendly (2001)
Current practice and hospital affiliation are not Pharma-
friendly (2010)
Many HCPs are witnessing this same evolution

4. NATIONAL SURVEY
2001 2004
92% of physicians
f h i i 78% received drug
received drug samples samples
13% received meals, 83% received food in
the
th workplace
k l
tickets to events, free
travel 35% received
reimbursement for
13% received fi
i d financial
i l costs associated with
or other benefits professional meetings
or CME
12% received
incentives to participate 28% received payment
in clinical trials for consultation,
lectures, or clinical
trials
ti l

5. PHRMA CODE 2002
The code states that the interactions between Pharma and
HCPs should primarily benefit the patients and enhance
the practice of medicine
Discourages companies from giving HCPs tickets to
entertainment or recreational events, goods that do not
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convey a primary benefit to patients and token consulting
and advisory relationships that are used to reimburse
HCPs for their time travel or out of pocket expenses
time,

6. AFFORDABLE CARE ACT
March 23, 2010, President Obama signed the Affordable
Care Act
The law puts in place comprehensive health insurance
reforms, with most changes taking place by 2014
Changes t note:
Ch to t
50% discount for name-brand drugs in the Medicare “donut hole”
Expanded coverage for young adults
Small business tax credits
Pre-existing condition insurance plans

7. AFFORDABLE CARE ACT
January 1, 2015 - A new provision will tie physician
payments to the quality of care they provide
Physicians will see their payments modified so that those
who provided higher value care will receive higher payments
than those who provide lower quality care
More preventative healthcare measures

8. LOOKING FORWARD
It is clear that pharmaceuticals companies
will succeed or fail based NOT on how many y
drugs they sell but on how well their offer
improvement in health outcomes.

9. EMERGING TECHNOLOGIES
By 2014 all medical practices and hospitals have to convert
to paperless electronic medical records
Currently,
Currently many doctors communicate with their patients via
email and text messaging
Smart phones, iPads and t bl t are b
S t h iP d d tablets becoming more
i
important in the doctor/patient relationship

10. EMERGING TECHNOLOGIES
For example:
Patient is away and develops a rash. He calls his HCP but
refuses to go to the ER. Patient takes a picture and texts it
to the HCP. That picture helps the HCP make a diagnosis
p p g
and becomes part of the medical record
Although there exists codes to bill for these encounters
encounters,
insurance companies typically do not pay for non-face to
face visits.

11. Rash

12. EMERGING TECHNOLOGIES
Consult reports from referring physicians, labs, and x-rays
reports can all be linked to patient’s medical record sa ing
saving
paper and postage
Patients
P ti t can l on t private access portals f
log to i t t l from th i
their
iPad/tablet, smartphone or home computer to view results
Prescriptions are transmitted electronically via the EMR
Psychiatrists a eady use S ype tec o ogy for virtual visits
syc at sts already Skype technology o tua s ts
Eventually, app technology (airlines) will allow pharmacists
to scan patients’ device to register prescriptions
patients

13. EMERGING TECHNOLOGIES
Smart phone app - Epocrates, medical calculators and linking apps to CME
credits
dit
Paper prescriptions will be transmitted via apps
Electronic medical records will eliminate paper resulting in less time on the
phone with a human receptionist
Making appointments, new pt registration and prescription renewal requests can all be
done through EMR
Text messaging services are already set up to send patients reminders
about upcoming appointments and the ability to change appointments
Patients and the government are pushing doctors/insurance companies
kicking and screaming into adopting emerging technologies

14. PHARMA/HCP RELATIONSHIP
Since the PhRMA Code was instituted, the Pharma Rep and
HCP relationship has changed
Currently they provide:
Lunch
Samples
On-label
On label data
Invitation to dinners with a contracted medical speaker
Facilitate meetings with MSLs
What measures can help facilitate a Pharma/HCP meeting?

15. PAPER VS IPAD/TABLETS
VS.
Green environment is Advantages of
g
pushing toward less iPads/tablets:
dependence on paper
No paper/nothing to
dispose of
Paper has to be disposed
Less time to turn on vs.
laptops
Reps have a shorter
window of opportunity to Providers are more prone
present to listen to a detail
Laptops need to be booted
up and are combersome

16. IPADS/TABLETS
Using an iPad/tablet can be interactive and transform
the lecture/detail into a dialogue
Physicians are more prone to pick up an iPad and if it
allows for interaction by clicking and linking to slides
and graphics, it has been shown to leave a more lasting
graphics
impression on the HCP
Afterwards, reps could provide HCPs with apps for
follow up and companies can track if these apps are
down loaded

17. ADOPTING APPS FOR PREVENTION
As more providers use iPads/tablets, they’ll be more
receptive to apps that make their lives easier
Alivecor unveiled its ECG app which turns an iPad or
app,
iPhone into an ECG device
Physicians can measure a heartbeat by simply pressing the
device against a patient’s chest
patient s
J&J’s Psoriasis App, designed by Creative Lynx, gives
Dermatologists an easy way t calculate PASI scores
D t l i t to l l t
during patient check ups

18. ADOPTING APPS FOR PREVENTION
Downloads for apps are comparable for either the
iPhone or iPad
For th
F other clinical apps d i
li i l designed b C
d by Creative Lynx, iP d
ti L iPad
download can exceed those for the iPhone
Apps are a much better way for a company to represent
themselves and communicate through the Internet

19. INTERNET AND RULES FOR ENGAGEMENT
The Internet will obviously not g away, but it’s
y go y,
important how you engage it
Digital technology and social media are now
essential for engagement

20. SOCIAL MEDIA
Patient to Patient
Patient to HCP
HCP to HCP

21. SOCIAL MEDIA
Pharma historically has marketed along two tracks:
Driving physicians to prescribe treatment
Encouraging patients to request treatment
The real opportunity for Pharma is to challenge these
modes with digital and social media - providing platforms
that extend the doctor/patient relationship, placing value
on the dialogue before and after a script is written

22. SOCIAL MEDIA
Social networks are important for Pharma to understand
and consider for communication and marketing
strategies
Consumers and HCPs are talking about treatment and
brands - ranging from usage questions to suggestions to
criticisms
Talk of brands reflect a need to seek help, feedback,
often amendable to information from the manufacturer
f f f f

23. SOCIAL MEDIA
Companies that ignore this approach run
the risk of leaving consumers and
HCPs feeling ignored and ultimately
distancing themselves from their
customers

24. SOCIAL MEDIA – MY PFO STORY
Imagine a relationship that begins in an online community
This leads to an office consult where the patient brings their
smartphone containing this information found prior to the office visit
The patient sits with their HCP, accesses this digital resource about
wellness, prevention or disease management
In addition to the prescription, patients get a mobile app that facilitate
care, monitoring, and adherence
The app reminds them of critical lifestyle considerations, such as
exercise during detected periods of inactivity, and provides geo-
targeted restaurants recommendations tailored to a specific diet
t t d t t d ti t il d t ifi di t

25. SOCIAL MEDIA
“Digital Care Kit” could include a referral to online support
groups where patients could track and share their care
Physicians could post answers to questions
Nurses would be alerted to patients who are lapsing and
schedule an online consultation b t
h d l li lt ti between office visits
ffi i it
The possibilities for brands to facilitate this type of
engagement are limitless

26. SOCIAL MEDIA
Bayer launched the WomenHeartStrong@Heart online community on
Facebook to encourage awareness of the millions of US women with
heart disease (www.facebook.com/pages/WomenHeart-Strong-
Heart/62833170782)
Children With Diabetes is Johnson & Johnson’s online community for
parents, children, adults and families living with Type I Diabetes
(www.childrenwithdiabetes.com)
Genentech’s Herceptin HER Story Community helps connect women
with breast cancer survivors (www.herceptin.com/community)

27. SOCIAL MEDIA
g g
Companies like Boehringer Ingelheim
(http://twitter.com/Boehringer) and Novartis
(http://twitter.com/Novartis) have Twitter accounts, though
most pharmaceutical companies on Twitter haven’t yet used
haven t
this medium to its fullest potential

28. SOCIAL MEDIA
Digital resources prescribed as part of care regimens
Pharma has to develop and curate reliable, objective information
online
This information is geared toward optimizing patient/HCP
relationships
HCPs must contribute to digital resources and participate in online
conversations with the goal of starting a dialogue before consultation
and maintaining it through the treatment cycle
Brands that focus on merging online and in-office experiences will
become the most relevant and valuable to both the HCP and the
patient

29. PHARMACEUTICAL/DOCTOR
g
Rep visits with the HCP have changed
iPads/tablets
Apps
Social Media – Facebook, Twitter and websites geared
to a d disease
toward d sease state
Human Field Representative?

30. IDEAL FIELD REPRESENTATIVE PROFILE
Education
Does degree or clinical experience matter?
Rep vs MSL
Core Responsibilities
Provide consistent, accurate and balanced scientific
information
Engage in unscripted scientific dialogue on relevant
topics related to disease state and product

31. IDEAL FIELD REPRESENTATIVE PROFILE
Venue
By appointment, in-person visits or virtually as needed?
HCPs and institutions are moving towards “no rep access,”
so can HCPs obtain access to scheduled virtual visits with
MSLs or Med Info to provide unscripted answers?
Tools d Resources
T l and R
Product and disease state information, on-label and off-label
(slide decks on iPads/tablets, links to websites, and apps)
HCP and patient education material (apps)
Literature searches and medical information letters via email

32. FINAL THOUGHT
g y
As the digital world evolves, the physical interaction
between Pharma and healthcare providers will diminish.
But there is something about the human connection that
g
transports us in a way that digital media will never do.
Until the time when in-person humans are replaced, Pharma
in person
should seize the opportunity to maximize on this most
cherished and dwindling connection.
Prepare to become a leader in the technological future.
-- Frank Spinelli, MD

33. Thank you!