1) Digital marketing has evolved over the past decade for pharmaceutical companies, moving from early hype to more realistic expectations and integrated multi-channel solutions. 2) Companies now target both doctors and patients online, with challenges around building trust and meeting real needs and preferences. 3) The rise of social media and user-generated content has led to a paradigm shift, with consumers and patients taking more control over health brands and discussions online. Pharmaceutical companies must now decide how and whether to actively participate in these online conversations.

1. Digital Pharma: Evolution and Revolution in Marketing and Sales Len Starnes Head of Global E-Business Primary Care, Bayer Schering pharma

3. A decade of digital pharma

4. 1996 2007 Hype Raising expectations Disillusionment Trough of despair Enlightenment Productivity Realistic expectations Evolution vs revolution Evolution 2006 Revolution

5. Expectations ’96: The 24 x 7 rep – how wrong! Branded websites will be more effective than a rep visit Sales forces will be cut Revenues will soar Doctors will flock to our sites One-size fits-all portal will suffice

6. HCPs ’ media consumption shifting from off to online 85% of EU HCPs say the internet is critical for success of their practice* 16% of EU HCPs use a PDA for professional purposes* Professional use of digital media by European HCPs* % European HCPs *Taking the Pulse Europe v6.0; sample of 1024 doctors from D/F/It/Sp/UK; Manhattan Research, 4Q06

7. Quality content yes, but in an appropriate context Credibility and trust will be crucial Expectations ’96: Health information seeker – right! Internet will become the most preferred source of health and medical information Internet will become a powerful medium for patient acquisition and retention Patients will be empowered

8. Consumers ’ favoured sources of health information moving online 143 million EU consumers have accessed health information or health services online during the last 12 months* Most frequently used sources of health information in Europe* % European consumers *Cybercitizen Health Europe; sample of 4302 consumers from 10 EU countries; Manhattan Research, 2Q07

9. Low digital marketing spend 1- 5% Digital pharma status 06/07 Industry remains a late adopter But solid experience and realistic expectations Too few digital-visionaries at senior level Moving slowly towards integrated solutions

10. Targeting doctors

11. Doctors generally prefer authoritative sources - medical societies, universities, hospitals A major challenge Doctors ambivalent towards pharma Doctors’ prime information needs focus on new research, clinical studies, case studies, continuing medical educational, networking with colleagues, cost constraints, running a surgery as a business,…

12. The sales force arms race

13. Result: ever decreasing detailing time USA: 1:30 mins Europe: 2 - 4 mins Number of sales representatives Detailing time 1980 - 2007

15. Live detail with tablet-PC Web-based e-detail Multi-channel CRM application Electronic details, interactions tracked and logged by CRM application Closed-loop marketing is next Interactive details customized to meet doctor’s needs Iterative detailing process

17. Targeting consumers & patients

18. Regulations constrain objectives DTC markets Disease & condition awareness Non-DTC markets Treatments awareness Brand awareness & conversion Drug compliance, loyalty & retention

20. 30 – 50% of medicines prescribed for long-term illnesses are not taken as directed* Compliance is a major issue *Adherence to Long-Term Therapies: Evidence for Action, WHO 2003

21. Isolated compliance channels SMS & mobile Pack & devices Contact centre Case manager VAT Internet & email Direct mail Patient

22. Germany Netherlands UK Global online support for Betaferon patients Denmark Norway Sweden International Finland

23. Integrated compliance channels Patient signs-up for ‘daily tips’ on coping with SEs Patient calls asking for advice about a severe SE Patient downloads a PDF on SEs management Application software accessed by a case manager All patient interactions and interventions logged Case manager alerted to SEs issue and makes appropriate interventions Secure patient database Patient

24. Multi-channel integration plus behavioural modelling Smarter systems through incorporation of constructs from behavioural models Identify a patient ’ s risk level and propose appropriate interventions

25. Healthcare social networking

26. ‘ An expert moderated repository of the knowledge base, in the form of a medical wiki, may be the answer to the world’s inequalities of information access in medicine …’* Web 2.0 is radically changing medicine and healthcare Dean Giustini, How web 2.0 is changing medicine, BMJ, 23 December 2006

27. ‘ Is pharma ready for social networking?’ ‘… it appears that the forces of change would come from the consumers’ ‘ Are social media dulling pharma’s marketing knife?’ ‘…it won’t be long before pharma realizes that it isn’t in control anymore…’ But pharma is still debating Source: www.forums.pharma-mkting.com

28. Web 2.0 is a disruptive technology Adapted from: Web 2.0 in Healthcare, John Sharp, Cleveland Clinic, USA Pharma values Web 2.0 values Risk averse Information from authoritative sources Privacy & security are regulated Long lead times Controlling access to data and information Intellectual property closely guarded Risk taking Crowd wisdom Anyone can join Rapid deployment Information contributed by and distributed to all Open Source

29. Disruption at all levels Pharma web 2.0 Public relations Consumers & patients Sales forces Internally: Enterprise 2.0 HCPs

30. Collaborating with online HCPs’ communities www.sermo.com Captures bedside and hallway conversations Helps ‘lonely’ doctors Aims are to discuss new clinical findings and to ‘work together to dramatically impact patient care’

32. Pharma may now mine the wisdom of the Sermo crowd ‘ Observe’ - Alpha MD View community via a customized list of subjects based on keyword tags ‘ Insight’ Post questions directly to community and take polls ‘ Action’ – Hot Spots Icons next to targeted conversations allowing access to relevant pharma information and services

34. Paradigm shift The doctor-industry relationship has the opportunity to become a true partnership based on mutual respect and collaboration Doctors can now dictate the terms of engagement to the pharma industry

35. 1/3 of consumers in USA consult a health SN site before visiting a doctor* UGC from health mavens can profoundly influence consumer and patient preferences Conversations are raging: patients are learning from one another www.revolutionhealth.com *Manhattan Research, 2007

36. Revolution Health 136 Betaseron ratings Effectiveness: 6.2/10 Lack of SEs: 5.3/10 Ease of use: 6.2/10 Health SN sites allow patients to rank treatments, doctors, hospitals & payers > 2500 ratings of all MS treatments

37. Health warning to pharma marketeers Don’t fake it

38. Paradigm shift The industry must decide whether it wants to actively participate in the conversations or remain an outsider Consumers and patients are taking ownership of brands, diseases and conditions

40. Pharma corporate blogs are emerging J&J BTW blog J&J blogger Marc Monseau ‘ Everyone else is talking about our company, so why can’t we?’

41. Pharma sales reps are the most visible active bloggers 5,000 threads 60,000 posts Rants & raves, corporate grapevines, jobs

42. The pharma marketing and sales revolution has begun