Selling drugs during an active pandemic
Despite uncertainty and operational challenges, finances are stable
For the most part, interviewees told us that companies are financially healthy, and that sales of marketed products have remained mostly steady. New drug launches may face some expected challenges with meeting forecasts, but interviewees said that revenue forecast revisions have not been necessary in the short term, nor has scenario planning for a second wave. “We aren’t seeing a huge shift yet,” is what one interviewee told us.
Delayed trials, for example, save money used for recruiting efforts in the short term, but those costs will be pushed to whenever the trial resumes—which most have done. However, if the pandemic lingers for the longer term, forecast revisions and adjustments to strategy might be warranted. In fact, several of our interviewees see this as an opportunity for biopharma. Those with excess cash may be looking to bolster their portfolios with external assets as their own pipelines are delayed. It may also force manufacturers to reassess their portfolios to focus on development where they have their best chances. Investments from private entities continue to flow into biopharma. But, as one interviewee said, “It will take years for us to fully understand the impact that COVID-19 has had on the industry.”
Product revenues are steady—for now
While interviewees said it has been challenging to sell new drugs in 2020, they believe the overall market share for products launched before the pandemic is steady. Companies have not seen dramatic losses in revenue beyond what was expected. There are a couple of reasons for this:
- In the first three months of 2020, stockpiling of drugs by wholesalers, pharmacies, and patients resulted in a sales boost of about US$1.2 billion across eight major manufacturers.2 This meant that companies supporting patients who were already enrolled in treatment regimens were temporarily buoyed by advance sales of drugs, even if potential new patients were not going to see their doctors for prescriptions. It also meant that companies could fend off competitive products since patients were not easily able to switch to something new. But if patients continue to postpone medical visits, the positive effects from stockpiling could wane and losses may be felt in the future.
- Many high-cost specialty drugs, particularly those in oncology or rare disease, continue to be dispensed or administered as part of critical, life-saving care. For example, while sales of Kymriah, a CAR-T therapy from Novartis, fell slightly short of analyst forecasts in the first quarter of 2020, they more than doubled between the first half of 2020 compared to the first half of 2019. This was despite a pandemic-induced pause in the provision of health care services.3
However, interviewees told us that they have seen a decline in the sales of some drugs that require a hospital or clinic visit for administration, including some for oncology and rare disease. Patients were either too afraid of contracting COVID-19 in the clinical setting or didn’t feel that their condition was bad enough to seek treatment and risk exposure. Several interviewees told us that health care systems are expecting to see more patients with advanced disease in 2021 as a result of delayed treatment or diagnosis.
Drug launches have suffered during the pandemic
Most of the marketing leaders we spoke to told us that companies have either revised or scaled back their launch strategies as a result of the pandemic. They also said that the market response to drugs that had launched as planned this year has been lackluster. As convenings of medical professionals—from large-scale congresses to small-scale dinners and events—have been cancelled and moved to virtual formats, biopharma companies are struggling to get the word out about new products. One interviewee told us that under normal circumstances, companies would be operating at a “running speed,” pursuing a variety of channels through which to release content. But since many of those channels are not options, companies are instead operating at a “walking speed.” He added, “The real estate that media, both specialist and traditional, dedicates to drugs and approvals is lower. COVID-19 is the priority, so there are just not as many eyeballs on our data.”
Interviewees also talked about how making the best of the one shot there is to get a launch right during a pandemic when traditional strategies can't be used is so difficult to figure out. One said, “I’m working on a launch right now and it’s crazy. No one knows what we should do and not do.” As highlighted in our recent article Key factors to improve drug launches,about 70% of products that miss expectations at launch continue doing so in subsequent years, making launch success imperative. But one interviewee told us that launch delays are not being considered since patent life must be maximized; another pointed out that delays cost the company money and that even modest revenue is better than no revenue. Therefore, any anticipated launch delays are likely due to delayed submissions stemming from issues such as stopped or slowed recruitment or missing or late data and not for strategic reasons. In fact, from our analysis of EvaluatePharma data, the average number of days from FDA approval to launch has increased only by 12 days for the first three quarters of 2020 compared to 2019.4
Sales representatives are less influential in a virtual world
One key component of launch strategy is having field sales representatives engage with physicians in person. This is a critical communication channel between the manufacturer and the prescriber. Every interviewee told us that COVID-19 has effectively shut down these in-person channels and forced a dramatic shift in how biopharma field sales reps work. Here is why:
- The engagement model: Social distancing requirements and shutdowns have forced reps to engage with physicians virtually, using new and sometimes yet-unproven methods such as apps and portals rather than through the usual face-to-face interactions in offices, at congresses, and at targeted events. Influencing physicians virtually is mostly uncharted territory. Companies are looking closely at which platforms are best for delivering specific kind of content. These include anything from customer resource management tools and videoconferencing to social media platforms meant specifically for physicians. But despite significant investments in adopting or upgrading digital and virtual technologies, interviewees told us that results have been mixed. Some suggested that a split approach taking physician preferences into account—where younger, more tech-receptive physicians are engaged digitally, and others are pursued through traditional methods—may be required.
- The audience and content: Many physicians have been called away from their usual services to provide surge capacity on medical wards, leaving little time to focus on other things. Additionally, interviewees said that the virtual environment lends itself to physicians being distracted or half engaged as they multitask on their computers from home, for example. In order to get the attention of busy clinicians, our interviewees told us that content offered through digital channels will likely have to be more compelling and differentiated from other content. Interestingly, one interviewee told that he’s seen a renewed interest in print content, likely because people are growing tired of looking at screens all day long.
- The role: In order to minimize contact, sales reps have not been allowed into private physician offices and academic medical centers. Charismatic, outgoing individuals are often drawn to the sales rep profession since it plays to their social skills and ability to make interpersonal connections. As one interviewee told us regarding the shift to virtual, “You hire the best pilots to fly 787s and now with the ongoing pandemic we ask them to fly helicopters. It’s sort of the same thing but it’s totally different.” Keeping reps at bay may lead to reduced productivity and job satisfaction, especially as the pandemic continues.