Pharma spends billions each year on DTC advertising to consumers, but too often assesses the performance of the DTC Managers responsible for that investment using metrics that tell you very little about whether it succeeded. Reach was achieved. Visits to your website increased. Search volume spiked. Billions of impressions delivered. The agency’s fancy attribution model shows positive ROI. You both feel pretty good walking into the quarterly review. But there’s a much tougher question that needs to be driving the conversation: How many appropriate patients were induced to start therapy because of DTC spending who would not have started therapy if that money had not been spent?
Stop Giving DTC Credit for Growth It Didn’t Create
Confusing correlation with causation plagues pharma marketing measurement more than any other issue. DTC spending goes up, and prescriptions follow, so marketers claim victory. But prescriptions could rise for dozens of reasons: new clinical data; better formulary access; a more effective sales force; new guidelines; competitor issues; seasonality; greater disease awareness; or simply the maturation of a successful launch.
The DTC organization should not take credit for patients who are going to get the drug regardless of what they do. Incrementality is the metric that matters. What would not have happened without our spending? Figuring that out requires more sophisticated measurement techniques than are typically used. Matched-market testing, geographic experiments, holdouts, patient journey analytics and credible causal inference are necessary to prove incrementality. An agency attribution model that simply assigns prescriptions to media exposures does not prove incrementality.
The Most Important KPI Should Be Incremental Appropriate Patient Starts
If I were evaluating a senior DTC manager, I’d put roughly 35% of the performance assessment on incremental appropriate patient starts. Not impressions. Not clicks. Not total new-to-brand prescriptions. The question is whether marketing caused additional appropriate patients to recognize a health issue, seek information, have a productive conversation with a healthcare professional and ultimately begin treatment when appropriate. The word appropriate matters. Pharma isn’t selling sneakers. The objective isn’t to generate maximum consumer demand. The treatment decision ultimately involves the patient and healthcare professional, and successful DTC should help the right patients move through that process with realistic expectations about both benefits and risks.
Patient Understanding Should Be a KPI, Not a Compliance Exercise
I’d put another 20% on the quality of the patient journey. Did consumers actually understand what they saw? Did they understand what the drug does, who it is intended for, what benefits they might reasonably expect, and what important risks they should discuss with their healthcare professional? Did the campaign help patients have better conversations with physicians, or did it simply generate more requests for a branded drug? Pharma marketers spend enormous amounts testing whether consumers remember advertisements. They should spend considerably more effort determining whether consumers understood them. Brand recall without comprehension may make a media dashboard look impressive, but it isn’t necessarily good healthcare communication.
ROI Needs a Much Tougher Definition
Another 20% should be based on incremental economics. Pharma executives should be exceedingly dubious when presented with an ROI number that claims a campaign generated 4: 1, 6:1 or 8:1 ROI without a transparent and easily replicated methodology used to produce the number. Attribution is not incrementality.
Just because you associate revenue with an exposed patient doesn’t mean that the advertising CAUSED that revenue. Better questions to ask are: What was the incremental cost to get an appropriate patient start? What was the marginal ROI for the next $1 million dollars spent? How much media spend went toward producing attractive incremental returns? Which channels truly drove behavior versus channels that simply got credited for behavior that was already going to happen? Asking those questions makes marketing reviews less comfortable. They also make them far more useful.
Trust Should Be on the Scorecard
I’d allocate 15% to brand health, credibility and trust. Pharma marketing operates under circumstances unlike almost any other consumer category. Nobody hopes to become a customer for an oncology drug, diabetes treatment or cardiovascular therapy.
Patients may be frightened, confused, and overwhelmed with information. That puts a different responsibility on the marketer. DTC communications should improve understanding rather than merely maximize persuasion. Research should therefore measure credibility, message comprehension, relevance, understanding of benefits and risks, and whether advertising helps patients navigate their healthcare decisions. A memorable advertisement that leaves consumers with an exaggerated perception of efficacy shouldn’t be considered brilliant marketing.
Compliance Is the Price of Admission
The remaining 10% should evaluate execution, compliance, and organizational leadership. Can the DTC manager manage agencies rather than allowing agencies to manage the brand? Can the manager challenge a media recommendation when the economics don’t make sense? Can they work effectively with medical, legal, regulatory, analytics, market access and commercial leadership? Can they distinguish an interesting marketing metric from a meaningful business metric? And are they willing to kill programs that aren’t working? Regulatory compliance obviously matters enormously in pharmaceutical promotion, but compliant advertising shouldn’t by itself earn an executive an outstanding performance rating. Compliance is the minimum requirement for being allowed to play the game.
Impressions Aren’t Outcomes
Reach. Frequency. Impressions. Click-through rates. Video completion. Website traffic. Search volume. Social engagement. They all factor in. The problem is they are symptoms, not outcomes. Diagnostics. They tell you if parts of the machine are working. But at some point along the line, pharma conceded these middle stage metrics became the representation of business performance.
Generating five billion impressions shows a company bought five billion impressions. It doesn’t show that spending changed patient behavior. Increased branded searches tell you that people searched. It doesn’t tell you how many incremental appropriate patients ultimately received therapy—or if they would’ve regardless. Media activity is not the same as patient impact.
Maybe the Best DTC Manager Is the One Who Doesn’t Spend the Entire Budget
There’s one number that you don’t see in DTC performance reviews but should: How much money did the manager choose not to spend?
Large organizations inadvertently incentivize spending budgets. Give a marketing team $100 million, and they’re expected to spend close to that figure. But what if reliable analysis proves that the first $65 million invested drives strong incremental returns and the last $35 million is increasingly less effective? The smart move is not to scour the media landscape for a place to park that money before December 31.
The smart move may be to stop spending. Shift the money into patient support, adherence, market access, physician education, another brand—or just don’t spend it. A DTC leader that returns $20 million because of the marginal returns
