If you flip on the TV during primetime news or Sunday football, you will see pharmaceutical advertising. Psoriasis. Ulcerative colitis. Migraine. COPD. HIV. Cancer. You name it. Here’s a question you won’t hear discussed in the pharma industry: How many patients should there be before a company invests hundreds of millions of dollars into DTC TV commercials? Not every drug should be marketed on TV.
Done well, consumer advertising can help educate patients, destigmatize conditions and motivate treatment-seeking behavior. There’s no doubt advertising has increased diagnosis rates of conditions like depression, hepatitis C and migraine.
The issue is television has become the go-to solution rather than part of a strategic plan. Annual spending on a national television campaign can reach $100 million to upwards of $300 million once media buying, creative development, celebrity endorsements and production costs are factored in. If you’re marketing a blockbuster with millions of eligible patients, that investment can be justified. But for most niche indications it can’t.
If fewer than 500,000 to 1 million Americans are realistically eligible for a therapy, national television advertising should be the exception—not the rule.
The burden of proof should shift. Companies should have to demonstrate why mass-market television is the most effective and responsible use of shareholder capital and healthcare resources.
Why 500,000 to 1 Million?
Television is the definition of a mass medium.
A prime-time commercial reaches millions of households indiscriminately. That model works when millions of viewers could plausibly benefit from the product. It breaks down when the eligible patient population represents only a tiny fraction of the audience.
Think about the math behind it. Let’s say there’s a disease that affects 10 million Americans. It’s possible to reach a meaningful percentage of these potential patients with print, TV, and online messaging. But you also reach family members and caregivers who can help educate and influence patient decisions. If just a fraction of those patients start taking your medicine, you’ll make billions of dollars. Now think about rare diseases that only affect 40,000 or even 100,000 people across the country. Over 99.9% of the people watching your television commercials will never need that drug. Millions of advertising dollars are poured into reaching people who will never be patients. That is an extremely expensive way to reach a relatively small number of people who are eligible for your medication.
There are much more targeted options available. Online ads can target patients looking up symptoms. Social media can target disease-specific communities. Patient advocacy groups already have established relationships with patients. Physicians who treat the disease know where their patients are. Specialty pharmacies have robust networks. These strategies are far more efficient than purchasing a commercial during the NBA Finals. The problem is pharma has mastered precision medicine but applied mass-market messaging. Science is being personalized. Marketing rarely is.
There’s also an opportunity cost that must be considered. Every dollar going towards television advertising is one less dollar going towards physician education, patient services/support programs, financial aid, clinical research, or access.
Pharma companies often tout that patients come first. If so, their marketing budgets should be spent in a way that benefits patients the most – not inserts the most pixels on TV. You’ll hear many arguments that TV advertising raises awareness amongst physicians and investors. It puts conversations about disease into the mainstream. All of this is true. But there are diminishing returns on awareness. Once you have enough awareness that the general public knows about your rare disease, more dollars spent on television will yield smaller and smaller returns.
Eventually you are just buying extra awareness versus actual patient identification. My question is where do we draw the line?
Of course there’s no hard-and-fast rule, but a reasonable heuristic might be: Conditions that affect millions of patients are worthy of national TV campaigns. Conditions that affect several hundred thousand patients merit thoughtful economic analysis before investing in broad-scale media.
Conditions that impact less than 100,000 patients are generally better addressed through direct digital outreach, physician engagement, advocacy collaborations, and patient-centric education. Advocating for the end of DTC isn’t the point. Ensuring it’s used effectively, where it makes both business and economic sense, is.
Pharma likes to tout its reliance on evidence-based decisions. Let’s start making those decisions when it comes to marketing, too. The best media buy is not the one that reaches the most eyes. It’s the one that reaches the right patients. If we’re going to embrace an era of precision medicine for drug development, let’s embrace precision marketing to reach the patients who need those drugs.
