Spherix Global Insights

October 14, 2021

Launching a Drug in the Era of COVID-19: How Important is Sales Representative Contact Really?

By: Eric John

Pandemic aside (if you can imagine that), launching a drug in the pharmaceutical industry is no walk in the park. There are a number of factors that influence the success (or failure) of a new brand, including clinical performance (efficacy, tolerability, safety, etc.), insurance coverage/cost, and manufacturer perceptions – just to name a few.

In addition to the factors listed above, promotional activity, such as sales representative visits (in-person or virtual) and non-personal promotion (e.g. emails), play an important role in physicians’ uptake of new treatments. Now more than ever, the bulk of communication surrounding drug launches/label expansions is done virtually – and many pharma manufacturers have struggled to accommodate to this new normal in the era of COVID-19.

Whether it has been practice/facility restrictions or physicians’ own personal preference, sales representatives are still challenged with engaging in physician discussions (both face-to-face and virtual) about newly approved therapies 18 months after the start of the pandemic.

The following analysis examines the influence of the COVID-19 pandemic on sales representative interaction, brand familiarity, approval awareness, and ultimately uptake of newly launched products. Insights were gathered from multiple reports across indications included in Spherix’s Launch Dynamix™ service.

Post-COVID launched brands were compared to benchmarked KPIs from the combined average of multiple brands introduced prior to the pandemic (analyzed at a similar post-launch time frame). Examining the tracking data across three treatment areas (gastroenterology, neurology, and rheumatology), the analysis uncovers:

  • How gaps in sales representative contact translate into lower brand familiarity and less overall prescribing for launched therapies during the pandemic
  • Post-COVID launches that were able to achieve sales representative interactions with physicians at levels on-par with therapy introductions that happened prior to the start of the pandemic

Of the launch brands tracked by Spherix, there are three therapies with the clearest impact of sales representative limitations affecting familiarity and patient initiations:

  • BMS’ Zeposia in ulcerative colitis (UC)
  • Janssen’s Tremfya in psoriatic arthritis (PsA)
  • Janssen’s Ponvory in multiple sclerosis (MS)

 

BMS’ Zeposia in UC: Launch Analysis

Benchmarked to Janssen’s Stelara and Pfizer’s Xeljanz

The chart below compares the percentage of sampled US gastroenterologists who have never seen a sales representative for Zeposia to that of Stelara and Xeljanz (combined average) – time aligned to their respective launches (by number of months post commercial availability).

While BMS has been able to narrow the gap in more recent months, there is still a much higher percentage of gastros in the US who have not seen a Zeposia sales representative at the four-month benchmark compared to the two brands that launched before March 2020.

Despite the gap in sales representative call frequency, Zeposia aided awareness of FDA approval is close to what the pre-COVID launches achieved by the same time frame. This is somewhat impressive given that Zeposia is BMS’ first foray into the inflammatory bowel disease treatment landscape. Typically, companies new to a given disease state need to work more diligently to get noticed by their target physician audience.

However, awareness is not enough to move the needle when it comes to prescribing. Physicians need to become comfortable with products (side effects, insurance coverage, etc.) before they actually decide to prescribe. It’s familiarity that is most impacted by the limited Zeposia sales representative call frequency. The graph below shows a consistent imparity (at least 20%) in Zeposia familiarity relative to the launches that happened pre-COVID.

While likely due to several factors, average Zeposia patient initiations trail their earlier counterparts at the same point in time post-launch. Given these data, it’s reasonable to speculate whether the lower level of Zeposia sales representative frequency is at least a contributing factor. It should also be noted that a potential outcome of fewer direct sales representative interactions is that sampling of therapies could be diminished (unless there is a program to automate that process outside of visitations).

 

Janssen’s Tremfya in PsA: Launch Analysis

Benchmarked to Eli Lilly’s Taltz, Pfizer’s Xeljanz, and BMS’ Orencia

The Tremfya launch in PsA happened just as COVID-19 began spreading across the globe – providing more data for comparison to prior launches. The lack of rheumatologist-reported sales representative contact is consistently higher for Tremfya compared to the pre-pandemic launches.

This dearth of sales representative activity did not significantly impact Tremfya aided awareness of approval in PsA, as the therapy was roughly on par with similar launches prior to the pandemic. This could likely be attributed to the well-known approval of the IL-23 inhibitor to treat psoriasis in 2017 – which often goes hand-in-hand with PsA treatment.

Again, it is the familiarity of Tremfya in PsA that seems most impacted by the lower level of sales representative call frequency. In the graph below, we see that Tremfya PsA familiarity has consistently trailed that for the earlier-launched competitors throughout the past twelve months.

While not dramatically different, the lower levels of Tremfya familiarity led to lower levels of PsA patient initiations (by roughly 20%) when compared to therapies launched prior to the pandemic.

 

Janssen’s Ponvory in MS: Launch Analysis

Compared to Biogen’s Vumerity, EMD Serono’s Mavenclad, Novartis’ Mayzent, and Genentech/Roche’s Ocrevus

The analysis also identifies a similar precedent for the MS therapy, Ponvory, launched earlier this year. Similar to the first two examples, neurologists not seeing a Ponvory sales representative tended to have lower levels of familiarity (relative to prior MS launches) and correspondingly lower levels of Ponvory patient initiations. It is important to note, however, that Ponvory was the first MS launch for Janssen, so there were additional familiarity hurdles to overcome.

Again, like the first two examples, Ponvory aided approval awareness was only slightly lower (5% on average) at each month when compared to launches that occurred pre-pandemic. Neurologists were aware of the Ponvory launch, they just did not have the details about the therapy that a sales representative could potentially provide. As we can see from the third chart below, average Ponvory initiations at each point post-launch were lower than pre-pandemic launches.

 

COVID-19 Sales Representative Successes

So far, the analysis has proved the notable impact that the absence of sales representative visits has on familiarity and new product uptake. What happened to post-pandemic launch brands where manufacturers found a way to be competitive in sales representative call frequency relative to pre-COVID launches? Two specific examples of success are Novartis’ Kesimpta in multiple sclerosis and Biohaven’s Nurtec ODT’s label expansion in migraine prevention.

It is important to note that both of these therapies continued a presence that the launching companies already had in these treatment areas. Nevertheless, both of these brands have been able to maintain levels of familiarity and initiations that are on par with launches that happened prior to the pandemic. That begs the question, what was their level of sales force engagement?

Novartis’ Kesimpta in MS: Launch Analysis

Compared to Biogen’s Vumerity, EMD Serono’s Mavenclad, Novartis’ Mayzent, and Genentech/Roche’s Ocrevus

A critical component to Kesimpta’s launch success, despite the pandemic, was the brand’s ability to maintain sales call frequency levels comparable to launches that happened before the pandemic. The graph below shows that the percentage of neurologists reporting no Kesimpta sales representative visits is on par with earlier launches.

As mentioned earlier, this sales representative persistency led to comparable levels of familiarity and patient initiations.

Biohaven’s Nurtec ODT in Migraine Prevention: Label Expansion Analysis

Benchmarked to Lundbeck’s Vyepti, Teva’s Ajovy, Eli Lilly’s Emgality, and Amgen’s Aimovig

Similar to Kesimpta, the Nurtec ODT label expansion put in a strong performance regarding sales representative interaction. In fact, it was so strong that US neurologists actually reported a lower “no visit” rate for Nurtec ODT than for launches that happened prior to the pandemic. It is important to note that the May 2021 launch was for a label expansion for the preventive treatment of episodic migraine.

This impressive performance in sales representative visitation translated into levels of Nurtec ODT familiarity and initiations that exceeded pre-COVID-19 launches.

 

Conclusions

Despite the limitations triggered by the pandemic, personal sales representative interaction can still play a vital role in implementing a successful pharmaceutical launch. It is critical for firms launching pharmaceutical brands in the COVID era to understand that sales representative contact can foster physician brand familiarity, which in turn aids in physician prescribing uptake. Additionally, firms should have launch-tracking capabilities that enable them to:

  • Closely monitor any correlations between sales representative interaction and physician brand familiarity, and eventual initiations
  • Quickly identify gaps with competing/historical brands in sales representative interaction, physician brand familiarity, and initiations
  • Develop strategies/tactics to address less-than-optimal sales representative/physician interaction frequency

If you would like more information on Spherix’s Launch Dynamix™ services offered across dermatology, gastroenterology, nephrology, neurology, and rheumatology indications, please contact info@spherixglobalinsights.com. See available titles listed below.

Dermatology

  • Launch Dynamix™: Opzelura (Incyte) in Atopic Dermatitis (US)

Gastroenterology

  • Launch Dynamix™: Stelara (Janssen) in Ulcerative Colitis (US)
  • Launch Dynamix™: Zeposia (BMS) in Ulcerative Colitis (US)

Rheumatology

  • Launch Dynamix™: IL-17 Inhibitors in nr-axSpA (US) – Cosentyx (Novartis), Taltz (Eli Lilly)
  • Launch Dynamix™: Tremfya (Janssen) in Psoriatic Arthritis (US)
  • Launch Dynamix™: Saphnelo (AstraZeneca) in Systemic Lupus Erythematosus (US)

Nephrology

  • Launch Dynamix™: Benlysta (GSK) and Lupkynis (Aurinia) in Lupus Nephritis (US)
  • Launch Dynamix™: Kerendia (Bayer) in Diabetic Kidney Disease (US)

Neurology

  • Launch Dynamix™: Qulipta (Allergan/AbbVie) in Migraine (US)
  • Launch Dynamix™: Nurtec ODT (Biohaven) for Prevention in Migraine (US)
  • Launch Dynamix™: Trudhesa (Impel) in Acute Migraine (US)
  • Launch Dynamix™: Kesimpta (Novartis) in Multiple Sclerosis (US)
  • Launch Dynamix™: Ponvory (Janssen) in Multiple Sclerosis (US)
  • Launch Dynamix™: Zeposia (BMS) in Multiple Sclerosis (US)
  • Launch Dynamix™: Aduhelm (Biogen) in Alzheimer’s Disease (US)