Over-the-counter switch programs that engage health care professionals as partners generate two to three times the consumer awareness as those that do not, said Rohinish Hooda, VP of upper respiratory at McNeil Consumer Healthcare.

In that role, Hooda helped shepherd the Rx-to-OTC switch of the antihistamine Zyrtec (cetirizine).

Hooda and other switch experts stress the increasing importance of leveraging marketing strategies that have traditionally been part of the prescription market, such as outreach to health care providers, managed care programs and third-party payers.

"How you support your switch is extremely important," Hooda said Sept. 15 at the Nicholas Hall Rx-to-OTC Switch Conference in Somerset, N.J. "It drives the size and scope of your switch."

If sponsors simply "launch it and leave it," they risk a substantial drop in sales because consumers will feel abandoned and will opt for other Rx products covered by insurance or OTC competitors, he warned.

The involvement of health care professionals is integral to a successful switch, Hooda said. Physicians, pharmacists and nurses will "drive success by driving a variance of potential users to your product," he said.

Brian Doherty, executive VP director of client services at CommonHealth, a network of health care marketing companies, agreed. "The doctor recommendation implies a level of value" that marketers and manufacturers can not generate alone, he said.

"The idea that 'My doctor told me,' is a very, very powerful emotion," so if physicians tell patients to switch to OTC, they usually do, Doherty added.

He recommends reaching out to health care professionals about a switch six months before the launch. "If they don't know what is happening, you won't be able to leverage and move their patients over after the launch," Doherty said.

He said it is important to "sample like crazy," as marketers do for prescription products because professionals are more likely to recommend a product for which they have a sample.

Managed Care Providers Tap Into Target Group

A key way to communicate to health care professionals and consumers about a switched product is through third-party payers.

Because managed care plans pay health care professionals, they know who prescribes which brands when. They also know how frequently specific professionals prescribe a product and in which doses.

As a result, teaming up with managed care plans to advertise an upcoming switch allows manufacturers to target and tailor marketing, Patrick Beers, a managing partner with health care marketing agency Everything Health, said at the switch conference.

He added that health plans are equally interested in working with manufacturers to raise awareness about switched and other OTC products because "they have skin in the game" and want to lower their health care coverage costs while still providing members a wide array of options.

Even a smaller-scale switch or OTC opportunity can pique managed care organizations' interest, he said.

Managed care organizations are hungry for general information about OTCs "even if it is not a switch or a huge" product because "they have a vested interest in keeping people healthy," Beers said.

Third-party payers often are eager to help firms "switch the patient as well as the drug" by marketing information about a switch directly to members who are current and former prescription users.

Managed care organizations know their 200 million members "by name, by habits, by prescription profile and by medical profile," and as a result "they can make things happen," said Mary Alice Lawless with Everything Health.

Third-party payers favor marketing that "is delivered in a very educational tone," Lawless said at the conference. She explained payers will offer "coupons, discounts ... and all the other things typical of the marketing promotion" if they have "an educational tenor to" them.

In addition, as more managed care providers expand their direct mail programs to include shipping OTC products, there is an opportunity to "have a direct sales ad on pharmacy benefit manager mail order forms, depending on what the product is," Beers said, noting Medco recently began shipping OTCs directly to members in the mail.

Spreading the word about a switch or OTC via a third-party payer, PBM or employer "brings an additional level of credibility" to the message because it is "not just an ad" sponsored by the manufacturer, Lawless added.

Despite managed care organizations' "embedded desire" to expand OTC use and lower their coverage costs, many stop short of covering OTC drugs because it "is a slippery slope for them to decide whether to cover this one but not that one," Lawless said. However, there are some "liberal plans" that have covered specific OTCs for common ailments, such as P&G's heartburn drug Prilosec OTC , she added (¹ Also see "WellPoint NextRx/BCBS Pilot Program Encourages Members To Buy OTC" - Pink Sheet, 14 April, 2008., p. 3).

Rather than cover OTCs, many managed care providers push their use by highlighting health savings accounts as a way for members to select OTCs that are less expensive than prescription options, Lawless said.

Some plans are mulling alternative co-pay structures to persuade members to use OTC products that are less expensive but which may cost more out-of-pocket than the co-pay for a prescription drug, Beers said.

Some providers structure their formularies so that the co-pays for prescriptions are higher in areas where there are several OTC options, such as the allergy category, he noted

Payers also drive OTC use by requiring members to try OTC products before they try an Rx product, Lawless said. To do this though, there must be multiple OTC choices for a condition. So a first-in- class switch likely will not benefit from this strategy.

- Elizabeth Crawford (e.crawford@elsevier.com)

Switch Sponsors Find Key Partners In Payers, Providers and Managed Care

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