The brand comes second
One small pharma company is meeting the challenge of COVID-19 by finding new ways to support the practices of its specialist physician customers.
The COVID-19 pandemic is impacting all pharma companies, with each forced to rethink communications and support strategies for the physicians who prescribe its products. One small eye care-focused company, Aerie Pharmaceuticals, has chosen to respond by finding ways to help ophthalmology practices recover and retool themselves to provide better care in the face of the pandemic, putting that effort ahead of messaging for its own brands. Med Ad News spoke with Deanne Melloy, Aerie’s VP of global strategic marketing, to find out how and why.
Med Ad News: Tell us about Aerie and your recent product launches. 
Deanne: Aerie Pharmaceuticals was founded by Dr. David Epstein, the late Chair of the Department of Ophthalmology at Duke, who was seeking a cure for glaucoma. Very few pharma companies in today’s environment are actually able to commercialize their own R&D. You get bought out or you get merged. But that hasn’t been the case with Aerie. When I started, I was employee number 123. We had not commercialized anything yet. So we had to create a market within 12 months of when I started, with low recognition out there about Aerie and our new product. This product, Rhopressa, was the first new chemical entity in the category in 20 years and represented an entirely new class of glaucoma medications, Rho kinase (ROCK) inhibitors. So, a lot had to be done, and we didn’t have the luxury of having a lot of money to be able to do two years of market shaping. We had 12 months to do that, while at the same time build out a commercial organization.
Unlike many companies in our position, we didn’t hire a CSO. We hired all of our own sales representatives. And then just 12 months after the first launch, we launched the second product, Rocklatan, the first combination drug in the United States containing a prostaglandin analog (PGA) and a ROCK inhibitor. So again, another first with a lot of unknowns, in a market that had been pretty static for two decades. That was our biggest challenge – it required a major disruption in the way ophthalmologists think about practicing glaucoma care. And we’ve been successful. Rocklatan has been on the market now for almost two years, Rhopressa for three years. We are now nearly the fourth largest branded franchise in the space. The market is still predominantly generic. However, we are continuing to surpass any previous launches, even from 15, 20 years ago. Of course part of it has to do with our coverage, because we know in this day and age, coverage is a requirement. We now have more than 90 percent coverage for our products across commercial and Medicare Part D in less than two years. And that has to do with the fact that we delivered a real innovation with a completely novel MOA which has made a tremendous difference, but it’s also required strong positioning and effective storytelling to get us there.
Med Ad News: What’s the difference between Rhopressa/Rocklatan and what came before?
Deanne: The only therapeutic target for glaucoma right now is lowering intraocular pressure, or IOP. Our products have superiority when it comes to efficacy – they lower IOP more than other agents. Also, a ROCK inhibitor treats the underlying cause of increased IOP in glaucoma, the diseased trabecular meshwork. Physicians have seen that with Rhopressa, they can get their patients to low target pressures and keep their IOPs low, in some cases delaying the need for glaucoma surgery. We’ve shown that Rhopressa has this consistent effect whether it is used as monotherapy or added to one medication, usually a PGA, or many medications.
Med Ad News: What did you do in terms of marketing that was unique and interesting and different to go along with these novel agents that were themselves unique and interesting and different?
Deanne: In the past, selling and marketing in ophthalmology has been very, very relationship-based. There were a handful of big players – Alcon, Allergan, Bausch+Lomb – and their interactions with ophthalmologists were for the most part very relationship-driven. In a marketplace that was 80 percent generic, that was fine for them. But now we were coming to market with a product that was radically different than anything that had come before, with a story that needed to be told and differentiating characteristics that needed to be explained. A relationship might get you in the door, but it wouldn’t be enough to overcome the inertia of 20 years of same, same, same. So we decided to move away from the traditional relationship-based approach to a tighter focus on the benefits of the new products. For example, we had to hire a team of 100 sales reps, and when we did so we focused predominantly on finding people with experience in ophthalmology. We really needed people who were hungry, humble, and wanting to sell and promote these particular products versus just building relationships. These drugs were not going to sell themselves, so we needed to focus more on that style versus the relationships. And that has paid off even more than we’d hoped because now, in the COVID-19 environment, when our sales force has not been able to be out in the field and ophthalmologists haven’t been seeing reps live, we have been able to pivot to non-personal promotion, predominantly in digital, without getting tripped up the way we might have if we’d relied exclusively on a relationship-based approach.
Med Ad News: Let’s talk about COVID a bit. When it became clear that the virus was going to have a major impact on the United States at large, how did you shift your strategy and how has that shift turned out?
Deanne: I believe that we were one of the first companies in ophthalmology to respond substantively to COVID. We conducted more than 10 roundtables, worked with our speakers, did virtual training and made a whole lot of connections with our physicians. And then we did more than 1,000 engagements with our physicians virtually within 45 days of COVID-19 hitting. That has definitely paid off. In fact, I recently got an email from one of our doctors that said he has been so impressed with our organization and how our marketing team has conducted themselves during this pandemic. He basically told me that nobody else has done what Aerie has done.
We took an approach that we were going to be there for ophthalmology, and glaucoma treaters in particular, in a comprehensive way. We sponsored a daily email update from AAO, the largest ophthalmology association, to help their members get through COVID-19. We’ve made the physicians’ survival and successful re-emergence the goal rather than heavy promotion of our products. We know that physicians’ staffs were also going through tremendous challenges, and so we’ve been offering them multiple programs on how to understand what COVID-19 has done to impact their practice. And we’ve been offering ideas and tips from industry consultants on how to approach practice recovery, from telemedicine, to new office protocols, to accessing emergency funding. And the result has been that our products are doing well because the physicians like what Aerie has been doing for them. That new equity in Aerie, as a committed partner to the clinician, has translated into an increase in equity for our brands as well.
Med Ad News: So you’ve essentially turned yourselves into a support system for ophthalmologists?
Deanne: Yes. When I got that email from the doc, it was a thrill because it was completely unsolicited by us and he just said, in his career, he’s never seen an organization do this and he’s so proud to be working with the Aerie team. It was a gamble, right? I had told our president, whenever we come out of this crisis, if an Aerie sales rep shows up and tries to promote our products, unless we do something like this, the docs will say, “I’m sorry, who are you? Where were you when I needed you?” And it’s worked. Ophthalmologists and ophthalmology practices have really responded positively.
Med Ad News: Has there been any sign of the other high rollers in ophthalmology, your larger competitors, trying to do something similar?
Deanne: We did see one company send out a message and sponsor a new practice management offering in the last month. However, at the same time, substantively they’ve done very little. We haven’t seen B+L or Alcon do anything like this. I don’t think they saw us, as such a small player, being able to make such a significant difference – both for our glaucoma customers and for ophthalmology as a whole.
Med Ad News: So what happens now? How do you continue to maintain and improve those relationships you’ve built and support those practices you’ve helped?
Deanne: We’re going to try to pin down and define the stages of practice recovery, since of course every practice is in a different phase. And then, how do practices prepare more effectively for future crises? We really see profound and permanent changes in eye care being made. For example, are there now opportunities for ophthalmologists to treat their glaucoma patients more with telemedicine? Is there a way in which they can approach glaucoma differently with fewer IOP checks? Basically we are taking advantage of what we’ve learned from this experience and developing more case studies and ideas for practice evolution specific to glaucoma, though not necessarily specific to Rocklatan and Rhopressa. Again, not taking it from a brand-necessary approach, but taking it from a total therapeutic class approach. Because what we’ve heard from ophthalmologists is, “Had I known that I wasn’t going to see my patients in the normal cycle of time, I would have treated this or that patient much more aggressively from the get-go.” So, how do you take that lesson and say, “Don’t wait for another pandemic to come. You should look at treating your patients more aggressively from the beginning.” Don’t wait for their IOPs to get into the 20s and 30s before you go stronger. Taking the lessons learned and what’s been helpful and moving the conversation in that direction. Versus the same old song and dance of going back out with our reps and having them say, “Here are the features and benefits of Rocklatan and Rhopressa,” pretending nothing has changed. We’re not doing that. We are incorporating brand messages into an approach that reflects the current reality and addresses clinicians’ concerns.
Med Ad News: I assume that means a pretty big shift in approach and preparation for the members of the sales force.
Deanne: Absolutely. One program the sales force is rolling out, for example, is called the “Tech Deck.” It’s a presentation specifically developed for practice technicians, because we observed that, in ophthalmology practices, the majority of the staff either hasn’t returned yet or has had to change their roles and responsibilities. So we are going out and helping those offices get set up and trained for this new environment. You now have technicians who normally would be doing eye exams triaging patients in the parking lot instead. You don’t have the same people doing reimbursement. We are helping to train all these folks virtually and sharing success stories from other practices all around the country.
Med Ad News: You’ve mentioned the email you received from an individual ophthalmologist. Is it commonplace for you as a VP of marketing to interact directly with individual physicians on the ground?
Deanne: I communicate with doctors on-on-one all the time. We also do what we call “executive exchange.” We’ll have a group of doctors that are interested in having a Zoom call with us, and we just have open conversations with them and ask questions. It’s VP and above, so it’s myself and my other colleagues in senior management, as well as the president of our company. They’re just open dialogues. It’s not uncommon to have at least two of these a week with eight doctors at a time. Some of the participants are prominent ophthalmologists, some aren’t. They don’t have to be huge prescribers. I guess this is one way we are pursuing the traditional “relationship” playbook in ophthalmology. We just don’t rely completely on it. I know many, many doctors by their first names, and can pick up the phone and talk with them all the time, any time. That is an Aerie-driven cultural dynamic. No doubt. It’s just another way to stay closer to the actual needs of the ophthalmology practice community and therefore be able to provide better support.
