Overview
On January 7th, we spoke with a senior marketing executive at a global pharma company about digital marketing/advertising trends and the use and utility of platforms like GoodRx (GDRX) and Doximity (DOCS), among others. Our contact was quite skeptical of the ROIs that platforms/vendors regularly throw around and has a holistic, risk/reward sort of approach to deciding what to spend (and where/with whom). We were less surprised to hear about the willingness to move spend around given our 11/8 Field Notes, and the immediate positive reaction when we asked, "OK, so, does GoodRx make sense?" left an imprint.
Overall, the shift away from in-person selling and toward digital and more versatile sales programs should be a big theme this year, and that's why we're so interested in DOCS and GDRX, among others like OptimizeRx (OPRX), Optum Perks, SingleCare, and RxSaver. We're also wondering if/when the PBMs will shift to a less complacent stance on GDRX. Last, whether regulatory action moves the needle here and impacts GDRX remains up in the air, but it does seem like there's more interest in doing "something" to help independent pharmacies year-over-year.
Highlights
- Doximity's model delivers value. If our contact were looking to increase spend this year, DOCS would be at the top of the list given its ability to reach HCPs.
- GoodRx is unique and offers unique value, in our contact's opinion. The ability to reach and engage customers that are clearly searching for the brand is something that's worth the spend, regardless of the ROI. Given the cost to test-and-learn, which is in the $130k realm, it's a "no brainer."
- PBMs appear to be jockeying for position in/around coupons (Inside Rx), but the system remains broken.
Call Notes
Edited lightly for length and clarity.
Background: Our contact has over 20 years of experience in marketing, with the majority of the past 15+ years in marketing roles at biotech, pharma, and spec pharma companies (consumer and health care providers (HCPs), mostly branded drugs, especially more recently). She has experience w/ GDRX, DOCS, and many other platforms, as - in her current role, she's managing budgets that range from ~$1MM - $2MM for multiple branded therapeutics, and "almost all" the money goes toward digital, and there's some direct mail.
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Our contact either has direct experience or is familiar with WebMD/Medscape, OptimizeRx (OPRX), Optum Perks, SingleCare, RxSaver, Epocrates (acquired by athenahealth way back), and copayment/patient support and patient engagement programs (working w/ the PBMs).
Can you tell us a bit about sales reps vs. media/digital spend to start?
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The way to think about a sales force is all-in comp is around $300k per rep, plus or minus, and you can go from there based on the team/company and tell what's going on - it's usually the bulk of the sales and marketing spend.
OK, we hear a lot about access to the doctor and how reps have limited access, etc. Is some of that budget swinging toward you? Is there a "mix" shift or at what point do you not need bodies?
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I've worked on brands where we've cut the sales force - it's one of those things that everyone talks about but nobody wants to do. If a sales team is promoting one brand, it's hard to justify (having a big team), but if they have a few brands, then you spread the spend out.
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It also depends on how much buy-in and payer coverage there is... it's less about "spend more on digital" and more about EBITDA for the brand or portfolio, the copay programs, whether there are outside vendors involved, care managers calling offices, people helping to drive insurance coverage, etc... So, you might align spend on that and put some more media out there to maintain product awareness and brand presence. The latter is all digital – email, banners, custom programs w/ Doximity, Medscape, etc.
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Media programs – always test and control groups. I run them very targeted to HCPs and often work with a media agency. I go down to the individual level. I want campaigns targeted at the right HCPs, and then I look at the overall return. The numbers almost never look good.
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Really? Yes, all the players will say, “We can do an ROI for you.” Sometimes it’s an additional fee, but IMO it doesn't work/isn't accurate because you have other media going against the HCPs… its not just that one campaign. All the partners think they are making us look good, but I'm really trying to find out what helps pharma make money. Also, if your only job is to manage media programs, are you really going to come back and say, “This media program doesn’t work.”?
Is the PBM in there at all – discounting?
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Sure - that's all in the opex budget/P&L. The rebates, contracting, etc. all hits your price but doesn't always mean higher placement in formularies. I try to be flexible - paying in PBM rebate, but they don't seem to be working, so that's part of the reason for looking at GoodRx.
Where is the sales model going?
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The model still works if you’re a brand with good coverage, but it seems like there are more/many brands without good coverage (i.e., someone willing to pay a bigger rebate)… scale matters. With branded drugs, you can do a lot of damage to your nearest competitor by being more aggressive.
What are DOCS and GDRX bringing to the table? What do you like/not like?
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DOCS has been a good partner – I've worked with them for years and view them as a top performer. That means a very high match rate if you give them a list. They have good engagement, deeper content. I put content in two categories – 1) awareness and getting a brand out there (buy programmatic banner ads, can still target, but no engagement (it’s just a billboard)), 2) engaging content - and if I want engagement (clicks, reads, other interaction), then Doximity continues to be one of the top performers.
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DOCS must balance out the platform so the platform is attractive to doctors, and if they can hold onto the engagement, they'll do well.
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GoodRx is good for brands with access issues. Maybe a custom cash offer program or their patient navigator – if you're looking for an offer, GDRX can provide a custom unit to help. If you don't have a commercial/patient marketing program, but need a way to overcome insurance challenges, they can tell you how many people are searching for the brand, and then you can see that people are filling scripts.
Thoughts on GoodRx Care?
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It's interesting. When I was running DTC, I spent a lot on WebMD. They used to be really expensive, super hard to work with, but they came around because of all the other sites that came on – therapeutic specialization.
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GoodRx laid out a lot of the data – # of clients, brands, how it works, etc. - and it didn’t seem like a lot [of $] per brand…. Patient navigator - where they come in search, custom unit, costs around $130k … interesting, we had pegged it at $144k – yeah, it is almost a "no-brainer" - no agony over that.
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How many scripts might you get out of that? It’s cheap enough that I don’t need an ROI on it.
What do you think about GoodRx's MAUs?
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To me, they are big enough, well-known enough. If you look at the majority of scripts coming through, cash card programs, the majority are coming through GoodRx, but a good number are from InsideRx (ESI)... everyone is going to cash card savings. Is that GoodRx or are they backing Amazon Pharmacy?
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The other question is whether one program w/ GoodRx is enough, or do we need to do more programs?
Your relationship becomes more to do w/ the patient you're helping – cash cards, patient support – you're focused more on provider and patient, and that’s more digital?
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We’re trying to work around the broken system – does the physician matter? If they aren’t prescribing your product, that’s one problem. If you have to pull back from rebates and figure out how to get a price to patients that’s simple enough for a doctor to deal with… that’s where reps can still be important.
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How much can we do to empower patients to go to GoodRx? If they are going there, we will offer a lower price through a custom program.
What other options are there?
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Medscape and different programmatic players; Lasso, the marketing and analytics platform.
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MD Alert – custom programs
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Epocrates can be helpful
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OptimizeRx – if you have a copay program, you can try that, but they aren’t at the same scale (compared to GoodRx), in my opinion.
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I'm hard-pressed to say that any program equates to an 8-10 to 1 ROI. Regardless of whether it's a patient w/ a $150 or $150k lifetime value, the media costs the same amount. We just have to get a couple of things right, but can you really attribute it back to that particular campaign? They can't take credit for it all.
Will you use GDRX more going forward?
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I probably will this year. I'd like to put a cash offer where I know people are going to the site looking for the brand, and I want a cash program that can be easy/simple for reps to promote to HCPs, and that I know pharmacies can do without complication.
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Also assuming insured? Yes, they might just not have good coverage. Give rebates to a PBM, let them keep it, and we know the breakpoint is ~$60. The most profitable scripts are not scalable. The cash price is usually 20-25% of WAC. You'll have other copay programs - insurance pays all over the place on the WAC price.
Increasing spending on Doximity this year vs. last?
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I’m not, but if I were looking to increase media spend, they are at the top of my list for who helps brands, and that spending would grow.
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For GoodRx, you’re playing in competitive retail brands fighting it out based on patient out-of-pocket copay programs. Missing out on bigger specialty brands – they don’t’ have the volume. Not a lot of patients looking for a lower price for a $30k drug. That could be why they are trying to play up the content side of things.
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Healthy Nation – they seem like they are trying to expand the offering beyond copay. They haven’t talked about EMR integration with me (GoodRx). It’ll serve up a custom unit - do you have insurance, try this copay card; if not, here’s this cash price.
Where does TV spending fit?
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I don’t do TV now. I have historically, but you need a massive patient lifetime value to make that profitable. $50MM starting point, TV + Reps.
Is there a trend with engagement on DOCS? Rising or falling?
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No, I haven’t noticed. Maybe they sandbag the guarantee, but they beat the ROI numbers.
Is there anything, if you were in our shoes, that you think we should consider as we try to model this out?
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For GDRX, they are in a good position now, but they are at that point where PBMs are paying attention and figuring out how to get in on it. Maybe GDRX is nearly too big? InsideRx, Amazon, etc. - I've been trying to map out all the cash cards and who is connected. My bet is always on the PBMs winning.
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Can GoodRx come direct to you on pricing? Yeah, but what’s that starting price? The best price from a PBM - do we even know what that is? I’m very skeptical of PBMs getting in – "Here’s access to this price... it's bogus."
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If GoodRx chews down commercial volume, then they’ll be like, "whoa" – right
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But their coupon won’t work, they won’t get the other guy’s best price – right
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If GDRX can get to 20MMM MAU and offer value… maybe they don’t get disrupted, maybe they win? Yes. They are very easy to work with, flexible on pricing, and they are different from everyone else - they are one to watch. I don't think they are going away.
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Thomas Tobin
Managing Director
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