EXECUTIVE SUMMARY Recapturing the vision* Restoring trust in the pharmaceutical industry by translating expectations into actions PricewaterhouseCoopers’ Health Research Institute “There is one great problem that about practices that carry significant Consumers and stakeholders seriously challenges the ability reputation risk: research and do not understand the drug of America’s research-based development, sales and marketing, development decision process, and pharmaceutical companies to continue product pricing, finance and ethics. do not understand the risks and doing what they do better than any The survey results strongly supported costs involved in researching new other entity on the globe: research and our hypothesis: we found significant drugs and bringing them to market. develop new cures and treatments. strategic, reputational and operational Most consumers and stakeholders In a word, it is trust.” That statement, gaps between the pharmaceutical underestimated by more than made recently by Billy Tauzin, president industry’s perspectives and priorities 50 percent the average financial and CEO of Pharmaceutical Research and those of the industry’s stakeholders. investment required to research and Manufacturers of America, Based on our findings we believe that, and develop a new drug. This captures the core of one of the greatest with support and positive publicity misperception may result, to some challenges to the pharmaceutical from industry organizations, individual degree, from a recent industry trend: an industry in America and throughout the companies can restore and strengthen inverse relationship between increasing world: that of restoring its damaged the foundations of their damaged research and development (R&D) reputation. reputations by better understanding spending and a decreasing number of and addressing those gaps and their new drugs brought to market. Unaware While the industry’s reputation associated issues. of the higher price pharmaceutical has been damaged, however, it companies must now pay to develop a has not been destroyed. Although In short, our research indicates that new product, many stakeholders perceive healthcare remains one of the least- companies can narrow strategic, that increased industry spending focuses represented industries in the Financial reputational, and operational gaps (and on marketing—particularly on highly Times/PricewaterhouseCoopers thereby enhance their reputations) by visible direct-to-consumer advertising annual reputation rankings, a few demonstrating a successful balance of products for non-life-threatening pharmaceutical companies maintain of their primary mission to improve conditions. a position among the world’s most human health and their fiduciary reputable companies.1 Recapturing obligation to manage shareholders’ There appears, furthermore, to be a the Vision is PricewaterhouseCoopers’ assets wisely. discrepancy between the definition view of how pharmaceutical of innovation held by stakeholders companies can identify, address, and Key survey findings and the definition held by the alleviate the core issues that affect pharmaceutical industry. Consumers their reputations and how they can Consumers and stakeholders believe think of innovation in terms of products take steps to regain any lost respect. that pharmaceuticals constitute a much developed to address unmet medical higher percentage of total healthcare needs rather than lifestyle needs or We base our point of view upon costs than current information from incremental improvement on existing the hypothesis that pharmaceutical the Centers for Medicare & Medicaid treatments. Those consumers, industry stakeholders* and consumers Services (CMS) indicates, which however, also do not understand the have lost trust in the industry because distorts the value–for–money argument complexity involved in the discovery, they believe that financial success and used by the industry. Those surveyed formulation and development of subsequent pressures have blurred the said that drugs consume too high novel medicines. industry’s greater purpose of improving a percentage of health spending, human health. We believe this is just and they significantly overestimated Stakeholder groups and consumers one of several reputation-related the value of that percentage. The continue to have concerns about the issues on which key stakeholders and disconnect may in part result from the nature and extent of pharmaceutical pharmaceutical companies perceive fact that pharmaceuticals consume sales and marketing practices. More the industry differently. While reputation a higher share of consumers’ out- than 94 percent of stakeholders said knows no national borders, we focused of-pocket spending than does any pharmaceutical companies spend too on the U.S. market, where—primarily other component of health spending; much on advertising; they also feel that because of the rise in consumerism— many other health services receive industry advertising lacks transparency we see reputation-related issues as far better coverage from insurance with respect to drug risks and benefits. most pervasive and as posing the plans. As healthcare grows more Most stakeholders expressed concern greatest threat to the industry. consumer-driven in the near term, this about the amount spent on sales disproportionate cost-sharing could and marketing, about the influence To test our hypothesis, we surveyed continue to feed the public’s distorted marketing has on prescribing habits pharmaceutical industry executives, view of how much drugs contribute to and about the impact of off-label drug consumers, and stakeholders* overall health spending. promotion. While stakeholders accept * Industry stakeholders, as referred to throughout this paper, are defined as the groups represented in our survey: doctors in physician groups, researchers in academia, former health policy makers, hospital executives, managed care organization executives, and employer executives. the need for pharmaceutical companies Recommendations for performance incentives that to market products, those stakeholders consideration reward preventive treatment plan believe that marketing focuses too compliance—thereby ultimately much on sales and not enough on Our recommendations for saving on hospital costs for payers patient treatment and outcomes. pharmaceutical companies to • Differentiate the corporate consider fall into two categories. They brand with communications that Pharmaceutical executives and are summarized here and further feature improved, cutting-edge stakeholders hold strikingly different discussed later in this report: pharmacovigilance activities views on a number of issues affecting • Ensure that company culture and reputation. These gaps in perception— 1. Restore trust in the company’s incentives promote compliance particularly the following—may explain choices and processes regarding with sales and marketing policies much of the well-documented erosion of drug discovery and clinical and controls the industry’s reputation in recent years. development. • Work with state pharmaceutical • Communicate to stakeholders distribution licensing agencies, • When deciding whether to use the differences between chemical enforcement agencies and a given pharmaceutical product, and biological innovation and wholesalers to strengthen consumers place more value educate stakeholders about the controls over the integrity of the on a pharmaceutical company’s difficulties and nuances of fostering pharmaceutical supply chain reputation than pharmaceutical breakthrough medical products executives believe • Address consumer misconceptions • In contrast to the views of about the costs and risks of Conclusion pharmaceutical executives, pharmaceutical product development the majority of consumers and • Understand the most effective It continues to be difficult to stakeholders view pharmaceutical channels for the accurate and understand why an industry whose companies as too aggressive in their complete reporting of clinical trial mission is to save lives and improve promotion of drugs for unapproved outcomes by collaborating closely the health of our communities should uses, and many said that companies with healthcare workers and patient be held in such low public esteem. lack adequate processes to monitor groups, and establish links so that Whether consumers and stakeholder unapproved drug use once a product information can be provided for group perceptions are accurate or are has been released to market relevant stakeholders based on misconceptions is to some • Though pharmaceutical executives extent irrelevant. The realities are that report that they make health needs 2. Refocus sales and marketing perceptions drive people’s behavior and their top priority when deciding activities on improving the efficacy, that in recent years the pharmaceutical which drugs to research, consumers safety and compliance of patient industry has, for a myriad of reasons, and stakeholders do not recognize treatment. lost the trust of its key stakeholders— those executives as doing so • Ensure that marketing practices regulators, payers, physicians, and and promotional activities focus patients. As such, the industry can and Increased transparency by the on improving the treatment of should act to restore trust as the central industry could improve its image with diseases, as well as—in light of the tenet of all of its relationships. all stakeholders. Most stakeholders trend toward consumerism—the and consumers know very