There's a reason the Trump administration wants to require drugmakers to include list prices in advertisements for prescription medicines on TV: It's where the money is.
In recent years, direct-to-consumer advertising has touted to consumers prescription medicines for relatively common ailments like high cholesterol or impotence. Think Lipitor (atorvastatin) or Viagra (sildenafil). While pharma has never liked the idea of price disclosure, the cost of drugs previously most familiar to the American public are nowhere near the cost of the most commonly advertised products today.
Patent expirations, along with the rise of specialty drugs and biologics, have shifted the line-up of drugs consumers are likely to see hawked on TV.
In 2018, a traditional 60-second spot is likely to come from one of a handful of large pharmas and feature a specialty medicine approved for sale in the past five years. Gone are the twin bathtubs and little blue pills, replaced instead with promotions for new psoriasis biologics and cancer drugs.
Spending, though, remains high. Through the first nine months of this year, pharma companies have spent more than $2.8 billion on TV drug ads, up from around $2.5 billion through the same time period last year, according to analytics firm iSpot.tv.
Here are five common themes among the top ranks of pharma TV advertising:
A handful of drugmakers account for the lion's share of drug ads on TV
In proposing to mandate inclusion of prices in drugs ads last week, the Department of Health and Human Services estimated its rule would affect roughly 25 drugmakers that air about 300 commercials a quarter.
Data from iSpot.tv, though, shows that the number of pharma companies putting up serious money on television drug ads is an even narrower group.
Spending by Pfizer, Eli Lilly, AbbVie and Bristol-Myers Squib, for example, represented about 40% of the $2.81 billion spent on TV drug ads through the first nine months of 2018, according to an analysis of iSpot.tv numbers
AbbVie's investment in promoting its blockbuster drug Humira (adalimumab) made up 8.5% of the total just by itself.
Top 5 spenders on TV drug ads, first nine months of 2018
|Company||TV ad spending for top drugs||Drugs advertised||Number of ad spots|
|Pfizer||$481 million||Lyrica, Xeljanz, Ibrance and Eucrisa||24|
|Eli Lilly||$318 million||Trulicity, Jardiance, Taltz and Verzenio||15|
Note: Pfizer's figures above don't include Eliquis, which it co-promotes with Bristol-Myers Squibb SOURCE:Data from iSpot.tv
All told, 12 drugmakers were behind the top 20 brands by ad spend, and those products accounted for three-fifths of overall investment in television DTC.
Given the sums involved, it's not exactly surprising that large pharmas invest the heaviest. Still, there's a reason that it may seem the same drug ads keep coming up in TV programming.
Advertising is heaviest for brands locked in battles for market share
Drug companies argue that direct-to-consumer advertisements are an important tool to raise awareness among patients that treatment options exist. Commercials can also act as a push, reminding consumers to ask their doctors about whether a drug might "be right" for them.
Critics say drug ads overweigh the benefits while consigning risks to rushed voiceovers at the end of the ad. Some research has backed the concern that doctors may be more inclined to prescribe drugs patients ask for — whether they are necessary or not.
While the pharma industry does invest in unbranded "awareness" marketing, the most heavily advertised brands generally are in competitive markets.
For example, J&J's Xarelto (rivaroxaban) and Bristol-Myers Squibb and Pfizer's Eliquis (apixaban), two competing anticoagulants, were both in the top 10 brands by TV ad spending so far this year and in the top 15 last year.
A twist on this general theme are drugs nearing the end of their patent protection. Drugmakers tend to ramp up DTC spending ahead of patent expiry, before sharply cutting back after generics enter the market.
Pfizer, for instance, has spent over $200 million this year on TV spots for its nerve pain treatment Lyrica (pregabalin), the principal patent for which expires this year.
Most top advertised brands are considered specialty medicines
Unlike the blockbuster drugs of the 2000s, many of the top drugs both by revenue and ad spending are considered specialty medicines.
While the definition varies, specialty drugs typically are more expensive, prescribed by a specialist rather than a primary care physician or treat more complex conditions. Many are biologics.
In 2017, specialty medicines accounted for nearly half of per capita net spending in institutional and retail settings in the U.S., data from Iqvia shows.
That increased utilization is reflected in which drugs are advertised most heavily, too. Humira, Trulicity (dulaglutide), Otezla (aprelimast) and Keytruda (pembrolizumab) were all among the top 10 brands by ad spend, according to iSpot.tv. numbers.
"We are moving away from the old way in which specialty pharmaceutical manufacturers thought they had to only talk to the health insurers and the physicians, and then they would drive it to the patients," said Sam Cannizzaro, an executive creative director at the Syneos Health-owned GSW Advertising, in an interview with BioPharma Dive. "I think that model is evolving."
DTC advertising for specialty medicines can also make economic sense. While a condition like rheumatoid arthritis might affect fewer people than high cholesterol, an expensive marketing campaign for a drug costing thousands of dollars a year can generate substantial returns on investment by boosting prescription uptake.
Still, top advertised brands mainly target broad indications
Pharma and biotech companies are investing more and more R&D dollars into rare diseases. Technologies like gene and cell therapy are putting a wide range of inherited disorders within reach of treatment, spurring buyouts and pipeline investment.
Given the smaller patient populations, though, rare disease drugs don't make a great case for wide-reaching advertising. More targeted digital technologies could offer a better channel for pharma advertisers but, for TV, DTC marketing campaigns mostly focus on broader indications like rheumatoid arthritis, diabetes and psoriasis.
One exception is cancer, where specific targeted therapies might only be approved for a narrow group of patients with a specific genetic mutation, for example.
Even there, though, advertised brands tend to be aimed at cancer types with higher incidence. Merck & Co.'s Keytruda, for instance, is approved for nearly a dozen indications, including non-small cell lung cancer, one of the most prevalent types in the U.S.
Cancer drugs are making the airwaves more often
DTC advertising for cancer drugs comes with its own set of challenges and controversies.
Patients with cancer can face a deadly prognosis, and aren't as well-positioned to weigh the risks and benefits presented in a drug ad as those with other, less fatal diseases. Even for drugs with impressive clinical promise, ads that trumpet "a chance to live longer" can spur backlash.
Which type of cancer a patient has typically isn't established until after testing, too, making the kinds of "ask your doctor" prompts in ads more spurious.
More and more though, cancer drugs are showing up in TV ads, mirroring the rise of immuno-oncology and a broader boom in cancer research.
This year, Keytruda, Pfizer's Ibrance (palbociclib) and Eli Lilly's Verzenio (abemaciclib) were all in the top 20 most heavily advertised brands. In 2017, Bristol-Myers' Opdivo (nivolumab) was also among the top ranks.
Data from both iSpot.tv and Kantar Media show that DTC advertising for cancer drugs has increased sharply in recent years. Through the first nine months of 2018, pharma companies spent $268 million on TV ads for cancer medicines, up 18% from the same period a year prior, according to the iSpot.tv figures.