Since the approval of Linzess in 2012, Ironwood (and its big marketing partner) have been changing the way patients talk about uncomfortable topics like constipation.
While the companies' original direct-to-consumer campaign for the drug would be considered a success by virtually any measure, Ironwood and Allergan have not rested on their laurels. The marketing duo – which originally started out as Ironwood and Forest Laboratories before it was acquired by the company that is now Allergan – have now gone through three iterations of marketing campaigns for the irritable bowel syndrome with constipation drug, each more successful than its predecessor.
The original ad launched in 2014 and tested significantly higher in market research than the industry benchmark on motivation scores among IBS-C and CIC patients, according to the company. The campaign drove total prescriptions (TRx) up 21% compared with the pre-DTC-launch trend established in the 12 months leading up to the launch of the drug.
The next two campaigns, which ran in 2015 and 2016, respectively, received higher motivation test scores than the launch ad and increased total prescriptions by 27% and 30%, respectively.
"We've been very fortunate that we've been able to uncover insights that have led to broadening the appeal and motivation of each campaign," said Mark Rossetti, a senior director at Ironwood and the U.S. brand lead on Linzess. "You generally peak at your first ad because you're launching something new and that newness factor is what drives peoples' interest."
Linzess, which was discovered and developed in-house at Ironwood, wasn't an overnight success. Both companies knew going into the launch of the drug that it would be an uphill battle, entering a market that was already largely entrenched with cheap over-the-counter products like Miralax. In fact, in its first year on the market Linzess only brought in $138 million in U.S. revenues.
"Unlike a lot of pharmaceutical categories, we're not trying to compete head-to-head with another pharmaceutical product. We're actually trying to compete with over-the-counter products that are being used by patients that are naïve to the fact that they have a real medical condition or the over-the-counter products weren't designed to treat their condition," said Rossetti.
"The vast majority of patients that ultimately talked to their doctor and received a Linzess prescription were previously undiagnosed, and a smaller population was diagnosed because they had multiple conversations with their doctor. In most cases, people out there were not understanding and blaming themselves – their diet and their sedentary lifestyle."
It has been a little over four years since Linzess launched and it managed to bring in $626 million in U.S. sales for the full-year 2016, a 38% increase over the year-prior. But growing the brand this dramatically took more than just detailing by a sales force, it required a strong awareness campaign to educate people about the condition and make them feel comfortable seeking treatment.
Identifying the symptoms
"What we tried to do with the first campaign was get people's attention around self identification of their symptoms because what a lot of people were doing, and their physicians in turn, were treating the symptoms of the condition, not the condition itself," said Rossetti.
The campaign tried to close that knowledge gap between these symptoms – infrequent or difficult-to-pass stools, not completely emptying the bowels and belly pain – and the condition, to show patients that all of this could be indicative of IBS-C.
Launched April 2014, the campaign included print ads in magazines such as People, Cooking Light and Better Homes & Gardens, as well as television ads that ran during shows like Modern Family, The Voice and NCIS.
The ad described the pain as a knot or bricks piling up in your stomach and used a blue string to depict the problem.
While most companies don't hit the same level of success on the second iteration of the campaign, focus groups and market research told Ironwood and its partner that the campaign needed to evolve.
The first campaign presented the symptoms and told patients that this drug may be for them; the second tapped into deeper feelings that patients were experiencing.
"When we evolved we moved more into emotional territory. Our market research showed that not only did they have these symptoms, but they were frustrated by the fact that they kept coming back," said Rossetti.
Ironwood believes the second campaign resonated with patients because it tapped into the frustrations that they were feeling, particularly if they had been treating their condition with an over-the-counter laxative and their symptoms kept returning.
Ultimately, the third campaign, launched exactly a year ago, took the narrative further – now pointing the finger at those laxatives for constantly letting patients down.
Rossetti pointed out in an interview that the theme worked especially well in 60-second television ads because there was no longer a need to list the symptoms and patients who were using these over-the-counter laxatives regularly knew who they were.
"As a marketer it makes my job a little easier in that I don't have to name all the things I'm trying to fix. I simply have to say what products that may not be working for you and that it could be solved with our product," he added.
Ironwood may be taking a different approach to its direct-to-consumer marketing, but being able to move from functional insights to emotional insights has paid off for the tiny biotech.