Anti-Allergy Drugs: How Doctors Make Prescribing Decisions

In this article, we will focus on seasonal allergic rhinitis and explore our research results on how to increase physician engagement.

Measuring Physician Engagement

Big Data in Pharma

Nowadays, many companies are incorporating various types of information internally and utilizing it for strategic planning under the wide spread of digital transformation.

Information on the therapeutic effects of each product, patient information, side effects, etc. are stored through daily sales or contact records of MRs (Medical Representatives) and MSs (Marketing Specialists) and analyzed. In addition, many companies are also working on analyzing medical professionals' access logs on their websites.

Although data is stored and analyzed, there are some pitfalls a company cannot fully understand by itself, for example — doctors' behavior. Their actions as a result can be recognized, but what decisions triggered them to do so, or how they compare with other companies, what their future recruitment intentions are and such cannot be determined only by information from MRs and MSs.

One reason, a company cannot understand on its own, is related to changes in the doctor's environment. First, for prescribing new drugs correctly, doctors are always seeking accurate, up-to-date information. Second, since the impact of COVID, the way to approach doctors has become complex, involving both in-person and online. Third, manufacturers are being evaluated by multiple aspects.

For pharmaceutical companies, it is becoming increasingly important not only to provide products, but also to provide non-product related support, disease awareness initiatives, and help doctors approach patients. In this rapidly changing environment today, not only product evaluation but also an understanding of various perspectives and backgrounds of the behavior of doctors and patients, are necessary. We believe that physician engagement will be effective only if internal data is supplemented with external data, and customer feedback is analyzed from multiple perspectives. Precise analysis using rich data should help differentiate the company from competitors and push forward to outshine others.

How Nikkei Research Measures Physician Engagement

Nikkei Research has developed a unique scheme for measuring physician engagement. There are four factors: product, information provision, non-product, and MR. The company's status of everyday contact and its volume may be known, but it will not know that of other companies. In addition to these factors, there are overall evaluation items (KPIs). These indicators are chosen according to the characteristics of the industry, product, and strategy of each company.

Survey Results: Company Ratings in Anti-Allergy Drugs

Survey Outline

Top Prescribed Anti-Allergy Drugs of Spring 2023

The table shows the ranking by each department, accumulated votes of the top three most frequently prescribed medicine chosen from 16 selected products by each participating doctor.

In the top 5, unlike the market share or amount of sales, this shows the preference strength of prescriptions. Among branded drugs, Bilanoa, Desalex, and Rupafin were the most commonly prescribed across all departments, respectively. Bilanoa was the most chosen, especially by otorhinolaryngologists and dermatologists. In internists, on the other hand, Allegra (generic drug) topped the list over Bilanoa.

Reasons Why Internists Choose Allegra

Why do internists choose Allegra over branded drugs?
Comparing the reasons for prescribing between the two, internists, who need to manage various diseases, tend to choose drugs they are familiar with as the first choice for patients with allergies. While Bilanoa was rated high for its low concerns on impaired performance and short time for showing effect, it is chosen when doctors want specific results.

Reasons for Prescribing Branded Drugs

Since all the branded drugs presented in the survey have presence in the market for some time, the top reason for prescribing them was "familiarity." Besides the familiarity, where the choice of drugs depends on each patient's situation, other reasons for prescribing were related to the characteristics of each drug's efficacy and effectiveness, such as fast effect, the convenience of dosage, and drug administration.

Communication Over Anti-Allergic Medicine by Pharmaceutical Companies

The table shows the status of information provision since January 2023. Among the 19 companies measured, we looked at the top 5 that handle the most frequently prescribed products. We picked manufacturers of branded drugs, in cases where generics are available in the market. You can see that there has been a great deal of activity by MRs. In addition, the recognition of companies and products through medical-specialized media is also large. This spring, the amount of pollen in the air was high and probably induced many reports in the specialized media referring to the sales status of each company's product.

Looking at the results closely, both Taiho Pharmaceutical and Mitsubishi Tanabe Pharma stand out in overall total contact volume. Taiho Pharmaceutical, which handles Bilanoa, had the most volume of contacts with strong communications covering various channels, such as in-person MR and MS, online lectures, and sharing brochures, while its product sales stood well. Mitsubishi Tanabe Pharma also had a large volume of contacts by in-person MR and MS. KYORIN Pharmaceutical was the strongest in terms of information provision by in-person MRs, and giving out brochures and other materials was slightly higher than that of Taiho Pharmaceutical. The weight of overall in-person contacts was high in both KYORIN Pharmaceutical and Meiji Seika Pharma.

Ratings of Companies Handling Branded Drugs

While each company has unique characteristics in contact with physicians, we will focus on the 4 companies that handle branded drugs and how they are rated by physicians. The graph shows the differences in the ratings of two companies that handle Bilanoa — Taiho Pharmaceutical and Meiji Seika Pharma.
In general, Meiji Seika Pharma is rated the highest, followed by Mitsubishi Tanabe Pharma and KYORIN Pharmaceutical. Those 3 companies are perceived trustworthy as a manufacturer and reliable as a distributor. As for KYORIN Pharmaceutical, which had great in-person MR contacts, the respondents expressed that they are much more interested to hear from KYORIN Pharmaceutical's representatives than from other competitors.

Ratings of MR of Companies Handling Branded Drugs

How about the performance of people? The graph shows the ratings of MR's activities, across 5 categories from necessity/partnership to support. We asked the respondents to evaluate the MRs of companies with which they had contact over antihistamines and anti-allergy drugs. Since MRs do not deal only with anti-allergy drugs, it is more likely the impressions and evaluation of MRs representing that company.

Again, there was a difference between the two companies handling Bilanoa. Meiji Seika Pharma received higher ratings as a necessary partner and understanding well about the disease. On the other hand, Taiho Pharmaceutical was better in expected response time, providing information about new drugs and product development, proposals from a patient's perspective, and initiatives on disease awareness. In terms of response time, Mitsubishi Tanabe Pharma, which handles a larger variety of products besides anti-allergy drugs than other companies, also received high ratings. KYORIN Pharmaceutical got relatively more impressions over "provide appropriate negative information as well" and "helpful non-product supports."
Ratings of MRs are thought to impact the overall company evaluation. However, in the case of Taiho Pharmaceutical, no connection was discovered between the ratings of the company and its MRs, while MR's ratings were likely induced by the product through contact points. The connection between MR's ratings and the company's ratings was seen in Mitsubishi Tanabe Pharma and KYORIN Pharmaceutical.

The Most Reliable Company

Looking at the overall evaluation of each company, based on their background of product, people, and company ratings. We asked the respondents to pick the top 3 most reliable companies overall, among the manufacturers of antihistamines and anti-allergy drugs.

There were notable differences in the ratings between internal medicine, which oversees many diseases, and otorhinolaryngology, which specializes in this field.
Internists have "nothing in particular" in 2nd, and the rest of the rankings are close to the order of the shares of branded drugs. On the other hand, otorhinolaryngologists do not seem to reflect the share of prescriptions.
Are companies thought of as "reliable" because of their product penetration or by other factors? To understand the reasons, we should explore the survey results from different perspectives that will reveal the strengths and weaknesses of each company from their differences in the ratings.

NPS®by Company

We evaluated companies with NPS®, the willingness to recommend, which can be said as another form of "reliability." NPS (Net Promoter Score)® is a popular indicator for measuring customer recommendation and customer loyalty. In our survey, based on the respondents' overall experience, we asked them on a scale of 0 to 10 how much they would recommend to their colleagues as a pharmaceutical company specialized in antihistamines and anti-allergic drugs across products, activities, information provisions, etc. Respondents who rated 9 or 10 were categorized as promoters and those who gave a score from 0 to 6 were grouped as detractors. The NPS® is given by subtracting the share of detractors from promoters.

The table shows the results of the NPS® of companies handling anti-allergic drugs, and we see notable differences between departments. While the overall average is negative, the two companies handling Bilanoa showed a positive score in otorhinolaryngology (negative in internal medicine). Where there are no products that can be labeled as "defective" or "brittle" in medicines with a certain level of quality, the differences between companies should come from the performance of non-product related, corporate brand, or activities by MRs.
The defined calculation of NPS® may not be entirely suitable for the Japanese market as people do not tend to rate 10-9 or categorize 0-6 as detractors without considering the response distribution. However, we believe NPS® is efficient for the pharmaceutical industry, we see physicians with high loyalty give scores of 10-9 without hesitation. For example, in our previous article about the lung cancer area, AstraZeneca and Chugai Pharmaceutical received strong support with NPS® exceeding 30. KYORIN Pharmaceutical and Sanofi were highly recommended regardless of department, with positive NPS® in both internal medicine and otorhinolaryngology. In the previous section, the rankings of the most reliable company were similar to the share of prescriptions, but this seems not to be the case for NPS®. It indicates that the power of the product or sales does not necessarily lead to loyalty.

Future Intentions for Prescribing Branded Drugs

We have looked at the survey results from various perspectives, but for a pharmaceutical company, the most concerned issue is perhaps whether prescriptions of their products will increase or not.
In the survey, we asked the physicians about their future intentions to prescribe the branded drugs. If they were already prescribing them, they were asked whether they would further expand, continue, reduce, or discontinue the prescriptions. If they were not currently prescribing them, we asked whether they would consider prescribing them in the future.

Bilanoa seems that it will continue expanding. Regarding the current market share, Rupafin and Desalex still have room to be chosen, and there is a trend of increase.

Does physician engagement lead to an increase in prescriptions? In the world of pharmaceuticals, prescriptions will increase if the product is good and the sales volume can somewhat be predicted. While on the other side, if you have strong physician engagement, the probability to be the first choice over other companies or frequency of opportunities for consultation and proposal will most likely increase — and that will be a great advantage in influencing doctors to adopt and prescribe the product. Measuring physician engagement may be the key to unraveling product and non-product-related factors for maximizing sales.

Characteristics of Each Company

Below is the summary of the 4 branded drug handlers from our survey results. You can see the differences in communication with doctors and the characteristics of the engagement between companies.

To Increase Engagement

In conclusion, we would like to explain how pharmaceutical companies can enhance engagement further.

Physician Engagement Differs by Disease Area

Through our survey on anti-allergic drugs and the previous survey on oncology, the goal of physician engagement should be different depending on the disease area and department.
In oncology, physician engagement needed "good partnership" supporting advanced treatment.

On the other hand, in the case of general prescription medicine like anti-allergy drugs, engagement is built from the point of contact through the product. Then, followed by each company's unique types of engagement, such as fast delivery, or providing materials and supporting treatment as a manufacturer, leading to impressions and ratings of the company. In the case of anti-allergic drugs, each department, such as internal medicine and otorhinolaryngology, had different aims of engagement. It should vary by company depending on their product lineup, sales strategy, or corporate strategy.

Surveys for Enhancing Engagement

We should aim to maximize sales by building an engagement that better fits the needs, strategies, and circumstances of the company, while also incorporating external evaluations. Here, we would like to introduce our three support methods. The first is the quantitative survey to "visualize evaluation," which is the topic of this report. While listening to your company's issues, we will propose a survey design that meets your objectives. In addition, interviews with doctors, agents, and partners to deepen understanding are also effective. And to ensure that the survey does not end there, we also provide support through workshops where we work together to understand the survey results and organize issues.