Capitalizing on NPs and PAs by Specialty: Understand and Reach this Prescriber Segment in the Digital Age of Marketing and Market Research

Capitalizing on NPs and PAs by Specialty: Understand and Reach this Prescriber Segment in the Digital Age of Marketing and Market Research

Targeting High Value Prescribers NPs and PAs now treat higher percentages of patients presenting new conditions 3 1 Did you know 1 in 4 physicians won t see pharma reps? 1 Access to physicians has declined rapidly over the past 6 years, only half get past the receptionist, 2 and most visits last only a few minutes. In addition, physicians who have had patients on the same medications for years are unlikely to switch. Spending major marketing dollars on those who are already brand loyalists to either you or your competitor may no longer be the best use of your budget. High value prescribers such as nurse practitioners (NPs) and physician assistants (PAs), and those who see the most patients with new health concerns, are the better targets to increase new prescriptions. According to a CDC / NCHS data brief, in Community Health Centers (CHCs), NPs and PAs treated a higher percentage of patients presenting with new conditions (45% and 38% respectively) than did physicians (36%). 3 1. SK&A's 2010 Physician Access Survey. 2. ZS Associates AccessMonitor 2013 Executive Summary 3. CDC/NCHS National Ambulatory Care Survey. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 2

Is a Focus on Saturated MD Prescribers Leaving You at a Disadvantage? NPs and PAs prescribe as often as MD counterparts NP and PA influence increases as evidenced in a National Ambulatory Medical Care Survey of CHCs where there were no differences among MDs, NPs, and PAs in the percentages of visits in which drugs or immunizations were prescribed and labs or other tests were ordered. 4 An NP or PA not only prescribes as often as a physician counterpart, but NPs and PAs are also high value prescribers due to the amount of new patients they see and nearly 17,000 new NPs and PAs entering the healthcare system each year. 5 There was a nearly 50% increase in NP graduates from 2004 to 2010, 5 and PAs are one of the other fastest growing professions in the U.S. 6 By 2020, AAMC anticipates a shortage of 45,000 primary care doctors and 46,000 MD level specialists. 7 The solution, already in effect, is NPs and PAs treating more patients in all settings which has created an opportunity on which many pharma and medical device marketers and market researchers are capitalizing. For example, 28% of details are to NPs/PAs for diabetes products. 8 4. CDC/NCHS National Ambulatory Care Survey. 5. American Association of Nurse Practitioners. 6. National Bureau of Labor Statistics. 7. AAMC Center for Workforce Studies 8. Encuity Research Promotional Trends Report July 2012 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 3

Mid-Level Prescriber Behavior & Potential 2/3 of NPs hand out free drug samples 9 There are 260,000 NPs and PAs who can prescribe legend drugs in all states and controlled substances in 48 states and D.C. NPs also staff walk-in clinics in retail pharmacy stores whose usage tripled since 2008. 10 NPs and PAs write close to 30% of all prescriptions in the U.S. and recommend millions of over-the-counter therapies annually. 11 In one CHCs study, NPs/PAs were more likely than MDs to provide health education services during patient visits. 12 A CMI/Compas study found NPs/PAs spend as much as 20 minutes with new patients and an average of 12-14 minutes on follow-up visits which is significantly more time than MDs spend. 13 NP/PA patient interactions can vary significantly by specialty; for example, in chronic pain management, they usually see new patients for 45-60 minutes and spend 15-30 minutes for followups. 14 Today, NPs and PAs permeate all specialties. Online healthcare professional (HCP) market research focus groups and surveys help pharma and medical device companies determine more precisely the demographic and behavior profile of high value prescribers for their own products. 9. Ladd EC, Mahoney DF, Emani S. "Under the Radar": Nurse Practitioner Prescribers and Pharmaceutical Industry Promotions. AJMC. December 2010. 10. The nurse practitioner will see you now. Consumer Reports magazine. August 2013. 11. AANP and AAPA 12. CDC/NCHS National Ambulatory Care Survey. 13. CMI/Compas Engaging Nurse Practitioners and Physician Assistants Using HCP-Level Promotional Access 14. Schneider, J. Emerging Role of NPs and PAs in Pain Management. Practical Pain Management. June 2008. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 4

NP/PA Interaction with Industry 48% of NPs are more likely to prescribe a drug highlighted during a dinner event 15 Although mid-level practitioners have as much need for professional education as physicians, they are underserved. NPs and PAs are seeking information about the latest research, upcoming therapies and new medical devices. Studies found that NPs have a positive attitude toward pharmaceutical marketing efforts. According to the American Journal of Managed Care, 90% of NPs believe it is acceptable to attend lunch and dinner events sponsored by the pharmaceutical industry. 15 Almost half (48%) stated they were more likely to prescribe a drug that was highlighted there. 15 NPs/PAs, who see over 1.2 billion patients per year, 16 are considered to be the segment with the most additional potential to increase marketing efforts and market share. On average, 20-30% of detailing is focused on NPs and PAs. 17-19 Compared with the previous quarter, spending on NP/PA detailing increased 13% in the first quarter of 2012. 19 The focus can be increased even further to capitalize on the untapped potential in this educationally-hungry segment. For instance, a pregnancy prevention device launch recently spent 40% of a $2 million budget on NPs and PAs. 20 15. Ladd EC, Mahoney DF, Emani S. "Under the Radar": Nurse Practitioner Prescribers and Pharmaceutical Industry Promotions. AJMC. December 2010. 16. AANP and AAPA. 17. Verispan 2006 Year in Review. April 11, 2007. 18. Scott-Levin s Sales Force Productivity & Effectiveness Study, 2000. 19. Encuity Research Promotional Trends Report July 2012 20. Encuity Research. COPD and IBS drugs lead promotional spending among newly launched products. FirstWord Pharma. Pharma Outlook 2013. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 5

Targeting NPs/PAs By Specialty NPs and PAs Specialize In The Same Manner As MDs Pharmaceutical and medical device companies can target mid-level practitioners by specialty and other criteria to ensure marketing dollars are directed specifically to those NPs and PAs who influence the success of their business. In addition to primary care, NPs and PAs are found in significant numbers in most specialties. For example, NPs/PAs are seen for over 19 million Emergency Department visits per year, 40% of which don t involve MDs. 21 Pain clinics are increasingly hiring PAs and NPs to assess the patients, prescribe pain medications, and monitor, explains Dr. Jennifer Schneider. 22 NPs and PAs may even see more patients than physicians for some fields and conditions such as pediatrics, depression and obesity. 23 The most common agents prescribed by NPs include antihypertensives, antimicrobials, dyslipidemic agents and diabetic agents. 24 In addition to area of specialization, similar to MDs, NPs and PAs can be targeted by practice setting. Categories include single-specialty group practice, inpatient unit of hospitals, hospital ER or OR, retail outlet, and urgent care facility. 21. Brown, DF. Continued rise in the use of mid-level providers in US emergency departments, 1993-2009. Int J Emerg Med. 2012 May 23. 22. Schneider, J. Emerging Role of NPs and PAs in Pain Management. Practical Pain Management. June 2008 23. CDC/NCHS National Ambulatory Care Survey. 24. AANP. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 6

Physician Assistants (United States) Specialties/Subspecialties Over 20,000 PAs practice in surgery and nearly 10,000 in emergency medicine Emergency Medicine 10.7% General Surgery 2.7% Internal Medicine Subspecialties 10.1% Pediatric Subspecialties 1.6% Primary Care Family General Internal Medicine Pediatrics 31.0% Surgical Subspecialties 22.8% Other 21.1% Some of the PA subspecialties include: Anesthesiology Cardiology Cardiovascular / Cardiothoracic Surgery Dermatology Gastroenterology Geriatrics Hospital Medicine Neonatal / Perinatal Obstetrics / Gynecology Oncology Orthopedics Surgery Pain Management 25. AAPA Census Report. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 7

Nurse Practitioners (United States) Specialties/Subspecialties Over 16,000 NPs practice in pediatrics and more than 17,000 in women s health Acute Care 5.6% Adult 19.3% Family 48.3% Gerontological 3.2% Neonatal 2.0% Oncology 1.0% Pediatric 8.5% Psychiatric / Mental Health 3.0% Women s Health 9.0% Some of the NP subspecialties include: Cardiovascular Emergency Endocrinology Gastroenterology Neurology Occupational Health Oncology Pain Management Palliative Pulmonology School Health Wound Care 26. AANP National Database. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 8

Benefits of Online NP/PA Marketing and Market Research Niche social networks grew 48.1% in 2011 30 as NPs/PAs spend a median of 10 hours per week online for professional purposes 29 Digital marketing is expected to hit $77 billion by 2016 which is more than double 2011 levels. 27 Marketers surveyed believed that social media marketing would increase the most in effectiveness compared to other channels. 27 In 7 years, spending on online surveys quadrupled to reach $2 billion. 28 The shift away from traditional methodologies can be attributed to the low cost, speed, and flexibility of online market research. For example, RNsights has turned around market research surveys using skip logic (also known as branching) in less than 24 hours and conducted virtual focus groups and advisory boards for less than $10K. The digital age allows pharma and medical device marketers to precisely target and educate the right NP/PA sub segments, A/B test messages and measure outcomes to ensure marketing dollars are successful. Researchers can more easily collect feedback and determine profiles of prescribers who improve ROI. NPs and PAs are a particularly technology savvy group. They spend a median of 10 hours per week online for professional purposes. 29 About 90% of NPs and PAs visit pharma websites. 29 27. Forrester Research. US Interactive Marketing Forecast, 2011 To 2016. August 2011. 28. Hogg 2003, Inside Research and Manhattan Research s Taking the Pulse Nurses 2013. 29. Manhattan Research s Taking the Pulse Nurses 2013. 30. comscore and Social Networking Growth Stats and Patterns Social Media Today. June 2011. Dan Nelm. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 9

Filling Prescriptions is as Important as Writing Them 1/3 of patients don t fill Rx while 32-33 studies show NPs affect treatment plan adherence 31 Nurses and NPs are responsible for patient education, and studies have shown they directly affect behavior like adherence to treatment plans. 31 NPs and PAs can write more prescriptions for your medication or purchase your medical device, and they have one of the most influential voices in patient education. Increase your ROI by providing NPs/PAs with tools they need: Emails with links to adherence tools and apps for a targeted opt-in NP/PA community Educational articles in community e-newsletters Host educational webinar programs Distribute samples of OTC therapies and, where allowed by law, prescription medicines Use focus groups to understand most pressing issues in your target area How many prescriptions did you lose today? If you don't reach NPs and PAs, you may have lost as much as 30%. Your smartest competitors know exactly where to find them. To learn more about these and other opportunities to interact with a vast opt-in community of leading NP and PA professionals by specialty, contact RNsights today. 31. Sandberg J. New Study Finds Pharmacists and Nurses are the Most Effective in Promoting Medication Adherence. Updated December 1, 2010. 32. Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The Incidence and Determinants of Primary Nonadherence With Prescribed Medication in Primary Care: A Cohort Study. Ann Intern Med. 2014;160:441-450. 33. Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010;25:284-90. 978.684.2065 / JayL@RNsights.com / www.rnsights.com / 10

About Us RNsights hosts targeted online communities where marketers and researchers engage with nurse practitioners, physician assistants and nurses with purchasing and prescribing power. RNsights delivers fast and effective lead generation, marketing, market research and continuing education. We connect you to an opt-in audience of healthcare professionals through our online communities organized by specialty, which include primary care, critical care, the largest online group of school nurses, and more. To learn more about how RNsights can help you access this critical market, contact us for a tour of one of our online communities or a free survey. Jay Levenson 978.684.2065 JayL@RNsights.com www.rnsights.com