Introduction

SPEAKERS:

- Philip Stern, Professor and Senior Marketing Scientist, Ehrenberg-Bass Institute
- Aniruddha Kusurkar, Managing Director Consumer Dairy Netherlands, Royal FrieslandCampina

KEY TAKEAWAYS:

• Pharma brands grow through more prescribers, not major increases in prescription frequency
• Brand consistency outperforms continuous modernization across consumer and pharma markets
• Evidence reveals reproducible growth patterns that challenge traditional loyalty-focused assumptions
• Occasion-based strategies require integrated physical and mental availability at decision moments
• Sustainable transformation demands five-to-six-year, cross-functional capability building beyond marketing

Aniruddha Kusurkar spent over 15 years in commercial roles before confronting an uncomfortable truth about his marketing education. "I could never really reconcile with the view of hardcore loyal consumers," he explained. "Even after working on some of these brands myself, I couldn't force that kind of loyalty from my own mother." This realization catalyzed a transformation in how FrieslandCampina approaches brand building—a shift grounded in research from the Ehrenberg-Bass Institute that challenges pharma industry assumptions about prescriber relationships.

The evidence contradicts conventional wisdom about deepening existing prescriber engagement. "Big pharma brands have got more active prescribers, in fact many more, and they prescribe those brands slightly more often," Philip Stern noted. "The key implication for you, from our work, is that penetration or breadth is the route to what we would call sustainable growth." For pharma executives accustomed to intensive key opinion leader cultivation and high-decile account management, this represents a fundamental strategic reorientation.

Evidence Validates Penetration Over Frequency

The Ehrenberg-Bass Institute approaches marketing as a scientific discipline rather than creative speculation. "What we try and do is find real scientific law-like relationships, which you don't often see within the social sciences and within marketing," Stern stated. As the world's largest marketing research center, the Institute identifies patterns that hold across contexts—from shampoo purchases to aviation fuel contracts to pharma prescribing behavior.

The fundamental pattern appears consistently: market leaders command dramatically larger customer bases while showing only marginally higher loyalty metrics. Stern highlighted consumer data showing the top shampoo brand in the United States achieving penetration levels ten times higher than smaller competitors, while purchase frequency varied by only a factor of two. "Big brands have more customers, a lot more customers than small brands and those big brands attract slightly higher loyalty," he explained.

Does professional medical decision-making exempt pharma from these patterns? The evidence suggests otherwise. Analysis of the English Prescribing Dataset for antidepressants revealed fluoxetine prescribed by 38% of general practitioners at an average frequency of 1.4 times monthly, while fluvoxamine reached only 1% of practices with virtually identical prescribing frequency among users. The breadth variation of 38-fold dwarfed the negligible depth difference.

United States data for psoriatic arthritis among dermatologists showed 23-fold variation in prescriber penetration versus twofold variation in prescribing frequency. Identical patterns emerged across rheumatologists treating axial spondyloarthritis, cardiologists managing congestive heart failure, and primary care physicians across therapeutic areas. Clinical importance and professional training do not insulate pharma brands from the fundamental relationship between market size and prescriber base.

Practitioner Journey From Theory to Implementation

FrieslandCampina's transformation began when leadership recognized that evidence contradicted established practices. As the fifth-largest global dairy company, FrieslandCampina manages brands including Yazoo and Chocomel in the United Kingdom. Kusurkar's chemical engineering background and experience selling toilet cleaners, soaps, and dairy products positioned him to appreciate analytical rigor over marketing convention. His conversion to evidence-based principles 12 years ago has shaped his commercial strategy ever since.

The company's portfolio offers a contrast between consistency and modernization. Chocomel, acquired in 2014, maintained remarkable visual and positioning stability over decades. Kusurkar attributed its strength to minimal packaging changes, consistent recognition cues, and resistance to redesign impulses. "A brand is simply recognition for a certain proposition people want to buy," he stated. "Make it easy for them, don't confuse them and don't try to fill your own space with activities that in the end hurt the brand." This "boring" consistency correlated with strong performance.

“By contrast, we also have examples of brands where we were less consistent with the visual identity as successive marketers attempted changes that they believed were relevant to modernize and differentiate the brand. Frisian Flag in Indonesia is a good example where we moved away significantly from the original visual identity and therefore risked creating consumer confusion. Modernization is not a consumer requirement, it is a marketeer requirement," Kusurkar observed. The lesson applies equally to pharma brands where visual identity refreshes and repositioning may satisfy internal stakeholders while undermining recognition.

FrieslandCampina embedded five principles into operations: push for penetration rather than volume alone, focus on occasions rather than romanticized need states, accept that traditional loyalty doesn't exist, prioritize distinctiveness over differentiation, and maintain consistency. "More people need to buy us a greater number of times every year," Kusurkar said. Occasion-based thinking required portfolio architecture aligned with purchasing contexts. The company developed Rally, an internal methodology for testing brand assets against recognition criteria rather than aesthetic preference; recognition on shelf became the primary design metric.

Implementation required capability building across finance, supply chain, and sales—not just marketing. "I actually find some of my finance and supply chain colleagues much more enthusiastic, sadly, compared to some of my marketeers," Kusurkar noted. The transformation took five to six years, using crises such as COVID-19 and inflation as integration opportunities. "Trust, credibility and capability comes on foot and it leaves on horseback," he reflected. "So it's hard to build this. It's very easy to lose it."

Rethinking Pharma Resource Allocation

The evidence challenges pharma's commercial model assumptions. Traditional strategies emphasize deepening relationships with existing prescribers through advisory boards, speaker programs, and intensive management of high-decile physicians. If penetration drives growth more powerfully than frequency, resource allocation may be misaligned. The question becomes whether marginal investments in expanding prescriber bases would generate superior returns compared to incremental engagement with established prescribers.

Kusurkar's framework posits that brand growth requires only two elements: increased distribution and increased awareness. "In the end, the only way a brand works and becomes big is if it increases distribution and if it increases awareness," he stated. "I think that's it. Yeah, it is not more complex than this." Physical availability and mental availability must converge at decision moments.

For pharma, physical availability encompasses formulary access, inventory, prior authorization pathways, and sample availability. Mental availability involves prescriber awareness, category entry point associations, and recall at clinical decision moments. Occasion-based thinking translates directly to specialist initiation, primary care maintenance, hospital discharge, formulary reviews, and urgent care. Each occasion requires different availability strategies, and gaps at any point can limit penetration.

The Shell aviation fuel example shows that professional B2B decisions follow identical dynamics—73% airline penetration with moderate contract frequency outperforms deep relationships with narrow customer bases. "It even works in something like aviation fuel," Stern noted. The pharma context does not exempt brands from these patterns.

Building Capability for Sustainable Transformation

FrieslandCampina's experience reveals that evidence-based transformation cannot succeed as a marketing initiative alone. "Start from the top," Kusurkar emphasized. "This is not a program for marketeers. This is a program for everyone in the company." Leadership commitment, cross-functional engagement, and concrete tools are critical to embedding these principles.

Stern concluded with an architectural metaphor: marketers need to understand scientific principles before applying creativity, just as architects require physics before designing ambitious structures. "Just like architects, marketers need to understand the science and then put the creativity on top of that science," he stated. Effective marketing requires a foundation in evidence about how brands actually grow; creativity then determines how best to build mental and physical availability, maintain distinctiveness with consistency, and organize resources for penetration expansion.

For pharma executives, the key question is not whether these patterns apply—the prescribing data confirms they do—but how quickly they can redirect resources toward penetration-building strategies that evidence demonstrates drive sustainable growth.

To get you highlights of Pharma Customer Engagement EU faster, we are using generative AI technology to summarise the transcripts of the sessions. If you have any feedback about the summary, please contact lucy.fisher@thomsonreuters.com

"Out of all the last five years of innovative rare disease drugs which have been approved in Europe, 85% are available to German patients, reimbursed, available to German patients. 74% are available to Italian patients. Pretty much the same for French patients," she noted. "Do you know the amount that is available in the Nordic countries? Anywhere between 19% actually and 29% of these innovations."

This gap persists despite Nordic countries ranking among Europe's highest GDP nations, fundamentally challenging the narrative that rare disease drug costs create insurmountable affordability barriers. Instead, the data points to broken processes and stakeholder dynamics that prevent effective decision-making.

Katri Asikainen, President of HARSO—the Finnish Alliance representing approximately 400,000 rare disease patients across 28 disease and disability organizations—described the reimbursement reality facing patient advocates. "The reimbursement system in Finland for rare disease patients is broken. It's a black box system. We have no access to it," Asikainen explained. "We don't know—the only information we get from either of those dual systems in Finland is the name of the drug and the date that is going into those HTA bodies."

For ultra-rare populations, the challenge intensifies further. Rie Krabbe, HPP Patient Representative for Denmark's XLH Patient Association, explained her motivation for founding a patient organization despite managing three rare diagnoses herself.

"I was told that you can never have it, it's too expensive. So that's why I started to gather people with HPP in Denmark to try to make some visibility, to try to give us a voice," Krabbe said. "And we're only like 50 people in Denmark at the most diagnosed with HPP."

Communication Breakdowns in Clinical Care

Beyond access barriers, fundamental breakdowns in patient-physician communication prevent optimal care even when treatments exist. Vigier illustrated this with a clinical assessment story where a myasthenia gravis patient repeatedly answered "no problems chewing" to standardized questionnaires. "The nurse asked the second question. She said, when was the last time you had a steak? And the patient said, oh, no, I never have steak. I can't chew them," Vigier recounted. The anecdote reveals how consultation quality and question framing directly affect clinical data capture and treatment decisions.

Krabbe described her own clinical encounters with similar frustration, highlighting how time constraints and narrow specialty focus create incomplete patient assessments. "My disease is much more than a bone disease. It's a systemic disease. It's also muscle weakness, it's pain, it's a lot of other things, fatigue and such, brain fog. We didn't talk about that at all," she explained.

The knowledge gap extends beyond consultation quality to fundamental disease awareness among treating physicians. "Sometimes I get doctors who cannot pronounce my disease or who don't know that there is a drug and who don't know about the disease. They just look it up on like Wikipedia sites or something," Krabbe said. This knowledge asymmetry places patients in the untenable position of educating their own physicians while simultaneously seeking treatment.

Asikainen's experience reveals an even more fundamental gap in care continuity for rare disease patients without available treatments. "None of my diseases get any kind of ongoing survey or checkups from doctors. The only doctor that I see regularly is a dentist," Asikainen said. "So that tells a lot about the way—if you don't have a treatment or a cure or any kind of medication for your rare disease, you won't even necessarily be seen by a doctor for it."

From Patients to Advocates: Navigating System Failures

Both patient advocates described their pathway into advocacy work not as voluntary engagement but as necessary response to systemic failures. Asikainen's motivation was deeply personal, rooted in her own experience navigating multiple rare disease diagnoses simultaneously.

"I have four rare diseases myself. I'm a rare disease and disabled person," she explained. "And that brought me into patient advocacy because we were mistreated by the system and I was put in a place, by the system, by the society, that I could not get out of myself."

Krabbe similarly described her two-decade healthcare journey using language that captured the isolation and resource scarcity rare disease patients encounter. "I've been walking through the healthcare system for 20 years. I have three rare diagnoses," she noted. "But I've been walking—it's been a desert walk, trying to get help, trying to find a bus stop to move on and get some help."

Asikainen's advocacy work extends beyond individual patient support to legislative reform addressing systemic barriers. "We also have problems with research laws in Finland and usage of patients' information. So I do a lot of legislative work to get that on the side of rare disease patients so that our lives can be easier via the laws that govern us," Asikainen explained.

The financial burden on rare disease patients compounds clinical challenges. "The financial burden for rare disease patients is disproportionate compared to any other patient group out there. We are taking more on our individual backs and we still have a legislative uphill battle on getting things like disability retirements and sick leave," Asikainen said.

Krabbe emphasized the need for coordinated care that addresses patients holistically rather than fragmenting treatment across disconnected specialists. "For my co-patients to experience that they actually get a doctor that they feel like they're getting help and the doctor is seeing the whole patient, not just a single toe or foot or something," Krabbe explained. The burden of coordination falls to patients least equipped to manage it.

Redefining Pharma's Customer Model

Vigier argued that the pharma industry must fundamentally rethink its commercial model to address these systemic challenges. "We can't continue to consider customer and focus on super sophisticating our customer engagement when we talk about HCPs only," she stated. "We need, we must—of course payers are not hurdles, they are our customers. Society is our customer and patients are our customers."

The rare disease context offers particular urgency and opportunity for this transformation. "If we get it right in rare diseases, we will get it right in all the rest," Vigier argued. The logic suggests that engagement models effective for ultra-rare populations will scale effectively to larger therapeutic areas.

Central to this reimagining is recognizing that stakeholder groups operate with fundamentally different value definitions. "The biggest conundrum we're facing as pharma, in a way, is the very different perceptions of value by the different groups of customers, decision makers," Vigier explained. The solution requires convening rather than convincing—facilitating dialogue where stakeholders collaboratively define value.

Data supports pharma's ecosystem impact potential when engagement extends beyond traditional HCP audiences. "Do you guys know that rare disease patients spend on average about five years going from doctor to doctor before they get the first diagnosis?" Vigier noted. "And one thing that I was impressed by was there is a study lately that showed that basically as soon as there is an approved EMA treatment or FDA treatment, an approved treatment in a rare disease, that time is diminished by a factor of four."

Patient Education as Strategic Imperative

When asked how pharma could best support patients, Asikainen emphasized capability-building over awareness campaigns. "I'd say the key number one is educate the patients and you do that via the patient organizations. When we educate the patients to talk about themselves in a more non-passionate way to the doctors, we get a better response from them," she explained. "But we also need to educate the patients about the whole field and the bureaucratic jungle out there."

Asikainen described the complexity patients must navigate as requiring professional-level expertise. "It's not that simple that you just get sick and then you get a treatment—it's not like the flu when you have a chronic rare disease. It's a whole different ball game. And I say that it's being professionally sick because you're advocating for yourself," she said.

Building Trust Across the Value Chain

The session concluded with a call for trust-building across all stakeholder groups as the foundation for systemic change. "The last thing that I really would love to see more and more is trust between the stakeholders in the rare disease field. It's not just about us patients trusting the doctors, but the doctors trusting us patients, but also the pharma companies, the payers, the systems," Asikainen said.

Vigier synthesized the discussion into two core imperatives for the pharma industry moving forward. "HCPs are a diminishing part of your customers. There is a rising and a very important need to sort of consider the same way we're considering our HCPs as customers to consider patients, support their education, support their understanding and the relationship," she stated. "And the second thing I would like us to leave with is trust. Let's build that, let's use that." These twin priorities—expanding customer definition and building trust—frame the transformation required for pharma to effectively serve rare disease communities.

To get you highlights of Pharma Customer Engagement EU faster, we are using generative AI technology to summarise the transcripts of the sessions. If you have any feedback about the summary, please contact lucy.fisher@thomsonreuters.com.

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