Act Two From The Purple Pill

Linda Palczuk /Doug Levine /Suzanne Delaney

Blockbuster, the sequel: With new Nexium and Prilosec, AstraZeneca created a model for next-generation drugs.

One might say, in theater terms, that drug companies are masters of the first act. As the Millennium approached, pharmaceutical juggernauts paraded their medications in TV ads in front of not-so-healthy consumers-and voil! The industry had a string of runaway successes that it spun into household names: Prozac, Claritin, Lipitor, Paxil, Procrit, Viagra, Zyrtec, Zoloft.

The problem, of course, came when it was time for an encore. Drug patents expired, generics cut into profits and ongoing switches from prescription to over-the-counter meds left the pharmaceutical giants desperate to produce a compelling second act.

Now, all eyes are on the repeat performers known as next-generation drugs. Schering-Plough attempted that feat with Clarinex as a follow-up to its prescription allergy pill, Claritin, now OTC. But its effort has been a severe disappointment. Enter AstraZeneca with Nexium, the next-generation version of its "purple pill" stomach remedy, Prilosec. Nexium easily weathered last fall's OTC switch of Prilosec and remains neck and neck with TAP Pharmaceuticals' Prevacid atop the prescription stomach relief category, with sales of $2.1 billion through July '04, per IMS Health. Nexium's 2003 sales of $3.3 billion, per Med Ad News, already ranked it as the world's seventh-largest prescription drug. (Pfizer's Lipitor was No. 1, with $9.2 billion.) Prilosec OTC, meanwhile, is expected to ring up more than $400 million in sales this year.

By contrast, prior to the OTC launch of Claritin in 2002, fewer patients than expected switched to Clarinex, which generated relatively meager sales of $694 million in 2003. To be sure, Claritin's $600 million in retail sales have hardly compensated for what was once a $3 billion gold mine.

Having succeeded on many levels where Schering-Plough did not, AstraZeneca was the first drug company to establish a workable next-generation model. It moved quickly to ward off competition from Prevacid (whose patent expires next year) by launching Nexium back in 2001, whereas S-P milked Claritin as long as it could before developing a successor.

"AstraZeneca did a number of things right," said Gil Bashe, head of the healthcare unit at pr firm Makovsky, New York, who has consulted for Pharmacia and Schering-Plough. "One of the biggest was having Nexium and Prilosec share the same space: It wasn't afraid to market . . . two [similar] branded products."

And while consumers were given little reason to choose Clarinex over Claritin, AstraZeneca positioned Nexium's eso-phageal healing properties as a point of differentiation from the acid reflux treatment of Prilosec, even as it retained much of the latter's signature "purple pill" branding.

Additionally, the European company-with U.S. headquarters in Wilmington, Del.-facilitated the transition of Prilosec to OTC through a licensing arrangement with Procter & Gamble.

Over the years, antacid medicines such as Pepcid, Tagament and Zantac have made the switch to OTC, but none were followed by a more advanced prescription drug-a much tougher challenge. The next-generation pill must compete against its sibling, which, though established as the gold standard, becomes cheaper and more readily available. AstraZeneca, in particular, had a lot riding on its effort, as combined sales of prescription Prilosec and Nexium accounted for a third of its $18 billion in revenues in 2002.

Overcoming those obstacles, AstraZeneca built Nexium into a blockbuster drug in less than two years, thanks in large part to the integrated efforts of our Marketers of the Year: Linda Palczuk, executive director of commercial operations; Doug Levine, executive director of development; and Suzanne Delaney, director of consumer marketing.

Each division at AstraZeneca is responsible for a single drug, the result of a restructuring in early 2003. Levine, a medical doctor, has long worked in AstraZeneca's labs, while Palczuk marketed drug treatments for the central nervous system. The new operating model "gave us a very deep focus and understanding among customer segments," said Palczuk. "Previously, we didn't get the depth of input into the ongoing development studies on the brand. "Now there's so much integration, so we have the commercial and developmental view."From the very beginning, AstraZeneca had employed a simple but memorable way to brand Prilosec: its trademarked phrase, "the purple pill." It was an original marketing approach, one that only Pfizer has hinted at with its diamond-shaped blue Viagra pill.

By folding the purple heritage into Nexium, AstraZeneca deliberately called out the association with the drug to which consumers had grown loyal. At the same time, however, Nexium offered a clear distinction over Prilosec: an added ability to ease the pain of chronic heartburn, in which excess acid often leads to erosion of the esophagus.

"Our messaging was not, 'This is the new Prilosec,' but more like, 'This is Prilosec plus,'" said Delaney.

The evolution of Nexium ads illustrates how AstraZeneca capitalized on its "purple pill" heritage while establishing Nexium in its own right. Initially, the focus was on promoting the brand's connection to Prilosec. But with each successive campaign iteration, the emphasis shifted toward a message about Nexium's additional benefit.

TV ads, via Saatchi & Saatchi, New York, helped launch Nexium as "the new Purple Pill, from the makers of Prilosec." Those introductory spots used dramatic images of men and women on a steep cliff, proclaiming: "I'm every man . . . and every woman, who ever suffered from frequent persistent heartburn."

The effort was intended to offer consumers "comfort and familiarity that this new product was associated with something they'd heard of," explained Delaney. A second round of ads in late 2001 began to push the healing message, using images of impending danger, such as people standing near a river that morphs into a volcano. "Heartburn boils up, but the real threat is what lies beneath," a narrator warns. As the virtues of Nexium are rattled off, the hot lava becomes a meadow of purple flowers.

Subtle changes have accompanied more recent efforts. The tagline, for example, has evolved to "Stop the pain, heal the damage" and later, "Relief. Healing. Nexium." Later campaigns did not mention the term "purple pill" but rather used a purple hue as a backdrop for the narration, which included a more detailed explanation of esophagus erosion.

One spot takes place in an Italian restaurant. As a waiter describes the menu specials, a diner tunes out, hearing instead "sure to give you heartburn so bad, the acid may even eat away at the lining of your esophagus." A voiceover explains that Nexium "goes deeper to heal erosion acid can cause, so you don't just feel better, you are better."

A print ad in the campaign also vividly makes the point. A Photoshopped image of a carton of onion rings, against a purple background, replaces a portion of the rings with twist-tied steel. "If you suffer from acid reflux disease, any food can trigger an attack of heartburn," the copy warns. "And over time, all that churning acid could do real harm to your esophagus." The tagline refers to Nexium as "The Healing Purple Pill."

AstraZeneca spent a hefty $219 million on Nexium ads in 2003, per TNS/CMR, a 22% increase from 2002, making it the most heavily advertised drug to consumers last year. To keep up, TAP increased its ad spending on Prevacid 35% in '03, to $133 million.

Those investments could be crucial, given the lack of breathing room between the two category rivals. According to a recent study, Nexium had a slight edge in one regard over Prilosec. An August survey of 3,000 physicians by drug tracking firm Impact RX, Mount Laurel, N.J., showed that of the 427 requests for a branded PPI (Nexium's drug class, short for proton pump inhibitor), 29% asked for Nexium versus 26% for Prevacid.

Patrick Angelastro, vp-marketing and client services at Impact, said those numbers have remained steady over the last six months. "In general, the PPI market is promotionally sensitive," he said. "[Doctors] may not actually think there's much difference between the prescription PPIs, but will prescribe one over the other based on promotions or relationships with sales reps." Since its inception, Nexium ads have boasted a free trial as an enticement. But with the OTC launch in 2003, product promotions on Nexium were stepped up, in part to offset losses. Professional advertising, to boost new prescriptions, was increased by almost 60% in the first half of last year, according to the Journal Ad Review.

Levine and Palczuk agree that these efforts enabled the company to better address each type of customer-whether it's speaking about the disease to patients and doctors, or delivering an argument to insurers to cover the drug. "The way [acid reflux disease] is regarded is highly variable in different parts of the country," noted Levine. "In some cases, both patients and doctors trivialize the disease . . . they want to think of it as just a symptom [of an unhealthy] lifestyle."

AstraZeneca has done well to convince a significant number of patients to switch to its newer drug. In the period from February 2002 through January '03, for example, the number of Prilosec prescriptions written declined from 21.5 million to 17.1 million, while Nexium prescriptions grew from 15.1 million to 21.3 million, per NDC Health. (A contributing factor may be Nexium's relatively low price at $3.89 wholesale per capsule, versus Rx Prilosec at $3.69 per capsule.) Eventually, however, Prilosec could catch up with Nexium. Since the launch of Prilosec OTC, new prescriptions for Rx PPIs have declined 4.3%, versus average growth of 12.7% in the five months preceding the launch, per Goldman Sachs.

While AstraZeneca has in many respects paved the way for future next-generation drugs, the company has also come under scrutiny by industry critics for the chemical difference between Nexium and Prilosec. "Prilosec wasn't a slouch in healing-that was the challenge-but not all patients experience healing with Prilosec," said Levine.

More specifically, Nexium helps heal damage to the esophagus in 92-94% of patients with GERD (gastroesophageal reflux disease), whereas Prilosec helps esophageal erosion in 82-89% of patients. That may not sound like a significant difference, but AstraZeneca says it's meaningful because chronic acid and esophageal erosion is now thought to be linked to more serious diseases.

Levine describes Nexium as a single version of a drug mixture that has "metabolic advantages." When Nexium was in development in the mid '90s, he noted, single-molecule drugs weren't common. "It sounds simple to say, but it was a significant technological achievement to develop the chemistry to produce an optically pure isomer of Prilosec."
To keep consumers on the medication, commercial operations have been hammering the healing message. "If people are medically diagnosed with acid reflux, they're going to require continued drug therapy," said Levine. Sales reps have been visiting doctors' offices encouraging a dialogue with patients, emphasizing that healing is not correlated to the severity of symptoms and that GERD is chronic, requiring continued medication.

Going forward, the company has begun looking at ways to boost compliance, a practice that remains an enigma and a growth opportunity. (Brandweek, July 23). "We've just this year started with [the simpler] efforts, like refill reminders," said Delaney. "But we're also trying to help patients understand that GERD is not just heartburn; it needs to be actively managed and they need to be in close communication with their doctor to treat the disease."

TAP, meanwhile, is looking to match AstraZeneca's success when its Prevacid patent expires in 2009. For the time being, it is looking to additional forms, such as a dissolvable medication. Last month it licensed the rights to a micropump technology to aid the development of a time-release pill, which could extend the patent.

Palczuk, for one, is confident of success at AstraZeneca. For the remainder of 2004, she predicted: "Nexium is on target to be the top selling prescription PPI."

And that would surely spell relief.