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2. 2 EU DTCA Ban: Effect on Patient Awareness & Influence on Prescribing Carol Faverger Rosalyn Twite Director Director

3. 3 Context: Direct to Consumer Advertising in EU Advertising non-prescription medicines Generally allowed, but with restrictions Advertising Prescription medicines Prohibited as per The Advertising Regulations 1994, which implement EU directive 92/28/EC Exceptions allow information on prescription only medicines (POMs) to be provided to the public e.g. reference materials (without product claims), human health and disease related statements with no direct or indirect reference to the product

4. 4 Crystal Ball Questions Given DTCA of POMS in EU is banned, have we under-estimated the role of patients in prescribing decisions when conducting research? Are patients being influenced by other means? Are we reaching out to the correct decision makers when conducting our research? Has the DTCA ban really led to less-informed patients in EU than in the USA? In the future, should we be increasingly focusing on patients as decision makers ?

5. 5 Gauging the True Influencers: Method KQH linked up with Research Now

6. Are patients discussing / just accepting?

7. 7 Findings Majority across all countries are accepting without discussion Drs and patients agree that in over 80% of cases there will be no discussion Drs also state in over 80% of cases there is no discussion BUT patient responses flag up a greater willingness to mention alternatives (30 – 47%) EU patients self report as being more likely to accept without discussion (74% EU average vs 56% US) Awareness of alternatives significantly higher amongst US patients (47% vs 28% EU average)

8. If neither suggesting alternatives nor accepting.. Main concern was to learn more of side effects and efficacy Reluctant patients who are not keen on taking drugs Like to confirm medication choice with a Specialist Financial side mentioned Patients discuss with Pharmacist “Many patients have preconceived ideas about what product should achieve which results” Fear that physician will prescribe the cheapest possible alternative

9. Patient Influencers

10. 10 Findings Physician main sources: articles, internet & advertising Patient main sources: internet, articles & educational leaflets Advertising high in EU despite DTC Advertising ban? US patients self report that they use ALL sources of info more than EU Physicians report higher use than patients

11. 11 Other sources uncovered 18-20% of PCPs mentioned other sources Patients & PCPs in all countries mentioned friends & family as the main other source Pharmacists Patients consult with a specialist Other patients

12. Patients actively searching for information on drugs

13. Findings An average of 24% of patients across all countries have not searched for information – very high in France (39%) Internet leads – average 66% across all countries Educational leaflets next most common - 26% average, helped by high proportions in US and Italy (34%) Friends & Family – All Specialists Pharmacists Other patients

14. Awareness of Pharma Cos / Associations

15. Awareness of Pharma Companies

16. Is patient input growing?

17. Why patients are more likely to discuss different drug choices – The Physician Viewpoint More information available But are they better informed? Doubts on validity of source of information Searching for cheaper alternatives

18. Why patients are more likely to discuss different drug choices – The Patient Viewpoint More information available Drs seen as more approachable Cost Increased concern about side effects

19. Drug most asked about in the last 12 months

20. Today Perceptions of Physicians and Patients vary EU DTCA ban less impact than expected? Patient apathy in France & Spain? Patients more likely to discuss alternative drug choices than 5 years ago Patients self-educating primarily using the internet, then educational leaflets, then the media Side effects and cost driving patients search for information

21. Tomorrow – in the Crystal Ball … Patient use of support groups rises Greater collaboration between Physician and patient Increased focus in media on health related issues Patients more aware of cost considerations Increasing role of alternative medicine EU / USA awareness distinction narrows

22. 22 For more information, please contact... Carol Faverger Director +44 (0)20 8090 5547 carolf@keyquesthealth.com Rosalyn Twite Director +44 (0)20 8090 5549 rosalynt@keyquesthealth.com