Drug maker breaking new ground with grassroots marketing of BiDil

By Mark Jewell
Associated Press
(April 11, 2006) After services at a predominantly black church in Atlanta, parishioners in their Sunday best roll up their sleeves to get their blood pressure checked at a health screening where they learn about symptoms of heart failure and a new drug approved only for use in blacks.

At another black church in Detroit and a black health fair in Chicago, participants pick up pamphlets about the drug BiDil that are filled with patients' smiling black faces - not the usual sea of white faces with just a smattering of minorities.

In the nine months since BiDil became the first drug approved for a specific racial group, NitroMed Inc. has been sticking with narrowly targeted, homespun-style pitches as it tries to turn around disappointing initial sales that led two top executives to resign last month.

There's no plan to abandon NitroMed's grassroots-style marketing in favor of mass-media ad campaigns that accompany many drug launches. Meanwhile, NitroMed's sales force is focusing only on 144 U.S. metropolitan areas that have large black populations.

Such targeted marketing approaches are expected to become more common as technology continues to advance so treatments are more frequently tailored to individuals' genetic make-ups.

"In a sense, BiDil is a trial balloon for personalized medicine," said B.J. Jones, NitroMed's vice president of marketing.

In the near future, drug makers could get medications initially approved for a single racial group - then eventually seek even more narrow clearance for use among people with specific gene types. NitroMed said last month that researchers have identified gene variations that may determine which patients are most likely to benefit from BiDil - variations that aren't exclusive to blacks, meaning the drug might someday be approved for people of other races as well.

"Race is only a surrogate for ultimately looking at one's particular genes and proteins," said Dr. Flora Sam, a Boston Medical Center cardiologist who has prescribed BiDil.

That could have big implications for drug marketing in an era of personalized medicine.

"The more specialized the medicine gets, the smaller and smaller the target audience for a drug gets," said Nancy Barlow, president of Xchange, a firm specializing in highly targeted drug marketing.

While mass media campaigns aren't likely to disappear, industry experts say so-called "opt-in" marketing - in which patients respond to more-direct pitches via e-mail or at seminars - could become more common with personalized medicine, along with community events like those promoting BiDil.

"It's going to require a different approach - more technology-based, one-to-one marketing, where you really do get to speak to individuals one-on-one," said Sheri Rosenblatt of ad agency FCB HealthCare, whose clients include large drug companies.

The Rev. Cecelia GreeneBarr dislikes mass-media drug ads, so when an acquaintance who is also a BiDil sales representative asked her about hosting a session at her church, Trinity African Methodist Episcopal Church in Detroit, she signed up.

A NitroMed medical liaison discussed heart health and BiDil with two-dozen parishioners at what was billed as "Dinner with the Doctor," also featuring a low-fat meal.

"It was not a hard-core pitch at all," said GreeneBarr. "It was 90 percent educational. The people walked away with more than they would ever get from a commercial.

"When you see a TV commercial for a drug, it's not informational except for the blurb at the end about who shouldn't be taking it. A commercial is just pushing a drug, they're not pushing the educational piece."

The researchers who developed BiDil didn't start out looking for a drug that worked better for a particular racial group. After reviewing earlier studies indicating black participants in clinical trials benefited more from taking the drug than those of other races, NitroMed began its own study involving only blacks.

That study revealed a 43 percent reduction in deaths among black patients taking BiDil along with standard heart failure drugs, compared with those receiving standard therapy and a placebo.

So far, BiDil sales have fallen short of expectations, and NitroMed's chief executive officer and chief financial officer resigned March 21. Nine days later, the Lexington-based company announced plans to cut 30 research and development positions from its 100-person staff.

Initial BiDil sales came in at $4.5 million in last year's final six months from 14,000 prescriptions, behind some analysts' initial projections of around $200 million in annual sales next year.

Analysts and NitroMed officials agree the main problem is difficulty persuading pharmacy benefit plans to approve low patient co-payments for BiDil of around $20 a month, rather than the current $50 a month most plans charge.

To turn sales around, the company is focusing on increasing that insurance reimbursement by trying to convince health plans that BiDil offers easier dosing and greater health benefits than taking two older generic drugs. BiDil is a combination of those two drugs, which are approved for high blood pressure and heart pain but not for heart failure. The two together can increase the blood's level of nitric oxide, which is found in lower amounts in blacks and which has several roles in heart health.

NitroMed also has partnerships with the National Association for the Advancement of Colored People and the Association of Black Cardiologists to sponsor health screenings and reach more of the estimated 750,000 American blacks suffering from heart failure.

The first BiDil ads aren't expected until this summer, and those will run only in black media, including radio stations and community newspapers.

NitroMed also hopes to market a once- or twice-a-day version of BiDil, rather than the current three-tablets-a-day formulation.

"We think the product has great growth potential," Jerry Karabelas, NitroMed's new interim CEO, told analysts the day after his appointment.

Liana Moussatos, an analyst with Pacific Growth Equities, said a once-a-day formulation could prove a strong selling point and lead NitroMed to launch a mass-media campaign for BiDil.

Even if that doesn't happen, she believes NitroMed will get past its initial missteps and eventually see BiDil sales balloon.

"It's the classic things early in a launch that you have to go through," she said. "They're pioneers in a new market, and there is a learning curve."


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