The Challenges Ahead

As a big part of the medical activity associated with Cialis culminated in the application to the FDA in June of 2001, attention was now focused on the marketing challenges that lay ahead. In preparation for the upcoming brand council, Brown and Blum reviewed the results of the extensive market research conducted over the past two and a half years. Several issues needed to be resolved for the product team to be able to present a coherent strategy to the affiliates. First, it was important to agree on the patient target market. On the one hand, it seemed logical to consider Viagra usage status in any segmentation scheme. After all, someone who discontinued using that drug was probably dissatisfied with it for some reason or another. Given that by the end of 2001 there were an estimated 6 million to 7 million Viagra dropouts in the U.S. (compared to 3 million Viagra current users), this seemed fertile ground. On the other hand, age and comorbidities seemed potentially relevant as well. Furthermore, it was important to understand which product benefits to emphasize and how. Would the longer duration of Cialis be equally valued by all ED patients? Was the lack of interaction with high-fat meals important? Should the answer to these questions differ for Europe vs. the U.S.?

Second, given that the marketing budget for all affiliates was not unlimited, there was a need to understand the relative emphasis to be placed on physicians vs. patients. Without doctors signing for Cialis, no patient would realistically be able to get hold of it. Yet, given that Cialis was considered a “quality-of-life” drug, it was becoming clear that doctors alone might not hold the key to success. Even if the correct balance between these two parties was found, should the same benefits highlighted to doctors also be highlighted to men suffering from ED? Kershisnik (executive director, GMP) also prompted consideration of the role, if any, partners should play in the marketing of Cialis. Some, like Beebe, the U.S. brand leader, saw a potential risk in alienating men if too many messages were directed to partners.

Third, there were competitive pressures to take into account. While clinically both drugs were well tolerated by patients (despite the much longer half-life of Cialis), Brown estimated that Viagra would take full advantage of its nearly five years of being tried and tested. With Viagra years past its initial “death-scare” episode, it was not clear how easy it would be to convince doctors to switch. Recent discussions with many primary-care physicians revealed a certain degree of contentment with Viagra. The drug enabled many men to have sex, did not linger in their body, and hence could be considered a reasonable solution to the medical problem.

Given the similarity of the product profile of Levitra to that of Viagra, some industry observers predicted Bayer would go for a niche strategy by targeting diabetic patients with ED. At any rate, the Cialis team was well aware of analyst predictions for a fierce marketing war between all three companies that would make ED drugs, in the United States at least, the most heavily advertised category of pharmaceuticals.

In addition to addressing the above issues, there were several other decisions to be made. There was a debate on whether Cialis should be priced higher than Viagra’s $10 per pill to reflect its longer duration, or lower, due to the fact that for the vast majority of ED patients the drug would not be fully covered by their health insurance plan (see Exhibit 9a). With respect to direct-to-consumer advertising, the central theme of TV ads that would be produced over the summer had yet to be decided. Should Cialis ads also have a sports-related theme? Should they feature celebrities? If so, which ones?

As Brown, Blum, and Beebe were getting ready to make their final recommendations to Barbato— and then to the Lilly ICOS LLC board—in advance of the January brand council, they likened their decision on how to position the Cialis brand to that of a baseball player stepping up to the plate: “We feel like we have just been handed the baseball bat, and, as the ball is getting closer, we have to decide whether to take the risk and try to swing for a home run or, at the other extreme, be more conservative and merely try to reach first base.”

Exhibit 1 Comorbidities Associated with ED

Source: Internal Lilly ICOS document.

Exhibit 2 Reactions to Viagra in the Popular Media

Source: Image: Christian Kargle, Getty Images.

Source: Copyright 2002 Mick Stevens from cartoonbank.com. All rights reserved.

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