We've consulted our crystal ball (okay, actually our team chat) and come up with some predictions for 2019, along with the key trends that stood out to our analysts in 2018.

Ten trends that stood out in 2018:

  • Health applications of chatbots go from shiny and new to tried and true, and pioneering companies are beginning to figure out how to use them to triage inquiries and smooth the customer experience without falling afoul of legal regulatory boundaries.
  • Health AI has a “Last Mile problem” – Watson shows great promise but foibles recall those of driverless cars. The technology is amazing at validating diagnoses against what an MSK oncologist would say, but continues to suffer from cultural and organization-specific blind spots and data constraints, and with lives at stake, close ain’t gonna cut it.
  • GDPR and its California cousin prompt a rethink of data privacy protections, forcing industry to get its act together, build out data management capabilities and negotiate with patients for the use of their data.
  • Substantial improvements in wearables, with ECG applications showing particular promise and BG meters getting smaller and more sophisticated -- but wellness programs’ worth is increasingly in doubt.
  • Physicians’ rage at EHRs boils over in the U.S., even as their potential to tap big data begins to bear fruit; voice tech shows promise to alleviate some of that suffering, but it’s early days yet for the technology. At least the NHS is throwing out its fax machines?
  • Payer and IDN marketing comes into focus for pharma amid continued erosion in physician prescribing autonomy.
  • Pharmas bring on high-level digital and consumer marketing expertise, with several leading companies appointing Chief Digital Officers for the first time (Lidia Fonseca joining Pfizer from Quest Diagnostics, Karenann Terrell joining GSK from Walmart, and Bertrand Bodson joining Novartis from Sainsbury's Argos).
  • An Amazon-induced scramble for scale sees the rise of a new type of vertically-integrated healthcare megalith in the U.S., from CVS+Aetna to Cigna+ExpressScripts, UnitedHealth+DaVita, Humana’s hospice push, etc.
  • Social media’s mystery fades as a small set of dominant platforms selling out-of-box solutions (Facebook on the consumer side, LinkedIn, Doximity and Sermo for professionals) emerge.
  • Copay accumulators emerge as the latest weapon in the eternal discounting arms race between pharma and insurers in the U.S. Could this be the end for co-pay cards and coupons? Probably not, but stay tuned!

Nine predictions for 2019:

  • The sun begins to set on the Age of the Pharmaceutical Sales Rep as automation shifts an increasing number of traditional rep responsibilities over to chatbots, on-demand webinars and other forms of non-personal engagement. This won’t happen overnight – physicians in many markets and specialties continue to value the rep relationship – but in 2019, we’ll begin to see field forces taper down earlier in the product cycle as companies ramp up investment in NPP (M3’s partnership with Novartis Oncology on a sample-ordering Amazon Ping button is a prime (rimshot) example of this).  Given the enormous hegemonic power pharma sales orgs have exerted on larger commercial orgs, this will portend broader shifts in pharma commercial culture.
  • Med affairs faces automation, too, as more pharmas tinker with using chatbots – tightly scripted, narrow pathway, clear guardrails – to triage physician and other HCP inquiries. You can already see this phenomenon on Pfizer’s medical affairs site, where Medibot, reminiscent of the Jetsons’ Uniblab, fields physicians’ questions.
  • Pharma’s initial forays into chatbots and AI will be concentrated in apps for healthcare professionals, sidestepping the higher regulatory burden that comes with consumer applications. They’ll be tightly scripted, narrowly focused and clunkily utilitarian. But a few brave pharmas will branch out into consumer-directed efforts – as Novartis has already with its Alia Facebook Messenger chatbot.
  • Facebook is 2019’s Outcome Health – pharma just can’t quit it, but the platform is losing its luster, and a chunk of its user base in The West, amid a cascade of damaging revelations about its sketchy handling of customer data and exploitation by malevolent state and extra-state actors around the globe. Add to that the parallel collapse in advertiser confidence and we may see pharmas hedging their bets by placing more of their budget in endemic health platforms.
  • Massive real-time patient data and genetic data sets come into play for clinical trials and patient care. Apple Watch and its competitors are becoming standard issue for insurers and commonplace in clinical trials. Meanwhile, 23andMe and other consumer genetic testing firms are seeing their data sets swell just as their commercial model begins to gel.
  • Digital therapeutics prove to be as risky a bet for pharma as drugs – and pharmas clamor to invest and partner. You might think the failure of the most-hyped of Alcon’s partnerships with Alphabet’s Verily, on a blood glucose-reading contact lens, might dampen the fervor for pharma investment in digital or digitally-augmented treatments. But this will probably be the year of the first prescription videogame (Akili’s ADHD treatment is with FDA), and digital treatments for pain are in the works, too (FDA just greenlighted Pear’s app for opioid addiction).
  • Biosimilars crash the party, and market themselves much like traditional branded biologics do. Launches of brands looking to play in crowded and lucrative categories like RA and oncology will aim to make a splash, and will air TV ads and field substantial sales forces to generate awareness. But the real competition will be wooing payers, and the makers of incumbent biologics will need to sweeten the pot substantially to preserve their market positions, while trumpeting their trusted-brand status to all stakeholders.
  • Political whiplash as Trump actually gets tough with pharma and Brexit causes disruption. It’s one of the biggest wild cards in Washington: Does Trump deal with Congressional Democrats on a plan to Get Pharma? So far, the Trump Administration has talked tough on drug prices but been a pussycat in practice. Democrats will offer Trump an opportunity to play up his Man-of-the-People, anti-establishment cred and join them in soaking Big Bad Pharma. Odds are he’ll take it, particularly as the economic situation and the various investigations darken going into a presidential election cycle, and a Republican Senate may have to play along. Question remains: would bipartisan moves to address pricing tend toward the symbolic (prices in drug ads) or the substantive (say, sanctioning CMS price negotiation with pharmas)? Meanwhile, across the pond, Brexit promises to be highly disruptive to pharmas in 2019, on both sides of the divorce. Hard or soft, “Norway” or No Way, Brexit will cause shortages of therapeutics and force an abrupt realignment of regulatory and administrative structures.

Biotech set for good start to 2021

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