The availability of generic Lipitor marks the beginning of the end of the blockbuster drug. Though certain pre-pharma-guideline activities such as meals and sporting events certainly helped to build relationships with physicians, there also used to exist a wealth of new information that representatives could bring to the physicians, and thus provided true value.Though branded products still exist and there are still a few more non-biologics on the way, the real question is whether, in today’s environment, pharmaceutical representatives can still provide value to a physician. Granted there are barriers to physician access, including time constraints and anti-industry policies and sentiment.However, providing value even for those physicians who are still willing to interact with representatives remains a challenge for the industry.

Part of the problem is that the value equation has changed, at least in the minds of patients and providers. Priorities used to be efficacy, safety, and cost—in that order.Now, those priorities are reversed. It doesn’t matter that new product X shows head-to-head superiority in a specific (often surrogate) end-point. If I can’t get it for $4 at Wal-Mart, then any efficacy data or new indication is essentially useless. In addition,most companies no longer hand out primary literature (reprints), even though this is still allowed by FDA policies. Yet, if the regulatory environment has limited conversations to nothing more than the package insert, why would a busy clinician bother interacting with a pharmaceutical representative?

If industry is still going to provide value to physicians via sales representatives, they must understand the current climate and adapt. Primary care physicians are overworked and thus have very limited time.With a horrible economy and the proliferation of $4 generics, patients are generally reluctant to cough up a tier 2co-pay unless a convincing argument can be made. Anti-industry reporting in the media and a barrage of DTC advertisements have increased skepticism towards the industry by both patients and providers.Understanding these and other changes lead to potential approaches that may still allow industry representatives to provide value to doctors. Here are just a few suggestions:
1. Recognizing that most physicians will always use a generic when possible, due to both patient preference and formulary restrictions; representatives should provide information regarding specific instances when a generic might not be the best option, rather than focus on why their product is simply better than a generic.
2. Provide information on how patients can get your product for less, i.e., coupon programs, formulary advantage.
3. Since nothing is worse for a physician than a prior-authorization, telling us that your product is preferred on “most formularies” is unhelpful. Tell us when it would be difficult to get your product so we can avoid the call from the pharmacist or angry patient.
4. Competitive marketing against another class of medications in the same disease state is confusing and thus counterproductive.Industry reps should embrace the need for multiple classes of agents within a given disease. Physicians would prefer to hear about the types of patients on whom one drug’s class works particularly well, as well as the patients for whom the drug’s class does not work as well or is even harmful.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at


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