Physicians and pharmaceutical reps face similar barriers regarding prescription medications. Commiserating and partnering could lead to success.

Being a pharmaceutical representative these days must be quite frustrating. More and more physicians are refusing to see reps and they are using fewer branded products. In addition, there are few new products with little new data to promote them. Finally, and possibly most importantly, insurance formularies have become an even bigger barrier for reps to get their products written.

However, pharma marketers and sales people would be wise to consider the situation from the physician’s point of view. Not long ago, there were many branded products in multiple classes of medications that were usually at even-tiered co-pay. Rarely did the patient or the insurance company second guesses the physician’s choice of therapy. Times have certainly changed. Patients’ requests for “don’t give me the generic,” have quickly changed to “does that come in a generic?” Daily emails and faxes arrive from the insurance companies and PBM’s requesting a switch to a cheaper brand, generic or another class of therapy altogether. Formulary status on certain medications changes so rapidly that even those physicians with the luxury of an EMR with formulary information can’t keep up. Media sound bites and lawyer ads regarding the latest “dangerous” drug generate multiple daily inquiries from worried patients. In other words, if you think you are frustrated with the current status of prescription medications, physicians are probably even more frustrated.

A smart approach would be shared misery. Pharmaceutical marketers and representatives would be wise to recognize these shared obstacles and become the physician’s ally in fighting them. Here are a few suggestions:

  1. Empathy. One of the first lessons we teach our medical students is how to become more empathetic, because we know that builds trust and strengthens the doctor-patient relationship. Acknowledging how hard our situation is, rather than focusing on writing your product as much as possible would go a long way.
  2. Identify barriers. As I have said before in this column, nothing is worse for a physician than a prior-authorization. Thus, proclaiming your product is preferred on “most formularies” is extremely unhelpful. Let us know when your product is NOT preferred so we can avoid the call from the pharmacist or angry patient.
  3. Proclaim victories, but quietly. Similar to identifying barriers, if a commonly prescribed competitor has moved from a preferred to difficult status, alerting physicians will also prevent pesky callbacks. However, an overly excited pharma representative’s “good news” may be perceived more as a sales pitch than a service, and therefore susceptible to physicians ignoring the message.
  4. Clarify battles worth fighting. Pharma marketers commonly create patient profiles to aid sales representatives and physicians in identifying candidates for their product, i.e. “Doctors, whenever you see a patient like Mrs. X we hope you will think of our product Y.” The problem is that in the current environment, a generic product or lower tier branded product is likely also appropriate for the marketed patient profile. What would be more helpful is identifying the patient where a particular product is truly needed and worth the lengthy prior authorization call to the insurance company.

Times are tough for both sales representatives and physicians when it comes to use of branded medications. Rather than pushing even harder against these barriers, representatives should recognize these similar frustrations and partner with physicians to achieve successful patient outcomes.

  • 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