A myriad of factors will affect pharma’s approach to sales in the next year including the implementation of the Affordable Care Act, the increase of Accountable Care Organizations (ACOs), a shift to a pay-for-outcomes system and, of course, the continually shrinking sales force. We asked a cross section of industry experts to give us their best strategy to overcome the many challenges.
Todd N. Smith
Executive Vice President
Chief Commercial Ofﬁcer
In order to meet performance goals in today’s environment, companies need to move away from reach and frequency to a true business outcomes selling model. Though the HCP’s potential prescribing volume remains important, reps also must consider the ability of the HCP to prescribe a product (managed care access), their willingness to write that product considering barriers and fatigue associated with today’s market environment.
The role of the rep has shifted to managing a book of business. In addition to selling, the rep must educate and support the ofﬁce staff to effectively manage pharmacy and patient call backs as well as inform the pharmacy on product beneﬁts and the importance of dispensing as written.
Smaller, more effective sales forces require a change in hiring proﬁle. At Horizon, we consider the following: Has the rep launched in a market where their product won’t be a blockbuster or where managed care will be an issue? Do they have business-to-business selling experience and understand partnering with customers to ensure product pull-through?
One of the most effective strategies we have implemented is empowering our sales force to walk away from customers who aren’t writing our product, despite the potential prescribing volume. We have found that if a HCP hasn’t written our product by the sixth call, there is less than an approximately 10% chance the HCP will ever prescribe our product. At that point, our reps are trained to have a direct conversation about what he/ she could have done or said to encourage the HCP to trial the product.
Because sales reps have become business managers, marketing and managed care have shifted from a top-down to bottom-up mindset. Local- and prescriber-level issues should drive these functions and roll up to a national level instead of programs being created at a national level and pushed down to a territory level. Marketing and managed care dollars are shifting from programs and promotional materials to solving access issues.
VP Marketing, Healthcare
As life sciences companies are pressed to better demonstrate the value they bring to patients and other stakeholders, the same demand is being made of the tools and providers that serve pharma and life sciences. In the commercial area, this means systems and processes that have treated marketing and sales as loosely connected, parallel activities are no longer acceptable. Healthcare marketers and sales reps, rather than addressing different “sides” of the customer interaction, are bridging that gap with the incredible opportunities that current technology offers. In effect, technology, marketing and sales are converging to deliver comprehensive management of campaigns, customer experience and optimization.
There are three key capabilities needed to make this shift happen: data for all personal and non-personal activities integrated by customer, campaign management serving as “air trafﬁc control” to direct all tactics (including sales calls), and real-time insights/analytics. Many companies are leveraging cloud-based tools that provide ﬂexibility to quickly integrate new vendors, data and features to the marketing process. This, combined with digital tools such as iPads in the hands of the reps, will enable a new kind of ﬂexibility in the selling model, including:
• Territory call lists becoming much more dynamic, driven by real-time campaign management across channels.
• Dynamic messaging and content served to the sales team at point of call based on the most current activity and analysis of the customer.
• Seamless experience when customers subsequently access self-service channels such as web and call center.
• Ability for marketing to quickly adjust the throttle in applying resources to a speciﬁc customer based on value and predicted likelihood of return.
• Having non-personal promotion triggered by representatives via the central marketing system, using pre-set customization options.
This will result in a much smoother continuum between personal and non-personal efforts, carefully titrated through campaign management, with just the right touch for each customer based on his or her needs, preferences and value.
Dr. Samuel Dyer
Chairman of the Board
Medical Science Liaison Society
Over the last several years, the pharmaceutical industry has seen a dramatic decrease in the number of sales reps. This paradigm shift has been driven, in part, by direct feedback from physicians and Key Opinion Leaders (KOLs) regarding the perceived value that sales reps deliver.
Traditionally, pharma companies have considered the relationship between sales reps and KOLs to be very valuable. However, over the last several years, physicians and KOLs have increasingly reported that they actually prefer to engage with and place a much higher value on the information they receive from Medical Science Liaisons (MSLs). This preference is reportedly due to the level and depth of clinical exchange that physicians have with MSLs versus sales reps whose primary role is to promote. Even though the sales rep-physician relationship will continue to be vital to the success of pharma companies, physicians will likely increasingly prefer to engage with MSLs because of their ability to have peer-to-peer, non-promotional conversations. As a result, the MSL role has seen exponential growth during this same period and is increasingly playing a crucial role in the success of global pharmaceutical companies due to the value that they bring to KOL relationships.
A number of recent studies have demonstrated this paradigm shift. In one study conducted by Thought Leader Select, both top and emerging KOLs reported that they prefer to engage primarily with MSLs versus sales reps, with less than 3% of respondents favoring sales reps. In another study, also by Thought Leader Select, physicians placed a 30% higher value on the information they received from MSLs versus the information they received from sales reps. Pharma companies can adapt to this paradigm shift and overcome the shrinking sales force presence by addressing the perception that KOLs have regarding the value that sales reps deliver.
One proven way to help overcome current sales challenges is to patch leaky buckets. During the boom times of the 80s and 90s, pharma was willing and able to live with leaky buckets. Blockbusters were providing such rapid and sustained revenue growth (water pouring into the bucket) that high prescription (Rx) abandonment, poor compliance and dismal adherence (water leaking out of the bucket) were not overly worrisome. But in today’s low-inﬂow environment, Rx abandonment rates of 20% to 30% take too large a toll on sales, and 50% adherence rates just can’t be tolerated. These days, brand managers are working overtime to plug leaks wherever possible. But what interventions truly increase adherence? Let’s check the latest published data.
A September 2012 article from Annals of Internal Medicine (bit.ly/AOIM2012) provides a robust meta-analysis of 67 published trials of 18 types of interventions intended to improve medication adherence for chronic diseases including diabetes, hyperlipidemia, asthma, depression, etc. After crunching all the data, only three of the interventions improved adherence across multiple clinical conditions. The authors found “robust evidence that reduced out-of-pocket expenses improved medication adherence across clinical conditions.” Beyond that, just case management and patient-level educational interventions with behavioral support enhanced adherence in more than one clinical condition. The investigators went on to note that compared with other effective interventions that are relatively complex and labor intensive, “reducing copayments can potentially improve adherence for large numbers of geographically diverse patients.”
The bottom line? Take a long hard look at where your bucket is leaking. Is your initial abandonment rate too high? What about day-to-day compliance? Or reﬁll adherence? Fight aggressively to hold on to those patients. In these tough times, you can’t afford these leaks. And besides, scripts that go unﬁlled can’t help patients to live longer and healthier lives, which is our primary goal.
David M Paragamian
Group Company President, North America
The ApotheCom Group: ApotheCom; Apothe-Com ScopeMedical, Axiom companies
Readers of this magazine have heard the news, and seen with their own eyes, the transformation in the pharma selling model over the past several years. Pharmaceutical and biotech sales forces have been “right-sized,” realigned to include a mix of MSLs, and redeployed with iPads, but they have not been replaced. While the state of the industry rightly suggests that sales force size may continue to shrink and sales force tools may change, there is something special about a face-to-face conversation about patient needs, the disease state and the company’s solution set. That something special is added value. Now, more than ever, it is imperative that the rep deliver value.
One of the most important ways for that to happen is to send a rep in armed with knowledge and training— exactly the types of things that took too much time in the old school model. It used to be that training for new reps was two weeks in the company facility and lots of Marriot points. Today, we can deliver that training in an e-environment so the rep trains on his/ her own time, in his/her environment and comes to the new, shorter sales meeting ready to go. This new model relies on partner agencies with sales learning tools to deliver high-science content in order to make the rep a value-added partner to the physician. And, this new model also requires a sales training and delivery tool that can be both laptop and iPad compatible, as different pharma companies are in different states of embracing these technologies. This technology agnostic e-delivery exists with software solutions now available that works on the rep’s laptop, iPad and smartphone, delivering the high science coursework that is now required.
The pharma ﬁeld sales model has changed, but not vanished. Smart reps with smart tools get access and get results.
It’s interesting to note that the shrinking of sales forces has been due to budget constraints and not because pharma leadership thought it was the most strategic way to grow their business. Until recently, no one got ﬁred for spending too much money on reps; it was the most reliable way to reach target physicians. Until it wasn’t. But even then, few managers were willing to risk relying on non-personal channels or restructuring the sales force into a more efﬁcient organization.
There are several strategic “by-products” of this forced shrinkage, all of which could bring new life to a brand’s customer relationships and new productivity to its sales efforts.
First, having to suddenly do more with less has a unique way of focusing the mind. Targeting and segmentation gets a fresh look. Deﬁning who is a “most-valuable customer” and even more importantly, who is a “most-growable customer” gets the attention it deserves. Our research shows that conventional targeting often misses up to 40% of potential prescription writers and may focus too much time chasing physicians who aren’t worth the investment. These are opportunity costs that were seldom obvious when a brand was rich in Primary Detail Equivalents.
Second, a smaller sales force actually offers greater business experience for the right sales rep. As sales forces consolidate, there is a real opportunity for sales reps to take on a portfolio of customers and products and treat them as a small business. This leverages the most important beneﬁt of a personal sales force: the relationship.
Finally, non-personal relationship marketing is getting its 15 minutes on stage to prove its value. What we’re ﬁnding is that it not only makes the remaining sales reps much more productive, but it cracks open access to the lower-decile customer ranks in a way that is more strategic and integrated into the formal sales plan.
Senior Principal and Center of Excellence – Commercial Models
The rapidly changing pharmaceutical marketplace demands a more holistic perspective and understanding of inﬂuence attributes, including the growth of health systems, an increased focus on generics and specialty products, an increased reliance on non-personal promotion that has marginalized reps, and rep access being further limited by integrated managed markets. To this end, the emerging challenge is to understand the multi-dimensional interactions and dependencies between varied marketing and sales communication platforms and inﬂuence interaction points. Internal interaction points include digital, social media, promotion and advertising while externally integrated delivery networks (IDNs), accountable care organizations (ACOs), payer formulary status and hospital formulary all have a signiﬁcant impact on the prescribing paradigm. Understanding these inﬂuence dynamics is critical to improve and support the current commercial and contracting strategies.
One of the key emerging stakeholders is Health Systems (IDNs, corporate parents and group practices). These are networks of facilities and providers working together to offer a continuum of care to a speciﬁc market or geographic area. Health Systems, primarily IDNs, emerged to address common concerns like capitation, excess capacity, decreased margins and complaints from patients regarding access. Often IDNs are under the management of a corporate entity and share formularies and treatment protocols. And although a newcomer in the market landscape, ACOs are also taking on a larger role from an inﬂuence perspective—around 90 ACOs that cover over 2.5 million beneﬁciaries.
The continued emergence and increasing power of IDNs and payers has motivated the pharmaceutical industry to re-evaluate its commercial strategy. Many pharmacos are migrating away from a share of voice model with a smarter approach that integrates multiple inﬂuence factors. Understanding the next generation commercial model requires an understanding of the increasing inﬂuences on physician prescribing. Regionalization of commercial approaches combining sales force effectiveness, key account management, contracting strategies and patient-centric marketing tactics ultimately pays signiﬁcant dividends from a proﬁt and loss perspective.