Why Company Promotion Isn’t Enough: Managed Market Access

In an increasingly competitive market, pharmaceutical and biotech companies are actively seeking ways to meet physicians’ evolving service and information needs. While many manufacturers have focused on traditional company promotion (Figure 1), a new model (“Total Prescriber Influence,” TPI) suggests that such tunnel vision can be a losing strategy—company promotion typically accounts for only one-quarter of the influence that shapes physicians’ future prescribing behavior. The TPI approach measures the influence of forces— beyond company promotion—that drive prescribing. The approach quantifies the influence of more than 15 factors on physician prescribing across seven categories: anticoagulants/anti-platelets, cardiovascular, asthma/COPD, antiretrovirals, hypoglycemics, multiple sclerosis, and rheumatoid arthritis.

Four forces drive physicians’ future prescribing decisions (Figure 2):

Company Promotion. Sales behaviors and resource utilization, marketing programs, and support resources.

Outside Information Sources. Information the physician reads or hears.

Environmental Factors. Changes in the professional “weather,” such as modifications in formulary status, new product launches, or generic entry.

Product Experience. The physician’s conclusions about his or her treatment experiences and patient feedback.

Over the past three years, this model has guided the gathering of more than 25,000 physician product observations across 13 therapeutic categories and 15 physician specialties. These data were then correlated with subsequent prescribing behavior to produce a predictive model. For example, a 10-point increase in a brand’s TPI score corresponds to a 20% increase in favorable prescribing outlook.

While many pharma marketers continue to focus their efforts on sales representatives, their interactions with physicians, and the resources they provide prescribers, this broader analysis shows that sales-force activity typically only accounts for about one-quarter of the physicians’ prescribing decisions (Figure 3). The other measured factors— outside information, environment factors, and physicians’ product experience—are each nearly as important as company promotion. Only by combining them can we form a complete picture of what drives physician prescribing.

The interplay of the four forces varies by product category, but the model can be adjusted to highlight areas of competitive advantages or vulnerability, diagnose underlying causes, and determine the most useful strategies and tactics for increasing brand effectiveness. This approach measures execution by assigning scores (which brand marketers can use to determine where they stand in a category). The maximum score a brand can receive is 100, representing ideal performance on all four forces—it’s a 2400 on your SATs. Brands that score 100 are maximizing their outlook for favorable future prescribing (Figure 4). Guided by the index numbers, brand marketers can see how to alter their strategies, increase their scores, and therefore up their prescriber influence.

To make the TPI model work for them, marketers need to be keenly aware of the role that each of the four forces plays in physician decision making. Here is how they break down.




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Physicians continue to want information and services from pharmaceutical and biotech companies, and such efforts still have high potential to change prescribing behavior. However, companies that focus solely on promotion are missing significant opportunities, since it is only one of four forces that influence physicians’ future prescribing decisions. Some of the factors include:

Marketing programs and support resources. The metric assesses 18 factors, such as patient education, e-detailing, and Web-based programs.

Representative behaviors and resource utilization, which includes an assessment of representative knowledge, skills, and resource utilization grouped into six building blocks:
• Clinical Expertise.
• Current Information.
• Customer Focus.
• Patient Management.
• Selling Skills.
• Resource Utilization.


The influence of product experience is also significant in predicting physicians’ future prescribing behavior. After one positive clinical experience, physicians are likely to reuse products with similar patients. With sustained success, physicians expand their product use to other patient types—in other words, good experiences create a “snowball effect.” (The components of the snowball effect: trial with ideal patient; positive outcome and patient feedback; prescriptions to new patient sets; more positive feedback; continued and broadened use.) The elements of this dynamic include:

Patient feedback, specifically positive patient feedback received for each product in the past year.

Treatment outcomes, including assessment of key product attributes such as safety and efficacy. The index should also encapsulate physician perceptions of certain category-specific product attributes, such as variability in patient response and bleeding risk across anticoagulant brands.


Outside information sources continue to grow in importance as factors influencing future prescribing decisions. Some of these metrics include:
Journal publications.
Expert panel/medical association advocacy.
Peer advocacy, specifically attitudes of peers towards each product.
Third-party Internet sources, (e.g., Epocrates, Medscape, WebMD, UpToDate) for each product.


Environmental factors that play a role in influencing future prescribing behavior include:
• Managed care interventions, such as prescribing interventions and out-of-pocket expense for each product.
Product class attributes.
Influence of prescribing management within health information technology systems.

This evolving model offers new tools for brand marketers to measure and improve the success of their tactics and strategies by category. It underscores the importance of a broad approach to maximizing future prescribing, an approach that looks beyond company promotion alone. Companies that maintain a multi-pronged approach to their marketing efforts are much more likely to be successful as competition continues to heighten.

  • Tom Martin

    Tom Martin is Research Director with Health Strategies Group and author of the Health Plan Oncology Pathways Insight and Evolution report. He has more than 20 years of experience assisting pharmaceutical companies in developing brand and customer strategies to help them realize opportunities for growth and increased profitability.


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