Limiting Sales Rep Access to Physicians

Transcription

1 May 2017 Vol. 16, No. 2 Pharma Marketing Network Limiting Sales Rep Access to Physicians Do the Benefits Outweigh the Risks? Author: John Mack Published by: Pharma Marketing Network

2 Contents Introduction... 1 #Pharma Sales Reps: Declined & Denied!... 3 Restricting #Pharma Sales Rep Access to Docs Cuts Down Branded Drug Rx s... 4 Allowing Pharma Sales Reps to Discuss Off- Label Drug Use Would Make Them More Helpful, Says KevinMD... 5 Novartis Must Reveal Details of 79,200 "Sham" Physician Speaker Events... 6 Chicago Ordinance to Require Pharma Sales Reps to be Licensed "May Be Helpful, But Has Limitations"... 7 GSK's "Ethical" Sales Model: Is It a #Pharma Oxymoron? Pharma Marketing Network. All rights reserved. Pharma Marketing News

3 P harmaceutical sales representatives are faced with increasingly limited access to physicians. According to ZS a consultancy that provides research on physician access only 44% of physicians were considered accessible by pharma sales reps in 2016, compared to 47% in 2015, 51% in 2014, 55% in 2013 and 65% in One way that the pharmaceutical industry may be dealing with the problem is to reduce the number of sales reps, especially the low-performing reps. In 2006 there were nearly 105,000 reps in the field. By 2014 that number decreased to about 60,000. Although most of that decrease may have been due to a decline in products coming to market during that period, limited rep access also played a role and continues to do so. Another tactic is to target prescribers other than physicians, such as nurse practitioners and physician assistants. ZS found that 53% of these prescribers are accessible, compared to 44% of physicians. Why are more and more physicians limiting access to drug company sales reps? As pointed out by my friend Rich Meyer at World of DTC Marketing, [Physicians] are under more pressure than ever to make their practices profitable and really don t have time for conventional sales reps who are usually trained over one or two days and sent to try and have a peer to peer conversation with them. In addition a lot of drugs really don t require a sales rep to interact with physicians. Meanwhile, a report published by Cegedim Strategic Data found that many physicians like the convenience of non-personal digital detailing such as communications, video streaming, automated detailing, and webinars that can be viewed on demand. Consequently, the pharmaceutical industry is in the process of moving its sales force to a smaller structure that is more directly aligned with this new digital reality. Physicians also have access to many other sources of information about the drugs they prescribe and feel that sales reps do not offer unbiased information, especially when their incentive is a commission based on scripts written. That is one reason why many academic medical centers have instituted conflict of interest policies restricting detailing by pharma sales reps. These institutions believe that detailing which most often includes a meal along with an educational presentation is associated with higher rates of prescribing 2017 Pharma Marketing Network. All rights reserved. Pharma Marketing News expensive brand-name drugs, even when equally effective and cheaper generics are available. To test that hypothesis, an NIH-funded study looked at how conflict of interest policies affect medication prescribing. The study found that physicians in academic medical centers prescribed fewer of the promoted drugs, and more non-promoted drugs in the same drug classes, following policy changes to restrict marketing activities at those medical centers. While the decline observed was modest in terms of percentage, proportionally small changes can represent thousands of prescriptions. The decline in prescriptions of detailed drugs was greatest at centers with the most stringent policies, such as bans on salespeople in patient care areas, requirements for salesperson registration and training, and penalties for salespeople and physicians for violating the policies. In 8 of 11 academic medical centers with more stringent policies, the changes in prescribing were significant. But all this does not mean that the pharma sales rep will soon become extinct. For one thing, many physicians prefer personal interactions with sales reps, especially when they come with food for the staff and free samples for patients. A JAMA editorial also pointed out potential advantages to pharmaceutical detailing: Although physicians can find prescribing information using online resources, noted the editorial, one report estimated that it takes nearly 10 years for evidence from reviews, research articles, and textbooks to be widely adopted by the medical community. Pharmaceutical companies have the resources, national workforce, and financial incentive to address this issue, so detailing may accelerate adoption of novel therapies. And there are many more novel therapies coming to market these days, especially new drugs for the treatment of cancer. This is of particular concern because many oncologists think the hype (i.e., marketing) from pharma companies about the efficacy of these drugs far outstrips the real world benefits. An indication that this concern may be justified is research by the US Food and Drug Administration, which found that websites for cancer drugs are ten times more likely to include quantitative information about all the benefits of a drug versus all its risks. So, detailing may accelerate the adoption of novel therapies that do not work as advertised and cost hundreds of thousands of dollars per treatment cycle. Continues Page 1

4 One other factor to consider is the drug industry s campaign to force the FDA to allow it to provide physicians with off-label information about drugs, especially those novel, ineffective, and costly cancer drugs, which are often prescribed off-label already. Continues Sales Force Effectiveness Increase Physician Access and Detailing Effectiveness Everyone knows that pharma sales reps are less effective than they used to be. Although the pharmaceutical sales force has doubled between 1995 and 2000, the number of audited calls has only increased by 10%. Through articles and real-world case studies this Special Supplement presents the collective wisdom of many marketing experts who offer solutions to the problem of decreasing sales rep effectiveness and decreasing return on the physician marketing dollar. The information in this Special Supplement is certain to give you a better understanding of the issues relating to physician access and how to improve the effectiveness of your physician marketing and sales campaigns. TABLE OF CONTENTS A Crisis in Professional Detailing Marketing's Role in Limiting Physician Access Finding the "Right Stuff" to Revitalize Sales Productivity Facilitating Physician Access and Education Through Online Conferencing The Targeted Model Limbic Market Research Intelligent Online Sampling Strategies Increase Prescription Sales with Smart Tools at the Point of Care A Novel Approach to Communicating with Physicians Increase Sales Representative Performance and Productivity by Building Collaborative Physician Relationships Promoting Pull Through Prescriptions via Value-Added Free Medical Practice Web Sites and Patient Education Gauging Physician Behavior and CE Impact with Two-Way, Real Time, Web-Based Technology Live, Online, Interactive Conference with Experts to Provide Detailed Product Information to Physicians Audio with Synchronized Visuals Streaming Over Low Bandwidth Internet Connections for Physician Detailing Online Content Management System for Sales and Marketing Representatives Access the PDF file here Pharma Marketing Network. All rights reserved. Pharma Marketing News Page 2

5 #Pharma Sales Reps: Declined & Denied! [From worldofdtcmarketing.com] One of the reasons that pharma is allocating money to digital channels to reach HCPs is that access by sales reps continues to decline from 77.1% in 2009 to 68.1% in 2014 (44% in 2016). HCPs are under more pressure than ever to make their practices profitable and really don't have time for conventional sales reps who are usually trained over one or two days and sent to try and have a peer to peer conversation with them. In addition a lot of drugs really don't require a sales rep to interact with physicians. More here... Further Reading: A growing number of doctors prefer digital communications and the pharmaceutical industry is currently in the process of moving its sales force to a smaller structure that is more directly aligned with this new reality. One aspect of that change is the deployment of "virtual" sales reps. The following article presents a Wockhardt USA case, which employed a virtual sales rep platform. The Virtual Pharma Sales Rep: Ensuring the Survival of a Venerable Species 2017 Pharma Marketing Network. All rights reserved. Page 3

6 Restricting #Pharma Sales Rep Access to Doctors Cuts Down Branded Drug Prescriptions [From Restricting drug company access to doctors at academic medical centers resulted in a substantial reduction in the number of prescriptions that the physicians wrote for drugs touted by the pharmaceutical industry, a new study found. The University of Pittsburgh School of Medicine was among 19 academic medical centers in five states that were examined in the study, which appeared in the latest issue of the Journal of the American Medical Association. The institutions represented nearly 35 percent of all prescriptions written in Pharmaceutical companies earned more than $60 billion for the eight detailed drugs that were part of the study while generic drugs are on average 80 percent to 85 percent less expensive than branded drugs. Eight drug classes were part of the JAMA study, including medications to lower lipids, control gastroesophageal reflux disease, treat diabetes and others. "It's amazing how little it takes to influence how somebody thinks about something," said George Loewenstein, one of the study's authors and a professor of economics and psychology at Carnegie Mellon University. "The study really supports the need for more academic medical centers to adopt stronger policies." More here Pharma Marketing Network. All rights reserved. Page 4

7 Allowing Pharma Sales Reps to Discuss Off- Label Drug Use Would Make Them More Helpful, Says KevinMD [From - December 6, 2016] In the past, pharma reps were a source of samples that I could provide to my poorer patients who could not afford their meds. This was a real value: I depended on reps to provide these medications for my patients. In the days of print-only access to journals, I may not have been as current with the medical literature. Reps would often come in and discuss breaking trial news that I had not yet had time to read about. Often they would discuss upcoming trials and plans for the future. We would have spirited "academic" debates over drugs, trial design, and outcomes or endpoints. When you were unable to attend scientific meetings, the pharma rep would often be able to summarize the latest trials after they were released. Now, my institution no longer allows samples to be left, and honestly, if I need a drug rep to share the latest data with me then I am not doing my job as a physician. Online access to immediate data from trials upon their release makes keeping current much easier. Social media and other digital tools make it possible to attend national academic meetings such as the American Heart Association annual scientific session or the American College of Cardiology meetings allow everyone to be virtually present for groundbreaking presentations of late-breaking clinical trials. Don't get me wrong, there is nothing wrong with the people who choose to be pharma reps: Many are smart, classy, well-meaning folks. However, there is a lot wrong with the antiquated pharma rep sales model in today's world. Modern technology and easy access to data allow physicians to keep up with the latest clinical trials. Pharmaceutical detailing by reps is not very helpful; it is scripted and based solely on what the FDA allows them to say (think on label vs. off label). Reps are not allowed to talk about upcoming trials or discuss any off-label applications. More here. The author - hints that one way that sales reps can regain their influence in today's world is if they can talk to docs about upcoming trials and off-label applications of drugs. The drug industry concurs and is pressuring the FDA to allow it. Read more about FDA and off-label communications here Pharma Marketing Network. All rights reserved. Page 5

8 Novartis Must Reveal Details of Alleged 79,200 "Sham" Physician Speaker Events [From After a year-long battle, a federal judge ordered Novartis to turn over to the Department Justice documents containing details of allegedly 79,200 "sham" speaking events the drug maker used to encourage doctors to prescribe several blood pressure medicines. The decision stems from a whistleblower lawsuit, which was initially filed six years ago by a former Novartis sales rep, contending the drug maker violated federal anti-kickback laws for nearly a decade. The Justice Department later joined the lawsuit, which alleged Novartis paid bribes to boost prescriptions and, as a result, caused federal health care programs to overpay for medicines (read "U.S. Seeks Records of 80,000 Novartis 'Sham' Events for Doctors"). The drug maker often treated doctors to expensive dinners at high-end restaurants, according to the documents. In one instance, a dinner for three, including the speaker, at a Washington, D.C., restaurant cost $2,016, or $672 per person. At another event held on Valentine's Day in 2006, Novartis paid $3,127 for a meal for two at a West Des Moines, Iowa, restaurant. More here... Further Reading: Novartis Wines - er, Beers - and Dines Docs at Hooters! - I love this story about what may have gone on at Hooter's between the docs and waitress staff! Perhaps the documents will reveal that my imagination is "somewhat vindicated." 2017 Pharma Marketing Network. All rights reserved. Page 6

9 Chicago Ordinance to Require Pharma Sales Reps to be Licensed "May Be Helpful, But Has Limitations" [From - November 18, 2016] In hopes of reducing inappropriate opioid prescribing, the Chicago City Council on Wednesday, November 16, 2016, passed an ordinance that requires all pharmaceutical sales reps to become licensed. The ordinance, which the pharmaceutical industry opposed, will require sales reps to undergo training for ethics, marketing regulations, and applicable laws. Reps will also have to file reports with the city that disclose the names of doctors they visit as part of their work, the number of visits, and any samples, materials, or gifts provided, along with their value. Reps will also have to pay a $750 licensing fee and renew the licenses annually. "Opioid addiction is a public health issue impacting cities like ours across the country," said Dr. Julie Morita, the Chicago Department of Public Health commissioner, in a statement when the ordinance was unveiled last month. "Law enforcement alone cannot solve the problem." The city expects to collect more than $1 million in licensing revenue and will use that to support ongoing efforts to educate doctors and the public about opioids, and cover the cost of regulation, according to a spokeswoman for the Office of Budget and Management. Chicago officials also hope to use the funds to boost existing investments in drug treatment, expand opioid and heroin addiction treatment, and provide seed funding to existing health clinics to expand and create new opioid treatment programs, she added. Once the ordinance goes into effect in July, 2017, Chicago will become only the second government in the country to take such a move in order to license sales reps in hopes of clamping down on inappropriate marketing and prescribing. In 2008, Washington, D.C., began requiring sales reps to become licensed. A license costs $175. One expert suggested the ordinance may be helpful, but may also have some limitations. "If they collect all that information [about sales reps visits & physician prescribing habits], the city could use that as leverage on the pharmaceutical companies," said John Mack, who publishes Pharma Marketing News. "The data they're collecting could make a better case for the argument that doctors overprescribe these medications." However, he also noted that sales reps are following marching orders and, despite any required education or training, will remain under pressure to market certain medicines at certain times. "I think will be hard to prove its an effective way to control the prescribing, so I don't think itâ s really going to solve the problem directly. It might help indirectly if the city can say that overprescribing is caused by aggressive sales tactics," he continued. More here Pharma Marketing Network. All rights reserved. Page 7

10 GSK's "Ethical" Sales Model: Is It a #Pharma Oxymoron? [From 1.eyeforpharma.com - November 24, 2016] In a bid to overcome stubborn industry-wide challenges, improve external perceptions and build stronger relationships with customers, some companies are seeking radical changes to age-old, traditional processes. One such company is GlaxoSmithKline, which began the introduction of a new, more ethical approach to its interactions with customers in 2013, then accelerated its efforts following the infamous Chinese bribery scandal in As part of its more "ethical" approach, GSK decoupled sales force incentives from prescription volume, rede ned its interactions with physicians (including stopping all payments for doctors to speak on behalf of the company) and made greater investments in its people and transparency measures. The company encountered a number of initial hurdles. These were: company size, employee resistance and pushback from physicians. While positive benefits of the new model were slow in coming, for GSK executives, the experiment has, they believe, been a huge success For example, in 2015, a survey of more than 3,500 HCPs in the United States saw GSK ranked the number one company in terms of trust and customer value. "It was a big change and it has been a big, booming success," remarked George Katzourakis, Senior Vice President Europe, in our recent interview "We are absolutely convinced that this is the way forward for the industry," says Denise Dewar, the company's Head of Multichannel Marketing Excellence for EU, Canada and EMA Similar exclamations have been received from other senior staff. While GSK's move to a new model has been well-received internally, many external commentators remain skeptical that this "ethical" model - especially the decoupling of sales incentives from prescription volume - is robust enough to deliver results in the long-term. This skepticism coalesces around four key questions: Why change the sales model entirely? Is GSK simply overcompensating for previous mistakes? What is the risk to R&D budgets? Can this model be sustained with the upcoming change in CEO? Given this criticism, there has been much debate about whether the rest of the pharmaceutical industry will follow GSK's "ethical" model. More here Pharma Marketing Network. All rights reserved. Page 8