What the Market is Telling Biopharma About Reps That They’re Still Not Hearing

I went to a meeting this week about improving the effectiveness and impact of biopharmaceutical promotion via personal sales reps. We listened to experts talk about all the usual stuff: how hard it is to maintain meaningful sales relationships with physicians, how aggressively regulatory agencies are pursuing bad actors in the space, and how the value proposition of a rep talking to a doc continues to erode. There were the requisite presentations on technology (apparently iPads are going to change the world for drug reps too) and detailed discussion of how to assure optimal formulary position through relationships with payers. All said, though, the general tone of the meeting was pessimistic. One presenter put it all together, “If the biopharma market is a river, it’s all white water from here out. Strap in.”

I think, though, that the audience wasn’t really listening. That isn’t to suggest that no one was paying attention. Rather, it’s that no one heard the larger message that seems so readily apparent from “outside the jar.” There is enormous opportunity for biopharma. Furthermore, reps can play a pivotal role in the industry’s future. It just takes a little hard listening to figure out what that looks like.

First thought: the market and its regulators are sending a very clear message. “What you’re doing isn’t working.”

Fewer and fewer physicians allow sales representatives into their offices. Similarly, large systems or networks of physicians are defining policies that explicitly ban sales reps from any interaction with physicians during working hours. Of the physicians who can and still do allow reps access, many limit the time they spend with them to extremely limited exchanges structured largely around the signature required to maintain sample supplies. The implicit message of these behaviors is that physicians simply don’t value the detail the way they used to.

Payers are also sending a message. Formulary status has emerged in the last decade as a powerful lever payers use to limit branded pharmaceutical market share. Defining tiers of preference — what the first versus second versus third choice of therapy for a given condition should be — all but dictates what a physician can or cannot (or, more precisely, will or will not) prescribe. Gone are the days when a new product can command a premium price and a preferred formulary position simply by virtue of a novel mechanism of action or a marginally better safety profile in the face of generic alternatives. Their message is that the new products emerging from the biopharma pipeline aren’t worth the money the industry hopes to charge.

Regulators also have something to say. The combined fines levied against the industry in the last six years for illegal or misleading marketing practices total some $6 billion. The FDA’s “Bad Ads” program is specifically designed to cast the net wider by using industry stakeholders (namely physicians) to identify misleading or inaccurate promotional material. OIG, DOJ, SEC . . . name your three-letter agency, they’re all after biopharma in a big way. The message here is also clear. The legal assessment of traditional pharmaceutical sales relationships tends toward illegality. The government doesn’t really want reps doing what they do.

Second thought: physicians consistently describe a real opportunity when you ask them what’s wrong. “Time is my most valuable asset; don’t waste it or make more of it for me.”

As a general rule, physicians are not happy with the current state of practicing medicine in the U.S. Of 12,000 primary care physicians surveyed in 2009 by the AMA, fully 49 percent reported having considered quitting medicine for another profession. Their common complaint is not that they have to see too many patients or that they don’t make enough money, but rather that there’s simply “too much red tape generated by insurance companies and government agencies.”

Adding drug companies to the mix only exacerbates the problem. Reps demand time for detailing. Pharmaceutical patient assistance programs generate paperwork. Maintaining sample supplies requires signatures and follow-up. Assuring payment for new medications requires jumping through additional insurance company hoops. Even simply staying abreast of the latest clinical data related to various therapies requires constant double-checking and validation of claims made by reps who oftentimes no longer command the trust of their customers.

The common theme underlying all of these behaviors is simpler than it seems. Doctors enter their profession to take care of patients; that is elemental. The structure of our system, however, demands that they spend a disproportionate amount of time managing the practice that facilitates that goal. In fact, it has begun to subsume it. What physicians need is more time to care for patients. They need help to do that and aren’t really clear on how to ask for it.

Third thought (the big concluding one): stop what isn’t working and give your customers what they want . . . time.

It is certainly true that relationships will always continue to drive sales. The fallacy too many sales and marketing executives still subscribe to, though, is that a productive sales relationship needs to be based exclusively on “three points and a close.” The detail is a means to share of mind — nothing more. And, there are a million different ways to get to the same end without sticking to a scripted call. If doctors, payers and regulators are screaming, “Stop doing what you’re doing!” then stop.

So how can biopharma maintain share of mind without the traditional detail? Use reps as an extension of what doctors are trying to do; give them more time to provide the care they want to. That means better support for patient assistance programs. That means more support for physicians as they deal with insurance bureaucracies. That means robust patient education programs. It could mean using the rep as a vehicle for patient adherence and compliance programs. In the final analysis, it’s really as simple as asking where and how, beyond the detail, you could add value. Put the visual aid down and ask your customers how to help.

Easier said than done? Maybe. Hard to find a legal way to get it done? Probably. Hard to build a business case around putting aside the model that’s worked for so long? Definitely. The hardest part of this charge, though, is cutting through the clutter and listening to your market. The messages are clear; they just may not support the model that we’ve all come to believe is the only way to maintain a share of mind.

It is hard to read the label from inside the jar; it’s harder to hear the messages the market’s telling you through the glass.