Selling to doctors using zip-code data resembles how a hospital representative sells to hospitals, residency programs, or long-term-care facilities. These reps start with Drug Distribution Data that lists product sales as well as the therapeutic classes the product competes in. However, the data do not show who the big subscribers are or how they affect overall sales. I call these physicians "key doctors," who need to be researched within the account. In order to identify key doctors, reps should pay careful attention to relationships within the account environment, including support sectors such as nursing, library services, microbiology, pharmacy, medical education, and so on. The support areas will vary depending on the disease state in which the product is used. For example, if a rep sells an antibiotic, she ought to cultivate close relationships with the microbiology lab, pharmacy (including floor pharmacists and PharmD consultant pharmacists), infectious disease, nursing (especially the charge nurses for each shift), the quality-assurance-committee members, and possibly the intensive-care-unit staff. Developing information from these sources to identify key physicians is account-based selling.

Doing the Research

Applying account-based selling strategies can help a sales rep compensate for the lack of prescriber-level information. The information-development process in the community setting is similar to the hospital strategy, although the players are slightly different.

The sales representative begins by assessing the extent to which a particular customer or group has defined a need for the products. For example, a rep sells a drug for osteoporosis, which is generally an affliction of the elderly (steroid use notwithstanding). The rep may not want to target a pediatrician because at first glance it may not make sense. Unless, of course, the doctor also uses the pediatric formulation of one of your antibiotics, and is good friends with a rheumatologist, whom you have not been able to meet. The pediatrician may provide an introduction. In addition, you have also learned by speaking to the DEXA scanning technician that this rheumatologist orders a lot of these tests and many of them are positive for osteoporosis. (DEXA stands for Dual Energy X-Ray Absortiometry, and is currently the most widely used method to measure bone mineral density, a key diagnostic indicator for osteoporosis.) Qualifying a doctor means understanding his relative potential, including his relationship to your entire business. The pediatrician, in this scenario, might help you gain access to the rheumatologist.

Next, the sales representative should understand the roles and responsibilities of personnel within the office. It is especially important to know whom the physician relies on most to get things done. By understanding everyone's role—nurses, billing, coding, and front office—the sales representative will improve her sensitivity to each person and be able to incorporate this into her message.

Once the physician is qualified and relationships within the practice are understood, the rep should consider how specific Health Maintenance Organizations (HMOs) or Preferred Provider Networks influence prescribing behavior. Marketplace drivers, such as specific plans, have increased their influence over prescribing behavior, primarily through the use of closed formularies. Medications not on the formulary may be unavailable or accessible only through a rigorous prior-authorization process. The relative impact of this varies by physician and plan.