Sometimes there are different doses, different schedules, that are developed—sometimes both—that can change the financial
ramifications of a particular therapy. That makes it a challenge to set the initial price for a particular drug at a particular
dose at a particular schedule. And you may not know it, but two years from that date of approval, you could have different
schedules and different doses that could change the price of a therapy.
NAEYMI-RAD: What is difficult for payers is obviously advocacy pressure. I mean, people with cancer want the best choice available to
We are also interested in how payers could enact therapeutic caps. While this is still very much in a hypothetical form, you
could see the day where a payer would say, for a first-line colorectal cancer patient, "For X dollars, you can get very good
choice and very good care. Anything above that, you're going to need to get some kind of prior authorization to say why you
need multiple branded products instead of generics and bio-similars."
CLINTON: All the new competition, the focus on reimbursement, the increasing specialization of therapies. How do you see sales
reps fitting in with this new paradigm of cancer commercialization?
LACAZE: We have all these different drugs, all the different clinical trials, all the new data coming out; it becomes extremely difficult
for physicians to keep up with the latest information. From a selling standpoint, the representatives provide a very valuable
service—albeit sometimes the information they can disseminate is a lag to the label.
We have to get smarter and better at delivering information. We need to start acting more like others do in primary care–
type selling where there's lots of different segmentations of the audience—both the physicians and the patients.
SEELEY: The job of the sales representative becomes much more difficult, because not only do they need to understand their product
but all the other products that are being used in that particular patient. The level of knowledge that a sales representative
has to have in order to bring value to the customer is very significant. Plus, I would argue that in a more competitive environment,
sales reps also need to have much stronger fundamental consultative skills.
AYERS: Compared to 10 years ago, it's incredibly hard to disseminate new clinical data if it's not strictly within your label in
every aspect of the patient populations studied. And that's a tremendous shame because we have sales representatives who are
extremely well trained and capable of having discussions that can inform physicians about good data and peer-reviewed articles.
What's New, What's Next?
CLINTON: What other aspects of the commercial organization are also undergoing change?
NAEYMI-RAD: Medical affairs is where most of the service is provided to the customer in terms of addressing their questions and doing
studies that provide useful answers to real-world problems. Although medical affairs is not commercial anymore, it needs to
go to an entirely different level in terms of how they're going to serve the customer in a more restrictive environment because
the marketers and the salespeople just can't go there.
SEELEY: There is no doubt that the legal and compliance environment has changed the way that pharma marketers and sales reps do their
jobs. But we have seen these legal and compliance changes generate interest in areas that were underutilized in the past:
e-marketing and the Internet, large investments in developing managed-care materials, access programs—making sure that your
copay-assistance programs, your uninsured-patient programs, things like that, are the best that they can be.
CLINTON: People talk about, and hope that, the future of cancer care means treating patients like they have a chronic disease.
Where are the early signs this is happening?