To complicate predictions further, some companies are likely to keep their larger sales force size as a source of competitive
advantage. In addition, generics companies will likely take up the practice of detailing when/if a regulatory pathway for
bio-similars and other follow-on biologics is established—something Doug Boothe, executive vice president of US commercial
and administration for generics firm Actavis, says is currently within the company's plans. "We do not currently detail physicians,
though as we look at new categories, it's potentially in our future," says Boothe. "If it's oncology or injectables or others,
we are contemplating—and actually have in our five- or 10-year strategic-planning horizon—investments in sales expansion."
TargetRx's Luby points out that as tricky as cutting back may be, it only gets tougher after that. "How can you improve the
quality of your effort so that when you've dialed down the volume, you can still hold your own?" he says. "[The challenge
is for] companies to find their way out of the arms race and into being able to deliver comparable outputs with fewer, better-directed,
There is some evidence that this is already happening. "There's a growing consensus among Big Pharma companies," says Eran
Broshy, chairman and CEO of InVentiv. "When it comes to primary care offices, most companies are envisioning some type of
The tiered model is a system of reps that works by catering to the different needs in the physicians' offices and sets out
different roles and responsibilities to fulfill them. While tiering doesn't drastically reduce the number of reps in the physicians'
office, it cuts down the pressure on the physician's time by making better use of it.
"You can think about companies moving to where they may have, say, three reps, instead of five or six," says TGaS's Gerard.
"One is engaging with the doctor and taking the higher, scientific approach. The second rep has a more general, office-based
approach, where he educates the doctor and staff about managed care. The third is a sample or merchandising rep—not really
going to engage with the prescriber, but will stock the office with samples and starter kits."
And even for companies that choose to use the traditional measures of reach and frequency, the key word will be metrics—analyzing how reps are driving scripts and getting time with the doctors. "I think customer satisfaction—physician satisfaction
with the rep's service—is going to emerge as a very important measure," says Marquard.
To up the quality, reps need to become knowledgeable—less rehearsed and more prepared for real conversations with physicians.
And it is in this way that we see Big Pharma emulating if not the tactics, then the ethos, of specialty sales. Says Gerard,
"For companies with primary care sales forces, the whole desire to be specialty really means just taking a more scientific
approach in their dialogue with customers and physicians."
Certainly, companies will need to rethink their approach to training. "The question is how companies will support their reps
as they move to the next model," says Pat Pesanello, chief knowledge officer for BusinessEdge Solutions. "Whether it is the
same or a modified model, there's no question that the rep needs to be more skilled."
Jim Dutton, president of Certified Medical Representatives, agrees. "Companies have to rethink the education process," he
says. "Today's rep has to have a comprehensive knowledge behind the medicine and be well versed in disease-state management
and the world of healthcare."