As with other parts of the sales model, companies need to test whether training moves the needle on outputs. While deploying
fewer but smarter, more strategic reps seems like a logical next step, at the end of the day, if it doesn't up prescribing,
why make the effort? "There's no ensuring that seasoned, very educated reps are having more sophisticated dialogue that is
going to translate into more time with the primary care physicians," says O'Grady of Campbell Alliance. In this way, O'Grady
points to the limitations of the primary care office to accommodate pharma's strategy for increasing value. "The providers
have only so much time to interact with reps. So your rep that can do a deeper discussion of ancillary care and the care continuum
may not offer any benefit over a rep that is delivering a basic core message and samples if both reps are getting less than
Managed markets have been putting the squeeze on pharma's sales model by hitting patients with co-pays at the pharmacy counter
that are high enough to make them rethink their brand choice. In response, companies have focused their efforts on proving
the value of their drugs to medical directors at managed care organizations through pharmacoeconomic studies as well as offering
service packages that increase wellness and compliance. But surprisingly, there is nothing really new here—pharma has been
using these tactics for years. "With managed care field forces or marketing, it seems to have gravitated toward 'It's all
about price,'" says Gerard.
For the moment, companies are on the defensive, distributing their marketing might where there's the most favorable formulary
access. "We're seeing managed care companies getting more stingy with putting products on tier two, and at the same time the
co-pay differential between tier two and tier three is much greater every year," says O'Grady. "Companies used to say tier
three is good enough because they had so much muscle in the market, they would drive demand—but that's changing."
Indeed, much of Pfizer's stated realignment of sales with managed markets is thought to exploit this niche. "Pfizer is probably
cutting their sales force disproportionately where managed care is either restricting their access to physicians, which is
a real problem in some parts of the country, like the Pacific Northwest and California," says Amundsen Group's Tenaglia. "It
could also mean they are adjusting their sales force downward where they have restricted formulary access. That's a very sophisticated
view of the world, but if anyone can build in that sophistication, it's Pfizer."
In addition to the access issue, many companies are realizing that running a sales force at the national level in this new
reality is neither effective nor efficient. Given the variability of regions in terms of payer mix and formulary status—not
to mention regulations of per-doctor spending caps and practice guidelines—firms are eyeballing a shift to a more on-the-ground
approach. "There are wide geographic differences, and physicians have to practice within them," says Nancy Lurker, senior
vice president and chief marketing officer at Novartis. "At the corporate level, we're never going to know with the same granularity
what the regional managed-markets person is going to know."
In many ways, this moves the responsibility and accountability for sales down the line, to regional sales managers and even
reps. "Some say, 'We've got to treat these sales people like they're business managers,'" says TargetRx's Luby. "We're not
going to tell them they have to make eight calls a day or who they have to call on and when. We're going to tell them, 'In
line with regulation, do what you need to do to make sure you can deliver the sales out of your territory.'"