So Big Pharma's embrace of specialty markets makes sense on every level. But the verdict is out on how successful companies
can actually be in exploiting the opportunity. Clearly, large-scale development and marketing of specialty products will require
changes in organizational structure, resourcing priorities, alliance strategy, and stakeholder relationships. An industry
reared on medicinal chemistry will not easily yield that bias. R&D managers are more comfortable with small-molecule chemistry,
while the sales and marketing side is habituated to the straightforward reimbursement dynamics, pricing algorithms, physician
targeting, and marketing communications of oral drugs for large primary care markets.
The two top focus-on-the-specialist drivers
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One thing, however, is certain: The increasing involvement of top 20 pharma companies in specialty therapeutics will usher
in deep changes at both the operational and the cultural levels. The big question is which of these industry giants will find
a way to be nimble and innovative enough to optimize the enormous opportunity that specialty pharmaceuticals present. And
as always, bold leadership at the top will prove decisive. Kindler's and Brennan's big-time biotech boosterism is a very positive
sign.
The Specialist Is In
This deepening specialty involvement will bring Big Pharma into close contact with a key stakeholder—one with whom most large
firms have had only a marginal relationship: the specialist. Mastering this new dynamic is essential. How well companies cultivate
and collaborate with key opinion leader (KOL) specialists will make the difference between market success and failure. Specialists
are poised to become major players in the new healthcare economy. Significant treatment advances on many serious-disease fronts
will greatly expand patient populations, placing unprecedented demands on specialists in community and hospital settings (see
"The Two Top Focus-on-the-Specialist Drivers".)
However, Big Pharma needs to be attuned to the differences between specialists and primary care physicians (PCPs)—in terms
of their education, for example, and their accessibility—as well as the implications for marketing and detailing. Getting
(and staying) up to speed on such specialist-specific complexities as practice economics, referral flows, and product reimbursement-and-utilization
management is crucial for both drug developers and marketers.
What pharma can do for specialists
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To start with the easy stuff: Specialists specialize! They focus in depth on a particular disease area, while PCPs are broadly
familiar with many conditions—that way, they can better treat or refer patients presenting a wide spectrum of symptoms. Specialists
also see fewer patients and are not as time-pressured as PCPs. Most work in teaching hospitals or medical groups, unlike PCPs,
who toil away in fast-paced managed-care organizations and see one patient every eight minutes.
In terms of patient interactions, specialists generally are much more focused and go much deeper; as a result, detailers tend
to have longer, more in-depth conversations about a product with a specialist. This receptivity to substantive communication
flows mostly from the fact that the specialist is more clinically oriented—and more attuned to clinical findings that differentiate
products—than the generalist practitioner. A successful specialty rep must be able to talk the specialist talk—and able to
make a truly technical pitch, based on state-of-the-art knowledge of diseases, therapeutics, and patient needs—rather than
relying on samples, incremental labeling differences, or a variety of promotional inducements.
Although the knowledge demands are considerably greater on specialty reps, other aspects of the specialist population can
make specialty sales and marketing easier. Many specialties have only one or two thousand specialists, which makes for a tightly
knit, largely homogeneous community. They attend the same meetings, read the same journals, and generally observe the same
treatment guidelines.
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