For instance, neurologists from around the world go to the same annual neurology confabs—likewise for rheumatologists, pulmonologists,
and oncologists. Physicians within a specialty share the same understanding of current and emerging practices and developments
in the diseases they treat. This greatly simplifies sales and marketing. (Compare this profile with that of the national PCP
population in the United States, which is 222,000 strong—including 91,600 family-care and general-practice physicians—and
exhibits immense regional and professional variation.)
The Details of Specialty Detailing
Sales and marketing expenditures, driven up by the need to support high-volume primary care products, are rising despite a
hostile environment. The window for face time with PCPs is shrinking. A McGraw-Hill Healthcare study showed that while the
number of reps had more than doubled from 40,000 to 90,000 between 1996 and 2001, the number of doctors has essentially remained
steady (approximately 350,000 to 400,000). Moreover, the quality of PCP detailing is diminishing with respect to access, duration
of visit, physician recall, and ability to leave samples. PCPs complain about sales force overkill, and provider institutions
are erecting more hurdles to limit rep access.
What specialists can do for pharma's life cycle management
In many managed care settings, sales rep access to physicians is controlled, if not prohibited. At the least, reps have to
negotiate with receptionists and nurses to get through the door to the MD. Once they gain access, reps are lucky to get a
full seven minutes for their troubles. Many of their time-tested tools, such as samples, promotional gifts, and complimentary
events (dinners, conferences, etc.), are limited or proscribed by PhRMA's Code of Interaction or the recently promulgated
In any case, there is considerable evidence that the power of drug samples, a mainstay of PCP detailing, has been waning.
A 2003 IMS Health sample-tracking survey found that only 36 percent of samples were actually delivered to the target physician.
These challenges are compounded by the fact that the samples in primary care reps' bags are me-too drugs offering only marginal
advances. Moreover, armies of reps from competing companies—to say nothing of multiple details from the same company, often
for the same drug (a phenomenon one physician calls "the spam effect")—are wearing the patience of harried physicians. By
contrast, the less-time-pressured specialist is likely more welcoming of a substantive clinical detail. Samples are not an
element in specialty reps' marketing mix.
Finally, although the fully loaded annual cost per specialty drug rep is, at $330,000, substantially higher than for a primary
care rep, specialty sales forces are considerably smaller and more productive on a per-rep basis. Where the top 10 pharma
companies ranged from $1.6 million in sales per rep (Sanofi-Aventis, Novartis, Abbott, Lilly) to $2.9 million (Pfizer), the
top three biotech companies ranged from $3 million in sales per rep (Biogen Idec) to $9 million (Amgen).
The Specialist-Focused Mutual-Support Strategy
Any successful specialty-care business franchise will incorporate specialist expertise into every stage of a product's life
cycle, from early in discovery to long after the launch. Establishing ongoing connections to KOL specialists should be a priority
from the moment a company decides to enter a specialty-disease category. Moreover, this focus must be shared by the entire
therapeutic franchise—clinical, business development, marketing, patient support. Pharma teams need to develop approaches
that will create equity with the most forward-thinking and respected medical authorities in a way that benefits all stakeholders
(see "What Specialists Can Do for Pharma's Life cycle Management")