Hull: I'm somewhat of a cynic until I see it. We can't get too far ahead of ourselves. After all, the organization first has to have the internal fortitude to have the systems in place that can use this information for the benefit of sales and marketing. If you don't have those underlying operating systems that support all of the new information, what's the point?

Breitstein: Many Big Pharma companies are working under corporate integrity agreements. Is there a natural intersection where technology can monitor compliance?

Jennings: We have to find ways to prove that we are providing a scientific or a clinical message to doctors that will benefit their patient population and increase the wellness of our communities. As the technology changes, we're going to have sources, like with tablet PCs, to prove that we are doing that, even down to the page or the chart being presented in the doctor's office.

MANAGED CARE IMPACT

Herman: How will the industry modify its sales approach to handle the increasing impact of managed markets?

Hull: We've seen huge growth at Abbott in the managed care system that supports our customer units. And throughout the rest of the industry, I see more of an account-based sales force as well.

Jennings: Some of our larger pharmaceutical company clients are beginning to understand where the access is and explore the regionalized approach—again. They're experimenting and trying to maximize their dollars within each geographic area.

Hull: The smart sales reps understand the business of medicine and how the business side effects physician's medication choices. Being mindful of this helps deliver more responsive sales approaches.

Stickler: One area that has not been affected as much by managed care has been in the hospital. And that's been a very nice place to operate as a company because all of our products are covered under a DRG (diagnosis-related group).

Snow: For those of us who have been in the industry a while, to hear that the hospital market is so attractive just gives you an idea of what we're facing today.

We're working hard to maximize access, but by no means have we got that whipped. It's a challenging environment and changing every day. Medicare Part D had a lot to do with the change.

Breitstein: With this year's election, what will—and won't—change for representatives?

Snow: In the United States, the government is the largest customer—and that's not going to change. I think we all take pause when we think about what could potentially happen down the road.

Rosenthal: The increasing importance of government as a payer for the pharmaceutical industry has larger strategic implications outside of sales forces for how companies price and market their products. But if the effect of government's involvement is to fund a benefit through plans, then the job of the representative isn't going to dramatically change.

Maybe the rules of the game will shift, but I don't expect there to be a dramatic impact on the life of a sales rep based on a party coming to power or a future change to the benefit design.

Herman: Looking forward, the challenges seem to grow even greater. What's the prognosis for reps? Can they still succeed?

Stickler: Restricted access to physicians is going to continue to be a real challenge for the industry. In an issue of Newsweek, there was an article called "Thanks, but No Thanks." It described a number of medical schools, hospitals, and doctors offices across the country that have basically signed up to say, "We're not going to accept any representatives' visits at all."

Keefer: It's true—as healthcare professionals become less of a decision maker about what to prescribe, their need to see reps is sometimes perceived to be less. A lot of offices have shut out reps due to state, clinic, and hospital regulations.

At the same time, clinics in the retail drug stores are rapidly ramping up, staffed by nurse practitioners or physician assistants. That's new to the industry, and we now have to be able to put that into the mix.

Rosenthal: Representatives who face the same managed care hurdles still demonstrate a wide variety of performance results at the end. So even though managed care can set up roadblocks that make it more difficult, you still find reps, regardless of the environment they're in, that outperform people with the same market dynamics.

Snow: Obviously with single-payer systems in Europe, you still see lots of personal selling. We can take some satisfaction in recognizing that in markets where the margins are lower and the challenges higher, personal selling and conveying information is still an important part of the pharmaceutical industry and is seen as valuable by the physicians in those markets.

A version of this article also appeared in the February issue of Pharmaceutical Representative.