Of course, no model is perfect. And Hastings says one of the biggest challenges of the Customer-Centric Alignment model relates to the district manager's role. District managers are typically expected to be product specialists. But as the number of drugs promoted expands within the territories they manage, it will be difficult to maintain that high standard of drug knowledge. However, adds Hastings, district managers will still be critical for coaching, and maintaining the in-call effectiveness of the rep.

AstraZeneca is another company changing the way it details doctors. Faced with significant patent expirations, the company has responded with large layoffs—and expects the number of reps to continue to decrease as generics eat into the sales of mature brands. But AstraZeneca redefined the way it organized its field force—and began framing its future—when it launched a new selling model in 2007.

AZ's sales model focuses on the total office call with the goal of developing deeper relationships with the entire physician's practice, improving access, and delivering greater selling impact, says Mark Mallon, vice president of marketing and sales operations. To do that, AZ gives its pharmaceutical sales specialists (PSSs) fewer accounts to call on. This allows for the time and focus it takes to build stronger relationships with the office's prescribers and non-prescribers—to whom reps provide education about patient assistance programs, reimbursement, and patient education, including the messages about the importance patient adherence to prescribed therapies.

It's the type of model that's familiar to some of the smaller pharma companies, with a stronger heritage in detailing specialty drugs. For example, Shire Pharmaceuticals has long focused on disease areas where it can maintain small sales forces focused on serving specialists. It's gastrointestinal (GI) division, which houses the Lialda and Pentasa brands, employs specialty reps to call almost exclusively on gastroenterologists—and these reps know they provide value by going far beyond just a product pitch. "We expect our representatives to go in there and identify the needs of the GI doctor, understand the local marketplace, the drivers, the payers in that marketplace," says Todd Lambert, vice president and national sales director, GI. "They should understand the referral network they have within the healthcare systems in which they operate—and fundamentally understand the business drivers."

"For other opportunities, we would bring in a partner if we think that there's significant value to be realized for both companies," says Roger Adsett, senior vice president and business unit lead, GI. For example, Shire has a co-promotion deal with Takeda on Lialda. "[Takeda is] able to not only expand our reach to doctors that Shire's can't reach, but also increase the frequency to see some of the GI doctors," Adsett says. "That's part of what Shire is striving to build as part of the business model—you bring in talent for your core competencies, and then you partner with best-of-breed organizations for things that are potentially not core to your strategy to give your organization the flexibility to adjust as conditions change."