From selling to merchandizing
If most pharma companies aren't upending the sales model with respect to how reps are compensated, they are experimenting
with a more service-oriented model that focuses on channel specific resource allocation. The mix of roles and responsibilities
that round out a company's field force are beginning to reflect changes that consumer packaged goods and the tech industry
instituted years ago: expect to see more of those pharma conference speakers from Hewlett Packard and Pepsi that everyone
used to criticize for being irrelevant to the heavily regulated drug industry.
"The [drug] industry is focusing on the end customer experience," says Jennifer Colapietro, a partner at PricewaterhouseCoopers.
Industry executives are "reassessing their go-to-market business models and practices to figure out how to provide more value,
or added services to the end physicians in the clinics and hospitals." This requires reps to maintain an active knowledge
of an individual physician's business and patient population, says Colapietro. "It's no longer just coming in and detailing
a product...[sales managers] are organizing around a portfolio of products, programs and services, so that the field rep has
a broader arsenal regardless of the individual they happen to be speaking with." That includes services that flow through
the physician to the patient, like disease education materials, financial assistance or co-pay cards, or call center information
for patient questions about a therapy.
Other channel-specific roles are emerging to help service physician practices and other healthcare delivery systems in an
attempt to differentiate a product by the added services that come with it. Matt Gurin says Pfizer has been able to pivot
away from one of the most extreme patent cliff scenarios—Lipitor—in part by experimenting with new service roles. One such
role is reimbursement specialists; instead of talking to physicians about drug attributes, these "specialists" come in to
help ensure that patients can get access and reimbursement for a drug after the prescription has been written, or that the
physician practice itself will get reimbursed. Another is long-term care reps. "Long-term care is as much about reimbursement
and Medicare as it is about understanding the product," says Gurin. These reps are tasked with "understanding the demographics
and symptomology of elderly patients, and the economics of long-term care," Gurin says.
IBM went from marketing PCs to marketing "solutions," and Procter & Gamble went from huge sales forces calling on grocery
store chains—and making sure the Ivory soap was well positioned on the shelf—to having account managers calling on Walmart
and Target, recalls Gurin. "You have 10 customers who make up 95 percent of the business."
Fewer promotions into market access
Payer consolidation in the healthcare market—the combined Express Scripts/Medco PBM now represents some 155 million US covered
lives, and some 40% of the total drug volume in the United States, according to concerned letters Sen. Tom Harkin (D-IA) and
others sent to the FTC prior to the merger approval—has led to a shift in the core competencies required for certain account
managers, and a change in career path for others, says Gurin. "Increasingly, there is not a direct path from field sales into
managed care, or market access. Companies are looking for business to business, account management people, not pharmaceutical
sales insiders who are looking to make more money or get out of managing people directly."
Pharma is willing to train people for the new account manager role; it's an economic buy at the corporate level, says Gurin.
For an account manager in the context of consolidated, enormous payer accounts, the core competencies "aren't product knowledge...it's
the ability to negotiate your way into the corporate hierarchy or sophisticated matrix to find out who the buyers and influencers
are, what their buying triggers are, what the economics of their value chain are, and to be able to put together a solution,
or a value proposition, that will get their attention."
Gurin says he doesn't see a lot of district managers that have the business acumen or the executive presence to step into
that kind of role, given the stakes. The days of the traditional RAM, or regional account manager—the person who typically
called on small managed care networks and reported in to the sales organization—are coming to an end. A RAM used to be "somebody
good with numbers and relationship management, but either wasn't good at managing a sales force, or had done something weird,"
says Gurin. "We have several clients who have cut the cord on that in terms of a career path. To us, that's a bellwether in
the change of the kinds of people working in these roles."
The Digital Dynamic: Changing the Pharma-Physician Interaction
In response to a question about reimbursement pressures in managed markets—prior to the news that Novo Nordisk lost two contracts
with Express Scripts—Ajello insisted that Novo "is not going to give our products away. That's a decision we've made. It might
not drive the market share, but we'll be very profitable as a company." That may be true in Novo's case, for now, but consolidation
in the commercial payer space will demand some careful math and deft maneuvering going forward. Considering the drug volume
Express Scripts and others like it represent, pharma companies will have to come up with an increasingly sophisticated answer
to the question of, "How low can you go?"