Under the Influence

Oct 01, 2005

UNTIL RECENTLY, BUILDING UP PHARMA'S ARMS RACE OF REPS WAS CONSIDERED a best practice. Since reps were the primary influencers of physicians' prescribing behaviors, increasing the number of feet on the street proved that companies were hard at work, with reps reaching the high prescribers with as much frequency as possible. The "mirrored" or "pod" sales force—criticized today by many—was an insurance policy of sorts back then, intended to gain greater message penetration than the competition. This approach was considered safe: Just as no one had ever fired the head of information technology for buying IBM, no head of sales at a pharmaceutical company was ever criticized for beefing up his sales force to maximize share of voice in a particular product category.

The share-of-voice model worked because the operating assumption upon which it was based was true: Reps really did influence physicians. But the world has since changed—the number of influences that affect physicians' prescribing has increased and rep saturation has reached the tipping point, resulting in "customer fatigue." Today, the list of influences includes managed care, DTC advertising and media, the Internet, government, CME and peer influence, advocacy groups, and group-practice dynamics—just to name a few. No wonder the old model no longer works.

Companies must now take into account a plethora of influences when planning their sales and marketing efforts. To that end, as companies experiment with and establish new sales models, they should think about creating a framework based not on voice but instead on influence. They should understand the key levers of influence, and how those levers work together for a given product—be they formulary restrictions, peer influence, or patient requests. In doing that, pharmaceutical companies can identify the sales and marketing approaches and messages that best affect these varying influences, which, ultimately, will affect prescribing.

This new paradigm requires companies to understand the nuances of influence at every level—from what affects doctors' prescribing habits to which physician is most influential in an office. There are certain benefits inherent in this approach:
  • It shifts the focus from quantity to quality.
  • It necessitates a better understanding of the target audience, going beyond a solely decile-defined value to a broader, more sophisticated profile.
  • It calls for a holistic, integrated approach so reps can understand and speak about the context of these market influences, to help physicians manage in this more complex environment.
  • It creates real value for physicians.
  • It demands flexibility and rapid response to changing market conditions to better serve healthcare providers.

Share of influence affects every aspect of sales-force infrastructure—recruiting, training, sales operations, and performance management. While no silver bullet exists to rapidly identify and implement the sales-force model of the future, the new share-of-influence approach has certain implications that affect how companies should define any new model. Here, we offer five strategic and tactical implications of the influence model, and some ideas about how to deploy and organize the sales infrastructure around it.

Five Tips for Growing Sales

(1) Use influence mapping to define target audiences

Influence mapping is one key to unlocking the share-of-influence paradigm. It is a sophisticated approach to physician targeting that goes beyond understanding the number of prescriptions physicians write, and instead examines the complicated and interrelated influences within the peer-to-peer medical community at the local level. It zeros in on why high-level influencers have prescribing preferences, and how those preferences are translated along that intricate web of relationships. By looking at the market this way, companies can more efficiently allocate sales and marketing resources because they can direct their efforts toward those influences that have the most impact on actual prescribing and dispensing behaviors.

Local influencers have an impact on sales and market share far beyond their individual prescribing behavior. They can include:

  • established and well-regarded regional and local thought leaders
  • community specialists (who garner the lion's share of referrals in their specialties, but whose patients eventually return to the primary-care referrer)
  • group-practice thought leaders (who influence the prescribing of the entire group)
  • academic and attending physicians (who influence residents by training them, thereby creating prescribing habits).

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