“Way out there in the blue, riding on a smile and a shoeshine” is how Arthur Miller’s Willy Loman described his life as a sales person. It was both a tribute to and an obituary of the traditional sales profession. It’s also a feeling that’s quite familiar to primary-care sales reps trying to do their job in a very tough sales environment.

Much has been written about the decline of face-time with primary care physicians, but the lack of access that troubles many pharmaceutical sales organizations is often due more to a lack of relevance than a physician’s short attention span or heavy patient load. Sales organizations in any industry become irrelevant for one simple reason: Customers find a better (cheaper, faster, more convenient) way to buy products and get the information they need.

To counter the declining marginalization of the sales force, many large pharmaceutical companies have taken aggressive measures, including developing sales centers of excellence and implementing sales force effectiveness strategies. Novartis has moved to a regional model in the US, and AstraZeneca has created a sales and service model with sales associates delivering the samples, better trained reps delivering the science, and inside sales calling on hard-to-sees. 

These are all important structural changes towards creating a new service model, but how do they impact the experience of the primary care physician? Are we performing well on those attributes that doctors care about? Are we giving them the kind of customer service they need and want, with a cost structure we can afford?

The key to managing the pharma sales force crisis of marginalization is to know when the customer wants good customer service and when the customer needs good self-service. 

In 1999, Fast Company predicted the death of the travel agency. After the launch of Orbitz.com, pundits assumed that leisure and small business travelers would rather search for discount tickets online than pay full-fare through a travel agent. Airlines followed suit and drastically cut the commissions paid to travel agents. Did this hurt the industry? Yes. Did it kill it as predicted? No. It merely forced the travel industry to change.

Last month, a colleague took his family on their first-ever Caribbean cruise. Although he is a seasoned traveler, he had no experience with cruises, and decided to engage a “consultant.” He called a travel agent who specializes in cruises, and got access to information and insight that it would have taken him hours or even days to uncover on his own. As for the flight to Miami for his family of five? He booked that himself online.

As Clayton Christiansen observed in a June 2006 

 article, we all have “jobs” that we need to get done during the course of a day. Jobs like information gathering, communication, purchasing, relaxing, etc. To get these jobs done, we “hire” various “contractors.” My friend had the job of conceiving, planning, and booking a family vacation, and he hired various resources to get the job done, including a travel guide, a travel agency, and an online travel site. For some jobs, he needed good customer service, and for others, he needed good self-service.

Similarly, physicians have numerous information gathering and processing jobs that they need to get done in the course of a week. Understanding those jobs and balancing the right customer service and self-service response is part of the pharmaceutical sales role.

The typical physician has four information jobs that need to be performed: inform, inspire, reassure, and support. These jobs correlate to the behaviors all of us exhibit as we move through a buying process. Traditionally, the primary-care sales representative was hired to do all of these jobs, with some occasional marketing support. But with that traditional role going away, we need to reconsider each of these jobs and hire the optimal set of communication channels to meet those needs.


  Primary care physicians need to stay informed on new developments that impact their practice. Given their broad scope of clinical responsibility, this is one of the jobs they need accomplished on a regular basis. The typical way they get this job done is to scan the customary professional channels, most of which are self-service. A new product or indication, updated clinical information, or a new patient compliance program will be found through self-service channels such as conferences, journal ads and wraps, media reports, search engine results, e-mail, social media, e-detailing, from online ads and Web site sponsorship, and through conversations with colleagues. Targeted awareness building activities through these non-personal, self-service channels is the most efficient way to inform and raise interest and curiosity. 

Many franchises have begun to build their own physician email databases of opt-in professionals, and this can be one of the most effective and efficient ways of informing existing customers about new developments and gauge interest. Curiosity causes people to raise their hands with questions, and good self-service informing channels include a response mechanism-usually an invitation to visit a special Web site, make an inquiry to the call-center, or make an appointment with a sales representative to learn more. 


  The need for inspiration starts when we are piqued by new information. We realize that we have a need to be filled. Sometimes we have been living with this need for a long time (will someone please find a solution to…), and sometimes the realization hits us out of the blue (I really need an iPhone app that…). The promise of a new solution needs to be vetted.

Whether it’s pulling out our wallet or contemplating a change in behavior, we have an emotional need to be convinced, even excited. Physicians, after becoming aware of a new or improved therapy, have the same need for inspiration. 

Delivering inspiration is generally where sales teams have excelled. Time and money have been invested in naming, positioning, and tagline development, and agencies have been engaged to come up with inspiring creative for the sales aid. All the primary-care sales rep needs to do is get the two minutes in front of the physician to show off the impressive charts and read the compelling claims. But what may be inspirational at the agency is not necessarily what a doctor would consider “inspiring.”

Inspiration is framing the promise in light of a primary-care physician’s specific practice and need. General product claims are just that-they are one-size fits all messages that are rarely exciting or practice changing. But when there is information about a product that is tied specifically to information about the prevalence of a disease in a geographic area, or a certain patient type, then suddenly the product claims are relevant-and inspiring. 

Unique insight into disease prevalence in a geographical territory is the type of value-add information that will make the product claims and the sales representative relevant to the physician.


  Product claims that ask me to change behavior are always suspect. We might revel in the inspiration, but the closer we get to actually deciding to start or increase prescribing behavior or change our treatment practice, the more that questions and doubts arise. The physician may ask: Why is this new product better than my customary therapy? What facts do I have at my disposal to make an informed decision? What do the doctors I respect think about it? How good are the patient outcomes? Will it achieve its claims with minimal side effects? Is it covered by insurance?

In this phase of the buying process, professionals actually don’t want to hear more inspirational selling messages. In fact, this is when doctors are ready to throw eager sales representatives out of their office. It’s an important transitional period when only hard data will suffice.

This stage is ideal for a robust self-service process. When a physician wants reassurance and access to data, they want it on their own terms. The last thing they want is a sales person breathing down their necks. They want to be able to review the data and draw their own conclusions. Creating a secure professional Web site that physicians can use to review clinical data is an important tool to support the customer during this critical buying phase.


  Once a physician has made the decision to support a new therapy regimen for a set of patients, selling moves to support. In fact, how pharmaceutical marketers provide support will often dictate whether or not there is a gain or lose share of wallet. If marketers provide strong support for a physician’s practice (in terms of how the physician defines his or her need), and the product performs as promised, then it is more likely that the brand will enjoy loyalty. 

Support doesn’t necessarily require personal customer service to deliver samples or patient education materials. An easy-to-use self-service process will get the job done, and is generally preferred. An integrated online self-service section of the professional Web site with ordering functionality is what most physician offices look for.


  The typical primary care physician has many information jobs to do in the course of a day. With the press of a heavy patient load, those jobs often go unfilled. The typical sales representative tries to provide information or inspiration, but it’s not always the right type of information at the right time. A strategic approach looks at the specific information jobs the physician needs accomplished and aligns the right channel.

Understanding the specific information jobs that physicians need filled, when they need them filled, and the types of media and communication channels that they prefer hiring to do those jobs will lead to a more comprehensive and integrated approach to sales. An integrated sales approach that respects the value and timing of both good customer service and good self-service will deliver a much more effective customer experience for the physician, and those brands that embrace this approach will find that their sales teams are (once again) relevant in the primary-care physician’s practice.

Articles

News Analysis

The key to managing the pharma sales force is to know when the customer wants good customer service, and when the customer needs good self-service.

Managing the Crisis of Marginalization

Opinion

Due to pharma's voluntary moratorium on doling out totefuls of freebies and all the lattes you can swallow, thousands of docs, researchers, and reporters had only their sleep-deprived selves to carry from data dump to data dump at this week?s American Society of Clinical Oncology (ASCO) annual confab in Orlando, Florida.

ASCO Roundup: Winners, Losers, and Also Rans

A potentially powerful new technology found a big-pharma sponsor this week as GlaxoSmithKline announced on Tuesday that it had signed a collaboration agreement with three-year-old biotech firm Concert Pharmaceuticals.

The deal provides Concert with $35 million up-front and up to a billion dollars in milestone payments. Under the terms of the agreement, Concert will develop three of its compounds through agreed-upon clinical trials, at which point GSK will have an option to obtain an exclusive worldwide license to them. Concert will also provide versions of three GSK pipeline drugs modified using Concert’s innovative deuterium technology

The technology involves replacing ordinary hydrogen atoms certain existing drug molecules with deuterium-also known as “heavy hydrogen-an isotope of hydrogen in which the nucleus contains one proton and one neutron. (In ordinary hydrogen the nucleus consists only a single proton.) Deuterium, which is easily isolated from seawater, has twice the atomic mass as ordinary hydrogen, which means that it bonds differently with other elements-for instance, forming a much stronger bond with carbon.

According to GSK, Concert has demonstrated that this increased bond strength, in select cases, can be used to improve important drug properties including bioavailability, half life, and levels of beneficial or undesired metabolites,. The resulting novel compound has the potential for improved drug efficacy, safety, and tolerability.

“A drug with deuterium in it will have the same pharmacological effect as a drug with hydrogen, but the metabolism can be significantly changed,” said Roger Tung, president and CEO of Concert Pharmaceuticals. For example, one of the drugs covered by the agreement is Concert’s CTP 518, a protease inhibitor created by substituting deuterium for hydrogen in some key locations in atanazanavir. In preclinical studies, CTP 518 maintained full antiviral potency, but with significantly slower metabolism in the liver. The hope is that because it will be easier to maintain higher blood levels of CTP 518, the drug will become the first protease inhibitor to be used without a booster drug such as ritonavir.

“It’s this process of being able to fine-tune the fate of the drug after it enters the body that allows us to start with something with known activity and enhance it in ways that make it a better drug,” Tung said. 
  Known Quantities

One of the advantages of the deuterium technology is that it can change the properties of molecules whose actions are already known. “When you look at the overall costs of R&D, the majority of costs are due to drugs failing in the clinic,” Tung said. “So you put a tremendous amount of time and effort in getting a compound to get into clinical trials in humans and then the trials are long and expensive. And if the drug fails, it could be a huge lost cost-into the millions of dollars.”

“In terms of the benefits we would we expect to see of deuterium-modifying the three GSK pipeline products, the answer depends on the GSK compound in question,” a spokesperson at GSK told 

. “However, potential effects-all of which are the result of modifying drug metabolism-may include enhanced safety profiles, increased therapeutic index, improved dosing regimens.”


  Concert said that this agreement follows their corporate strategy to partner certain programs while independently advancing others.

“GSK will help us in a number of ways,” Tung said. “They offer a validation for the technology. Deuterium is not an atom that has ever been used in a human drug before. It has been used in metabolic probes, and in compounds that have been studied scientifically, but it has never been used in people as an approved agent. With GSK’s knowledge of approved pharmaceuticals, they believe that you can get drugs made this way and the answer to that is obviously yes, or they wouldn’t be paying us this much money.

 “We have very clearly demonstrated that we are the leading company in the application of deuterium to pharmaceuticals,” Tung said. “It’s creating a new platform with substantial opportunity for creating a lot of important products in a situation where pharma companies are looking for products and I think it’s the right kind of technology for the current times.”

GlaxoSmithKline has entered into a collaboration deal with Concert to create drugs using deuterium-“heavy hydrogen”-that can be gathered from seawater and used to alter the way molecules perform in the body.

GSK Signs Deal with Concert Pharma to the Tune of $1 Billion

FDA, on Tuesday, announced the formation of a transparency task force, charged with determining how to make the agency and its actions more apparent to the general public. The new program is being created in direct response to President Obama’s comments that the new administration will be more open to public participation in government.

A first impression: Judging by the clarity and detail of the announcement, the task force has its work cut out for it.

“Over the years, there have been complaints made against FDA’s lack of transparency,” said FDA Commissioner Margaret Hamburg in a press call. “The agency has been referred to as a black box that makes important decisions without explaining them. While the agency can’t disclose all types of information, I believe that the agency can do a better job of providing useful information to the public in a timely manner.”

Hamburg says she wants all stakeholders-physicians, pharma, and the public-to provide suggestions as to how the agency can best inform the public. The task force is holding two public meetings, establishing a public list of important issues to consider, and using the Internet to allow the public to provide comments and feedback to the agency. 

FDA Deputy Commissioner Joshua Sharfstein will be chairing the internal task force on transparency. 


  Given the tenor of the past few years’ attacks on the agency, there’s a good chance that the proceedings will be dominated by the usual suspects-David Graham, Steve Nissen, Marcia Angell, and the like-wanting exactly what they have wanted for ages: everything. It’s easy to imagine that hearings will lead to a well-documented demand for full access to clinical trials data, personal information about advisory board members, and full documentation about every internal disagreement at an agency at which scientific debate is supposed to lead to decision-making, not an endless continuation of debate.

Here’s a prediction: The transparency task force’s first crisis will be explaining why they can’t provide more information on how they decided not to give critics everything in their shopping baskets.

Sharfstein, meanwhile, says FDA is approaching the initiative less from the angle of fixing past transparency problems, and more to take a fresh look at what information the public wants to see made public, including the possibility of releasing clinical trial data. 

And how will the FDA find resources to run the task force?

The commissioner was vague in her response, stating only that she would work with the task force on implementation after the requests are read. She also said that there might be fewer requests and citizen petitions for information, leading to a decrease in resources. 

A more complicated question is how this new, more transparent FDA be affected by laws that have been put in place to keep proprietary secrets secret is still unknown. Hamburg said that FDA would be reviewing procedures surrounding accessibility of information. 

“I think we will see a range of areas of needed activity that will require different solutions to address them,” Hamburg said. “Certain types of information such as reports and documents can just be put up on the web site in a timely way, other types of information dealing with clinical trials data will require a very different framework to make it available.”

“Currently there are obligations to protect confidential information and I don’t think FDA or the Obama administration is suggesting that they be disregarded,” said Jill Kopeikin, partner at Dechert LLP told 

on Wednesday. “But the parameters could be implicated and that is the question that people will be watching closely.”

The first public task force meeting will be held Wednesday, June 24. 

The feds green lit a task force charged with easing the flow of communication between FDA, pharma companies, and the general public. While the team is being billed as a task force for transparency, it?s still unclear what is being revealed.

Pharmaceutical Executive-06-04-2009

Managing the Crisis of Marginalization

ASCO Roundup: Winners, Losers, and Also Rans

GSK Signs Deal with Concert Pharma to the Tune of $1 Billion

FDA Launches Transparency Task Force