• Sustainability
  • DE&I
  • Pandemic
  • Finance
  • Legal
  • Technology
  • Regulatory
  • Global
  • Pricing
  • Strategy
  • R&D/Clinical Trials
  • Opinion
  • Executive Roundtable
  • Sales & Marketing
  • Executive Profiles
  • Leadership
  • Market Access
  • Patient Engagement
  • Supply Chain
  • Industry Trends

Are you a managed care expert?


Pharmaceutical Representative

Convince customers that you are.

What is a managed care expert? If you ask 10 people, you'll likely hear 10 different answers. Unfortunately, there is no single correct response to the question. You can develop some expertise, however, by gaining a basic understanding of the business principles and processes that drive the delivery of managed health care.

These include, but are not limited to, pharmacoeconomics, disease management, clinical practice guidelines, health outcomes, capitation, risk sharing, contractual agreements, performance incentives and pull-through tactics. Understanding the various types of managed care providers and the ever-evolving list of acronyms used to describe them is also helpful. Doing so will benefit your customers, your company and yourself.

Establish credibility

To be successful, your objective must be to develop a working understanding of how each account in your territory works, what they value, who makes the decisions and how your products and services can be positioned to meet their needs.

This does not mean interrogating your prospective customers. Customers expect to get more information than they give during every call. If they conclude that they are giving more than they are receiving, they may feel that their time is being wasted, and they will be less inclined to see you in the future.

Quickly establish your business acumen, industry savvy, track record and understanding of their operation. Make sure it's evident that you know what you're doing and how you can help them.

Prepare and practice a brief capability statement, such as, "Mr. Bud Jet, we have been pioneers in x therapeutic area(s) with x discoveries for the past x years. Our reputation for quality, service and x are known and respected. I have worked with companies similar to yours for the past x years during which time we have been able to save those companies x dollars. The same quality can be applied with a customized approach to your operation (institution or practice)."

You can transition from the general capabilities statement to address their specific business goals. Keep the following in mind when preparing for every call:

•Â Be prepared to demonstrate cost savings. Forget about talking in vague generalities or examples that aren't comparable to the company you are dealing with now. Customers want to know how the purchase improves their quality, efficiencies, and bottom line. If you can't show financial benefits, you're in trouble. Present any preliminary data, confirm assumptions or gather information that only the customer can provide.

•Â Sell to what the customer values. While data provides a lot of clues, finding out what the customer values is something that only the customer can answer. Design questions to which the customer's response is likely to reveal his attitudes and beliefs about the topic. Then, once revealed, speak directly to how you and your products can support their values and beliefs. For example, if the customer is extraordinarily conscious of the bottom-line, there's not much point in stressing quality and value-added services. However, if quality is a key value, the customer wants confirmation that what he buys now is going to be a good choice in the long term. Whatever the case, make sure that you speak to what they value.

•Â Become a genuine business partner. Become an information source, help broaden the customer's perspective, and open his eyes to new business possibilities. Share what others are doing to deal with similar business issues. Send news clips or relevant articles addressing their business concerns.

•Â Practice patient persistence. This is the hardest step of all, particularly at a time when you're under pressure to gain new business or retain existing business. Show interest and offer to do any of the legwork to make things happen. Be very visible throughout the organization. There's a fine line between friendly persistence and badgering, so determine the customer's expectations of your follow-up and service. Then, exceed expectations.

•Â Watch your back. Until the first order is placed, remember that every competitor in the market is out to unseat you. Once the business is secured, continue to look in the rear-view mirror. Is the competition gaining on you? Continue to gather information, track ordering patterns, provide great service and make sure that customers know the value of doing business with you. If the customer can switch only at a high cost, it's easy to have a false sense of security, so be on guard to protect your hospital contracts and wholesaler rebates. Competitors will do all of the legwork (purchasing, returns, staff training) to take your business away.

•Â Expand the depth and breadth of your contacts. Friends in decision-making roles are invaluable, especially in national accounts and in hospital and wholesale selling. It's equally important to protect your franchise by broadening your sphere of influence (from gatekeepers to department heads) throughout the organization. Don't jeopardize your position by limiting the relationships that you build. Inevitably, key decision-makers get promoted to different areas or leave the company.

• Dedicate yourself to learning and gathering information. The rapid and complex nature of our industry means that information you learned three months ago may no longer hold true. Stay apprised of industry change by reading journals and trade publications. When you learn of anything that might impact the account, check it out. Most importantly, pour over data reports to identify purchasing trends or other data that may help expand or retain the business.

Gather information

The following list covers a spectrum of managed care account and customer topics and questions. Adapt them to gather information on your accounts.


• Ownership, management structure and political landscape.

• Mergers or acquisitions.

• Affiliations with payers, providers, plans and patients.

• Major customer and supplier contracts.

• Patient demographics, lives covered, service areas and plan types.

• Patient literacy and educational needs.

• Prominent disease states treated and cost-containment initiatives.

• Scope of care, such as out-patient, in-patient, emergency, rehab, long-term care and home care.

• Sophistication, integration and sharing of information technology

• Purchasing and distribution channels.

• Fee scheduling for various plans and services provided.

• Drug-dispensing channels.

• Types of drug benefits, such as unified, carve-out, patient-claims reimbursement, copay and variable copay.

• Product formulary status.

• Use of non-physician providers, such as nurse practitioners or physician assistants.

• Major competitors and potential threats.

• Provider incentives and/or disincentives, such as withholds, risk pools, rebates and bonuses.

• National Committee for Quality Assurance and Healthplan Employer Data Information Set compliance or rating initiatives.

• Use of third-party administrative services.

• Clinical practice guidelines, protocols and disease management programs.

• Ability or desire to measure economic, humanistic and clinical outcomes.

• Communication to provider and patient customers.

• Customer service initiatives and satisfaction surveys.

• Enrollment and retention initiatives.


• Types of decision-making committees, such as quality management, pharmacy and therapeutic, utilization review, medical advisory and education committees.

• Chief residents' names and locations.

• Internal stocking and ordering numbers for your products.

• How products are listed in ordering system, relative to competitors'.

• Names, titles and locations of decision makers and influences.

• Director of pharmacy's and/or purchasing director's relationship with key competitor company and sales rep.

• Purchasing and inventory protocol.

• Formulary restrictions. (If formulary is closed, can physicians easily order products that are not on formulary?)

• Status of your products and key competitor products on affiliated formularies.

• Substitution policies and procedures for generic and therapeutic substitutions.

• History and success/failure rate of substitution policies.

• Detail policy. (Are all sales reps allowed to detail, or only some?)

• Does the customer have a counter-detailing program?

Bids and contracts:

• Is the contract performance-based? If so, what's the status?

• Compliance and pull-through measures. Are they in place? If so, what are the success rates?

• Stakeholders' general satisfaction with existing contract and products.

• Bidding process, decision makers, influences and timelines.

• Current pricing and usage of your products and key competitors.

• Has your company bid and lost in the past? If so, why?

• Decision-making considerations, in order of priority.

• How does the customer define and evaluate drug cost? Drug acquisition cost? Pharmacoeconomics, such as cost effectiveness, utility, benefit or minimization? Outcomes, such as cost-of-treatment episode, or drug costs alone? Direct and indirect costs of illness, hospital length of stay or overall resource utilization?

Develop expertise

Unless you are a national or corporate accounts manager, this is a lot of information to learn about every managed care account. However, you must know this fundamental data for your top accounts. Your conscious decision to become a managed care expert will impact your earning power today, as well as your status in tomorrow's pharmaceutical industry. PR

Related Videos
Related Content