How to Target Top Prescribers

February 1, 2003
David Lefkowitz III MD

David Lefkowitz, III, MD, CEO of the healthcare consultancy PPN Wireless, LLC, has more than 20 years of experience as a marketing consultant in sales force effectiveness. He can be reached at david.lefkowitz@ppnwireless.com or at (704) 372-4348.

Pharmaceutical Executive

Pharmaceutical Executive, Pharmaceutical Executive-02-01-2003,

Eighty thousand pharmaceutical reps crowd US waiting rooms vying for the opportunity to see physicians. Meanwhile, managed care companies require contracted physicians to churn through a growing number of patient appointments each day. And regulatory forces have removed from the marketer's toolbox many effective tactics for gaining access to doctors outside their offices. With less physician face time available, stiffer competition for each moment, and tight restrictions on access, pharma marketers find themselves hamstrung in their efforts to move product and meet aggressive sales goals.

Eighty thousand pharmaceutical reps crowd US waiting rooms vying for the opportunity to see physicians. Meanwhile, managed care companies require contracted physicians to churn through a growing number of patient appointments each day. And regulatory forces have removed from the marketer's toolbox many effective tactics for gaining access to doctors outside their offices. With less physician face time available, stiffer competition for each moment, and tight restrictions on access, pharma marketers find themselves hamstrung in their efforts to move product and meet aggressive sales goals.

In December 2002, PPN Wireless queried 150 top-decile prescribers-primary care and specialty physicians-over their wireless handheld devices about their pharmaceutical sales interactions. Based on their response, this article outlines tactics that will help pharma companies target their most valuable physician customers and establish ongoing access to them.

It provides strategies for evaluating both new and traditional media tools and demonstrates how marketers can structure their marketing programs to meet the needs of busy physicians while creating high-quality messages that will leave them wanting more interaction with the company.

Precision Targeting

Pharma marketing and sales executives have long struggled to gain access to hard-to-see physicians. In 1987, PE published "The Myth of the No-See Physician," which encouraged marketers to use more precise techniques to reach high-value physicians who managed to elude even their best sales reps. The article focused on the need to tailor messages to the preferences of individual doctors. That strategy is even more important today and should be expanded to include four primary tactics:

  • Segment physicians according to their value and focus resources on those with the greatest worth.

  • Find out how doctors prefer to receive information. Many high-value physicians will give permission to interact with them regularly, providing a critical advantage in gaining share of voice with that physician.

  • Assess the tried-and-true communications tools that are currently used and evaluate the new tools available to marketers. An appropriate mix can maximize the company's share of voice with high-value physicians.

  • Tailor the message to the individual physician. Listen to what he or she says. That's as important today as it was 15 years ago.

In a time when marketing and sales purse strings are pulled tight, it's important to acknowledge that not all physicians are equal. Therefore, reps should not detail an allergy product to cardiologists, who clearly will have no effect on that product's sales. Marketers should focus on primary care physicians and respiratory care specialists who treat patients needing allergy medicines.

Going a step further, not all PCPs and specialists are equal when it comes to prescribing a product. Some are more valuable than others simply because they see more patients who will benefit from using the product. A simplified market case study illustrates the point:

An allergy product costing $60 is refilled three times, meaning each new script is worth $240 in sales. Two physicians, a PCP and a respiratory care specialist, see 4,500 patients each year. Being a generalist, the PCP treats a wide array of diagnoses, for which the product is indicated in only 5 percent of the cases. Of her 4,500 patients, she sees only 225 who can use the product. She represents $54,000 in potential sales.

Because of the nature of specializing, the respiratory care physician treats a much narrower range of diagnoses. The product is indicated for 20 percent of his cases, or 900 of his 4,500 patients. As such, he has the potential of creating $216,000 in sales for the company.

In his June 2002 article in PE's Successful Product Management supplement, Archibald Anderson discusses physician "persuaders," suggesting that the personal communication network among physicians is the most powerful influence on how widely and quickly the medical community accepts a product. According to Anderson, doctors watch each other and have a tendency to mimic the prescribing patterns of respected peers.

Applying Anderson's theory to the allergy product case study further extends the potential value of the respiratory care specialist. Not only does he have 400 percent higher direct sales potential, he also has indirect influence over the prescribing habits of the specialists in his practice. His influence even spreads to his referring base of primary care physicians who read his referral letters as they update the files of their shared patients.

Get Permission

Busy specialists run in and out of examination rooms, seeing 25–30 patients a day. To keep to that schedule, some offices have restricted sales reps' access to one hour a day or less. Sales reps know the routine: they sit down and rehearse product messages, glance nervously at their watches, and hope they get a chance to present their spiel. But more often than not, they have to settle for a quick handshake, a hurried signature, and a "thanks for the samples." (See "Got a Minute?")

Sales reps shouldn't take that personally. The survey physicians indicated that they often find the sales reps' messages helpful in keeping current on medical issues and scientific breakthroughs. (See "At Your Service," page 62.)

Reaching the busiest doctors during office hours is not an option. Until very recently, pharmaceutical marketers could compensate for that by reaching key physicians through after-hours activities such as golfing and other sporting events, meetings at resorts, and fancy dinners. In response to PhRMA's new code released in July 2002, most companies have agreed to refrain from such activities.

So, what is the best way to gain access to key high-volume physicians? Permission-based marketing is the foundation for successful interactions with physicians who want the information offered but need it delivered in ways that better fit their busy schedules. In such a system, marketers offer something physicians consider useful. In exchange, doctors "opt-in" or agree to provide some of their time.

In 2001, an Ohio physician practice experimented with one type of permission-based marketing. Believing that a physician's time is worth money, it required sales reps to pay $50 to deliver a ten-minute product detail. The pharma industry refused to comply.

Permission-based marketing does not require the exchange of money. In fact, according to the survey, physicians indicated that they value high-quality messages, such as new clinical data, as the most important aspect of interactions with pharma companies.

In the survey, 80 percent of the physicians indicated they would accept permission-based sales interactions with a representative who had a track record of making good use of their time by supplying useful information. Even more said they would be willing if the information was good (84 percent) and the scheduling was convenient (90 percent). More than half of the physicians who answered the survey are already participating in convenient new forms of electronic detailing including e-detailing, handheld wireless detailing or call-center based detailing. The key to those new forms of sales interactions is that they are scheduled with the permission and at the convenience of physicians.

Although the permission-based model works in many relationships between sales reps and physician customers, it often requires a high degree of flexibility to meet doctors' scheduling constraints. To obtain permission for ongoing sales interactions, the survey results suggest electronic media are most likely to meet physicians' needs.

Media Mix

That is not to suggest that sales reps don't serve an important purpose in marketing to physicians. On the contrary, the rep is the marketer's hammer-a sure-fire tool for tapping out consistent and ongoing messages. But physicians have varying preferences for communication media, and primary targets are valuable enough to warrant finding and using the tools that work best with their individual tastes. The ultimate goal is to increase share of voice to improve the return on the investment made in marketing to physicians.

Scott Neslin, a professor at the Tuck School of Business at Dartmouth, conducted the comprehensive ROI Analysis of Pharmaceutical Promotions (RAPP) study in May 2001. The study analyzed the ROI from a variety of marketing tactics including physician meetings, sales rep detailing, and medical journal advertising. Neslin found that the mix of marketing approaches and the stage of the product lifecycle had significant impact on effectiveness and ROI. Neslin concluded that detailing's ROI was affected significantly by the amount of money invested in physician meetings and medical journal ads over the same period of time.

Neslin also found, on a macro level, that the campaigns using a calculated mix of marketing tools realized higher returns. Messages delivered through various touch points-the internet, advertising, wireless transmissions, and sales reps-have a greater chance of sticking with physicians. That integrated approach is the cornerstone of successful marketing programs in any industry.

On the micro level, pharmaceutical executives must determine which of their precision one-to-one tools are most likely to produce a favorable response with high-value physicians. Through call centers, the internet, and handheld technology, marketers can simultaneously share information with, and collect information from, high-value doctors.

The marketing and sales teams that make the best use of such tools understand that they cannot segregate high-value physicians into disconnected projects. Rather, they must coordinate projects to ensure a continuity of message and to ensure that the information they gather from each target can be organized to help with the next interaction. It is an iterative process in which each interaction builds on the last.

To maximize access, pharmaceutical companies should increase their knowledge of each high-value physician, monitor his or her changing preferences, mix the media approaches to fit, and tailor their messages appropriately.

Tailor to Fit

Individualized message creation can be the most difficult part of one-on-one marketing. Generating content is time consuming and challenging. Marketers must seek approval for every product message, and the process of wrangling with company attorneys and regulatory bodies can take months. But once they have identified target physicians, received permission for ongoing access, and selected an appropriate media mix, the success of a physician marketing campaign still relies on the quality of the message and how tailored it is to physicians' preferences. (See "Timing is Everything," page 62 and "New Details," below.)

For example, a doctor participates in an e-detailing program with a major drug manufacturer. In addition to product information, the e-detail contains questions that get to the heart of the physician's attitudes about the product. The questions are designed to uncover a particular negative impression the physician may have that prevents him or her from prescribing the drug. The sales rep has access to the information regarding that bias, then can prepare materials and respond accordingly in the next office visit. In that way, sales reps can tailor their product messages for any physician whose preferences they understand.

The survey physicians said they resented time spent with sales reps who had nothing interesting to share. That sentiment holds true no matter what channel marketers use. If doctors agree to an e-detail campaign but find the content irrelevant, they won't participate in another one. And if a journal ad is innocuous, they'll pass it by without a glance.

Get Through

It takes a high degree of cooperation among pharmaceutical marketers, legal departments, creative agencies, vendors, and technologists to devise methods of approaching high-value target physicians with a mix of media and messages customized to their preferences. But the payoffs for pharma companies that put forth the effort are phenomenal.

A Big Pharma executive recently shared one of his experiences. He had impressive clinical data demonstrating a safety point that distinguished his product from a major competitor. The executive knew that the high-value physician wrote many prescriptions for a competitive product, but he also knew the physician enjoyed keeping up with the latest clinical studies. Using a combination of sales details and messaging through a wireless handheld device, he shared data with the physician several times in different packages.

After a couple of months, the executive received a call from a sales rep, exclaiming, "He finally got it!" The physician had reviewed the material over the wireless device and greeted the sales rep enthusiastically, saying "Why haven't you told me this? You should be telling every physician!" Overnight, the physician switched from the competitor to become an advocate of the company's product. Mission accomplished.

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