The value of medicine

July 1, 2006
George Hradecky
Pharmaceutical Representative
Volume 0, Issue 0

GlaxoSmithKline is empowering its sales representatives to act as industry ambassadors. Will other companies follow?

As pharmaceuticals and medicine in general become increasingly politicized in our digital media age, sales reps are beginning to see new types of objections when they call on physicians: objections based on industry reputation. These objections occur not only in doctors' offices, but also at family gatherings as aunts, uncles and cousins ask reps questions based on media portrayals of the industry. Enter Philadelphia-based GlaxoSmithKline. Three years ago, in response to the declining public trust in the industry, the company decided to go on the offensive with a program that would help spread the word about the lives the industry saves and the reasons drugs cost what they do. Because of their presence in doctors' offices around the country and their natural enthusiasm, the company's 8,000-strong field sales force was the natural place for GSK to begin the program. Pharmaceutical Representative spoke with Mike Pucci, vice president of external advocacy at GSK and the head of the Value of Medicine initiative, about the company's success in improving the industry's image and what reps at other companies can do to become advocates for the industry.

PR: In the past, the pharmaceutical industry has been slow to respond to its critics. What was it that made GSK want to go on the offensive in dealing with these issues?

Pucci: It came about as a result of the continuing decline of the industry reputation, as measured by the Harris Interactive audit that's done every year on industry reputations. The first people affected when the public perception of the industry goes to the depths it had gone to are employees nationwide. They're hit with it by customers, by friends and family, by people in their social network. When someone found out you worked for a pharmaceutical company, you got an earful. So right upfront, we felt the most important thing was that we needed to develop the capability for our employees to respond to some of these issues and also to be proactive in going out and telling our story in social settings. We wanted to be able to spread the word about the value of medicine, why we do what we do, the cost of research, the importance of innovation and why in many cases – especially in the treatment of chronic disease – prescription medicines are the solution to rising healthcare costs. That message is very powerful, and delivering it in a grassroots way does two things: It helps us get the word out, and it also restores the faith and spirit of our employees – that they work for a great company and a great industry, and we do have a story to tell.

Mike Pucci

What is it about sales reps that made you see them as your frontline industry advocates when you started this program in 2003?

It's a natural fit, if you stop to think about it. We trust our sales representatives with skillfully handling conversations with the smartest people in the world: physicians, pharmacists, nurses, people involved with healthcare delivery. And we give them thousands and thousands of samples and a company car and a lot of responsibility, and yet in the past, we haven't given them the license to speak about these industry issues. That's kind of silly, isn't it? These are expert communicators, they're smart, they're very well trained and they know how to handle objections. And for the most part, the questions they get on the value of medicine are no different from any objection they run into in the course of the sales call. You apply the same methods to responding to these societal issues about the industry. You convert the discussion from the issue to a value discussion, and that's what we train them to do. And they pick up the language very easily.

Are all GSK reps trained on the value of medicine?

We're only training people who want to be involved. We don't make it mandatory, although it's unavoidable that reps will deal with these issues at some point. But really, the people I train are the ones who look at the material and look at the initiative and say, "Wow, I really want to be part of this." I take those people and I train them to another level and they become advocates.

What is the process for someone who looks at the material and says, "This is great! It would really help me in my territory"?

The first level of engagement is to be able to handle a discussion with your family and your neighbor and your friends. That's just a matter of being conversational with the information and being able to respond to informal questions that you happen upon. We've got a book that's called "Beyond the Basics: The Value of Medicine," and it can be read in about an hour, and it's tabbed by issue. Once you understand the facts, it's a matter of verbalizing [them] and learning how to position the answers with the information. The second level of engagement is being able to present at a local nursing association or a rotary club or something like that. And if you're going to get up in front of a group and handle questions, we'd like you to sit down with me for a couple of hours and go over the questions you're likely to get and the best way to respond. The third level is representing [the] region. The training we put the third level through is about a day, and it's usually one-on-one with me.

What is the number-one "Value of Medicines" objection sales reps might come across while they're interacting with physicians and the public?

Pricing generally is number one and probably constitutes about half of the comments. It usually takes the form of a comment like: "Why do 13 [osteoporosis] pills cost $153?" It's people focusing on the price and not thinking about what that drug's doing for them and what it's preventing. That is the first and foremost objection we teach everybody to handle.

How do you train participants to handle that objection?

If [you're] dealing with somebody who has insurance, who's playing the devil's advocate, you remind them of the value. In the statin class – and 10% of prescription drug spending is for statins today – you remind people that for less than $3 per day, they can reduce a major risk factor for a heart attack. It's cheaper than a fancy cup of coffee at Starbucks. Now if someone is saying, "It's $153, I can't afford it, I don't have insurance, I'm having to choose between my groceries and medicine," the answer is very different. The answer is immediately to acknowledge and say, "You're right, I understand these things can be expensive, let me show you how we can help." And then we talk about patient assistance. The most immediate thing we can do is acknowledge that issue and connect them back to their doctor's office to maybe get some samples. Whether it's my drug or my competitor's drug, we're reminding our sales reps that when they're presented with this issue, they've got an opportunity to help somebody. Even if the patient never goes back to the doctor to pick up the samples, it shows that you care.

So the reps are trained to answer the question differently depending on who's asking it?

[The representative has] to qualify that comment. Who's it coming from and what's that person's perspective? If they truly are advocating for someone who can't afford their medicines or if they are truly in need themselves, the answer is to go right to the support networks to get them help. When we started out three years ago, we would answer that question, "Well you know, it takes 15 years and $800 million to develop a medicine." Nobody cares about that answer. Basically, the listener hears that and they say, "Well that's fine, but that's your problem. All I know is I can't pay for your meds." Even though statistics on the huge risks and costs associated with [research and development] are true, the only time that answer would be appropriate is in an academic environment where someone is really trying to understand your economic basis for your cost structure. To the general public, it's a non-starter.

What is another typical objection sales representatives might get?

The second most common issue we get today, especially in the medical community, is direct-to-consumer advertising. That question usually comes in the form of a comment like: "If you just stopped doing the television advertising, you could lower the price of your medicines." The physicians will also say that advertising drives people into their office and those people demand the advertised drugs even if they don't need those drugs.

What are your reps trained to do when they encounter that kind of comment?

We train our reps to remind people why we're advertising in the first place. We're trying to let the public know that there are treatments out there, and if they've got these symptoms or are not satisfied with their current therapy, they should talk to their doctor because there might be something that will help them. I think the problem of overprescribing is a myth compared with the volume of people who have undiagnosed conditions and whose condition is progressively getting worse because they're not being treated. That's the response and that tends to work. If you need to get deeper into the price structure, the industry spends 2% of sales on television advertising. If we stopped today and lowered the price of drugs by 2%, would that help access for people who can't afford medicine? I don't think so. You basically can put it into context and remind people that we aren't spending as much on advertising as Coca Cola is – and by the way, this is about your health, not about selling sugar water.

Recent news stories on drug safety are leading reps to see more physician objections to their study reprints. The objection is usually based on a physician's claim that the study is biased. How are you training your reps to deal with this objection?

You have to say upfront that that bias is fully acknowledged and understood. However, we're applying the standard of care in the design of our studies that the Food and Drug Administration requires of every company in the business. There are people with a large body of evidence before them who are looking at the entire basis of this research to come to their conclusions about the labeling, the risks and the benefits. But we really can't go much deeper with that discussion, because we're not that close to clinical development. That's where you stop and say, "If you want to have this debate, let's sit down and let you talk to a researcher." We're in the process of making sure we have people in the R&D organization that are capable of responding to this type of question.

Is the concept of empowering reps as industry ambassadors catching on with other pharmaceutical companies?

Yes, Pfizer was a fast follower and immediately began experimenting with what we're doing. At Eli Lilly, they're kicking off a four-state pilot right now. Purdue Pharma picked up our material and developed their own version of it and launched a campaign to their sales force. Allergan has used our training materials and has also sent all the material out to their sales force. The uptake has been very gratifying to see, because the more people who are out there doing this, the better. This message is not about GSK; it's about the benefit of medicines and the industry, and ultimately, it's about taking care of patients.

For reps whose companies have yet to train them on the value of medicines, what advice would you give for improving the industry's image?

We provide our information to people regardless of who they work for. It's nonbranded material and the answers are universal. So we can provide our material to anybody who's looking for help. We're in an election year, and the issue of affordable medicine is not going to go away. We've got to be out there with proactive messaging, and we've all got to pick up the kind of language that makes a difference with the audience. The difference is to talk about prevention, better treatment of chronic disease and, finally, the need for innovation to treat diseases we don't treat today. We can all carry that message.