GPs harried by reps, oncologists not as much

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The drug industry may be shifting its attention to specialty drugs, what with oncology products driving strong sales, but detailing pressure and pharmaceutical rep access are still much higher in primary care, data show.

The physicians receiving the most number of calls are those on medicine's front line, internists and general practitioners. Generalists received an average of nearly two sales calls per working day—more than any other specialty—during the 12 months to June 2012, said CSD—Cegedim Strategic Data. 

“Some specialties seem to be almost overwhelmed with pharmaceutical company attention,” CSD wrote in an e-mail to clients last week.

Moreover, CSD pointed out, those well-groomed sales people lurking in the primary care waiting room are looking to discuss a greater variety of products from different categories and classes than they do with specialists.

The higher degree of promotional pressure on the PCP stood in contrast to a field like oncology, where detailing is less frequent. A typical oncologist saw an average of 180 details during the entire July 2011-June 2012 span. That's well under one sales call per working day. The data are from CSD's US Promotion Database, which includes about 15,000 oncologists who are seeing reps (not those "no-see" ones who refuse to see reps).

But consulting firm ZS Associates adds that, a few years from now, reps will be lucky if they get to meet with an oncologist face-to-face more than four times a year. That's due to the increasing restrictions on sales rep access. About 61% of oncologists placed moderate-to-severe restrictions on sales rep calls, according to its spring 2012 AccessMonitor report. Only 38% of PCPs restrict rep access to the same degree.

Their increased patient load and more time spent on reimbursement issues have often prompted oncologists to require reps to book appointments in advance, or not see them at all. Only 39% of oncologists were “accessible,” vs. 65% of all prescribers, ZS Associates noted, and 11% of cancer docs severely clamped down on access, vs. 9% of all prescribers.

For the first time this year, found the consultancy, which has been doing the report since 2006, the inaccessible cancer doctors began to outnumber the accessible ones, making oncology the most restrictive of the 20 most common medical specialties measured.

These hurdles don't bode well for pharma. The introduction of new oncology therapies—last year, 10 out of 30 new drugs approved by the FDA were for treating cancer—has been one of the lone bright spots in its bid to jump-start R&D productivity.

“With the increasing number of approved oncology drugs and the active pipeline, properly introducing these therapies to physicians is going to get more complicated,” noted Jon Roffman, associate principal at ZS who leads the oncology practice's field force strategy work, in a statement.

However, when they do get a foot in the door, reps are getting some serious time with oncologists. CSD found that most (53%) of the 2.7 million sales calls to oncologists that the firm tracked from July 2011-June 2012 lasted longer than 10 minutes, 41% lasted between five and 10 minutes, and only 6% were for less than five minutes.

The more specialized the doctor is, the longer the detail. So far in 2012, for generalists, 48% of all calls were under five minutes; the same metric for specialists was 29%, CSD told MM&M. Specialists have almost twice as many longer calls (those lasting over 15 minutes) as generalists: 4%, vs. 11% for specialists. For oncologists, the rate of longer details was 38%.

If pharma is tempted to address access challenges by launching a new sales rep arms race, blitzing oncologists with multiple reps, it should think again, said ZS Associates. Using a mix of services and tactics, including new technologies, is the way to go. In fact, a recent study showed traditional direct mail trounced every other form of promotional outreach when it came to connecting with physicians.

“Instead of designing their field organization based on, ‘How many sales reps do I need?'” explained Maria Whitman Mumm, associate principal and leader of East Coast marketing in the ZS oncology practice, “pharmacos should ask, ‘What is the physician experiencing, and how can I help improve the experience by bringing the most value?'”

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