New regs exorcising the devil in the details

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Goodbye, branded notepads, pens, mousepads and stress-balls. Hello, academic detailing.
It's been a bumpy couple of weeks for a traditional pharma sales model buffeted first by PhRMA's revised Code on Interactions with Healthcare Professionals, that now bans gifts and most meals for doctors, then by legislation in Massachusetts and the US Congress that would fund academic detailing programs. 

There's more than an element of Big Pharma-bashing in all this. But it may not be all bad, said John Kamp, executive director of the Coalition for Healthcare Communications, noting that the service provided by detailing is still very much in demand. “After the dust settles, the industry may be well served by the changes,” said Kamp. “There may be fewer ‘boots on the ground' carrying cookies and pens, but they'll be armed with what prescribers really want, which is information to advance patient care.”

Sales forces were shrinking anyway, and while new restrictions on gifts and meals might limit reps' access to physicians incrementally (since by and large, pharmas had already implemented these policy changes), access was already getting scarce.

“This comes on the tail end of access being hindered by physicians themselves,” said Louisa Holland, co-CEO of the Americas for Sudler & Hennessey, which explored the topic in its recent Forum on Industry Change, learnings from which will be covered in a forthcoming white paper. “They're under a lot of time pressure, and there have been individual and institutional decisions to ban reps, so the access issue is multifaceted. It's not just regulatory scrutiny or the PhRMA Code. When physicians do see reps, they're either limiting their time with them or they expect more value for the call.”

And how to deliver that added value in lieu of tchotckes and lunches out? Holland is advising clients to explore alternate media channels like web and phone-based details and education that allow them to reach physicians when they're not attending to patients. “We have to redefine what the sales call is about,” says Holland. “It has to be more educational. We have to look again at the volume of calls—maybe we can field smaller and more effective sales forces.” 

Some companies are exploring tiered sales forces of the sort implemented by Wyeth, in which an elite corps of MSLs or specialty trained reps call less frequently with more exhaustive, higher-science information and a second group handles sample and literature drops. With approvals more uncertain than ever before and generics on the hunt, many are looking for more flexibility, as was AstraZeneca when it inked a co-promote with Abbott on one of its most important products, Crestor, for the US last month.

It's a relationships business, the adage has it, and relationships deteriorated in the age of managed care and ever-increasing sales forces. It was no surprise when a PeopleMetrics survey of regularly prescribing psychiatrists and physicians in the atypical antipsychotics market found fewer than a third of respondents to be “fully engaged” or “engaged” by pharma reps. The largest number, 53%, were “on the fence” about their relationships with reps. For the detailers of today, then, time to get back to basics of information provision—sans the branded bells and whistles.
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