Sales rep restrictions point to need for a pharma rethink

Quantia EVP Dan Malloy
Quantia EVP Dan Malloy

Quantia EVP Dan Malloy has a problem: the latest edition of his firm's survey his group compiled with Capgemini Consulting shows that change in certain aspects of the pharma commercial space is happening very, very, quickly— but he says the industry is not doing enough to adapt its promotional strategies to address a healthcare environment dominated by cost-conscious medical groups and performance-focused federal health programs.

But first, a little math. This years survey showed that 32% of physicians said they cannot talk to reps, compared to 27% last year. Apply this limit to doctors in organized health systems, and the restrictions become even greater: 42% of doctors affiliated with integrated health networks say they are not allowed to see reps—a 17% increase since last year.

Malloy told MM&M his group was surprised by how quickly the no-access population jumped since last year and said it probably reflects a higher pace of change than the industry is aware of. Further, he said the industry is wrongly using the same perspective it uses to woo doctors to court payers and integrated networks. He said that this is a pretty big problem because organizations don't need breakfast meetings, portals or newsletters. Instead, he said groups need technology and that pharma has an opportunity to “bring that expertise on how to use digital tech [like EMRs] effectively.”

The Quantia/Capgemini data indicate that getting the integrated-system approach right is only going to become more urgent: 2014 data suggest 57% of physicians now work within an organized provider system, like an Integrated Delivery Network/Health Network and 44% of doctors said they are working for organizations that are moving towards an Accountable Care Organization model, which generally means implementing even more restrictions around rep-doctor contacts and greater formulary control.

Malloy said this same data also outlines how pharma can become part of the health conversation by uniquely partnering with administrators and doctors. The EVP said the opportunity with groups lies in helping them align and manage their information, an effort he said  will permit the industry to act like true partners, as opposed to a party that only provides condition-specific solutions.

The provider angle requires a rethink about what it means for a drug manufacturer to become a resource for health professionals. “Administrators don't have good relationships with their doctors... they have trouble communicating with the doctors they have acquired through acquisitions,” Malloy said, and noted that he sees an opportunity for pharma to position itself as a healthcare partner invested in the overall patient experience as opposed to a single condition. He that this change requires having reps address different levels of expertise—nurse practitioners, for example, instead of just doctors—and providing educational support that is not just pinned to a manufacturer's product.

He said addressing the organizational piece includes engaging with the systems CMS requires groups to use to meet their performance metrics, such as electronic medical records, as well as staying on top of what CMS requirements.

Malloy described this two-pronged approach as a “top-down push strategy and a bottom-up approach” in which pharma simultaneously provides the requisite level of partnership for organizations (top-down push) and doctors (bottom-up) approach, and brings them together.

This concept hits on one the IMS Institute for Healthcare Informatics mentioned in a recent write-up about the importance of the patient journey, which IMS said is about more than Googling symptoms and potential physicians and includes the full experience—physician education, doctor-patient relationships and back-of-the-house considerations like formularies and the regimens physicians will be able to offer during exams.

Bristol-Myers Squibb Associate Director Serge Moskalenko told MM&M in an earlier interview that no one is really putting these pieces together in the US. Moskalenko, whose background includes working with the cancer drug Erbitux, said his experience in the oncology space is that in many ex-US markets the full argument for a treatment will be presented, in large part because decision making is concentrated. He said because decision-making is more fragmented in the US, and presenting drug information depends on a different sensibility because pharma is working with multiple payers, but that lack of unity in the US does not mean the wider narrative is not needed here. For example, Moskalenko said that US doctors and payers are not demanding information about considerations like affordability and access. Yet this summer's anger over the $84,000 price of Gilead's hepatitis C medication Sovaldi shows that addressing this wider narrative is important.

Malloy said being the go-to that puts all of these pieces together is a time-sensitive opportunity and unless pharma figures out “how to work with systems so they can directly and indirectly influence [the way] formulary management systems... are structured,” the impact will be harsh: “All the decision-making will be taken and pharma won't be able to influence it.”