Death of the Pharma Sales Rep?

bah humbugWe’re not feeling a whole load of Christmas cheer among the pharmaceutical industry this festive season.

First came the news that GSK is phasing out all payments to doctors and will no longer be bonusing their reps based on sales.  Now, a new study suggests the end of the road may be nigh for pharma sales reps.

According to a survey of nearly 3,000 physicians undertaken by CapGemini and QuantiaMD, when it comes to receiving clinical and medical info, reps rank last as a resource behind print, digital media and phone links.

  • 67% of physicians say digital media is their preferred source of information from drug-makers
  • 40%  believe digital media has the most relevant and personalized content
  • 52% believe sales reps will eventually become information coordinators
  • Only a paltry 20% say reps are their favorite source of information

no repsIn parallel, more health care providers are shifting toward larger, organized health systems, which make it more difficult for reps to reach physicians for visits. Sixty four  percent of those surveyed say they restrict rep visits and 31 % of physicians in organized health systems do not allow reps any access, due to corporate policies.

Newer and younger physicians are more likely to rebuff reps – as many as 80%  impose restrictions. 90% of new physicians are joining organized health systems right out of medical school.

Physicians today are in a time crunch, juggling more commitments than ever before and no longer have the time to dedicate to in-person meetings with pharmaceutical representatives. So the reliance on more digital channels comes as no surprise,” said Dan Malloy, Senior Vice President at Quantia. “This study supports what we’re already seeing from our 200,000 members–that a physician-centric, digital communication model is the most effective way for reaching and engaging doctors.”

On a more positive note, reps slightly edge out other resources when it comes to finding product info and patient education.

Hala Qanadilo, a principal in life sciences at CapGemini says, “While the more traditional face-to-face, in-office visits might decrease, the role of these representatives is projected to be as important as ever. Moving forward, they will need them to be the directors of multiple information sources, customizing their outreach so it is more personalized and physician-centric.”

How are you tackling the changing healthcare environment in these increasingly restrictive times?  We’d love to hear from anyone out there in Pharmaland.

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Pharma Under Fire for Fair Balance Failings

Unfair balanceUh oh! Seems like the Pharma industry is in trouble again.

Research published in the Journal of General Internal Medicine suggests that family physicians receive “little or no information” about adverse effects associated with medicines in the majority of drug promotions made by sales representatives.

In the study, 255 family doctors from urban practices in the US [Sacrameto], France [Tolouse] and Canada [Montreal and Vancouver] answered questionnaires following visits from sales representatives.  The primary outcome measure was “minimally adequate safety information” (mention of at least one indication, serious adverse event, common adverse event, and contraindication, and no unqualified safety claims or unapproved indications).

The findings showed that sales representatives did not provide any information about common or serious side effects, or identify the patients who should not be using the drug, in 59% of the promotions. In Canada, no potential side effects were mentioned for 66% of promoted products, according to the results.

yes no riskThe researchers also indicated that although 57% of the promoted drugs carried boxed warnings from the FDA or Health Canada, serious adverse events were only discussed in about 6% of the sales pitches.

Félicitations to the French reps who provided information on harm for 61% of the promotions, compared to only 34% in Canada and 39% in the US.

Despite this lack of “fair balance” overall, the doctors considered the quality of the scientific information to be good or excellent for 54% of the promotions and indicated that they would be willing to prescribe the drugs 64% of the time.

Laws in all three countries require sales representatives to provide information on harm as well as benefits,” says lead author Barbara Mintzes, Assistant Professor at the University of British Colombia. “But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion.”

Despite widespread belief by physicians to the contrary, the information provided by pharmaceutical sales representatives has been shown to influence prescribing. Greater exposure to promotion is associated with higher prescribing volume and costs.  And while regulations in all three countries require sales representatives to provide information on the risks as well as the benefits of their drugs, there are differences.  It’s interesting, to correlate the above results with the fact that that France has the strictest information standards, whereas Canada relies on industry self-regulation.

However, across all three countries, the results of this study would appear to question if current approaches are adequate to protect patient health.

The Pharma Industry should take note.  Time to clean up your act before the Government and Regulatory Authorities do it for you.

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Rehab for Ruined Reputations?

pharma industryAfter 25+ years working in or for the pharmaceutical industry, I’m probably one of its greatest supporters. I’ve witnessed the impact that pharma R&D has on the lives of patients, the benefits that pharma supported education offers physicians and the global impact of the pharma industry on the economy.

Yet despite all the good it does, pharma has somehow ended up with a reputation that, to put it mildly, sucks. Rather than being hailed as responsible and innovative the public perception of the industry is more likely to be fat cat greed.

So how did pharma earn itself a place in the ‘damaged goods’ file?

According to a new survey pharma’s poor reputation  stems mainly from concerns over safety, pricing and transparency.

The global survey, conducted by Patient View, in November and December 2012, explored the views of 600 international, national, and regional patient groups on the corporate reputation of the pharma industry as a whole, and the top 29 companies in particular.

The results are in and they’re not good. The Pharma Industry’s reputation has taken a dive.

ReputationOnly 34% of those surveyed said that multinational drugmakers had an ‘excellent’ or ‘good’ reputation last year- compared with 42% in the 2011 survey.

The survey also asked patient groups – many of which receive financial backing from the pharmaceutical industry – to rank drugmakers on six indicators that influence corporate reputation: patient-centeredness; patient information; patient safety; useful products; transparency; and integrity.

Overall when comparing 2012 with 2011, the industry’s reputation suffered the most in the following areas:

  • managing bad news about drugs (29% decrease)
  • having ethical marketing practices (23% decrease)
  • having a good relationship with the media (19% decrease)

Other factors cited for the poor performance: a continuing failure to help patients in cash-strapped countries gain access to medicines; a preoccupation with drugs that offer short-term health benefits and not enough effort made to discover new drugs for neglected groups of patients.

Patient groups also pointed to inappropriate and off-label marketing; a perceived lack of transparency, especially when it comes to reporting disappointing trial results; and giving the impression that profits come before patient well being.

What else?

pharma money13% said that the industry does not provide high quality patient information; 11% believe that no drugmaker has a good patient safety while 9% think that the industry does not provide useful products.

Brand-name drugmakers, ranked poorly compared with other players in the healthcare sector. Patient groups graded retail pharmacists, medical device makers, generics companies and even “for-profit” health insurers, as having ‘excellent’ or ‘good’ reputations. Only non-profit health insurers fared worse.

Can the industry turn itself around? We sure hope so.

Stakeholders, especially those who receive money from the industry, should respect pharmaceutical companies as corporate citizens.  At the same time, Pharma needs to recognize that they have a  key opportunity to demonstrate leadership by addressing the growing problem of chronic disease. Policy-makers, health care providers and patients will all benefit if the industry plays a more prominent role in helping to better manage chronic disease and partner with the public health community in promoting disease prevention.

And Pharma needs to tackle the price complaints head on, rather than shying away.  Whatever happens with healthcare reforms, politics or the economy, affordability and pricing will remain perennial reputational challenges for the industry. Period. We are all consumers at heart. Consumers, looking for bargains. And while I don’t support price cuts, I would advocate greater transparency around drug pricing. Pharma could both help themselves and make a meaningful impact by educating policy-makers and the public on the cost of medicines and by demonstrating how medicines decrease health care costs overall.

Managing reputation by meeting stakeholders’ myriad expectations for pharmaceutical companies is more than merely ‘doing the right thing.’

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Could “No See” docs be doing a disservice to patients?

One of the biggest challenges facing any Pharma rep is the increasing number of  doctors who won’t see them. Every week, more and more physicians are restricting, and some even eliminating, their face time with sales reps.

In fact, the number of doctors willing to see reps has declined by about 20% since 2008.  And while some clinicians chose to do this, others have had it thrust upon them by their institutions or employers who are concerned that medical practice may be unduly influenced by pharmaceutical industry representatives.

Although  “no see” advocates argue that removing commercial influence is better for patients, a new study suggests the practice has downsides too.

This should be good news for the Pharma, who has always maintained that the clampdown on reps amounts to overkill and that more than selling, reps  provide information that can benefit patients.

The study, published in the Journal of Clinical Hypertension, divided medical practices into four categories. Based on the degree of sales representative access to clinicians, they were classified as either very low, low, medium, or high.

The clinical decisions, and prescribing behavior of over 72,000 physicians were then statistically analyzed, with regards to the drugs listed below:

The authors found that after the FDA approved Januvia, docs who had little interaction with reps took longer to write prescriptions than docs whose access to reps was not as restricted. Meanwhile, physicians who rarely, if ever, saw reps were slowest to change their prescribing habits after negative news emerged about Avandia and Vytorin .

Specifically, the study found that docs with very low access to reps had the lowest adoption rates for Januvia. They took between 1.6 and 4.6 times longer to start writing prescriptions after the pill was launched than docs who had low, medium or high access to reps. Docs who had very low access to reps were also 4 times slower than those of their counterparts to reduce their use of Avandia, after the Black Box warning was issued in 2007.  There was also “significantly less” change in the prescribing habits of those who had less access to reps in response to controversial and disappointing trial results released in 2008 for Vytorin, than those with fewer restrictions on rep interactions.

The study authors commented, “These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative drugs.”

George Chressanthis, professor of healthcare management and marketing, and acting director for the Center for Healthcare Research and Management at Temple University Fox School of Business, agrees.

The study affirms simple intuition that when physicians have to make decisions involving complex issues with less than complete information available to them, and where the consequence of a wrong decision is significant… unintended consequences are likely to appear. Policies that promote physician ignorance of new medical information resulting from access limits, run counter to protecting patient health.”

Could increasing, rather than decreasing  sales representative access to physicians lead to better clinical decision making and better patient health? Let us know what you think.

Prescriptions, Physicians, Patients and Payers: Let the battle commence!

Last week the FDA announced that it wants to remove obstacles to America’s most commonly used drug treatments.  If the Agency gets its way, some drugs used to control chronic conditions, such as high cholesterol, diabetes and asthma may soon be available without prescription.  But in doing so, they have reopened a  big can of worms. One that brings into question the very nature of health reforms, preventative medicine and improved access to healthcare.

Here’s the proposal: The FDA would create a new class of “safe use” drugs. While consumers would not need a prescription, they would still need to get clearance from a pharmacist or from specially designed websites to purchase them.

Battle lines are being drawn! With physicians on one side, and patients, pharmacists, pharma and payers on the other.

Doctors are most definitely not thrilled by the idea. Removing the prescription requirement for an inhaler refill, for example, doctors fear they would be taken out of the loop on everyday care decisions.

Insurers, on the other hand are embracing the move. They recognize that they could save big bucks if physician visits weren’t required for run-of-the-mill complaints and ongoing medication monitoring. They might even save on the costs of the drugs themselves because, depending upon how they’re classified, most health plans don’t pay for over-the-counter treatments.

Pharmacists see it as validation of their expertise and pivotal role in primary healthcare and the pharmaceutical industry, who has repeatedly asked for permission to sell such drugs over-the-counter, must surely be cautiously optimistic.

Even normally conservative regulators are supporting the move. “Greater over-the-counter and behind-the-counter access will lower costs and make healthcare more accessible to consumers,” former FDA commissioner Scott Gottlieb said via Twitter. “It’s a good idea, long overdue.”

Even so, the FDA will have a fight on its hands as it moves to turn its proposal into reality. The American Medical Association lambasted the idea in USA Today, saying that patients need guidance from doctors. The doctors’ association also points out that giving patients more control could complicate coordinating care, such as, tracking all the drugs a patient uses to prevent interactions.

But, as The Washington Post points out, FDA sees the doctor’s visit as a hindrance to care; some patients don’t seek treatment if they have to see a physician first. “Obviously, it’s much easier for you to go to your drug store and pick up an item than it is to make an appointment, take a prescription, drop it off and get it filled,” says Nancy Chockley, president of the National Institute for Health Care Management.

About 20% of prescriptions written in the United States currently go unfilled. Removing obstacles that keep Americans from managing their own health care is, according to one patient, namely me, a good thing.

The FDA contends, and I agree, that some consumers may not even go as far as getting a prescription because of the “cost and time required to visit a health-care practitioner.  Earlier this month, I stood in line at my local pharmacy for thirty minutes to pick up a refill prescription for blood pressure meds. On reaching the end of the line I was told that there was no prescription. The pharmacist called my doctor and the lack of prescription was confirmed. I called my doctor and was told I would need to make an appointment to have the prescription renewed. I pointed out that I had done that one month earlier and that nothing had changed regarding my health. I was then informed that it was a new policy to issue prescriptions on a month-by-month basis rather than provide automatic refills. Even when I pointed out that I have a chronic condition that I’m doing my best to manage and part of that management is the medicine I have been taking for years, they wouldn’t sway. No doctors visit, no prescription.  And the kicker, I couldn’t get an appointment to see my doctor for a week…meaning, I had to go 7 days without blood pressure meds, all so my doctor could better manage my care!

Practicing medication adherence is very hard when your doctor won’t give you medication…and leaves me wondering if this policy change had more to do with revenue generation than improving chronic disease management.

My personal experience aside, at the heart of this discussion is a fundamental disagreement over what role doctors play in managing patient care. The FDA proposal views a trip to the physician as a hindrance to care, whereas doctors see that visit as crucial, especially as chronic conditions become increasingly prevalent.

The FDA proposal is still in formative stages, meaning there’s still a lot of space for this debate to evolve. Where the discussion heads on this particular issue could end up guiding health policy on what role doctors play in managing patient care – and, at what point, the patient takes charge.

I, for one, can’t wait to see how it plays out, assuming of course that I’m not dead from uncontrolled hypertension!

Broken promises & fresh starts

SRxA’s Word on Health can’t help but wonder how Abbott employees are feeling today after learning that 3,000 jobs are to be cut.  According to Bloomberg, the corporate axe will fall as part of the company’s restructuring plan following its acquisition of Solvay’s pharmaceuticals business.

How ironic and painful it must be each time they see their corporate mission statement:  “A Promise For Life.”

So who will stay and who will go?  According to the company, most of the positions to be eliminated will be in sales, corporate staff, manufacturing and research.  While we’re not quite sure who that leaves, we do know that there will soon be a lot more pharma people out there looking for jobs.

Though few Abbott workers will take comfort from the fact that the restructuring will result in savings of $810 to $970 million over the next two years, they are certainly not alone.

2010 has been a busy year for the pharma chopping block.  A Google search on “pharmaceutical sales job cuts + 2010” elicited 331,000 results.

In the last quarter alone, Astra Zeneca, Merck, GlaxoSmithKline, Pfizer, Roche, Takeda, and UCB have all announced significant reductions of their sales force.

It’s all a far, far cry from the pharmaceutical industry zenith of 2004 when roughly 105,000 sales reps were employed in the US.

These latest job cuts appear to support the notion that the pharmaceutical industry is moving away from transactional selling to more value-oriented or solution-oriented selling.  Without its traditional army of sales reps the pharmaceutical industry will need to come up with new and better ways of engaging the physicians.

SRxA is here to help.  Contact us today to learn how we can help you to create and deliver successful programs in these changing times.

New Perspective on Pharma- Physician interaction

Despite ever increasing regulations, and even though some institutions and medical societies have adopted policies that limit or ban such practices, new research shows that most physicians and doctors-in-training still have a positive attitude toward the marketing activities of pharmaceutical companies.

According to the study published in the June Archives of Surgery 72% of surveyed doctors and medical students said sponsored lunches were appropriate. Nearly 60% said samples improve care for their patients, and 71% said pharmaceutical and device company money is useful for funding residency programs.

Additionally, the majority of doctors thought that educational material supplied by pharma (68.8%) and device (78.5%) companies was a useful way to learn about new products.

There were limits, though. About 3:4 respondents believed gifts valuing more than $50 were unacceptable and almost all thought vacations were inappropriate.

The study authors polled almost 600 faculty and medical trainees at 11 New York City hospitals that have banned or limited the interaction between physicians and industry.

Some difference was seen between different physician groups. Surgeons were more likely to have a positive attitude toward industry. They believed that gifts, such as residency funding and travel reimbursement for attending lectures, are acceptable. Pediatricians held less favorable attitudes.

Interestingly, 73.2% of physicians thought that their institution should allow physician-pharma interaction while almost the same number (72.7%) strongly believe that their prescribing was not influenced by industry marketing practices.

Clearly, not all physician-industry interactions are created equal. While politicians and regulators would have physicians shun all contact with the pharmaceutical and device industries, many doctors believe such relationships are healthy and beneficial.

Before regulators rushed to reduce conflict-of-interest, maybe they should have talked to the very people most impacted by the rules.  Word on Health is not surprised that doctors take umbrage at the suggestion that a pen or a sandwich paid for by industry might affect their judgment. The public demonization of financial relationships between physicians and industry, although widespread, is not supported by any conclusive evidence.

Despite this, relationships continue to be investigated and regulations become more rigorous. Are they too much or too little?  We’d love to hear your views on this. Please leave a comment below.