Ferry from "Statin Island"

Statins have become some of the most widely prescribed drugs of all time.  Atorvastatin calcium (the artist formally know as Lipitor) is prescribed an estimated 50,000 times a year according to the FDA and is by far, up until it lost patent protection in November 2011, the best selling statin of all time (see graph).  And to make them even more spectacular, statin benefits are not limited to simply lowering LDL cholesterol levels.  Recent studies have shown that statin use could potentially treat or prevent cancer as summarized by John LaMattina, a contributor to Forbes. 

Image courtesy of Pharma Marketing News

Even with the extensive benefits and proven efficacy of statin therapies, adherence to prescribed therapies is still an issue.  PMPNews.com recently summarized the results from the USAGE survey, which was the largest cholesterol survey ever, tracking treatment adherence and physician-patient communication of 10,100 statin users. 

With 75% of all newly prescribed statin users discontinuing their therapy by the end of the first year, we believe it is essential that healthcare providers uncover the reasons behind this trend in their patients and do not assume the patient is "compliant." We further encourage healthcare providers to develop strategies and leverage support tools that encourage treatment adherence.  

Studies show increasing the adherence rate will result in improved health for patients, higher revenues for drug manufacturers, and reduced future healthcare costs.  The USAGE survey shows that side effects (62%), cost (17%), and lack of treatment efficacy (12%) lead the way for reasons why statin users discontinue prescribed therapies.  However, revamping physician-patient dialogue and education techniques will help address adherence issues because part of good adherence counseling includes discussions about how to manage potential side effects.    

For more information about the USAGE survey, please visit www.statinUSAGE.com.

Prescription Smartphone Apps for Medication Adherence

When it comes to embracing new technology, we like to think that we are ahead of the curve.  However, our approval is only bestowed upon technology that provides a substantial benefit, especially given costs or numerous unavoidable advertisements. As illustrated in a recent article by Pamela Lewis Dolan at American Medical News, a new wave of technology will become the norm in healthcare by way of smartphone and tablet apps that will allow physicians to closely monitor many aspects of patient compliance. 

There are a few questions however for the future implementation of these “prescribed apps”:

1. Does the app serve a utility that is worth the cost/adherence?
2. How much data will the app produce for the patients?  
3. Will the physician have the time/man power to properly utilize the data?
4. How will physicians monetize the use of the apps?
5. With data being retrieved without office visits, will this mean decreased revenue?
6. As with any prescribed therapy, how does a physician ensure patient compliance?
7. Will health-related apps be regulated by the FDA?

Physician-patient communication desperately needs creative improvements to ensure therapy compliance and persistence.  With the growing use of smartphones, using healthcare apps and the field of mobile health is only expanding in the coming years. The FDA has already approved a select number of apps to deal with clinical care and bills are currently in place to create an FDA Office of Mobile Health.  For a fraction of the cost for an office visit, patients can purchase an app that allows them and their physician to monitor health progression, collect critical health outcome data between office visits that may reduce visits to the office.  

We know medication adherence and health outcomes can be improved by allowing healthcare professionals to track metrics that normally are not monitored, such as heart rate, glucose levels, and calorie count.  This is not driving the conversation out of the exam room, but extending the reach of the physicians diagnostic and treatment capabilities.  With 10% of smartphone users having downloaded health-related apps, the practice of “Prescribing an app” will continue to catch on.  Generating a large market from the almost 1 billion smartphone user base will be as easy as posting that picture of dinner to Instagram. 

Six Enemies of Greatness (and Happiness) in Pharma

I was just browsing twitter and found a great article by Forbes contributor Jessica Hagy.  The article entitled "The Six Enemies of Greatness (and Happiness)" has real implications to life science and specifically large pharma companies.  Here are some of our thoughts.  

1. Availability
• Marketers typically take the path of least resistance.  They feel they need to push things fast and often miss future opportunities when the evidence right in front of them aligns 
2. Ignorance
• Life science marketers often have settled for what they can get done with their regulatory/legal colleagues. If we do not know how to make something great, we simply won't. It is easier to succumb to the legal challenges than take a longer term view and fight the key issue facing marketers.  The ability to create valuable medical content that patients and healthcare professionals want to read 
3. Committees
• Hagey's quote here says it all. "Nothing destroys a good idea faster than a mandatory consensus.  The lowest common denominator is never a high standard.
4. Comfort
• Many of us are all well paid and very comfortable in our lives.  People who are complacent are often not encouraged to pursue greatness. Only recently has the industry been feeling the need or desire to change.
5. Momentum
• If you have been doing something for more than 3-5 years and it is no longer providing you exciting results, you might want to change.  Marketers should begin to look at how the electronic communications are conveying important messages and value to customers.  
6. Passivity
• Do not accept something if you truly believe "this is a bad idea."  The challenge with many senior leaders is that they hear only the good news and do not accept contradictory views.

Finally, Hagey finished the article with a survey question to the reader.  What did they think was the biggest obstacle in achieving greatness?  The respondents suggested that comfort and passivity more than any other barrier prevent greatness.  

Lets see if we can not change this some.  

The Ongoing Dilemma of Physician Access and Selling

The issue of physician access has always been present. In years past pharmaceutical companies employed thousand of representatives to “detail” their product message.  As the shift in healthcare has accelerated in the past couple of years, many representatives have found it increasingly difficult if not impossible to gain an audience with the physician.  A number of these operational challenges loom large in the future of pharmaceutical sales: Improving sales productivity per person Growing sales volume significantly Improving relationships with customers to create value Increasing sales force profitability Finding better ways to measure performance Improving customer service Retraining the sales force The consultative selling approach is the biggest trend today, and pharmaceutical representatives are using it to redefine their roles. Consultative refers to a style of selling in which the pharmaceutical rep devotes more time to investigating and analyzing physician needs and less time in presenting products and service. The term comes from the consulting professions in which clients hire professionals to analyze problems and offer recommendations. It involves much more than asking good questions and listening to the answers although both are critical to successful consultation. This approach is generally yields more value according to physicians because the exchange of information is based a inherent trust in the relationship. Consultative selling requires the sales person and/or company to bring expertise to the table. It demands high levels of knowledge, strategy, and skill all grounded in a thorough understanding of the pharmaceutical selling process. The physician's ever growing time and patient demands require company's to bring clear, concise and accurate information to every encounter.  We believe access remains an issue for those representatives who are not providing that value. Today’s successful reps are not only positioning themselves as a great resource but also delivering value that helps the physician in improving treatment outcomes.   The next issue involves pharmaceutical marketing, which has not caught up with physician’s response to the 'demand' issues.  It is a proven fact that physicians are using online, digital channels and social media to stay abreast of information.  However, the pharmaceutical industry spends less than 5% of their budgets on online initiatives to reach them.  We believe marketing integration of alternative channels will lead companies to improved physician access.  Physicians have continued to reflect the need for pharmaceutical sales rep information, including but not limited to promotional education, patient and disease state education material.  But healthcare professionals also need flexibility with which they get that information. The companies that assertively integrate pharmaceutical reps with online programs provide a holistic approach to educating physicians about conditions, drug therapies, and patient treatment options.  This integration can also reinforce the role a representative can establish as a "trusted adviser" to the medical community.  This process accrues value to companies as trusted partners by build lasting relationships while growing product sales.

Engaging Customers in Today’s Challenging Pharmaceutical Sales Environment

The drastic changes to the pharmaceutical industry over the past many years has had a harsh effect on the pharmaceutical and biotech industry and it's efforts to engage both physicians and key opinion leaders within the health care community. It appears pharma has found a healthy middle ground in their approach to creating value with healthcare providers as a result and is creating better working parameters for physician interaction. Pharmaceutical and biotech companies have been strong partners in the healthcare continuum and should continue to work closely with healthcare providers to create a scientific alliance that brings value to the relationship through good clinical and scientific exchange of knowledge.  This collaborative exchange has delivered better treatment outcomes. So the issue remains as to how to engage today’s physicians and demonstrate value.


The action steps necessary to create value and engage physicians include several key steps. We believe the following are some major areas that will set the path to successful engagement.

1. Engage customers with assurance and confidence that representatives create value for healthcare professionals and their patients. The vast amount of clinical information the physician needs to sort through can be daunting. If the rep can be an expert in a therapeutic area for not only your product but also your competitor’s there is value for both physician and patient. It sounds like old news but knowing everything about a particular disease state builds credibility and trust.
2. Focus on continuous learning. The pharmaceutical industry got away from true continuous learning years ago as it got caught up in share of voice and the sheer number of calls that "needed" to be made to providers. The old saying that “knowledge is power” is still true today. Representatives must strive to learn all they can about what they are promoting. Just because your company does not provide the training, should not mean the rep should not take on the responsibility themselves.  It is imperative representatives have a thirst for learning and lead by suggesting new ideas.
3. Establish a relationship built on trust with the healthcare provider. It includes learning about both professional and personal interests by listening to the customer needs and providing the best solution for those needs.  It is a critical step for success, even if the solution does not include your company's product. The integrity and credibility a rep creates is immeasurable. By providing fair and balanced responses a representative can establish respect and more than likely help the customer determine the best course of therapy.
4. Use and leverage social media and digital channels as an information source. This is an effective and growing part of creating both value and strengthening relationships with healthcare professionals.  While industry says they have adopted the use of digital services, they still have yet to provide value to physicians and patients because of the regulatory challenges in promotion. It is important that representatives continue to push their management teams to allow the use of Internet channels as credible sources of information.   

So what are the early results and achievements from these steps? The industry will become more visible with their work and research. This will help both the companies and physicians more clearly and effectively communicate with one another. We believe it can demonstrate the value of the products the industry develops and delivers. By telling their own story, representatives can create transparency, develop trust and belief in what companies are doing provides value. 

The amount of clear, concise medical information the industry produces not only on it's products but the associated disease state is significant.  A recent study in Europe by the Manhattan Research Group showed that more than two-thirds of physicians wanted to direct their patients to pharmaceutical product sites for information. The research and ongoing activity demonstrate physicians not only trust pharmaceutical companies information but value it as well. 

Finally,online activities are having a significant impact on physician’s professional lives and the value the place upon it. There has been a double-digit growth in the consultation of online educational resources since 2007. Some highlights to show the importance of making sure online information is presented in a rigorous and disciplined manner is critical. In 2007, the average physician spent 9.5 hours per week online; in 2010, this figure had risen to 14 hours. Of those physicians who use the Internet for professional purposes, 83% said this was essential to their practice.

In summary, the ability to engage providers in a meaningful manner and develop trust has changed in some ways while in some respects remains the same because the process instills confidence and most importantly value for the physician. Technology and new information stream into healthcare daily. A representative must know their products, become an expert in their field and strive to read and learn daily.  This will present the representative as fair and balanced while establishing a relationship built on trust and credibility.

A “New” Venue for MDs, Sales Reps

Talk about unintended consequences. Even though some physicians and medical institutions may not welcome industry sales reps into their offices during business hours, they seem to have no problem getting together at educational events.

A recent survey found that 71% of those who shut their doors to sales reps while they are working will meet with them at these live events.

Pri-Med conducted the survey, which comprised 1,100 doctors who attended seven medical education meetings nationwide. Pri-Med says it’s about choice. Sam Bishop, director of research for Pri-Med, told Medical Marketing and Media that “[the physicians] have personally chosen to come to this event. If industry is there, the majority will choose to opt in. If they are in their practice, working with patients, struggling through the day, typically they don't want to be intruded on” in reference to the current rep calls that take place.  

Okay, maybe it’s about choice. But maybe it’s also about the need for physicians to learn about the R&D that industry is up to. And, maybe physicians don’t want to be hassled with new rules governing a rep in their office. Or, maybe they just want to chat with business associates who have become friends.

Humans are funny. If they don’t like a rule, they’ll find a way to work around it. The question is then, does industry still need more than 65,000 sales representatives in the U.S. detailing these doctors? 

The Variability of Patient Care

Back in May, Hospitals and Health Networks Magazine published an article by John Glaser, CIO of Partners Healthcare in Boston.  He is now CEO of Siemens Healthcare's Health Services unit, and a thought leader you might want to watch.  We thought this article was particularly relevant because it discussed the two types of care that EMRs need to account for, sequential care which follows certain processes and iterative care or the discovery/ diagnosis of disease.

Why is this relevant to pharma marketers?  Because industry marketers need to think differently!  They need to comprehend that electronic barriers are going to impede their product's prescribers and subsequently adoption of their product. And depending on the product, many marketers are only focusing their messaging on that iterative care piece.  But the real dollars are in the sequential care processes that follow the initial diagnosis. This we believe is where many companies and their agencies need to be focusing their message development.

We think this article begins to help marketers understand the issues going forward and offer some examples of other industries that adapt to situations.  Glaser says, "We may be able to learn from other settings in which iterative and sequential activities are occurring simultaneously —for example, soldiers in combat situations, pilots landing planes in the Hudson River and scientists conducting experiments. These settings must also balance the information technology needs and the implementation mindset."

Even Neil Versel at FierceEMR said, "Ever notice how so many examples of how EHRs can improve care focus on diabetes? That's because diabetes care has many clear protocols, copious amounts of scientific evidence that gets included in clinical decision support and clear quality measures."

Our summary point to all of this suggests, EMRs will have a tremendous impact on the future of product selection for prescription medicines and medical devices.  If you do not know a lot about this now, you may want to learn more quickly.

Are Pharma Reps Robots or Salespeople?

We're wondering about the wisdom of it all. Back on July 7th the WSJ Blog asked the question of whether pharma reps are robots or sales people.

At issue: Does Novartis owe some reps OT under federal law for working more than 40 hours per week?  According to the law, it depends on the work. If the salespeople are closing deals away from the office, then it doesn’t owe them the OT; if the salespeople aren’t closing deals, then money is owed. Novartis obviously argued the former. But the blog post and one of the reps bringing forth the lawsuit actually contend they are more like “robots,” because they lack the “discretion and independent judgment” needed under the definition of outside sales representative to fit that description.

We understand why the company would not want to provide back pay, and why sales reps feel like they’re entitled to their back pay. But let’s face reality, this case highlights something we must all come to terms with and the customers the industry speaks with may be telling us as well.  Reps are like robots, they no longer possess or are given the "discretion and independent judgment" once seen in this profession 15 to 20 years ago.

When we speak with family and friends who are in the industry today, it is clear they do not like their jobs because it is so programmed, so heavily regulated, and to be honest, risky. The majority of good sales people just want the ability to converse with their clients and customers.  So much of this has been clouded for so long, we really question the value a rep brings to an interaction with a physician today.  And to be honest, maybe market forces are solving that problem for us.

Our whole point in bringing this up is to appeal to the legions of sales executives in the industry. Do some self-examination, make some reasonable fact-based decisions on reducing the troops.  Realize that the U.S. market is not the favorite marketplace any longer, and that customers demand more from your organization.  Help to make that a reality.