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We all know that the pharmaceutical sales model is being seriously re-thought. Every business model needs periodic review, to see if it continues to be a value-add, or if, in fact, it is losing effectiveness.

The interrupt-driven model of having drug reps come to doctors’ offices for fewer and fewer minutes of discussion, plus dropping off of samples, is rapidly losing market favor. It’s costly and increasingly inefficient for the drug companies, and it fills offices with non-paying people jockeying for time and attention in a marketplace where both are scarce.

So is there a better way? The industry is experimenting – with things like e-detailing and the like. And healthcare professionals are experimenting – for instance, many of them are simply barring reps from the premises.

Hmmm….

One start-up (contract sales) services company that I’ve been talking to has an interesting model – make the process doctor-driven. The (contract) reps are called in by the doctor’s office when needed for drug sample replenishment, and they are not there to sell, but to drop off samples and acquire an e-signature (tablet). The tablet also has software that the doctor pages through to request more information, set up an appointment with a trained sales rep, schedule and e-detail, contact a Medical Affairs person, etc.

I could see this approach having value for drugs that are near the end of their patent cycle, when promotional efforts are going to be scaled back, but a drug manufacturer still wants to have a presence in the marketplace. There may be other places for a contract services approach like this as well. But the major point is, all contact is driven by the healthcare professional. And there is potentially a big gain in efficiency – highly-trained reps are not idling away time hoping and praying to see 8 docs a day for a few milliseconds each.

What do you think? Does this have value? Serious drawbacks? Let me know your thoughts! (stevew at impactiviti.com)

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TODAY’S NEWS

Sometimes I can’t help but voice a bit of skepticism, especially when it comes to sexual disorder treatments. So, count me as less than convinced about this experimental treatment from Boehringer-IngelheimData from pivotal Phase III clinical trials demonstrate that a higher proportion of pre-menopausal women with Hypoactive Sexual Desire Disorder (HSDD) receiving flibanserin 100mg reported both an improvement in their condition and a meaningful benefit from their treatment, compared to placebomore (the single-question Patient Benefit Evaluation appears to me to be really…ummm…meaningful).

Lung cancer preventer for former smokers? Interesting – A drug approved to treat a range of conditions may also work to prevent lung cancer in people who have given up smoking, U.S. researchers reported on Tuesdaymore

AstraZeneca replaces Nexium sales force with telemarketers. And it works.

J&J‘s recall of OTC products. This is becoming a huge black eye, for a company that managed to keep quite a good reputation over the years. It will be an interesting case study of reputation management and quality improvement, esp. for a company that has been a leader in social media usage in this sector.

RECOMMENDED

Compliance and Diversity. The Impactiviti partner network has the providers you need for corporate training – including diversity, compliance, ethics, and much more! Contact us (stevew at impactiviti dot com, or phone at 973-947-7429) for recommendations.

PLUS

Red Meat – maybe this picture isn’t so simple after all. Intuitively, this result is actually not too surprising. AND – Are you in a Museum?

JUST FOR FUN

I only rarely get to see hailstorms. That’s what makes this video particularly awesome. Must be seen to be believed!

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We are loaded up this week!

Can Enbrel reverse Alzheimers? – Alzheimer’s patients given a drug usually used to treat arthritis have shown dramatic improvements, leading to hopes of a breakthrough in treating the disease…more

Pfizer plunges on reduced profits – The pharmaceutical maker reported worse than expected results across the board in its first quarter, with its earnings plunging 18% following the advent of generic competition for blood pressure treatment Norvasc and allergy medication Zyrtec…more

Merck and ghostwriting – Two JAMA articles say Merck misrepresented the death risks in one study and routinely stuck the names of top researchers onto ghostwritten scientific reports…more

Memory loss due to incontinence drugs? – Commonly used incontinence drugs may cause memory problems in some older people, a study has found…more

Takeda buys Millennium, further expanding into oncology – Japan’s largest drug company Takeda Pharmaceutical Co. Ltd. (OOTC:TKPHY) said Thursday it’s buying U.S. biotech company Millennium Pharmaceuticals, Inc. (NASDAQ:MLNM) for $25 a share, in an all-cash deal valued at about $8.8 billion…more (here is an extended article from Forbes on Biotechs for Sale)

Eli Lilly cutting 500 jobs (not in sales) – Drugmaker Eli Lilly and Co said on Wednesday it would cut up to 500 jobs as it streamlines manufacturing operations in its hometown of Indianapolis…more

Abbott announces strong financial results – Abbott Laboratories Inc said on Wednesday first-quarter earnings increased 34 percent on higher sales of its prescription drugs and medical devices and favorable foreign exchange factors…more

Forest: Good revenue, dim prospects, shares down – A better-than-expected profit was not enough to boost Forest Laboratories shares Tuesday, especially after the drugmaker offered a dim outlook for 2009 and forecast significantly increased spending on research and development to improve its drug pipeline…more

Attacking Alzheimers: are we on the right track? – The drug industry has bet heavily on one theory about the disease. What if that theory is wrong?…more

PDI and Novartis sign deal for Elidel promotion – Contract sales firm PDI signed a four-year agreement with Novartis to deploy a field force promoting Elidel, a second-line eczema treatment for patients older than 2 years, according to Kim Golodetz, a spokesperson for PDI. The deal calls for deployment of “approximately 100 full-time equivalent sales representatives who will call upon physicians nationwide,” a PDI statement said…more

Novartis promotes two more to top positions – Swiss drugmaker Novartis AG on Thursday said it promoted two senior U.S. executives to head its U.S. drugs unit and overall U.S. operations…more

Promising MS treatment results from Novartis drug – Novartis AG’s once-daily FTY720 pill reduced the number of attacks suffered by patients with multiple sclerosis (MS) after three years, according to data presented on Tuesday. Nearly three-quarter of patients taking a 5 milligram dose of FTY720, and 68 percent on a 1.25 mg dose, remained free of attacks after three years, Novartis said in a statement…more

Wild new cancer therapy (no side effects?) getting a trial run – A promising new cancer treatment that may one day replace radiation and chemotherapy is edging closer to human trials. Kanzius RF therapy attaches microscopic nanoparticles to cancer cells and then “cooks” tumors inside the body with harmless radio waves. Based on technology developed by Pennsylvania inventor John Kanzius, a retired radio and TV engineer, the treatment has proven 100 percent effective at killing cancer cells while leaving neighboring healthy cells unharmed. It is currently being tested at M.D. Anderson Cancer Center in Houston…more

Migraine drug from GSK/Pozen finally cleared – The U.S. Food and Drug Administration has approved a combination migraine drug from GlaxoSmithKline Plc and Pozen Inc, the companies said on Tuesday. The two-in-one drug has faced repeated delays since Pozen sought U.S. approval in 2005. FDA officials had earlier expressed concern over heart safety and the risk of gene toxicity, asking for more data…more

Pre-emption: it’s a big deal – The Third Circuit Court of Appeals found in favor of pharma last week, stating that FDA labeling preempts any liability on the part of the drug companies. According to the decisions in two cases—Colacicco v Apotex and McNellis v Pfizer—pharma can not be held accountable for adverse events caused by drugs that were being monitored by FDA…more

Carlat’s drug rep free zone: one doctor decides to close the door – I’ve had it. As of today, I am no longer allowing drug reps into my office…more

Some docs no longer taking industry money – With little fanfare, a small number of prominent academic scientists have decided to stop accepting payments from drug and device makers for speaking at meetings or for sitting on advisory boards. And while they maintain that it’s important for for knowledgeable scientists to help companies draw up and interpret studies, any work they do will be pro bono…more

Banning drug rep gifts in Mass.: not all docs are on board – Some legislators in Massachusetts would like to make the Bay State the first to ban any gifts to doctors from drug makers, right down to pens with product logos. Docs taking as little as a pen or a slice of pizza from Big Pharma could end up paying $5,000 in fines and serving two years in jail, according to penalties contemplated by drafters of the legislation. Today comes a counterpoint from some heavy-hitting academic docs, who argue that the legislation, rather than solving problems, would be a profound threat to good medicine…more

More transparency in grant $$ spending – For years, the nation’s largest drug and medical device manufacturers have courted doctors with consulting fees, free trips to exotic locales and sponsoring the educational conferences that physicians attend. Those financial ties in most cases need not be disclosed and can lead to arrangements that some say improperly influence medical care. Now, under the threat of regulation from Congress, the two industries are promising to be more forthcoming about their spending…more

Internet vs. Sale Repswhich do doctors prefer?

And finally, how the flu travels the globe – interesting little article, but I really like the graphic!

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This post is meant to promote discussion. I’m not going to presume to think that I have anything close to all the answers. But a discussion needs to take place about the current sales model in pharma.

It’s common knowledge that the current pharmaceutical sales force model is inefficient, expensive, and poorly designed to meet current healthcare practitioner business needs. So, here is the question…what would be the IDEAL model for a pharma field force that would actually meet both drug manufacturer, and healthcare practitioner needs?

I’ll throw one idea out there. Feel free to comment, critique, eviscerate, refine, make suggestions, and have a discussion in the comments.

Let’s look at the mass market field force model – sales reps visiting multiple doctors’ offices in a territory. That one rep is meant to provide clinical/product information, business/managed care information, samples, other company information, and build relationships with healthcare providers…all in the space of, say, 3-5 minutes of face-time (if they’re lucky) with any given doctor on a given day, during busy office hours.

Ummm…is something wrong with this picture? Can one person (often starting out quite young and inexperienced) actually do all this? In competition with the increased demands and decreased access marking doctors’ offices?

What if the model included 4 key players that serviced physicians? They would be:

  1. A territory account manager, whose role is to bring samples, discover needs, and coordinate all other channels of influence for that account (see below for other channels). This account manager would also give basic product information.
  2. A regional clinical specialist, who is more highly trained (say, a MSL-lite) and able to speak much more in-depth with physicians in the territory about the complex issues of the drug’s usage and clinical challenges (this person will add greater value because much more time is spent acquiring deeper knowledge than just driving around doing “details.”)
  3. A regional business specialist, who is deeply trained in managed market issues and able to bring genuine in-depth value to the office staff about health plans, prior authorizations, reimbursement issues, etc.
  4. An on-line detail rep who is available for off-hours (I said off-hours, not off-label!) promotional discussions with doctors, when significant interaction time is much more likely.

What are the advantages of a coordinated structure like this?

  • The account manager would cover a larger territory, need to be somewhat less trained initially (they now have “experts” on their team backing them up), and would have new avenues of professional growth that could keep them in the field (they could become product or business experts). This role is now partially sales rep, partially account manager and partially team coordinator.
  • The on-line resource would greatly increase the opportunity for getting (virtual) face time for product messaging, esp. during non-office hours (nights and weekends).
  • The pharma company would be providing genuine, in-depth value by having clinical and business specialists available for visits.
  • If one member of the team is promoted or leaves, there is still continuity with the account, as the team is multi-faceted.

OK, there’s one idea. I’m sure many holes can poked in it. What would you come up with if you had to design the “ideal” setup from scratch??

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