Q&A: The changing role of KOLs
Neil Kendle, director of Kendle Healthcare, on how to manage relationships with non-traditional and non-clinical KOLs
By on Jul 5, 2011Key Opinion Leaders (KOLs) have always played an important role in the pharmaceutical industry.
But now, with constraints on prescribing practices and more government controls on payment, developing quality relationships with both traditional and non-traditional KOLs is critical.
Eyeforpharma talks to Neil Kendle, director of Kendle Healthcare in London, about how to manage relationships with non-traditional and non-clinical KOLs.
How has the role of KOLs changed over the years? Why are they important today?
The importance of KOLs has changed more than the role. Medicine has moved away from autonomy of prescribers to something more constrained and formalized. Prescribing at a primary care level was often based on habit rather than on anything very rational. Now we have formularies and limited lists, guidelines, etc. Although we are in an era of so-called ‘evidence-based medicine’, opinion and interpretation of evidence are more important than ever. Added to that, companies have only slowly begun to realize the importance of a systematic approach to opinion leader engagement. (For more on evidence-based medicine, see ‘How to build value through comparative effectiveness research’.)
There seem to be more non-traditional KOLs. Why?
Until fairly recently, the main decision maker on which drug gets used and when was the prescriber. There were others involved—often, a hospital would have a formulary committee, for example—but the clinicians were powerful voices on these committees. In primary care, prescribers had even more autonomy, and the vast majority of scripts are written in primary care, of course.
The most important people influencing these primary and secondary care physicians are traditional opinion leaders; for example, expert clinicians and medical researchers. Price and cost-effectiveness were minor issues, if at all. When I was a sales rep—and admittedly that was a long time ago—we were always told that price was a false objection, and that was generally the case.
There is not a country in the world that can afford to do everything patients want. So this means that decisions are influenced—driven by health economics, the need to prioritize and ration treatment, and political and social decisions about what will and will not be funded. These are not clinical decisions, or at least, not solely clinical decisions. Hence, non-clinical KOLs: payers and market access influencers. (For more on health economics, see ‘Health economics data and market access’.)
Why is the pharma industry concerned about non-traditional KOLs? How is the industry communicating with these groups?
The pharma industry is concerned because the price of medicines is being controlled. For example, last year many regions in Spain cut the price they would pay for generic drugs by approximately 25%. In August, the Spanish government slashed the price of all branded drugs by a similar amount. Drugs are being blocked from reimbursement because of decisions about their cost-effectiveness and the value of introducing those drugs.
The industry is communicating with these people in many ways. Still often using field forces, but moving away from large numbers of reps (what’s the point of spending a fortune persuading primary care physicians about the benefits of your drugs if they have very little autonomy about which products they use?) to small numbers of highly experienced key account executives and market access executives who are able to negotiate with payers and even working as trusted partners in helping decision-making. So they are collaborating with KOLs to influence decision-making. Only now, the KOLs are different: payers and other market access influencers rather than just clinicians.
Are there special KOL relationships, where the pharma company mentors or has a special program catering to the needs of the specific KOL? I am thinking about the Lance Armstrong Foundation and its KOL relationship with Bristol Meyers.
This sort of high-profile, celebrity-driven program is somewhat rarer in Europe. KOL activities are most effective where they are mutually beneficial, and so you do get educational programs headed up by one or more KOLs with support from one or more pharma companies that meet both parties’ agendas. For example, ensuring new guidelines are communicated where the KOLs want to improve management of a condition for its own sake and the company or companies want to do it because improved management will benefit their drugs or because the drug is favorably positioned in the guidelines. There is, however, increasing resistance to the idea of single company sponsorship for such initiatives.
What advice would you give pharma regarding relationships with non-traditional and non-clinical KOLs?
To a large extent, our advice to pharma companies about working with KOLs is the same whether they are traditional or non-traditional. First, they should work toward a mutually beneficial relationship. In the past, companies often saw KOLs as people who they went to for collaboration on a specific activity; to take part in a trial, for example, or to act as a speaker in one or more meetings.
Second, we advise them to find out what the KOL wants from the relationship. With medical opinion leaders, this will be a range of things such as involvement in trials, exposure/raising of their profile, support for their departments or their specialties, helping spread educational messages, etc. With non-traditional KOLs, it is more likely to be information, particularly early information about drugs and cost of disease data, genuine partnerships about how best to afford new drugs by making savings elsewhere, but also profile raising. Added to this, KOLs want to see transparency and clarity from companies, respect for their independence, and high ethical standards.
For Malcolm Allison’s take on KOLs, see ‘M’s the Word: Let the sun shine on KOLs’ and ‘M’s the word: Keep KOL relationships in the open’.
For more on the relationship between KOLs and market access, see ‘Marketing with opinion leaders in mind’, ‘Forecasting the potential of the biosimilars market’, ‘Why oncology market access models must evolve’, and ‘How early access strategies affect market access’.
For exclusive business insights into KOLs, attend KOL and Stakeholder Engagement Europe 2012 on February 21-22, 2012 in Berlin.
For more articles on KOLs, see Special report: KOLs and pharma.
For more exclusive business analysis, download eyeforpharma's Pharma Emerging Markets Report 2011-12 and Pharma Key Account Management Report 2011-12.
For all the latest business analysis and insight for the pharma industry, sign up to eyeforpharma’s newsletters and follow us on Twitter.