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De Nayer, Managing Director of Citobi, says that focusing too much on SoV is “missing the market.” Sales reps are crowding doctors’ offices, even to the point where the reps are bei

By Editor on Oct 18, 2007

De Nayer, Managing Director of Citobi, says that focusing too much on SoV is missing the market. Sales reps are crowding doctors's offices, even to the point where the reps are being shuttled off to their own waiting rooms, there to sit in hopes of a few minutes with the physician. In some cases, reps aren'st even given chairs to discourage them from staying very long. The time physicians are willing to spend one-on-one with reps is decreasing, says De Nayer, and it's time to look at new ways to have quality interaction between doctors and the pharma sales force.

Limits of SoV

According to De Nayer, the numbers are pretty grim. Only 43% of reps even get past the doctor's receptionist, and when they do get to an actual physician, only 7% of those visits last longer than two minutes. It's not surprising that 90% of reps complain that access to physicians is their biggest challenge, when 60% of doctors have established barriers to minimize contact with reps or refuse to meet with them at all.

And adding new reps to the force doesn'st help. One new rep equals only 17 additional physician meetings per year. Says De Nayer, the correlation between sales rep activity and company growth is declining every year, so many companies are trimming their sales forces instead. In 2006, four of the top 10 US pharma companies began reducing their sales force numbers.

How, then, to get the attention of physicians?

Says De Nayer, it's time to think beyond the simple one-on-one meetings; it's time to take a broader view of the market, look at other existing channels of interaction and encourage collaboration between sales and marketing teams.

The new era marketer

Traditionally, marketing efforts have focused mainly on getting doctors to prescribe a particular drug. This strategy assumes that patients have already been identified and are ready to begin treatment all that remains is convincing doctors to prescribe your therapy X over someone else's therapy Y. In order to succeed, says De Nayer, companies fully leveraged their reps and followed their IMS figures.

However, that leaves a lot of the patient flow process out of the equation. There are many potential points of contact and interaction, De Nayer says, and a new era marketer looks at marketing from the perspective of a consumer and capitalizes on every stage in the patient flow. Happily, e-marketing and CRM can be huge helps.

Key issues and opportunities

So what are the key issues? Well, patients may be unaware that they have a medical issue. De Nayer gives the example that up to 80% of the people in Belgium with osteoporosis are unaware of their condition. Raising consumer awareness is a big issue and a big opportunity for interaction. Disease awareness schemes, treatment awareness schemes, small and large scale campaigns, surveys: the goal is to educate the market, says De Nayer. We want to push patients into the doctors's waiting rooms, then give them tools to talk knowledgeably with their HCPs. Systematic screening programs, possibly done in cooperation with social security or other government agencies, are an excellent tool for raising awareness among the unaware.

Once a patient becomes aware of a need for treatment, how do we get doctors to prescribe our therapy X? As De Nayer points out, doctors might simply tell patients to get more exercise; eat more fish. Sales force effectiveness is crucial at this stage, so the more information the sales reps can get, the better their interactions with doctors will be. Here, says De Nayer, you can optimize SoV across the media spectrum.

The Internet is a rich source of stored information. It is possible to do profiling and targeting, to collect information about physicians from databanks, online surveys or newsletter subscriptions. Marketing teams often have access to this kind of data, and if we break down the information-hoarding silos, says De Nayer, the shared wealth can truly animate the sales force. Reps can address very specific, tailored issues with the doctors they see, helping to build strong, lasting relationships.

Ongoing compliance and control are the final issues in the patient flow. Patient support and patient control programs which track behavior can be powerful tools in ensuring compliance.

Handling hypertension

De Nayer gives the example of a pharma company that was marketing a treatment for hypertension. In this case, the lion's share still came to only 9% of the market, leaving considerable room for growth. Though more than 80% of patients were aware of their condition, less than 10% were under control using this company's drug X, and a lot of hypertension patients generally were poorly controlled, with or without drug X. And, despite high awareness, patients weren'st diagnosed as early as they could be. Quicker diagnoses, obviously, could benefit both patients and pharma.

The pharma company was offered three options to improve on market share. They could focus their efforts on physicians only, they could work on influencing physicians plus fostering systematic screening programs, or they could work toward developing an integrated approach.

If the company chose to focus on physicians only, then one strategy might be to perform an online survey. The survey would look at how target physicians handle hypertension. The results of the survey would inform an e-detailing campaign.

In option two, the same survey would be conducted, but this time a systematic screening program would be proposed in addition. This program would answer needs identified by doctors in the survey. Such a program could find patients who had already been diagnosed but who had, for one reason or another, slipped through the system and were not being treated for their condition.

Option three adds yet more sophistication. Thanks to new technology which can handle vast amounts of information, results of what De Nayer calls an evidence-based marketing and sales survey could be communicated to doctors in a one-to-one sales aid. These individually tailored sales tools would have been impossible even five years ago, De Nayer says, but now we have the technology to leverage the results of surveys in ways that will truly build relationships with doctors. Surveys in this case would include not only doctors but also key opinion leaders, specialists, GPs and third parties. Once survey results are in, pharma companies can propose a series of high value added services as answers to identified needs. These services can include e-detailing, screening programs, rep visits, etc.

Identifying needs, finding solutions

One advantage of looking beyond SoV is that there are so many tools out there, from simple to sophisticated, to help manage relationships with physicians.

In one case, a company was finding it difficult to have any influence with target physicians because the company had a limited number of sales reps on the ground. The solution was to create an educational newsletter. This newsletter, written by a community of scientists and key opinion leaders worldwide, was sent via email to target physicians. The newsletter not only allowed for interaction between doctors and pharma, it provided a wealth of feedback on opening rates, click-through rates, etc. This information was then fed to sales teams who capitalized on it in their detailing calls.

Online and e-tools have the decided advantage of information harvesting. As De Nayer says, you can measure everything. If, for example, emails to a doctor bounce back, it's an opportunity for a sales rep to call and re-establish the relationship.

In another case, online and e-tools overcame patient embarrassment and reluctance to consult with a doctor. Erectile dysfunction is an uncomfortable topic for patients and doctors alike, and so many cases go untreated. The challenge in this case is in getting the patient to the doctor's office. The solution was a CRM-based disease awareness scheme.

Television commercials, newspaper ads, web banners and e-newsletters about ED triggered interaction on a company's website. No matter where patients were in the patient flow process, tools provided a call to action and invited patients to get informed and get in touch with their doctors. And all online interaction was recorded in a database and used to inform marketing and sales force activities.

In a compliance case, doctors introduced their obese patients to online tools that helped them measure and track their weight and BMI. They could participate in surveys about their behavior and medications and choose to share or not share this information with pharma companies and their physicians. Those who opted to share fed a database which in turn provided information about prescriptions to the sales force. This program, now four years old, has proven very successful and has raised compliance rates dramatically.

Going beyond the SoV paradigm

Says De Nayer, going beyond SoV is both necessary, and thanks to modern technology, feasible. Actions that leverage the Internet and other media channels are now appropriate at every stage in a drug's lifecycle, and the costs of such programs are truly affordable and generate proven, measurable ROI. And for marketers, these new market tools mean new visions, new ideas a chance for creativity and interaction with physicians, with patients, and between teams.

Those who went beyond the SoV paradigm never came back . . . but they are still alive, says De Nayer. In an era of ever-increasing technological sophistication, the companies quickest to evolve may be the only ones left standing.