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Pharmaceutical representatives

Pharmaceutical representatives. Pharmaceutical Industry Marketing. A key to industry profitability Highly effective Very sophisticated Multi-pronged campaigns targeting clinicians and patients. Pharmaceutical Industry Marketing.

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Pharmaceutical representatives

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  1. Pharmaceutical representatives

  2. Pharmaceutical Industry Marketing • A key to industry profitability • Highly effective • Very sophisticated • Multi-pronged campaigns targeting clinicians and patients

  3. Pharmaceutical Industry Marketing • In 2004, pharmaceutical companies spent almost $12 billion on marketing activities • This amount does not include the retail value of samples (>$15 billion) • Despite (or perhaps because of) these high marketing expenses, pharma profit margins are among the highest of any industry • The trend of increasing promotional spending and profit margins has substantially increased over time Sources: IMS Health, Top-Line Industry Data; Fortune 500, 2006 (http://money.cnn.com/magazines/fortune/fortune500/performers)

  4. Pharmaceutical Industry Promotion & Marketing Source: N Engl J Med 2007;357:673-81. 2005 Dollars

  5. Annual Increase in US Prescription Drug & Total Health Expenditures Annual % Change Rx Drugs Health

  6. Gagnon MA, Lexchin J. PLoS Medicine 2008;5:1-5 Expenditures by Type of Marketing 2004 ($ Billions)

  7. Effect of Advertising on Drug Sales • Drugs that are heavily advertised contribute disproportionately to the increase in pharma spending Increase in Retail Prescription Drug Sales, 1999-2000 Source: Prescription Drugs and Mass Media Advertising, 2000, NIHCM Foundation, November 21, 2001.

  8. Drug Promotion – the Pharmaceutical Representative.

  9. Drug Promotion by Pharmaceutical Companies. • Journal advertisements • Mailings • Samples • Sponsored meetings • Gifts • Direct-to-consumer advertising • Company representative visits

  10. Recent Changes in Pharma • Recently, some large companies have announced plans to cut their sales forces: • Late 2006 and early 2007, Pfizer announced it would cut: • 20% of its 11,000-person US sales force • 20% of its European sales force • In 2005, Wyeth cut: • 15% of its sales force • Other companies (e.g., Novartis) have announced plans to increase sales forces

  11. Pharmaceutical Representatives • Still the major focus of pharmaceutical marketing • Approximately 100,000 reps in 2005 vs 38,000 in 1995 • 1 rep per 6 MDs in US and 1 rep per 2.5 targeted MDs • 6 million detail visits annually • Cost estimate $12 - $13 thousand per MD on detailing (IMS data) • PhRMA:”serves an essential function in the health care delivery system”

  12. Characteristics of Representatives • Presentability/appearance • Outgoing personality • Excellent interpersonnal skills • Assertive

  13. Plos Medicine 2007;4(4):0621-25 Representative Training • How to be observant and assess clinician personalities • How to adjust approach based on reactions and profile information • How to gather and use personal information to establish a connection • How to monitor impact of various marketing strategies on prescribing

  14. Plos Medicine 2007;4(4):0621-25 Frame interactions as gesture of friendship Use literature, humility, appeal to their “high intellect” Make best effort to establish personal connection, best gifts How Representative Can Tailor Approach • Friendly clinician • Skeptical clinician • High prescribers

  15. Plos Medicine 2007;4(4):0621-25 • Find out why, try to capture a niche • Try to work through office staff, can get useful information • Friendly thought leaders groomed for speaking circuit. Monitor impact of local talks and their allegience How Representaive Can Tailor Approach • Clinician prefers competing product • Refuses to see reps • Thought leaders

  16. Targeted Clinicians • High volume prescribers • Specialists: scripts they initiate can continue for years by PCPs • Opinion leaders • Low volume, non-influential clinicians receive much less attention

  17. Kaiser Family Foundation Report March, 2002 Physician Rating of Rep Information Usefulness

  18. Kaiser Family Foundation March, 2002 Physician Rating of Accuracy of Representative Information

  19. Representatives Objectives. • Sell company products • Inform and educate professionals • Gather information

  20. London Medicines Information Service (Northwick Park Hospital) - June 2008 ‘The meeting’. • What’s in it for me? • Be selective • By appointment with time limits • Be in control • Prepare standard questions • Beware of bold statements & ‘glossies’ (check evidence)

  21. Stages of Rep/Provider Interactions • Acknowledgement of relative status • Valuable time, opinion leader • Find out what is known • Outline benefits of product • Expert name drop • Provider resistance • Reinforcement of role • Compliments, sympathy • Closure: ensure opportunity for return, gifts, obligation

  22. Benefits to Provider • Pleasant respite from workday demands • Someone who is “impressed” with their “superior knowledge” • Can be object of flattery and sympathy • Psychological benefits • Receipt of gifts • Can present themselves as skeptic • Questions information, doesn’t agree to prescribe • Can feel like they were in control

  23. Representative Goals • Develop positive relationship • Opportunity for future contact • Create a sense of obligation • Control agenda • Promoting product appears secondary in many interactions

  24. Influence on Prescribing • Studies show that prescribing is influenced by industry representatives • Higher cost, less rational prescribing is associated with: • Frequency of use of representatives as an information source • Perceived credibility of representative • Even a few minutes of contact can impact prescribing

  25. Am J Med 2001;110:551 Perceived Influence of Pharmaceutical Reps

  26. N Engl J Med 2007;356:1742-50 Physician/Drug Representative Meetings SpecialtyMeetings/Month Family Physicians16 Internal Medicine10 Cardiology 9 Pediatrics 8 Surgeons 4 Anesthesiology 2

  27. N Engl J Med 2007;356:1742-50 Physician Industry Relationships Benefits% Reporting Samples78% Gifts83% Travel/CME funding35% Payments28% Any Relationship95%

  28. N Engl J Med 2007;356:1742-50 Physician Factors Associated With Receipt of Payments • Practice with < 25% Medicaid/uninsured • Private practice • Less likely in hospital/HMO setting • University/Medical School • Role as a preceptor • Developer of clinical guidelines • Cardiology specialty (of the six specialties studied)

  29. J Gen Int Med 2007;22:184-90 Methods to Deal With Potential Conflict of Interest • Eliminate the conflict • Can be difficult and painful • Rationalization • “Its educational” • “Patients need samples” • Denial • “It doesn’t influence me” • “I take it with a grain of salt”

  30. Conclusions on Representative Marketing • Industry invests billions on detailing • Most prescribers meet with representatives • Representatives are skilled at developing relationships with and influencing clinicians • Meetings with representatives are associated with less rational prescribing and increased costs • Most physicians feel they are not influenced

  31. Thank you for attention!

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