Over the last decade, less time with doctors and the use of digital have contributed to a general downsizing of the drug company sales force.
In 2006, Pfizer Inc. chopped 20% of its U.S. sales staff, or about 2,200 employees at the time. Late last year, Sanofi eliminated a similar percentage of its U.S. diabetes field force. In between those dates, thousands more sales positions were lost at AstraZeneca plc, Novartis AG and many fellow pharmas.
As sales force sizes ebb and flow, companies often consider which brands, therapeutic areas and prescribers to prioritize for the best chance of turning a profit. Looming over each decision, however, is a central question: what makes a pharma sales force the most effective?
General marketing skills, specific therapeutic knowledge
People who are socially adept, understand customers and adhere to protocols make for good marketers in general — and that holds true for field forces at drug companies, according to Ray Pressburger, a managing director at Accenture Strategy’s Life Sciences division. Yet, unlike some other industries, effective pharma sales reps also must be able to navigate strict regulations.
"Sales reps can't say things that aren't pre-approved, and it's very, very steep fines and penalties by doing things like going off label for a product," Pressburger said. "The big difference historically has been you need a lot of the same selling skills [as other industries], except you also need to be able to follow instructions and be scripted very well, very easily."
Therapeutic areas add another layer of complexity to the skills required of a pharma salesperson. Dendreon Pharmaceuticals LLC’s CEO Jim Caggiano, for example, told BioPharma Dive in an interview that his company looks for sales reps with a deep understanding of urology because Provenge (sipuleucel-T), its main product, is an immunotherapy indicated for advanced prostate cancer.
Dendreon’s former owner, Valeant Pharmaceuticals International Inc., has also tailored its sales team based on specific areas of disease.
Valeant explained earlier this year that, in the wake of Xifaxan (rifaximin)’s U.S. approval in irritable bowel syndrome with diarrhea (IBS-D), it added 250 sales reps to its primary care sales force of about 100 after observing that IBS-D patients tend to seek treatment first from their primary care physicians.
"As much as there are some basic skills that are common in all sales team, every sales team, every product set is different," Pressburger said. "Just because they were an all-star rep at Pfizer doesn't mean they'll be an all-star rep at Shire in rare disease."
Giving doctors the full package
Regardless of therapeutic area, however, the needs of patients and physicians have changed in recent years.
Accenture, for instance, in a recent study found 85% of patients expect their healthcare providers to tell them about pharmaceutical services such as support programs. Paradoxically, doctors are finding it harder and harder to carve out meaningful time with their patients.
To stay relevant, researchers note that pharma sales forces have to offer healthcare stakeholders more value instead of simply a product marketing channel.
"Rather than 'spraying and praying' — sending out digital messages in high volume to every name on their lists, across every possible channel — companies need a smarter approach," ZS Associates Inc., a consulting agency specialized in pharmaceutical marketing, wrote in a 2016 report.
For Dendreon, that smarter approach included switching its marketing focus from oncologists to large urology group practices, as well as ramping up educational efforts.
"Rather than follow the strategy of trying to teach the urologist to find the patient ... and then refer to his neighboring oncologist, we decided to try and educate the urologist on what exactly immunotherapy is, why it was so important to treat his patient within his practice, and then set up the processes by which they could execute that. And that's really been the core of [our sales force’s] turn around," Caggiano said.
The reworked sales force, according to Caggiano, helped improve Provenge’s profitability. In 2016, revenues from the drug rose more than 21% year over year to $303 million — though it’s unclear what affect Valeant, which owned Dendreon from early 2015 to early 2017, had on that growth.
Importantly, no two doctor-patient relationships are the same. In fact, Accenture estimates more than half of all physician group practices are owned by large healthcare organizations called integrated delivery networks, wherein physicians don’t have the final say in treatment protocols. Optimizing a pharma sales force, then, must include training employees how to identify the decision makers in a doctor’s office, and then craft for them personalized lists of products and services.
"The doctor might say 'I'm having a hard time keeping my patients on their therapy after 60 days,' and I might then say 'Oh, well do you know I have a patient support program that we offer that we can call and remind your patient to take their medication? We can educate them on the benefit of staying on medication,'" Pressburger said.
"By putting services into the bag, I can solve a broader set of problems for that doctor, be more valuable to them," he added. "And, I can still drive commercial value because, by the way, if a patient stays on medication longer, I'm still getting more commercial value for my organization."
Acquiring and holding onto talent
Before a drugmaker can even begin trying to sell products, it first has to acquire a talented field team. But that can be tricky, particularly if the company doesn’t have the sexiest therapies or the best track record.
Looking again at Dendreon, Caggiano noted a period early last year when the company had issues attracting field reps, likely due to previous setbacks, including filing for bankruptcy in 2014. While talent acquisition appears to have strengthened since then — Dendreon's sales force currently clocks in at about 70 members — Caggiano said forming a strong company culture has been a crucial tool for retaining those employees.
"We haven't lost many folks at all to emerging technologies or companies, and I think that's because we work deliberately on establishing a culture here, we attract people who buy into this patient-first sort of methodology, and we deliberately reward thinking like that," he added.
The good news for the pharmaceutical industry, according to Pressburger, is that there’s plenty of sales talent ripe for the taking. The more difficult task is actually finding the best fit among a sea of qualified candidates.
"Really investing heavily in the talent part of the equation, which is kind of the denominator in all of this, is extremely important for optimizing the impact when you continue to get smaller. Finding the right talent, sourcing the right talent, recruiting it, hiring it, developing it, are all quite important," he said.
Successfully completing those actions will require some leg work. Accenture and PwC, for instance, highlighted in separate reports that pharmaceutical companies will probably need to establish new systems for talent management and new positions, such as key account managers who deal with institutional purchasing organizations like payers, to better optimize their sales forces for modern challenges.