The alternate way to progress

Gaurav Kapoor, Executive Vice President, Asia Pac & Emerging Markets, Indegene and Gaurav Sharma, Senior Business Director, Europe, Indegene, in a white paper titled, ‘Alternate Channel of Physician Engagement: Achieving Higher ROI for End-of-Life Products’ talk about the need for newer models of physician engagement and the financial advantages they would herald

Sales representatives have been a key component of the marketing strategies employed by pharmaceutical companies and have traditionally formed the primary link between the company and the physician. Between 1996 and 2005, total real expenditure on detailing in the United States increased from $3.7 billion to $6.8 billion—an increase of more than 80 per cent1 compared with the decline in revenue growth over the same period.

Although the pharma marketplace has undergone significant changes over the last three to four years, the industry keeps relying on its ‘tried and tested’ sales model. Most pharma companies are still employ an army of sales reps to attain appropriate share of voice with physicians. But this marketing blitz has been increasingly seen as a drain on physicians’ time while failing to meet their real needs. Several studies have highlighted that oversized field sales forces have saturated the market, and that physicians are more reluctant to see reps in their offices. About 20 per cent of US and British physicians now refuse to see any sales reps2 leading to a slide in the ROI on detailing. All the above factors have led to a perfect storm that has recently culminated in a record number of sales force layoffs in recent times (Figure 1).

Fig. 1 Decline in Pharma Sales Forces

Although layoffs help pharma companies manage costs in the short run, the search for a better way to engage physicians still remains. The pharma industry is experimenting with various sales models, such as e-detailing and brand Web sites, and attempting to leverage credible online aggregation portals for engaging physicians. Because of inherent limitations, these channels have not been able to fill the void created by the reduction in face-to-face detailing.

In this paper the need to adopt alternate channels of physician engagement and provide an outline of its key attributes has been explored. An overview of the Indegene framework to leverage alternate channels of physician engagement is also presented. Finally, we will discuss the transition of pharma sales and marketing to an alternate channel for products nearing the end of their patent life.

Patent expiry: Looking into the Abyss
Rapidly changing economics, legislation, and market evolutions are pressurising the pharma industry to fundamentally rethink its business model. Faced with the challenge of products going off-patent combined with the pressure to reduce sales force, it is becoming increasingly daunting for pharma marketers to achieve a brand’s optimum value throughout its life cycle in a cost-effective manner. Leading pharma companies will lose between 14 per cent and 41 per cent of their existing revenues as a result of patent expiries (Table 1).4

 Table 1. Existing Revenues of Leading Pharmaceutical Companies
 Company   2010   2011   2012  Share of Revenues(%)
 AstraZeneca  Arimidex ($2.2 billion)* Seroquel  ($4.7 billion)  Symbicort  ($3.7 billion)  38**
 BMS      US Plavix  ($4.8 billion)  Abilify  ($2.1 billion)  30
       Avapro  ($1.3 billion)      
 GSK Advair  ($3.8 billion)      Avandia ($2.5 billion)   23
 Eli Lilly      Zyprexa  ($4.8 billion)      22
 Merck  Cozaar/ Hyzaar  ($3.2 billion)      Singulair  ($4.5 billion)  22
 Novartis  Femara  ($1.1 billion)      Diovan  ($6.0 billion)  14
 Pfizer  Aricept  ($800 million)  Lipitor  ($12.1 billion)  Viagra  ($1.7 billion)  41
       Xalatan  ($1.6 billion)  Detrol  ($860 million)  
           Geodon  ($1.1 billion)  
 sanofi-aventis  Taxotere  ($2 billion)  US Plavix  ($3.8 billion)  Lovenox  ($3.1 billion)  34
       Avapro  ($2.1 billion)      
*Estimate of global sales in 12 months prior to patent signing   
**Value of products losing patent protection as a percentage of total company sales over the next 5 years       
Source: AXA Framlington 

The silver lining in this grim scenario is the fact that “despite their waning position in the product life cycle, the profit potential for many established brands is quite strong. The investments made in building a brand are fully amortised and, therefore, any growth in the top line falls almost directly into the bottom line. Again, as the product progresses through its life cycle, there is no dearth of additional data to share and leverage the track record.”5

However, a confounding factor is introduced due to the high detailing costs, because of which it has become normal practice for companies to relegate their mature brands to second or third positions in the detailing sequence with the hope of getting some attention within the sales call. Such positioning can work in cases where the sales rep has the necessary face time to go through his or her entire detail aid. However, the emphasis is often on the launch of the growth brand, with the mature brands receiving little or no mention. This lack of attention on the established brand negatively impacts its sales and the company’s overall profits.

When one considers the cost of primary care physician details (excluding samples), which average $167 per detail and $195 for speciality details according to statistics published in 2007, it is easy to understand why many established brands are not getting the attention they should be getting.6

Redefining the physician engagement landscape for products nearing patent expiry
From the information analysed so far, it is clear that pharma companies are not optimising their returns with the existing sales models for brands nearing patent expiry. The share of voice of an established brand begins to decline as it nears patent expiry. However, allowing this downward spiral to continue is to simply throw profits away (Fig 2).

Over the last decade, pharma companies have invested in numerous tools and technologies to meet this end-of-life cycle challenge with mixed results.

Fig. 2 Products nearing Patent expiry

The drawback with the existing non–sales force channels are as follows:

  • Most of the channels rely on “push” to physicians. There is lack of engaging and frequently updated clinically rich content for physicians who allow for a “pull” effect
  • Most of the channels take a “one size fits all approach” and lack capabilities to track data to analyse physician preferences and then deliver relevant content and brand messages to change behavior
  • The cost of running these programmes is quite high.

The need of the hour is to adopt a fresh approach to reach physicians through communication strategies that adapt to their clinical interests and needs. In the current multichannel environment, based on the preferences, it is important to successfully engage physicians on their own terms using an alternate channel that provides them control over when, where, and how they get information. With media fragmentation on the rise, it is critical to offer physicians a variety of content format options and use all available communication channels in an integrated manner. A transition from a predominantly “push” model to one where a mix of “push” and “pull” elements are judiciously leveraged is critical for success.

The ideal solution would be one that

  • Provides the infrastructure to deliver high-quality rich content in an interactive manner
  • Collects core data that can be analysed to refine the physician engagement process to make it more meaningful for the physician as well as the company
  • Can be deployed rapidly for multiple therapies/brands, measure the results, and then optimise the communication elements 

Alternate channel of physician engagement: Indegene approach
The guiding principle of the framework solution developed by Indegene is that the medical information should be “pulled” by physicians when they need it rather than “pushed” at them by pharma companies. It is aligned toward the goal of physician education and skill enhancement. It provides physicians with pertinent, contextual information tailored to their immediate needs and access to multiple knowledge access points, including on-demand live video detailing sessions with medical representatives and a scientific discussion with MSLs (Fig 3).

Fig. 3 Key Attributes of Indegene’s Alternate Channel of Physician Engagement

The primary aim of the alternate channel is to “lead with education” and subsequently leverage this credibility to introduce brand-related communication and messages in a manner that is appreciated by the users. The journey of education continues for the physician while brand communication is initiated and integrated into the overall experience. During every interaction, user data points that help refine both the medical and brand messages are captured and analysed.

The starting point of implementing the alternate channel of engagement is physician grouping based on individual knowledge attributes vis-à-vis the treatment guidelines, patient profiles seen, prescribing habits, brand attribute preferences, and content delivery format preferences. This information is aggregated through brief online and offline surveys as well as through existing client CRM databases. This process helps in segmenting target audience with homogeneous attitudes and beliefs into groups large enough to be efficiently targeted with focused messages.

At the core of the system is a powerful set of algorithms that help address the challenge of continuous segmentation of content on an incremental basis by extending the analysis of physician behaviuor through multiple visits to the platform. The comprehensive physician profile is continuously updated based on actual captured data on preferences and usage, thereby ensuring that the system is responsive to the user’s evolution. After the initial set of user interactions, the system is designed to respond to individual preferences and learning patterns and deliver content based on specific requirements. During this entire process, there are business rules built into the system to make sure all national regulatory guidelines are strictly adhered to.

Using a dynamic content management system that is fully integrated with an intelligent reminder/alert engine, data management, and collaborative tools, Indegene’s alternate channel of physician engagement can accelerate the delivery of key messages, information, and knowledge through a genuinely open dialogue with physicians. 

If required, the automated tools within the platform can be integrated with a system of intelligent human support via globally located specialised scientific resources. Channels of communication include e-mail, telephone, or Web conferencing. This human support integration reduces the cost of providing focused, relevant information and knowledge to physicians to meet their evolving needs while allowing a further level of personalisation and community building to build and maintain a high product and brand SoV.  To reiterate, an integration of high-quality content and microtargeting tools through customer intelligence, specialised human expertise on call, and a global resource model allows for a viable alternate channel of physician engagement to succeed in today’s marketplace. This alternate channel can be implemented along with the regular sales force channels, thereby lowering the overall cost of maintaining the SoV and engaging physicians for end-of-life products. 

Step-by-step transitioning to an alternate channel of physician engagement
Indegene recommends a step-by-step transition from a pure sales force approach to that of a hybrid alternate channel approach. The transitioning roadmap (Figure 4), as suggested by Indegene, can help make decisions related to transitioning from a 100 per cent face-to-face detailing model to one with a reduced dependency on sales reps to communicate with physicians in face-to-face meetings. Part of the savings by this reduction could be deployed in initiatives to engage the physicians by adding value to their practice.

Figure 4. Stepwise Transitioning to an Alternate Chann

The ideal focus of the initiative has to be on the high prescribers so that the prescription volume is not diluted. It is imperative that the tactics agreed upon ensure that physicians spend as much time with alternate channels as with a sales rep as measured by effective minutes of brand detailing in a year.

The data presented in Figure 4 are representative. The final goals a company wants to go after can be decided based on the risk appetite of the company, the physician mix, and the progress with the alternate channel. These goals can also be changed after reviewing the progress of the alternate channel.

Key questions that ought to be addressed before embarking on transitioning plan are

  • What are the goals of such a programme?
  • What are the metrics to track the effectiveness of an alternate channel?
  • When is it appropriate to reduce the frequency of sales rep visits?
  • How to manage quality of customer experience beyond the sales transaction?

During transition, the following critical metrics should be tracked:

  • Time spent by physicians on the channel for education
  • Number of physician interactions with the channel in a predefined period
  • Willingness and time spent by a physician on the channel to view brand messages
  • Willingness and time spent by a physician on virtual detailing/discussions
  • Types of content assets that were viewed by physicians more and the ones that were not viewed much
Figure 5. Comparative Sales Cost Figure 6. Comparative Minutes of Engagement

The metrics stated above may help take decisions on the speed of transition to the alternate channel as well as provide for a more objective methodology for deciding on investments for creating content and other online resources.

If executed well, there can be a substantial impact on the cost and time of engagement with targeted physicians using the framework suggested here.


  • The pharma industry has traditionally relied on face-to-face detailing approach. But communication technology is transforming the way physicians access information as well as the way in which knowledge can be delivered to them.
  • Maintaining share of voice for mature brands is a potentially rewarding exercise since its results have a direct impact on the bottom-line. If this goal can be achieved through a cost-effective platform, then the ROI can be quite significant.
  • Using an alternate channel of physician engagement that integrates education, virtual detailing, and information delivery based on specific customer profiles can help increase share of voice in a cost-effective manner.
  • A prudent metric-based approach is recommended for transitioning a mature brand from a 100 per cent face-to-face detailing model to reduce the dependency on sales representatives to communicate with physicians.

1. Julie M Donohue, PhD, Marisa Cevasco, BA, and Meredith B Rosenthal, PhD. A decade of direct-to-consumer advertising of prescription drugs. N Engl J Med. 2007;357(7):673-681.
2. For further information on the situation in the United States, see “Rep Alert,” Pharmaceutical Executive, January 2008, p. 2. For further information on the situation in the United Kingdom, see “Getting the Mix Right: New Roadblocks and New Routes to Market,” Paul Jones and Nic Holladay, Pharmaceutical Executive Europe, September 2006.
3. Drivers of Change to Pharmaceutical Commercial Models. ZS Associates 2009.
4. Pharma 2020: The Vision, PriceWaterHouseCoopers.
5. Nancy Connelly. Mining for Gold: Sales Force Models that Optimize Established Brand Performance.
6. Pharmaceutical Sales Management 2008, Cutting Edge Information.

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