2014: End of the Road for the American Rx Salesperson?

“The only thing you’ve got in this world is what you can sell.” Willy Loman, Death of a Salesman.

During my years with two major U.S. pharmaceutical companies, some of the most interesting individuals I got to know were field salespersons. Certainly one of my favorites was a gentleman I met early in my career.  He had achieved “master salesperson” status with the firm and had amassed a sales record few could rival.  When I occasionally did a professional “tag along” with him in the field, just listening to his banter with doctors was more than worth the trip.

His entire being was centered on “the sale” - the presentation, the response to objections, and the closing of the deal with “his doctor”.  To me, his handling of these encounters was just this side of magical.  It was rare that he didn’t make the sale and he frequently told me, “There’s no better job in the world than being a drug salesperson.  I just love the hunt”…which was how he saw his Rx sales work.

That, of course, is not the situation today for the American Rx salesperson.  The “hunt” is pretty much done.  Overall, and based on the pharmaceutical sales layoffs of the last 36 months, it appears that fewer than 60,000 Rx representative positions exist in the U.S. today.  This is down from well over 100,000 in 2006 (http://goo.gl/fF8Kci ).  Indeed, Lilly announced less than a year ago that it was laying off 1/3 of its entire sales force (http://goo.gl/S5G4xU ).

There are, of course, several causes for the rapidly declining numbers of sales reps.  Lost patents on major drugs; the rise of managed care; and the steadily growing resistance of physicians who refuse to see “magical” representatives like my old friend are certainly contributing factors.

But if the past few years have been difficult for the American drug sales personnel, 2014 may shape up as the year that the dying breed known as the “pharmaceutical salesperson” really begins its slow walk into extinction.  The one-two punches of Obamacare, as well as the rapid rise of the “private employer health exchanges” could spell the end of this career designation, once and for all.  Here’s why…

Obamacare and the Rx Salesperson
As most of us realize by now, Obamacare for all its chaos and uncertainty, is very likely to become a lasting reality on the American healthcare scene.  If this premise is true, as I pointed out in an earlier article (http://goo.gl/4iGeyy ), we should understand that the underlying concept of Obamacare is “less is more”…That is, Obamacare is spreading out the current service that is “American healthcare” by clipping off the quality & quantity of care at the top of healthcare and using that “excess” to provide, for the first time, basic healthcare at the bottom…In so doing, Obamacare maintains that it increases and provides “more” care for more citizens in the United States.  “Less really is more” is the line of thinking.

And if less is more, how is the U.S. drug industry to be impacted?  It’s really quite simple.  On the healthcare cost-of-operating spreadsheet, the expense for Rx care, as with all healthcare services, must be reduced.  How is that to be achieved?  In the case of prescription drugs, fewer brand name drugs are being provided; most Rx drugs that are being prescribed are generic; and all drugs, whether brand or generic, are being subjected to dramatic demands for discounted pricing by the insurers who are providing the prescription drugs through either the state or federal exchanges.

Where does the Rx salesperson fit into this scenario?  First, it is not hard to see that if eventually 30 million Americans are receiving their Rx services through an Obamacare insurance program, the opportunity to “present, respond, and close the deal” is very likely going to be limited…if ever provided.

This is because the public exchanges are working through very limited offerings that each insurance provider has assembled for the four “metal” classes of care (http://goo.gl/19hbCP ) that are being provided to the public.  The idea of a salesperson walking the halls of say, Aetna Insurance, to “close the deal” for the Aetna “bronze level” of care in the California exchange ( http://goo.gl/3CIW5H ) is just not the reality of 2014.  If anything, Aetna is likely communicating with that salesperson’s pharmaceutical headquarters, indicating the drug categories that Aetna intends to offer in California’s various programs, and is requesting bids from the Rx company to determine if there is anything further to discuss.  The Rx firm dealing with California will engage the insurer via a very limited number of specialized company negotiators.  Thousands of sales field force reps pounding the pavement will have nothing to do with the outcome.

This scenario is being played out across America this year.  As Obamacare slowly finds its equilibrium, the cold, hard fact of where this new public health plan will leave the traditional drug salesperson is becoming quite clear.  That is, they simply are not be needed.

Private Employer Health Exchanges
But as the state and federal exchanges operating under Obamacare quietly close opportunities for Rx salespersons, another concept, potentially even more impactful than the public operations, has quickly become a major player in the life of Rx salespersons in this country.  This is the healthcare concept known as the “Private Employer Health Exchange”.

Not heard of this?  Check this out:  On January 1, 2014, more than 330,000 employees from companies like Sears, Darden Restaurants, Walgreens, and many others began utilizing the services of an employer health exchange (http://goo.gl/YRl4Or ).  And according to Buck Consultants another 400,000 private employees were just added to their private health exchange offering (http://goo.gl/2WNYfI ).  In fact, as all of the new private exchange participants are tallied over the next three years, it’s expected they will be running about even with the Obamacare signups – i.e., about 30 million.  If true, that would still leave another 140 million privately insured “defined benefit” employees who could potentially be brought into the private health exchange concept in the future (http://goo.gl/W8xXi4).

How do the private employer health exchanges work?  Unlike the public exchanges in Obamacare, each employee is actually given a “defined contribution” or amount of money to “buy” their healthcare needs.  The employee will then be provided with a series of insurance options offered through entities like Aon Hewitt, Mercer, etc.  The employee then chooses the best healthcare option that the employee can buy from the stipend provided.

Why is this so suddenly so popular with employers?  Because unlike the “defined benefit” healthcare approach that has been utilized since the end of World War II, the “defined contribution” literally puts a cap on healthcare spending for the employer.  In short, it saves money.

And how does this work for the employee?  Specifically in the area of Rx drugs, as with the Obamacare approach, the employees are experiencing limited formularies, which although perhaps a bit “richer” than those being offered under Obamacare, are none the less, reduced brand name offerings versus those that the employees were receiving under “defined benefit” plans.

These also feature large numbers of generics in their formularies.  The thinking here is that for employees who have become more cost conscious of their healthcare spending due to the “defined contribution”, using more generics will be accepted.  This type of consumer attitude will obviously reduce the number of brand name products dispensed in private health exchanges.

Which brings us back to our American Rx salesperson.  How do these folks fare under this rapidly expanding private care scenario?  As with Obamacare, not well.  Firms like Mercer and their competitors certainly are not making time for drug sales presentations from individual reps as they design the Rx offerings they are creating for the employers and insurers.  Once again, the “sales” of drugs to these massive “defined contribution” options is being undertaken by specialized Rx headquarters groups who carefully calibrate and bundle the best possible packages their firms can offer in an attempt to win large chunks of business from these private health exchanges.

Obviously, there is no place for the Rx salesperson in this scenario.  None.

The End of the Road for Rx Sales in the U.S.
Given all of the above, it does appear to be just about the end of the road for Rx sales in the U.S.  One-on-one sales, if occurring at all, now appear to be trending towards digital Skype presentations, or You Tube videos that a physician can watch whenever convenient (http://goo.gl/MSTweY ).  In many of these formats, the doctor can actually access a “sales rep” to question some aspect of an Rx product.  It’s similar to what we do when we contact an Amazon rep with a question about a sweater purchase.  In short, there are no “real sales people” involved.  Only Rx telemarketers.

So, my favorite old sales friend, who is now retired and spends his days caning antique chairs, no doubt wouldn’t recognize the Rx “hunt” of today.  Of course, it still exists.  It’s just that the mechanisms used to accomplish the goals of the hunt have changed.  Prescription drug companies are still making sales, and are still making profits, if greatly diminished as compared to the halcyon days in the 1990’s and early 2000’s…

But the days of the selling by a “Willy Loman” like Rx sales “magician” would appear to be over.  Replaced instead by digital algorithms, reams of user analytics, and highly trained pharmaceutical employees - who probably couldn’t artfully answer a physician’s “objection” if they heard one.