How reps optimize brand pull-through

With the attention on managed care in the pharmaceutical environment today, it's easy, as a sales rep, to become preoccupied with the formulary status of products in certain managed care accounts. Although it is necessary for sales reps to understand what a formulary is, how it works and how it might influence their physicians' prescribing, it is also important to keep this information in perspective.

Before worrying about formulary status, each sales rep needs to answer the following questions regarding their territory.

• Which doctors in the territory are making prescribing decisions as a result of formulary status?

• For those physicians, which formularies are key to their practice?

• What is the status of key products on these formularies, and how can I relay the value of the products to my physicians for those plans? For example are they capitated, fee-for-service contracts or pharmaceutical withhold?

The data currently available to help answer these questions is not perfect and changes frequently. However, it is imperative that sales reps know with which MCOs their physicians are affiliated. They also need to work with managed care representatives in their territory to understand the influences that those MCOs have on their physicians and their prescribing habits. This information allows the sales reps to identify the physicians in their territory who are concerned about formulary status and who are using that information to influence their prescribing patterns. For these physicians, it will be important for sales reps to communicate the formulary status of their key products and show the value of the product to both the physician and the patient.

By identifying the physicians who are not necessarily concerned with the formulary status of a product, reps can focus their details on other features and benefits that are more salient, which will create more impact on prescribing behavior.

Ideally, all groups of people who hold information about the presence and impact of managed care in a specific area, such as account managers, managed care representatives, field sales representatives and hospital representatives, should meet and discuss these issues on a regular basis. However, additional communication may be necessary when changes occur in the selling environment. For example, there may be a significant change in a product's formulary status or a new competitor may enter the market.

Sales reps who have managed care representatives or account managers working in and influencing their territory should use them as a resource and interact with them often. If company protocol and computer software allow, sales reps and managed care representatives (or account managers) also may want to share physician information and records. It is beneficial to appoint someone as the contact person within each key managed care account so representatives know who to contact if they have questions, or if new information needs to be disseminated.

The shared objective should be to develop a consistent message that incorporates the goals of both product marketing and managed care marketing while maximizing the relevance of the message to individual physicians in order to increase product sales.

Leveraging formulary status

In order to drive market share, some pharmaceutical companies run targeted marketing programs for specific managed care plans with favorable formulary positions. These programs, if properly organized and run in a unified manner, are often very successful. But for managed care plans for whom companies do not have a specific marketing program, the decision to pull-through on the basis of formulary status should be made on a physician-by-physician basis.

Key factors to consider when making this decision include:

• The percentage of the physician's business that comes from managed care.

• The plans that the physician belongs to and which plans account for the largest portion of his or her business.

• How restrictive the corresponding formularies are.

• Incentives or penalties the plan may have in place to encourage the physician to write for formulary products.

• The physician's use of the plan formulary as a guide for prescribing.

If a physician has key managed care plans that account for a significant amount of his or her business and the physician makes prescribing decisions based on the formulary status of products within that plan, it may be necessary to address a product's status on those formularies. If the product is in a favorable position on the formulary, this becomes another selling point for the sales rep. If the product is not on formulary, the sales rep will need to provide the physician with reasons to prescribe in spite of the formulary status.

If a physician sees the benefits of a product that is not on formulary, he or she can become an advocate to get the product reviewed or added to the formulary in the future.

If a physician sees patients from many different plans, he or she needs to consider multiple formularies when prescribing. In this case, it may not be necessary to mention the status of a product on each individual plan formulary. Instead sales reps should focus on the global formulary status of a product, educating the doctor about the status of the product on the formularies as one entity.

Keep in mind that if a managed care plan is aggressive about enforcing formulary, a physician's impression of the number of patients he or she sees in that plan may be artificially inflated. In these situations, the physician may stick to it simply to avoid the annoyance of pharmacy interventions, and not because it accounts for the largest percentage of his or her patients.

The key to brand pull-through for today's sales rep is truly knowing the physicians to whom they are selling. PR

Robert DiChiara is managing associate, and Julie Rillo and Robert Ririe are associates of PricewaterhouseCoopers Integrated Health Care Consulting Practice, Florham Park, NJ.