How reps sell around the globe

Why should a U.S.-based pharmaceutical rep care what's happening abroad? It's simple. As one trainer put it: "The world is shrinking."

As the economy continues to become more global, major pharmaceutical companies are honing their worldwide sales and marketing efforts so that a unified message comes across, and reps are a big part of that effort.

To give a sampling of some of the world's unique selling environments, Pharmaceutical Representative asked three international trainers from Wyeth-Ayerst Global Pharmaceuticals, a Philadelphia-based subsidiary of American Home Products, to describe the selling situations in the United Kingdom, China and Latin America.

The United Kingdom

Other than driving on the left-hand side of the road, American sales reps who travel to the United Kingdom would feel fairly comfortable filling in for one of their international colleagues, said Ed Nathan, senior director of performance development, Wyeth-Ayerst Global Pharmaceuticals. That's because being a rep in the United Kingdom isn't much different from being a rep in the United States. For starters, reps in the United Kingdom have similar backgrounds to U.S. reps. "Most have college degrees, often in the sciences," Nathan said. "They also have selling experience. Overall, the real key is that they are good communicators."

Reps in both countries also share the same tools: Many reps in the United Kingdom use laptop computers for distance learning and account management. However, their sales offices don't have the same data that companies in the United States have for determining physician prescribing habits and rep effectiveness.

"Ironically, in the U.K., the quality of sales data is almost opposite to that in the United States," Nathan says. "For example, the best data available for a general practice rep in the U.K. is by postal code. So reps are compensated by sales within these postal codes - which are similar to our ZIP codes - instead of by doctor. However, most hospitals are run by the government, so the hospital distribution data system has become more sophisticated. There is now a report called an HPA 13 that shows promoted product usage down to the department level in many hospitals."

Reps in the United Kingdom must sell in a health care environment that places a strong emphasis on cost, which is being driven by the government-run health care system. "It has been more than 50 years since the government started its national, cradle-to-grave health care system in the United Kingdom," said Nathan, who trains trainers in Europe several times a year. "Naturally, the government is under extreme pressure to contain costs. People don't pay for medical care in the U.K., although they now have co-payments on prescriptions."

While the pressure to keep costs down may sound a lot like the situation in the United States, this government-run system has a flavor all its own. "People in the United Kingdom don't call it managed care - they don't like the term," Nathan said. "But like managed care, the government is looking at outcomes management and other initiatives to quantify and reduce costs."

One of the government's cost-containment initiatives is following up with doctors to ask them to justify why they prescribe certain drugs. In addition, the government offers some financial incentives to contain costs through mechanisms known as primary care groups, or PCGs, in England. There are four different levels of PCGs, each with its own level of autonomy over its budget. Medical care providers in these PCGs are encouraged to use cost-effective therapies and treatment options because savings remain at a local level, as opposed to reverting to the national level. Scotland and Wales also have their own version of PCGs; they are called local health care cooperatives and local health care groups, respectively.

Interestingly, members of the European Union share a centralized approval process that determines which drugs may be distributed and marketed in Europe. After a drug gains approval, a drug company usually needs about six months to prepare its sales forces in each country and ensure that it has enough supply to meet patient demand.

China

While American reps might feel right at home selling their products in the United Kingdom, they might be in for more of a shock if they switched places with reps in China. For one thing, they'd be hard-pressed to find any private doctors' offices. "The biggest difference between health care in the United States and China is that there is no private practice in China - all care is delivered at the hospital level," said Vince Peters, director of performance development at Wyeth-Ayerst Global Pharmaceuticals. In a big city like Shanghai, a rep may have 10 to 20 hospitals to cover, said Peters, who has been training reps in China for the last four years.

In terms of pharmaceutical sales, the most sophisticated countries in Asia are Australia, Taiwan, the Philippines and Hong Kong, Peters said. Still, China isn't that far off from the others. "China is a maturing market," he said. "The state of selling there is similar to the way it was 10 years ago in the United States. Today, a lot of pharmaceutical companies are looking to China as an emerging market for high-tech drugs. After all, their government-run health care system serves four times as many people as our system in the United States."

One interesting aspect about pharmaceutical sales in China is how the background of pharmaceutical reps is changing. Several years ago, most of the reps in China were actually medical doctors - that's because being a rep for an international company paid more than practicing medicine.

"In many ways, it worked out well for companies because they could have the best professors and medical minds detailing their product," Peters said. "Also, many of the doctor-reps knew their customers, because they attended the same medical school or had worked together."

One negative aspect of having doctors do the job of salespeople was that many companies' sales forces had high turnover. To deal with this, drug companies have started to hire more nurses, pharmacists and scientists, as well as professional salespeople, as reps, Peters said. "Besides solving the turnover problem, hiring these professionals has allowed companies to move beyond relationship selling to focus more on product information."

In China, the drug approval and reimbursement process is very similar to that of Canada: The health ministry approves drugs for safety, but the provinces approve drugs for provincial formularies, which determine which drugs get reimbursed. Once a drug has been approved and launched, it is the sales rep's job to ensure that health care professionals are getting the right message about the product. Like other global pharmaceutical companies, Wyeth-Ayerst aims to market its products with a consistent message all around the world, Peters said. They do this through a universal approach to training, based on effective communication, detail aids and clinical studies.

Because Chinese pharmaceutical reps spend most of their time at public hospitals, they do a lot of group presentations. "You can image that what started out as a one-on-one presentation turns into a group presentation when other doctors come around looking for information or goodies," Peters says. It can also be tricky for Chinese reps to maintain relationships with their doctors. "Because China has a government-run health care system, attending physicians and residents are always being moved around," Peters said.

Latin America

Three countries account for more than half of most pharmaceutical companies' total sales in the Latin American market: Brazil, Mexico and Argentina. Because of this, many companies concentrate their marketing efforts on these three nations, where health care is delivered through private offices, as well as through public hospitals for free to people who can't afford care from private physicians.

Pharmaceutical representatives in Latin America have college diplomas, usually with a science background, said Luciano Salerno, manager of performance development for Wyeth-Ayerst Global Pharmaceuticals.

Salerno, who trains reps all over Latin America, said Wyeth-Ayerst reps in the three key countries call on about 200 physicians every month. Like pharmaceutical reps elsewhere, they rely on commercial promotional material and clinical studies to get their point across to customers.

For reps in Mexico, Brazil and Argentina, a typical day begins at 8 a.m. "Reps in most Latin American countries will go to the hospital in the morning because most physicians who have private offices are there very early," Salerno said. "Our reps also try to spend time with residents, building awareness of our company and its products." Then at about 10 a.m., reps start calling on private physician offices. They will break for an hour-and-a-half-long lunch around noon, then continue making office visits until 5 p.m.

The routine is a bit different in Mexico, Salerno said. "In Mexico, nobody has lunch at noon. Instead, they have it in the middle of the afternoon, then they'll go back into their territory for physician calls in the early evening."

While selling in Latin America is certainly sophisticated, it lags behind the United States in technology. Many companies don't outfit their Latin American sales forces with computers, Salerno said. However, Wyeth-Ayerst is launching a pilot program in Brazil for an electronic territory management system.

Though computer technology isn't common at the rep level, Latin American sales operations do have the same kind of prescription data that is available in the United States: IMS, which represents sales from wholesalers to pharmacies; Close Up and INTE, which show prescription data by drug, physician specialty and indications; and DDD, or drug distribution data. As such, reps in Mexico, Brazil and Argentina are compensated in a fashion similar to American reps.