Howard Deutsch co-wrote this blog post with Alex Turok.
The evolution in the U.S. healthcare ecosystem has made it more complex. Individual physicians and small group practices have given way to large, integrated health systems with an array of stakeholders who have different needs, expectations and motivations. To engage effectively in this environment, pharma has developed new field-based roles beyond the classic sales rep to help train nurses, create awareness of companion diagnostics and interpret biomarker test results, manage complex authorization processes and much more. Yet while these roles address critical steps along the patient journey, pharma can get significantly more value from their non-rep roles.
Pharma invests significant time and resources to maximize return on salesforce investment. Every aspect of the sales rep job is optimized: territory configurations, training, targets and suggested frequencies, decision support and incentive programs. That level of rigor stands in stark contrast to field reimbursement managers or patient navigators. We see a gap in how pharma has answered three key questions:
1. Which markets? Non-rep roles are treated as an afterthought relative to sales roles. In 2018, ZS research showed that the most common sizing methodology for service and support roles was one per sales district, but the customer needs that these non-rep roles address are not uniform across the country. For example, geographies with lower than an average product adherence may require more nurse educators. The rep-centric mindset comes at the expense of being customer centric.
2. How many? Non-rep roles tend to be seen as cost centers, rather than drivers of revenue. We recently worked with a client that had a portfolio of blockbuster specialty products. We found that 30% of new prescriptions were never filled, and some of that lost opportunity was addressable by dramatically scaling up the field reimbursement role. The optimal size of that team was five times its current level, closer in parity with the salesforce. It’s rare for a field sales team in a sophisticated pharma organization to be so undersized, but such under-investment is common in non-rep roles.
3. How to be effective? Multi-role field coordination is important because of the many-to-many relationships between pharma and healthcare decision makers. ZS-sponsored qualitative research on non-rep roles found that, unlike sales reps, only a portion of their time is driven by a call plan or pre-defined customer list. Instead, they rely on sales reps to orchestrate visits and pull them into the conversation. Coordination and triaging customer requests are essential to a smooth patient journey. However, while most companies are aware of the need for coordination, many have taken only basic steps to enable it.
Pharma can address these gaps and capitalize on the tremendous potential of non-rep field roles through three critical moves:
1. From rep-centric to customer-centric: Dispense with the one-per-district mindset. Instead, look at customer situations and requirements in each geography and align service and support resources to those needs. Sure, this may feel unfair to the reps who have fewer of these non-rep roles assigned to them, but the intent of those roles isn’t to help the reps; it’s to serve customers properly.
2. From under-investment to right-sizing the opportunity: By taking a more patient-centric approach to resource planning, you can see non-rep roles with fresh eyes. These personnel play an important role in removing barriers. A patient who is not considered for your brand due to low awareness of a diagnostic test, or who never fills their prescription, or discontinues therapy early, is not a well-treated patient. When pharma starts measuring non-rep roles’ impact and linking activities to appropriate KPIs, only then will it become apparent how much opportunity is being left on the table. Ultimately, this will justify more investment.
3. From low to hyper-focus on non-rep effectiveness: The most successful field organizations will bring a complete team mentality, leveraging well-designed processes and CRM tools to have a coordinated engagement approach for the right customers, at the right time, with the right messages. In the short term, any company that can quickly improve analytics and HQ support (customer needs assessment, valuation, targeting and reporting) for non-rep roles will have a competitive advantage. This will persist until all of pharma has elevated non-rep support to be on par with sales reps.
These changes may seem daunting, but pharma has already done a lot of the hard work, since the industry has recognized changing customer needs and designed field-based roles to support a better patient journey. Now is the time for pharma to realize the promise that these roles bring.