Timing is everything! Pharmaceutical Sales Management September 2006
Maximising your product launch
Here’s my prescription for this problem.
Not so long ago, you wouldn’t have had to worry about this problem – there wasn’t one. You made as much noise as possible and concentrated on identifying and establishing key opinion leaders to get behind your product, and your sales team saw as many prescribers as they could with your good news.
Then along came PCOs and targets and NICE and all the other hurdles that get in the way of a successful launch, and you had to work out how to persuade people who never saw a patient – and never wanted to – to pay for your drug when they all said they had no money for it.
So what should you do? The easy answer is ‘everything’ – which is what the NHS is supposed to do but can’t, and neither can you, no matter what some clinicians and managers (and your MD) may think. So if not everything, then what?
Funnily enough, ‘everything’ is what I would prescribe – just not all at the same time. In all of life, timing is the thing: if you get that right, you’ve done well.
Your colleagues back in the labs and research departments will have spent years perfecting your new drug, testing it to prove it’s safe and refining which patients it should be prescribed for and in what doses. This is part of the ‘timing’ issue – please forgive my stating the obvious, but you’d have a really hard time of it if you were trying to launch a drug that didn’t have a licence and the prescribers didn’t know what it did. So that part of the timing conundrum should have been sorted for you already. Now what?
Again, please forgive me if this sounds like stating the obvious – a lot of successful careers have been built on doing just that – but it seems to me that, given that the ultimate objective of all your efforts is to get the name of your brand on a script, you need to persuade clinicians that your drug is the name to write. If you aren’t able to do that, then you’re going nowhere fast. Management can ‘block’ specific products, but it can’t make anyone prescribe them. Even in this day and age, there have to be options open to the prescriber as different patients have different needs.
Assuming that your clinical argument works and prescribers want to use your product, the next step is the challenging one in terms of timing. No matter how good your field team is, clinicians throughout your territory can’t all be persuaded at the same time – and they can’t all be persuaded in the same place either. Managers love clinician disagreement: if the local doctors can’t agree on the merits of something, why not keep things the same rather than try some expensive new drug that may be no better than what’s already tried and tested? So you need to look for places where there is ‘consensus’: enough (and preferably all) local specialists agree that it’s time for a change – to your product. That’s when you start on the managers: when you’ve built up a head of steam and have a unified front among the doctors that matter.
All strategists know that a two-pronged attack from above and below is better than one that leaves an escape route. You’ve got one approach sorted by organising the local clinicians – now you need to organise some pressure from above.
If you can remember a time before you needed to worry about managers and identifying the funding source for your drugs, you can definitely remember a time before NICE! Cast your mind back and try to remember what the mood of the industry was when NICE was announced and the first drug was fast-tracked through appraisal under Government direction. To say that the pharmaceutical industry felt negative about this would be the understatement of the year, especially after the first ruling on Relenza. Then what happened? Gradually people began to realise that having a NICE appraisal might not be a bad thing after all, particularly as some products were actually being recommended for use.
I am sure that you or your colleagues will at some time have worked for months on a submission and been delighted with a positive response that somehow never seemed to have any impact on your sales figures, no matter how good you were at modelling or regression analysis. So what was going on? Well, the PCOs were confronting the same issues themselves, but thinking along the lines of “If we pay for everything NICE says we should, we won’t be able to pay for anything else sooner or later, so what shall we do?” The inevitable response to that question, for many PCOs, was – nothing!
Appraisals take time, and there’s no guarantee of the outcome; but a positive NICE response is definitely ‘a good thing’ and constitutes pressure from above. It’s just not enough on its own, even though the PCOs are supposed to implement the guidance that is issued. Managers have become very adept at avoiding doing what they are told to do by doing what they ‘have to do’ – which is still a very strong argument.
How else can you apply top-down pressure, then? The key groups are the specialist representative organisations, such as the Royal Colleges. Working with these can be a two-edged sword, however – as I’m sure you know. You can never be sure whether they will adopt a positive position towards you – and if they don’t you could be generating major problems, particularly for your on-board local clinicians. Even if those organisations do support you, you will need to make sure that you get the right kind of support from them: there is a tendency for management to stonewall over-vociferous campaigners, which could lead to a total impasse.
Again, organising top-down pressure is all about timing. Too soon and your local clinicians will feel a bit cornered, as everyone else seems to know about things before they do – and no-one likes to be in that position. Too late and the managers could have carried out a local evaluation and made up their minds before the reinforcements arrive – and there aren’t too many policy decisions made in the NHS that get changed this side of the next election, so once you’re out you’re going to stay out for a whole planning cycle. And by then something else will have come along that’s better (and more expensive).
To summarise: get local clinicians on board and in agreement; get the right organisations behind you; and get local funding.
There you have it. My prescription is ‘timing’ – timing for everything! Just make sure that your sales team keep up their compliance rates…
Dr Matt McGlennonMB, ChB, MPH, MFPH, CPD is Market Access Director at Binley’s, a sales and marketing solutions provider for the pharma industry.
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