Pharmaceutical marketing
An advertisement for the prescription antidepressantWellbutrin antidepressant Wellbutrin,, targeted to a physician audience.
Pharmaceutical Pharmaceutical marketing is the business of advertising or otherwise promoting the sale
of pharmaceuticals pharmaceuticals or drugs or drugs.. Evidence show that marketing practices can negatively affect both patients and the h ealth care profession. profession.[1] Many countries have measures in place to limit advertising by pharmaceutical by pharmaceutical companies. companies . [edit edit]]History The marketing of medication has a long history. The sale of miracle cures, many with little real potency, has always been common. Marketing of legitimate non- prescription prescription medications, medications, such as a s pain relievers or allergy or allergy medicine, has also long been practiced. Mass marketing marketing of prescription medications was rare until recently, however. It was long believed that since doctors made the selection of drugs, mass marketing was a waste of resources; specific ads targeting the medical profession were thought to be ch eaper and just as effective. effective.[citation needed ] This would involve ads in professional journals and visits by sales staff to doctor¶s offices and hospitals. An important part of these efforts was marketing to medical students.[citation needed ] [edit edit]]Direct
and indirect marketing to health care providers
Physician are perhaps the most important players in pharmaceutical sales. They write the prescriptions that determine which drugs will be used by th e patient. Influencing the physician is the k ey to pharmaceutical sales. Historically, Historically, this was done by a large pharmaceutical sales force. A medium-sized pharmaceutical pharmaceutical company might have a sales force of 1000 representatives.[citation needed ] The largest companies have tens of thousands of representatives representatives around ar ound the world. Sales representatives representatives called upon physicians regularly, providing information and free drug samples to th e physicians. This is still the approach today; however, economic pressures on the industry are causing pharmaceutical companies to rethink the traditional sales process to physicians. More recently, the Partners Partners Healthcare, Massachusetts' Massachusetts' largest hospital and physician network, will adopt new guidelines prohibiting physicians and researchers from accepting gifts from pharmaceutical manufacturers. This will include meals or individual drug samples, and a lso drug samples left by companies will be distributed through a centralised system, while educational programmes programmes and fellowships fellowships will also be r equired to be centrally reviewed and approved.[1] approved.[1]
Pharmaceutical companies are developing developing processes to in fluence the people who influence the physicians.[citation needed ]
There are several channels by which a physician physician may be influenced, including self-influence self-influence through research,
peer influence, direct interaction with pharmaceutical companies, patients, and public or private insurance companies. There are also web based in struments that can be used to determine the influencers and buying motives of physicians. There are a number of firms that specialize in data and analytics for ph armaceutical marketing. [edit]Individual research Physicians discover pharmaceutical information from such sources as the Physician's Desk Reference and online sources such as PDR.net, as well as via PDAs with applications. They also rely upon pharmaceutical-branded e-detailing sites, pharmaceutical sales and non-sales representatives, and scholarly literature. Scholarly literature can be in the form of medical journal article reprints, often delivered by sales representatives at their place of employment or at conference exhibitions.[citation needed ] [edit]Peer influence
K ey opinion leaders
K ey opinion leaders (KOL), or "thought leaders", are respected individuals, such as prominent medical school
faculty, who influence physicians through their professional status. Pharmaceutical companies generally engage key opinion leaders early in the drug development process to provide advocacy and key mar keting feedback.[2] Some pharmaceutical companies identify key opinion leaders through direct inquiry of ph ysicians (primary research).
Colleagues
Physicians acquire information through informal contacts with their colleagues, including social events, professional affiliations, common hospital affiliations, and common medical school affiliations. Some pharmaceutical companies identify influential colleagues through commercially available prescription writing and patient level data[3]. Doctor dinner meetings are an effective way for physicians to acquire educational information from respected peers. These meetings are sponsored by some pharmaceutical companies. [edit]Direct Currently,
physician contact with pharmaceutical sales representatives
there are approximately 100,000 pharmaceutical sales reps in the United States[4] pursuing some 830,000
pharmaceutical prescribers. A pharmaceutical representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200 physicians with 120 targets that should be visited in 1-2 week cycles. Because of the large size of the pharmaceutical sales force, the organization, management, and measurement of effectiveness of the sales force are significant business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness. A few pharmaceutical companies ha ve realized that training sales r epresentatives on high
science alone is not enough, especially when most products are similar in quality. Thus, training sales representatives on relationship selling techniques in addition to medical science and product knowledge, can make a difference in sales force effectiveness. Specialist physicians are relying more and more on specialty sales reps for product information, because they are more knowledgeable than primary care reps. [edit]Physician targeting Marketers attempt to identify the universe of physicians most likely to pr escribe a given drug. Historically, this was done by measuring the number of total prescriptions (TRx) and new prescriptions (NRx) per week that each physician writes. This information is collected by commercial vendors. The physicians are then "deciled" into ten groups based on their writing patterns. Higher deciles are more aggressively targeted. Some pharmaceutical companies use additional information such as:
profitability of a prescription (script),
accessibility of the physician,
tendency of the physician to use the pharmaceutical company's drugs,
effect of managed care formularies on the a bility of the physician to prescribe a drug,
the adoption sequence of the physician (that is, how readily th e physician adopts new drugs in place of older, established treatments), and
the tendency of the physician to use a wide palette of drugs
influence that physicians have on their colleagues.
Data for drugs prescribed in a hospital are not usually available at the physician level. Advanced analytic techniques are used to value physicians in a hospital setting.[citation needed ] [edit]Opinion Leader I nfluence Mapping Alternatives to segmenting physicians purely on the basis of pr escribing do exist, and marketers can call upon strategic partners who specialize in delineating which characteristics of true opinion leadership, a physician does or does not possess. Such analyses can help guide marketers in how to optimize KOL engagements as bona fide advisors to a brand, and can help shape clinical development and clinical data publication plans for instance, ultimately advancing patient care. [edit]Sales force size and structure Marketers must decide on the appropriate size of a sales force needed to sell a particular portfolio of drugs to the target universe. Design the optimal reach (how many physicians to see) and frequency (how often to see them) for each individual physician. Decide how many sales representatives to devote to office an d group practice and how many to devote to h ospital accounts. Additionally, customers are broken down into different classes, each class is differentiated by their prescription behaviour and of course, their business potential. [edit]Private
and public insurers
Public and private insurers affect the writing of prescriptions by physicians through formularies that restrict the number and types of drugs that the insurer will cover. Not only can the insurer affect drug sales by including or excluding a particular drug from a formulary, they can affect sales by tiering, or placing bureaucratic hurdles to prescribing certain drugs. In January 2006, the U.S. instituted a new public prescription drug plan through its Medicare program. K nown as Medicare Part D, this program engages private insurers to negotiate with pharmaceutical companies for the placement of drugs on tiered formularies. [edit]Direct
marketing to patients
Since the late 1970s, direct-to-patient marketing of prescription drugs has become important. Many patients will inquire about, or even demand to receive, a medication they have seen advertised on television. In the United States, recent years have seen an increase in mass media advertisements for pharmaceuticals. Expenditures on direct-toconsumer (DTC pharmaceutical advertising) have more than quintupled in the last seven years since the FDA changed the guidelines, from $700 million in 1997 to more than $4.2 billion in 2005, according to the United States GAO (Government Accountability Office, 2006). [edit]Regulation In the United States, marketing and distribution of pharmaceuticals is regulated by the federalPrescription Drug Marketing Act of 1987. In general, pharmaceutical companies adhere to FDA regulatory guidelines which call for all DTC advertising and information to be accurate, to provide substantial evidence for any claims that are made, to provide a balance between the risks and benefits of the promoted drug, and to maintain consistency with labeling approved by the FDA. [edit]Controversy
The mass marketing to consumers of pharmaceuticals is controversial. It is banned in over 30 industrialized nations, but not in the US and New Zealand, which is considering a ban.[5]Some feel it is better to leave the decision wholly in the hands of medical professionals; others feel that consumer education and participation in health is useful, but consumers need independent, comparative information about drugs (not promotional information)[6]. For these reasons, most countries impose limits on pharmaceutical mass marketing that are not placed on the marketing of other products. In some areas it is required that ads for drugs include a list of possible side effects, so that consumers are informed of both facets of a medicine. Canada's limitations on pharmaceutical advertising ensure that commercials that mention the name of a product cannot in any way describe what it does. Commercials that mention a medical problem cannot also mention the name of th e product for sale; at most, they can direct the viewer to a website or telephone number operated by the pharmaceutical company.
The number and persistence of pharmaceutical representatives has placed a burden on the time of physicians[7]. "As the number of reps went up, the amount of time an average rep spent with doctors went down²so far
down, that tactical scaling has spawned a strategic crisis. Physicians no longer spend much time with sales reps, nor do they see this as a serious problem."
Recent legal cases and US congressional hearings have provided access to pharmaceutical industry documents revealing new marketing strategies for drugs.[8] Activities once considered independent of promotional intent, including continuing medical education and medical research, are used, including paying to publish articles about promoted drugs for the medical literature, and alleged suppression of un favorable study results.[9]
