Sales reps need an edge to get face time with the physicians these days. The way to their schedule calendar is through evidence-based medicine, our experts say. Studies show that not only does adding evidence-based medicine information to the sales call increase the value of the sales rep’s role, evidence-based medicine data can also help drive physician prescribing behavior. by Robin Robinson According to Michelle O’Connor, senior VP, learning strategy and innovation, at CMR Institute, clinicians have reported that the most useful interaction is one with a highly educated representative who brings a broad understanding of the healthcare continuum to the table and who delivers information that benefits patient outcomes. “Evidence-based medicine information gives sales reps the opportunity to provide data based on research that clinicians value as opposed to a marketing message," she says. “Physicians tell us again and again that this is what they value most." Mark Sales, global practice leader, stakeholder management, at TNS Healthcare, says pharmaceutical companies have begun a dramatic transition from product-centric sales models to physician-centric service models. “More than 90% of companies now say they are adopting service models, expanding their focus from measuring internal sales processes to motivating external sales drivers: the physicians writing prescriptions and the stakeholders influencing them," he says. “As service models evolve, the industry is moving toward patient-centric approaches, in which physicians and the industry partner to advance patient care and improve treatment outcomes. Evidence-based medicine will be an important tool in ensuring reps can form that kind of strong partnership with their physician customers in helping them optimize patient care." (For more information on creating successful service models, please turn to page 44.) The Evidence for Evidence-Based Selling Recent studies reveal that physicians want and need to have more valuable clinical information coming from pharmaceutical companies. In a 2008 Sermo study sponsored by Publicis Selling Solutions Inc., with physicians from a wide variety of different specialties, 85% of respondents wanted “more" or “significantly more" higher-quality representatives, defined as more highly trained, “specialty type" representatives. Fully 87% of respondents wanted “more" or “significantly more" use of clinical studies and evidence-based medicine in their discussions with sales representatives. Surveyed physicians preferred clinical studies to “glossy brochures" and evidence-based medicine-oriented discussions versus promotional details. Another study, conducted annually by the Health Strategies Group, shows that only 40% of physicians said they were satisfied with the information that reps shared during product discussions and only 30% were satisfied with the supporting materials that sales reps used. “These figures are not positive indicators," says Rick Rosenthal, principal and practice leader, sales force effectiveness, Health Strategies Group. “Particularly since we know that visual aids and clinical reprints that support what sales reps say in the office are important predictors of prescribing changes." Mr. Rosenthal says now, more than ever, sales reps should be able to speak more clinically to the doctors who desire this type of discussion. Solvay recently studied the results of syndicated reports from physician focus groups to determine how its sales reps can better fill physicians’ needs. The overriding conclusion was that doctors like the interchange with reps and appreciate the services they bring, but they have limited time for the interaction, says Kevin Guthrie, VP sales, Solvay Pharmaceuticals. “Sales reps need to bring physicians relevant, up-to-date, good, sound clinical information," he says. “As a result, our reps have found that if they provide good information, they get more face time with the physician. But, if the information provided is just a repeat of the last five visits to the office, they won’t get any of the physician’s time." Mr. Rosenthal says physicians report that they want to see reprints, professional journals, consensus statements from medical societies, and other information of this type. “Physicians’ underlying concern is around bias," he says. “Physicians may hear from one rep that their drug is better than another and when that scenario is repeated over and over again, category by category, soon they start to wonder who is giving the most truthful and accurate information." Richie Bavasso, president of Exploria SPS, says because of the advent of alternate channels for the physician to find and review unbiased and comparative data on therapies, the sales-rep channel has become less valued and important. “If pharma companies want to improve the value of their reps and strengthen this channel in the eye of the physician, they must provide sales reps with the tools to participate in discussions that present the appropriate therapy for a patient population," he advises. “This means it is just as important for sales reps to inform physicians when not to use their brand as it is when to use the product." Ms. O’Connor says building trust is key in a successful clinician and rep interaction. “To maintain credibility with clinicians it is imperative that evidence-based medicine or any type of clinical-trial results are presented in an unbiased and factual way," she says. “Physicians don’t want to hear a sales rep criticize a competitive product." Craig Sponseller, M.D., executive VP and chief medical officer at Vox Medica, agrees that trust is paramount to rebuilding the value proposition between sales reps and physicians. “We need to help re-establish the reps’ value for this new era, as they are our industry’s front line," Dr. Sponseller says. “It starts with rethinking the salesforce strategy, rebranding the reps, and training them to deliver on their brand promise, not just that of the products they sell." Dr. Sponseller says there are three driving factors to making a sales rep essential in today’s environment: access, credibility, and success. (To learn more about these interrelated factors to improve the value proposition, please turn to page 46.) Training Reps in Evidence-Based Medicine Integrating evidence-based medicine into a sales strategy requires reps to understand the impact of data on clinical decision-making, key research findings and evaluations, and the validity of trial results. Training reps on evidence-based medicine is more important than ever in a downtrodden economy, says Paul Mignon, chief operating officer of inVentiv Commercial and president of inVentiv Selling Solutions. Trained in how to best use evidence-based medicine, reps will bring more value to the physician and gain more access as a result. “Because so many physicians are programmed to think that a rep is going to repeat a marketing message, they shut down," Mr. Mignon says. “Once sales reps start using evidence-based medicine, there will be an evolution in how physicians think about reps; they will believe that reps can bring information that is worthwhile." Mr. Mignon says there also needs to be an evolution in how sales reps are trained. “Historically, companies trained their sales people to be experts in their own products; now, sales reps need to be experts in all products and the diseases," he says. “Doctors diagnose disease, but a well-trained rep is a better facilitator of the appropriate products for the physician to use." Mr. Guthrie says his salesforce teams already have reaped the benefits from this change in focus. “Anecdotally, we have witnessed that when sales reps bring new landmark data to physicians, they tend to get extended time with them," he says. “For many physicians who normally won’t see us, when we tell them we have new and important data, they often make appointments with us." Solvay began training its sales reps in evidence-based selling four years ago. The module used provides sales professionals with the foundation to fully understand clinical study data. “We explain study design, we talk about report structure and background on statistical analysis and statistical significance, we help pinpoint key findings and establish the terminology to be used in the review of the articles we provide to them," Mr. Guthrie explains. Mr. Guthrie says the training includes working in partnership with several other departments in the company. “We have great relationships with the medical services group, the regulatory and marketing groups, and the sales and training departments," he says. “This helps us to be proactive in identifying therapeutically relevant information as it comes to market and we can discern if it fits promotional opportunities, or if it should be used strictly for educational purposes for sales reps, or if it fits better with medical affairs." Don Hribek, VP of sales at EMD Serono, recommends that evidence-based medicine information is best communicated in a face-to-face environment, which means special training. “Just sending out an article with a fact sheet is not enough to verify that all of the sales representatives will deliver the message effectively and in-line with the label," he says. “Training workshops need to be conducted to effectively roll out this type of information." Mr. Rosenthal adds that evidence-based training needs to be an ongoing endeavor and not a one-time shot. An overlooked opportunity is listening and learning from the physicians’ feedback regarding the data presented, he says. “Many times, reps lock into the idea that customers are only there to be persuaded, but physicians have years of training and experience and they can be a great source of information and can provide feedback to help sales reps do their jobs better," Mr. Rosenthal says. One of the critical steps in training is to teach sales representatives how to pull pertinent information out of clinical papers and to help them communicate this information in the best way to the physician, says Celeste Mosby, VP, Life Sciences, of Wilson Learning Worldwide. “It is important to align the technical skills of understanding evidence-based medicine to the skills of communicating this information," she says. Ms. Mosby says the conversations that sales representatives will now need to have will be more complicated than writing one prescription for success; it will take a shift in go-to-market strategy. “Sales representatives will serve as captains of a very integrated service team," she says. “The way this service team is rewarded should not just be individual; incentives, rewards, and recognition of the team’s productivity and success must also be the focus of sustaining this new service model." (For more information on the value proposition of a new sales model, please turn to page 48.) While vitally important in this new environment, arming sales reps with evidence-based medicine could increase the probability of compliance risk in discussions between reps and physicians. “Risk is a challenge," Mr. Guthrie says. “More information doesn’t mean better information. In today’s Internet world, at the click of a button sales reps have a lot of information at their fingertips, but with this access comes a greater burden to understand the data." Mr. Guthrie says it is important that pharma companies ensure that their reps are getting balanced information and that the interpretation of that information is appropriate. “We must hold evidence-based medical material to the same standards of promotional materials and make sure we are meeting regulatory and compliance guidelines," he says. To facilitate adherence to the standards, companies need to stay on top of scientific information and review and interpret information for sales reps. “Sales reps may be tempted to use unvetted information in promotional selling, but we are training our reps to wait until the data have gone through the appropriate process," Mr. Guthrie says. “When a breaking new study comes out, the sooner the company makes the appropriate evaluations and trains them on the appropriate use of the data, the fewer compliance issues there will be." Research and innovation can actually increase the risk for the sales representative. Even the most innocent conversations around any research can have serious implications for pharmaceutical companies, Mr. Hribek says. “The industry must ensure that all information disseminated to physicians is on-label," he says. “This becomes challenging when new studies are published that discuss off-label use of an existing drug or a compound currently in research. Sales representatives might be asked by the physician to weigh in on the data; however, they need to ensure they are discussing on-label use only." However, the benefit of providing relevant study information to the physician far outweighs the compliance risk, as long as pharmaceutical companies develop sales materials that are approved by their regulatory department and adhere to the standards outlined by the FDA when discussing disease state and product information. In general, presenting data that are based on results of a randomized controlled trial or other research study doesn’t present a compliance risk if the presentation is offered in an unbiased framework and follows FDA guidelines, Ms. O’Connor says. “Reps have very strict parameters about what they can and cannot speak to even when using reprint materials," she says. “For example, when using clinical reprints, the guidelines state that the document cannot be altered in any way. In other words, a rep cannot highlight a portion of reprint." Clinicians are taking a more objective look at scientific evidence than ever before, especially when written clearly and logically, says Robert Norris, president and founder, Complete Healthcare Communications. “The credibility of promotional vehicles and messages, as they have been presented in the past, are vulnerable in light of validated peer-reviewed scientific evidence," Mr. Norris says. Sales reps and pharmaceutical marketers must adapt to a playing field in which highly technical information is readily accessible to all clinicians as well as savvy patient populations, he says. “Being able to provide hard medical evidence should make carrying the bag easier in the long run, but the challenge is adapting to the change," Mr. Norris says. F PharmaVOICE welcomes comments about this article. E-mail us at [email protected]. Thought Leaders Richie A. Bavasso. President, Exploria SPS, which offers sales performance solutions for tablet PCs and other mobile technology to the pharmaceutical and medical-device industries. For more information, visit exploriasps.com. Kevin Guthrie. VP, Sales, Solvay Pharmaceuticals Inc., a research-driven group of companies that constitute the global pharmaceutical business of the Solvay Group, which seeks to fulfill carefully selected, unmet medical needs in the therapeutic areas of neuroscience, cardiometabolic, influenza vaccines, gastroenterology, and men’s and women’s health. For more information, visit solvaypharmaceuticals.com. Don Hribek. VP Sales, EMD Serono, which specializes in several therapeutic areas, including reproductive health, neurology, and metabolic endocrinology. For more information, visit emdserono.com. Paul Mignon. Chief Operating Officer, inVentiv Commercial; President, inVentiv Selling Solutions, a segment of inVentiv Health that provides outsourced product commercialization programs, recruiting, professional development and training, and regulatory compliance services; and salesforce automation/data analysis, as well as planning and analytics, and other services. For more information, visit inventivhealth.com. Celeste Mosby. VP, Life Sciences, Wilson Learning Worldwide, a provider of human performance improvement solutions for Global 20 0, Fortune 500, and emerging organizations worldwide. For more information, visit wilsonlearning.com. Robert A. Norris. President and Founder, Complete Healthcare Communications Inc., which focuses solely on the art and discipline of strategic publication planning. For more information, visit chcinc.com. Michelle O’Connor. Senior VP, Learning Strategy and Innovation, CMR Institute, a not-for-profit, 501(c)3, independent educational organization that provides advanced education and professional certification and sets national standards for pharmaceutical representatives and managers. For more information, visit cmrinstitute.org. Rick Rosenthal. Principal and Practice Leader, Sales Force Effectiveness, Health Strategies Group, a leading consulting firm that provides market intelligence and research to pharmaceutical and biotechnology professionals. For more information, visit healthstrategies.com. Mark Sales. Global Practice Leader, Stakeholder Management, TNS Healthcare, A Kantar Health Company, which provides globally consistent solutions and custom advisory services to support product introductions; brand, treatment, and sales-performance optimization; and professional and DTC promotional tracking. For more information, visit tnsglobal.com/healthcare. Craig Sponseller, M.D. Executive VP and Chief Medical Officer, Vox Medica Inc., an independent healthcare communications company. For more information, visit voxmedica.com. Robert Norris Complete Healthcare Communication Sales reps and marketers must adapt to a new playing field —one in which highly technical information is readily accessible to both physicians and savvy patient populations.

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