Responses on the value of eDetails compared with in-person details differed significantly across the four practice areas covered – family medicine, oncology, cardiovascular and allergy/immunology – and suggest that biopharmaceutical companies have an opportunity to adjust the promotional mix for stronger returns.

Over the last two years, in-person visits to oncologists decreased by 14%, but eDetails for the group only increased by 4%. Allergy/Immunology docs saw a 5% decrease in rep visits, but eDetailing grew by 8%. Still, allergy/immunology docs only received 1.8 eDetails per week, on average, but would like to see 3.3 eDetails per week, according to the survey results.

In terms of perceived value, in-person reps ranked higher across the board. However, oncologists and family medicine practitioners said they were better educated by eDetails, whereas cardiologists and allergy/immunology docs said in-person reps provided a better education.

Regardless of whether a physician prefers eDetails or traditional sales calls, the kinds of material preferences included in a detail also vary by practice area. “If you go into a cardiology detail without referencing clinical trial data, they’re going to feel like something’s missing,” says Kevin Olson, CEO at Industry Standard Research, publisher of the survey. Oncologists, on the other hand, “don’t tell us the same thing” about clinical trial data, says Olson. Oncologists (39%) cited the ability to answer product-related questions as the most important aspect of a detail, followed by the inclusion of information that is “sufficiently patient focused,” at 30%. Fifty percent of cardiologists said clinical trial data is most important.

Samples remain a critical part of the in-person detail experience, according to survey results, despite the fact that many eDetailing platforms provide an easy way to request samples. Asked what is lost when in-person details go the way of the dodo bird, Olson says that distribution of samples was “one of the biggest results,” although it’s “pretty clear in our data that physicians do receive value” from the opportunity to dialogue with a human being. Asked about some of the more surprising results of the survey, Olson says one question asked about the importance of key opinion leader (KOL) content; he was surprised to learn that it did not rank highly in comparison to other aspects of the detail.

The 130-page report, titled eDetailing vs. In-person Detailing: A head-to-head comparison of Volume, Time, Value, and Outcomes, surveyed 118 practicing U.S. physicians during the fourth quarter of 2011. Participants completed a 15-minute web-based quantitative survey.

Today, GSK announced phase two of the program, which includes incentive components that sound a lot like sales-based goals. Phase two, which began on July 1, consists of three criteria for sales rep compensation: selling competencies, customer evaluation, and the overall performance of the rep’s business unit, according to a statement.

If sales targets aren’t part of the new incentive structure, what exactly are selling competencies? “We’re not giving details on assessing things like sales competency and customer evaluations, because we really consider the methodology and process that we’ve developed and put in place to be proprietary,” says Kevin Colgan, a GSK spokesperson. The methodology “uses information from multiple data streams,” and will “provide a good way to differentiate the performance of the sales professionals,” says Colgan.

The third criterion – overall performance of the business unit – is a measure used to evaluate other employees in the organization, not just sales reps, according to Colgan. Asked about reactions to the new incentive structure (first implemented in January 2011) from the rank and file, Colgan says, “I think the sales force is pleased with the rigor of the new approach, and that it will do a good job in determining the success of the sales force and how they’re performing relative to their peers.” GSK’s first quarter sales in the US were down 4%, to $2.27 billion, but that was thanks to “higher discounts required as a result of US Healthcare reform, generic competition to Hycamtin…and the impact of the divestment of Zovirax,” sold to Valeant during the first quarter, the company said.

All three drugs are atypical antipsychotics indicated for schizophrenia, and had US launches in late 2009 (Saphris), early 2010 (Fenapt) and February of this year (Latuda). Latuda, however, appears to be gaining favor with at least some psychiatrists, due in part to successful interactions with sales reps.

When asked about the most important part of a Latuda sales call, and the brand’s greatest advantage, “metabolic profile was frequently singled-out” by survey respondents, according to David Rittenhouse, manager, analytic services, at DTW Marketing Research. “In addition, unaided message recall showed that [Latuda’s] reps are pushing two unique aspects of the product in their overall message, when compared to the competition: metabolic profile [cited by 45% of respondents] and once-daily dosing [24% or respondents], both of which are topics that can help improve patient compliance,” said Rittenhouse.

Among surveyed psychiatrists that attended a dinner meeting for Latuda (28% of respondents), almost half rated the information given at the dinner as “extremely useful,” or a five on a one-to-five Likert scale. Eighty-six percent gave the dinner information a rating of four or five, the top two scores. “This shows the influence that in-person discussions can have and still have, even if it’s not necessarily one-to-one,” said Rittenhouse. Too few psychiatrists had recently received an invitation for an e-detail on Latuda to analyze their perceptions of face-to-face detailing versus online detailing, Rittenhouse said.

With Big Pharma sales teams awash with iPads and 72% of US doctors now armed with smartphones for professional use, are we finally approaching the day when the rep is replaced by digital technology?  And if so, is it a good idea?

The number of pharma sales reps industry has fallen by more than 25,000 employees since 2006. And for those who remain, it’s getting harder to see the doctor. The Wall Street Journal (WSJ) Online points to a 2009 report, which revealed that 1 in 5 doctors would not meet with reps in a traditional office visit — decrying them as intrusive and irritating — and says about three-quarters of industry visits to US doctors’ offices fail to result in a face-to-face meeting.

In announcing plans to reduce its workforce by 16%, AstraZeneca is jumping on the digital marketing bandwagon with the introduction of AZ Touchpoints, a website offering ordering information, insurance coverage and answering doctor’s questions; Sanofi-Aventis’s www.ipractice.com and Merck & Co’s www.merckservices.com are similar services.

But as WSJ points out, the use of technology is not a complete alternative to a sales department. Systems can contract viruses and are at risk of being hacked. One of the biggest data breaches in history, the recent hacking of the Sony Playstation Network, left 77 million customers in the dark. GlaxoSmithKline’s (GSK) email database was also hacked earlier this year by an unauthorized third party. The hackers sent spam to consumers who had signed up to the GSK product website.

Where human staff can cost the company in vacation time and sick days, securing a qualified specialist to eradicate computer viruses or tighten up security systems can also be time-consuming and costly.

And not all pharma firms are replacing their reps with technology, WSJ reminds us. Danish drugmaker Novo Nordisk AS introduced a new iPad/iPhone app called Coags Uncomplicated to plug its drug NovoSeven, but left its US sales force alone.  Eli Lilly has closed down its lillyconnect.com portal, the channel it established in 2002 for marketing its drugs to doctors.

The future clearly lies in using these new sales tools, but it seems it isn’t necessary or wise to cut thousands of rep jobs to make way for them. Instead, the sales people and their digital counterparts just need to be able to work together.

Last week brought a small but dedicated group of sales professionals to a CBI conference in San Diego with a clear mandate: to rate the future of the “detail man” — dead or alive?

Surprisingly, the consensus was that the function still retains its value, even as e-detailing and other online technologies are transforming the traditional way the industry interacts with healthcare professionals. One interesting data point is how provider attitudes toward working with sales representatives vary with the nature of the practice: survey research presented at the conference showed that while roughly a quarter of all physicians in the US now ban rep calls, including the bulk of all primary care professionals, 74 percent of specialist physicians still prefer that face-to-face contact.

What matters today is the relevance and quality of the interchange, and what physicians want most is the most current information available on the progress of clinical trial studies. This is no doubt a consequence of pressures from patients, which is why a key element in the curriculum of the new sales rep should be how to  build ties to disease groups and patient advocacy organizations. Another trend is making the rep more engaged in market access support through better awareness of the reimbursement policies and options set forth by payers. As this task of “fighting the insurance companies” takes a good deal of a physician’s time, the ability of the rep to synthesize and explain the rules on P&R can free the physician for the clinical interventions that save or extend lives.

The other topic for debate was the merits of GSK’s new formula for calculating performance bonuses among its US sales teams. It focuses heavily on informal feedback from healthcare professionals as to the quality and breadth of information received from the individual rep, rather than the traditional approach based on hard targets like scrip volume within each rep’s territory. GSK says its compensation plan will significantly reduce the potential for compliance problems, such as when sales reps skirt illegal behavior by promoting off-label prescribing.

That said, participants at the CBI event asked whether customer feedback is sufficient to ensure that the process of awarding bonuses will be objective and transparent. What happens when this subjective assessment of performance is at odds with the sales and revenue numbers? And does any of this really matter when payers are driving the agenda so completely in managing pricing and access?  There were no hard and fast answers, except for the premise that the safest ground is for the rep to link his own performance to the interests of the patient in getting timely access to the right drug at a reasonable price.

In order to incentivize the formation of ACOs, the CMS guidelines for the Medicare Shared Savings Program would reward ACOs that treat Medicare Part A and Part B beneficiary populations at or under a pre-determined cost benchmark; for those ACOs that keep costs below the benchmark, as much as 60% of the money saved would be distributed back to ACO members. Benchmarks for specific ACOs would be determined by average per capita Medicare Parts A and B expenditures, according to the proposed guidelines. Exceeding the benchmark, however, means being held accountable, or paying the government for overage costs.

Are physicians ready to take on that kind of risk? “Frankly I think that [risk] is one of the things that will limit the number of institutions or organizations that are interested in playing here,” said Dan Mendelson, CEO of Avalere Health, a consulting firm. “If you have excellent data systems, and you understand risk, and you have control over your providers in terms of utilization, you’re probably a managed care company already,” he said. Managed care organizations are not eligible for the Shared Savings Program. Jeremy Lazarus, speaker for the American Medical Association (AMA) House of Delegates, said in a statement that “ACPs offer great promise for improving care coordination and quality while reducing cost, but only if all physicians who wish to are able to lead and participate in them.” A spokesperson for the AMA said more time was needed to digest the guidelines, before making additional comment on whether a critical mass of physicians would join or create ACOs.

Regarding the impact of ACOs on drug sales, Mendelson noted a “broad flexibility for ACOs to introduce concepts like step therapy,” or the practice of beginning treatment with the safest and cheapest drug therapy. With ACOs, the “organization controlling the spend is no longer the physician, it’s now the system,” said Mendelson. “From that perspective, [ACOs] look more like Kaiser [Permanente] than like selling into an oncology practice.”

John Kamp, executive director of the Coalition for Healthcare Communication, said ACOs represent additional pressure toward the use of generics and other cheap alternatives. In order to cope with those pressures, drug marketers will need to become more sophisticated in “talking about the system economics of using specific new drugs, as well as the individual patient outcome,” said Kamp. “The short-term cost pressures are much more acute than long-term cost savings.”

To participate in the Shared Savings Program, an ACO will need at least 5,000 beneficiaries on its roster, healthy and sick, according to the guidelines. “One of the things that emerges here is that if you can enroll patients who do not have multiple sclerosis or cancer or other biotech-targeted conditions, you’re going to do better,” said Mendelson. “There’s an incentive for the selection of healthy patients that the government will need to mitigate over time.” According to the guidelines, ACOs taking steps to avoid “patients at risk in order to reduce the likelihood of increasing costs” will face sanctions, which could include “termination from the program.”

Health providers eligible for participating in the Shared Savings Program include physicians in group practices, networks of individual practices, partnerships or joint venture arrangements between hospitals and physicians, hospitals employing physicians, and “other groups of providers of services and suppliers as the Secretary determines appropriate,” according to the guidelines. ACOs must enter into a three-year agreement with CMS to be eligible for the savings incentives, using one of two proposed models described in the guidelines.

Those two products – AstraZeneca’s Brilique (Brilinta in the US), a blood thinner, and Pharming’s Ruconest (Rhucin in the US) – were held up during FDA’s review process. Brilique (ticagrelor), AstraZeneca’s leading pipeline drug, was approved last December for patients in the EU with acute coronary syndromes, which includes a high risk of heart attack.

In the US, however, AstraZeneca received a complete response letter from FDA in December, addressing concerns about ticagrelor’s efficacy in American subjects, and requesting additional data from the company’s PLATO trials. AstraZeneca said in a reply to FDA that differences in efficacy across geographies were the result of interactions with high-dose aspirin. The company, and most analysts, expect ticagrelor to gain FDA approval this July. Brilique/Brilinta is a direct competitor of Sanofi-Aventis’ and Bristol-Myers Squibb’s Plavix, a blockbuster drug several times over, but Plavix faces patent expiration in the US next year, and has already gone off-patent in some European countries. Thomson Reuters Pharma put global sales of Brilique/Brilinta at $185 million in 2011, and an estimated $1 billion by 2014.

Pharming’s Ruconest/Rhucin, a drug extracted from the milk of transgenic rabbits, was approved in the European Economic Area (EEA) – which includes the EU plus Iceland, Liechtenstein and Norway – but FDA rejected its biologics license application in late February, citing insufficient clinical trial data. FDA did grant an orphan designation for the product. Pharming, a biopharma based in the Netherlands, developed Ruconest/Rhucin, a recombinant human C1 inhibitor, to treat a rare genetic disease called hereditary angioedema (HAE), which causes swelling. The drug is the company’s first to reach the commercial stage.

Marketing partners on Ruconest/Rhucin include Santarus in the US, Laboratorios del Dr. Esteve in Spain, Portugal, Greece and Andorra, and Swedish Orphan Biovitrum International (SOBI) for all other European companies. Saloni Shah, managing editor, drug information at Thomson Reuters, said in an email that Ruconest is an example of companies coming together to “offer new hope to HAE” patients. Approximately 1 in 30,000 people worldwide suffers from HAE, according to Pharming estimates.

The other three top new approvals singled out by Thomson Reuters include Forest Laboratories’ Teflaro, an injectable for bacterial pneumonia and infections; Halaven, a breast cancer drug from Eisai; and Kombiglyze XR, a combination pill for diabetes, from AstraZeneca and Bristol-Myers Squibb (BMS). Teflaro is expected to generate global sales of $514 million by 2015, and Halaven, a late stage drug for patients with metastatic breast cancer who have received at least two prior chemotherapy regimens, is expected to generate sales of $414.6 million by 2014, according to Thomson Reuters Pharma estimates.

AstraZeneca and BMS’s Kombiglyze XR, an extended-release drug combining saxagliptin, the active ingredient in AstraZeneca and BMS’s Onglyza, and metformin, the active ingredient in BMS’s Glucophage, is set to pull in close to half a billion dollars by 2015, according to Thomson Reuters Pharma. Shah said the drug “offers patients the ideal medication: a once-a-day oral tablet which combines two existing drugs, making disease management easier.”

Other drugs to keep an eye on, according to Thomson Reuters’ “The Ones to Watch” report, include Phase 3 treatments such as ArTiMist, a malaria drug developed by Star Medical and Eastland Medical Systems, ChimeriVax Dengue, a Sanofi Pasteur drug for dengue virus infection, and Merck’s V-212, for chickenpox and shingles, among others. The report, published in February, covered new drug approvals and pipeline candidates through then end of December, 2010.

The survey incorporated responses from more than 4,000 physicians worldwide. Reps were rated on a number of criteria such as objective and ethical behavior, quality of medical information, and professional relationship. Physicians were asked to rank the leading three companies by the above criteria, according to their experience and perception.

In India, when physicians were queried about “quality of professional relationship”, domestic companies received better ratings, with Mankind, Cipla, Lilly and Lupin topping the rankings; in China, doctors rated domestic player Yangtze River well when it came to objective and ethical behavior, but also gave high marks for western companies like GlaxoSmithKline, Merck, and Pfizer.

In Brazil, Eurofarma, GlaxoSmithKline and Bayer scored best among secondary care specialists, while in Japan, when asked about quality of information provided, primary care doctors gave Tsumura, GlaxoSmithKline, AstraZeneca, Takeda and Shionogi the highest ratings.

“[T]he companies that have risen to the top have honed their ability and skills in terms of what doctors want,” Christopher Wooden, Cegedim Strategic Data’s director of global sales and marketing told Pharmaceutical Executive. “In the emerging markets they are taking their experience with them.”

For further survey results, click here.

This is the first time AARP has measured the retail price of Rx drugs. In the past, the lobby group only tracked the wholesale manufacturers’ price of generic, branded, and specialty drugs, which is traditionally considered to be much higher than the retail price.

The brand name pharma firms had criticized those reports for not taking into account rebates and couponing offered to pharmacies and hospitals.

“What we found was that the prices are still trending way up, and for the most part they are relatively similar increases that we received when we were measuring the manufacturer prices,” AARP spokesperson Jordan McNerney told Pharm Exec in an interview. “Those discounts and rebates aren’t making much of a difference on the bottom line as far as the consumer is concerned.”

The concern was that if the wholesale price of drugs was increasing, then the cost had to be passed along to the consumer.

Boehringer Ingelheim’s prostate drug Flomax saw the biggest jump in price, increasing nearly 25 percent. McNerney pointed out that the treatment’s price appears to have jumped as the drug prepared to go off patent.

In response, the pharmaceutical lobby group Pharmaceutical Research and Manufacturers of America (PhRMA), released a diatribe on its website, supporting drug companies for innovating new treatments. PhRMA also supported industry against catcalls from AARP and another study released at the meeting of the American Sociological Association that claimed that few of the new treatments released in recent years offer significant improvements to patients’ lives.

“AARP’s report is misleading because nearly half of the drugs on its top 25 brand-name drug list were filled as generics in the first part of 2010, but AARP counts these drugs as if they were brand-name drugs,” stated PhRMA Senior Vice President Rick Smith in a release. “The report calculates costs in this inaccurate way even though it acknowledges that brand-name drugs typically lose about 90 percent of their sales after going generic.  The result is an overstatement of consumers’ actual costs for these medicines and there is a tremendous disparity between AARP’s report and the numerous independent analyses showing drug costs growing slowly.”

McNerney explained that the patients most likely to feel the spike in price are those in the Medicare Part D “donut hole.” Once a patient reaches a certain threshold of drug treatment, they hit a cap where they have no coverage and must pay out of pocket.

“We are looking at Congress and industry to control these prices,” McNerney said. “We would love to see Medicare negotiate directly with drug companies so patients can get the best prices on drugs and we would like to see any legislation to get generic drugs on the market faster.”

The company has strongly denied the allegations, and insists it will appeal the verdict. “We believe the plaintiffs’ claims were unfounded,” a company spokesperson said. “Throughout our history and, in particular, in the time frame of this lawsuit, [Novartis] has developed and implemented policies setting the highest standards with regards to diversity and inclusion for the development of our employees. … We are proud of the public honor and recognition we have received for the policies and programs we have in place to support the advancement of women in the sales force.”

“I think this is a huge victory for all working women,” Holly J. Waters, a former sales representative who was awarded $476,000 in compensatory damages, told The New York Times after the verdict. “We’ve waited a long time for this. It’s been five and a half years.”