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.

As the cancer therapeutics space grows more crowded, the task of identifying and building productive relationships with “key influencers” has become vital to a successful launch strategy.  Like everything else in oncology, performing that task is harder today. What was once an inbred club of clinical practitioners has morphed into a complex array of interests that, like an orchestra, has to be managed to filter out the discordant notes that depreciates the distinctive value of the asset.

How to address this challenge was one of the more interesting sidebars to this week’s annual meeting of the American Society of Clinical Oncology [ASCO] in Chicago.  In an exchange hosted by the data analytics vendor Cegedim Relationship Management, three prominent physicians – Peter Harper of St. Guys Hospital in London, Paris-based clinician Alain Hererra, and William Gradishar of Northwestern University – reviewed the climate for shaping opinions of the clinician community active in the treatment of cancers.

The consensus view is that simple peer group awareness remains the best way to determine key players in driving decisions on prescribing.  Documenting influence in the physician community is challenging because the acknowledged experts are often self-nominated.  There is no real metric that can certify such influence; it tends to wax and wane around the clinician’s level of engagement in clinical trials, development of practice guidelines, on line education and other activities that bear directly on treatment.   Organizational affiliation is important as well, with the larger academic/teaching hospital groups reinforcing the ranks of those who are deemed most influential.

In a follow-on discussion led by Cegedim subsidiary SK&A, the three physicians reviewed a data evaluation tool – Physician Connect – that contains information on some 24,000 physicians who as a result of detailed peer survey work have been identified by the profession as being “leadership influencers” in their respective areas of practice.   The survey pool incorporates input from more than 100,000 practicing professionals active in treating seven cancers/tumor types and eight malignancies in nine countries, including the US, Canada, the big five EU and Belgium and the Netherlands.  This exhaustive survey data is ranked, verified and standardized into protocols by a dedicated team of Cegedim staff at a network of research centers.

“Physician Connect is able to shed new light for the industry in determining how physicians are treating and managing cancer patients; documenting the dense web of connections that help in selecting nominees for external scientific advisory committees; and – ultimately – who the profession actually relies on in setting new paradigms for practice,” Cegedim vice-president Marcus Bergler told Pharm Exec.  The company has plans to build the data base further into the hematology area and extend survey capabilities to additional country markets, including Japan and ultimately China.  Bergler said interest in Physician Connect is strongest today in Europe, where information on physician influencers is sketchy, disaggregated and under-resourced, despite the growing need of the local industry for better outside sources of support to counter payer pressures on access to oncology meds.

It is also important to filter this data in conjunction with the strong anecdotal input built through ongoing company-specific outreach initiatives.  Leadership status is often a consequence of simple name recognition. Successful leveraging of the Physician Connect tool depends on being able to make it synch with evidence that leaders in the field can spark a genuine change in the treatment paradigm. Determining that depends on supplementing data with practical market savvy and good judgment – horse sense, so to speak.

The code, which is open for public comment until June 30^th, states that “no gifts, pecuniary advantages or benefits in kind may be supplied, offered or promised to persons qualified to prescribe” a drug. Additionally, “gifts for the personal benefit of healthcare professionals (such as tickets to entertainment events) also are not [to] be offered or provided,” the code states.

However, some concessions are made for continuing medical education (CME). For example, pharma companies may provide monetary assistance covering “actual travel expenses, meals, refreshments, accommodation and registration fees” for physicians, but the events and expenses “have to be organized in India only…and incurred only for the events held in India.” Assistance funds are not to be extended to “spouses or other accompanying persons” hoping to travel to CME events, and companies are barred from organizing meetings that “coincide with sporting, entertainment or other leisure events or activities.”

On his MedCom Strategies blog, Dr. Neelesh Bhandari, a New Delhi-based medical communications consultant, took issue with the rule about meetings coinciding with other events. “This is a totally uncalled for limitation. Why shouldn’t healthcare professionals attend meetings because of the IPL [Indian Premier League] being held at the same time?” wrote Bhandari. The IPL is a professional cricket league.

Other proposed rules in the code limit drug sampling “to prescribed dosages for three patients,” and sample packs “shall not be larger than the smallest pack presented in the market.” Providing samples of “anti-depressant, hypnotic, sedative or tranquillizer” drugs in any amount or packaging unit is disallowed, under the proposed code.

Regarding textual and audio-visual promotional material, marketers are prohibited from using the “names or photographs of healthcare professionals.” Marketers are also asked to avoid “extremes of format, size or cost of promotional material.” On his blog, Bhandari wondered if that rule would “limit the size and costs in pharma marketing projects.” Audio-visual material “must be accompanied by all appropriate printed material” as well, prompting Bhandari to suggest that “this could kill digital pharma marketing in India.”

The full document and code is available here. The regulations are voluntary for now, but “its implementation will be reviewed after a period of six months form the date of its coming into force, and if it is found that it has not been implemented effectively…the government would consider making it a statutory code,” the document says. The Department of Pharmaceuticals is a division of India’s Ministry of Chemicals and Fertilizers.

The stated aim is to assist FDA’s Division of Drug Marketing, Advertising, and Communications (DDMAC) in its efforts to deter promotional activities. DDMAC examines promotional pieces submitted to the agency, scans ads and TV commercials informally, and monitors drug company exhibits and programs at medical meetings. An important source of information is all the complaints the division receives are from industry competitors who see another company getting away with off-label promotion or unfair comparisons. It’s impossible for DDMAC to catch everything, and certainly not what’s said in meetings between doctors and sales reps or at sponsored dinner programs.

To kick off the Bad Ad program, which was announced last month, DDMAC staffers will give talks and distribute educational materials to providers at medical conventions and society meetings. A brochure advises doctors on how to recognize misleading promos: omitting risks, overstating effectiveness, promoting off-label uses, or making misleading comparative claims. FDA is making it easy for doctors to squeal about objectionable messages by establishing a special call-in number and email address.

It’s not yet clear if the campaign will generate a lot of finger-pointing—or if it does, how DDMAC will deal reports that are vague and undocumented (anonymous calls are okay). Marketers fear that doctors will file complaints based on misunderstandings and personal prejudices. Supporters of the program anticipate that marketers and sales reps will modify their pitches if they think that their audience is taking a much closer look at what they say. But free-speech advocates like the Washington Legal Foundation fear it will chill open exchange of health information, which can be useful.

The Bad Ad campaign fits FDA’s effort to step up enforcement, as Commissioner Margaret Hamburg promised a year ago. The agency has issued 186 warning letters so far this year, putting it on track to meet last year’s record of 570 enforcement missives, according to BNet Pharma. And more of those are coming from DDMAC, which doubled its warning-letter rate to 41 in 2009, vs. 21 the year before. Many recent letters challenge Internet marketing, an activity that remains on FDA’s radar screen. In April, DDMAC sent a long warning letter to Novartis challenging the company’s use of Web sites to promote unapproved uses and to make unsubstantiated claims for Gleevec. FDA plans to develop guidelines on Internet promotion and use of social media by drug marketers, but it’s proving to be a complicated business.

When 5,742 physicians opt in voting for their favorite medical journal ads over utilizing spare time that never comes, you know it’s a big deal. And yesterday at The Doctor’s Choice awards luncheon sponsored by the Association of Medical Media (AMM), their input was not only showcased on a most refined level but also indicative of what they want pharma marketing to deliver.

It became quite clear to me early in the ceremony that physicians weren’t selecting ads based on how fun and fancy they were, but rather on how they delivered a message straight and to the point. William Castagnoli, director of The Doctor’s Choice awards, echoed my thoughts.

“Doctors are looking for information and they very often are not impressed by what we would think is a bright clever headline or photo,” he said. “There were a lot of ads this year that were atypical.”

Despite a lack of fluorescent colors with flashy themes, most ads did present more text and fewer frills. Dusa’s Clindareach launch ad combined, what I thought, the right mix of amusement and information for doctors. In fact, Topin & Associates, the agency that created the ad, walked away with the most awards – highest scoring specialty ad, the four-page and over, and dermatologicals categories.

“Clearly this is a concept that’s been proven to deliver impact,” said Alan Topin, president and founder of Topin & Associates. “I’m proud of our experienced team that developed this award-winning work,” he added.

Companies close behind taking two awards were Merck, Lilly, Alcon, Pfizer, and Salix.

For the first time in history, Lilly’s four-page Cymbalta ad created by GSW Worldwide won in two product categories: diabetes therapy and neurologicals. Again, we saw tons of text going on in this ad but the clincher here was the patient who tells a story.

Kris McGlosson, vice president creative director for GSW Worldwide said that Cymbalta targets endocrinologists and neurologists because it effectively communicates both diabetes and pain. She also pointed out that the key was casting somebody who could play the role of a diabetic.

“I think doctors in their educational progress are data driven so when you ask their response to communication they say show me the data,” said Dean Tepper, senior vice president group creative director, GSW Worldwide. “They digest communication in an emotional way and if they can become a hero they will respond.”

Click here and here for a full list of winners