Pharma seems to have spent the past decade contemplating change. For all the predictions of evolution and the demise of the field force, the representative remains the focal point of promotion. But the selling environment is changing and only the fittest will survive. Do you have the right tools for the job? Nick Lavery takes a Darwin-esque look at Advocacy Mobilisation.

Last month marked the 200th anniversary of the birth of Charles Darwin. Although 150 years have passed since he first published his seminal work On the Origin of the Species, it is perhaps appropriate that the pharmaceutical industry remains guided by his theory:

“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change” Charles Darwin

In the early 1990s companies were predicting: ‘the pharmaceutical industry is about to change’. Despite this, the environment in the UK remained fairly constant throughout the 90s even with the introduction of several NHS initiatives such as Fundholding in Primary Care.

Finally in the last three to four years the industry has seen the promotional environment change significantly. The NHS is now being shaped by the Darzi report and multiple bodies are involved in issuing guidance, such as NICE, SMC and local Medicines Management Teams. The ‘mega-brands’ of the 90s have been replaced by an environment dominated by generics and the individual Health Care Professional (HCP) has much less influence on prescribing decisions than 10-15 years ago.

Traditionally pharmaceutical companies have focused the majority of promotional activities through the sales force. In 2008, a survey of promotional focus showed: ‘75%-90% of pharmaceutical companies’ budget (headcount) is committed to the 2-key activities of personal selling and advocacy meetings’ (Republic M! promotional survey – 2008).

The impact of selling and advocacy on influencing prescribing is well documented. However, as the NHS has evolved, physical access to target customers has become increasingly difficult for representatives. The trend over the last five years has seen a reduction in sales calls and attendance at pharmaceutical-led meetings.

So, have we seen the end of the influence of the pharmaceutical representative?

Evolution

What really matters in evolution is long-term change. Despite radical reforms within the customer environment, the sales force remains the most important promotional resource for any pharmaceutical company. The volume of representative activities may have reduced across the industry, but quality people are still making a difference as competencies are evolving and companies start to adopt an account management approach.

Steve Sweeney, Director of 212 Degrees, experts in key account Management implementation, says: ‘Traditionally the industry has been successful in communicating its value by delivering key selling messages…and this remains appropriate for some customers… for others our approach needs to be more about creating value and providing a bespoke service’

As the pharmaceutical model changes, it is important that the traditional activities of selling and advocacy evolve to remain relevant in the new environment.

Brand advocacy

Medical practice is greatly advanced when HCPs share and discuss clinical experiences with their peers and colleagues. This sharing of experience helps to translate important clinical trial data into real life practice and is a very powerful way of changing prescribing habits. Organising these meetings can be difficult as experts tend to be centrally located and opportunities to connect on a wide scale are limited.

Pharmaceutical representatives play an important role in arranging meetings. This activity is known as ‘Advocacy Mobilisation’ and a speaker sharing their clinical experience can persuade other HCPs to review their prescribing.

Shelagh Feeney, Director of Scarlett Oh! brand advocacy specialists, says:‘A key factor in successful advocacy mobilisation is developing the speaker. For maximum impact, it is important that speakers are aware and understand the background to how the brand is perceived and used. This ensures speakers communicate their clinical experience in line with disease and brand communications which has far greater value for the audience and impact for the brand’

However, HCPs are less inclined to travel to meetings and the availability of experts is limited due to time and geography and therefore the traditional format is challenged. This is where evolving practice becomesvery important as we know that HCPs will attend pharmaceutical-led meetings if they are convenient and interesting.

The industry has been slow to embrace technology into the range of promotional tools at its disposal. There are many reasons for this reluctance, ranging from fear of the unknown to perceived code issues, however, HCPs have already embraced technology, so there is an opportunity to exploit: 87% of family doctors (GPs) in Europe use a computer and more than 90% of doctors want eCME options – but only 30% of CME has an e-component (European Commission E-Health in Europe – April 2008).

Sometimes the reluctance to embrace technology is based on our own knowledge of what technology can achieve and therefore it is often reserved for limited tactical responses rather than being integrated early into the planning stage. Advocacy mobilisation is an excellent example of where creative use of technology can make a dramatic commercial impact as well as provide a valuable service to medicine.

A new standard in Advocacy Mobilisation

The future is very positive. Pharmaceutical companies are starting to take a lead by connecting experts in their field with HCPs via the internet on a regular basis. Virtual meetings enable intimate discussion without costing time as they take place during the working day, with the speaker and the audience remaining in their hospital, practice or office.

Companies are now mobilising their best speakers more frequently and access to audiences has increased as the company has worked on to agenda, time and location. Virtual meetings are simple to arrange and don’t compete with 1:1 selling time. Furthermore, participant evaluation of virtual meetings demonstrates their value, as can be seen in Figure 1.

The new approach to Advocacy Mobilisation can also strengthen the sales and marketing relationship. The industry has often employed a ‘one size fits all’ approach, however, as regional and national requirements vary, virtual meetings provide a way to maintain a clear strategy whilst enabling local flexibility to deliver.

Traits for success

So how can the industry itself evolve to exploit the opportunity and take Advocacy Mobilisation to the next level? Preparation is the key to connecting a quality speaker with a quality audience. Here are some simple tips to give you the best chance of success.

1. Current brand situation
   • Identify your target audience of prescribers and/or influencers
   • Identify the barriers to increasing prescribing of your brand, e.g. safety, efficacy, personal experience, titration, etc
   • Profile and brief your speakers
     • Who gives the right message?
     • How influential are your speakers?
2. Set clear objectives
   • Intention to prescribe your brand in the next four weeks for a specific patient type
   • Attendance of target customers at the meetings
   • Brick sales analysis, growth vs territory average following your meetings
3. Inspire audience attendance with a bespoke offering
   • Speaker quality
   • The quality of the subject
   • The convenience of the meeting
4. Follow up to encourage a change of prescribing.

The final word

Despite all the changes in the environment, the representative remains the focal point of promotion. Great people are still making a difference and the tools available to them are now capable of evolving with the environment.