Key opinion leaders (KOLs) have for a long time played an important part in pharma marketing. But as NHS reforms change the way prescribing decisions are made, they are increasingly significant for the sales force, argues James Mundy.

IT USED TO BE SO SIMPLE: reps called on doctors, who made prescribing decisions, and so the sales force knew that as long as it achieved geographical coverage and visit frequency, sales would surely follow. Even if this simplistic model was ever true, it certainly isn’t now, nor has it been for some time. Doctors don’t have the time to see individual reps for different products, and anyway, they are only a part – and an increasingly minor part – of the prescribing process.

Much has been written about how this spells the death knell for the sales rep. If by that, commentators are saying that this model of selling is dead, then they are probably right. But, as Mark Twain might have said, reports of the death of the sales force are premature. It’s just that they need to be structured and acting differently. And near the top of the new to-do list should be the cultivation of those vital KOLs.

Improving patient care

So what exactly is the role of the KOL in the process? There are those, myself included, who have always thought that the term ‘clinical advocate’ might be a better one. Either way, their role has been under the microscope over the past couple of years, not least because of the seeming ethical contradiction surrounding senior clinicians endorsing individual – and commercial – products.

That said, if the KOL is respected and perceived as speaking from true clinical opinion, rather than the piper simply playing the payer’s tune, then their endorsement can be hugely valuable, making the representative’s ‘selling’ environment much more receptive. In an era when engaging with every single clinician – let alone all the other potential prescribers, such as nurses and pharmacists – is practically impossible, building relationships with advocates who can themselves influence those prescribing decision-makers is perfectly valid.

What’s more, done properly it should lead to improvements in patient care – and there is certainly no ethical problem with that, whichever side of the fence you are sitting on.

Solution building

The techniques used in engaging with KOLs should be very familiar to those versed in the art of the sales representative. Just as identifying customers, assessing their needs and then communicating a compelling message that meets those needs is grist to the mill of any effective salesperson, then the same process is just as valid in finding KOLs and going on to build effective relationships with them.

The fundamental difference, however, is that they are not there to be sold a product. A message, maybe, but they are not going to be swayed by a simple clinical detail. Rather, they will be looking for someone who is genuinely committed to building a real partnership to further their clinical – and just as importantly, health economics – goals.

Timing Is everything

All of this does imply a fundamental change in the way that pharma companies go about launching a product, especially the stage at which the sales force gets involved. In the traditional model, there was little sales force involvement prior to launch – the R&D specialists and marketers did their bit, and then threw the finished product to the reps for them to take out and sell.

Pour KOLs into the mix, especially if you accept that the sales force should play a big part in engaging with them, and you change that model fundamentally. It is widely accepted that KOL involvement is most effective if it happens as early in the process as possible. Generally, the earlier their involvement during clinical trials, the greater influence they have over the design of those trials, which means that the final product will better meet the needs of the market that the KOL represents. There is a neat additional benefit to doing this as well: if you give the KOL more and earlier involvement, you start to build a profile for your new product among the key audiences – your customers. You end up shaping the market so that the launch and subsequent sales activity become easier and more effective.

Real partnerships

The success of such an approach depends on a shift in mindset from everyone involved in the commercial side of pharmaceuticals, none more so than sales representatives. If you accept that the traditional model has been about ‘smash and grab’ short-term sales target-meeting, then you must also accept that developing effective relationships which will create an environment in which you can persuade those with their hands on the purse-strings and their signatures on the formularies is a longerterm prospect.

Using KOLs to help get across the health economics benefits of therapies is key, and this suggests a more planned approach in which the sales force shows a better understanding of the long-term health goals of customers.

This is the basis of the account management model, and it is one that fits well with slotting KOLs into the equation. If the presence of clinical advocates can demonstrate that a representative is more interested in helping a PCT achieve its own goals than in achieving his or her own sales target, then ironically those sales targets are more likely to be achieved.

Transforming yourself into an account manager is undoubtedly the key to survival and prosperity for many representatives, and the evidence suggests that there are too many sales professionals out there who think that that transformation is simply a change in job title. The harsh reality is that it isn’t – there are lots of new skills to be learned, and perhaps the key one is the ability to build long-term, mutually beneficial relationships, recognising that adding real value is the key to that.

Convincing customers of that value becomes more difficult as the number of prescribers, and prescribing influencers, mushrooms in the new NHS. Communicating with all of them directly will be nigh on impossible, which is where having a network of influential, credible and trusted advocates – the KOLs – becomes vital. The true account manager will know how to shape this resource and tap into it effectively.

A new challenge

The sales force will survive this current round of massive changes to our industry. But the reality is that not all the current individual members of sales forces will. Those who are willing to adapt to the new NHS, and who recognise that forming genuine long-term partnerships to help meet the NHS’s goals – something that hasn’t happened in any depth up until now – is the way to achieve that, are the ones who will survive and thrive.

But you can’t achieve that alone. You have to work more closely with your non-sales colleagues in a restructured and more open industry. And you have to realise that there are hugely effective advocates out there who can create an environment in which trust is built up to enable such partnerships to exist.

KOLs are no longer the exclusive property of the marketing team: they are also there to help representatives – assuming that the representatives themselves can understand the benefit, and choose to engage with the KOLs.

James Mundy is a freelance writer.