Pharmaceutical Outsourcing Post-Launch : Contract Manufacturing, Biomanufacturing and Sales, 3rd Edition

Excerpts From Interview with Kalorama Information Publisher Bruce Carlson on the Outsourcing of Pharmaceutical Sales

By some estimates, the practice of “third-party pharma product detailing” to physicians began in the late 1980s. How would you characterize the growth/adoption of the practice since then: Steady growth/adoption of the practice by pharma companies, or more of a back-and-forth pendulum swing over the years, depending on prevailing market conditions?

We’ve seen pretty consistent growth this decade. The historical time range is accurate. Late 80’s probably the first companies.. It really took off in the 1990’s when it was a new concept and then since 2003 has settled into a pattern of steady growth consistent growth…I would say consistent growth. Individual companies might experience ups and downs, but the market since

What has the adoption trend looked like over the past 5 years or so, vis-à-vis the pharma industry’s short-term or log-term use of third-party contract sales personnel? What are the major market drivers that account for this most-recent trend? Can you share any market data/statistics or anecdotal evidence to support your characterization of the recent trends?

No stats directly in terms of adoption, but revenues at these companies have increased dramatically, so we can assume adoption is occurring

Proponents say the use of temporary, third-party pharma detailing teams can save money for the pharma co. Where do these savings come from, and what type of savings are typical/possible (i.e., what percentage savings might a pharma co. expect compared to the costs associated with maintaining a dedicated internal sales force)?

What happened with outsourced manufacturing from the early 90’s until now..we expect with outsoursed marketing and sales. In pharma outsourcing of manufacturing, it started as a cost-saver and now is more.. Initially companies were looking for cost savings, or just frantically looking for a solution when due to a corporate reorganization their R&D or manufacturing was gutted. Now, companies go to these outsourcers for drug discovery for instance because they have better computer systems can work faster, and get better results. Take bio manufacturing. These days, you use an outsourcer not only because they are cheaper, not only because you have too little capacity, but because they might even be better at doing the myriad processes of biomanufacturing than you. This is a trend I think you will see with sales and marketing. The CSO does marketing and sales, all day every day. The pharma company has other concerns - product management, production, R&D, regulatory activity.

Especially considering the types of compensation plan discussed in 6. below… where some of these CSO contracts are risk-shared. It should be saving in terms of reduced costs of internal sales staff, less downtime for sales staff because staffing is hired out more tightly according to the products that are being promoted. but also earning “lost revenue” from a product that might have been abandoned by internal sales management due to lower sales and profit margins than the blockbuster products. An in-house sales force costs not only in terms of the representatives themselves, but also in terms of recruitment, sales support, etc. The CSO delivers that.

When it comes to the contracts that a pharma company might establish with a CSO vendor to line up contract sales reps, how are the payments, incentives and metrics for success typically defined? (Could you provide some illustrative examples?)

In our interviews with excutives in the industries few wanted to discuss details of contracts but all gave a general sense, and the most common is a one fee payment based on the size and scope of the project plus either a) payments broken out when various goals are achieved

CSOs can enter in to risk-based ‘co promotion’ contracts in which all or a portion of revenues earned are based on defined percentages of either a) product revenues or the market value of prescriptions written and filled in a given period. However, if a pharma company contracting only the sales services it is predominately on a fee for service bases. They will promise a dedicated team, specific activities. But usually you are going to see operational bench marks.

When it comes to the use of contract pharma sales personnel, how are the “rent-a-reps” typically compensated and incentivized — on a per-call basis or as a salaried employee of the CSO employer? What are the pros and cons of each approach?

That depends on the size and scope of the CSO. Larger CSO firm Cegedim Dendrite, InVentiv Health and Professional Detailing have enough regular work that they have full time employees.. Take Professional Detailing Inc. for instance. They have 1,100 employees, most of those are sales reps and sales managers. About half of the sales reps are full time and the others work based on jobs that they get. The advantage of a CSO using those full time employees is the experience of a professional, and the relationships these reps have with doctors (depending on the type of doctor targeted) In a way the reps function like any other sales force because they are at the ready.

Full time reps at a CSO are generally getting some form of salary plus incentives as would in-house rep but not as much. A significant number of them have worked as pharmaceutical reps before. It may be a good trade off to the rep because their future at a larger pharma may not be as secure as a CSO bustling with business.

There seem to be quite a few vendors available in the CSO space. What are some of the factors that help to distinguish competing vendors competitively? In terms of your company’s own offerings, what are the key “selling points” or “unique offerings” that help to distinguish your company from your competitors?

There is and there is not. It’s a market that is competively robust but not fractured… there is a great number of vendors in the space. Some are started by former sales employees at major drug cos. Having said that however, it is still a market where the ‘Other’ revenues earned do not add up to revenues from the 3 big chains who earn most of the contracts. 2/3rds of the market. Dendrite, InVerta Health and Physician Detailing. These guys have established relationships, experienced reps/managers, big enough to have presence in major MSAs, and technology. These are the three other CSOs want to emulate. Reputation is the currency in this business. There is probably room for more players but if I were a very small CSO looking to grow I would start in a niche therapeutic area or geographic region.

All pharma products are said to have a natural lifecycle as they move from launch to peak adoption to maturation and dwindling sales as they approach patent expiry. In your opinion, are certain phases of the lifecycle more or less amenable to the use of an outsourced sales team? I’d love to hear your thoughts here.

I suppose I could separate what we think is most amendable to ‘where are CSOs being used’ It could be useful at many stages - even the near expiration stages where the pharma company may not be putting sales muscles into in order to get the best results out of all year of the drugs life. But in reality, launches are where they are used most. The trouble with a launch is the conflict between the product’s priority and the company’s priority.

I understand that many efforts related to pharma detailing to physicians are trying to incorporate high-tech/wired/electronic elements to improve the delivery and convenience of the information, and to meet the physicians’ on-demand need for information in ways that go beyond the traditional face-to-face sales call by the pharma rep. Can you comment on the growing importance of these “state-of-the-art tools and techniques,” and discuss some of the market drivers that are helping to spur the ongoing interest in, development of and use of such alternative sales-support/educational tools? Illustrative examples would be great!

E-detailing is a key tool and one where a CSO may be able to help the traditional pharma co. The physician will either engage in one on one interaction with a pharamcetuical representative over the Internet, or they complete a Web-based detail on their own ina self service manner..or video e-detailing where the physician gets a video system installed in the office and conducts meetings with sales representatives through this system. Companies spend about $150-200 detailing doctors; e-detailing can cut that into about $100. and they can take less time from the physician and reach more physicians with less reps. This is not exclusively a CSO function of course; traditional pharma is in on this but since CSOs are focused on sales and marketing and traditional pharmaceutical companies have myriad other areas to improve performance in, one might expect CSOs to keep up with the latest.

PDAs, handhelds are used by many pharmaceutical reps, again given that CSOs are sales and marketing experts you can expect the larger companies to implement these and keep up with software and hardware changes. The more a CSO works. Advance CRM systems. If you look at Dendrite’s marketing for instance, they are not just selling rent a reps, they are selling a whole package with data management, established knowledge of physicians and their prescribing habits, IT systems

How would you summarize the most important “pros” or “potential upside reasons” for a pharma company to use a contract sales team to augment its existing internal sales force?

There are 85,000 sales reps in the United States according to IMS Health. A lot of competition, and that means diminishing returns from the use of sales reps over the years as physicians are simply too busy to see them. Therefore each internal rep doesn’t pay as much as they used to. So do you disable your sales force? Well, that has negatives too. CSOs are useful to balance reductions in internal sales force. This is particularly useful during mergers. Companies may want to combine sales forces and in most cases reduce the combined force of both companies, but fear loss of sales. CSOs help to provide that comfort level.

Internal sales forces can only do so much and the average pharmaceutical company has a wide portfolio of products. Without a CSO, products may be dropped and not get the detailing and sample management efforts needed to make them effective business units. Company may be able to shed internal sales force if enough CSO solutions are used.

How about “potential downside or cons” to the use of a third-party, outsourced physician detailing team? I’m sure there are skeptics out there; how would you address their lingering concerns they may have about entrusting such an important task to a team of outsiders?

Less and less, using a CSO in some part of a companies sales efforts is becoming close to a ‘must do’ but of course having an internal staff is optimal where it is profitable; you get their attention all the time, they are not working on your drug one day and a competitor’s product the next. Profit is a concern - if it turns out to be a profitable drug product you want your own sales force and not a CSO working on it especially where it’s a risk-sharing contract-everything they sell is in our pocket. We did not get a lot of downside factors in our research, but it could be because they are more subtle reasons within organizations.