Alternate Channel of Physician Engagement:

Achieving Higher ROI for End-of-Life Products

Gaurav Kapoor, B Pharm, MBA Gaurav Sharma, BSc (Chemistry), MBA
Director, Indegene Strategic Marketing Solutions, Indegene
 Background
Sales representatives have been a key component of the marketing strategies
employed by pharmaceutical companies and have traditionally formed the primary
link between the company and the physician. Between 1996 and 2005, total real
expenditure on detailing in the United States increased from $3.7 billion to $6.8
billion—an increase of more than 80%1 compared with the decline in revenue
growth over the same period.

Although the pharmaceutical marketplace has undergone significant changes

over the last 3 to 4 years, the industry keeps relying on its “tried and tested”
sales model. Most pharmaceutical companies still employ an army of sales reps
to attain appropriate share of voice with physicians. But this marketing blitz has
been increasingly seen as a drain on physicians’ time while failing to meet their
real needs. Several studies have highlighted that oversized field sales forces have
saturated the market, and that physicians are more reluctant to see reps in their
offices. About 20% of US and British physicians now refuse to see any sales reps2
leading to a slide in the ROI on detailing. All the above factors have led to a perfect
storm that has recently culminated in a record number of sales force layoffs in
recent times (Figure 1).
105,000

80,000

60,000

40,000

20,000

0
2002 2009 2012
Figure 1. Decline in Pharma Sales Forces3

Although layoffs help pharmaceutical companies manage costs in the short run,
the search for a better way to engage physicians still remains. The pharmaceutical
industry is experimenting with various sales models, such as e-detailing and brand
Web sites, and attempting to leverage credible online aggregation portals for
engaging physicians. Because of inherent limitations, these channels have not been
able to fill the void created by the reduction in face-to-face detailing.

In this paper, we try to explore the need to adopt alternate channels of physician
engagement and provide an outline of its key attributes. We also present an
overview of the Indegene framework to leverage alternate channels of physician
engagement. Finally, we will discuss the transition of pharmaceutical sales and
marketing to an alternate channel for products nearing the end of their patent life.

Alternate Channel of Physician Engagement: Achieving Higher ROI for End-of-Life Products Page 2 of 10
 Patent Expiry: Looking Into the Abyss
Rapidly changing economics, legislation, and market evolutions are pressurizing
the pharmaceutical industry to fundamentally rethink its business model. Faced
with the challenge of products going off-patent combined with the pressure to
reduce sales force, it is becoming increasingly daunting for pharma marketers to
achieve a brand’s optimum value throughout its life cycle in a cost-effective manner.
Leading pharmaceutical companies will lose between 14% and 41% of their existing
revenues as a result of patent expiries (Table 1).4
Table 1. Existing Revenues of Leading Pharmaceutical Companies

Company 2010 2011 2012 Share of Revenues (%)

AstraZeneca Arimidex ($2.2 billion)* Seroquel ($4.7 billion) Symbicort ($3.7 billion) 38**
BMS US Plavix ($4.8 billion) Abilify ($2.1 billion) 30
Avapro ($1.3 billion)
GSK Advair ($3.8 billion) Avandia ($2.5 billion) 23
Eli Lilly Zyprexa ($4.8 billion) 22
Merck Cozaar/Hyzaar ($3.2 billion) Singulair ($4.5 billion) 22
Novartis Femara ($1.1 billion) Diovan ($6.0 billion) 14
Pfizer Aricept ($800 million) Lipitor ($12.1 billion) Viagra ($1.7 billion) 41
Xalatan ($1.6 billion) Detrol (860 million)
Geodon ($1.1 billion)
sanofi-aventis Taxotere ($2 billion) US Plavix ($3.8 billion) Lovenox ($3.1 billion) 34
Avapro ($2.1 billion)
*Estimate of global sales in 12 months prior to patent signing Source: AXA Framlington
**Value of products losing patent protection as a percentage of total company sales over the next 5 years

The silver lining in this grim scenario is the fact that “despite their waning position in
Ideally, one would like to continue to the product life cycle, the profit potential for many established brands is quite strong.
promote the product with the same The investments made in building a brand are fully amortized and, therefore, any

intensity to squeeze out the entire growth in the top line falls almost directly into the bottom line. Again, as the product
progresses through its life cycle, there is no dearth of additional data to share and
potential of the product. leverage the track record.”5

However, a confounding factor is introduced due to the high detailing costs, because
An established brand that of which it has become normal practice for companies to relegate their mature
showed 84% growth when it brands to second or third positions in the detailing sequence with the hope of getting
some attention within the sales call. Such positioning can work in cases where the
was at Position 1 in the detailing sales rep has the necessary face time to go through his or her entire detail aid.
sequence dropped to 12% growth However, the emphasis is often on the launch of the growth brand, with the mature
brands receiving little or no mention. This lack of attention on the established brand
when it was at Position 2. negatively impacts its sales and the company’s overall profits.
When one considers the cost of primary care physician details (excluding samples),
Verispan Data 2006 which average $167 per detail and $195 for specialty details according to statistics
published in 2007, it is easy to understand why many established brands are not
getting the attention they should be getting.6

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 Redefining the Physician Engagement Landscape for Products
Nearing Patent Expiry
From the information analyzed so far, it is clear that pharmaceutical companies are
not optimizing their returns with the existing sales models for brands nearing patent
expiry. The share of voice of an established brand begins to decline as it nears
patent expiry. However, allowing this downward spiral to continue is to simply throw
profits away (Figure 2).

Over the last decade, pharmaceutical companies have invested in numerous tools
and technologies to meet this end-of-life cycle challenge with mixed results.

The drawback with the existing non–sales force channels are as follows:
99 Most of the channels rely on “push” to physicians. There is lack of
engaging and frequently updated clinically rich content for physicians who
allow for a “pull” effect.
99 Most of the channels take a “one size fits all approach” and lack
capabilities to track data to analyze physician preferences and then
deliver relevant content and brand messages to change behavior.
99 The cost of running these programs is quite high.

The need of the hour is to adopt a fresh approach to reach physicians through
communication strategies that adapt to their clinical interests and needs. In the
current multichannel environment, based on the preferences, it is important to
successfully engage physicians on their own terms using an alternate channel that
Dropping provides them control over when, where, and how they get information. With media
growth rate
fragmentation on the rise, it is critical to offer physicians a variety of content format
options and use all available communication channels in an integrated manner.
A transition from a predominantly “push” model to one where a mix of “push” and
Position 1 to
Position 2
Position 2 to
Position 3
“pull” elements are judiciously leveraged is critical for success.
downgrade downgrade

Patent expiry The ideal solution would be one that

A. Current Scenario: Diminishing Returns
Alternate Channel 
Retains share of voice
Delivers message(s)
Cost-effective
99 Provides the infrastructure to deliver high-quality rich content in an
interactive manner
99 Collects core data that can be analyzed to refine the physician
engagement process to make it more meaningful for the physician as well
as the company
99 Can be deployed rapidly for multiple therapies/brands, measure the
results, and then optimize the communication elements

Patent expiry

Revenues Sales Expenditure

Alternate Channel

B. Desired Scenario: Squeezing More

Figure 2. Products Nearing Patent Expiry

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 Alternate Channel of Physician Engagement:
Indegene Approach
The guiding principle of the framework solution developed by Indegene is that the
medical information should be “pulled” by physicians when they need it rather than
“pushed” at them by pharmaceutical companies. It is aligned toward the goal of
physician education and skill enhancement. It provides physicians with pertinent,
contextual information tailored to their immediate needs and access to multiple
knowledge access points, including on-demand live video detailing sessions with
medical representatives and scientific discussion with MSLs (Figure 3).

Engaging Content
Ability to deliver content and brand
message in an engaging fashion
and in a way that lends value to the
physician’s practice

Cost-Effective Intelligence and

Use lower-cost channels of segmentation
communication; use global pool Ability to capture intelligence about
of expert resources coupled with the physician’s preferences and
technology to reduce head count customize the content, format, and
dependence channel of communication

Human Engagement
Availability of trained global
resources to engage in a scientific
The guiding principle of the platform dialogue with the physician whenever
required to address queries on
is that the medical information should demand

be “pulled” by physicians when they Figure 3. Key Attributes of Indegene’s Alternate Channel of Physician Engagement

need it rather than “pushed” to them The primary aim of the alternate channel is to “lead with education” and
subsequently leverage this credibility to introduce brand-related communication and
by pharmaceutical companies. messages in a manner that is appreciated by the users. The journey of education
continues for the physician while brand communication is initiated and integrated
into the overall experience. During every interaction, user data points that help
refine both the medical and brand messages are captured and analyzed.

The starting point of implementing the alternate channel of engagement is physician

grouping based on individual knowledge attributes vis-à-vis the treatment guidelines,
patient profiles seen, prescribing habits, brand attribute preferences, and content
delivery format preferences. This information is aggregated through brief online and
offline surveys as well as through existing client CRM databases. This process helps
in segmenting target audience with homogeneous attitudes and beliefs into groups
large enough to be efficiently targeted with focused messages.

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 At the core of the system is a powerful set of algorithms that help address the
challenge of continuous segmentation of content on an incremental basis by
extending the analysis of physician behavior through multiple visits to the platform.
The comprehensive physician profile is continuously updated based on actual
captured data on preferences and usage, thereby ensuring that the system is
responsive to the user’s evolution. After the initial set of user interactions, the
system is designed to respond to individual preferences and learning patterns and
deliver content based on specific requirements. During this entire process, there are
business rules built into the system to make sure all national regulatory guidelines
are strictly adhered to.

Using a dynamic content management system that is fully integrated with an

intelligent reminder/alert engine, data management, and collaborative tools,
Indegene’s alternate channel of physician engagement can accelerate the delivery
of key messages, information, and knowledge through a genuinely open dialogue
with physicians.

If required, the automated tools within the platform can be integrated with a system
of intelligent human support via globally located specialized scientific resources.
Channels of communication include e-mail, telephone, or Web conferencing.
This human support integration reduces the cost of providing focused, relevant
information and knowledge to physicians to meet their evolving needs while allowing
a further level of personalization and community building to build and maintain a
high product and brand SoV.

To reiterate, an integration of high-quality content and microtargeting tools through

customer intelligence, specialized human expertise on call, and a global resource
model allows for a viable alternate channel of physician engagement to succeed
in today’s marketplace. This alternate channel can be implemented along with the
regular sales force channels, thereby lowering the overall cost of maintaining the
SoV and engaging physicians for end-of-life products.

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 Step-by-Step Transitioning to an Alternate Channel of Physician
Engagement
Indegene recommends a step-by-step transition from a pure sales force approach
to that of a hybrid alternate channel approach. The transitioning roadmap (Figure 4),
as suggested by Indegene, can help make decisions related to transitioning from a
100% face-to-face detailing model to one with a reduced dependency on sales reps
to communicate with physicians in face-to-face meetings. Part of the savings by this
reduction could be deployed in initiatives to engage the physicians by adding value to
their practice.
Metrics Metrics
Metrics
>40% of target audience Next 30% of target
>40% of target audience
to spend >6 minutes on audience to spend
to spend 6 minutes in
education and >6 minutes on education
2 separate interactions
>2 minutes on brand and >2 minutes on brand
over a 6-month period
promotion promotion

Milestone 1 Milestone 2 Milestone 3 Milestone 4

Introduce alternate Demonstrate buy-in Demonstrate Demonstrate effectiveness
channel for physician of physicians to effectiveness of of platform with larger Milestones
education alternate channel physician engagement group
with brand messages
Introduce brand Demonstrate willingness
messages Reduce frequency of to engage with virtual reps
visits to larger group
Reduce frequency of
sales visits

100% of target Frequency of sales No more sales visits No more sales visits
group visited by visits to 40% of to 40% that is fully to 90% of the original Activities
sales force doctors reduced engaged target audience
by half
Frequency of sales
visits to another 30%
of doctors reduced
by half

Figure 4. Stepwise Transitioning to an Alternate Channel

The ideal focus of the initiative has to be on the high prescribers so that the
prescription volume is not diluted. It is imperative that the tactics agreed upon ensure
that physicians spend as much time with alternate channels as with a sales rep as
measured by effective minutes of brand detailing in a year.

The data presented in Figure 4 are representative. The final goals a company wants to
go after can be decided based on the risk appetite of the company, the physician mix,
and the progress with the alternate channel. These goals can also be changed after
reviewing the progress of the alternate channel.

Key questions that ought to be addressed before embarking on transitioning plan are

99 What are the goals of such a program?

99 What are the metrics to track the effectiveness of an alternate channel?

99 When is it appropriate to reduce the frequency of sales rep visits?

99 How to manage quality of customer experience beyond the sales

transaction?

Alternate Channel of Physician Engagement: Achieving Higher ROI for End-of-Life Products Page 7 of 10
 During transition, the following critical metrics should be tracked:

99 Time spent by physicians on the channel for education

99 Number of physician interactions with the channel in a predefined period

99 Willingness and time spent by a physician on the channel to view brand

messages

99 Willingness and time spent by a physician on virtual detailing/discussions

99 Types of content assets that were viewed by physicians more and the
ones that were not viewed much

The metrics stated above may help take decisions on the speed of transition to the
alternate channel as well as provide for a more objective methodology for deciding
on investments for creating content and other online resources.

If executed well, there can be a substantial impact on the cost and time of
engagement with targeted physicians using the framework suggested here.

Sales rep–based costs Offline sales costs

Online channel costs Total costs

3,500,000
3,000,000
Indicative costs

2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
Month 0-6 Month 6-12 Month 12-18 Month 18-24

Figure 5. Comparative Sales Cost

Sales rep–based minutes Offline sales minutes

Online channel minutes Total minutes

1,200
Indicative minutes across

1,000

800
100 doctors

600

400

200

0
Month 0-6 Month 6-12 Month 12-18 Month 18-24

Figure 6. Comparative Minutes of Engagement

Changing the mechanism and the medium by which a pharmaceutical company

provides information to accommodate the physician’s clinical needs is therefore a
step in the right direction. By using a stepwise transition roadmap, the transition
risks can be mitigated. A successful implementation of an alternative engagement
channel helps stretch the sales and marketing dollars while squeezing more out of
products nearing patent expiry.

Alternate Channel of Physician Engagement: Achieving Higher ROI for End-of-Life Products Page 8 of 10
 Conclusion
99 The pharmaceutical industry has traditionally relied on face-to-face
detailing approach. But communication technology is transforming the way
physicians access information as well as the way in which knowledge can
be delivered to them.
99 Maintaining share of voice for mature brands is a potentially rewarding
exercise since its results have a direct impact on the bottom-line. If this
goal can be achieved through a cost-effective platform, then the ROI can
be quite significant.
99 Using an alternate channel of physician engagement that integrates
education, virtual detailing, and information delivery based on specific
customer profiles can help increase share of voice in a cost-effective
manner.
99 A prudent metric-based approach is recommended for transitioning a
mature brand from a 100% face-to-face detailing model to reduce the
dependency on sales representatives to communicate with physicians.

References
1. Julie M Donohue, PhD, Marisa Cevasco, BA, and Meredith B Rosenthal, PhD.
A decade of direct-to-consumer advertising of prescription drugs. N Engl J
Med. 2007;357(7):673-681.
2. For further information on the situation in the United States, see “Rep Alert,”
Pharmaceutical Executive, January 2008, p. 2. For further information on the
situation in the United Kingdom, see “Getting the Mix Right: New Roadblocks
and New Routes to Market,” Paul Jones and Nic Holladay, Pharmaceutical
Executive Europe, September 2006.
3. Drivers of Change to Pharmaceutical Commercial Models. ZS Associates 2009.
4. Pharma 2020: The Vision, PriceWaterHouseCoopers.
5. Nancy Connelly. Mining for Gold: Sales Force Models that Optimize
Established Brand Performance.
6. Pharmaceutical Sales Management 2008, Cutting Edge Information.
About the authors
Gaurav Kapoor, BPharm, MBA

Gaurav has more than a decade of experience in the pharmaceutical industry in positions that have included product
management, international marketing, marketing management, and general management. Gaurav has a graduation
degree in pharmacy from St. John’s Pharmacy College, Bangalore, and an MBA degree in International Marketing and
Strategic Planning from ENPC, Paris.
Prior to joining Indegene, Gaurav was responsible for managing the cardiovascular product portfolio of Torrent, a large
Indian pharmaceutical company. At Indegene, he is the business head for the emerging markets business. Gaurav is
one of the founder members of Indegene.

Gaurav Sharma, BSc (Chemistry), MBA

Gaurav has more than 12 years of work experience in the field of Sales & Marketing Management and Customer
Relations Management in the pharmaceutical sector. Gaurav completed his BSc (Chemistry) from the Delhi University
and earned his MBA (Marketing) from the Nanyang Technical University, Singapore.
In Indegene, he is part of the Strategic Marketing Solutions group that is responsible for conceptualizing and launching
of innovative strategic marketing solutions for Pharma company’s key stakeholders – health care professionals, patients
and sales force.

Write to us at bd@indegene.com to know how we can help you make an impact at reduced costs

Alternate Channel of Physician Engagement: Achieving Higher ROI for End-of-Life Products Page 9 of 10
About Indegene
Indegene is a scientific partner to life science companies to enhance the commercialization and marketing success of their products

Overview

Services Insights
Indegene’s suite of scientific content, media, and technology We provide scientific, clinical, and competitive insights to help
services are at the heart of our clients’ regulatory, communication, align the business development, licensing, clinical development,
and education initiatives. Our services span the product life cycle and marketing activities of our clients to current and future
and help clients reach out to key stakeholders with greater impact. market needs. Our insights help answer key intelligence
Scientific Competitive Intelligence Services questions at every stage in the product life cycle

Regulatory Writing and Safety Services Assessment of unmet market needs

Learning Solutions Status and potential of novel products and technologies
Medical Communications and MedEd Programs Pipeline and competitor landscaping
Clinical trial analytics

Solutions

Indegene’s proprietary solutions cover a range of critical unmet client needs

Physician Engagement Platform – Indegene’s proprietary platform, P360, is an
intelligent, multichannel sales and marketing platform for engaging physicians in
medical education and pharmaceutical communication programs. P360 unifies
technology, intelligence, medical expertise and offshore resources to deliver
targeted messages to physicians in a sustainable and cost-effective manner.
TrialPedia – a revolutionary clinical trial benchmarking platform
Therapy Area Intelligence Center – dedicated therapy area surveillance system
Patient Support Platforms – patient adherence and disease management
solutions
MedCampus – enterprise-wide virtual learning solutions

The Indegene Advantage

Legacy
A Leader in the New Pharmaceutical Services Model: Preferred global partner to more than 15 of the top 20 pharmaceutical companies worldwide
Experience and Track Record: Ten-year industry experience delivering more than 3000 solutions worldwide across more than 15 therapeutic areas.

Scientific Expertise
A Scientific Core: A team of more than 275 full-time professionals that include 150 PhDs, MDs, pharmacologists, and life science graduates bringing
scientific expertise across the range of our services and solutions.
Worldwide Networks: Strong partnerships with academic centers and medical associations and a rich network of clinicians and KOLs across
the globe.

Partner for Transformation

Reduced Costs: Significantly reduced cost through a unique tried and tested scalable global delivery model
Global Partner: Global footprint through a network of 11 offices across 4 continents to enhance your integrated global activities
Solutions for Today’s Challenges: Proprietary platforms and innovative solutions that address critical challenges in an evolving marketplace
Leader in Processes: Best-in-class operational processes to ensure consistent quality and timeliness with ISO 27001/ISO 9001 certification

To know more about us, write to bd@indegene.com or visit www.indegene.com

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