Outperform investor expectations with healthcare provider retention and productivity

What do drug launches that outperform investor expectations have in common? Two things: an unusual level of healthcare provider (HCP) retention and well-above-average HCP productivity growth. Retention occurs when HCPs continue to prescribe a drug in the years following their first prescription. Productivity is the volume of prescriptions per HCP. In our experience, most pharma companies focus on top-line sales volume as the primary measure of success. While we agree top-line sales is a vital measure, the levers to maximize it elude most drug launches. Only 13% meet or exceed expectations in each of their first three years. The source and quality of top-line growth are underappreciated aspects of successful launches.

Based on ZS research, we believe every pharma company should consider the following more rigorously:

• Focus on the right HCPs before launch. Go beyond traditional measures of potential to achieve above-average retention and productivity. Appropriate engagement with HCPs during the market development phase can improve your focus on where to start your launch.
• Prioritize the HCP post-prescription experience. As launch strategies and tactics are developed and deployed, companies should more proactively invest in a well-designed product fulfillment journey. Incentivize field teams to focus on retaining early adopters.
• Ensure HCPs find the right patients. HCP retention and productivity can be maximized only if the right HCPs have the right post-prescription experience and find the right patients. Evaluate existing HCP productivity and retention through launch and adjust commercial execution to improve performance. Marketing and sales teams may shift their focus to different HCPs than they did pre-launch to capitalize on retention and productivity learnings.

To develop a more nuanced perspective of top-line growth, ZS explored the relationship between prescriber behavior and sales performance for 92 drug launches from 2015 to 2020. The assets, which were selected based on data availability, focus on chronic diseases and span 13 therapy areas. Oncology, neurology and infectious diseases were the most common. We defined sales performance as the percentage of sales achieved with respect to analyst estimates from the beginning of each year. Drugs were classified as top, moderate, low or bottom performers based on quartiles of sales performance for each year. We found the most successful drug launches are differentiated across several key measures, especially prescriber retention and prescriber productivity growth.

If you perform below expectations in your first year of launch, you’re unlikely to meaningfully course correct in years two and three. As shown in Figure 1, 57% of top- or moderate-performing assets remain in the upper half of the distribution through years two and three. Only 17% of the bottom-half performers are able to improve significantly. This suggests that while corrective actions are possible, efforts to drive HCP productivity and retention are more impactful earlier. Launch leaders may understandably worry about being a niche player at launch. Investors prefer hearing about big markets with big opportunities. However, this leads to a lack of focus as the wide net cast at launch has in-field teams “focused” on everyone. And so many companies avoid focusing on retention and productivity until middle or late product lifecycle stages. Our research indicates that is too late to make a meaningful difference.

The top half includes moderate and top performers. The bottom half includes low and bottom performers. The biggest levers to achieve early success are the quality of the asset and the opportunity in the market. However, once you’re on a launch team, the asset and market have largely been decided. So how can launch leaders improve their early launch trajectory? Based on ZS’s experience with hundreds of launches, here are some ideas to improve your ability to identify and engage high potential HCPs.

• Predict demand before launch. Identify signals of interest from potential top prescribers beyond traditional measures such as patient volume by creating opportunities for prescribers to engage with company- or disease-focused educational content ahead of launch.
• Prepare adaptive targeting. Don’t remain in the “broad trial” phase for too long. Companies that narrow in on top prescribers earlier have more time and resources to engage with them.
• Think beyond your therapy area. Prescribers think about therapy areas other than your product’s. Develop indicators of prescriber behavior in therapy areas beyond your own.
• Invest in experience design. Allocate resources to HCP productivity by reducing the friction experienced in the post-prescription process. Study analog product launches for their successes or miscues in handling the post-prescription experience.

While new prescriber adoption is obviously important, our finding that prescriber retention is a key differentiator for top-performing drug launches might surprise launch leaders. Top performers, on median, demonstrate significantly higher prescriber retention in the second year of launch than bottom performers, with 83% and 66%, respectively (Figure 2). We recommend a retention goal of 65-70% or greater from year one into year two.

Most companies do not prioritize prescriber retention early in the launch unless top-line growth is a problem. Based on our findings, we believe prescriber retention is an important KPI to improve the quality of growth. Whether you’re a pre-launch leader who wants to improve your odds of getting to 65% or better retention or an in-market leader whose retention is below 65%, there are several areas you can explore to improve your HCP retention.

Plan for great HCP engagement by asking the right questions

• Have we selected the right HCPs? Choosing the wrong HCPs can lead to low retention.
• Do we have the right HCP engagement process? Deploy personal and non-personal channels in a way that meets or exceeds HCP expectations across sales, reimbursement and medical for optimal results.

Question your organizational readiness to track HCP feedback

• What is our plan to capture the drivers of HCP decision to abandon the use of our product?
• What is working well in our post-prescription experiences for HCPs? What should be improved?
• How can we ensure feedback loops are continuous and cost effective? For example, trigger automated surveys to HCPs who have stopped prescribing your product in 45 days.

Reward and reinforce good HCP experiences

Ensure sales force compensation targets and territory planning do not disincentivize prescriber retention. Companies typically reward reps based on volume, regardless of source. Instead of simply using total prescription or new prescription measures for incentives, consider differential rewards for metrics from existing prescribers. Other industries call this a “same store sales” metric.

Evaluate whether you’re adequately enabling collaboration across HCP-facing roles. Individual functions often compete for HCP attention, potentially eroding the HCP experience and allowing providers’ needs to fall through the cracks.

Emphasize engagement with the most loyal and productive prescribers

We found the most successful drug launches drive the highest productivity increases year-over-year among the prescribers they retained. Figure 3 illustrates the stark disparity between top- and bottom-performing drug launches. Top-performing launches quickly ramp up the productivity of their retained prescribers in the second year. Those at the top have an average of 273% prescriber productivity growth compared to 159% for those at the bottom. That pattern continues from year two into year three. Top performers sustain productivity growth at 43%, while bottom performers record a 2% decrease in productivity from the second to the third year.

As the most loyal and productive segment, retained prescribers have the potential to disproportionately drive sales performance compared to the rest of the prescriber population. It’s apparent in Figure 4 that top-performing drug launches take advantage of this the most. In the second year, the proportion of retained prescriber claims is due to year-over-year productivity gains.

By monitoring productivity as a KPI, companies can identify the highest potential prescribers and prioritize promotion accordingly. Potential actions can come across multiple levels of the pharma organization.

At the company level, build patient-level data capabilities to predict eligible patients within the offices of existing prescribers. At the territory level, enable, train and incentivize sales and marketing to engage more with existing prescribers who have untapped patient segments. Finally, at the HCP level, build HCP-level selling plans to identify next-eligible patients in existing prescriber offices and HCP experience friction points specific to individual HCPs.

One way to get started with exploring how HCP retention and productivity can help improve your product’s performance is to ask the following questions:

Find the right HCPs

What is the contribution to total sales of my retained vs. new HCPs? Contribution to total sales from returning HCPs should be greater than contributions from new HCPs in years two and three. In the first few years of a launch, companies often are focused on top-line growth, blinded by the HCPs they’ve yet to reach or commit to a product trial. We must focus on finding the right HCPs, not all the HCPs.

Ensuring the right customer experience pre and post prescription

What is the year-to-year HCP retention rate? What percentage of HCPs who have ever written prescriptions for my product are still writing today? You can evaluate your HCP retention rate in different ways such as starting year, HCP segment or total since launch. Understand how the retention rate differs across HCP segments and make sure you have a clear target. We recommend annual HCP retention rates of 65% to 70%+ or better. If your sales primarily come from new HCPs, you might miss important underlying issues with your HCP experience that drive HCPs to abandon your product after trying it.

Find the right patients

What is the productivity growth of my retained prescribers? Getting existing prescribers up the adoption continuum can be difficult and requires longer term thinking than most quarterly sales compensation plans encourage. How are all your HCP-facing investments such as marketing, sales and market access coordinated to improve HCP productivity by helping HCPs select the right patients?

Get started by asking these questions. Wherever you are in your launch journey, you can find a way to improve your odds of success by better planning for and enabling the drivers of healthcare provider retention and productivity.

ZS colleagues who contributed to this article include Gurav Naveen Kumar, Vijay K. Laddha, Vincent Peng, Parul Rewari and Matt Van Eerden.