Restricted access, more competition: Rethinking sales planning for oncology

Sales force access is at a premium in today’s pharma customer engagement environment. A ZS study of 25,000-plus physicians found that healthcare providers (HCPs) experience an average of nine face-to-face sales rep touchpoints every day, with certain targeted providers far exceeding that total.

In oncology, only 32% of providers are fully accessible, as shown by ZS Access Monitor^TM data. The wave of new oncology launches will continue to increase competition for “share of voice” among a finite set of often overlapping customers. These upcoming oncology launches have smaller peak sales expectations; however, pharma companies continue to justify rep engagement, owing to the high disease burden, concentration of specialized customers and cost of care.

Despite this evolving landscape for rep access, pressure to demonstrate launch success is at an all-time high, leading organizations to use sales reps aggressively as the primary channel to engage HCPs, versus more innovative go-to-market approaches.

As customer engagement preferences for both channel and frequency continue to evolve, pharma must consider how to rethink deployment models appropriately to meet these new customer needs. This article takes a closer look at declining access trends, addresses some of the top field deployment questions and offers tangible steps organizations can take to evolve their sales planning efforts.

Oncologists continue to be the least accessible provider specialty, with almost one-fifth of physicians considered severely access restricted (able to be reached by less than a third of sales force reps). Sixty-eight percent of the oncology universe is considered access restricted, a number 2.5 times higher than other specialties such as gastroenterology and rheumatology. Access to hematologists is only slightly better, with 61% considered access restricted. 

With difficult provider access, sales rep productivity continues to decline. Oncology reps deliver the lowest average number of calls per day across specialties—at 2.6 calls total, across targets and non-targets. By comparison, primary care reps are achieving more than seven calls per day, on average. 

Even among reached providers, access restrictions have affected frequency. During the past 10 years, we have seen a continued decrease in the total number of annual calls delivered to reachable oncologists. As of the latest ZS Access Monitor^TM report, reps detailed only 5% of oncologists at least 12 times annually. A decade ago, that number was closer to 20%.

These figures are even worse for oncologist nurse practitioners and physician assistants. Almost 50% have been seen no more than six times annually, compared to 37% for oncologists.

The decrease in delivered frequency over time has led to an organizational disconnect between “planned effort” and “achievable effort” with large pockets of sales force capacity left underutilized.

What’s leading to this trend? We know that access restrictions are felt most acutely in integrated delivery networks (IDNs) and academic institutions. This rise in access restrictions mirrors the trend of both increasingly busier providers and greater organization control. In IDNs, an increased protocolization of care has led to tighter restrictions on pharma engagement, with a desire for sales force promotion to be in line with organization priorities.

In the academic setting, the specialization of HCPs lends itself to higher order engagement less focused on the approved label, with a customer base that looks to other sources for information outside of sales reps. Academic HCPs are also more likely to have additional responsibilities outside of patient care, including teaching, research responsibilities and clinical trial participation, so they are less available and less likely to engage with sales reps.

In top institutions across the country, more and more access policies for pharma sales reps are being implemented, ranging from requiring department sign-off for all interactions, not allowing colleague or partner accompaniment unless pre-approved by the physician and required credentialing that allows systems to revoke access on the spot.

For instance, Memorial Sloan Kettering Cancer Center (MSK)—one of the nation’s leading cancer centers—has taken a clear stance on promotional interactions with pharma’s commercial organizations, not permitting sales representatives on any MSK campus. ZS Access Monitor^TM data shows the impact of this policy. When focusing on access to oncologists at the main New York City hospital, 95% of HCPs are considered access restricted. Engagements with oncologists affiliated with MSK are often happening off campus at non-affiliated sites or at larger congress and conference events.

Even the community setting, which was historically perceived as more receptive to rep interaction, has seen increased access challenges. Adoption of rep appointment scheduling software, controlling for who can see the physician within a set number of appointment slots, also brings greater rigor to access controls. As community oncologists treat across a range of tumor types (according to ZS Panorama^TM , 90% of oncologists treat at least nine tumor types) manufacturers are often sending multiple teams into the same facilities, while sales planning processes are often still brand-centric, without taking into account the entire effort being planned.

All of this means that oncology engagement is increasingly competitive, with a larger number of brands looking for time with a finite number of HCPs. While there is no one-size-fits-all solution to guarantee access, companies are being forced to evaluate the value their engagement brings to customers.

Approaches to role design and structure must be grounded in an understanding of customer needs and provider preferences. In one ZS study, 80% of surveyed oncologists stated they prefer rep engagement and support that takes into account their broader practice and customer experience needs. This desire for practice expertise is a theme, with 60% of oncologists preferring a rep that has deep knowledge of the provider’s clinic or institution over deep clinical or product expertise. Companies today can better equip their reps with broader knowledge about the HCP and their practice setting based on available data and practice demographics.

It is almost nonnegotiable that pharma organizations must tailor their offerings to align with customer needs in this environment. Many are doing so by reevaluating their go-to-market approach, exploring novel role designs that tailor the offerings delivered within and across interactions. Examples of customer-centric engagement include the adaptation of commercial field roles with a shift from sales toward service orientation.

Equipping a single role with a broader set of tools, including the ability to address a wider spectrum of questions compliantly in real time, improves the customer experience and demonstrates ongoing partnership that helps mitigate access challenges. This movement to tailor roles to meet customer needs may call into question the need for traditional commercial engagement with some provider institutions.

Pharma companies must evaluate their go-to-market model beyond just commercial, thinking strategically about how to identify customer needs and appropriately and compliantly address them across sales, market access, patient services and medical.

There are several common strategic but tactical questions pharma organizations are asking about commercial deployment.

How many products should be in the bag?
 

For a sales rep, the balance between product and customer expertise is top of mind, with oncologists preferring reps who have deep practice experience three times more than those who have deep clinical expertise.

Increasingly, organizations are seeing that in most situations, with the exception of highly strategic launches, single-product focus is both unsustainable for access and does not meet customer needs. ZS Access Monitor^TM shows that oncology sales teams with at least two products in the bag have better access than their counterparts detailing a single product. These multiproduct teams have 45% higher customer reach, delivering on average six annual calls per provider compared to only four for single product teams.

As companies equip sales reps to engage customers on a wider range of products, cross-training across the portfolio is gaining traction in oncology. Having additional products in the bag provides reps with greater diversity in topics, allowing for tailoring based on the interest and needs of the customer in real time. The customer-centric approach increases the value being brought to customer interactions, creating a greater likelihood that the manufacturer’s agenda aligns with the customers.

Especially in the community environment, where oncologists treat across a broader range of tumor types, there is value of establishing a relationship across an oncology portfolio versus competing for access against your own colleagues.

How should product combinations be considered?

As organizations see the necessity of portfolio-based approaches, the question is often how products should best be combined. Specifically, pharma organizations often question the feasibility of promoting solid and liquid tumor products within a single team. Historically, as commercial organizations grew larger and were looking for natural ways to manage organizational spans, the split between solid and liquid tumor types served as a logical divider, especially for home office and marketing organizational structures.

In today’s environment, organizations are now breaking down those artificial barriers, focusing instead on customer overlap. Particularly for more prevalent tumor types treated in the community setting, the overlap may be substantial between solid and liquid tumors. As companies continue to launch products with more niche indications, customer overlap and commercial needs should dictate product bags.

To mirror or not to mirror?

Mirrored sales lines are another common field force design choice. Historically, mirrored deployments served as a way to increase share of voice and the number of face-to-face interactions. Given increased competition, many provider offices are cognizant of the number of faces from each company looking to engage and restricting access.

These mirrored deployments bring benefits outside of access, such as better preservation of a company relationship and built-in vacancy coverage. However, they also come with increased competition for access and without close coordination they may not serve customer centricity goals.

Across top pharma organizations today, we observe far fewer cases of true mirroring, where multiple reps work in tandem to engage customers while carrying the same products or indications. A more commonly deployed structure includes “sleeved” approaches that link the underlying footprints across oncology sales lines to drive better coordination and insight sharing. Geographic coordination is also extended beyond sales to other functions (medical, market access, patient services, etc.) to drive better cross-functional coordination. 

Customer access has long been a measurement of success for a sales force. As access in oncology remains challenging, organizations need to take a closer look at how they are designing and equipping their field teams. While benchmarks are helpful in understanding the success others in the industry are able to achieve, they often do not show the full picture of strategic investments organizations are making to deliver a differentiated customer experience.

Here are four steps oncology manufacturers should take to understand the realities of rep access and implications for their sales teams:

• Understand planned versus actual engagement across sales teams, taking into consideration both an HCP-to-manufacturer and account-to-manufacturer view. How many calls are you asking sales teams to deliver to a single HCP? How many calls are you planning in aggregate to the same account because of HCP-focused sales planning approaches?
• Incorporate guardrails on overall account touchpoints by sales reps, building upon the more common practice of adjusting individual rep-HCP interactions based on achievable frequency benchmarks and rethinking engagement planning for your highest priority HCPs, including how to drive the most value with your limited in-person touchpoints.
• Assess sales force target overlap across the portfolio to understand synergies in the customer universe, with a focus on the community setting where less specialization leads to greater relevance across tumor types. Beyond overlap, assess similarities and differences in commercial model elements across products/indications to inform logical pairings that will enable capitalizing on practice expertise of our reps (i.e., two products or indications may have high customer overlap, although one may be a much more niche indication requiring diagnostic education related to patient finding).
• In line with unbundling the rep and being more intentional with field force promotion, begin assessing overall customer strategy (oncology portfolio) and the engagement that should be driven by field channels. Leverage understanding of where the sales rep can make an outsized impact (relative to other roles and channels) to inform resource allocation tradeoffs across the portfolio recognizing the access-restricted environment.

Long term, a customer-centric approach to commercial model design includes revisiting the role of the rep; focusing on delivering a tailored customer experience, ultimately ensuring access; and delivering more impact for customers and their patients.