In the UK joint working is being encouraged to develop innovative services and propagate best practice. But in France, new legislation is placing significant barriers between pharma and its clients. Jérôme Guermonprez explains the implications for market access strategies in the country.

Across Europe pharmaceutical companies have been looking to underpin market access strategies with strong links to healthcare professionals. And while most pharmaceutical companies admit there are significant national differences that demand specific market access strategies, there has been a push, where possible, to leverage expertise, messaging and strategy to drive economies of scale.

Many organisations are now actively embarking upon innovative, cooperative working with regional decision-making bodies – such as the Clinical Commissioning Groups (CCG) in the UK; whilst doctors and pharmacists are increasingly involved in research projects, from clinical research to patient care, patient outcomes and procedures. Indeed, the UK’s amended Health and Social Care Bill strongly encourages pharmaceutical research, innovation and the use of scientific evidence in decision-making.

In France, the forthcoming radical overhaul of the drug regulatory system will significantly change relations between pharmaceutical companies, healthcare professionals, patient associations and physician associations. The “Reforme du Medicament” legislation aims to crack down on health practitioner conflicts of interest, restructure the country’s drug regulator and tighten the process for licensing drugs and for monitoring their effects once in use.

The proposed bill creates compliance requirements that far outstrip the UK anti-bribery laws and includes a number of significant changes which will directly affect the way pharmaceutical companies interact with opinion leaders across the French health service.

To minimise the risk of conflict of interest, the new legislation mirrors the US Sunshine Act by requiring pharmaceutical companies to disclose all financial relationships with healthcare professionals, patient associations and scientific experts.

With an emphasis on patient safety, the bill also requires far more detailed information and discussions about indications – from the provision of a helpline number on every drug packet to enable patients to report problems, to the creation of a government watch list of drugs under review.

It also demands pharmaceutical companies no longer undertake direct physician training but instead provide the funding for training to the government, which will then oversee independent training programmes.

 

Restricted access

Critically, from a market access perspective, the bill will prohibit individual medical representative visits to physicians within a hospital; visits must be collective to avoid any one-to-one relationships and ensure discussions are open and transparent.

The impact of this legislation – which is currently being discussed and should be passed by the French government by the end of 2011 – will be significant for pharmaceutical market access policies and demand companies gain new insight into key opinion leaders (KOL).

Under this new model, the industry will have to be incredibly careful about the type of relationships that are put in place with stakeholders; indeed, at least one pharmaceutical company has already announced it will no longer pay physicians directly in the future or invest directly in physician grants to avoid any regulatory compliance issues.

Furthermore, with many physicians likely to back away from any interaction with the pharmaceutical industry, at least in the short term, patient and physician associations will have a far greater role to play. Pharmaceutical companies will have to rapidly assess the way these associations and individual physicians respond to the new legislation and amend market access strategies accordingly.

 

Regional structure

This new challenge comes at a time when pharmaceutical companies are still adjusting to the major overhaul of the French healthcare system – which has seen the creation of 26 Regional Health Authorities (RHA).

While drug reimbursement is still set nationally as in the UK, since 2009, each region has found the responsibility to adapt national objectives to local or regional health and demographic problematic. Over the past year, each region has had to sign multiple year contracts between the  state and the region to deploy the health strategy.

As in the UK, over the past two years, pharmaceutical companies have realigned resources to create a regional approach based on a key account management (KAM) model. The regional structure has significantly broadened the number of stakeholders involved in decision-making, both financial and medical.

Furthermore, each RHA has a different demographic breakdown and health issues, creating very diverse goals for each region. This change has required a far greater insight into decision-makers and regional objectives; it has also demanded pharmaceutical companies use the KAM approach and strong CRM tools to drive synergies between teams at local, regional and national level.

Pharmaceutical companies in both France and the UK are now actively seeking in-depth insight into the KOLs within new regional structures. Information from the structure of the new organisations, including the multiple drug, technical and price commissions, to identifying specific members, roles and drivers is proving key to create the right regional messaging.

And with this regional, KAM-based model still in its infancy in France, pharmaceutical companies face a tough challenge to ensure the implications of the new medical reform legislation are incorporated.

Messaging, for example, must now be amended to include product safety, as well as quality and efficacy; while companies must ensure information is up to date to ensure changes in physician attitude to the pharmaceutical industry as a result of the new regulations are flagged to remove the chance of inappropriate or unwanted contact. CRM tools will also be essential to coordinate group visits to physicians to avoid any chance of the forbidden one-to-one interaction.

As in the US following the introduction of the Physician Payment Sunshine Act in 2009, pharmaceutical companies will also need help to meet their obligations to declare all activity with physicians.

 

What next?

It is tough to predict how the health service in France will respond to the new legislation over the next 12 months. For pharmaceutical companies there is no doubt that direct physician contact will decline and organisations will have to refocus efforts towards the increasingly influential patient associations and physician associations.

But for those organisations operating across Europe, the changes must demand very different approaches towards health service co-operation. As the UK market looks to drive service innovation and close ties with practitioners at every level, counterparts in France are being compelled to be transparent and improve patient safety. The concept of the global, or even pan–European, market access strategy looks ever less practical.

Jérôme Guermonprez is the Vice President and General Manager, France, Cegedim Relationship Management.

The frustrations that pharma – and clinicians – face when trying to secure a drug on formulary have been well documented. But Omar Ali (pictured) explains that understanding the Payer’s ‘language’ can greatly increase the chances of success.

The NHS changes over the last decade have shifted power away from secondary care to varying degrees in different specialties. These new NHS changes are further exaggerating this. Pharma has a significant role in facilitating consultants in keeping in step with these changes, supporting them through the brave new world, and ensuring that they learn a second language – the language of the Payer.

A very good friend of mine – she is a Consultant Cardiologist – said to me not so long ago: “Omar, I don’t see why I have to justify my prescribing to you. This is the drug I want, just give it to me.” This was a delicate discussion. I needed to handle myself carefully but be firm to the point. There were also two pharma representatives at the table. Basically my reply went something like this: “Dear Dr, regardless of what you feel about justifying your prescribing decisions to me, this is the process, this is the financial framework for the managed entry of new drugs into the health economy – so get with the programme.” I also added that I could help her if she’s interested in how to best go about this. Within the next
three months I was indeed requested to present at a mandatory briefing for all consultants within the Trust on the current financial position and the future of our organisation with the new financial framework for commissioning new products onto formulary – my presentation was sandwiched in between our CEO and the Department of Finance!

So what can pharma do to assist my Consultant Cardiologist colleague to better ‘frame’ her positional argument to me? There are five key factors to consider:

1. Understand the Health Bill and commissioning: secondary care is somewhat hidden from much of these changes. Pharma needs to pull these influential clinicians out of their comfort zones and brief them on the changing NHS.

2. Understanding the Drug and Therapeutic (D&T) processes/ APC Formularies: many clinicians are frustrated with the system, do not understand and speak the ‘Payer language’ and so disengage from the process as a result. Pharma needs to bring them back to the table and empower them in a new way.

3. How to get a drug ‘through the D&T’: – it’s a simple workshop and a skill that can be learned with clinical and geo-political factors brought in. Use your brand as a ‘case example’, but the principles are the same. Many consultants will echo the discussion I had
with my consultant – frustration at the barriers to access, pointing accusingly at cost savings, and not prepared for the Payer’s rigorous Q&A. In a way, these KOLs need to be briefed in a secure environment as to what they may face when in front of the firing line
of the PCT/D&T Committee.

4. What makes a good D&T Application: streams of new drugs fail at the first hurdle. Quality of submissions are often poor and do not resonate with the Payer’s audience. They still resound of “I’m professor of cardiology, if I bang my fist on the table I will get my drug funded”. You have a role, duty and responsibility in assisting one of your most valuable
support mechanisms. Without KOL support the Payer’s influence is actually irrelevant.

5. Understand the difference between ‘being on formulary’ and ‘commissioning a new drug
into a pathway’: most consultants don’t fully understand how their own activity is reimbursed; issues around expensive drugs, tariffs for admissions/outpatients – and related trim-points – and implications of red/amber/green prescribing guidance. The subsequent generation of a shared care guidance is critical for your brand. Without this will mean a lack of prescribing which results in a reduction of sales.

We currently have at least eight new brands which have passed D&T application, have passed PCT APC, and are on formulary; but do NOT have a shared care guidance in place. This means they are in ‘limbo’. They are in ‘hyper-space’. A consultant simply won’t be able to prescribe it. The GP won’t be able to continue. This is about joint working, bringing
stakeholders around the table, bringing examples of best practice from around the country, and bringing your agenda so that it becomes higher on my own.

The KOL ‘demand’ factor

It’s one thing for a Payer having to deal with a well prepared consultant who understands the financial process and has made a convincing positional QIPP framework for your brand. It’s quite another when the KOL has not even turned up and has disengaged from the application and support process. That speaks volumes to the Payer. Please don’t confuse ‘KOL demand’ for a treatment option with a ‘KOL demanding a brand’.

Payers look for and make a judgement on ‘KOL demand’ for a product. It is critical when deciding on an initial interest level. Remember that Payers are often ‘fighting off’ consultants from various disciplines and specialties wanting new products. The silence from KOLs with reference to your brand can be deafening in what it spells out: “this product holds no value to us”. Make sure they are knocking on my door with ‘demand’. Now once we have engaged, what I don’t want is your KOL simply ‘demanding the product’. What I want now is a financial QIPP framework focusing on how we redesign our services around a new intervention, in both clinical and commissioning terms.

What disappoints me is that the majority of D&T support to consultant KOLs I see today from pharma falls under two main themes:

1. Pharma translates ‘the need for evidence’ into dumping ream after ream of largely irrelevant clinical papers onto the desk of the consultant – which further makes them want to disengage.

2. Pharma translates ‘the need for a better quality application’ into taking the D&T form
and having their medical departments complete them on the behalf of the consultant.
Trust me, when these come to D&T you can see them a mile away!

Given pharma is always touting joint working why don’t you work together on this issue? Coordinate your timetable of formulary applications, enrol your KOLs into a D&T workshop where they receive some skills set training and ‘mock D&T’, and empower them in the ways of the new NHS. And have your executive teams keep them abreast of local payer
influencers and mechanisms with underlying framework for prescribing pathways.

Falling in love

Some of you will know I’m currently in the process of moving house. We have just gone in to the market and indeed have fallen in love with a house in Guildford. Now here’s the thing. We fell in love with the house when we first saw it and this continued throughout
our viewing. We have pictured it becoming our home, almost living out the years. The garden is perfect, the rooms all fit with what we want and, although it’s not quite the ‘moon’, it sure as hell is a good way towards it.

Now, to get into the house – our new home – we need to go and see the bank. It wasn’t a great first meeting, I can tell you. All of a sudden we found ourselves wrestling with APRs,
2yr/3yr/5yr fixed plans, repayment versus interest only, deposit amounts, indicative financial re-payments and limitations on loan to value thresholds that have unsettled us somewhat. We came out of that meeting a little dizzy, somewhat dejected and unsure now of what and where we want to go. We still don’t relish the idea of going back. We won’t say it out loud, but we are slowly losing this house.

The discussion at the bank was a far cry from the romantic notion of what was to be our home. The bank was not really interested in the lovely garden, wonderful residential location and how we could see our children growing up in the various rooms within the property. No, it seems the meeting with the bank revolved around a very different language. It was a financial framework. It was a requirement we have to prepare for adequately to get us into our next home. I now know we could have been better prepared
and that poor preparation may have cost us our ‘moon’. I learned that I had to get with the programme, regardless of my views of bankers’ bonuses, financial hurdles and an annoyance at justifying our income/expenses to a third party.

There is no way I will get into my dream home without getting to grips with the financial framework that is required to proceed the dream into reality. Many of your KOL consultants have already done the first part. They see the USP of your product, the
clinical need is palpable, they have patients waiting to reap the benefits of your drug. In essence they’ve fallen in love with the brand. But here’s the thing, are they prepared for meeting with the bank? Are they prepared to entangle with the financial framework
to get them their gold standard product? Or are they in danger of losing their dream home because they have not got with the financial framework?

Think about it.

Omar Ali is the Formulary Development Pharmacist for Surrey & Sussex Health NHS Trust and sits on the External Reference Group for Cost Impact Modelling for NICE.He may be reached on omar.ali@sash.nhs.uk.

The NHS may be changing, but some challenges remain the same. The battle pharma companies face is not simply to identify Key Opinion Leaders at local, regional, national and even international level, but to understand the different roles these individuals play and how they interact to create a Market Access influence network. Richard Gray explains.

The complexity of introducing a new drug into the NHS with a view to open up prescribing at local level has changed quite drastically over the past few years. The shift in emphasis from clinicians to payers and the growing significance of national and regional bodies has fundamentally transformed, not only the stakeholders, but also the shape of teams within many pharmaceutical companies.

Most notable has been the expansion of pharmaceutical sales people operating at a more senior level within their customer accounts. Companies now have to consider the key national organisations such as Health Technology Assessment (HTA) bodies and the influence of patient advocacy groups and charities, as well as the explosion in regional decision makers, from Medicines Management committees to regional procurement organisations.

Furthermore, it is becoming increasingly clear that national boundaries are being blurred. While each European country will undoubtedly continue to make its own drug approval decisions for some time to come, there is growing communication and collaboration between national HTAs. There is also evidence that local clinicians in the UK are increasingly as likely to consider the recommendations of SNC and SIGN in Scotland, IQWIG in Germany and AIFA in Italy as those of NICE in England, or the All Wales Medicines Strategy Group (AWMSG) in Wales.

This extension of the sphere of influence across national boundaries now creates the need to track the interaction of KOLs across Europe; to highlight specific disease areas in which collaboration and communication is greater; and to understand the extent of individual and HTA influence on clinicians.

Expanding remit

One of the greatest shifts now facing pharmaceutical companies is the need to significantly ramp up activity at a strategic, national level. While historically, lobbying parliamentary groups and collaborating with charities was the role of a single Policy and Affairs Manager, today this role requires an entire team. There are now large numbers of national bodies, including HTAs to consider. Patient advocacy groups and charities also have huge influence, taking a key role in many HTA committees, influencing care pathways and, in many cases, leveraging significant financial resources to lobby parliament.

Many of these individuals will have multiple other roles at regional and local level, offering many opportunities for pharmaceutical company interaction – creating the need for a strong Market Access team able to track interactions at every level and across these diverse spheres of influence. In fact, there is evidence to suggest that pharmaceutical companies who do not track and manage individual interactions at all levels of their organisation may actually be harming the reputation of their company at a regional or local level. A traditional pharmaceutical sales call made by an inexperienced representative on a GP may not immediately trigger alarm bells, but if that GP is the PCT Lead on a purchasing or prescribing committee, damage to the relationship may occur.

Indeed, in addition to increasing the expertise and experience within Policy and Affairs, pharmaceutical companies are having to address the new regional tier for the first time. Whilst most organisations will have, in the past, made little attempt to build relationships with the Strategic Health Authorities (SHA), preferring to work with clinicians at Primary Care Trust (PCT) and GP level, the growth in regional procurement strategies is creating a new group of stakeholders.

With the emphasis on cost containment, the remit of regional procurement has expanded from the traditional focus on disposables to incorporate drug acquisition. These stakeholders are primarily focused on finance and are looking for discounts and opportunities to collaborate with other regional bodies to further drive down the cost of drugs, which requires pharmaceutical companies to create and deliver individual messages.

Clinical relevance

In addition, there are a number of emerging disease specific groups, including cancer and cardiac networks, that are operating at a regional level. The UK Medicines Information Centre has 14 regional centres and has a huge influence on prescribing; as does the National Prescribing Centre, which works alongside NICE to distil and assess new drug evidence and provide advice to prescribers.

Furthermore, many of these regional groups work together: decisions made by one Commercial Support Unit (previously Procurement Hub) or Medicines Management group are often repeated across the country. It is therefore essential, not only to identify these groups, but also to track decision making and assess which groups are leading the way in both procurement strategy and pharmaceutical decision making.

It will also be important to reinforce the work done at national level with patient advocacy bodies and charities at both a regional and local level. Most of these organisations focus their attention on national bodies, and undertake local patient-centric communication. There is therefore a key role for pharmaceutical companies to ensure joint projects, messaging and disease specific developments are clearly disseminated to the new regional stakeholders.

Political change

Given the efficiency drive that must now be put in place in order to attain the estimated £20 billion savings required across the NHS, it is also clear that rationalisation at management level is likely. The Government’s new White Paper promises a major reorganisation of the NHS, with PCTs and SHAs facing a slow death. The long-term impact of this remains unclear and, with change likely to occur in steady phases, pharma’s customer-base and targeting strategies will not change overnight.

The reforms, combined with a need to drive greater cost savings at every level of the NHS, will place further emphasis on the regional procurement bodies. Throughout this time it will be essential to track changes, assess the impact on KOLs and networks of influence and rapidly assimilate the implications of new strategy, such as a renewed emphasis on generics or a stronger adherence to the QIPP agenda.

Irrespective of the speed of change and moves towards a clinically-led health service, the influence of payers will continue. However, it is also important to recognise that this influence is inconsistent. Disease areas typically treated in primary care, such as hypertension, are highly influenced by both the HTA and PCT. In secondary care and some specialist areas, clinicians retain control. And there are also local drivers that reflect the health needs of local communities and, in some cases, the personal goals of that individual.

In this complex, fragmented marketplace the goal is not just to identify the new breed of non-clinical stakeholders – although this is essential since the number of non-traditional stakeholders has increased significantly – but also to understand how these stakeholders interact at a national, regional and local level and to determine an accurate network that spans these tiers of influence.

Richard Gray is Commercial Director (CCI) for Cegedim Dendrite, responsible for their

segmentation and targeting services and KOL / stakeholder mapping.

Key Account Management might be an effective way of approaching your business, but it certainly isn’t a quick fix. Management Consultant Joanna Allen explains how to go about identifying your key accounts.

Previous articles have explored Key Account Management (KAM) as the means by which organisations manage their strategically important customer relationships. Key accounts are said to be ones producing the most profit for an organisation or possessing the potential to do so. Developing these accounts and relationships with their customers to aid their retention can be critical to business success. Identification of these accounts requires systematic analysis in order to decide which accounts are crucial to the organisation. Secondary to this is the determination of the needs of the accounts, and implementation of added values services – ensuring they receive premium customer service to increase customer satisfaction. Wide discussion around what constitutes a key account exists across different industries. Given the different metrics and measurements of definition it is hardly surprising that a model key account does not exist. Research performed by IMONIC showed that, when questioned, Key Account Managers from other industries could offer up at least eight different definitions of a key account. These ranged from customers who contribute significantly to turnover to their oldest trading customers. Potentially the most fitting definition for the pharmaceutical industry is key customers who are also alliance partners, i.e. those with whom we can build collaborative partnerships, focusing on shared value and commitment, especially given the NHS and industry share a common agenda to improve health or prevent disease. The question therefore becomes: how do you identify these key accounts in order to form alliances with them?  

The identification stage

In the identification stage, considerations of how you match your internal resources to the external opportunities and which accounts will generate the best return on investment for the organisation is required. Given the critical importance of this stage, time is required in the analysis of your current accounts and the ranking of them. This goes beyond analysis of your sales and competitor data, to a more comprehensive analysis of the internal and external environment in which you operate. Internal environmental analysis considerations need to be given to the resources that are available to you, these may be financial, availability of added value services or internal organisational skills that you can utilise to improve your competitive offering. A good starting point in the analysis of your external environment is utilisation of the PESTLE model, which is widely used in other business sectors and will be familiar to those of you with any marketing experience. The PESTLE model encourages you to examine a wide variety of external influences that may impact negatively on your business or present opportunities. Key to completing the analysis is the ability to look at the future rather than the past.    

PESTLE Analysis

Political Influences	Whilst these can arise from central government policies, consideration needs to be given to local issues and their impact. Patient groups are a source of political influence so awareness of their agenda is needed and how you can leverage the opportunities that they present. Internal politics may also impact on available resources and therefore require consideration.
Economical Influences	These influences can be multi-factorial and include the customer drivers and the impact of their budgets, internal resources available to you, the seasonality, if any, of your product and factors specific to the industry or your product area.
Socio-cultural Influences	Related to the attitudes of consumers, demographics of the area that you operate in, including population shifts, education, local attitudes towards health and living standards. Addressing inequalities in health is a key agenda item for many local NHS organisations – does this relate to your area?
Technology Influences	Consideration needs to be given to any new products impacting on your market, internal and external research and current trends in your therapeutic area. What tools do you have at your disposal to improve internal and external collaboration? What technological changes are impacting on your customers?
Legal Influences	This includes current and future legislation which may impact on your business, including the ABPI Code of Conduct.
Environmental Influences	Spans a broad range of issues. Of importance are factors considered important to your customer.

  Identification of the influences with the potential to impact on your business in a negative or a positive way will allow you to rank the influencers in order of the most and least important. In performing the ranking, consideration needs to be given to the identification of influencers that may span several categories, as these can create the greatest potential or be the highest source of risk. A comprehensive PESTLE analysis helps define the opportunities and threats to your business, allowing creation of a SWOT analysis matching your internal resources to your external opportunities.   Further analysis PESTLE analysis followed by SWOT creation is a useful starting point in key account identification, but neither fully considers the competitive threats that you may face in your operating environment. Michel Porter (1979) defined five competitive forces businesses are faced with. These are:

The bargaining power of customers: In very competitive markets this is relatively high and customers may leverage their advantage to gain better services elements.

The threat of substitute products: If customers perceive no difference in the products or services offered to them, there is a risk that they will substitute for a lower priced product.

The threat of new entrants: Whilst the number of new products coming to market may be slowing, there is always a need to be aware of potential new entrants which create a threat to your business.

The intensity of competitor rivalry: This will vary depending on the therapeutic area but a comprehensive knowledge of your competitor will help you gain advantage. This goes further than the cost or perceived weaknesses of products and extends to the added value service that may attract customers, and the resources that are available to them.

The bargaining power of suppliers whilst Porter views this in the context of supplying raw materials it can be extended to pharmaceuticals in form of who supplies the medicines to the public. Combining the three analyses allows you to: 1) Define the opportunities and potential threats in the market place 2) Match your internal resources to the external opportunities 3) Analyze the potential threats from competitors.  

The JOST model

Following robust analysis of your internal, external and competitive environment, it is then possible to categorise your accounts and determine the strategic approach to them. The JOST Key Account Management matrix was designed to rank key accounts in the pharmaceutical industry, as other generic models were less specific to the changing needs of our customers and their operating environment. A complete explanation of the model can be provided by the author on request. The model’s intention is to be a fluid, as customer priorities change, increasing or decreasing their attractiveness over time. The launch of new products and the provision of new services to the customer will also change competitive advantage. Effective analysis and use of the model enables benchmarking and identification of areas of weaknesses compared to competitors, thus allowing planning to create added value services which will provide differentiation. Relationship selling has previously being held in high regard within the environment so care needs to be exercised in the top two thirds of the grid in order not to loose potential relationships for the future. Completion of the matrix requires a comprehensive knowledge of competitor activities and their priorities. This is essential in terms of accounts where no advantage exists over the competitor. If these accounts are not a priority to your competitor leverage can be gained through the lack of competitor activity in them. The principles of Key Account Management state that, to practice it effectively, it is only possible to work 25 to 30 accounts at any one time. Therefore, your competitor cannot be everywhere. Guide to plotting your accounts:

Competitive advantage: This may be related to the company, your products or the added value services that you can provide in comparison to your main competitor. A combination of all three gives the strongest advantage.

Account attractiveness: This is related to how your offerings fit with the priorities and needs of the customer, how large the account is and how long it will take to secure the account. A large account with a fit to products or services that can be secured faster than others represents the most attractive account.  

JOST Key Account Management Matrix 

Stakeholder mapping

Having identified and prioritised your key accounts, it is then possible to start to identify and map out the key stakeholders within an account. Stakeholder mapping is the process of identifying the key people crucial to the success of your strategy. These people can possess either high or low power and have a high or low interest in your strategy. An individual or group of individuals with high interest and high power will be critical to the success of your plans, it is important to remember that these stakeholders will be internal and external. For example, your manager will have both high power and interest so you need to plan your benchmarks of success and how and when you will communicate them to him/her. The matrix below provides a structure to plot your key customers and define your tactics for dealing with them.  

Power Interest Grid

High Power, Low Interest  Keep informed and involve accordingly. Satisfy their needs/wants but do not over engage them.	High Power, High InterestKey organisational stakeholders – need to fully engage with these and ensure that their needs/wants are satisfied.
Low Power, Low Interest  Monitor this group – provide input as required.	High Interest, Low Power  Keep these people informed – they may be able to help you with information.

Whilst the planning and identification process may seem lengthy, it is critical to ensure that you have the right accounts with the right plan to ensure long term success. KAM is not a short-term fix – research shows it takes between five and twelve meetings with the key decision-maker before an account can be earned. This process requires a high level of planning and the setting of milestones to demonstrate your effectiveness in moving the account forward. Whilst it may be a resource-heavy adoption in other industries, the last 15 years have shown that there is a distinct relationship between profitability and KAM and that ultimately the benefits outweigh the risks.  

Joanna Allen is a Management Consultant with 15 years industry experience, providing a range of tailored programmes to improve people performance. Joanna can be contacted at joanna@jostconsulting.co.uk.

Key Opinion Leaders are the key to selling to the modern NHS. But who are they, where can you find them and how do you harness the relationship’s potential when you do? Ruth Lessar offers some expert advice.

Many a new representative is somewhat mystified by the use of the words Key Opinion Leader or, on finding out their meaning, is perhaps in awe of this terrifying all-knowing expert creature against whom they may have to pit their newly-acquired skills and knowledge. Let’s face it, we’re all terrified of looking foolish; especially in front of others!

The truth is more mundane but necessary and effective if developed and used correctly.

KOLs are generally not the deities that, in the past, they were assumed to be. Sir Lancelot Spratt is thankfully long gone. KOLs are, in short, usually physicians trained as specialists in a particular field, such as diabetes or rheumatology, to name a couple. They may even be involved in sub specialities of a discipline. These specialists are able to influence their peers’ medical practice, including their adoption of new drugs.

“It’s time to get creative and seek those potential KOLs in different areas that will be of benefit to your business. A new KOL could be a commissioning director or a finance director”

NHS changes and KOL recruitment

The NHS is going through the biggest change since its inception and, as time goes on, we’re witnessing a change in KOLs and their chains of influence. So how do we harness the changes and use them to our advantage to gain more from KOLs?

Have a look at your NHS database and witness the volumes of consultants, staff and specialities within a hospital and this will give you an idea of the potential for future KOLs. If you don`t have access to a database, befriend someone in a hospital or PCT with access to a phone directory. Even a quick look online can be useful.

These days KOLs need not be the traditional consultants of the past. Many nurses are highly influential and specialist in their areas. Increasing numbers of them are prescribers and can influence their peers. There might also be other healthcare professionals who could be very helpful, such as extended scope physiotherapists or dieticians. It really does depend on your product.

Don’t ignore primary care either. Remember, they hold 85% of the NHS budget, and those holding the purse strings should not be discounted. They also network with each other and news of good practice travels fast. There are many GPs with special interests who may also be developed as KOLs. Never forget that the emphasis is now on keeping patients out of hospital wherever possible. That doesn’t mean we’ll see the wholesale closure of hospitals, as some treatments will always need to be carried out there but there is and will be further rethinking. Your potential KOL could be involved in redesigning patient pathways and this could be beneficial.

Practice-based commissioning offers some opportunities for KOLs in this area, especially where projects have been successful. It’s time to get creative and seek those potential KOLs in different areas that will be of benefit to your business. A new KOL could be a commissioning director or a finance director.

With many pharma companies using Health Economics as a powerful weapon rather than a dark art it should be remembered that:
clinical support + financial balance or savings = potential sales.

Why are KOLs important?

Finding that somebody who can see the benefits of your product and wants to disseminate the information to their colleagues is invaluable. Many of you will have walked away from that ‘really special’ call where it all gels and the consultant or other healthcare professional really buys into your product. It’s a great feeling and this could be the start of that beautiful KOL relationship. That’s the time to develop those fledglings.

It is through this process that new pharmaceuticals become accepted therapies, the prescribing ‘norm’ – something to which we all aspire.

“Finding that somebody who can see the benefits of your product and wants to disseminate the information to their colleagues is invaluable”

KOLs are able to influence at a variety of levels. They may have international gravitas, although these are few and far between. Remember, everyone has to start somewhere, so look out for the rising stars. Influence at national, local or even regional level can be very effective tools to have in the chest.

Don’t lose sight of the fact that the pharmaceutical company/KOL relationship is mutually beneficial. KOLs often rely on data supplied to them by pharmaceutical companies to ensure they communicate vital, accurate and up to date information. KOLs often want to publish papers and you could be helping them along the way, so it’s important to remember the relationship is a two-way street.

Relationships between your company and KOLs will need to be managed. This ensures that in big companies there are not several divisions of the company already engaged with the particular KOL. Duplication can sometimes occur and this can be costly, is bad practice and at worst can lead to serious PR problems or even litigation. In smaller operations, manage your relationships with KOLs with care. Always keep track of any business transactions and make sure you communicate them with colleagues.

Slippery customers

So, you have a niche product in a specific area. Chances are that any other company with an interest in that area is already using your potential KOL – tricky, but quite a common occurrence. The smaller the niche the more pressure there is on the KOLs in that area. It may be that your KOL has a relationship with several pharma companies.

If you can’t catch your KOL in this way or your chosen KOL is a little oversubscribed, don’t give up. A bit of lateral thinking and a brain storming session with your team could yield dividends. Look at the KOL’s team members, consider their needs and try again.

Once you’ve caught your KOL, it’s vital that you understand their needs so your relationship can be meaningful and you both benefi t. Determine how this relationship will develop and monitor it continually.

Communication is key

External

So, the team has identified all contenders for potential KOLs. Quite often there is only one. However, there are some points you must consider in your approach to KOLs:
• be objective in choosing your KOL – don’t choose them just because they told great jokes round the table after a few bevies at the conference dinner. However, this might mean that they have good public presence, which is no bad thing! Test this in the cold light of day
• understand the needs of your KOL and their perception of your company and products
• make sure you monitor, manage and measure your KOL programme
• be strategic in managing your KOLs – profile, follow up and implement a strategic plan to manage the relationships
• review and analyse input regularly to measure change and programme effectiveness.

Internal

Sales and Marketing are quite often run as separate directorates within companies. Communication is crucial. It is obvious, perhaps, but there’s nothing more damaging than finding out that one of your KOLs has been courted by a different directorate or division within the company and you know nothing about it until the KOL tells you. This is not only bad form but can create very poor relationships within the company. It should therefore be avoided at all costs.

KOLs present pharma companies with a great opportunity. Enjoy working with them and you will reap what you sow.

Ruth Lessar is an independent consultant specialising in the healthcare market. She has worked in the NHS as a nurse and practice manager and has many years of experience in NHS Liaison in the medical technology and pharmaceutical industries. Ruth has lectured in legal aspects of healthcare and advised businesses on strategy in the new NHS.

Key opinion leader development is now a vital part of the marketer’s armoury and critical to commercial success. But, in a changing market, are UK sales forces getting all the opinions that matter? Pf Editor Chris Ross looks at the growing importance of non-clinical opinion leaders.

Over the course of the past ten years, the pharmaceutical industry’s investment in Key Opinion Leader (KOL) development has increased significantly. Research suggests that companies now spend as much as a quarter of their marketing budgets on meetings programmes and speaking events, most of which deploy KOLs to support and endorse clinical findings. In addition, a huge proportion of the educational material developed by pharma is built on studies carried out by KOLs. As a consequence, KOL development is now considered one of the most important initiatives in any brand’s lifecycle. For the sales professional, getting to know your KOLs is critical. And therein lies the conundrum: who are they? In an evolving market where traditional customers are no longer the only game in town, new stakeholders and influencers have emerged and their ‘opinions’ could be ‘key’ to the success of your products. The battle is finding them, understanding them and engaging with them.

Despite clear evidence that the decision-making power of clinicians is declining as PCTs grow stronger – highlighted not least by clinicians losing control of their own budgets – the UK pharmaceutical industry has been slow to move away from the traditional approach that has earmarked the GP as its key target. As the majority of medical representatives will attest, actually getting in front of these primary customers has become more and more challenging and, as a result, access rates in the UK are now among the lowest in Europe. Despite this, many companies still build their sales strategies around high volume activity and measure performance against the twin pillars of access and call frequency. And the GP remains at the fulcrum of their attack.

Non-clinical opinion leaders

It would, of course, be churlish to suggest that the importance of the GP in the delivery of healthcare is being marginalised – clinicians will continue to play a significant role and will no doubt remain a key customer at the heart of the pharma industry’s sales and marketing strategy. But, as its customer-base expands, the industry’s focus must expand with it and break away from what has largely been a sole focus on clinicians. In an era where Continued Medical Education (CME) is regarded as a central plank in any sales and marketing strategy, KOL development must reflect the shifting customerbase. In fact, for the greatest success, non-clinical Key Opinion Leader development is emerging as a must-have initiative for pharmaceutical marketers, in concert with the sales professionals who are charged with delivering their messages out in the field.

Payers are players

So who are these non-clinical Key Opinion Leaders? Broadly speaking, though not exclusively, they can be categorised as ‘payers’. They have an influence over which drugs can be used and how they will be funded. The most common non-clinical influencers include:
• Commissioners
• Prescribing (or Pharmaceutical) Advisers
• Directors of Public Health
• Medicines Management
• Business Managers.

The question remains: how well do you, as sales professionals, understand these important groups? There has been much written recently about the industry’s widespread move towards an ‘Account Management-led approach’ to sales and marketing. This philosophy aligns with the theory that the decision-making powers of traditional GPs is being diluted and that stakeholders from across local health economies now exert far greater influence on how healthcare is delivered in the NHS. The move towards account management does appear to be taking place and, as a consequence, payers have become vital customers for sales professionals. In an, albeit embryonic, era where representatives (or Account Managers) are being afforded greater autonomy and given responsibility to engage with a diverse range of influencers across their local health economies, you will no doubt already be calling on individuals from the disciplines listed above. But how much do you know about them?

Understanding the responsibilities and priorities of new customers is paramount to success in the modern market. Ideally, this understanding will be developed well in advance of any product launch. Indeed, the most proactive brand teams will be engaging with non-clinical opinion leaders early enough for them to influence clinical trial design in a fashion that may drive health outcomes data that could be vital at launch. For most, however, simply engaging with these emerging influencers takes them into new territory. Literally.

“Sales and marketing departments need to move away from their traditional silos and to work collaboratively to develop a range of effective marketing messages that resonate with specific customer-groups and address their priorities”

A marketer’s mission

With tight ABPI regulations governing communication between the industry and its customers, particularly dialogue involving sales representatives and NHS professionals, great care needs to be taken during discussions with non-clinical influencers. Dialogue must not, of course, be promotional. As such, non-clinical or payer opinion leader development is very much an initiative for marketers. Nevertheless, to ensure pay-off at launch and beyond, when sales activity begins and those carefully crafted marketing messages are delivered, close interaction between sales and marketing teams at the earliest possible stage is critical. Marketers are charged with the responsibility for developing the messages that representatives take to market. When these messages work, marketers are happy to accept the praise. When they don’t, they are quite often happy to blame the sales effort! In reality, there is little to be gained from playing the blame game. Sales and marketing departments need to move away from their traditional silos and to work collaboratively to develop a range of effective marketing messages that resonate with specific customer-groups and address their priorities. The sales force is, of course, a pharma company’s largest customer-facing body and, as such, is responsible for delivering huge amounts of market intelligence and customer information back into head office. This data is vital in the development of brand messages and sales and marketing strategy. However, to complement this, marketers too have a responsibility to develop insights into their customer-base, to help craft stronger messages for the sales force to deliver.

Clearly, in an environment where newer customers are exerting a greater influence over whether a specific therapy will be funded and, in real terms, prescribed by the clinical community, how your marketing team interacts with non-clinical influencers could well be a significant factor in how well you are able to perform in the field. How well you understand your new customers is vital. In the first instance, this understanding may well depend upon the effectiveness of your marketing team’s non-clinical opinion leader development programmes. With this in mind, before you embark on implementing your call strategy, it is important to ask yourself, and indeed your marketing team, the following:
• Has our marketing plan captured insight from non-clinical stakeholders?
• Do we understand the roles and responsibilities of the non-clinical customers who may influence the use of our product?
• Do we know where each individual customer sits, and how they interact with other clinical and non-clinical customers? Who are the stakeholders? Who are the influencers?
• Have we established the local and national issues that may impact each individual customer? What are their priorities? Does our brand help them address these priorities? Could it be delivered as part of a new service to help them meet their goals?
• How are we going to access these customers? And once we have, how are we going to ensure that we return to them and keep the momentum going? What is our strategy for ongoing engagement with these key decision-makers?

The key to a successful sales and marketing strategy depends upon developing and delivering messages to the market that resonate with influencers critical to the uptake of a product. In the current pharmaceutical market, capturing the opinions and perspectives of what is now a wide array of stakeholders and influencers, and crafting messages that align with their needs, is vital. Clearly, achieving a balance of clinical and non-clinical opinion leaders will go a long way towards determining the success of your brand. The battle is to understand them. The challenge is getting in front of them to begin that process.