Play Your Position

By Malcolm Fleschner

At one time pharmaceutical sales might have been a level playing field where sales professionals competed on the strength of their products and their knowledge and selling skills. In today’s managed care environment, however, the race often goes not to the swift, but to the product that’s listed on the right formulary or that fits with the prescribing guidelines at a specific managed care organization (MCO).

Yet even within this tumultuous selling environment, savvy pharmaceutical sales reps can position their products effectively with the physicians they call on. So say the folks at Pinsonault Associates, a pharmaceutical and biotech training and education firm. One key, they say, is to understand how the tiered copayment system functions and then adjust selling efforts accordingly.

The first step in this process is to determine which of your competitors’ products physicians are prescribing, as well as what their copayments are at the primary MCOs in your territory. This information arms you with ready responses for physicians who might object to prescribing your product in favor of products with lower copays.

Typically, there are three categories of products within the tiered copayment system. First are generics that require only a nominal copay such as $5 to $10. The second tier, ranging in copay from $10 to $25, includes branded products on formularies. Third are the nonformulary branded products that carry higher copays ranging from $25 to as much as 50% of the drug’s cost.

Your product likely will fall into one of three MCO buckets: advantaged position, neutral position or disadvantaged position. Where your product falls will affect your selling strategy.

Advantaged Position. If you’re in an advantaged position, your product probably is listed as a preferred agent on an MCO formulary’s second tier. Nevertheless, the product won’t sell itself, which is why Pinsonault Associates recommends a pull-through strategy.

Your company and an MCO might have an existing pull-through program driving market share for the specified drug. You should be sure to use the detail pieces provided by your company with information aimed at providers, pharmacists, patients and payers. Also make available patient education materials to whoever is responsible for distributing them to patients.

With physicians, emphasize the copayment savings your product offers while providing supporting product differentiation information that is specific to the disease state, product, patient or marketplace. Also bear in mind that your doctors probably receive drug utilization review letters from the MCOs identifying preferred products. Remember to remind providers about your product’s preferred status, as well as the safety, efficacy and low-cost benefits it offers their patients.

Neutral Position. A neutral position means your product has no advantage or disadvantage with regards to an MCO formulary. Your job here is to differentiate your product against competing drugs by emphasizing the clinical aspects that provide unique benefits to patients.

Disadvantaged Position. A disadvantaged position means your product has been relegated to a formulary’s third tier, or worse, locked out altogether. Your competition is likely in a better position on the MCO formulary.

Nevertheless, all is not lost. Here Pinsonault Associates suggest you use a push-through strategy that stresses the overall economic benefits your product offers, such as the need for fewer specialist and hospital referrals, fewer additional medications, fewer repeat office visits, fewer lab requirements and other benefits that will lower costs or offer increased convenience for the physician, patient or MCO.

Physicians who are persuaded to prescribe your product despite a disadvantaged position often become pioneers themselves, stressing safety and efficacy benefits to patients who might otherwise frown on the increased copay.

Ultimately, the more physicians you’re able to convince about your product’s benefits, the more likely word will get back to the MCO’s pharmacy and therapeutics committee. Then, it’s likely just a matter of time before you no longer have to sell from a disadvantaged position.

For more information, visit