The Changing Pharmaceutical
Industry in a Changing World

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Transactional selling – the process by which a sales representative seeks out prospects, develops a relationship and then tries to close a sale – has been the mainstay of pharmaceutical field-based activities for over a century. The first mention of salesmen employed by drug wholesalers is as far back as the 1850s. In the 1930s and 1940s, when prescription products started to bring in significantly larger profits than over-the-counter drugs, it made economic sense for companies to invest heavily in qualified and skilled sales staff who were able to win over physicians.

From then until about two decades ago, the process of selling in pharmaceuticals was fairly straightforward – identify the physicians who might prescribe your product, build up a relationship with them and then get them to prescribe your product. This, of course, accompanied by the pandemic of cheap branded give-aways, free dinners and sponsorships to attend meetings.

However, in recent years, the situation has changed dramatically. Is it any wonder that pharmaceutical companies often struggle to find the best way to identify, engage with and influence the key decision makers in the healthcare environment?

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The UK National Health Service changed dramatically in the 1990s, following the publication of “Working for Patients”. The single biggest change was the introduction of an “internal market” for health care, in which Regional Health Authorities became responsible for purchasing any services needed, whilst NHS Providers focused on delivering services efficiently. Providers found themselves having to compete with one another for funds from purchasers. Overall, the reforms were designed to improve efficiency, equity, choice/responsiveness and accountability.

This new focus on the “business” of healthcare led to each Regional Health Authority setting their own priorities and budgets. The knock-on effect of this was an increasing inequality of access to care (“Postcode Prescribing”). Since decision-making was now in the hands of the Regional Health Authorities, different decisions about eligibility for care and treatment options were being made in different areas of the UK. Towards the end of the decade, pressure was being put on prescribers to limit their prescribing of “more expensive” drugs. From 2000 onwards, the move has been towards re-establishing a truly national NHS. NICE was established in 1999 to reduce variation in the availability and quality of NHS treatments and care. By 2013, NICE were established in primary legislation, placing them on a solid statutory footing. At around the same time, the Health and Social Care Act 2012 was published, which introduced huge reforms to the NHS. The structure now includes The Department for Health (covering national funding and policy-making) and country-level NHS umbrella bodies for each country within the UK (overseeing healthcare in each country), plus local-level Clinical Commissioning Groups (commissioning healthcare in their local area) and NHS Foundation Trusts (providing the care that CCGs commission).

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All this means that the decision to prescribe a specific product for a specific patient is not a simple one and is often not made directly by the prescriber. In other words, transactional selling is destined to fail in the new NHS, and in similarly structured healthcare settings around the world.

The situation is very complex, leading to much confusion within the pharmaceutical industry, who are broadly still playing catch-up with the rapidly changing NHS. One thing is clear, however. The importance of the pharmaceutical field-force is as high as ever. Whether sales reps, KAMs, MSLs, Market Access Specialists or Nurse Advisors, everyone in the field has a responsibility to fully understand the healthcare environment, the decision-making unit for the prescribing of their company’s drugs and to develop a strategically-aligned, cross-functional account plan to achieve local objectives through specific and well-implemented tactics, covering all relevant stakeholders. It is vitally important, therefore, that field teams have the sufficient therapy area, product and healthcare knowledge to have mutually valuable discussions with these external stakeholders and have the skills to elicit key insights and to ultimately drive increased advocacy and ensure patients have access to the company’s drugs.

ACHiiVE is the leading learning and development consultancy to the pharmaceutical industry. Our solutions focus on the skills, knowledge and processes needed to deliver excellent customer facing interactions across Commercial, Medical and Market Access teams, and embedding a strategic, account management mindset.

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