I remember early in my marketing career being put on a team to evaluate a new electronic call report system that utilized some basic physician information to help prioritize rep activity. I recall the VP of Sales being very excited about the new technology and saying if a rep didn’t know who to call on all they had to do was push a particular button and the system would tell them the perfect place to go. A rep didn’t even need to think. This seems a little silly today, but yet we continue to believe we can prioritize a rep’s work better than they can.
For the last 20 years, we have pushed targeting so tightly that reps really have very little say as to who they call on to grow their local business. We are now in a period where generics have about 85% of all prescriptions written, blockbusters aren’t happening and launches are failing. Despite all this, we continue to do targeting in a very similar way as we did 25 years ago. We even target doctors who don’t see reps or who seldom stray from formularies we are not on. We keep giving the reps impossible things to do and then are bewildered when they can’t pull it off.
I would challenge commercial teams to begin to look at things a little differently. One of my favorite marketing beach books is Blue Ocean Strategy that talks about avoiding the competitive sharks and swimming in other parts of the huge ocean where there is no competition. I think there is some relevance here. Why are we all trying to work with the same small percentage of potential prescribers? Maybe we should start thinking about swimming in the blue water, where there is no blood in the water.
There are a number of things that have bugged me about targeting for the last couple decades. I always thought it was funny that we spent incredible time and energy as hospital reps working with residents but when they went into private practice we ignored them for years until they became a high enough decile. It always bothered me that KOLs who influenced huge teaching programs never had the prescription volume reported that would be expected. I also recognized that KOLs would often write initial prescriptions for products and the PCPs, who merely continued the therapy, went up the decile ladder. When Walmart and others stopped reporting, we recognized how that biased the data sets but we kept using them. I could go on and on.
There needs to be a different way. We need to bring targeting theory into the the 21st century. I would start by teaching representatives that they are responsible for bringing in so many prescriptions for a product each month. I would teach the principles of targeting but not bind them to complete adherence. I would then challenge them to put together their unique local plan to get the most prescriptions they can in their area.
I would tell reps to prioritize their targets by first determining who they can have access to on a regular basis and who will actually give them the time to explain the features and benefits of the product. I would much prefer a rep call on 100 decile 5-6 doctors who will give them 5 minutes every couple weeks then to have them constantly sample drop and watch decile 10s sign their names. Obviously, the higher potential doctors can’t be ignored, but if you can’t work with them it is better to prioritize effort elsewhere.
I would teach reps the concepts about working with group practices where they can use highly influential lower decile doctors to help change the habits of the others in the group. I would identify those physicians who are quickly moving up the decile chain and super target them as they soon will be targeted by everyone else. I would aggressively try to call on younger physicians even though they may be lower decile as they will be around for a long time. I would have the reps work with pharmacists, key office nurses or anyone else who can influence the prescription.
I would teach and preach the concept of subsidiarity, which says that decisions should be made by the lowest, smallest or least centralized competent authority. In other words, there should be no way a computer model located in headquarters should be able to out think a person who works in a local community month after month, year after year. We need to constantly challenge the established way of thinking. I never spoke up at the meeting with the VP of Sales so long ago and I have regretted it ever since.