SALES & MARKETING ROUNDTABLE
With Moderator Kathleen DeLawrence, Chief Operating Officer, Ability Prosthetics & Orthotics, Inc.
Our Panel of Experts:
CHARLES T. (CHIP) BERNHARDT
Former Interim Chief Financial Officer Echo Therapeutics
EVJATAR (EVI) COHEN
Pharmaceuticals Global Practice Leader Appian Corporation
Co-founder and Principal Life Sciences Law Group
BioPharma Commercial Strategy Consulting
Senior Consultant TayganPoint Consulting Group
KATHLEEN DeLAWRENCE : The integration of sales and marketing has long been the challenge facing the industry. There are numerous examples of connected, collaborative and cohesive sales/ marketing successes. Given the changes in the U.S. healthcare environment, we wanted to explore what’s happening in the current landscape to see how these two functions are facing the challenges. I’m happy to welcome a diversity of voices to the table. Our panel includes people who bring varied experiences and viewpoints to this topic. So let’s get started.
What are the challenges sales and marketing have to navigate based on the current healthcare landscape in the U.S.?
EVI COHEN : The bar is being raised on quality and compliance, both domestically and internationally. The Sunshine Act, and complying with the Act, will take on new focus, with companies required to demonstrate stronger compliance, but furthermore, show true intent with changes of behavior.
TOM ROSELLA: Key challenges include healthcare reform, evolving customer behaviors and preferences, declining innovation and ongoing cost pressures, to name a few. These are forcing us to re-evaluate our strategies and business models in search of new, innovative ways to generate revenue, improve productivity, and ensure compliance.
MANYA DEEHR: We are adapting to a world where we have the ability to access and transmit an enormous amount of information from many different sources, but at the same time are expected to communicate in abbreviated sound-bites in order to accommodate the expected minuscule attention span of the intended recipient. In my world, this entails a daily wrestling match with the FDA’s promotional and advertising requirements. Some days this feels akin to trying to use the Dewey decimal system to catalog a digital library; it makes sense on some level, but you cannot help but think that perhaps a revolutionary approach, maybe involving an army of FDAgenerated emoticons, might be warranted.
PAUL FIRUTA: In the orphan drug market that I’m familiar with, patient identification and supporting the patient through the process of getting access to the drug are the two most challenging aspects of sales and marketing. Patient identification can be very challenging, because in the orphan drug market there are no treatments for the conditions. In many cases patients are taking OTC drugs or commonly used drugs to better manage the symptoms of the condition. It is not uncommon that the patient is no longer being seen by the specialist who would diagnose the condition and is more frequently being seen by an internal medicine or primary care physician. This can be very challenging for sales organizations in terms of sales force sizing, targeting, and patient identification. Product access can be a time-consuming and challenging process. This includes drug reimbursement, nursing services and patient financial assistance programs. It can be challenging and time-consuming to move through the process of obtaining reimbursement from the payors, set up nursing services to provide in-home reconstitution and administration support services, and work through a complicated process of obtaining financial resources need to cover large co-pays and other out-of-pocket costs.
Given the rapidly changing healthcare landscape, patient access to information and strict compliance challenges, what do you see changing for sales forces and marketing teams?
MANYA DEEHR: There is so much information available to patients and HCPs and it is difficult to give them the tools that allow them to gauge its accuracy and merit. Wikipedia has been reported as the most frequently consulted site for product and disease state information, and that’s in addition to the disease awareness and product websites. Complement this with the sites that rate the efficacy of prescription products and allow patients to report common side effects, add in patient forums and anti-product websites and the wealth of opportunities for individuals (sometimes activists and competitors) to, rightly or wrongly, influence people’s perspective of a product, a company or even an active ingredient, and you’re looking at an enormous map of choices. The result can leave marketing and sales navigating a quagmire of confused messaging, competitor-generated misperception and concentrated misinformation. A social media wave can engulf the largest of companies; it is not a medium that can be ignored and every team must have the tools to manage through.
EVI COHEN: Another factor is that market transparency is improving, with the health exchanges, and value-based purchasing payments, which determine how hospitals score on various sets of measures, including “patient satisfaction.” This trend will separate those that “say” from those that “do.” This will require sales forces and marketing teams to hone their messaging and tie it to concrete cases and success stories.
TOM ROSELLA: The quality and quantity of face-to-face interactions with physicians in the U.S. continues to decline as a result of pressure on physicians to increase the number of patients under their care. As a result, physicians limit face-to-face meetings with sales professionals and seek alternative channels for their interactions with healthcare companies. Companies are responding by reducing the size of their sales force and increasing investments in new, innovative marketing channels and multichannel marketing campaigns. This shift in investment is also propelling a shift in power and influence inside companies from sales to marketing.
PAUL FIRUTA: In the orphan drug space it’s a little different. The most significant change to the sales organization is the sales representative hiring profile. The primary function of the rep is patient identification and knowing how to maximize resources and to educate the physician and patients in compliance with pharmaceutical marketing and sales guidelines. This is often a process of creating disease awareness with physicians and helping the physician recognize and potentially diagnose a patient with a condition that may have been misdiagnosed simply due to the rarity of the orphan disease. In many cases a physician may never see or see only one case in their career. The sales organizations are being built today about 50% larger than they were about 6 to 8 years ago to target patients in primary care and other specialties. The new profile is the reps that have track records of success and are motivated to spend 40% to 50% of their time making cold calls to try to identify patients outside the primary medical specialty where the orphan disease is most often treated.
What needs to be considered to forge a stronger collaboration and integration between sales and marketing to get through the hurdles?
CHIP BERNHARDT: Nothing brings together the communication and effort of the sales and marketing teams as much as shared financial incentives based on achievable budgets and projections. Companies must financially incentivize sales and marketing with emphasis on shared compensation for sales results based on an overall realistic product plan for marketing, advertising, contracting, production and resulting sales. There must be a strong, bonus-driven incentive for the success of the group as well as the individual.
EVI COHEN: Consistent messaging is also vital. Sales forces and marketing teams, including strategic marketing, have to work closer together to distill a coherent message that can withstand skepticism in the market place, and endure through timely sharing of information and knowledge in a dynamic market place that requires agility from the whole customer-facing echo system.
PAUL FIRUTA: Sales and marketing teams in conjunction with patient services teams and specialty pharmacy partners need to work through the challenges of identifying patients and initiating the therapy. The key to success is to create positions within the organization that focus on consistent and continuous education across all functions and all stakeholders, and to facilitate open and frequent communication. The experience of providing a patient with the opportunity to better treat their condition and/or improve their quality of life is extremely fulfilling.
TOM ROSELLA: Success for sales professionals in the future will depend on how well they embrace new, innovative marketing channels. If they see these as a threat to their existence they will eventually lose their jobs. However, if they embrace these new channels and help to personalize messages and guide channel interactions with physicians, they will thrive in the new environment. Improved collaboration between sales and marketing professionals will also lead to better returns on marketing investments and ultimately higher operating income for healthcare companies.
Clearly there is a shift from product-focused marketing to service-focused marketing. What changes are taking place in the movement from selling pharmaceuticals to providing more to help the HCPs be effective?
TOM ROSELLA: Yes. This shift has been occurring for several years and will likely continue into the future. For example, pharmaceutical companies can no longer just sell pills. They need to partner with HCPs to improve patient care. Pharmaceutical companies typically provide services to help diagnose and treat a patient’s condition. Some examples of these services include medical information, dietary programs, access to nurses and mobile applications that help patients manage their condition.
EVI COHEN: There is focus on services, and overall solving of problems for patients, rather than product-based point solutions. Sales forces and marketers need to position themselves as sincere participants in the overall healthcare echo system, with one goal: to assist HPCs in caring for their patients.
MANYA DEEHR: With the increased number of orphan drug and rare disease products, a model has evolved that focuses on supporting the patient not just with the product, but with goods and services to assist them and their caretakers in coping with aspects of the disease. While this may be, in part, the result of the need to justify higher prices for products that address fewer patients, it has on occasion moved HCPs to servicing patients from positions within the manufacturer’s organization rather than as the customers for the products themselves. This paradigm naturally shifts the company focus away from pitching to the HCP and towards caring for the patient by focusing the organizations on identifying and assisting patients across a broad spectrum of needs and deviating from the narrow focus of supplying product for one particular component of the disease to a physician.
PAUL FIRUTA: True. In the orphan drug space 60% of the time is providing education about the disease and helping the physician identify a patient that may need additional diagnostic testing or consultation to determine if the new therapy is appropriate for the patient. Providing very expensive therapies that require self-administration is a complicated and a resource-intensive process that requires a great deal of coordination across all stakeholders, one patient at a time.
Let’s spend a moment on the external pressures coming from government and payors.
MANYA DEEHR: It would seem that the continuous pressure to reduce cost has been augmented by an increased pressure to demonstrate the value of the product or service to every particular patient. With the ability to track data from patients and patient registries and the concomitant ability to analyze it to identify trends, there is (and likely will be) an increased emphasis on evolving predictive models for the likelihood of disease state exacerbations, the initiation of prophylactic measures to avoid them and, of course, coverage predicated on treatment compliance.
TOM ROSELLA: Just a few examples of the pressure the industry faces: the FDA has increased the hurdles to obtain regulatory approval for new products; payors require outcome studies that demonstrate superior safety and efficacy profiles before accepting new products on their formularies; HCPs need assistance to care for patients that are more knowledgeable and involved in determining their treatment choices.
PAUL FIRUTA: In an orphan condition where there is only one approved therapy, the payor community generally accepts covering the product price, because it appropriately reflects the patient population and creates value for all stakeholders. The payors are typically using the label and the clinical trial enrollment criteria to establish coverage guidelines. It is critical that Phase III trial design and enrollment criteria be reviewed to ensure the intended patient population is appropriately represented. In the case where there are several therapies approved for the same orphan condition we are beginning to see employers require payors to find more value in their formularies.
How much of this is driven by an increased emphasis on patient centricity?
EVI COHEN: It is all driven by an emphasis on patient centricity, while focusing on efficiencies to reduce costs. But the devil is in the details.
PAUL FIRUTA: It has been my experience that working with the patient community is the key to success. A great deal of time needs to be dedicated to understanding the patient advocacy organizations’ goals and objectives. Over time the goals and objectives may change and the pharmaceutical company will have to evolve with the patient advocacy group to ensure they are continuing to meet their needs.
TOM ROSELLA: Patient centricity is an outcome of the shifting healthcare landscape, not necessarily the driver. Patients today are being forced to pay a higher percentage of the costs associated with their medical care, at times forcing them to make difficult trade-off choices within the family budget. Patients want access to medical information and clarity regarding their treatment options. Luckily, technology advancements in recent years have enabled healthcare companies to invest in new communication channels to interact directly with patients and provide the information they seek.
MANYA DEEHR: Not to be too cynical, but if patient centricity saves costs for payors, it will continue to be the subject of increased emphasis. That being said, patient centricity may increase personal responsibility for self-care, focus treatments, minimize unnecessary pharmaceutical prescriptions and, ultimately, benefit individual patients. Providing patients with real time data predicting outcomes based on a similarly situated population could be invaluable in assisting them in making treatment decisions for themselves.
What will the commercial business model look like in 3-5 years?
EVI COHEN: Companies that are able to grow with the times, leverage social media, and create an intimate echo system around them, will be the ones that will survive and succeed.
PAUL FIRUTA: There has been a great deal of consolidation in the biotech sector with larger biotech companies and large pharmaceutical companies acquiring biotech companies with one or two commercial products and a pipeline. I see this trend continuing for the foreseeable future. The risk in this model is losing the focus on the patient. In the orphan drug space the products programs are established and managed as independent and stand-alone programs. An effort to consolidate orphan drugs by specialty, and leverage resources such as sales, marketing, manage care and patient services, may dilute the patient-centric approach that is required to deliver all the necessary services and resources to each patient.
TOM ROSELLA: The U.S. landscape will continue to change, and the interactions amongst healthcare companies, payors and patients will continue to evolve. Access to electronic medical records will enable payors to make more informed decisions regarding medical care and increase the role they play in determining the price of new products and the selection of a patient’s ongoing treatment plan. Technology advances will also enable better patient adherence to prescribed medicines, reduce time to market for new innovations and further enhance customer engagement via digital channels, which will continue the trend of reduced face-to-face interactions with sales professionals.
What are the leading companies doing to succeed?
PAUL FIRUTA: I believe companies that will be successful have patient-focus; a commitment to developing programs and services that meet the individual needs of each patient; highly-motivated sales and marketing professionals who educate a broad spectrum of physicians; highly motivated medical affairs teams that can provide in-depth scientific and clinical training to physicians; and finally, an outstanding patient service function to support patients as they initiate therapy and stay on therapy.
TOM ROSELLA: Leading companies are proactively evolving their business models in order to capitalize on emerging trends. For example, they are reducing the number of face-to-face interactions with HCPs, shrinking their sales force and investing in new engagement models that enable customers to access consistent, relevant, timely and accurate information via their preferred channel and at their preferred time of day. They are recognizing the increased importance of payors and patients and adjusting their engagement models to care for the growing needs of these customers segments. They are also responding to increased competition by choosing to differentiate themselves based on providing a superior customer experience instead of only relying on the excellence of their products. They evaluate their business models from the lens of their customer and holistically design their customer interactions to achieve a more deliberate and positive outcome.
EVI COHEN: To succeed, companies are making sure to continue to educate their sales force and marketing teams about the changing ecosystem. They are also building application platforms that utilize embedded business process management (BPM), in order to provide better awareness, that is translated to knowledge, and fosters actions and better decision making.
KATHLEEN DeLAWRENCE: Thanks to all of our participants for sharing their perspectives, insights, and learnings. It appears that sales and marketing functions are being pulled closer together by the sheer force of market dynamics, ready access to information and patient centric focus on healthcare coupled with government and payor influences. The models of the past that had sales and marketing pointed in different directions simply won’t deliver the goods. I believe there is an incredible opportunity to focus both functions towards patient health management, delivering on outcomes and continuing to educate clinicians and payors to meet these changing market demands. The teams that honor collaborative participation and stay focused on the best practices in the industry will deliver success. Our panelists have provided a panorama of ideas that describe the path to this future. •
MEET OUR MODERATOR
KATHLEEN DeLAWRENCE, Chief Operating Officer at Ability Prosthetics & Orthotics, Inc.
Kathleen DeLawrence is Chief Operating Officer at Ability Prosthetics & Orthotics, Inc., a mid-Atlantic company with 10 offices that evaluates, designs and fits patients with custom and off-the-shelf orthotic and prosthetic devices. Prior to joining Ability she built a strategic consulting practice focused on entrepreneurial businesses in the healthcare and life sciences market. She has over 20 years of pharmaceutical industry experience that includes strategic planning, operational management, supply chain, product launch, marketing and sales operations management, and merger integration across small, mid-size and large companies. Kathleen was the Chief Operating Officer for Prism Pharmaceuticals, a VC-backed company which was acquired in 2011 by Baxter Healthcare for a total value over $300M. Preceding Prism, she was VP and General Manager of Dover Communications, a privately- owned medical education company that was acquired by CardinalHealth. Before joining the private company sector, she enjoyed a successful career working at AstraZeneca, AstraMerck, Price Waterhouse, and General Electric. email@example.com
MEET OUR EXECUTIVE PANEL:
CHARLES T. (CHIP) BERNHARDT
Former Interim Chief Financial Officer, Echo Therapeutics
Charles T. (Chip) Bernhardt is a Certified Public Accountant who currently offers financial consulting services to life science companies. Until December 2014, he was the Interim Chief Financial Officer for medical device company Echo Therapeutics. Prior to that, he served as Chief Financial Officer and Chief Accounting Officer for Hemispherx Biopharma for five years. He attained an undergraduate in Accountancy from Villanova University and received a Masters’ Degree in Business Administration from West Chester University of Pennsylvania. Mr. Bernhardt was formerly the Director of Accounting for Healthcare Division of Thomson Reuters, where he was responsible for their accounting operations including the Physicians’ Desk Reference business and shared financial services for the Healthcare and Scientific Divisions from 2006 to 2008. He was also the Regional Controller for Comcast Cable during 1999 to 2002, Director of Finance for TelAmerica Media from 2003 to 2006 and earlier in his career a member of the Internal Audit management teams for American Stores Corporation and ICI Americas/Zeneca (currently AstraZeneca Pharmaceuticals). firstname.lastname@example.org • www.linkedin.com/in/chipbernhardt
EVJATAR (EVI) COHEN
Pharmaceuticals Global Practice Leader, Appian Corporation
Evjatar (Evi) Cohen is an experienced pharmaceutical executive with extensive background developing global business portfolios with emphasis on new products and technologies, IP, and global business process transformations. Recently, he joined Appian Corporation, an applications platform and business process management (BPM) software company, as Pharmaceuticals Global Practice Leader, responsible for ensuring client success and steady growth in license revenues across all pharmaceutical clients. Formerly, he was VP of Global Innovation & Portfolio Management at Catalent Pharma Solutions, a leader in drug development, drug delivery technologies, and manufacturing, where he led Catalent’s approach to innovation. His achievements set Catalent on a trajectory to its successful 2014 IPO. Prior roles include positions in Legal Affairs, Portfolio Management, R&D, Quality Assurance, and Project Management. email@example.com
Co-founder and Principal, Life Sciences Law Group
Manya Deehr is the co-founder and principal of the Life Sciences Law Group, LLC, a law firm dedicated to providing business-savvy legal services to the life sciences industry, and the CEO and founder of Pediva Therapeutics, a company focused on reengineering commercial-stage products for pediatric applications. Manya has provided strategic and operational support for numerous consumer and prescription product launches/relaunches, including drug delivery technologies, animal health, orphan, and pediatric drugs. She has extensive experience in structuring and negotiating life sciences collaboration transactions, having negotiated deals in excess of $25B for numerous companies at all stages of development.She has spent over 24 years advising public and private life sciences companies in all stages of development, drug and device discovery, drug delivery, and commercialization. Manya has also held a number of executive leadership positions at Receptagen, Eurand, and Velcera, and has played integral roles in facilitating product launches and supporting sales and marketing efforts. firstname.lastname@example.org
BioPharma Commercial Strategy Consulting
Paul Firuta is past president of U.S. Commercial Operations for NPS Pharma, with 23 years of industry experience launching and commercializing biologics and pharmaceutical products. Previously, he served ViroPharma, Inc. from 2008 to 2014 as Vice President and General Manager, Americas, where he was responsible for managing the U.S. Commercial Operation and building the Canadian and Latin America business units. He has also been on the commercial leadership team for Lev Pharmaceuticals and OraPharma, a subsidiary of Johnson and Johnson, where his responsibilities included developing strategic plans and leading the Sales and Marketing, Managed Care, and Markets Access business functions. He also served SmithKline Beecham for nine years in multiple roles in the Managed Care Division. BioPharma Commercial Strategy Consulting is a consulting firm focused on providing resources to support commercial launch and operations of orphan drugs. Key areas of focus include: 3PL, specialty pharmacy distribution networks, nursing networks, sales force operations, strategic marketing, pricing, managed care, market access, and patient financial assistance. email@example.com
Senior Consultant, TayganPoint Consulting Group
Tom Rosella is Senior Consultant at TayganPoint Consulting Group. He has proven expertise in strategy, business planning, business transformation, governance, enterprise process management, change management and program and project management. Tom has more than 25 years’ experience, predominantly in the pharmaceutical industry, leading global transformation efforts. Prior to joining TayganPoint, he was a director in KPMG’s Customer Strategy and Growth Practice, driving sales and marketing transformation for life sciences companies. Before that, Tom spent 24 years at Merck, leading strategy and transformation groups in their Marketing, Global Business Services, Finance, Research, and IT organizations. TayganPoint Consulting Group is an award-winning management consulting firm which specializes in dynamic business transformation primarily in the life science, healthcare, and bio-pharma space. Through a collaborative and hands-on approach, clients achieve business benefits sooner than with traditional consulting methods. From strategy through execution, TayganPoint aligns people, process, culture and technology to deliver custom-tailored solutions that improve performance, and deliver measurable, sustainable results. firstname.lastname@example.org