As a sales representative selling pharmaceutical products, you probably have a number of different types of hospitals in your territory, be they public institutions – such as federal, state, county or city hospitals – or voluntary, non-government institutions – such as for-profit or nonprofit hospitals.
Although many differences exist among hospitals, there are also many similarities. For example, several key individuals and departments exist that, if leveraged properly, can enhance your sales efforts and increase sales in your territory – because sales generated in the hospital may flow into the territory.
Let’s discuss three key areas in the hospital that require special selling tactics.
The pharmacy department
The pharmacy department is a primary source of information that can be used to help set objectives in the institution. Hospital pharmacists can provide the names of influential hospital personnel and formulary committee members, as well as information on the competition and the prescribing habits of staff physicians. They can also encourage the use of your products through negotiation of bids and contracts; grant permission for hospital displays and lunch-and-learn programs; introduce you to attending physicians, residents and interns; purchase or request your product line; and use available promotional materials to assist in their drug education efforts in the medical center.
When a hospital has a drug formulary, as many do, the chief of pharmacy is usually a member of the formulary committee and acts as the committee’s secretary, recorder and reporter. In this capacity, he or she usually determines when the committee will meet and what products will be presented for standardization within the hospital. In addition, the chief pharmacist is often a member of the rules and regulations committee that establishes hospital protocol. This professional is also largely responsible for the hospital’s attitude and policy toward salespeople and suppliers. Your ability to establish rapport and a working relationship with the chief pharmacist can favorably affect your total promotional effort within the institution.
When working the pharmacy department, there are several questions you will want to answer. What is the organizational structure of the hospital pharmacy? What are the functions of the director of pharmacy and the chief pharmacist, and how do they influence the use of products in the hospital? What is the function of the pharmacy supervisor? Who in the pharmacy is responsible for inventory control? Who in the pharmacy is directly responsible for ordering? How does the hospital buy its drugs (direct, buying groups, wholesaler, other)? Who makes up the pharmacy and therapeutics committee? How do drugs get on formulary?
Since the means used to distribute drugs within the hospital and outpatient department can favorably or adversely affect your promotional strategy, you should also learn about the pharmacy’s drug distribution system. How are outpatient prescriptions handled versus inpatient orders? How are prescriptions/orders sent down to the pharmacy from the individual floors? How are generic equivalents handled in the hospital pharmacy? Are certain products stocked on the floors and, if so, where? What is the difference between free-floor stock and charged-floor stock? Who is responsible for or determines what is stocked on the floor? Are there satellite pharmacies in the hospital? If so, where are they located? Who is in charge? Who is the IV pharmacist?
Remember, establishing a good working relationship with all institutional pharmacists is an excellent way to obtain information you need to work an institution effectively, and to ensure that these customers will support your product for addition to the formulary.
The formulary committee
The pharmacy and therapeutics committee is often referred to as the P&T or formulary committee. This committee has the primary responsibility for determining which drug products will be included on the hospital’s formulary. Obviously, in each hospital this committee is fundamental to the success of your company, the product line and your selling efforts.
The formulary committee is a complex structure that varies somewhat from hospital to hospital, but most of the operational principles are similar. The chairperson is most frequently a physician who is the head of one of the hospital’s major departments (for example, the department of medicine or surgery). He or she is often the most powerful influence on the committee’s decision-making process.
There are generally several other physician members of the formulary committee. These physicians may either be heads of other hospital departments or services, or attending physicians acting as designees of other departments or services. The opinions of these other physician members may carry more or less weight depending on their status in the hospital, their knowledge of pharmacology and their relation to the drug under consideration. For example, if physicians in a particular medical specialty commonly use a certain drug and the physician member represents that specialty department, he or she is likely to have considerable influence — even more so if the physician has participated in research on the drug.
When you are first assigned to a hospital, get to know the members of the formulary committee. Find out who regularly attends the meetings and determine the degree of influence each member has on formulary committee decisions. Develop a good working relationship with the committee members, because when you have a product coming before the committee for formulary approval, you will want to be able to speak with committee members openly about its benefits.
As you develop a working relationship with committee members, find out if they have particularly strong views about such issues as combination drugs, generic substitution, certain classes of drugs, etc. In addition, find out if they have any particular views about your company. If they hold views that might present a problem for your company’s products or products in the pipeline, try to work to change those views — don’t wait until the committee meeting where they will vote to add or delete your product.
Your sales call to each committee member on a regular basis will provide you with insight into his or her degree of support for your product. You may also be able to identify issues that may act as impediments or aids to formulary acceptance. By talking to committee members, you can also find out if the committee is receptive to guest presentations, and whether sales representatives such as yourself have been allowed to attend the meetings or even make presentations to the committee.
When one of your products is submitted to the committee for review, be sure you have provided the committee members with supportive print material, using the product information provided by your professional services department. Discuss the product with each committee member and make sure that each member is clear about all the information you have provided for his or her review. If you have identified individuals who can influence committee members, make sure they have whatever information they need to help you, and make sure they know the schedule for the committee’s work so they can meet with committee members prior to the decision-making meeting.
Try to obtain a commitment to support adoption of the product from each of the committee members. If a member is not initially supportive, try to identify his or her concerns and develop plans for overcoming these concerns.
It is important to remember that in some instances, the addition of a new product may mean that another product must be deleted from the list — so your effort to get a product on formulary will actually be a competitive selling effort. Therefore, you must keep abreast of new competitive products that may come to the formulary committee for review, because some new product may threaten to replace one of your products that is already on formulary.
Just prior to the formulary committee meeting, make sure you have covered everything with everyone. Check to make sure that the pharmacist, the purchasing agent and the diagnosis related group coordinator have up-to-date pricing and purchasing information. Check the meeting time and date, and confirm that your committee members and supporters will be able to attend.
Check with the physician who has made the request regarding the committee meeting date so that if he or she is able to attend, his or her opinion and vote will be cast. If the physician or physicians you contact are not able to attend the meeting, request that they call in to state their desires and reasoning. In extreme cases, you may need to have your request postponed until your “champion” can attend. Make a decision to proceed or withdraw the request.
Once your product is approved by the committee and adopted, work with the pharmacy to make the product available as quickly as possible and begin to promote the product.
If your product is rejected, find out who voted against it and why. Initiate efforts to alter the person’s opinion – without making them defensive – by presenting additional information that meets their needs; then initiate action to get your product placed on the agenda for a future meeting.
As you can see, getting a product on formulary is not a one-call, one-physician commitment. It involves selling and supervising a program of several months’ duration with members of the hospital formulary committee and often members of the hospital staff.
It is now time to meet the hospital staff that makes up the various medical and surgical departments, and the medical education department is a good place to start.
The medical education department
The medical education department, headed by a director who usually runs the office of education, is responsible for coordinating the institution’s continuing medical education efforts and for approving any CME programs brought into the institution. Continuing medical education plays an extremely important role in hospitals by keeping physicians, surgeons, nurses, social workers and other healthcare professionals abreast of the latest developments in their respective fields.
Your role as a pharmaceutical sales representative is important to the medical education department because the support you provide enables the medical school to impart new knowledge, teach new skills and develop appropriate physician-patient relationships through seminars, workshops, review courses and other educational activities. In addition to clinical topics, your support through hospital exhibits or displays provides new and current information about your products to all health professionals. By working through the office of education, you may contribute valuable suggestions of topics and speakers for grand rounds seminars.
When you meet the director of the office of education, explain why you are in the hospital. Some of the reasons you will want to discuss include: to provide continuing educational services for the physician, nursing and pharmacy staff; to save the hospital money by providing these services free-of-charge; to encourage the most effective use of your products; to help control budgets by getting the best price available for the hospital pharmacy; and to keep medical staff apprised of new products.
Most clinicians prefer educational activities with a practical, clinical focus. These activities may employ printed, recorded or computer-assisted instructional materials. Examples of such educational materials for independent learning by physicians include programmed CME courses, audiotapes, videotapes and computer-assisted instructional materials that are used alone or in combination with written materials. Distance learning activities may include monographs, journal supplements, audiocassettes, videocassettes, CD-ROMs, Internet-based activities, audio-teleconferences, videoconferences and visiting faculty programs.
In some hospitals, a specific department may be responsible for educating other health professionals within the institution. For example, a pharmacy department may present a monthly medical education conference to the hospital’s family practice residents regarding new drug therapies, common prescribing errors made in the hospital or dosing recommendations for certain medications. This is where your strong rapport with the pharmacy department and the product information you provide will help support their educational efforts.
When working the pharmacy and medical education departments and calling on the formulary committee, be sure to obtain a clear understanding of their role in the institution and determine the impact they have on the use of your products in the institution. When you can say in your sales presentations, “Doctor, this product is on your hospital’s formulary,” you have gone a long way toward convincing him or her that your product is the most efficacious product available in that class of drugs.
