Diagnosis
Physicians don't think representatives are up to speed on managed care.

Prescription
Better training will improve interactions between reps and doctors.

In late 2005, as the Medicare Modernization Act (MMA) and Medicare Part D loomed large, pharmaceutical training departments made significant investments in preparing sales representatives. On average, sales representatives spent six hours reading backgrounders, participating in online training and attending in-person training about the MMA and Medicare Part D.

The industry invested significantly to prepare representatives for Medicare Part D

This summer, Lambertville, NJ-based Health Strategies Group set out to understand the post-MMA selling environment — what's changed, what hasn't and where there are opportunities for improvement. To that end, we surveyed 255 primary care and specialty sales representatives, 16 district managers from 11 pharmaceutical companies, and 415 primary care and specialty physicians. The results have important implications for pharmaceutical training departments.

The Post-MMA/Medicare Part D environment

As a result of Medicare Part D, physicians constantly struggle over whether or not the products they're writing are "on formulary." They expect most prescriptions to be rejected by call back or fax back from the pharmacy. Physicians try to avoid these headaches by prescribing formulary drugs, but they're not always successful. As a cardiologist from Arizona said, "Prescribing today is like writing a bad check — you know it's going to bounce."

Representatives' self-assessment of Medicare Part D knowledge

Physicians look to sales reps to help guide them through the maze of managed care plans. And they believe it's a sales representative's responsibility to educate them, and keep them up-to-date, on a product's formulary status.

While most sales representatives talk about formulary during sales calls, the content of those formulary discussions rarely meets physicians' needs. Most representatives are conveying a simple message: "We're on formulary." This message frustrates physicians, who seek specific, local formulary messages that will help them decrease pharmacy call backs and fax backs. "On formulary is not enough," said a gastroenterologist from Florida. "It would be helpful to know tier and copays for their products and the competitors'."

Swing, shift

Sales representatives agree local formulary information is important. Sixty percent of representatives state formulary coverage drives prescribing decisions for their products. Yet, only one in five calls mentions any local, specific formulary information.

Physicians simply don't believe most sales representatives have a good understanding of managed care and how it affects physicians. Sales representatives support this observation – only one-third self-assess as having strong Medicare Part D and managed care knowledge.

Improving interactions between reps and physicians

Based on these findings, Health Strategies Group recommends a managed care training approach that will build sales representatives' credibility as a source of managed care formulary information. We've identified the following skills and knowledge to succeed in the post-MMA/Medicare Part D environment: