When it comes to customer importance, it seems many pharmaceutical sales representatives are failing to hold pharmacists in the same light as physicians — a trend that not only limits pharmacists' knowledge of medications and potentially impacts patient health, but also makes pharmaceutical companies more vulnerable to the competition.

In fact, a number of pharmacy industry representatives claim the amount of attention given by sales representatives has continued to dwindle over the years, despite pharmacists' increasingly vital role in healthcare and their growing influence on physician prescribing practices.

"Pharmacy is often seen as more of a pass-through customer, one that doesn't hold the same value or importance as physicians," says Todd Dankmyer, senior vice president of the National Community Pharmacists Association, Alexandria, VA. "As a result, many pharmacists are reporting that they are getting fewer calls from sales representatives. But underestimating the clout of pharmacists is an enormous mistake, particularly when you look at the soaring levels of prescription drug use and the influence pharmacists have with physicians, patients and the community in general."

A tough sell

Several factors could be at the heart of the pharmacy visit fall-off. Not only have some pharmaceutical companies streamlined their sales forces, thereby limiting personnel's time and resources in the field, but federal regulations such as the Health Insurance Portability and Accountability Act have also made it more difficult — if not impossible — for reps to make it behind the counter for meaningful visits.

Complicating matters further is the fact that pharmacies are busier than ever and operating under a pharmacist shortage, which makes it even more challenging for pharmacists to set aside time with drug reps. One East Coast rep says the task has become so difficult and tedious that she has "all but given up trying to get in to see the pharmacists," and essentially makes the rounds just to fulfill her job requirement.

Last year alone, 3 billion prescriptions were filled in retail pharmacies — a 50% increase since 1990 — and that number is expected to reach 4 billion by 2005. But the number of pharmacists is barely keeping pace. In 1998, there were only 129,000 pharmacists to fill those billions of prescriptions, and only 137,000 pharmacists are projected for 2005.

"That's a tremendous percentage increase, with only probably an increase of 4% to 5% of the workforce," notes J. Lyle Bootman, dean, College of Pharmacy, University of Arizona, Tucson.

The result is overburdened pharmacists who struggle to find enough time to fill prescriptions, phone physicians and answer myriad – and often complex – customer questions about specific drugs, and sales representatives who feel they are a nuisance and prefer not to waste their time waiting for an opportune moment to speak with the pharmacist.

"Pharmacists need and want information from reps, and reps need and want to make the visits, but there's often not enough time to [foster] effective relationships and visits," says Richard Jackson, director of the Center for Community Pharmacy Practice and Research, Southern School of Pharmacy, at Mercer University, Atlanta.

Unfortunately, that often translates into a lose-lose situation. The pharmacists don't learn about the new drugs, or have the information at their fingertips to help their customers and work more effectively with physicians. At the same time, the reps aren't getting the word out on their products or developing successful relationships with pharmacists, which hurts them, adds a pharmacy industry executive.

"Although pharmacists should be looked upon as a key member of the team, these barriers often prevent that from happening. What happens is we end up shooting ourselves in the foot," explains Steve Avey, executive director of the Academy of Managed Care Pharmacy, Alexandria, VA.

Data-driven market

However challenging it may be to detail pharmacists, sources agree that sales reps and pharmacists simply cannot afford to pass up the opportunity to forge a productive relationship.

According to Jackson, pharmacists are hungry for specific and timely product information that can help them better address customer questions and concerns, and relate more productively with physicians. That's especially true for new drugs, he says.

"As a pharmacist, it bothered me when I didn't have any information on a new drug that physicians were prescribing. Not only did I feel at a real disadvantage and unable to offer advice to customers, it was also very embarrassing to have to tell a physician that you aren't aware of the drug they're prescribing."

Putting current studies and drug regimen information into the hands of pharmacists would also be a welcome service, but sources indicate that many sales representatives reserve much of that material for physicians — much to the detriment of pharmacists. Several sources have referred to situations where certain drugs landed in the spotlight for potentially causing medical problems, which led to pharmacists being flooded with questions from concerned customers demanding more information.

"There have been cases where a study comes out and within ten minutes pharmacists are being hammered with questions," says Marissa Schlaifer, pharmacy affairs director for the AMCP. "Pharmacists would love to have information they can pass on, but that doesn't always happen."

Pharmacists would also appreciate information in times of drug shortages – which can occur at the end of the year, when pharmaceutical companies tend to shut off production – as well as alerts on counterfeit drugs and recalls.

"Pharmacists don't enjoy having to explain to a customer why they can't fill their prescription, especially when they can't tell them the reasons why and how long it will be before it's available," Schlaifer adds. "If they are at least armed with the information from the drug manufacturer, it makes it much easier for the customer and the pharmacist."

Additionally, any data that could help promote better drug compliance would also be helpful, particularly given that many of today's therapies are sensitive and cumbersome and require complex regimens. A Forum Drug Utilization survey revealed that as many as half of all patients fail to have their prescriptions filled, and as many as 30% of people who fill their prescriptions in the first place fail to have their prescriptions refilled. What's more, studies show that by the time patients get from the doctor's office to the pharmacy, many have forgotten half of the doctor's instructions about their prescribed medication. Estimated healthcare-related costs of noncompliance range from $50 billion to $100 billion annually. At the same time, drug companies are losing money if patients fail to refill their prescriptions, or don't fill them at all.

"It behooves pharmaceutical companies to help provide information that can boost compliance, because their products will be used to their maximum capabilities and will yield maximum results," says Crystal Wright, vice president of media relations for the National Association of Chain Drug Stores, Alexandria, VA.

Dankmyer foresees pharmacists having an enhanced role in the realm of compliance and says they "will become the linchpin in the system, which further highlights the need for product detailing by sales forces."

But the benefits of providing product-specific information aren't limited to pharmacists. Many times, pharmacists are put in the position of calling physicians and recommending substitutes for a certain prescription, either because the prescribed drug is not on formulary or because another therapy may be better suited for a particular patient. If a pharmacist has been apprised of all the latest information on a drug – or at the very least, has developed a positive relationship with a sales representative – he or she may recommend that drug as a substitute.

Although no statistics are available to show how many prescriptions are ultimately substituted by another drug on formulary, Dankmyer estimates the number to be "quite high," adding that most pharmacists are calling physicians anywhere from six to seven times a day to recommend another drug, and that roughly two-thirds of the time, physicians follow that recommendation.

Patgience pays

The way sales reps pass information on to pharmacists may be just as important as what they're providing, however.

Sources agree that the fastest way to turn a pharmacist off is by showing up unannounced and not being respectful of pharmacists' busy and unpredictable work environment. Jackson says it's not uncommon for sales representatives to show up, just drop information on the counter and then ask for a prescription label to show they were there — without making an appointment and coordinating the visit through the corporate office first.

"It's beneficial for the rep and the pharmacist to make appointments for the visit, and to be patient. Unlike physicians who have scheduled patient visits and can squeeze reps in between those visits, pharmacists don't have that luxury. They can become very busy at any moment, so patience really becomes key."

The initial approach to building a relationship with a pharmacist is also important. Avey says that when trying to establish a relationship, sales reps should ask what they can do for the pharmacist and avoid launching into a sales pitch on the first visit. If they're patient and wait for two to three visits before being product-specific, they will be more likely to earn that pharmacist's respect for the long haul, he notes.

"There were reps I knew from years ago that truly had my best interest in mind, and when I see them today, I still talk to them because I valued the relationship we had," he says. "On the flip side, there were reps whom I wouldn't give the time of day. It's always been my battle cry to have pharmacist-rep relationships that are built on mutual respect and partnership. The goal should be to go slow and focus on understanding and meeting one another's needs. When you get it right, it can have a great impact on both [parties]." PR