At some point, there will be some tie-in — even from an incentive standpoint — to make sure that reps drive the right message and we have proof sources to demonstrate that they are compliant and selling on label.

MANAGED CARE IMPACT

HERMAN: How will the industry modify its sales approach to handle the increasing impact of managed markets?

HULL: We've seen huge growth at Abbott in the managed care system that supports our customer units. And throughout the rest of the industry, I see more of an account-based sales force as well.

JENNINGS: Some of our larger clients are beginning to understand where the access is and explore the regionalized approach — again. They're experimenting and trying to maximize their dollars within each geographic area.

HULL: The situation is driven by physicians, who are now employees. My wife is an internist. She's told what to prescribe by people who sign her check. That's why we've all seen a decline in our sales rep responsiveness with our customers. It changes the dynamic and the rep/physician relationship.

STICKLER: One area that has not been affected as much by managed care has been in the hospital. And that's been a very nice place to operate as a company because all of our products are covered under a DRG (diagnosis-related group).

SNOW: For those of us who have been in the industry a while, to hear that the hospital market is so attractive just gives you an idea of what we're facing today.

We're working hard to maximize access, but by no means have we got that whipped. It's a challenging environment and changing every day. Medicare Part D had a lot to do with the change.

BREITSTEIN: With this year's election, what will – and won't – change for reps?

SNOW: The US government is the largest customer – and that's not going to change. I think we all take pause when we think about what could potentially happen down the road.

ROSENTHAL: The increasing importance of government as a payer for the pharmaceutical industry has larger strategic implications outside of sales forces for how companies price and market its products. But if the effect of government's involvement is to fund a benefit through plans, then the job of the representative isn't going to dramatically change. Maybe the rules of the game will shift, but I don't expect there to be a dramatic impact.

HERMAN: Looking to the future, the challenges seem to grow even greater. What is the prognosis for reps? Can they still succeed?

STICKLER: Restricted access to physicians is going to continue to be a real challenge for the industry. In an issue of Newsweek, there was an article called "Thanks, but No Thanks." It described a number of medical schools, hospitals and doctors offices across the country that have basically signed up to say, "We're not going to accept any representatives' visits at all."

KEEFER: It's true — as physicians become less of a decision maker about what to prescribe, their need to see reps is sometimes perceived to be less. A lot of offices have shut out reps due to state, clinic and hospital regulations.

At the same time, clinics in the retail drug stores are rapidly ramping up, staffed by nurse practitioners or physician assistants. That's new to the industry, and we now have to be able to put that into the mix.