PharmaFiles #1

How Big Pharma targets and influences doctors to push drugs

Let me share with you an open secret. Big Pharma does not care about your health. Everyone knows it instinctively, but no one knows how it works behind the scenes. I have worked in Big Pharma for almost 20 years across various functions, and I will reveal how the machinery behind Big Pharma works. 

In Pharma, we view all doctors as "customers" like any corporation. They are our primary source of income because doctors write drug prescriptions, and through drug prescriptions, we make money. So, therefore, the more prescriptions doctors write, the more money we make. It is as simple as that. 

Like most profit-making organizations, the 80/20 rule applies to Big Pharma. What does this mean? Generally, 80% of our income comes from the top 20% of our customers (doctors). 

How does this look in practice? Keep reading.

We measure and rank every doctor in terms of two dimensions.

The first dimension is what we call their "Potential". It means what the doctor's potential to write prescriptions is. The more prescriptions they write, the higher they rank in this dimension. 

We collect all kinds of data to rank a doctor's potential, ranging from their job seniority, their medical associations, the seniority within their medical associations, years of experience, specialty, the number of patients they see and many more. For example, in some countries, our Medical Sales Reps are assigned to stand outside doctor's clinics to count the average number of patients they see daily. 

The second dimension is "Loyalty". What is Loyalty? Loyalty means how likely a doctor is to prescribe our drug. For example, a high-loyalty doctor will write 10 out of 10 prescriptions for our medicine. A medium loyalty doctor will write 5 out of 10 for our drug and 5 for the competitor's drug. 

We put them in a chart with two dimensions that look like this.

Once all these doctors are ranked according to their potential and loyalty, we segment them into different categories.

The highest potential doctors prescribing our competitor’s drugs are in the upper left box. Sometimes, we call these the “Competitor’s wives”, and they are highly loyal to our competitors and they are the cash cows for our competitors.

We spend most of our efforts and resources on these doctors because they will become our cash cows if we increase their loyalty.

To shift their loyalty, we employ various tactics, including visiting them as frequently as possible, sending them on expensive overseas “educational” trips and dropping them costly gifts. We also send the most attractive Medical Sales Reps to some of these doctors because they like face-to-face discussions with these lovely Sales Reps. Although nobody wants to admit it openly, we all know sex sells!

In the last decade, regulations have tightened to prevent Big Pharma from incentivising doctors. However, there are always ways to go around it because rules often take a long time to implement and enforce. So it is a “cat and mouse” game, and it varies from country to country.

For example, in some countries, local regulations prohibit Big Pharma from giving gifts above a specific value to doctors directly, and these gifts must be declared under local Transparency Laws. One way to circumvent that is to increase the pay of our top Medical Sales Reps and encourage them to use their own money to incentivise doctors. Such private transactions are not captured, but it is an open secret within the industry. Other methods include funding their research (as long as their research produces the desired outcome) or promising to buy massive amounts of their books if they authored books. Many of these activities are invisible to the Regulatory Authorities.

In the upper right of the chart, we have our High Potential/High Loyalty doctors. These are our cash cows, or sometimes we call them our “Wives” because they are highly loyal to us and prescribe our drugs most of the time.

We only need to spend a little bit of time or effort on these doctors because the goal is to maintain their loyalty. Compared to the Competitor’s Wives, we visit these doctors at a much lesser frequency and perhaps send them to cheaper local educational events.

The reason is that doctors who already prescribe our drugs seldom switch to newer medications unless necessary. This is especially true for chronic diseases such as hypertension or diabetes. A doctor will never switch to a different drug if the patient’s condition is under control. The reason is that if they change the drug and some severe side effect occurs, they risk litigation or even worse, the local Medical Board will demand an explanation, and they risk losing their license!

However, sometimes they will try “new drugs” on new patients, especially when some competitors sponsor them to an expensive overseas “educational” event.

Once, when I ran out of marketing expenditures, one of my loyal doctors received a luxurious sponsorship for an educational event from a competitor. He called me to apologize and explained that he had to prescribe at least the competitor’s drug to his new patients for a few months.

This is how Marketing Budget is done in Pharma. Every doctor has a budget assigned to it, and we use those numbers to forecast marketing expenditures.

The question now is, do all doctors work in this way? Certainly not. Some doctors cannot be persuaded, no matter how much effort we put into them. However, we have many ammunitions to steer their loyalty. Remember that we collect all kinds of information on our doctors. This includes their friends, colleagues and even bosses.

We call it their “Sphere of Influence”, and we even have an excellent App to track this. The “Sphere of Influence” tells us exactly who we need to trigger to influence the doctor to prescribe our drugs.

For example, if the doctor’s boss is one of our loyal customers, we use these influencers to change their behaviour.

Here’s an example of how different Pharmas rank them using different terminologies. In the example below, Awareness is equivalent to Loyalty, and Target is identical to Potential.

I wrote this in a humorous and simplified way showing how Big Pharma targets and influences your doctors. There are many more tactics, and I am barely scratching the surface. It also gets complex depending on the country’s system and ways of working in different cultures.