Monday, June 16, 2014

I've Been Following This Quietly Since 2013 -- Will Merck Combine Sales Regions, In One Week? Persistent Rumors Of June 23, 2014


In the main, and mostly, CafePharma is a rumor board. The posted material is often accurate (one circa 2009 era example) -- but it is a rumor chat space -- and, mostly for sales folk, in the life sciences.

That said, not only does this poster get it bang-on right -- s/he ignighted a largely very thoughtful discussion of re-tooling the way US sales/detailing teams ought to function -- given the changed landscape in doctors' offices.

I reprint only a bit -- do go read the whole thread. Ignore the name-calling; and stay for the thoughts. I supsect something akin to the original poster's suggestions will roll-out on or around June 23 -- next Monday. We shall see:
. . . .An Open Letter to Merck Leadership:

I am a Sales Representative in the Southeast Commercial Operations Group and am writing to you on behalf of many of my colleagues in the Southeast. In a recent video address, Mr. Ken Frazier said, “our size and complex operating model have created inefficiencies and redundancies in the way we do business.” In Focus Forward in the U.S. Market, Mr. Bob McMahon requested direct and transparent feedback in areas we succeed and areas in which we need to improve.

In that spirit, I wish to present, in a challenges/solutions format, an area of inefficiency and redundancy my fellow representatives and I are experiencing in our region, neighboring regions and perhaps all regions. The inefficiencies, discussed below, negatively affect not only our bottom line but how my fellow representatives and I make business decisions on a daily basis.

In my region we have eight Customer Team Leaders (CTLs), Sixty-ish representatives, two Medical Account Managers and, of course, one Director of Commercial Operations (DCO). The Region ratio of CTLs to Representatives is 1 to 7.75 with some CTLs managing six or less representatives. Incidentally, our neighboring region has virtually an identical ratio. An individual sales territory, within a district, consists of two CTLs and four representatives. The bottom line is CTLs are required to spend four days per week in the field with representatives. We simply have far too many managers and these managers do not have enough work to keep themselves occupied. The result is managers spending a minimum of two days and on many occasions three days per month with representatives.

Does this situation have a negative impact on our business and the way we make business decisions? Consider the following. In our district we have been asked to focus on and hyper-target our top HCPs. Spending time with those who can have the biggest impact on our business is a strategy we as representatives completely support. Unfortunately, we cannot implement this directive. In order to have an adequate pool of HCPs to accommodate the excess field visits it is necessary for us to develop relationships with everyone so we don’t subject the same high prescribing physicians to constant field visits. So, whether a physician prescribes one product X per year or one product X per hour these HCPs effectively have the same weight or value because we have to cultivate relationships with everyone. This situation is further exacerbated when you throw in the occasional field ride with a Director of Commercial Operations and/or a Medical Account Manager.

During any given month, CTLs are in every sales territory two of the four weeks. Our customers are getting weary of seeing managers as often as they do and are expressing their dissatisfaction. In the late 1990s our company, and industry, made a terrible decision by over-hiring. The result was representative fatigue by HCPs and lack of perceived value by our customers which led to reduced access and lock-outs in some cases. Despite the introduction of the Medical Account Manager, our region has not made any headway in reversing policies of restricted access. We are, once again, going down a similar path of overwhelming customers. This time it is with managers rather than representatives. One of my colleagues referred to this system as a pyramid scheme. How productive is our system when leadership feels they must baby sit representatives and representatives feel their job is to entertain leadership? As an organization we must do a better job at evaluating the laws of unintended consequences before implementing strategies affecting how we interact with our customers. . . .

My solution is as follows: Regions should be combined, immediately. Early in my career, a Regional Business Director (today’s DCO) had two, three even four times as many representatives under their direction as compared to today. CTLs should have a bare minimum of twelve to twenty representatives to manage. Most of the administrative duties of CTLs could easily be handled by a region administrative assistant (approving expense reports, etc.) freeing CTLs up for coaching activities. Another idea is to put a detail bag in the hands of CTLs. Mandate that one day per week (in addition to their office day) CTLs call on customers who have lock-out or sign only in policies place. Perhaps the weight of a CTL title will prove beneficial reopening access to some of our most important customers.

Thank you for your time and consideration. . . .


Now -- we wait -- and see. June? July? Or August? It is coming. . . . and as we all now know, post the ENHANCE $687 million federal securities class action settlement -- CafePharma is often a good pulse on all things sales -- in pharma. Even so, some of the commentary in the thread suggests that the same sort of renewed de-layering -- of management -- may roll out in MRL, this summer, again, as well. We shall see.

9 comments:

Anonymous said...

While I do not disagree with that post there is a 600 pound gorilla in the room that hasn't been mentioned. The CIAs for past off label, among other, sales and marketing transgressions. Some inherited in the merger, some of the mother's own making.

Merck cannot, themselves, shrink management to a sensible size because of the oversight requirements of the CIAs. So, like all risk that is too expensive to manage directly, they will seek to transfer that risk to contracting companies. At least that is the long term plan. Other long term plans include developing disease area apps that providers will use on company issued devices (iPads) to access information directly, (eventually) use FaceTime for 'in-person' interaction, order samples and potentially even the popular food and snacks that make reps such a fixture today.

The consumerzation of technology has finally made the idea of physician self-service more of a reality than it has ever been. For many of the reasons pointed out in that post many providers have been loathe to meet with reps as the innovations of pharma have slowed - what physician needs to discuss a combo of available drugs? So, as with all things, we shall see.

Condor said...

Spot on! Especially the doctors self selecting combos!

Do stop back -- namaste..,

Anonymous said...

on another topic, your thoughts?

http://www.reuters.com/article/2014/06/13/astrazeneca-pfizer-idUSL5N0OT2S120140613

Condor said...

Well, that is a very common technique -- using CVRs in smaller deals -- to bridge the gap.

To write a contingent value right that means anything though, one must make many, many assumptions about the cost structure and probable price point -- for a given drug/therapy/product. One that might be years -- or half decades -- off.

And then the other side must agree to those assumptions. Otherwise, the solution really amounts to little more than kicking the can down the alley -- i.e., "we will negotiate about it later".

Note that any CVR driven off of a product's sales requires guessing at likely margins to come up with a fair value on the rights.

Similarly so, any EBITDA driven CVR for any wholly new business unit.

So -- one can write a CVR driven only by sales (as that is a very easily verified number) -- but what percentage of sales should each right be worth?

So to apply it to AZ, if the incremental future oncology sales revenue may reach tens of billions of dollars, then a few points here or there, will really be a fight.

Thus you often end right back at where this deal broke off: Pfizer wouldn't agree to come up another $4 or $5 billion.

Even on $118 billion, $5 billion is real money.

So -- I'll bet that AZ won't invite Pfizer back at the end of the "cool-down" period -- three months (under UK takeover rules) -- and when Pfizer pitches again in six, i.e., November (and Pfizer will so pitch!), it ought to pitch closer to $128 to $130 billion.

Just my guesses.

Namaste -- great link!

Do stop back.

Condor said...

So sorry -- I also meant to say this -- this morning:

Merck's C.I.A. -- or deferred prosecution agreement, if you prefer. . .

Lapsed in late 2013.

So, I think -- at least as to Main Justice, Merck is now operating normally.

But proving that it is not violating the maze of regs on drug detailing, that is a tall order to be sure.

So lots of one over one supervision will be the norm -- just at a longer ratio -- I expect, post the end of June 2014.

Namaste

Anonymous said...

The joint Merck S/P CIA goes through late 2016 (I believe). This agreement supersedes the separate CIA's that each company had at the time of the merger.

Condor said...

I'm pretty sure that it ended in late 2013. See here -- check the links. All SEC filed disclosures.

I've been tracking this since 2008.

Anonymous said...

hmmm. You are probably (as usual) correct, Condor, but I can tell you that Merck is still communicating to employees that the CIA remains in place. And please see page 2 (section on Terms and Scope) of the .pdf at this link.

https://oig.hhs.gov/fraud/cia/agreements/Merck_&_Co._Inc._11222011.pdf

Not sure why the SEC filings would say something that conflicts with this, but perhaps you have some additional insight on that. Interesting.

Condor said...

Nope -- I think you are correct anon.

Your PDF post dates the last Merck SEC disclosure I've seen on the topic -- and the reporting runs to 2016.

Great catch! I just ran a word search on lady year's SEC Form 10-K, and CIA nowhere appears.

Clearly this is an ongoing and material agreement under Reg S-K, so why no mention?

I'll go puzzle that one out! Do stop back by...

Namaste -- and well done!