eDetailing: A Strategic Analysis Of Implementation And ROI

eDetailing A Strategic Analysis OfImplementation And ROI 1

About EularisABOUT THE AUTHORDr. Andrée Bates is the Managing Director of Eularis, a company that applies sophisticated analyticalprocesses to quantify the sales impact of specific marketing programs for Pharmaceutical brands. Theseanalyses determine the financial return for individual sales and marketing activities as well as the optimalsynergistic combination of activities (and budgets) to have maximum market share growth. Eularis offersbrands and their agencies the bottom line facts: what messages, what activities (and what budgets) - inwhat combination - will provide what market share for your brand.Dr. Bates‘ career has encompassed academic, clinical and Pharmaceutical positions internationally. Shehas gained wide recognition within the Healthcare Industry internationally for ROI and marketingeffectiveness measures in Pharmaceutical marketing. She is the author of many publications on this topicin peer-reviewed journals. In addition, Dr. Bates has lectured on eDetailing ROI in the PharmaceuticalMBA program at INSEAD Business School and on marketing ROI at the Center for Pharmaceutical MarketingStudies, Erivan K. Haub School of Business, St. Joseph‘s University, Philadelphia.ABOUT EULARISEularis have unparalleled years of experience in Pharmaceutical marketing analytics and predictivealgorithm analyses of Pharmaceutical marketing activities. Their analyses quantify the financial impact ofindividual sales and marketing activity - as well as recommending the optimal synergistic combination ofactivities (and budgets) for an individual brand to have maximum market share growth. Eularis offersbrands the bottom line facts: what messages and which specific sales and marketing activities are trulyimpacting on a brand‘s prescription sales - by how much - and what elements within each activity need tochange (and how) for increased results. 2 © Copyright 2011 Eularis

About EularisEULARIS ANALYSES: Identify all factors really influencing prescriber behavior the most Evaluate which messages are having the most impact on actual prescribing Quantify the financial impact from each marketing program Identify which elements of each program are having most actual prescribing impact Determine the most effective mix of sales, medical education, advertising, PR, eActivities, etc. for optimal market share growth Forecast brand performance based on investment assumptions and market dynamics Highlight rep quality differences across brands and companies Provide Agency League Tables [according to which agencies activities are having most actual prescribing impact] Optimize all relevant resources for a brand or portfolio across multiple activities and geographies 3 © Copyright 2011 Eularis

ForewordThe Founder of interactive videoconferencing-style eDetailing speaks to Eularis about developing theconcept of eDetailing:John Benson, President of the Benson Innovation Group, Inc. (Bennovation):“As anyone who has ever been in the field knows, the challenge for Pharma reps and physicians is to find a time that isconvenient for the physician to hear the representative‟s product message. While some physicians offer appointments forreps, most often reps show up while the physician is trying to provide patient care. Patients everywhere know thatphysicians generally run behind in their patient appointments. Visits from reps during patient care hours only exacerbatethe problem physicians have trying to keep up with their appointment schedule.It was with this knowledge, and well before the popularity of the Internet, that the concept of eDetailing was developed— by accident. In May of 1995, I caught sight of a video-telephone in the window of an AT&T telephone store at a shoppingmall. I wondered if a video-telephone could be used to facilitate meetings between physicians and Pharmaceuticalrepresentatives. The answer was a resounding „no‟ and „yes‟.The video-telephone would not be adequate, but after considerable research it was determined that a newly developedconcept of desktop personal video-conferencing would improve the interactions between a physician and a Pharmaceuticalrepresentative. The key benefit to all parties is that the physician can initiate the interaction with a representative at thephysician‟s convenience. In addition, of course, representative productivity is increased, the average time the physicianspends with the rep is increased and Pharmaceutical sales increase. Thus the eDetailing concept was born.” 4 © Copyright 2011 Eularis

Executive SummaryTHE SCOPE OF THIS REPORTIn eDetailing: A Strategic Analysis of Implementation and ROI, Eularis provides a comprehensive insightinto the subject of Pharmaceutical detailing using the Internet. As the vast majority of eDetailing pilotshave taken place in the US, the report looks at the likelihood of European Pharmaceutical companiesfollowing suit. Return on Investment (ROI) is also important. This report discusses the available evidenceon ROI and illustrates some models that can be used.Eularis made extensive efforts to provide the most insightful information about this fast moving subject.This involved:• Surveying over 200 UK-based general practitioners about their attitudes to Pharmaceutical sales representatives and eDetailing,• Carefully assessing the current regulatory environment in the UK and how eDetailing programs could be affected,• Sourcing case studies of ROI from the USA,• Extensive research into vendor companies and their market positions,• Strategic considerations and advice. 5 © Copyright 2011 Eularis

Executive SummaryOVERVIEW AND BACKGROUND TO THE REPORTINCREASING COST AND EFFORT OF MARKETING MEDICINESIt is estimated that in the US, the Pharmaceutical industry spends about $15 Billion a year promoting itsproducts to the medical profession. By contrast, the industry spends a further $2.6 Billion targetingpatients. The top 40 Pharmaceutical companies alone employ over 80,000 sales reps. Within Europe, thePharmaceutical industry employs an estimated 200,000 people in marketing and sales.There are an estimated 11,700 hospitals, 115,400 Pharmacies and 1,090,000 doctors in Europe.The sums the industry spends are huge and is on the increase. Some key reasons for this are:Large numbers of new productsThe pipelines of companies are healthy, with over 30 completely new medicines hitting the market eachyear. In the fast moving therapeutic areas of gastroenterology and cardiovascular medicine, for instance,five or six new medicines are added each year. The result of this proliferation is that they all face thesame sales and marketing problem: how to create differentiation for their offerings.Blockbusters mean profitabilityCompanies stand to make the most profit from big product launches and ultimately achieve the elusiveblockbuster (sales of over $1 Billion) status. Intensive marketing and sales is the key to successfullyreaching this objective. 6 © Copyright 2011 Eularis

Executive SummaryReduced market exclusivityMany new products only have a few months of exclusivity before competing products threaten their sales.This contrasts to the past where an innovative product could dominate the marketplace for years (seeFigure A). Therefore, it is essential for companies to exploit the product to its maximum for this exclusiveperiod.Figure A: Shrinking Period of Market Exclusivity for Breakthrough MedicinesNew biotech playersBiotech companies are adding new products, which often need significant investment to compete head-to-head with big Pharma‘s products. 7 © Copyright 2011 Eularis

Executive SummaryAs detailing is the main method used by companies to gain market share (see Figure B) companies areinterested in methods that increase detail effectiveness.Figure B: How Pharmaceutical Companies Market Drugs $15.5 Billion marketing expenditures 2000TRADITIONAL METHODS CONVERGE WITH THE INTERNETThe Pharmaceutical industry has lagged behind other technology-driven sectors in the adoption of theInternet as a business tool. However, most companies now have an eBusiness department and Eularisexpects to see a more aggressive approach towards eMarketing. 8 © Copyright 2011 Eularis

Executive SummaryEularis has identified four drivers of use of the Internet in Pharmaceutical sales (eDetailing):• Most people within business and the professional sectors now use the Internet daily and it has become an integral part of working life. Virtually all doctors are connected to the Internet and are in a position to partake in online detailing programs. As connection quality improves, with the introduction of Broadband technology, Eularis expects the Internet to be used for increasingly complex functions.• One the most successful uses for the Internet is information dissemination. It also encourages responsiveness and allows companies to receive direct feedback from their customers. A good example of this is the newspaper/magazine industry where journalists can publish an e-mail address (usually on opinion pieces) and can get immediate feedback from the readers. Similar relationships can be built between Pharmaceutical companies and the medical profession.• Certainly within the US, it is now perceived that the number of sales representatives has reached near saturation point. Companies are reporting increasing difficulty in reps actually being able to see doctors and time of details is shrinking.• Running a large sales force is expensive. Internet-enabled detailing may be cheaper. eDetailing should also offer increased doctor interaction time and increased prescribing rates.The report looks at the environment surrounding eDetailing in the US and Europe. 9 © Copyright 2011 Eularis

Executive SummaryEularis has identified four drivers of use of the Internet in Pharmaceutical sales (eDetailing):TECHNOLOGY ADOPTIONMost people within business and the professional sectors now use the Internet daily and it has become an integralpart of working life. Virtually all doctors are connected to the Internet and are in a position to partake in onlinedetailing programs. As connection quality improves, with the introduction of Broadband technology, Eularisexpects the Internet to be used for increasingly complex functions.NATURE OF THE INTERNETOne the most successful uses for the Internet is information dissemination. It also encourages responsiveness andallows companies to receive direct feedback from their customers. A good example of this is thenewspaper/magazine industry where journalists can publish an e-mail address (usually on opinion pieces) and canget immediate feedback from the readers. Similar relationships can be built between Pharmaceutical companiesand the medical profession.SALES REPS AT SATURATIONCertainly within the US, it is now perceived that the number of sales representatives has reached near saturationpoint. Companies are reporting increasing difficulty in reps actually being able to see doctors and time of detailsis shrinking.CUTTING COSTS AND INCREASING ROIRunning a large sales force is expensive. Internet-enabled detailing may be cheaper. eDetailing should also offerincreased doctor interaction time and increased prescribing rates.The report looks at the environment surrounding eDetailing in the US and Europe. 10 © Copyright 2011 Eularis

Executive SummaryUNITED STATES LEADS THE WAYeDetailing was pioneered in the US. Virtually all the supplier companies are based in the US. Eularisestimates that all of the world‘s top ten companies are using some form of eDetailing.WHAT IS BEING OFFERED?Eularis examined which companies are offering eDetailing services. In the US there are some fairly wellestablished players already, but the market is becoming increasingly competitive as marketing servicecompanies and doctor portals enter the foray. Whether US eDetailing companies can cross the Atlanticand sell their services to European big Pharma remains to be seen. [Chapter 7]WILL EUROPE FOLLOW?It seems likely that European Pharmaceutical companies will follow the US and implement eDetailingprograms. Eularis believes the majority of the top ten companies in Europe are assessing its potential anda couple are already trying it. [Chapter 3]REGULATORY RESTRAINTSThere are barriers that hinder the development of eDetailing along the US model, in particular, regulatoryrestrictions that prevent sponsoring companies from offering doctors financial incentives for taking part ineDetailing. Whether European doctors are less accepting of eDetailing remains to be seen. [Chapter 4] 11 © Copyright 2011 Eularis

Executive SummaryUNDERSTANDING RETURN ON INVESTMENT (ROI)The main purpose of a detail is to increase prescribing rates for the relevant product. However, eDetailingmay also offer a lower operational cost necessitating the need to measure return on investment (ROI).Eularis has analyzed the various models used to calculate ROI and also the variables that must beconsidered. [Chapter 5]FUTURE PERSPECTIVESEularis assessed drivers and external factors that will influence the development of eDetailing. [Chapter8]STRATEGIC RECOMMENDATIONSEularis has made a series of recommendations for companies considering whether to employ an eDetailingsystem. [Chapter 9] 12 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?Detailing has about a 100-year history. In the early years of detailing, the representative, rather thanselling, was simply sharing the details about the available products. This arrangement allowed thephysician to retain his or her professional stature, yet obtain new information that would aid them intheir practice.Detailing remains a core part of any Pharmaceutical company‘s sales approach and has become a largepart of their promotional spend. This type of communication is familiar to doctors and the Pharmaceuticalindustry. It builds relationships between the company and the customer with the aim to influenceprescribing habits.Over the years, the number of sales representatives delivering these messages to doctors has increasedgreatly. Indeed, in the US, the total sales force of the top 40 Pharmaceutical companies has roughlydoubled over a 5-year period to around 63,000 (1994–1999), according to a Forrester report. Otherestimates suggest that this number is conservative, with the actual number of US sales representativestotaling 80,000 (including some 9,000 contract sales representatives).Table 1.1 US Sales Force Growth from 1996-2000(e) 13 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?The cost of employing this size of sales force is substantial – the average cost of a sales representative is$63,000 per year (plus sales training and detail aid material costs) and the total annual sales andmarketing expenses is around $15 Billion, resulting in the total expenditure on sales forces of $10 Billion,which clearly makes it the largest expenditure in the sales and marketing mix.Table 1.2: Estimated Sales Reps of Leading Contract Sales OrganisationsThe question that many companies are not asking themselves is: has traditional detailing ‗reached itszenith‘? Over the same period of sales force growth, the number of traditional detail visits to the doctorshas only grown by 15%i. In addition, 43% of the time, sales representative will not actually speak with thedoctor. Even when a sales representative speaks with the doctor, 87% of the conversation is less than 2minutes in length (with engaged contact often being 10–15 seconds). 14 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?Figure 1.1: Growth in Pharmaceutical Details (US)There is no doubt that detailing directly to the doctor is important but is there a more effective way todeliver messages and relationship build between sales representative and physician?WHY ADD „e‟ TO TRADITIONAL DETAILING?Whether the medical professional like it or not, doctors often rely on Pharmaceutical companies for druginformation. However, having time to see sales representatives is a limiting factor for doctors. Therefore,eDetailing provides the opportunity for Pharmaceutical companies to provide this interaction on thedoctors‘ terms, reduce sales force expenses without losing sales and continue to develop meaningful andproductive relationships with customers. 15 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?IS THIS APPROACH VIABLE?Three main factors will influence the success of eDetailing. These are:• Cost• Effectiveness• Physician acceptanceTypically, physician acceptance is the most important. According to Forrester, 75% of US doctors use theInternet and 80% have a computer at work. These doctors spend a lot more time seeking medicalinformation online than doing any other online activity, according to the report. Therefore, salesrepresentatives have competition in terms of medical information provision but it also shows thatelectronic delivery of medical information looks like a viable option. Moreover, of US doctors surveyed byDataMonitor, 90% wanted online detailing and only 3% have been offered the opportunity.To date the majority of online medical information offered to doctors by Pharmaceutical companies hasbeen static product information Web sites. This may be useful as a one-time visit but it does not engagethe physician, encourage them to return to the site and development a long-term relationship betweenthe company and customers. This is verified by the Forrester study where doctors ranked Pharmaceuticalproduct Web sites last with respect to perceived value and frequency of use — indeed more than 50% ofthe doctors surveyed had not visited a Pharmaceutical company Web site in the past 6 months.However, several pilots run by companies have found impressive return on investment as measured byincrease in number of effective calls, increased length of calls and increases in prescribing and is liked bydoctors. 16 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?eDetailing market research conducted with US doctors who have experienced both eDetailing andtraditional detailing showed that doctors found eDetailing:• more convenient than other media for obtaining information;• a better way to obtain needed drug information from Pharmaceutical companies;• helped establish a stronger relationship between the physician and the sales representatives and this relationship was equal to, or better than, the one they currently enjoyed with their existing non-e-sales representatives.eDetailing, when planned and implemented effectively, engages the physician, encourages repeat visitsand allows the sales representative to be more productive. Productivity increases are in terms of moreeffective sales calls each day (virtually and face-to-face), decreased costs and potentially increased sales(see Chapter 5: Return on Investment of eDetailing).It should be noted that eDetailing is not appropriate for all doctors, all products or all of the time.Pharmaceutical companies need to review its products, the lifecycle of each product, segment its doctorsand use a suitable approach with measurable return on investment. Moreover, it is expected tocomplement rather than replace traditional detailing.DIFFERENT eDETAILING FORMATSeDetailing simply means using Internet-enabled electronic technology in the detailing process; therefore,many formats are possible. The ‗e‘ represents the use of electronic technology and involves using thesetechnologies achieve the content of traditional non-eDetails, including educating the physician aboutproducts and interacting with the physician to answer questions regarding their individual informationneeds. It can also be used to offer samples, encouraging product use and increase prescriptions written. 17 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?Some of the current eDetailing activities being initiated by Pharma companies utilize integrated video-conferencing capabilities, Internet access and high-speed telecommunications lines that allow doctors tointeract with distant sales representatives at any time. However, there are a number of options that areavailable and are detailed below.1. Virtual Live eDetailingWith the virtual live eDetailing system, the doctor (chosen by the Pharmaceutical company) is provided apre-configured personal computer with all the necessary applications pre-loaded and web-cam to see andspeak with a sales representative.The doctor is provided with incentives (monetary) and, in return, is contracted to telephone all thePharmaceutical company representatives enrolled in the system at a minimum set frequency per month inexchange for receiving the hardware and software. The physician initiates the eDetail session and hascontrol over the timing of the call (both in terms of when to call and length of call). A typical interactivesession lasts around 10-15 minutes.During the call, the physician and sales representative (via a video-conferencing system) view and listento a multimedia presentation about the promoted product and have the opportunity to discuss any points.During the eDetailing session, the physician would be able to interact with the sales representative viavideo and audio in real time. This type of system is provided by iPhysicianNet. A variance on this approachis a system where only the sales representative is viewed, or only audio and data slides are shown,depending on the wishes of the physician. These systems are provided by CRX Solutions. 18 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?2. Scripted eDetailingThe scripted eDetailing enables the physician to use a personal computer to launch a sponsored learningapplication, often consisting of a series of interactive screens with multimedia information about thepromoted product, including research evidence, clinical practice guidelines, prescribing information andpatient advice. The doctor ‗walks through‘ the screens, usually with an honorarium incentive. This systemmay be on the Internet or on a closed Intranet.The software used is usually a form of customized profiling software so that individual doctor preferencesare taken into account during the session. This system does not have live interaction between thephysician and the sales representative. Questions and requests from the doctors would be available via ane-mail link with an option for telephone call/visit from a sales representative. The Physicians Interactive,Clinnix, and MyDrugRep systems all utilize this approach.3. eDetailing WebsiteseDetailing Websites have usually been developed by dot-com portals. These systems vary depending onappropriate physician targets, physician prescribing behavior segmentation and information supplied tophysicians on the site implementing them.4. Messaging to physicians‘ handheld computersMessaging is not being used yet, but will be the growth area of the future. Companies expected to launchproducts are ePhysician and PocketScript as well as the established players like Hewlett Packard. 19 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?5. Pharmaceutical company eDetailing systemsPharmaceutical company eDetailing systems are provided by a Pharmaceutical company with pre-loadedequipment to the chosen physicians. This does not involve a third-party eDetailing vendor company. Thesales team train the physician on the use of the system. These systems can be a variant of any of thesystems above.CRX Solutions creates individualized software solution systems for customization and use by aPharmaceutical company for their chosen physiciWan targets. This system also allows integration with theexisting IT platforms (Siebel, Autonomy, BroadVision, etc.) so that the data found can be easily integratedwith other data sets (including territory management systems and IMS data for ROI analysis).Other variants of this system are Pharmaceutical sales representatives‘ ―Call Me buttons‖ installed on thephysicians‘ computer or on a Web site. These systems require either a call centre link or a link to a salesrepresentatives‘ mobile phone.In these systems, the physician (who is already pre-identified through a verification system) can click onthe ―call me‖ button that immediately activates the specific sales representative responsible for thesystem to call the physician concerned. Choices as to whether they want the call immediately or in somespecified time interval (e.g. 15 minutes, 30 minutes, etc.) can be chosen. An example of this type ofsystem (in a non-Pharmaceutical setting) can be seen at the NTL site in the United Kingdom:http://www.askntl.com/locales/gb/en/. 20 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?COMMUNICATION CONSIDERATIONSPharmaceutical companies must keep in mind the factors of control and personal interaction whenevaluating the various options available. Questions that require consideration include:• What degree of control is preferred?• How do you wish for the sales representative to interact with your customers?• What is the aim of your eDetailing campaign? Communicating a marketing message? Interacting with customers? Controlling the interaction?The answers will aid your decision-making.THE ADVANTAGES AND DISADVANTAGES OF DIFFERENT FORMATSThere are advantages and disadvantages to most of the systems described. When deciding on the mostappropriate option, the following considerations are useful:• What are your objectives?• Who owns the system?• Who are your customers? Do you have control over which customers can be used by eDetailing?• Who else has access to these physicians?• Is there any interaction with the sales representative?• Does the system link to existing territory management systems?• Can this system track ROI?• Does this system fulfill your objectives? 21 © Copyright 2011 Eularis

CHAPTER 1:What Is eDetailing?In general, eDetailing systems based in the physician‘s office offer a great advantage (whetherPharmaceutical company-owned or eDetailing vendor-owned) as they are offering a valuable propositionto the physician and to the Pharmaceutical company. Vendor-owned systems are already in-situ and somesystems allow you to select physicians to target, while portal-based vendor systems rely on the portal‘scommunity of physicians, which may not be the target physicians (see Chapter 3: EU Implementation,Subsection: How to choose highest ROI target physicians).A system wholly owned by a Pharmaceutical company would confer an advantage over vendor-ownedsystems as companies are not competing with each other for time. An additional advantage of aPharmaceutical-owned system is that it can be tied into all other Pharmaceutical eBusiness platforms and,therefore, provide more accountability in terms of ROI terms (See Chapter 5: Return on Investment ofeDetailing, Subsection: How can these metrics be used to calculate ROI (i.e. formulas?).Table 1.3 How eDetailing could improve Pharmaceutical companies‟ marketing 22 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveIt is interesting to look at doctor behavior in the US in relation to detailing. Eularis looked at some of theevidence from US companies.Research from Physicians Interactive shows that 85% of physicians go through eDetailing programs aftersurgery hours, probably about 50% on their home computers. The length of the eDetail is on average 10minutes.Other reports suggest that eDetailing sessions last about 17 minutes between 8am - 6pm and 28 minutesbetween 6pm - 9pm.UK PHYSICIANS‟ ATTITUDES AND ACCEPTANCE (SURVEY FINDINGS)Background and ObjectiveEularis conducted a web-based survey with General Practitioners in the UK to determine:•What GPs think about Pharmaceutical sales repsand•What GPs think about the concept of eDetailing.Overview of Eularis‘ findingsMany GPs enjoy meeting with the sales representative in person and being able to discuss other relevantitems. It is considered social and does not appear to interfere with daily schedules once an appointment issecured with the rep. 23 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveThe average amount of time spent with a rep is anywhere between 6 and 20 minutes while only 48% ofGPs cancel an appointment 1-10% of the time. The meeting with their reps appears to be a useful portionof their time spent. The majority of GPs state they review their prescribing of the discussed productsafter a rep meeting.Many GPs would not prioritize eMaterial as highly as they would a face-to-face meeting. As such, 50% ofGPs are not interested in receiving promotional material electronically.eDetailing appears to be a completely new idea in detailing for the medical community in the UK. Only 4%of those interviewed had ever heard of eDetailing and the majority - 75% - were unsure of its intendedmeaning. It appears to be an immature arena and careful, continued research should be consideredbefore implementation in order to secure a healthy mind-set for adoption.GPs appreciate that eDetailing would possibly be a convenient method of information gathering. However,many are concerned that the use of computer hardware/software would actually cause more headachesthan benefits.Another area in which eDetailing could be beneficial is the amount and detail of information that could beshared with the GP. One respondent stated that ―its advantage is the ability to ask specific, detailed,technical questions (e.g. cost-effectiveness of a new product) which I often find reps have littleknowledge about‖.Overall, GPs are interested in the idea of eDetailing. However, depending on their computer comfortlevel, some are apprehensive that the benefits of eDetailing will not outweigh the possible frustrationwith compatibility and reliability of the technology. In addition, GPs appear to be concerned about thepriority they would give to electronic promotional material. 24 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveDetailed FindingsSample• Sample Size N = 204• All were General Practitioners• Males = 86% and Females = 14%• 90% Were employed full-time and approximately 10% were part-time• GPs were spread consistently across England, Scotland, Wales and Northern Ireland• Majority were qualified as GPs in the 70‘s (34%) and 80‘s (45%)• Survey took place in September 2001• Survey organized by Medix UK on behalf of EularisQuestion by question (see appendix for questions asked)Figure 2.1. Approximately how many Pharmaceutical sales reps do you see In a typical month?Approximately 60% of GPs typically see 1 - 5 Pharmaceutical sales representatives a month while 25% see6 - 10. 25 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.2 How often do you have to cancel or reschedule your appointments with representatives?One third of GPs state they do not have to reschedule appointments with representatives while themajority only have to reschedule 48% of the time. Rescheduling does not appear to be a concern whenGPs undertake this endeavor. A visit from a sales representative tends to be important to the GP. 26 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.3 What is the average length of a representative‟s visit?50% Of GPs state that the average visit constitutes 6 - 10 minutes of their time while a third find that theaverage visit comprises 11 - 20 minutes in total. The amount of time taken per visit generally appears tobe quite consistent.Figure 2.4. In general, do you find visits from reps useful? 27 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveOver 70% of GPs find sales rep visits ―sometimes useful‖ to ―occasionally useful‖. Many agree that thevisits keep them up-to-date on the company‘s products (17%), introduces them to new products (12%) aswell as being a way of keeping them in touch with the Pharmaceutical industry (11%).Figure 2.5 After a representative‟s visit, do you ever review your prescribing of the product(s) discussed?A large majority, close to 80%, of the GPs interviewed state that they review their product prescribingbased on the information discussed with the reps. It appears that the information presented to the GPs isheavily weighed and beneficial to their practice. 28 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.6. Which companies have the best sales reps?The top 3 Pharmaceutical companies cited as having the best sales reps are (respondents were asked tochoose from a list of 26 well known companies):1) AstraZeneca - 57%2) GlaxoSmithKline - 55%3) Pfizer - 37% 29 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.7 Would you be interested in viewing promotional information electronically?Figure 2.8 Reasons not to receive promotional information electronically? 30 © Copyright 2011 Eularis

CHAPTER 2:Doctor Perspective50% Of GPs state that they would rather not receive promotional material electronically when asked in ayes/no question. Some reasons cited for their negative response were that they do not prioritise e-mailmaterial received (62%) and that GPs prefer to meet reps in person (21%).Figure 2.9 Have you ever heard of eDetailing?Overall, GPs were not confident with their knowledge of eDetailing. Only a small minority - 4% - hadheard of eDetailing while the majority - 75% - were unsure of the correct and/or exact definition. 31 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.10. Which eDetailing system „live‟ or „virtual‟ appeals to you the most?‗Virtual eDetailing‘ was considered much more appealing to GPs when asked compared with the ‗LiveeDetailing‘ description. However, 26% of the GPs stated that neither of the choices were particularlyappealing.Figure 2.11 If you were to take part in either a „virtual‟ or „live‟ eDetail, which of the following options would appeal to you? 32 © Copyright 2011 Eularis

CHAPTER 2:Doctor Perspective40% Of GPs preferred to be sent specific questions by e-mail without the need of a rep visiting when askedwhich option would appeal to them if they were to take part in either a ‗virtual‘ or ‗live‘ eDetail. Manywere also interested in using e-mail for Q&A sessions while only 15% were interested in seeing the salesrep on a screen / 2 way ‗real time‘ conversation.Figure 2.12 Who would you prefer to deal with in an eDetail?Just over 50% of the GPs interviewed were not concerned if the usual representative would be involved inan eDetail.Figure 2.13 How would you choose to take part in an eDetail? 33 © Copyright 2011 Eularis

CHAPTER 2:Doctor Perspective72% Of GPs would take part in eDetail at their own convenience as opposed to 14% that stated they wouldwant to choose scheduled appointments.75% Of GPs state that they would require free hardware to act as an incentive to their adoption ofeDetailing.Figure 2.14. What do you consider to be the main advantage of eDetailing?63% Of GPs found that the main advantage in eDetailing lies within the convenience in scheduling as wellas its usefulness as a time saver - 18%. 34 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.15 What do you consider to be the main disadvantage of eDetailing?45% Of GPs enjoy the social interaction with sales reps and do not want it replaced by a computer. Inaddition, 27% perceive that the technology involved in eDetailing would not live up to their expectations. 35 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveFigure 2.16 What time of day would you be most likely to use an eDetailing facility?GPs anticipate that they would employ the use of eDetailing at various times but 23% state ‗After 9pm‘and 14% chose ‘12 - 3pm‘. 36 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveUnaided ResponsesIn the unaided responses (N=33), 27% shared their interest in eDetailing while 15% stated they wereuninterested. In addition, 18% were concerned about possible computer frustration / hardwaredifficulties.A few unaided responses include:―A very new and interesting concept. It would certainly allow more flexibility in receiving productinformation and would also allow me to tailor what I need to know much better‖. Interested―The very thought of eDetailing appalls me‖.―An interesting concept; however, with modem links as they are, I suspect that there would beconsiderable problems interacting without interference and break-up due to poor download‖. TechconcernResearch RecommendationsConduct trial eDetailing testing with similar / same population. It is recommended that the sampleinclude an equal mix of computer abilities.Conclusions Drawn From ResearchDrawing on the primary research, Eularis found that:• Currently, physicians have fairly good relationships with Pharmaceutical sales reps,• There are obstacles to be overcome before an eDetailing system would be widely accepted by GPs. 37 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveRelationships with Pharmaceutical Sales RepresentativesEularis found that, in general, UK general practitioners have a productive relationship with salesrepresentatives from the Pharmaceutical industry. Over 50% see more than five reps a month indicatingthat physicians are willing to meet with reps. Physicians generally think that the quality of informationthat they get from reps is good and does affect prescribing.Table: 2.1 Summary of the position of the average UK primary care GP towards Pharmaceutical sales reps(average means over 65%)Strategic AdviceEularis believes that physicians value the social interaction and information they get from meeting reps.After all, a rep may be the only well person they meet all day. There is definitely still a role for the salesreps knocking on surgery doors.GP Attitudes to eDetailing May Present ObstaclesAt the time of writing, Eularis found that only 4% of physicians have heard of eDetailing. Three-quartersare unsure about the term. Although this is a Pharmaceutical trade term, it does show that any companywishing to implement an online detailing program would have to educate physicians. 38 © Copyright 2011 Eularis

CHAPTER 2:Doctor PerspectiveThere could be some resistance from physicians to the very concept (see Table 2.2). Exactly half of thephysicians whom Eularis questioned said they would not be interested in using the Internet to viewpromotional information.Eularis recommends that companies wishing to implement an online detailing program start by identifyingthose physicians that are already keen to try this method.Table 2.2 Summary of doctors‟ attitudes that could be a barrier to eDetailingEularis has summarized the advantages and disadvantages of eDetailing to the doctor in Table 2.3.Table 2.3 Pros and Cons of eDetailing from physicians point of view 39 © Copyright 2011 Eularis

CHAPTER 3:ImplementationGLOBAL LESSONSCurrently most eDetailing initiatives are being run in the US and the reasons for this are clear: largestPharmaceutical market, more prescriptions, more physicians and greater Internet penetration. It isclearly the market to pilot first as the benefits found there are likely to be largest in ROI terms. IMSHealth (2000) report that the breakdown of prescriptions by region is:• 39.6% - US• 25.1% - EU• 16.4% - JapanThe Rest Of the World (ROW) combined comes nowhere close to meeting these proportions of prescriptionsales. Also, the majority of case studies showing strong ROI are in US also.Some of the lessons learnt so far are:• Physicians want to initiate the eDetail on their time terms• Physicians value the relationship with their rep• Physicians prefer inter activity.KEY QUESTIONS PRIOR TO IMPLEMENTATIONDetermining whether or not eDetailing is appropriate or not for a specific country or product is a key issuethat must be considered prior to developing or buying eDetailing capabilities. Factors affecting whether toinitiate eDetailing as well as which form of eDetailing to use will include:• drug stage in drug lifecycle and• segmentation of physician prescribing patterns.By examining these carefully, a path will start to become clearer as to whether and how to implement thesystem. 40 © Copyright 2011 Eularis

CHAPTER 3:ImplementationOBJECTIVES OF EdetailingThe first step in any strategy is to set business objectives. The types of objectives set for implementationof eDetailing systems are:• To increase the length of detail• To increase the effectiveness of the detail• To increase the number of prescriptions• To decrease sales force costs without losing effectivenessIncreasing Length of DetailA DataMonitor report states that industry experts agree the average length of a traditional detail call isaround two minutes in length. However, reports from companies utilizing different technology styles ofeDetailing have found that the average length of eDetails in the US is lengthened dramatically. ThePhysicians Interactive system was reported, by Dr. Gerber (General Manager of Physician Interactive), toincrease the length of a detail to around ten minutes. Using a video-conferencing style format, one USPharmaceutical company found that its average eDetail calls lasted around 17.4 minutes between thehours of 8am to 6pm and 28.6 minutes between 6pm and 9pm. This shows that, at the very least, anyform of eDetailing is showing increases of a minimum of 5 times the traditional detail. A key question toask is whether this is novelty and this length effect will wear off, or whether it will persist.Increasing Effectiveness of the DetailSince the physicians were actively involved for significantly longer and ended the call when they feltready to end it, it‘s believed that the effectiveness of each sales call was higher. The relationshipbetween IMS data monitoring of number of prescriptions written and the length of the sales call has shownthat this relationship does seem to exist, as the results have been found to be highly significant withtherapy response modeling finding increases in prescribing from 12.5% to 85%. 41 © Copyright 2011 Eularis

CHAPTER 3:ImplementationIncreasing Number of PrescriptionsThe overriding objective of any eDetailing activity is to increase the number of prescriptions written. Thismust be measured to ensure that there is, in fact, a significant return on investment. By dividing thetarget physicians into two groups (a study group receiving eDetailing and a control group receivingtraditional Detailing), this can be measured relatively easily. Do baseline measurements in both groupsusing IMS sales data or independent market research data and then implement eDetailing in the studygroup (who are also exposed to eDetailing rather than traditional detailing, as well as to all other salesand marketing activities). After a set period of time, measure again the number of prescriptions in eachgroup to determine whether there is a statistically significant increase in prescriptions written in thestudy group versus the control group. For more detailed information on ROI measurement, please turn toChapter 5: Return on Investment of eDetailing.HOW TO CHOOSE EDETAILING OBJECTIVES BY PRODUCTBy examining the product lifecycle, Pharmaceutical marketers can determine the most effectiveobjectives for the eDetailing projects. For example, for products early in their lifecycle, eDetailing maybe considered an adjunct to all the traditional detailing and all other marketing and promotional spends.For products late in their lifecycle competing for market share, eDetailing can be a way to extend theterritory of the sales reps. In this instance, a sensible way to do this would be to market the drugs tophysicians in rural or less densely populated areas, which clearly would be far less expensive than sendinga real life sales representative (travel time and costs). Another useful application of eDetailing is tophysicians who refuse to see sales reps at their offices. They may be happy to be involved in eDetailingfrom their home or out of office hours, or during office hours if it is remote and on their time terms. 42 © Copyright 2011 Eularis

CHAPTER 3:ImplementationHOW TO CHOOSE HIGHEST ROI TARGET PHYSICIANSThe eDetailing implemented should be focused on the physicians that will give the highest ROI.Figure 3.1 Which physicians will generate the best ROI according to prescribing behaviour?It is crucial that the eDetail targets the doctors that would provide the strongest ROI rather than simplytargeting any doctors. By targeting doctors without segmenting them appropriately, there is strongevidence that much eDetailing investment would be wasted and strong ROI wins would not be achieved.One method is to consider physicians‘ prescribing patterns in terms of number of prescriptions written aswell as how loyal they are to the brand in question. Doctors who are already high brand prescribers areunlikely to be a good target for this type of program as the eDetailing is aiming to get a strong ROI win.Since this group are already high brand prescribers, they are clearly already happy with the product and,whatever marketing is being done, do not need additional money being spent on influencing theirprescribing behavior as the change would not necessarily be so great in ROI terms. 43 © Copyright 2011 Eularis

CHAPTER 3:ImplementationThe best groups for quick ROI wins are clearly doctors who are high category volume prescribers but lowbrand prescribers as this group have a large patient group appropriate for the product but are notprescribing your product. By converting this group into higher brand prescribers, strong and fast ROI gainscan be made in clear, bottom line revenue terms.The DataMonitor report also discusses this concept well and outlines the drugs for diabetes as an example.A GlaxoSmithKline marketer could classify a certain doctor as a high class prescriber (endocrinology drugs)but a low brand prescriber (writes prescriptions for Avandia as well as Rezulin and Glucophage).DataMonitor points out that high volume/low brand prescribers yield the greatest ROI in the short-termbecause influencing high volume prescribers‘ behavior has the greatest potential to impact the bottomline.Following this model, doctors who are medium category volume prescribers but low brand prescribers alsohave a significant patient group appropriate for the product but are not prescribing your product. Byconverting this group into higher brand prescribers, strong and fast ROI gains can also be made (althoughnot as good as the high category group). The gains made with this group are more likely to be thestrongest measurable changes since this group are often subjected to less ‗noise‘ than the high categoryvolume group.However, if one is seeking ROI wins over a longer term (as opposed to quick wins to show the board tojustify eDetailing spend), the low volume prescribers are an interesting target group. They tend to beignored by most Pharmaceutical marketing and are a group that could combine to bring strong wins.Clearly, since they are low volume, the cost of the eDetailing program would need to be low to justify thisspend. However, in time, they could certainly add up to a collective increase in prescribing. 44 © Copyright 2011 Eularis

CHAPTER 3:ImplementationAs Pharmaceutical companies develop their eDetailing programs, more ROI models of which doctors totarget, and concrete results from their case studies, will emerge. However, for the moment, the analysisprovided here seems to more compelling. 45 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesPERTINENT RULES AND REGULATIONSeDetailing has been pioneered in the US and, as mentioned, is already in use there. Whether itsuccessfully drifts across the Atlantic will partially depend upon the ease with which eDetail systems canbe employed within existing legislation. It is important to be realistic about the European climate for thePharmaceutical industry which, compared to the US‘s, is a lot less free. The issue of ‗direct-to-consumer‘of prescription medicines clearly highlights the difference in approach. In the US, it has been perfectlylegal for some time to advertise prescription-only drugs to the general public. In contrast, in WesternEurope this is still illegal and only very slowly are the regulatory barriers being eroded.Advertising and marketing of medicines is heavily regulated in Europe, either by the European Council‘sDirective 92/28/EEC or national legislation. As eDetailing uses recent technologies and new forms ofcommunications, there could be problems with existing legislation governing the advertising ofprescription medicines.Another big difference between Europe and the US is comparative freedom that US companies have toreward doctors. For example, doctors taking part in programs run by Physicians Interactive must write apractice prescription before receiving a ‗reward‘ and reinforcement package, and iPhysicianNet providesdoctors with computer hardware to take part in eDetailing. These methods to entice doctors to use ortake part in a detail would be frowned upon in Europe, probably would break codes of practice and evenbreak legislation.Eularis has examined some of the regulatory issues directly affecting any eDetailing facility. 46 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesThe legislation of the 16 countries of the Union falls directly under the EC‘s; for those states outside theEU, national legislation will apply.The regulation of medicines‘ advertising in the United Kingdom provides a useful example of how cautiouscompanies must be when designing an eDetailing facility. Eularis has examined the various regulations andguidelines and contacted the relevant parties. Eularis posed questions about eDetailing for which theanswers were not already clear.THE MEDICINES CONTROL AGENCY (MCA)The Medicines Control Agency (UK) regulates and enforces the supply of medicines in the UK. The legalbasis for the control of advertising of medicines is based on the Medicines (Advertising) Regulations 1994and the Medicines (Monitoring of Advertising) Regulations 1994.These fall under the European Directive 92/28//EC on the advertising of medicinal products for humanuse. This covers all methods of advertising, including electronic and, therefore, eDetailing.The regulations concerning this topic are succinctly outlined in MCA Guidance Note No. 23 ‗Advertisingand Promotion of Medicines in the UK‘.Eularis wrote to the Medicines Control Agency to clarify a number of points surrounding eDetailing. 47 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesThe main question Eularis asked the MCA was:Q. Can the internet be used to promote prescription products to medical professionals?The answer is ―Yes‖, provided the site is ―wholly or mainly‖ directed at health professionals (regulation13(1) Advertising Regulations). This may involve confirming that the end-user is a health professional. Inparticular, a site offering an eDetailing facility must not be linked to other Web sites that are mainlyaimed at, or promoted to, members of the public.Q. What is the definition of a visit by a sales representative?This is an important question as the Guidance Notes states in Clause 4.7(2):―[Sales] Representatives should, during each visit, give to all persons whom they visit, or have availablefor them, a copy of the SPC data sheet for each product which they promote at that visit‖.The MCA defines a ‗visit‘ as a ―physical encounter‖ which does not include virtual interaction.Q. Can SPC information be delivered electronically?Provided that the SPC information meets the requirement of Schedule 2 of the Advertising Regulations,they can be delivered electronically.However, when a representative visits a prescribing professional (see above), the MCA considers that SPCinformation cannot be provided electronically and a physical document must be at hand. 48 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesQ. Can companies involved in eDetailing supply the necessary equipment (i.e. a computer) to doctors?The MCA replies,―Regulation 21 of the Advertising Regulations, which makes provision for inducements and hospitality, willalso apply to eDetailing. By regulation 21(1), a ‗gift, pecuniary advantage or benefit in kind may not beprovided unless it is ‗inexpensive and relevant to the practice of medicine or Pharmacy‘. The MCA regardsinexpensive as meaning a gift, etc which does not cost more than £6. The supply of such equipmentwould, in our view, amount to a gift, pecuniary advantage or benefit in kind and would be prohibited bythat provision, as it would cost more than £6‖.Therefore, companies cannot offer equipment to doctors to take part in eDetailing.Q. Can a health professional receive an incentive for taking part in an eDetailing Session?Gifts under £6 in value are acceptable provided they are relevant to the practice of medicine orPharmacy, but no other incentive can be used.The MCA suggestions that it would like to review an example of an eDetailing systems before it goes live.THE BRITISH MEDICAL ASSOCIATIONEularis made informal enquiries to the BMA to ask about Pharmaceutical sales/marketing and eDetailing.The BMA does not deal with either issue and thus has no reports or views on eDetailing. The BMA‘s Website, which is very comprehensive, makes no mention of this or any similar subject. 49 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesTHE GENERAL MEDICAL COUNCILThe GMC is responsible for the registration of all doctors in the UK and ensuring that the high professionalstandards are upheld.Interaction with Pharmaceutical companies‘ sales & marketing operations is covered in the GMC‘spublication ‗Good Medical Practice‘ (Second edition July 1998, para 53 & 54) and reads as follows:―Accepting gifts or other inducements -You should not ask for or accept any material gifts or loans, except those of insignificant value, from companies that sell or market drugs orappliances. You must not ask for or accept fees for agreeing to meet sales representatives.Hospitality -You may accept personal travel grants and hospitality from companies for conferences or educational meetings, as long as the main purpose of theevent is educational. The amount you receive must not be more than you would normally spend if you were paying for yourself‖.Doctors are expected to abide by the codes laid out in Good Medical Practice.Eularis made informal enquires to the GMC‘s Standards department and found that:• eDetailing is, in general, a new term and not widely used within the GMC;• Any online sales/marketing activity would still be covered by the existing Good Medical Practice codes;• As the code specifically focuses on gifts and financial inducements (paragraph 53), the GMC points out that there could be a problem if Pharmaceutical/eDetailing companies provided the necessary computer equipment free of charge;• The GMC also points out that an online link to sales representatives may restrict the number of companies that a doctor interacts with. However, the GMC does not see it as their role to have a position on this issue. 50 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesConclusionsSupplying doctors with high value computer equipment to allow eDetailing access could contraveneparagraph 53 of the Good Medical Practice code.Offering doctors a fee/incentive for involvement in a minimum number of eDetailing sessions would alsocontravene the code. (Note: this is not a formal view from the GMC)THE ASSOCIATION OF THE BRITISH PHARMACEUTICAL INDUSTRY (ABPI) AND THE PRESCRIPTIONMEDICINES CODE OF PRACTICE AUTHORITY (PMCPA)The PMCPA was established by the ABPI in 1993 to operate the Code of Practice for the PharmaceuticalIndustry 2001 which covers the advertising and promotion of medicines to prescribing professionals.Compliance with the code is obligatory for ABPI member companies. The PMPCA receives approximately130 complaints a year. The latest edition of the Code of Practice came into effect on 1st July 2001.Copies can be obtained from the ABPI.Eularis has examined the Code of Practice in detail and its implications for both Live and VirtualeDetailing. Eularis had informal discussions with the ABPI‘s regulatory unit to understand how eDetailingsystems could be operated in the UK without breaching the Code.We have assumed that a company offering an eDetailing option will make the utmost effort to complywith all relevant aspects of the Code of Practice. Eularis has identified a number of issues to consider thatare particular to eDetailing and the relevant clauses of the Code. 51 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesClear Indication That a Web site Contains Promotional MaterialWhen a doctor logs on to the Internet or eDetail application, he/she will probably be faced with a webpage offering a number of options. The icon for click-through to an eDetailing session must be preciselylabelled and clearly state that the doctor is about to enter a site with promotional activity. There must bethe option to continue or discontinue. Clause 10.1 of the Code states, ―Promotional material and activities must not be disguised‖.For example, an icon labeled ‗click here for new product information‘ could be misleading as the phraseis ambiguous and could apply to a news service or an updated independent compendium of medicines.The icon must also clearly indicate that the promotion is sponsored by a Pharmaceutical company,otherwise it could be in breach of Clause 9.9, ―Material relating to medicines and their uses, whether promotional in nature or not, which is sponsored by a Pharmaceutical company, must clearly indicate that it has been sponsored by that company…‖.and Clause 9.9 Supplementary Information, Declaration of Sponsorship, ―The declaration of sponsorship must be sufficiently prominent that readers of sponsored material are aware of it at the outset‖.In summary, the doctor must know that he/she is about to enter a product detail site that is sponsored bya Pharmaceutical company. 52 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesPrescribing Information Is Easily AvailableOnce the doctor enters the eDetailing website there must be a precisely labeled and easily accessible linkto the prescribing information and summary of product characteristic (SPC). The Code is explicit that allpromotional material must be accompanied with prescribing information that is easily identifiable. Clause4.1 states, ―The prescribing information must be positioned for ease of reference…..‖and in Clause 4.1 Supplementary Information, Electronic Journals states, ―The first part of an advertisement in an electronic journal - such as the banner - is often the only part of the advertisement that is seen by readers. It must, therefore, include a clear, prominent statement as to where the prescribing information can be found‖.An eDetail, whether Live or Virtual, will constitute an advertisement and, thus, prescribing informationmust be clearly labeled and easily accessible.Provision of summary of product characteristics is also important, as Clause 15.8 states:―Representatives must provide, or have available to provide if requested, a copy of the summary of product characteristics for each medicine which they are to promote‖.In an eDetail situation, SPCs must be readily available. A clearly visible button labeled ‗SPC‘ should be onscreen which would allow the doctor to print out the SPC or have it e-mailed to him/her. In a LiveeDetail, the rep should be able to put the SPC information on screen or e-mail it upon request.In addition, black triangle symbols should be included on relevant products in accordance with the Code(Clause 4.3). 53 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesIn summary, the first page of an eDetail site should have the words ‗prescribing information‘ and ‗SPC‘clearly displayed with click-throughs or, in a Live situation, the rep can provide this informationimmediately. The prescribing information must conform to the Code and cannot be treated anydifferently to paper-based material.A company must not offer a doctor an incentive or payment for taking part in an eDetailing session.Clause 15.3 of the Code explicitly states that it is unacceptable to offer doctors incentives or payments totake part in an interview: ―Representatives must not employ any inducement or subterfuge to gain an interview. No fee should be paid or offered for the grant of an interview.‖Although the clause refers to representatives, we believe that virtual eDetailing (which does notnecessary involve a rep) is also covered by this clause.However, it is common practice for reps to offer doctors or administrative staff promotional gifts(covered under Clause 18). A new clause (15.3) in the Code separates the delivery of such gifts from anobligation to see the representative.Clause 15.3 Supplementary Information, Items Delivered by Representatives states:―Reply paid cards, which have been offered to health professionals or appropriate administrative staff, should explain that there is no obligation to grant the representative an interview when the item is delivered. This is to avoid the impression that there is such an obligation, which would be contrary to Clause 15.3 which prohibits the use of any inducement to gain an interview‖.In Eularis‘ view, the application of this clause to eDetailing means that any gifts a company wishes tooffer a doctor must not be dependent upon whether the doctor takes part in an eDetailing session. 54 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesIf gifts are available through an eDetail site, these should be offered and delivered without the doctorhaving to complete a Virtual or Live eDetailing session.In summary, incentives cannot be used to encourage doctors to take up eDetailing. Gifts must not bedependent on doctors involvement in eDetailing.KEY QUESTIONS ANSWEREDQ. How can a company publicize its new eDetailing service?As an eDetail service is likely to be a very new concept, doctors will have to be informed about thelaunch. This could be tricky as the Code expressly forbids the use of the telephone as a sales tool withoutfirst getting the doctor‘s permission.Clause 9.8 states:―The telephone, telemessages, email, telex and facsimile machines must not be used for promotional purposes, except with prior permission of the recipient‖.This potentially poses problems for companies wishing to inform doctors about eDetailing, which is atelephone-based activity. Companies are effectively barred from offering an eDetail service until doctorshave granted permission for companies to use the telephone and e-mail. 55 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesThere are conventional methods of obtaining permission that could be used:• Existing representatives, whilst meeting doctors, could mention the eDetail service and obtain (written) permission from the doctor• Letters, with a permission form, could be sent to doctors introducing the new service.In summary, when offering an eDetailing service for the first time, companies must think about the Codevery carefully; written permission from the doctor is probably the safest route to take.Q. Can a Pharmaceutical company, or a third party working on its behalf, offer a payment orincentive to doctors to switch from physical interaction with sales representatives to eDetailing?The answer is ―No‖. Companies cannot offer any incentives to doctors for the reasons outlined above.Q. Can eDetailing sessions be scheduled using e-mail or telephone?Once a doctor has granted permission to a company to use electronic communications (Clause 9.8), acompany may wish to contact the doctor to notify them of a live eDetail appointment, times of a webcast, etc. In order to comply with the Code it is important that the doctor‘s permission specificallyincludes a question such as ―Do you want to receive updates about this eDetail service by e-mail?‖.Attention should also be drawn to sections of the Code that limit how many times a single rep can call ona doctor in a year. The Code (Clause 15.4 Supplementary Information) recommends a maximum of threevisits unless doctor has requested a visit. Thus, contact with a doctor about eDetailing should not beexcessive. 56 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesQ. Can promotional material be sent via e-mail?Promotional material can be sent via email providing the company complies with Clause 9.8.Q. Can a company, or a third party working on its behalf, supply doctors with equipment necessaryfor eDetailing?Some doctors wishing to take part in eDetailing may need some specialist computer equipment. Forexample, some doctors partaking in Live sessions could need a web-cam.The Code has very strict guidelines covering the use of gifts, goods or services stipulated in Clause 18.Individual gifts are limited in value to no more than £6, so it is unlikely that any computer equipmentwould fall within this price range. Also, giving a doctor a web-cam would be clearly linked to apromotional activity which is not allowed.Q. After an eDetail session, doctors may be offered to take part in a market research study. Will thisbreach the code?Follow-up market research, using the Internet, could be a key element for companies offering either aVirtual or Live eDetailing service.Companies conducting market research must be aware that market research is not actually promotional oris not perceived as an inducement for the doctor to take part in an eDetail session. Of course, marketresearch must be unbiased and is covered in more detail under the British Pharmaceutical MarketResearch Group‘s guidelines (see the British Pharmaceutical Market Research Group section). 57 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesClause 10.2 states: ―Market research activities, post-marketing surveillance studies, clinical assessments and the like must not be disguised as promotion‖.Thus, market research must be bone fide. Caution should also be applied to the selection of candidatesfor market research. By surveying doctors taking part in eDetailing there is already some pre-selection ofcandidates. Essentially companies must be able to prove that they are carrying out genuine marketresearch.As it is common practice to reward doctors for taking part in market research, it is important to separatethe eDetail session from the market research, otherwise it could be taken that the market researchelement is an inducement.Clause 15.3 states:―Representatives must at all times not employ any inducement or subterfuge to gain an interview. No fee should be paid or offered for the grant of an interview‖.If the option to take part in market research is offered directly to the doctor after every time he/sheengages in an eDetail session, then this could very easily be construed as an incentive (a fee) to gain aninterview (this also applies to virtual eDetail) and would be in breach of the code. 58 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesEularis suggests that, to comply with the Code, the following steps be taken:• The separation of an eDetail session from invitation to take part in a market research survey. In practice, companies should issue the invitation a few days after the promotional session by e-mail, post or telephone.• The invitation to take part in a survey should not be offered to every doctor after every eDetail session. Only a (random) selection of those who have completed a session should be invited. This avoids guaranteeing a fee (by taking part in market research) for engaging in an eDetail session.In Virtual eDetailing, E-mail Question and Answer Sessions Could Come Under ScrutinyVirtual eDetailing allows the doctor to contact a sales rep by e-mail, perhaps to ask a specific questionabout the product referred to in the promotion. An e-mail Q&A session differs from verbal discussionbetween a rep and doctor in that a record of the discussion is much more likely to be kept.Thus, a rep e-mailing a response to a doctor‘s request must be careful that the content of the reply doesnot contravene the Code. For example, Clause 7.10 states: ―Exaggerated or all embracing claims must not be made and superlatives must not be used except for those limited circumstances where they relate to a clear fact about a medicine…..‖.Reference to scientific literature should probably include links to the relevant article.Q. In a Virtual eDetail, are there any issues about the quality/type of information that could causeconcern?As the screen size is limited (in comparison to paper), it is very important that each web page displays thecontent clearly so it does not mislead. 59 © Copyright 2011 Eularis

CHAPTER 4:EU Legal and Regulatory IssuesQ. If an eDetailing link is established which, over time, favors one company or excludes othercompanies‟ sales representatives from approaching doctors, would this contravene the Code?Behavior by a company which effectively excludes other companies with similar products from dealingwith a doctor is not covered by the Code. However, this is very likely to be seen as anti-competitivebehavior and, thus, will be covered by the UK‘s competition laws.Table 4.1 Summary of how eDetailing activities are regulated (UK) 60 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingWHAT KIND OF METRICS SHOULD BE MEASURED?As with any business planning process, the metrics used in calculating ROI are directly related to theobjectives initially set). Therefore, the metrics most commonly used are:• Increasing length of detail• Increasing effectiveness of the detail• Increasing number of prescriptions• Decreasing sale force costs without losing effectiveness.It is important to remember that ROI implies the concept of time because ‗return‘ happens over time. So,what an ROI calculation really asks is ―What is my return on investment over time?‖. Without looking attime, the ROI cannot be calculated.With regard to eDetailing, Eularis has indented two ‗types‘ of time:A. Short period (probably 2/3 months) for a defined product marketing campaign.B. Long-term, taking into account all investment in technology and infrastructure. Software investments could be costed over a 12-24 month period (i.e. a positive return must be achieved by the end of this period). 61 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingHOW CAN THESE METRICS BE USED TO CALCULATE ROI (I.E. FORMULAS)What is needed before an ROI analysis can be attempted is a time-frame and a baseline. In this example,it would be figures for revenue/profit from a detailing campaign. The metrics can then be plugged intothe formula to determine ROI. Eularis suggests the following:pRx = profit from prescriptions written as the result of eDetailing (could use revenue)Rx = baseline profiti= initial investment in eDetailing technologiesn= number of eDetails completedc= cost per eDetail excluding initial investment (pRx – Rx) = a (profit attributed to eDetailing) (i / n) + c = b (actual cost per eDetail) bxn= c (cost of campaign) (a / c) x 100 = % ROIThis formula may contain certain assumptions but it probably is a good place to start. By measuring theincremental profits from increases in prescriptions written as a result of eDetailing (this will come fromIMS or Synavant data), and then dividing these by the cost of the eDetails added to the development ofthe program (start-up costs), a figure can be reached. 62 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingNaturally, assumptions are made within this formula. The cost per eDetailing session is not necessarilycompletely straightforward since:• the Pharmaceutical company may negotiate price breaks after a specified number of eDetails have been performed• contracts with eDetailing vendors may state that the Pharmaceutical company will only be charged for fully completed details.However, it is best to try and find the average cost per eDetail for the purposes of an ROI calculation.On a campaign-by-campaign basis, the following calculation can be used to compare a traditional detailagainst an eDetail. The time period must be the same for both.This is a short term ROI calculation to use right at the end of a campaign. 63 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingLONG TERM EFFECTS OF MARKETINGAs mentioned, ROI is dependent upon the time-frame used. However, it is important to remember thatthe total effect of promotion is not just realized in the immediate period after a campaign (or detail); itaccrues over several months.A major study by Dr. Scott Nelson into ROI found that with traditional detailing, 50% of ROI occurs withinthe first month but it takes a further nine months for the total ROI to be achieved. The study, whichcompared detailing with other forms of promotion, found (in contrast) that with direct-to-consumeradvertising, only 10% of ROI effect takes place in the first month, 72% in the first year, and it takes a full2 years for the total effect to accumulate. What the dynamics are of advertising effectiveness as far aseDetailing is concerned remains to be seen.WHO SHOULD CALCULATE THIS?Currently, the options available for calculating the ROI are:• the Pharmaceutical company themselves (often with the assistance of an independent third-party firm such as Eularis in conjunction with IMS Pharmaceutical data capture group), or• an eDetailing vendor company.Typically, this scenario involves some input from both parties outlined above, depending on the type ofeDetailing system employed. 64 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingCurrently, partially due to a lack of internal resources and perhaps partially due to a lack of Internetexpertise, Pharmaceutical companies tend to outsource their ROI role to independent groups. This alsoadds integrity and impartiality to the data collection and analysis process.Vendors tend to be charged with tracking the length of the interactions, time of day and who they arewith – which is also verified by the independent market research firms employed who also track these(just to be sure) - and then make an ROI calculation for the Pharmaceutical company.WHEN SHOULD IT BE CALCULATED?A set time period should be decided upon following which the ROI calculations are made each month. Thismust be carefully considered as the effects may not be immediate. Eularis suggest bimonthly calculationson an ongoing basis.OTHER CALCULATIONS: BRAND LOYALTYOne area of ROI calculation that is not often discussed but is of relevance is brand loyalty. In Chapter 3,we touched on the point that high volume/low brand prescribers yield the greatest ROI in the short-termbecause influencing high volume prescribers‘ behavior has the greatest potential to impact the bottomline. Therefore, if companies can convert these high volume/low brand prescribers into prescribers withincreased brand loyalty, this will increase the strength of the relationship between the physician and thesales representative and enhance the doctors emotional prescribing. 65 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingThis whole area of emotional branding and brand loyalty is an important one to consider in eDetailing. Itis highly relevant to products in certain stages of their lifecycle, which should be considered whenchoosing which products and when to implement any eDetailing initiatives. Branding makes choices easierfor the physician faced with many choices. With several brands to choose from, doctors are more likely toturn to a brand that they know and trust as this serves as something trustworthy and recognizable andsaves them the time and trouble of sorting through all the choices. Therefore, with the ever-increasingrange of drug choices available, there is now an even greater need than ever for companies to createstrong emotional branding.A ZS Associates paper (Bernewitz) discussed the whole lifecycle relationship to emotional branding. Theystated that before a product is launched, and shortly after launch when not much is known about aproduct, doctors base their decisions on emotional branding (or the trust they have in the company orrep). Then, a few months after launch, as more data becomes available and the physician has already hadsome experience with the product, the decision becomes more rational, branded based (clinical data,etc).Later in the lifecycle, doctors tend to revert back to emotional branding as they are used to the productand trust it and have a good emotional relationship with the product, sales rep or company. eDetailingworks best where the content is information-rich and many complex facts need to be communicated withgraphs, etc.Therefore, Eularis believes the best lifecycle time for a product to utilize eDetailing would be just afterlaunch, when the complex rational branding messages are being communicated. 66 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingMisconceptions about branding actually sometimes stands in the way of effective brand management ingeneral. However, the differences between rational and emotional branding must be understood clearlyfor eDetailing implementation.Clearly, Pharmaceutical brands do clarify exactly what clinical performance data (rational branding) is tobe expected from their drug. Nevertheless, it is well known that with most top tier competingPharmaceutical products, there are usually certain factors in each drug profile that provide advantages ordisadvantages over their competitors.Therefore, the choice of which drug to prescribe is not a clear-cut one based on clinical performance dataalone. ‗Emotional‘ factors can also be involved, making the brand an important part of the overallprocess. If the physician knows and trusts a certain brand name and it is associated (either quantifiably oremotionally) with high-quality clinical data, then it has a strong competitive advantage over unknownbrand competitors.No matter how objective doctors are, there will always be a certain emotional bias towards the knownbranded product versus a similar unknown product – all other things being roughly equal. The bottom lineis that a rational decision is one based on maximizing value and value can be based on an objective or asubjective decision. 67 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingCASE STUDIES AND HOW ROI WAS CALCULATEDCase Study 1: Physicians Interactive eDetailing Study (US)BackgroundA large Pharmaceutical company with a number two brand in its therapeutic class (which was near theend of its patented life) had been supported throughout its lifecycle with aggressive traditional detailingand sales/marketing (direct mail, journal advertising, physician education programs, etc). Despite this,market research had discovered that the doctors had very low awareness about the product‘s key sellingpoint (USP). Since the product was nearing the end of its lifecycle, the expense of additional sales forcetime could not be implemented. The company turned to Physicians Interactive to develop an eDetailingprogram to position the product as well as to educate the doctors about the product‘s USPs. The companyselected high category, low prescribers as their target doctors.Implementation and ResultsSince the Pharmaceutical company had little prior experience with the Physicians Interactive tool, itdeveloped a comprehensive market research program to measure the effect on prescribing habits,physician understanding of brand USP and attitudes towards eDetailing. They tracked a control group ofdoctors, a study group exposed to a single eDetailing program and a third study group exposed to twosequential eDetailing programs.The market share of new prescription doctors who participated in the two sequential eDetailing programsincreased significantly from a 3.2% peak to a 9.8% peak within 4 months. Market share was more than 3share points ahead of the control group at the end of the evaluation period (7 months). 68 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingThe study group exposed to only a single eDetailing program had results similar to the control group,suggesting that multiple sequential program exposures seemed to be the key to changing prescribingbehaviors. By calculating the ROI [based on measuring the incremental profits from increases inprescriptions written as a result of eDetailing (from IMS data) and then dividing these by the cost of theeDetails added to the development of the program], it was found that the eDetailing programs profitcontribution from high prescribing doctors created an ROI of 480%.Follow-up interviews were conducted using the telephone with 100 participating doctors and thesedoctors were asked to choose key brand attributes. The study groups of doctors who had received eDetailsranked the top attributes higher than the control group showing a higher recall amongst those doctorswho had received eDetailing. 60% Of the doctors who had received eDetailing also reported learningsomething new from the program. Considering that this particular brand had been detailed in thetraditional manner for 6 years prior to this, and had also had its usual blend of traditional advertising andmarketing applied to this, the results were impressive.Physician Reaction79% Of doctors, detailed with ‗e‘, rated the program favorably and believed that the company kept themwell informed. They said that the eDetailing program was a convenient source of information. The doctorsin this study spent an average of 12 minutes being eDetailed. 68% Of the doctors rated the eDetail betterthan a traditional detail due to it being easier and more convenient. The flexibility of the eDetail programwas rated highly, showing that the doctors preferred to be in control of when and where they weredetailed. Using the eDetailing program, 60% of the doctors requested samples and 40% requested atraditional sales call, suggesting that the program seemed to support the traditional sales call effectively. 69 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingSummaryThe study concluded that financial return was shown and the eDetail had the ability to be used effectivelyfor:• New product introductions• New indications• Latest clinical study results• Label changes• Medical education targeting high potential doctors• Smaller brands needing greater visibility• New competitive threat responses• Sales force capacity limitations• Persistency and compliance programs• Reaching ‗no-see‘ doctors (rural and sparsely populated areas)• Products nearing patent expirationCase Study 2: iPhysicianNet eDetailing Study(US)BackgroundiPhysicianNet is the only company to offer live videoconferencing for face-to-face details. Data from thecompany, from a 6 month 1,130 doctor study, showed encouraging returns for the sponsoring company. 70 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingResultsThe cost of running a detail through iPhysicanNet is less than traditional sales reps. In a study involvingNovartis, it was found that sales reps using the iPhysicianNet live video detailing system:• Are able to complete 13 calls per day compared to 8 for field reps,• Spend 9 minutes per call compared to 3 for field reps,• Deliver 2.7 details per call compared to 1.6.Novartis also found that virtual reps cost Novartis $18,000 less per year than field reps and their cost perminute is only $14 against $58, yielding a total cost per detail of $48 compared to the traditional $106.Measured against prescribing results, the bottom line was that Novartis reported an ROI 20% higher thanfor field reps.However, the research also shows that 58% of primary care doctors prefer to have calls equally dividedbetween field calls and so-called e-calls.Case Study 3: Aventis‟ eDetailing Study (Germany)BackgroundThe German section of Aventis has run the only large scale eDetailing project in Europe in two productareas: central nervous system (virtual eDetailing) and orthopedic/rheumatology (live edetailing)vii. Theyare also planning another eDetailing project in the antibiotic area with Ketek and in the diabetes areawith Lantus. 71 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingImplementationZinapse.deThe backbone of the central nervous system pilot is a dedicated website (www.zinapse.de) for productsfor the central nervous system and not currently covered by reps. The site is endorsed by the GermanAssociation of Neurologists. The development of www.zinapse.de took time as neurologists were e-maileda newsletter six months before launch in February 2001. The site offers services such as CME programs,PMS studies, VIP lounge, sample ordering, incentives and market research. Neurologists are givenincentives to use the site by a system call MediMiles, which are granted for a taking part in productquizzes, viewing case studies and taking part in market research, etc. MediMiles can be redeemed foritems such as ordering full articles (rather than abstracts seen on site), professional printing of onlinegenerated .pdf-lithographs or even special service upgrades at zinapse.de amongst other things.Arava/ActonelThe backbone of the orthopedic/rheumatology pilot is a live video-conferencing style web-cam (in themode of iPhysicianNet) connecting orthopedic and rheumatology physicians for promotion of the productArava/Actonel. The aims of this pilot were to:• Gain experience for further eDetailing• Increase sales and ROI• Improve sales force skills referring to new media• Keep up with (future) customer requirements• Improve image of Aventis as technology leader and first partner for physicians. 72 © Copyright 2011 Eularis

CHAPTER 5:Return on Investment of eDetailingResultsZinapse.deThe Zinapse site has been online since February 2001 and is now getting over 4,000 visits a month,approximately 140 visits a day from their target physicians. Data was not provided on how ROI wasmeasured or on what increase in prescriptions of this product was due to this eDetailing program.Arava/ActonelThe duration of this pilot study was from September 2001 to July 2002. The lowest call duration wasfound to be 8 minutes. The doctors enjoy using this system as they report that they find it confersadvantages such as:• Transfer of information at the desired time• Simplified and immediate transfer of all scientific material• Contact with medical rep is maintained• Physician may contact the medical department directly• Possibility to attain eCME at home• Video-conferencing• Possible participation in online-drug monitoring, market research, etc.The results, in terms of the specific set objectives, are not yet public.SummaryAventis is pleased with the results, intends to expand its eDetailing pilots and has recently announced anextension of its live, video-conferencing style pilot of Arava/Actonel to the product areas of Ketek andLantus. 73 © Copyright 2011 Eularis

CHAPTER 6:Technology IssuesWhen planning the type of technology required for eDetailing, CRx Solutions provided Eularis with a seriesof questions that companies should ask before making a technology investment in this area:• Has the company invested in any eDetailing initiatives to date? Describe.• Were they delivered by third party portals/providers, or within corporate web environment?• What is the product scope of the proposed initiative – eDetailing solution for single brand? Pilot test (proof of concept) with select brands? Development of corporate eDetailing platform (eg, iMarketplace linked to corporate site) for any/all company brands?• What therapeutic areas and customer types will be targeted?• What is the geographic scope – global, regional, single market?• What types of brands does the company believe will benefit from eDetailing – any/all, under-funded, launch phase, mature, low sales, etc?• What are the expected outcomes of eDetailing – improved ROI, cost reduction, supplement traditional marketing mix, extend reach to select customers, maintain competitive advantage, etc?• How was ROI measured in this instance?• What type of eDetail style is desired – static pages, flash animation, multimedia, live rep session, etc?• Which business units are supporting/sponsoring the development of eDetailing initiatives – individual brand teams, entire marketing organization, eBusiness department, etc?• What is the time line for launching the eDetailing initiative? Will there be specific phases?• How is eDetailing initiative funded? Fixed or incremental based on functional requirements?They recommended that the three elements required to build an eDetailing system are consideredseparately. These are:• eBusiness platforms and software,• Customer Relationship Management (CRM) Integration and Process,• Content Management Systems Integration and Workflow. 75 © Copyright 2011 Eularis

CHAPTER 6:Technology IssuesEBUSINESS PLATFORMS AND SOFTWAREWhen planning the eBusiness platforms and software, the following questions should be considered:• Has the company invested in (or planning to invest in) any of the following types of enterprise eBusiness software solutions (architecture and analytics): – Customer Relationship Management (CRM) – Sales Force Automation (SFA) – Content Management Systems (CMS) – Other eBusiness Platforms: Enterprise Portal Apps, eCommerce, Call Centre, On-line Sample Distribution, eMarket Research, Wireless Delivery, etc?• At what stage of implementation are these eBusiness technologies?• Are these technologies deployed globally, regionally or in individual markets?• Have eBusiness technology platforms and processes impacted the activities of brand teams using the Web? Positively or negatively?• Will any of these technologies, tools and processes be used to support the eDetailing initiative?• Is the company seeking recommendations for enterprise eBusiness technologies to support eDetailing programs and other digital initiatives?CUSTOMER RELATIONSHIP MANAGEMENT (CRM) INTEGRATION AND PROCESSWhen planning the CRM Integration and Process, the following questions should be considered:• What information is currently loaded into CRM databases?• What digital touch points do you see as important for CRM data collection and analysis?• What tools are you using to support CRM analytics?• Will eDetailing initiatives feed the CRM systems?• How are CRM databases structured currently?• Are CRM databases decentralized by brand with data marts and warehouses for enterprise analytics? 76 © Copyright 2011 Eularis

CHAPTER 6:Technology IssuesCONTENT MANAGEMENT SYSTEMS INTEGRATION AND WORKFLOWWhen planning the Content Management Systems Integration and Workflow, the following questions shouldbe considered:• How is promotional content currently delivered to Web? Describe the processes and tools used to support.• What are the highlights within the current process?• What are the pain points within the current process?• Will the eDetailing solution mandate significant change in the process model? If so, how receptive are the individuals for the change?• Are there any metrics to measure the effectiveness of the current process model?• What is the magnitude of the volumes handled in the current process – transactions, content base, user base, user activity, etc?• What factors will influence the process model to be the best in the industry?• Identify the priorities for the process model – responsiveness, accuracy, industry best, etc?• What type of security and access restrictions need to be imposed on the contents?• Is there common content across the business units that can be re-purposed for effective management?• What are the sources and frequency of content providers? 77 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisOverview of some of the leading or innovative companies developing or offering eDetailing services:„PURE‟ eDETAILING PLAYERSThese companies are start-ups with eDetailing type services as their main product.• ePocrates (US)• iPhysicianNet (US)• MarketRx (US)• MyDrugRep (US)• Physicians Interactive (US)• RxCentric (US)• TargetRx (US)• Zestica(Sweden) 78 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisePocrates Inc.120 Industrial RoadSan Carlos, California 94070USATel: +1 650.592.7900Fax: +1 650.592.6995E-mail: info@epocrates.comBackgroundePocrates was founded in 1998 by Richard Fiedotin and Jeff Tangney with venture partners Sprout Group,Draper Fisher Juvetson, Interwest Partners, Three Arch Partners and Bay City Capital.ServicesThe company‘s slogan is ―ePocrates is the leading provider of real-time information delivered to the pointof care‖. ePocrates differs from other eDetailing companies as it specializes in handheld devices fordoctors. Currently, there are 340,000 users including 165,000 doctors using ePocrates services, making itthe largest handheld physician network in the US.Users receive information on Palm handheld computers which are updated regularly through the internet.The first product called ePocrates RXTM was launched in November 1999 and has 260,000 users. It is acomprehensive clinical drug database and includes information on drug interactions. For those without ahandheld device, ePocrates can supply its own version and offer discounts to doctors who agree to takepart in market surveys. The other product is ePocrates IDTM, an information resource for infectiousdiseases. 79 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisKnown CustomersIn September 2001:Aventis Pharmaceuticals agreed to sponsor a pilot program whereby 500 primary care doctors andallergists would receive ePocrates drug reference guides which contained data on safety topics such asindication specific dosing, adverse reactions and drug interactions for 99 percent of the most commonlyprescribed drugs.AstraZeneca agreed to use the DocAlert® system to send out clinical news targeted to key specialties. theDocAlert® allows delivery of customized messages by specialty and geographical area.The institute for Safe Medication Practices (ISMP) signed a deal to deliver information through theePocrates network. The ISMP is a non-profit organization that provides independent reviews of medicationerror. The FDA Medwatch uses the ePocrates network to disseminate safety alerts, recalls andwithdrawals.OutlookBy building the largest handheld network of doctors, ePocrates plans to ensure that the informationresides with the patient, rather than on the desktop. Their doctors and engineers work together todevelop intuitive applications for mobile computing platforms. ePocrates works with a diverse array ofpartners to deliver content and services to doctors. Partners include Pharmaceutical companies,Pharmacy benefit managers, Pharmacies, contract research organizations, device companies, generalnews and content companies as well as leading academic institutions and organizations. 80 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisiPhysicianNet (US)9977 N. 90th Street #300Scottsdale, Arizona 85258USATel: +1 (480)368 2768 103E-mail: info@ipni.comBackgroundFounded by John Benson in 1996, iPhysicianNet was the first company to offer live, face-to-face videodetailing connections in doctors‘ offices.ServicesiPhysicianNet pioneered an evolutionary complement to traditional sales detail calls. It provides face-to-face video-conferencing between the sales representative and the physician. Doctors participate at theirconvenience, initiating calls on a monthly basis. The calls last an average of 8 minutes. The company hasaggressively signed agreements with 9,300 primary care doctors to install its video detailing system intheir private offices (it had completed 7,500 to date of the research). Under the terms of the agreement,doctors have to take part in a certain number of detailing sessions. Hitachi Data Systems supplies theequipment required in exchange for a percentage share of future revenue that the iPhysicianNet derivesthrough the installed unit.iPhysicianNet also has an agreement with contract sales outfit PDI, which provides sales reps andoutsourced call centre facilities to iPhysicianNet‘s clients. 81 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisCustomersThe iPhysicianNet primary care network is limited to 12 Pharmaceutical clients. On 1 September 2001,iPhysicianNet announced contracts with eight of the top eleven Pharmaceutical companies includingAstraZeneca, Aventis, Lilly, GlaxoSmithKline, Merck & Co, Novartis, Pharmacia and American HomeProducts.OutlookiPhysicianNet wants to expand the pool of primary care doctors signed up to its network. There are plansto launch specialty networks in areas such as neurology and cardiology. Other revenue streams will derivefrom organizing market research and delivering patient education materials and product information.There are plans to roll the system out internationally. 82 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisMarketRX.com1011 U.S Route 22 West2nd Floor, BridgewaterNew Jersey 08807USATel: +1 908 541 0045Fax: +1 908 541 1595E-mail: info@marketrx.comBackgroundMarketRx.com is a start-up company which provides interactive marketing to healthcare professionals.ServicesiDetailing SM is a Web-based application that delivers interactive, multimedia product promotions andmarketing services to doctors. Additional physician inquires are instantly answered by the customerservice centre using a variety of Web-based or call-back technologies. iDetailing is an automated toolbased on the Application Service Provider (ASP) model. It is fully hosted by marketRx.com and does notneed software or hardware investment.Known CustomersNone known. 83 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisMyDrugRep (US)4590 MacArthur Blvd. Suite 200Newport BeachCA 92660 USATel: +1 949 798 1000Fax: +1 949 798 1099E-mail: support@mydrugrep.com www.mydrugrep.comBackgroundFormed in January 2000 by Quang Pham. So far, the company has raised $16 Million from Sprout Group,Hummer Winblad Partners and Siebel Systems. The management team includes executives from leadingcompanies in the Pharmaceutical industry such as Bristol-Myers Squibb, AstraZeneca, Genentech, Merck &Co. Inc., Medical Economics, PriceWaterhouseCoopers and McKinsey. The company currently employees 42people.ServicesMyDrugRep has three services:• Virtual Detail - launched in August 2000 and has over 4,000 completed sessions a quarter.• Sales Force Synergy – which integrates eDetailing programs with existing sales forces. This can inform a sales rep when a doctors has been detailed.• Call Center Partnership – provides a routine call centre for doctors taking part in Virtual Detail.MyDrugRep has a strategic alliance with Salu Inc. which runs specialty hubs in areas including allergy,neurology, dermatology and cardiology. Salu has access to over 30,000 doctors. Through the MyDrugRep,doctors will be able to request drug samples and patient education material. Salu specialists will earnrewards for participating in the online detailing program. MyDrugRep has a partnership with iPhysicianNetto provide Web-based detailing services. 84 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisPhysician Interactive (US)2401 Commerce DriveLibertyville, IL 60048USATel: +1 800 794 6757Fax: +1 847 918 8977E-mail: info@pi-edetail.comwww.eDetail.comBackgroundPhysicians Interactive (PI) is a division of Allscripts Healthcare Solutions (NASDAQ:MDRX).ServicesPI delivers physician education programs. No scheduling is required and the service is available 24/7.Doctors are prompted through a ten minute interactive program on the Internet or the phone using voiceresponse and receive Pharmaceutical product information. As a reward for completing the session,doctors can choose a medically-related item sponsored by Pharmaceutical companies. The companyclaims to have completed over 14,000 eDetails.Known CustomersPI has signed contracts with Pharmacia, Boehringer-Ingelheim, J&J and TAP to supply Internet detailingamongst others.OutlookIn June 2001, PI and Physicians Online (POL), a medical information and communications network fordoctors, signed a strategic alliance whereby PI‘s products will be featured as POL‘s preferred provider. 85 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisRxCentric325 W. 38th Street, 17th FloorNew York, NY 10018USATel: +1 212 629 7711Fax: +1 212 868 6319E-mail: sales@rxcentic.comBackgroundRxCentric was established in June 1999 by Kevin Raidy and Sean Gaddis and received $2.2 Million financeto develop a CRM platform for the Pharmaceutical industry. Milestones in the company‘s developmentinclude:• March 2000 – signed a co-marketing agreement with Ventiv Health, a contract sales outfit.• April 2000 – raised $14 Million in series B financing. Signed up 1,000 doctors.• June 2000 – acquired Doctors Net Access, bringing physician base to 15,000.• August 2000 – implemented first generation online detailing package with Dura Pharmaceuticals.• October 2000 – launched two physician communities: the Primary Care Channel and the Urology Channel.• March 2001 – signed a deal with MedManage Systems Inc. which provides doctors with samples on demand.ServicesRxCentric provides a number of services in this arena and now has a base of more than 25,000 doctors. 86 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisOnline detailing system:• eSampling – requests are received and then mailed or hand delivered• eCME – an online multimedia edition package which is broadcast and archived• eEvent – doctors can access promotional events online• QuickSurvey – an online market research serviceRxCentric also provides services for Pharmaceutical sales forces by offering dedicated portals andbroadcast facilities for a sales force.Known customersTo date, RxCentric supplies ten Pharmaceutical companies with online marketing products, four of whichare in the ‗top ten companies‘ worldwide.RxCentric has partnered with the following organizations: MedManage Systems, Facts and Comparisons,HealthStream, The Health Exchange, MedPanel, Covance, MD Net Guide, Screaming Media, AmericanCollege of Cardiology, American College of Allergy, Asthma and Immunology and American College ofChest Physicians. 87 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisTargetRx (US)220 Gibraltar Road, 2nd FloorHorsham, PA 19044USATel: +1 215 444 8700Fax: +1 215 444 8701E-mail: info@targetrx.comwww.targetrx.comBackgroundFounded in 2000 and headed up by Micheal J. Luby, who worked for Merck & Co. for ten years in sales andmarketing positions. TargetRx received $12 Million of series B funding from New Enterprise Associates andDomain Associates.ServicesTargetRx provides a range of eDetailing services to US registered doctors. A key part of TargetRx‘soffering is the opportunity for doctors to participate in market research, for which they are compensated. 88 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisZestica (Sweden)Grev Turegatan 10SE-114 46StockholmSwedenTel: +46 733 119632E-mail: austin.wilson@zestica.comBackgroundBased in Sweden, Zestica is Europe‘s only dedicated eDetailing company. Zestica is pitching itself as theEuropean alternative to US supplies of eDetailing services.ServicesDetailingDesk© is a platform based on ‗narrowband‘ technology, allowing it to be used in existinginfrastructures. The technology stays in the background as there is no downloading or installationrequired. All that is required is Internet access and a telephone. The physician is sent a URL via e-mail.After the physician clicks on it, a two-way interactive Web-session is initiated, with a productpresentation via Web at the same time as the rep talks to the physician.Zestica claims that DetailingDesk© will complement existing promotional channels used by an existingfield sales force. The platform is not dependent on the number of doctors signed up to the platform, sothe Pharmaceutical company can target and select the doctors the company wishes to target, rather thandoctors delivered by the vendor.Known customersNone known. 89 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisSERVICE COMPANIESThese companies offer many services but have an interest in eDetailing:• Aptilon (Canada)• Dendrite (US)• CRX Solutions (US)• DoctorsNet (UK)• InfoMedics (US)• Medsite Inc (US)• Onmedica (UK)• Quintiles (Global)• Synavant Inc (Global) 90 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisAptilon1435 de Bleury Street,Suite 805 Montreal, Quebec H3A 2H7CanadaTel: +(514) 844-8866Fax: +1 (514) 844-8267www.aptilon.comBackgroundFormed in 1995. Received $5 Million in funding in April 2000 from Citizen Group and CapitalCommunications CDPQ. Announced that head count would increase from 60 to over 400 by end of 2002.ServicesAptilon offers e-marketing programs through ReachNettm.OutlookAptilon‘s foray into Europe has not been so successful, as most of its activities have been quietly closeddown. 91 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisCRX Solutions Inc.Tel: +1 908-231-9559Fax: +1 908-231-9029www.crxsolutions.comServicesCRX Solutions creates an individualized, customized software solution system that allows any of theapproaches identified above. This system also allows integration with the Pharmaceutical companies‘existing IT platforms (Siebel, Autonomy, BroadVision, etc) so that the data found can be easily integratedwith other data (including territory management systems and IMS data for ROI analysis).The CRX Solutions approach allows individual Pharmaceutical companies to buy one system and customizethe same system in different countries, in different languages and with different doctors according totheir needs. 92 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisDendrite (Allscripts)(only UK address given)Forum One, Station RoadTheale, Berkshire RG7 4RAUnited KingdomTel: +44 118 932 7600Fax: +44 118 930 4570www.dendrite.comBackgroundDendrite was founded in 1986. Its headquarters are in New Jersey (USA) and it employs over 1,300 peopleworldwide. It supplies software to over 150 companies in 57 countries.ServicesIn April 2000, Dendrite signed a co-marketing agreement with Allscripts to market an eDetailing program.The product is co-marketed in the USA and exclusively by Dendrite internationally. The eDetailing productis delivered through Dendrite‘s medical information destination portal MD-Connect.com. Capabilities ofMD-Connect.com include: eRep and eMed contacts via voice-over technology, Web-based clinical and peergroup meetings, clinical trial data collection for phase four trials, and data search and retrieval systemsfrom sponsored company‘s files. 93 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisDoctorsNet (UK)Tel: +44 (0)1235 828403Fax:+44 (0)7092 219031www.doctors.net.ukBackgroundDoctorsNet is a UK portal for general practitioners with 58,000 members.ServicesIn August 2001, DoctorsNet launched an online Continuing Medical Education (eCME) program. The initialmodules will cover Irritable Bowel Syndrome, Menorrhagia, Erectile Dysfunction and Hepatitis. eCME hasaccreditation from the Royal College of General Practitioners and a certificate is issued on successfulcompletion of each module.DoctorsNet is actively seeking commercial sponsors for modules. Sponsors will be able to use the eCME torun online market research.OutlookDoctorsNet‘s large membership base places it in a strong position to capitalize on the interest ineDetailing. In September 2001, former president of Innovex - Europe, joined as commercial director in aclear signal that the company is to expand revenues from the Pharmaceutical industry. 94 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisInfoMedics, Inc.12 Gill Street, Suite 2000WoburnMA 01801Tel: 781.938.6700Fax: 781.938.5303E-mail: webmail@infomedics.comwww.infomedics.comBackgroundInfoMedics was founded in 1995. Finance comes from United HealthCare, Johnson & Johnson, Sutter HillVentures, North Bridge Venture Partners and Merrill Lynch Ventures.Services OfferedInfoMedics does not offer a classic eDetailing package. Rather, it uses the Internet to gather feedbackfrom patients using a drug. Program sponsors, mostly Pharmaceutical companies, can then access thatinformation both online and through paper-based reporting and analysis mechanisms.The Brand Accelerator™ measures patient experience prior to and after the use of a Pharmaceuticalproduct. A patient enrolled in an InfoMedics program, often invited to do so by his or her physician, thenprovides baseline information to InfoMedics through the Web (or telephone or paper form). 95 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisWhile using the product for a determined period of time, the patient answers an identical series ofquestions about their experiences with the product. Often, their current satisfaction is compared withprior treatments.At the end of the course of therapy, the patient provides final feedback. Reports are then generated andsent to the participating doctors in the format most comfortable to each. The reports show a comparativeanalysis of the patients‘ baseline assessment and change after their use of the product. InfoMedics alsocreates an aggregate report for each of the participating doctors that shows the pool of participatingpatients and overall improvement of the group. Aggregate reports for the Pharmaceutical manufacturerscan be generated by sales representative, by sales territory and by MCO, and an aggregate national reportcan be created across the entire participating population.Known CustomersInfoMedics serves many Pharmaceutical companies including Alcon, American Home Products - Wyeth-Ayerst, Amgen, Aventis, Bayer, Galderma, GlaxoSmithKline, Janssen, Johnson & Johnson, Novartis, Pfizer,Pharmacia, Roche and Schering-Plough. 96 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisMedsite Inc.59 Maiden LaneNew York, NY 10038USATel: +1 212 417 9500Fax: +1 212 797 7480www.medsite.comBackgroundMedsite.com is a major physician portal offering an abundance of services and information sources mostlysponsored by organizations that sell to doctors such as publishers, office suppliers and software. It wasfounded by Sundeep Bhan who is the CEO.ServicesMedsite has reached over 200,000 doctors through its Medsite Rewards™ program and has transactionalonline relationships with over 125,000 doctors and 50,000 medical students. Using this experience,Medsite has developed a range of services that provide mutually beneficial interactions between doctorsand the organizations that want to reach them.In addition to Medsite Rewards™, services include online detailing, medical education and marketresearch. Medsite delivers these services in partnership with Pharmaceutical and biotech companies,medical device manufacturers, contract sales organizations, contract research organizations, medicalpublishers and medical advertising agencies. 97 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisMedsite Rewards distributes an average of 20,000 reward certificates each month to high prescribingdoctors who can redeem their certificates towards a large collection of medically related books andsupplies.Known CustomersInteractive Grand Rounds (IGR) is a free online CME service. These 10-15 minute case studies withinteractive multiple choice are sponsored by grants from Pharmaceutical companies such as Fujisawa,Merck & Co, Pfizer and Wyeth-Ayerst.In December 2000, Medsite announced that its Physician Access division has sold online projects to morethan a dozen Pharmaceutical companies, including eight of the 10 largest manufacturers in the US with acombined value of more than $15 Million.OutlookIn December 2000, Medsite raised $28 Million of equity financing, bringing the total raised in the year to$80 Million. Investors include Argentum Capital Partners II L.P., Bain Capital‘s Brookside Fund, InvestCarePartners Limited Partnership, I-tech Capital, Morgan Stanley Dean Witter Venture Partners, ReutersHoldings Switzerland S.A., Walnut Investment Partners L.P. and Weiss, Peck & Greer L.L.C. The companyaims to be in profit by the end of 2001. 98 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisQuintilesEUROPE - Innovex (UK) LtdInnovex (UK) Ltd - Innovex HouseMarlow Park Marlow, Bucks, SL7 1TBUnited KingdomTel: +44 (0)1628 491500Fax: +44 (0)1628 491555BackgroundQuintiles Transnational is a huge global company providing a full range of drug development andcommercialization services to Pharmaceutical and biotechnology industries.Founded in 1982 with its headquarters near Research Triangle Park, North Carolina, Quintiles is a memberof the S&P 500 and Fortune 1000. It has 18,000 employees in 39 countries.ServicesIn the US, QUINTERNET Details is under development. In the UK, Innovex is working with a Clinnix todevelop an eDetailing system.Known CustomersIn the UK, Novartis is rumored to be a client. 99 © Copyright 2011 Eularis

CHAPTER 7:Vendor AnalysisSynavantHeadquarters Europe3445 Peach Tree Road NE Swan HouseSuite 1400 24 Bridge StAtlanta LeatherheadGeorgia 30326 Surrey KT22 8BZUSA United KingdomTel: +1 404 841 4000 +44 1372 389 300Fax: +1 404 841 4111 +44 1372 389 303inquiry@synavant.comwww.synavant.comBackgroundSynavant is a spin-off from IMS Health, which combined its Strategy Technologies and Clark O‘Neill unitsand was launched in August 2000. Synavant is located in 23 countries, supporting clients in 30 countries.ServicesSynavant offers a wide range of interactive marketing services including:• First Rx — Targeted interactions custom designed to support initial prescribing.• The Medical Information Group — a peer influence approach, providing interactive promotional discussions between doctors via telephone to deliver product, service or educational information to targeted doctors. 100 © Copyright 2011 Eularis

CHAPTER 7:Vendor Analysis• Inbound Services — A trained staff of professionals provide information and respond to incoming requests from the healthcare sector. Multilingual operators and qualified healthcare professionals implement and follow up on promotional and educational programs.• Outbound Services — Programs for education promotion, market research or education among patients, healthcare practitioners or sales representatives.• Product Recall Services — Comprehensive support for product recall and withdrawal situations. This service assists manufacturers with notification, reimbursement or replacement.Known CustomersAll of the top 20 global Pharmaceutical companies are SYNAVANT clients somewhere in the world.Table 7.1 Breakdown of companies supplying eDetailing Services 101 © Copyright 2011 Eularis

CHAPTER 8:Future PerspectivesEularis assessed drivers in the near future that are likely to influence the introduction and uptake ofeDetailing.These include the:• role of marketing and sales within Pharmaceutical companies• overall move to eCommerce• growth of eSymposia• Marketing And SalesA recent study by consulting group, Accenture, into Pharmaceutical marketing and sales in Europe foundthat these capabilities are key drivers of financial performance. Accenture estimates that up to 70% ofthe difference in return on sales between companies can be accounted for by differences in marketingand sales capabilities. Accenture also found that selling and general administrative costs account for up to45% of the cost base in a typical Pharmaceutical company.To achieve a truly productive marketing and sales outfit, Accenture identifies a number of areas to focuson, including customer segmentation, understanding and exploitation of e-technologies. It, therefore,follows that eDetailing is an appropriate concept to achieve these aims.The consultancy identified eCommerce as the most important of the emerging sales capabilities and themost significant growth factor for marketing. Currently, says Accenture, most Pharmaceutical executivesbelieve that their current e-strategy is not sufficient to meet future challenges. 102 © Copyright 2011 Eularis

CHAPTER 8:Future PerspectivesEUROPEAN MARKET UNDER PRESSUREThere are clear differences between the US and the European Pharmaceutical markets. In most Europeancountries, the industry‘s growth and profit is closely monitored or controlled by government challengingthe sales and marketing function.A recent study from Urch Publishing illustrates the type of centralized factors that affect the market:• 9 Countries insist on company penalties for exceeding pre-agreed sales volumes,• Belgium - a bill proposes that industry reimburse the government up to 65% of any spending exceeding the medicines budget,• Germany - statutory insurers have tried to implement a round of price reductions without government approval,• Hungary - retail margins of 700 products slashed as government struggles with a 25 billion budget overshoot.As the overall spend on medicines is capped in so many markets, it is essential that leadingPharmaceutical companies differentiate themselves from their competitors to grow.So what does this mean for eDetailing?Eularis believes that it is an opportunity. With a slow growth market, it is essential that companies focustheir marketing sales efforts on key customers and high value customers from which they can measuretangible results. eDetailing offers exactly that ability. 103 © Copyright 2011 Eularis

CHAPTER 8:Future PerspectivesGROWTH OF eCOMMERCECertainly, the figures support a strong growth trend of eCommerce in the health-related fields. ThePharmaceutical industry is behind other global industries in its adoption of e-technology.Figure 8.1 Developing an eCommerce strategy is key to Pharmaceutical managementFigure 8.2 Online Health-Related Promotional Spending in the US ($ Million) 104 © Copyright 2011 Eularis

CHAPTER 8:Future PerspectivesTHE GROWTH OF eSYMPOSIAIn the US, the Pharmaceutical industry spends over $5 Billion a year on physician events. These caninclude dinners, weekend learning events and conferences. WR Hambrecht estimates that it costs aPharmaceutical company between $1,000 and $2,000 per doctor to run such events.The Internet can be used to disseminate the same information at a much lower cost plus could reachdoctors who never attend such events. Doctors would benefit by not having to take as much time outtravelling. It is not clear whether any companies are using eSymposia effectively yet. 105 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryeDetailing is a relatively new idea which uses the latest technologies. The danger with such concepts isthe risk of becoming blinded by and over-enthused with the very technology that the service is based on.Like all Web-based applications, the reality of how it can be used in day-to-day business is somewherebetween the sophisticated vision that a supplier company will weave and the existing, tried and testedbusiness methods.Companies must approach eDetailing with caution and dispassionately consider how it can be used. Thebenefits could go way beyond simple cost savings achieved by using the Web to detail.Eularis considered eDetailing from a European Pharmaceutical company‘s point of view. We posed a seriesof strategic business questions that a company should ask if considering investing in an eDetail system:• Is eDetailing just a passing fashion?• What are my competitors doing? If they have eDetailing, will I be at a business disadvantage?• Will eDetailing be hindered by regulation?• How will this affect the way my sales force is structured and mobilized?• Do contract sales forces have a role in eDetailing?• How will this affect the way my company markets products?• Will eDetailing result in better informed doctors, who proceed to prescribe my company‘s products?• Will doctors welcome Web-based detailing? 106 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryIS eDETAILING JUST A PASSING PHASE?Marketing and sales capabilities are the most important drivers for short term growth. Thus, innovationwithin this sector is crucial. eDetailing offers Pharmaceutical marketers a radically new method ofdelivering their messages to doctors.There will be an initial period of novelty as eDetailing is trialed when expectations may exceed thereality. Strategic Advice Eularis believes the most likely long-term scenario will be the routine integration of eDetailing into everyday sales and marketing activities.In essence, it will become second nature to use the Internet as a sales tool. Pharmaceutical companiesmust take the lead from other industries, such as insurance services, which have been using the Internetextensively to market and sell quite complex products. Doctors, like the general public, will appreciatethe multimedia/interactive way they can see drug information and will quickly come to expect thatpromotional product information is online. Strategic Advice In summary, Eularis believes that eDetailing is here to stay. 107 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryWHAT ARE MY COMPETITORS DOING? IF THEY HAVE eDETAILING, WILL I BE AT A BUSINESSDISADVANTAGE?This (currently) very much depends on whether you are in the US or Europe. Eularis‘ research shows thatwithin the US, all ‗top ten‘ Pharmaceutical companies are using eDetailing or are piloting systems. Anumber of companies, such as Aventis, have been very vocal about their investments in eDetail systems.European companies are behind their US counterparts but are not dragging their feet. A number of ‗topten‘ are publicly piloting eDetailing systems and others are rumored to be in discussions with varioussuppliers. Strategic Advice Eularis believes that companies not seriously considering implementing an eDetailing system run the very serious risk of falling behind their competitors.If good ROI rates, like those already proven in the US, can be achieved in Europe, then companies with aneDetail service will see improved sales and margins.WILL eDETAILING BE HINDERED BY REGULATION?The way drugs can be marketed in Europe is more tightly controlled than in the US. Thus, Eularis does notexpect to see such a quick take-up of eDetailing in Europe. 108 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryFor example, in the US, Pharmaceutical companies are allowed to directly reward doctors for taking partin an eDetail and can provide the relevant hardware (the iPhysicianNet model). Eularis found (in Chapter4) that such behavior in the UK and Europe would most likely break codes of practice. These twoexamples given are key drivers of why US doctors take part in an eDetail. The strict limitations upon gift-giving in Europe makes giving doctors incentives to use the internet to see promotional material tricky. Strategic Advice Eularis recommends that companies proceed cautiously and operate within the relevant legislation; then eDetailing systems should not fall foul of the law.HOW WILL THIS AFFECT THE WAY MY SALES FORCE IS STRUCTURED AND MOBILIZED?Introducing an eDetailing program will have extensive implications on the way a sales force is structuredand operates.Eularis identified a number of changes that will need to be made in the event of eDetailing becomingcommonplace:• Sales force targets• Sales force territorial realignment• Reps‘ job description• Type of sales force culture 109 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryThere is a new set of criteria/metrics for measuring the effectiveness of online detailing. For example, avirtual rep will be able to make a far greater number of calls per day (maybe 40 vs 9?). The cost of travelwill be significantly less. Strategic Advice Eularis recommends that sales personnel are set new targets and overall costs are recalculated.The Internet can effectively remove geographic constraint. eDetailing has the potential to radicallyreshape sales territories. If geographic constraints are removed, a sales team could structure their‗territory‘ around customer type (i.e. high generic prescribers) and be centralized in a similar manner tothe way the financial services industry uses call centers to service an entire country (see Figure 3.1).Eularis‘ research found an almost equal split between those doctors who would prefer to deal with theirexisting sales rep online and those who would deal with any rep (Figure 2.12). Sales reps, therefore, mayhave to be prepared to switch between performing physical details and virtual.eDetailing may not be welcomed by sales representatives who may perceive it as a threat to their jobs.Often, sales forces have strong cultures based on the extensive travel and ‗meeting and greeting‘ thatmany reps enjoy. Taking this away from a rep and replacing it with an office-bound working environmentcould cause discomfort. Just because eDetailing uses Internet technology does not mean that the human isredundant. 110 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryDO CONTRACT SALES FORCES HAVE A ROLE IN eDETAILING?Over the past few years big Pharma has been outsourcing much of its sales to dedicated contract salesorganizations (CSO) which have expanded rapidly (see Table 1.2). In the US, a number of deals have beensigned between eDetailing companies and CSO; for example, PDI has a relationship with iPhysicianNet. Strategic Advice Eularis believes that CSO could play a major role in rolling out any eDetailing service.HOW WILL THIS AFFECT THE WAY MY COMPANY MARKETS PRODUCTS?As discussed, introducing an eDetailing program will require companies to redefine the way they structuretheir sales forces. eDetailing is also likely to cause Pharmaceutical marketing departments to undergo asea change in the way they operate. Eularis has identified factors to consider:• Redrafting of promotional material,• Understanding information flows,• Re-evaluating investment returns and resource allocation,• Identifying best practice implementation.REDRAFTING OF PROMOTIONAL MATERIALImplementing eDetailing will require investment in developing a whole new set of promotional aids thatcan be used online. A whole new process of creating and continuously updating sales support materialsneeds to be established. 111 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryUNDERSTANDING INFORMATION FLOWSeDetailing must be fitted into existing marketing, sales and customer service channels. It is also importantto understand where it fits into the way promotional information is delivered. Figure 9.1 succinctlyillustrates this. eDetailing tends to veer on the pull side of communication. Companies must be awarethat push techniques will have to support any Web site.Figure 9.1 Spectrum of information flow of Pharmaceutical company messages 112 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryRE-EVALUATING INVESTMENT RETURNS AND RESOURCE ALLOCATIONAs we have discussed extensively in Chapter 5, return on investment is an essential calculation that anyleading company must make. eDetailing investment comprises two elements:1. The initial technology investment and infrastructure to enable eDetailing, probably a once-off cost•2. The specific marketing and sales campaign• Strategic Advice Eularis also recommends that marketing departments reassess how ROI is calculated.IDENTIFYING BEST PRACTICE IMPLEMENTATIONRealistically, Eularis believes that best practice can only be realized after a certain degree of trial anderror. The key factors to bear in mind are:• What costs are associated with an eDetailing campaign?• Who is the target market (using customer segmentation techniques)?• What benefit can be achieved from using eDetailing?• How can the results of a campaign be measured? 113 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryWILL eDETAILING RESULT IN BETTER INFORMED DOCTORS, WHO WILL PRESCRIBE MY COMPANY‟SPRODUCTS?So far, the evidence that Eularis has seen makes a good case that eDetailing can deliver healthy increasesin prescribing. The evidence from the US points to a better campaign ROI than traditional detailing.Eularis has identified two key elements that can really differentiate eDetailing from traditional detailingmethods:• Doctors who otherwise would not see sales reps may be amenable to taking part in a detail online. This opens up a new customer segment.• eDetailing can be used outside usual working hours and many doctors see this as a key advantage. Doctors who take part in a detail after work, at home, are more likely to take on board the promotional messages than in the time-pressured rush of surgery or hospital life.WILL DOCTORS WELCOME WEB-BASED DETAILING?Ultimately, the success or failure of any eDetailing program will hinge on whether the end-user, in thiscase - doctors, like the concept, find it easy and ‗fun‘ to use and reap tangible benefits. However,eDetailing is in its embryonic phase, so it would be rash to draw sweeping conclusions on doctors‘acceptance of the concept.Eularis reviewed the available evidence from the US, UK and Germany:• In the US, thousands of doctors across the breadth of the profession are already involved in eDetailing. So far the feedback is good.• In the UK, Eularis‘ own research showed that not many doctors are aware of eDetailing (Figure 2.9) but half of all • doctors are amenable in principle to receiving promotional material online (Figure 2.7). – Figures from Doctors.net.uk indicate that 56% of GPs are interested in interacting with Pharmaceutical • companies online. – In Germany, Aventis found that 55% of Internet-enabled doctors are of the opinion that the Internet is a • suitable communication tool with sales reps. 114 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma Industry Strategic Advice Eularis believes the most successful eDetailing systems are those which are tailored to, and based on, the doctors‘ needs rather than the requirements of the sales and marketing department.Eularis has identified a number of key services an eDetailing system should offer; these are outlined inTable 9.1, Figure 9.2 and Figure 9.3.Table 9.1 What the GP wants from an eDetailing systemFigure 9.2 What GPs think they would find useful (Based on a survey of 365 GPs - Asked to respond to the question “I do, or would, consider the followingservices useful”) 115 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryThe Doctors.uk.net data shows that more than half of GPs would be interested in interacting withPharmaceutical companies online.Figure 9.3 Times of day that GPs are most likely to use an eDetailing facilityData from Doctors.net.uk supports this. Figure 9.4 shows that doctors are already in the habit of learningoutside working hours. Medical education is important for GPs, most try to complete 30 accredited hoursa year (CME). It is significant that, currently, only 12% of doctors do their clinical reading solely at thesurgery. 116 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryFigure 9.4 Where GPs do offline medical readingFigure 9.4 Where doctors will do online CME(from Doctors.net.uk survey)The data from Doctors.net.uk supports that theory that may doctors will use an eDetail service eitheroutside hours or at home. 117 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma Industry Strategic Advice Eularis data clearly shows that provision of an eDetailing service outside surgery hours or in the doctor‘s home will be essential.Figure 9.5 How an eDetailing system can respond to doctors‟ needsUptake of an eDetailing system will also depend on the type of doctor. Eularis has identified four groups,outlined in Table 9.2. 118 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryTable 9.2 Types of doctors and attitudes to eDetailingHowever, there is evidence that suggests once a doctor has taken part in an eDetail, he/she issignificantly less likely to think that it has no value. The widespread adoption of eDetailing will rely ondoctors trying the system themselves or receiving recommendations from colleagues.What is also becoming clear in the US is that only a small percentage of doctors want eDetailing toreplace live details completely. Strategic Advice Eularis believes in the long run, though there may be an initial period of skepticism, doctors will welcome the opportunity to take part in Internet detailing. Strategic Advice Eularis recommends that, before introducing an eDetailing system, companies extensively ask doctors what they want from such a service. 119 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryCONCLUSIONSFrom our research Eularis drew a set of conclusions and factors which are summarized as:• Key elements of eDetailing for a Pharmaceutical company to consider.• Key analytical stages when considering eDetailing. Table 9.3 120 © Copyright 2011 Eularis

CHAPTER 9:Strategic Recommendations for Pharma IndustryWhat course should a leading Pharmaceutical company take when considering whether to implement aneDetailing program? In Eularis‘ experience, early adopters of this technology are moving through thefollowing stages. Table 9.4 121 © Copyright 2011 Eularis

APPENDIX 1:Survey QuestionsQUESTIONS USED IN SURVEY OF 204 UK GENERAL PRACTITIONERS1. Approximately how many Pharmaceutical sales representatives do you see in a typical month?1. 12. 23. 34. 45. 56. 6-107. 11+8. None9. Do not see Pharmaceutical representativesIf 8) or 9) Please proceed to QUESTION 72. How often do you have to cancel or reschedule your appointments with representatives?1. 0% of appointments2. 1-10% of appointments3. 11-20% of appointments4. 21-30% of appointments5. 31-40% of appointments6. 41-50% of appointments7. More than 50% of appointments 122 © Copyright 2011 Eularis

APPENDIX 1:Survey Questions3. What is the average amount of time taken by a representative‟s visit?1. 2 minutes2. 3-5 minutes3. 6-10 minutes4. 11-20 minutes5. More than 20 minutes6. Don‘t know4. In general, do you find visits from sales representatives useful? (Multiple choice)1. Yes, as they introduce new products or uses of products I am not aware of2. Yes, as it keeps me in touch with the Pharmaceutical industry3. Yes, as it keeps me up-to-date on the company‘s products4. Sometimes useful5. Occasionally useful6. No, all reps‘ visits are a waste of time5. After a representative‟s visit, do you ever review your prescribing of the product(s) discussed?1. Yes2. No 123 © Copyright 2011 Eularis

APPENDIX 1:Survey Questions6. Please review the following list of Pharmaceutical companies and select the three that you consider to havethe best sales representatives:1. Abbott2. Allergan3. AstraZeneca4. Aventis5. Bayer6. Boehringer-Ingelheim7. Bristol-Myers Squibb8. Eli Lilly9. GlaxoSmithKline10.Janssen-Cilag11.Merck Sharp and Dohme12.Napp13.Novartis14.Novo Nordisk15.Organon16.Pfizer17.Pharmacia18.Roche19.Sanofi-Synthelabo20.Schering Health Care21.Schering Plough22.Serono23.Servier24.Wyeth 124 © Copyright 2011 Eularis

APPENDIX 1:Survey Questions7. Would you be interested in viewing promotional information electronically?1. Yes2. NoIf YES, please go to QUESTION 9.8. Why would you not wish to receive promotional information electronically?1. I like to meet the representatives in person2. The electronic method would probably not work3. Asking questions could be difficult4. I do not have time to access a computer at work5. I would not prioritize time to look at electronic promotional material6. No particular reason7. Other9. Have you ever heard of “eDetailing”?1. Yes2. No 125 © Copyright 2011 Eularis

APPENDIX 1:Survey QuestionsThere are two types of eDetailing – please read the following brief descriptions of each, following which we will askyou a few questions to gauge your reactions.Live eDetailing - You log on to a dedicated Web site where you can see a sales representative speaking to you via a web-cam attached to the sales representative‘s computer. A personal and interactive eDetailing session is provided for youlasting 10-15 minutes on average, where you are shown information about the promoted product and can discuss thatinformation interactively and live with the representative. During the eDetailing session, you can simultaneously interactwith the sales representative in full video and audio, view a multi-media presentation with information about the productand receive written product information from the representative.Virtual eDetailing - You choose to learn about a promoted product at your leisure and enter a sponsored learningapplication on your desktop computer. Once you have logged onto the system, the sponsored learning application takes youthrough a series of interactive screens with multi-media informational content about the product including key productfeatures and benefits, research evidence and clinical practice guidelines supporting its use, prescribing information, patientadvice and a fulfillment section in which you can request clinical papers, samples, a visit from a sales representative, etc.10. Which of the systems described appeals to you the most?1. Live eDetailing2. Virtual eDetailing3. Both equally appealing4. Neither are particularly appealing5. Not interested in either systemIf 5) - END 126 © Copyright 2011 Eularis

APPENDIX 1:Survey Questions11. If you were to take part in either a virtual or a live eDetail, which of the following options would appeal to you?(Multiple choice)1. To see the sales representative‘s face on the computer screen and have a two-way, real-time conversation2. To use e-mail for questions and answer sessions3. To send specific questions via e-mail which will be dealt with without a representative visiting4. To schedule appointments with the representative12. If you took part in an eDetail, who would you prefer to deal with?1. The usual representative2. Any representative13. How would you choose to take part in an eDetail?1. At my convenience (e.g. during the day between patients, or at night, etc.)2. Appointments pre-scheduled by me3. Both of these14. Would you require free hardware (PC/web-cam, etc) as an incentive to use an eDetailing service?1. Yes2. No15. What do you consider to be the main advantage of eDetailing?1. It could save me time2. I would not have to see sales representatives3. I could schedule appointments at my convenience4. I think the product information would be better5. Other 127 © Copyright 2011 Eularis

APPENDIX 1:Survey Questions16. What do you consider to be the main disadvantage of eDetailing?1. It would not save me any time2. I enjoy the social interaction when seeing representatives and do not want this replaced by computer3. The technology would not live up to expectations4. I don‘t think that information provided would be good enough17. On weekdays, what time of day would you be most likely to use an eDetailing facility?1. Before 9am2. 9-12am3. 12-3pm4. 3-6pm5. 6-9pm6. After 9pm7. Various times8. UncertainYou have reached the end of the survey. Thank you for your participation. 128 © Copyright 2011 Eularis

Contacts Eularis JapanFor more information, please contact: Eularis North America Kamiyacho MT, 14th 415 Madison Avenue Floor 4-3-20 14th Floor Toranomon Minato-ku, New York, NY10017 105-0001 Tokyo Eularis Europe Eularis Hong Kong The World Trade Center Unit 10-18, 32/F, Tower 1, Leutschenbachstrasse 95 Millennium City 1 8050 Zürich 388 Kwun Tong Road, Kwun Tong Switzerland Kowloon, Hong Kong Contact: Dr. Andrée Bates (abates@eularis.com) Removing Uncertainty from Pharma Corporate and Marketing Decisions www.eularis.com 129 © Copyright 2011 Eularis

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eDetailing: A Strategic Analysis Of Implementation And ROI

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eDetailing: A Strategic Analysis Of Implementation And ROI Presentation Transcript