Medical Science Liaison Webinarv 2009

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Webinar I have presented around the importance of MSLs and how they work with other thought leaders within pharma organizations and with physicians.

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  • As companies compete for the attention of physicians, key opinion leaders (KOLs) and thought leaders, they increasingly use medical science liaisons (MSLs) to build and strengthen KOL relationships. Best Practices conducted its research with 24 companies gathering insights from 29 pharmaceutical and biotech leaders. The goal of our work was to uncovers the optimal size, mix and service frequencies of this elite medical specialist group. This work is focused mainly to what is going on in the United States. Today I will share with you insights around 5 basic, but critically important, findings that Best Practices made during its research on how to build better relationships between you Medical Science Liaisons and the KOLs and physicians that they work with.
  • “ KOL management is, first, teamwork. There should be a consensus on the importance of KOL with upper management, so there’s good alignment of objectives, what we need the KOL for, and that needs to be aligned with the phase of the products in the portfolio. Second, the communication, the collaborative spirit across team members in KOL management, because different team members may have individual interactions with KOLs. These interactions need to be communicated across the team to keep everyone abreast of the latest encounters with a particular KOL. Number three is the quality of interactions, meaning that interactions need to yield quality output. These interactions need to be coordinated for the benefit of the company, for the brand, and for the portfolio. This is the execution part of KOL management
  • The best time to create a medical liaison team is when you know exactly where liaisons fit into your product’s brand-plan, what liaisons will contribute to the organization, and how this will affect your hiring choices. Proper “care and feeding” of medical liaisons are independent from a product’s novelty status. Success with a medical liaison team can be built with a novel product or with a “me-too” brand. If a product is novel (enough), there is a need to discuss new mechanisms of actions or delivery systems. There is a widespread need for increasing awareness in the medical community. Novel products require scientific comprehension and competency to verbalize concepts, thus medical liaisons may naturally be the “educators of choice”. Are medical liaisons less valuable for “me-too” products? No. In fact, liaisons are often most valuable in a “me-too” market. Very few sales representatives will have the opportunity or the capacity to discuss intricate molecular differences between “me-too” drugs. MSLs provide the scientific acumen that allows for differentiations in your products to those of competitors. However your company chooses to deploy medical liaisons, you absolutely must communicate roles and expectations clearly to your liaisons. Companies often use medical liaisons as a means to a short-term end, and then wonder why they have problems retaining or attracting the best talent. Executives should only execute a strategy that involves medical science liaisons when resources are available to fuel both the plan and the development of their medical science liaisons. Otherwise, companies will continue to fan cynicism of their claims to develop their people, perpetuate confusion about the medical liaison role in their organizations, and disrupt their most important thought leader relationships.
  • Companies work to build a “cascade of influence” where specialists influence all stages of the product life cycle, from compound development to mature product development. By utilizing these field-based medical specialists at every stage of the product life cycle, companies can better manage their product portfolio and gain insights into how their portfolio is being utilized in the marketplace. Medical science liaisons (MSLs) engage in high-level knowledge exchange and collaborations with medical thought leaders who influence and drive healthcare. National thought leaders may not directly contribute to short-term sales for a pharmaceutical company, but they are the lifelines to the long-term competitive advantage of a company. MSLs' activities with influential thought leaders build the intellectual and scientific capital necessary for pharma companies to grow.
  •   A military man once said that "Intelligence is about people and a study of people. It is not simply a question of studying people on the other side, but studying one's own as well. We have to learn about one another, not just about strangers." I am not sure that you could find a more appropriate quote when it comes to examining how companies deploy their medical science liaisons in the field. Many companies now use their MSLs for thought leader management: Ensuring brands understand thought-leader attitudes, beliefs, interest and input Communicating unsolicited thought-leader feedback on key messages and concepts to the brands Proactively seeking thought-leader opinion on current market conditions, competitors, messages, and tactics This enables the companies to more effectively execute their plans because their medical science liaisons are gathering insight and opinions from respected and influential KOLs and communicating these ideas back to to the people who can execute the most effective strategies to meet brand objectives.
  • So we understand that information is a key component of why companies have MSL out in the field. They can gather information to strengthen the lifecycle plan and they can help provide insights from the marketplace. But this doesn’t come without some hard work. Developing relationships is at the core of thought leader recruitment.  Securing thought leader involvement is much more difficult than it once was, as 8 out of 10 requests for participation are turned down.  As a result, field-based medical programs have come to the forefront.  While traditional sales reps still dominate the field, Medical Science Liaisons (MSL) have assumed a pivotal role interfacing between pharmaceutical companies and opinion leaders .  MSLs, most with advanced medical or science degrees offer thought leaders the credibility and sophistication of a peer, but also provide insider’s knowledge about the company and products they represent. To ensure success, pharmaceutical companies must provide their MSLs with every available resource while using an integrated approach to optimize thought leader relationships . 
  • Thus, many companies segment categories of thought leaders as they recognize that different types require different approaches and can provide different benefits to the company. For example, practitioners are potential partners for clinical trials and academics probably provide the best benefit to reputation and brand prestige through endorsements and mentions in publications. One company segments its national thought leaders into two subsets of thought leaders. Group A thought leaders are the most elite and esteemed physicians in their field on a global level, usually in the academic arena. These are typically the heads of departments, authors of the leading textbooks, editors of esteemed journals, speakers, heads of their specialty organizations and members of national guideline committees. This company monitors these sources and often finds that the same names come up over and over again, a sign that the person is a Group A thought leader. This company categorizes about 15 to 20 people from each therapeutic area into this group. The next subset of national thought leaders are the “up-and-comers.” These are the people this company expects to be the next generation of elite-level national thought leaders. They are physicians increasingly recognized for innovative research; their names appear more frequently in scientific publications and on speaker lists at major conferences. This list is two to three times the size of the previous subset.
  • I bring up this next information that is gleaned from insights that those who run CME programs have recognized. Not all physicians are equally ready to discuss new therapies, changes in disease state management and other ground-breaking trends. It is important for your MSLs to seek out and build relationships with those who are on the cutting edge. This is what you generally have hired them for, and thus they should tailor their discussions to the target physician populations most ready to learn about new treatment paradigms -- those who are either early adopters or innovators. As such you as an organization need to be continually critiquing your MSL program and the strategies used to focus deployment. Keep asking yourself: Are they focused at the right physicians? Are they focused at all? Learn a lesson from one CME leader: “Marketers understand the importance of segments . . .We are trying to do the same thing.. . It is unfortunate to do one CME program for all people. We need to be targeting the early adopter groups.
  • You cannot get past needing to focus on the value your MSLs provide. The question is can it be tracked solely by hard numbers such as number of speakers lined up or number of papers written by your thought-leaders who have been working with your MSLs? DIRECTORS' VIEW Knowledge equals dollars and market share. If you can influence with knowledge, it's a clear competitive advantage. differentiate clinically and to discuss beyond price. impact sales by having relationships with KOLs and give feedback to sales to help them stay ahead of the curve. Data generation is the biggest benefit we bring . Without data, you're nowhere. MEDICAL SCIENCE LIAISONS' VIEW Driving business from science; selling through science. At this organization, our group is involved in the dissemination of off-label information. Senior management only looks at our short-term contribution to commercial value. Bridging the gap between commercial goals of companies and scientific desires of medical communities. If you focus solely to the metrics, you can expect some backlash or loss of quality MSLs who want to focus on the value and scientific insight they can provide to KOLs. You have to find the right balance for tracking their success because when you deploy them thoughtfully, you will reap the benefits Talk to the slide.
  • There has been this idea that when companies are preparing the market for launch or expanding therapeutic areas, MSLs are heavily invested in clinical research support and the dissemination of clinical information. And that once the product has been launched, medical science liaisons help maintain market position and momentum. Best Practices’ work has seen a shift in such activities with more emphasis paid to aiding in the commercial focus of the product – helping to ID and maintain thought leader relationships, gathering CI and helping the marketing and sales groups better prepare for launch. Companies see the value in sharing field-based medical program feedback with marketing to help focus research efforts on market demands. The depth of field-based medical specialists’ relationships with physicians can provide companies with a major additional benefit in market research. The specialists at Company D are able to report back to the marketing and market research departments exactly what doctors are saying about the company’s research efforts. While feedback on current efforts is helpful, the greatest value comes from understanding what doctors want to see in the future. If the specialists can make thought leaders see that the company hears their concerns, they hit a relationship home run. Doctors feel that they are influencing the company and feel that the relationship is really a two-way street that benefits not only the company, but also the medical community. This level of responsiveness takes market focused development to a new level. Doctors understand this and are willing to share information with the field-based medical specialists in order to help the company produce the most effective drugs. Of importance to note is that more than one-third of benchmark partners do not include their MSLs in Speaker Training during this time. Some companies when asked said that they try to maintain a separation during this period so that there is not a view that the MSLs are biased presenters of information.
  • Once a drug is launched does not impact what companies find to be crucial activities for their Medical Science Liaisions to focus upon. Pharma executive still want their MSLs to maintain KOL relationships, gather competitive intelligence that can guide future therapeutic decisions and work with the marketing group to continue shaping product perceptions. Nearly one-third of companies do not utilize MSLs in presenting pharmacoeconomic data for manage care and formulary decisions or in assisting with sales and marketing plans. There may be an appearance of being too salesperson-like to these companies who choose to maintain a more scientific approach to utilizing their MSLs.
  • Medical Science Liaisons (MSLs) have great success at gaining access to physicians that will not see a sales representative. The core activities of the FBMPs are geared towards achieving the “gold standard” peer level relationship with key opinion leaders (KOLs) and decision makers. Core skills focus on delivering knowledge around complex scientific issues, clinical trial/research support, publication support, and presentation support. Typically FBMPs have a diverse mix of MSLs with basic science/research, clinical practice, and/or pharmaceutical industry experience. The most effective and well-regarded MSLs have acquired the competence to leverage these relationships to support customer needs related to the products, therapeutic areas and disease states that are corporate priorities. In addition to their activities with external customers, MSLs can provide value within the company supporting the development and registration process, training local sales representatives on disease state, therapeutic area and product knowledge, as well as engaging in the business and account planningprocesses. Understanding of internal stakeholder objectives is fundamental to insuring that the work is aligned with organizational expectations. Organizations employ MSLs because they anticipate that such teams will improve business performance; specific expectations may vary, usually related to life cycle position of products for which FBMP support has been recruited.
  • But industry executives are challenged to measure the return on investment for their field-based MSL programs. Based on "Medical Science Liaison Performance Metrics Report," an independent survey of 23 MSL programs from 19 biopharmaceutical companies, MSL executives assign both quantitative and qualitative metrics for their MSLs' performance. They understand that there is a need for measuring value in a commercial organization, but they favor a predominantly qualitative approach for MSL performance evaluation. Many MSL directors define the metrics as accountability for time or activities, based on the assumption that value should follow.
  • Companies must align their medical science liaison mission with the company’s overall objectives. The makeup of the MSL program often depends greatly on the overall strategy and objectives of the company. While all pharmaceutical companies focus on both sales and science, each company's corporate culture assigns different emphasis to each phase of its business. Some are looking for short-term growth; others are planning for the long-term. Thus is it crucial for MSLs and the managers of MSL teams to prove valuable internally and externally.
  • As companies examine their product pipelines, directors identify areas in which the company has a strong presence and those in which the company needs to invest in anticipation of future products. One caveat that a director offered, however, is to be cautious in making radical shifts of field-based medical specialist personnel to new assignments: one must be careful not to disturb established, carefully nurtured relationships. “If you’re new going into a therapeutic area, it’s going to take a long time. These people are not going to wrap their arms around you. You have to break down their resistance,” one director told us. Best-in-class companies are always cautious when considering decisions to phase out or decrease coverage of a therapeutic area, because of the lost investment and the difficulty of reestablishing future relationships. “You have to be very careful of how you go in and out of thought leader relationships,” the director said. “When there are no products currently in that field, we maintain a small, ‘skeleton crew’ of field-based medical specialists in that area to maintain good relations for future use.”
  • Benchmark partners find that the key to field-based medical specialist effectiveness is their ability to access and influence thought leaders. Their kind of access and influence on thought leaders can only be maintained if thought leaders perceive them to be influential scientific experts who are highly placed in the company and provide value to the thought leader. At this director’s company, If another group wants to contact the thought leader, they first notify the field-based medical specialist, and then accompany the MSL on a thought leader visit. The MSLs are kept current on all other company activities dealing with their assigned thought leaders to provide comprehensive support to the thought leader and leverage some of these activities. More and more companies are beginning to use the MSLs as their main points of contact for all thought leader development activities to maintain the specialists' credibility and effectiveness. “ You have to preserve relationship credibility. The thought leader cannot perceive the field-based medical specialist as relatively insignificant.” -- MSL specialist director
  • Companies that have avoided a a sales-focused approach with their MSLs annecdotally have not seen a reduction in thought leader access. The doctors want to speak with MSLs who have a high level of scientific knowledge level. Thus companies that emphasize a “science over sales” Approach tend to gain more access. Of course, the access that the Medical Science Liaisons garner can make some companies to consider ways to have their sales teams exploit the relationships. Companies that have been successful in this approach advise against such thoughts. “ They must maintain their image as “coming from the medical side, not the business production side. Otherwise, we’ll see our access curtailed as well,” one director for MSL said.
  • Overall, alignment of KOL management at a high level with corporate “scientific platforms that shape the brand” allow clear definition of goal-driven activities. Develop reliable strategic profiling and recruitment mechanisms Distinguish between true influence and credentials Segment KOLs by traits required for your needs and strategy Seek opportunities to identify next generation of KOLs Use of new tools and vendors can be helpful, but costly and clunky Recognize role diversity Match talents with needs required at different stages of product lifecycle Manage roles and responsibilities to achieve different objectives Tune management processes To support specific roles and evolution over time To provide open, honest communication Take a long-term approach Build long-term relationships, where KOLs understand their roles and value Plan for continuity (and understood separations) Don’t lament inability to maintain attention of top people
  • Most MSLs agree that metrics are necessary and that they capture the quality and outcomes of an interaction. They view the predetermination of activities quotas without regard to rationale or quality as a way for an organization to "fly under the radar" when conducting inappropriate activities. Consequently, MSLs view performance metrics and accountability as separate issues. They see accountability as being synonymous with responsibility and performance as demonstrative of the effect for the organization. Because MSLs generally enter the profession to pursue the high-level scientific nature of these positions, many view the tracking of MSL performance with market share as inappropriate or illegal. This perception has led to apprehension and suspicion of tools traditionally linked with tracking sales force activities and performance, such as contact management databases. Medical science liaisons may be wary of management using these tools to "count calls" and evaluate their performance on call frequency.
  • To emphasize its therapeutic knowledge, one company aligned its field-based medical program organizational structure with its five top therapeutic areas. The company played to the field based medical specialists’ strength as topical guides for doctors, scientists and opinion leaders. Its MSls build relationships with thought leaders based not on the company’s products; but on better educating “customers” about the company’s current research into critical disease states. One part of that relationship is giving information about the company’s products and how they assist in treatment of the disease – the specialists' task is to tie these products into the information that thought leaders seek.
  • When you consider the number of calls that a physician might receive in a given week, the MSLs and others who are trying to maintain thought leader relationships need to coordinate their meetings with physicians. You do not want to lessen your value with these key physicians by meetings too often with them or intruding on the important work they do. Remember MSLs tend to serve a different "client base" than sales reps, but both are essential for the competitive advantage of a company. MSLs focus mostly on physicians who are involved in medical innovation and not necessarily high prescribers, while reps are able to target the community based specialists and primary care physicians who make decisions altogether differently than an academic-based research investigator makes decisions. Would it be more efficient for a MSL to call on "everyone" including the primary care docs? Maybe, but it is doubtful that this efficiency would translate into an effective use of the MSL's time and training. Since the industry is so heavily regulated by "perception", the perception that MSLs are separate and distinct from reps must be be preserved by companies.
  • Establish clear activity goals to ensure that solid benefits are realized. Clear goals have driven the most successful field-based medical programs by laying out a roadmap for which activities contribute the most value. For example, you could ensure that your MSLs daily activities reflect your program’s three overarching goals: • Communication – “Thought leaders should call us when they have a problem because we have the answers.” • Research – Identify trial sites for clinical research. Develop investigator potential by qualifying sites and doctors and help them find resources. • Influence – Build long-term relationships based on open, honest sharing of high-quality information. As you decide how to shift resources or continue to gain value, you must realize that field-based medical activities often reflect one or more of these goals or similar goals. Specialists and managers Communication and influence are achieved through building relationships that last beyond the next quarterly sales push, and research assists both the marketing and development departments by providing resources to build a stronger foundation for life cycle management.
  • Eli Lilly Gary Butkus Lilly organizes liaisons regionally. Regional liaisons handle both national and regional liaisons. They do not distinguish between pre and post launch because “science is science whether it’s before or after the product is launched.” Aventis Does not scale back liaison support for at least a year for some therapeutic areas/products because it takes that long to identify high prescribers who may become good advocates for the product. Sometimes KOLs are evident at launch, but other times high prescribers emerge and are actually better at speaker training and other activities because they have first-hand knowledge of and enthusiasm for the product. KOL relationships often take a very long time to develop but high prescriber relationships can be ramped up very quickly.
  • “ It’s important to have relationships with opinion leaders at all levels of the marketplace. It's not just your top-top guys. I can tell you, there's going to be rheumatologists and endocrinologists that may not have huge credentials, but they're going to be incredibly important in your regional area because they're the advisors to most of the primary care physicians in the area, and those people need to be known.” – Executive Director, Marketing
  • Clear breaks between program expansions have allowed leading companies to more effectively measure and manage future program needs. Companies have found that each expansion of its program should be followed by a year of stability in which there is no new hires or territory adjustments. “ Give them a year to function at full capacity before you try to make any changes,” one MSL executive told us, noting that the “breathing room” allows new specialists to absorb training and become comfortable withthe close relationships they are building with thought leader physicians. Other managers noted that efforts to constantly fine-tune the program only produce confusion among field-based medical specialists as well as physicians. Since there inherently seems to be a resistance to change, product and message decisions must be carefully considered before implementation. For example, once an MSL is focused on cardiovascular physicians at academic institutions, he or she should remain in that role for as long as possible to maintain the relationships built. Shifting people to different institutions or therapeutic areas every six months drastically reduces their effectiveness because doctors come to see field-based medical specialists as an extension of the regular sales force.
  • Medical Science Liaison Webinarv 2009

    1. 1. Best Practices, LLC Research Medical Science Liaisons: Gaining Access & Forging Relationships with Key Opinion Leaders Strategic Benchmarking Research Presented by Cameron Tew 2009
    2. 2. About Our Guest Speaker Cameron Tew is an executive director of research for Best Practices, LLC, a global thought leader in the field of best practice performance improvement for companies in the bio-pharmaceutical and healthcare sector. Client Sectors E-mail: ctew@best-in-class.com (Ph) 919-767-9246 #1 On Amazon.Com Reader Ratings – Customer Satisfaction PHARMA BIOTECH CRO’s COMMER-CIAL / R&D HOSPITALS MEDICAL DEVICES GROUP PROBLEM SOLVING
    3. 3. <ul><li>Abbott Labs </li></ul><ul><li>Allergan, Inc. </li></ul><ul><li>Anesiva </li></ul><ul><li>Astrazeneca </li></ul><ul><li>Axcan Pharma Inc. </li></ul><ul><li>Boehringer Ingelheim </li></ul><ul><li>Bristol-Myers Squibb </li></ul><ul><li>Cardiac Science Corp </li></ul><ul><li>CSL Behring </li></ul><ul><li>Eli Lilly and Company </li></ul><ul><li>Focus Technologies </li></ul><ul><li>Genentech </li></ul><ul><li>Innovex </li></ul><ul><li>Janssen cilag </li></ul><ul><li>Medtronic </li></ul><ul><li>Bertek </li></ul><ul><li>Novartis </li></ul><ul><li>Novo Nordisk </li></ul><ul><li>Organon. </li></ul><ul><li>Schering Plough </li></ul><ul><li>Shire </li></ul><ul><li>TTY Biopharm </li></ul><ul><li>UCB </li></ul><ul><li>Vertex </li></ul>The Benchmark Class Best Practices ® , LLC distilled observations and insights from interviews and benchmark performance data from a total of 29 leaders within the pharmaceutical and biotechnology sector.
    4. 4. Role of MSLs in Managing KOLs <ul><li>A “disciplined mandate” should guide structured interactions </li></ul><ul><ul><li>Often critical in recruiting KOLs and developing relationships </li></ul></ul><ul><ul><li>Lack of standards in what MSLs do can frustrate KOLs </li></ul></ul><ul><ul><li>Ideally serve to bridge between “scientific platform around which the brand is being defined” and commercial interests </li></ul></ul><ul><li>“ MSLs often have greater influence at the regional level.” </li></ul><ul><ul><li>Facilitate clinical studies in the geographies they cover </li></ul></ul><ul><ul><li>Use as a clinical trial liaison can support KOL activities </li></ul></ul><ul><ul><li>Excellent conduit for cutting-edge scientific matters </li></ul></ul><ul><li>MSLs need to “own” the relationship with the KOL </li></ul><ul><ul><li>MSLs can ensure that the company’s many touch points with a KOL (Scientific/Medical Affairs, Sales, Marketing) are cohesive and consistent </li></ul></ul><ul><ul><li>“ MSLs are often firefighters” who manage communication issues when a KOL is receiving mixed messages or signals from various functions </li></ul></ul>Although various and too often “undisciplined,” MSLs regularly have a critical role in recruiting, building relationships, and working with KOLs. The variety in both MSL skill levels and KOL roles can make these working relationships challenging.
    5. 5. Insight #1: Monitoring Markets & Competition Medical Science Liaisons (MSLs) forge thought leader relationships that provide critical windows into the market and the competition. Moreover, they gain superior access to key influencers. Key Findings <ul><li>Companies must utilize their Medical Science Liaisons throughout the lifecycle of a drug as they provide direct insight into how physicians and thought leaders perceive and use the product. </li></ul><ul><li>Product lifecycle, thought leader coverage and franchise objectives are the primary key drivers that influence how many MSLs a company deploys. </li></ul><ul><ul><li>The effectiveness of those three factors ranges from 74 to 81 percent, according to benchmark partners. </li></ul></ul><ul><li>Companies must define the role of their MSLs, who see themselves often as aids to those working with patients. Seek a balance between the scientific and commercial needs of the company. </li></ul>
    6. 6. Manage Thought Leaders To Optimize Product Impact Thought leaders are sources of great insight and value through the entire lifecycle of pharmaceutical products. Reduce clinical trial cost & maintain market-focused development Market awareness & enthusiasm enable faster sales penetration Physician education builds faster & more effective usage Influence managed care through education, advocacy, & health outcomes Feedback about and support for additional indications & guidelines shaping Using Thought Leaders Across All Value Fronts Compound Develop-ment Launch Correct Diagnosis (Individual & Group) Formulary Approval Lifecycle Manage-ment
    7. 7. Enable More Informed Decisions and More Effective Execution <ul><li>Ensure brands understand thought-leader attitudes, beliefs, interest and input </li></ul><ul><li>Communicate unsolicited thought-leader feedback on key messages and concepts to the brands </li></ul><ul><li>Proactively seek thought-leader opinion on current market conditions, competitors, messages, and tactics </li></ul>Thought Leader Insights and Opinions Communication to Brand Teams Impact on Brand Strategy and Tactics MSLs help brands understand key market dynamics and perceptions Medical Science Liaisons (MSLs) uncover key insights and behaviors from their thought leader relationships that provide critical input for commercial decisions.
    8. 8. Drivers for Field-Force Size Product lifecycle, thought leader coverage and franchise objectives are the primary key drivers of the number of MSLs a company deploys into the field. Not Important Assess the effectiveness of the following factors by which you determine how many liaisons to put into the field. N=28 Do Not Use Important Very Important 4% 7% 19% 19% 22% 33% 41% 48% 50% 39% 37% 37% 19% 37% 37% 33% 7% 18% 7% 11% 15% 4% 4% 4% 39% 36% 37% 33% 44% 26% 19% 15% Target ratio of specialists to potential $ value of drug Target ratio of specialists to existing corporate revenue Target ratio to align with regional or divisional distribution of sales force Target ratio of specialists to existing product or therapeutic franchise revenue Target ratio of specialists to sales representatives Corporate commitment to an over-arching franchise Target ratio of specialists to number of thought leaders Product Lifecycle Plan
    9. 9. Thought Leader Segment Definitions Thought leaders and KOLs have different spheres of influence. This section analyzes call frequency targets for national and regional thought leaders. Field researchers used the following definitions to evaluate service levels for each thought leader influence segment. Typical Characteristics National <ul><li>Nationally recognized specialist having global prominence </li></ul><ul><li>Affiliated with major academic Center of Excellence impacting health policy </li></ul><ul><li>Actively involved in scientific/clinical research, publications </li></ul><ul><li>Holds decision-making positions on professional societies/associations and specialty journals </li></ul><ul><li>Speaker at national society educational programs </li></ul>Regional <ul><li>Recognized as an opinion leader by peers within major US geographical region </li></ul><ul><li>Affiliated with major academic institutions impacting regional health care policy </li></ul><ul><li>Conducts clinical research and publishes in national/regional journals </li></ul><ul><li>Chairs or acts as faculty of national/regional educational programs </li></ul>Local <ul><li>A community-based specialist </li></ul><ul><li>Receives referrals from PCP colleagues in community </li></ul><ul><li>Conducts late stage clinical trials (Phase III, III B or IV) </li></ul><ul><li>Conducts educational programs for PCPs </li></ul><ul><li>Maintains active private practice </li></ul>
    10. 10. Learning From CME Work Just as with continuing medical education, not all physicians are equally ready to embrace new therapeutic approaches. Thus, your MSLs should tailor their discussions to the target physician populations most ready to learn about new treatment paradigms. Tactics To Align Deployment With Physician Change Readiness “ If you look at diffusion of innovation models, you find innovators; early adopters; the majority, late adopters, and laggards... Marketers understand the importance of segmentation. We are trying to do the same thing. “ “ To try to take a big heterogeneous group and to try to treat them all the same way, it’s naïve to think they will all change. . . Who is pre-contemplative?. Who is willing to change? Who is already treating their patients . . .There are very different goals on each of those.” -- Senior Director of Medical Education CME Program Strategists Align Programs with Targets By Stage D C A Innovation Diffusion Curve Among Physicians Cautious Majority Laggards Late Adopters Innovators B E Early Adopters Target First Movers With Tailored CME
    11. 11. Insight #2: Tracking Value Evolution Thought leaders are sources of great insight and value through the entire lifecycle of pharmaceutical and biotechnology products. MSLs harvest diverse insights throughout the pre-launch and post-launch lifecycle. Key Findings <ul><li>Thought leaders provide insights throughout the entire product lifecycle. </li></ul><ul><li>90% of companies use field-based medical specialists at pre-launch and at post-launch. </li></ul><ul><li>Medical specialists disseminate information to KOLs and also harvest competitor and market intelligence. </li></ul><ul><li>86% of companies use liaisons to gather competitive intelligence during pre-launch and 90% do so at post-launch. </li></ul><ul><li>Liaisons play a support role in clinical protocol development and site selection. 11% say liaisons are “very involved with protocol design at pre-launch and 18% are “very involved” in protocol design at post-launch. </li></ul><ul><li>“ Science is science whether it’s before or after a product has been launched.” </li></ul><ul><li>--Medical Liaison Team Leader </li></ul>
    12. 12. Pre-Launch MSL Roles (Top 6 Activities) Medical Science Liaisons (MSLs) continue to forge critical relationships with thought leaders and to provide competitive intelligence that helps their companies monitor the competition and discern market opportunities and obstacles for their products prior to market entry. How involved are your field-based medical specialists in supporting the following tactics at pre-launch ? N=28 Very Involved Somewhat Involved Not Involved 38% 39% 52% 54% 68% 68% 27% 43% 30% 25% 18% 21% 35% 18% 19% 21% 14% 11% Speaker Training Identify and interact with national societies and organizations Assist with sales force training prior to launches Provide feedback to marketing personnel on product perceptions Competitive intelligence Identify, develop and maintain relationships with thought leaders
    13. 13. Post-launch MSL Roles (Top 6 Activities) Thought leaders are the compass to competitor activities, market changes and early reactions to commercial products. Most companies focus their medical specialists on developing KOLs to guide these post-launch activities, as well as gathering competitive intelligence. How involved are your field-based medical specialists in supporting the following tactics at post-launch ? N=29 Very Involved Somewhat Involved Not Involved 41% 43% 50% 62% 75% 78% 34% 39% 35% 21% 25% 11% 24% 18% 15% 17% 0% 11% Speaker training Product attribute shaping Identify and interact with national societies and organizations Provide feedback to marketing personnel on product perceptions Competitive intelligence Identify, develop and maintain relationships with thought leaders
    14. 14. Insight #3: Determining Liaison Field-force Size Multiple factors – including product lifecycle, thought leader coverage, franchise objectives and revenue levels -- drive the number of MSLs deployed into the field. Consider all key factors – not just one or two – in setting group size. Key Findings <ul><li>Frequency, reach and approach are the key internal drivers that dictate the size of medical science liaison groups in the field. </li></ul><ul><ul><li>Of our benchmark partners 68 percent to 79 percent take these drivers into considerations when planning how many MSLs to send into the field. </li></ul></ul><ul><li>By maintaining more personal contact between managers and MSLs, companies can change direction more rapidly in the field to handle unmet medical needs or to follow up on key shifts in the marketplace. </li></ul><ul><li>Once a company successfully enters a therapeutic area and establishes relationships, it should not abandon the beach-head it has established. It is harder to create new relationships than to maintain current contacts. </li></ul>
    15. 15. Stakeholder Needs Analysis More than two thirds of partners use thought leader reach and call frequency – in combination with treatment area maturity levels – as key drivers for aligning their medical specialists in the field. What internal stakeholder needs drive your alignment? N=28 47% 47% 47% 68% 68% 79% Number of speakers needed Number of advisory boards planned Number of clinical trials planned Amount of desired interaction with thought leaders (frequency) Degree to which thought leader support is needed to change current approach to treatment. Desired number of thought leader/advocates (reach)
    16. 16. Span of Control: Managers to Specialists Nearly two-thirds of companies prefer a closer relationship of one manager to 10 or fewer medical specialists. However, a full third of companies move in the other direction with managers overseeing 11 to 16 or more liaisons. N=26 What ratio of managers to field-based medical specialists does your company utilize? 8% 23% 27% 42% 1 manager to 16 or more specialists 1 manager to 1-6 specialists 1 manager to 11-15 specialists 1 manager to 7- 10 specialists Span Of Control 65% prefer more personal span of control
    17. 17. Drivers for Increasing Number of Field-based Medical Specialists Product potential, clinical indications, speaker development status and approval progress are the greatest drivers for increasing the number of medical specialists. Please evaluate the importance of key factors that would cause you to increase the number of field-based medical specialists. Very Important Somewhat Important Not Important N=28 15% 15% 21% 33% 39% 43% 54% 54% 50% 67% 52% 50% 43% 36% 27% 31% 35% 12% 15% 11% 14% 10% 4% 69% Crowded market place with other products Governmental intervention Competition is increasing Corporate imperatives Developing speakers Approval status New Clinical data and potential indications High potential product
    18. 18. Drivers for Decreasing the Number of Field-based Medical Specialists Later lifecycle product stage, co-promotion support and market changes are the key drivers for decreasing the number of liaisons. Please evaluate the importance of key factors that would cause you to decrease the number of field-based medical specialists. Very Important Somewhat Important Not Important N=28
    19. 19. Insight #4: Developing & Managing KOL Relationships Call frequency varies in regards to regional and national KOLs but not significantly. Companies appear to spend more time fostering existing relationships than forging new ones. Key Findings <ul><li>It seems that synchronizing and optimizing service delivery across liaisons and sales representatives does represent a key productivity boost. </li></ul><ul><ul><li>More than two-thirds of benchmark companies choose to have their MSLs call on regional and national KOLs about once per month. </li></ul></ul><ul><li>More and more companies are beginning to use the MSLs as their main points of contact for all thought leader development activities to maintain the specialists' credibility and effectiveness. </li></ul><ul><li>“ You have to preserve relationship credibility. The thought leader cannot perceive the field-based medical specialist as relatively insignificant.” </li></ul><ul><li>-- MSL specialist director </li></ul>
    20. 20. Customer Access Is Declining for Sales Reps Physicians are limiting or closing access to their offices and clinics as a result of too many sales reps calling upon them. Access issues plague most major markets across the global marketplace. “ I don’t know if you saw it in the industry press or maybe it was even in one of the national newspapers. At some of the medical schools, the students are voting not to allow access to representatives. It Used to be that that was just faculty and the professors -- but now it’s the students. And when you’ve got an industry that was founded on educating the customer and thus driving prescriptions, and now new doctors don’t even want that, you’ve got a problem.” – US District Sales Manager Countries With Declining Access
    21. 21. KOL Structure Should Evolve With the Company In younger, smaller organizations with few products, KOL management should be very hands-on; as an organization grows and the number of therapeutic areas increases, clinical and commercial leaders employ more strategic approaches. KOL Function Maturity KOL Management Sophistication New Bio-Pharma Medical & clinical leaders collaborate with commercial to develop KOL strategy Identify Key Opinion Leaders for Therapy Develop excellent relationships with National KOLs Develop regional KOLs Leverage relationships to educate providers on disease and therapy Maintain and improve KOL relationships for existing and developing therapies Mid-Cap Bio-Pharma Medical, clinical & commercial leaders collaborate to develop stratified KOL strategy across therapies Leverage existing KOL relationships and experiences to develop KOLs in new therapeutic areas Develop and improve systems for tracking all company interactions with KOLs Shift National/Global KOL contact to dedicated functional personnel for each therapeutic area Conduct periodic reviews to identify and approach new KOLs Large Bio-Pharma Continue cross-functional collaboration to ensure KOL strategies remain current Periodic refinements to KOL management structures based on experience and changing therapeutic needs Focus on continuous improvement in KOL relationship management and tracking to optimize systems and processes for maximum impact Continue periodic reviews to identify and approach new KOLs
    22. 22. Liaison service levels seem to be focused to selective calls, with more than two-thirds of companies calling on KOLs 1 or fewer times a month. This appears to to reflect lifecycle of the project or product – and relative emphasis placed on KOLs to market success. What level of face-to-face calls from field based specialists do you expect in order to develop and grow regional-level thought leader relationships (per year)? Developing Regional Relationships Through Liaisons N=28 68% call no more than 1 time per month
    23. 23. Developing National Relationships Through Liaisons Nearly three-fourths of partners call no more than once per month on national thought leaders. Interestingly, three times more partners call 26 times or more per year on national thought leaders than called that frequently on regional KOLs. What level of face-to-face calls from your field based specialists do you expect to develop and grow national thought leader relationships (per year)? N=28 71% call no more than 1 time per month
    24. 24. Growing New KOLs Through Reps & Liaisons Companies are not visiting new thought leaders to build relationships as frequently as in years prior. In fact, most companies have their MSLs and sales representatives in touch with KOLs no more than twice per month combined. What level of call frequency for the entire company do you require to develop and grow a new thought leader relationship? N=25 68% call 2 or less times per month
    25. 25. What KOLs Value Most The open-ended responses were spread roughly evenly across three broad categories: contribution and involvement, rewards and benefits, and intangibles. Percentages of multiple responses are shown below with representative verbatim values. Q: What do KOLs seem to value most in their relationship with your company? (please list top three and describe as necessary) Being on the cutting edge; Involvement in changing science; Clinical studies participation; Innovative products; Engaging Peers; Chance to Give Advice; Ability to contribute Rewards and Benefits Contribution and Involvement Intangibles 0 Integrity; Ethics; Patient Focus; Honesty; Transparency; Service orientation; Brand value Support for research; Sponsorship; Honoraria; Ability to publish; CV building; business perks
    26. 26. Insight #5: Shifting Resources To Keep Relationships & Yield Value Forging thought leader relationships takes time and is an essential tool for understanding and competing in the marketplace. Key Findings <ul><li>Most companies do not automatically decrease field-based medical specialists after product launch. </li></ul><ul><li>Shifting resources to yield value and maintain the relationships is a key productivity frontier for managers of liaison groups. </li></ul><ul><li>Many companies deploy their MSLs medical specialists to reflect sales region configurations, geographic concentrations of key thought leaders and key medical center locations. </li></ul>
    27. 27. <ul><li>Benchmark Perspectives </li></ul><ul><li>KOL relationships take time to develop. </li></ul><ul><li>KOLs have influence during pre-launch and post-launch lifecycles. </li></ul><ul><li>KOLs provide competitive insights throughout the entire lifecycle. </li></ul><ul><li>KOLs are effective advocates. </li></ul><ul><li>High prescribers can be effective advocates as well. </li></ul><ul><li>High prescribers deep product experience make them effective advocates. </li></ul>Resource Shifting and Forecasting Companies do not downshift resources after a product is launched. Thought leader relationships are hard to develop and valuable throughout the product lifecycle. “ KOL relationships often take a very long time to develop but high-prescriber relationships can be ramped up very quickly .” -- Director of Sales
    28. 28. What Differentiates the Better Companies Respondents felt that several factors helped differentiate the best practitioners: experience and resources, continuity and collaboration, systematic planning and execution, and innovative science and robust pipeline. <ul><li>Continuity in their approach </li></ul><ul><li>Focus and persistency </li></ul><ul><li>Dedicated KOL managers </li></ul><ul><li>Company process that focuses KOLs as a customer and realizes that relationship is two-way and requires mutual respect and collaboration on both sides </li></ul><ul><li>“ They have been doing this activity longer and dedicate more resources in terms of both programs and people” </li></ul><ul><li>Program funding and dedicated staff </li></ul><ul><li>Deeper pockets </li></ul><ul><li>Adequately funded MSL teams </li></ul><ul><li>Cohesive interaction plan </li></ul><ul><li>Effective, validated long-term strategic plans </li></ul><ul><li>Company and regulatory guidelines </li></ul><ul><li>Planning, organization, metrics/tracking and excellent relationship management </li></ul>Continuity and Collaboration Experience/ Resources Innovative Science/ Robust Pipeline Systematic Planning and Execution <ul><li>An impressive pipeline in targeted disease states </li></ul><ul><li>More percieved focus on scientific vs. commercial benefit </li></ul><ul><li>Scientific approach and clinical studies participation </li></ul><ul><li>Pipeline access </li></ul><ul><li>Broader product portfolio </li></ul><ul><li>Differentiated pipeline </li></ul>Q: What do you believe are the differentiating factors that allow these companies to establish and maintain successful relationships with KOLs?
    29. 29. Deploying Liaisons Into Field Benchmark companies deploy their MSLs medical specialists to reflect sales region configurations, geographic concentrations of key thought leaders and key medical center locations. Assess the effectiveness of the following factors that drive how you deploy your liaisons and specialists into the field? N=28 Not Important Do Not Use Important Very Important 14% 43% 46% 46% 43% 39% 36% 32% 21% 4% 7% 5% 21% 14% 11% 18% Deploy to reflect sales distribution by geography Deploy to reflect medical centers Deploy to reflect thought leader geographic concentrations Align to fit sales regions/divisions
    30. 30. Automatic Resource Decrease Forging thought leader relationships takes time and is an essential tool for understanding and competing in the marketplace. Consequently, most companies do not automatically decrease field-based medical specialists after product launch. Yes 11% No 89% Is it standard policy to automatically plan to decrease the number of field based medical specialists after a product has been launched? N=28
    31. 31. Emerging Trends Most respondents saw new frontiers opening in how KOLs were identified, assessed, and deployed, with an emphasis on developing “up and coming” talent and differentiating their use. Q: Please describe what you see as the emerging trends in developing and maintaining effective relationships with KOLs. <ul><li>Continued tightening of guidelines will require increased vigilance </li></ul><ul><li>High costs of global development and international knowledge exposure changing deployment priorities </li></ul><ul><li>Greater agility to deal with need for “fast-moving and fast-changing” relationships </li></ul><ul><li>More affordable tools that provide a long-term view of KOL’s role </li></ul><ul><li>Integrated profiling platforms </li></ul><ul><li>Effective research on who’s who among KOLs </li></ul><ul><li>Identifying and developing KOLs who are better able to advise about newer and future events in the marketplace </li></ul>New Roles and Responsibilities New Tools and Tactics Responses to New Conditions <ul><li>Earlier engagement in new product development programs </li></ul><ul><li>More involvement in pipeline discussions with scientific bias </li></ul><ul><li>Differentiated uses and tactics over development lifecycle </li></ul><ul><li>Greater coordination with Disease Management and MSL programs </li></ul>
    32. 32. Summary of Key Take Aways From the many insights, findings and observations from the MSL research, these five represent recurring, high priority themes. Key Findings <ul><li>Monitoring Markets & Competition </li></ul><ul><li>Tracking Value Evolution </li></ul><ul><li>Determining Liaison Field-force Size </li></ul><ul><li>Developing & Managing KOL Relationships </li></ul><ul><li>Shifting Resources To Keep Relationships & Yield Value </li></ul>
    33. 33. Areas for Further Research <ul><li>What are leading indicators of KOL relationship depth? </li></ul><ul><li>What are optimal coverage rates of Thought Leaders per Liaison at different lifecycle stages? </li></ul><ul><li>What is the optimal structure and size for a world class field-based medical liaison program at different lifecycle stages? </li></ul><ul><li>What principles work best to coordinate liaison and sales representative activities? </li></ul><ul><li>How are regional and national liaison activities coordinated? </li></ul><ul><li>What systems are in place for resource shifting across pre-and post-launch periods. </li></ul><ul><li>What are key competencies for field-based medical liaisons at varying lifecycle stages? </li></ul>Current research surfaced various topics that were outside study scope but do invite further interviews or surveys among benchmark partners.
    34. 34. About Best Practices, LLC Best Practices, LLC is a research and consulting firm that conducts work based on the simple yet profound principle that organizations can chart a course to superior economic performance by studying the best business practices, operating tactics and winning strategies of world-class companies. Best Practices, LLC 6350 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517 919-403-0251 [email_address] www.best-in-class.com

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