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All in all, the Affordable Care Act (ACA) had a pretty successful uptake in 2015. Depending upon which source you listen to, roughly 8 million people enrolled in the program in 2015, each acquiring health insurance where they previously had none in 2014. As altruistic as the program may seem, the cost of keeping patients healthy has a price. The consequence of providing healthcare to everyone means belts have to be tightened elsewhere to save costs. Keep in mind, there are not more doctors, there are simply more paying patients to treat. Last I checked, there are still only 24 hours in a day, so that means treat more patients in less time.


Since the ACA’s inception, doctors have become stretched to capacity. Practices are growing to support the multitude of patients they see. Primary care acts as triage for almost all patients as the first line of defense to curtail unnecessary testing and spending, and there are a plethora of wellness programs that have been established for chronic diseases and their prevention – smoking cessation, managing diabetes, and weight loss, to name a few.

With less time for physicians to do their actual jobs, pharma access is being restricted like never before. Not only because they have no time to see pharma sales reps, but also because salespeople carry less clout in a market in which there is less choice on the part of the healthcare provider (HCP) to prescribe. In the spirit of cost savings, further reform on drug spend has instituted treatment algorithms that dictate the course of treatment and therapy options a healthcare provider may offer to his/her patients. Furthermore, most patients now have at least basic prescription drug coverage on their new health insurance plan. Many of those plans also impose formularies upon healthcare providers and limit what they can prescribe. Safety and efficacy considered, it is an issue of cost containment, and HCP’s are often incentivized to stay within guidelines.

Unfortunately, relationships can’t trump formularies. Consider that most HCPs with a license to prescribe medications have only completed 2 or 3 pharmacology courses during their medical education. Most lack the understanding of newer, more innovative therapies that may be available on the market, and truly benefit from the continuing education that pharmaceutical companies may provide. Some have really grown accustomed to their visits from salespeople, and appreciate them as valuable resources in helping treat their patients effectively. However, when the medical group they are employed by restricts access, that partnership is threatened.

New drugs are often the most adversely affected. Despite the promise of new entrants to the drug market such as biosimilars that offer less expensive alternatives to the costly biologics, they are too new to have adequate coverage by many insurance plans, so the likelihood of a physician knowing how to prescribe them is minimal. Enter the chicken and egg concept. In order to obtain coverage, you have to first drive demand and increase use to justify a formulary consideration. So, if the product is initially restricted in some way, how can that be done? Well, that’s exactly what healthcare providers want you to answer for them. Truth is, we don’t train reps to do this – we train them to talk drugs, not business.

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This is precisely why the way we train salespeople in the healthcare industry must evolve. We need to implement training platforms that focus more on B2B skill building than simply delivering product messages. We need to train them to:

  • find new ways to bring value and gain access to their customers
  • understand how to navigate formulary restrictions and other managed care challenges
  • act as a conduit between the physician, the patient, and their treatment
  • educate customers on REMS and other risk management strategies
  • consult with C-Suite decision-makers (arguably their new key customer)
  • truly know how private insurance versus government (Medicaid & Medicare plans) works, playing more of advocacy role
  • get back to the needs-based selling model, promoting a more patient-centric, wellness-driven solution (Forget customer centricity – the customer needs to prescribe what they want for their patients, and they can’t even do that anymore.)

Once we conform the way we educate sales teams, we can enable them to play a powerful role in the business of medicine. Product and disease state knowledge doesn’t go away, selling methods and tactics have their place as well, but the real impetus will come from hardcore business management training that they can in turn, equate to being consultative guideposts for the overworked HCP community who so sorely needs their advocacy.