Tom Quinn, Physicians Interactive

It is widely recognized that healthcare is in the midst of a digital revolution. Health systems and clinicians’ offices are moving forward with implementation of electronic health records (EHR) systems. E-prescribing (eRx)—the transmission of prescriptions electronically, rather than handing off a slip of paper to the patient&mdash;is now practiced by over 50% of physicians. And clinicians have been enthusiastic adopters of mobile devices&mdash;smartphones and interactive tablets. It is becoming commonplace for clinicians to conduct examinations with these devices at hand, both to look up relevant information and to record findings.

		Pharma marketers are looking closely at how to integrate their communications with prescribers into this digital environment. Specifically, how—and should&mdash;the practice of delivering samples to clinicians’ sample closets evolve in this new environment? There is little doubt that the pharma industry needs to adjust: the number of offices for which representative (rep) access is restricted (“no-see physicians”) is growing. At the same time, an increasing number of clinicians are growing accustomed to ordering samples online (e-sampling). Finally, the pharma industry itself wants to ensure better utilization of sampling and to integrate sampling activity into its other communication channels (closed-loop marketing).

		We propose that there is a new model of sampling being established, one that integrates all these trends, while providing efficiencies both for the time-pressed physician and for the budget-minded pharma marketer. This “e-sampling” model—still being worked out as EHRs and mobile connectivity evolve&mdash;has three landmarks to guide its development:

		For many clinicians, smartphones and tablets are must-have accessories and an essential component of a professional workday. The advent of the EHR system has furthered the need for integration into the online and mobile workflow of the clinician. The “digital workflow” as it can aptly be called, is a cornerstone of the most viable and effective new developments in health IT as of late. As EHR prevalence has expanded, so has the opportunity to elevate the quality of patient care, at the point of care. Another aspect of this digital workflow is the growth of eRx. By the end of 2011, more than half of office-based physicians used eRx, vs. one-in-ten just three years early. The number of prescriptions routed electronically increased 75% in that one year’s time, according to data published by SureScripts.

		EHR/eRx has also transformed the business outlook for pharma marketers on numerous levels. The need to obtain access to clinicians is as real and as strong as ever, but there are also more ways than ever to support sales, advertising and marketing programs now, thanks to the digital channels and targeted tactics emerging from the EHR/eRx movement. Online and mobile tools that fit within the medical professional’s workflow, with e-sampling being a premier example, provide resources to make the physician’s job easier. These resources circle back to helping the clinician serve patients at a higher level, which provides relevance for the company to the clinician within the workflow. Perhaps even more importantly, it supports good will between prescriber and patient.

		As such, increased access to prescribers is a welcome benefit and one very good reason why pharma companies should align their sampling efforts with workflow integration top of mind. Also consider current e-sampling technology that enables 24/7 on-demand access to sample requests—a significant advantage to both clinicians and pharmaceutical companies.

		We know clinicians are facing demands of more patients and less time, not to mention healthcare system pressures revolving around meaningful use requirements, patient satisfaction, group profitability, compliance and more. Detailing time is shrinking and offices are limiting access, yet clinicians need and want to offer patients a chance to try an emerging therapy or to experience a trusted brand to treat their newly diagnosed condition. The landmark at this juncture, where e-sampling is rising to meet the needs of the various stakeholders, is the digital workflow of the prescriber.

Credit: Physicians Interactive 2012 HCP Survey

		With pharma under the ever-present pressure to do more with less, holding down costs while preserving revenue means everything from investing wisely in new processes and campaigns, to finding the right balance of channels for existing products and applications. New drug launches, ongoing marketing efforts for mature products, reinforcement of alternative therapy evaluation…a close look at the specific value a rep can deliver also reveals a number of ways to view the pharmaceutical company’s balance between face-to-face engagement and e-sampling services. In most cases, direct sales will co-exist with an e-sampling program for specific strategic purposes. Each promotional channel’s tactics and initiatives will support the other and fill in the gaps where the other can’t reach, is cost-prohibitive, or doesn’t offer the best potential return on investment.

		Like all sampling programs, e-sampling offers ways for pharma to encourage patient trials of new medications—new to a patient, or new to the market. It helps clinicians get patients started sooner with treatments, and also potentially improves compliance. All this returns benefits to pharma as it ultimately creates more demand for brands. But what e-sampling brings is the ability to maximize time, effort and investment on behalf of all the stakeholders&mdash;clinicians, patients and pharmaceutical companies.

		For pharma, it begins with the physical logistics: more optimal inventory management and distribution, while reaching a broader set of clinicians in a wider geographic area and at the same time minimizing issues like rep “stockpiles” and other inefficiencies. Additionally, sample integrity can be further ensured when medication samples are distributed from a centralized, regulatory-compliant center associated with the e-sampling service. For clinicians, that same sample integrity, along with easier inventory management of their own virtual drug closet, matter as well.

		Finally, crucial to its effectiveness as a resource, an e-sampling program is an investment that can be very efficiently maximized because it exists in a digital world. It extends the sales force’s capabilities exponentially by being available anywhere, anytime, to all users. Once the program is up and running, it doesn’t require training, reimbursement, or the like. Additionally, eRx programs can bring data on prescribers’ needs, preferences and sampling activities to the forefront for pharma, which in turn can be used to hone marketing efforts, improve future strategies and elevate returns.

		It’s been established that eRx is on the rise, digital workflow integration is something clinicians need, and tools that bring benefits to the patient are things clinicians want. Relevance, convenience, access, good will…all are keys to the landmarks that will guide the right strategies when balancing new promotional channels with traditional programs to maximize resources. With drug sampling, one underlying question regarding all these factors remains: How shall pharma get the samples physicians want to distribute, and patients want to benefit from, into the hands of clinicians, when those same clinicians have less time, inclination or freedom to see sales reps?

		Often, clinicians recognize the value in the detailing and sample delivery meetings, but simply can’t accommodate the means to the end. Or, sometimes there just isn’t a way to bridge a gap—of geography, availability of rep appointments, etc. It might be impossible to schedule appointment upon appointment with different pharmaceutical company representatives with hopes of keeping a full drug sample closet, or up-to-date with new product launch samples from multiple manufactures, while staying properly stocked with oft-prescribed mature brand samples.

		E-sampling “1.0,” if you will, might be considered to have been a first step on the road toward helping clinicians streamline their workday and cut back on appointments, as pharma begins to address that original underlying question. Adopting technology that allows a clinician to visit the Internet to securely browse and order samples from a pharmaceutical company, gives clinicians a chance to get samples they want for their patients at their own convenience. Of course, certain drawbacks come along with the need to register for multiple sites, one brand at a time—especially in larger practices, for general practitioners, etc. Indeed, most physicians do stock samples from multiple companies and recognizing this point is central to enabling a successful clinician-driven model for e-sampling.

		In a literal sample closet, shelf space is shared by multiple brands from various companies. Since reps delivered samples from their own company, there can also be reluctance at first to share that online “shelf space” with other brands. Still, a newer multi-brand e-sampling closet, where clinicians can visit one website to request many samples from different companies in a single transaction, now represents the kind of digital workflow integration today’s clinician requires. Physicians Interactive delivers this model with the first-ever patented medication sampling solution, branded as Samples on Demand, offering secure access to nearly 100 brand-name medications and growing.

		This technology allows pharmaceutical companies to provide direct access, 24/7, to the broadest selection of medication samples, when and where prescribers need them. Not only is it very easy for prescribers to send electronic requests, the metrics provided support improved modes of customer service by the pharma company clients as well. With a model like this, clinicians benefit from greater usability, quicker evaluation of alternative therapies, greater choice right at their fingertips, a way to encourage patient compliance and the chance to minimize delays in treatment.

		Physicians Interactive offers this feature within its e-sampling solution. We’ve found that allowing clinicians such an efficient system with flexible access to samples for their patients returned remarkable results very quickly: a 259% increase in e-sampling transactions between 2010—2011. This was with 72 brands participating at the time, a number which is on pace to eclipse 100 brands by the end of 2013.

		By allowing for an industry-wide multi-brand e-sampling closet, where clinicians can visit a single interface to request a wide variety of brand samples in a single transaction, further efficiencies within the clinician’s workflow are enabled. Evidence for the growth of this, a “distribution model” of e-sampling in the healthcare marketplace, might be the number of sample orders received through Physicians Interactive’s own patented, e-sampling solution, which grew from 14,000 brand orders per month in April of 2010, to 85,000 in October of 2012. It’s easy to see how the case for the clinician-driven solution is an important guiding landmark when organizing e-sampling approaches.

What prescribers conclude, and pharma should know

		In a December 2012 Physicians Interactive survey of clinicians, the desire for more manufacturer participation in the e-sample closet was nearly unanimous—almost 90% agreed they wanted more pharma represented. The top four reasons for using e-sampling are superior ease/convenience of process, 24/7 access, lack of rep for specific products, and single source for multiple manufacturers’ samples.

Articles

The accelerating adoption of electronic health records, e-prescribing and mobile technologies will change the conventions of sample distribution