A pragmatic guide to the evolving role of reps in the era of direct sales, and to mitigating unintended effects on incentive compensation.
Summary takeaways:
- DTC sales channels should be seen as complementary to traditional field sales, not replacements.
- Incentive compensation plans must evolve to capture reps’ indirect influence on prescribers.
- DTC expands patient access by reducing barriers and reaching new populations, driving growth opportunities.
- Partnerships with telehealth providers and tech integration are key to building seamless patient experiences.
- Balancing innovation with fair recognition of reps’ contributions will sustain motivation and commercial success.
The direct-to-consumer (DTC) sales model for medicines continues to grow in popularity. Pressure from President Donald Trump is driving interest, but multiple pharma majors were already leaning in by opting to sell their medicines directly to patients.
Last month Swiss pharma giant Roche said it’s weighing the channel, following the launch of DTC websites by Eli Lilly, Novo Nordisk and Pfizer. Multiple other heavyweights have also made commitments to sell medicines direct over the last two years, from Amgen and AbbVie to Bristol Myers Squib.
But what does that mean for the industry’s sales representatives? Is this shift set to make longtime incentive models obsolete? Not necessarily, says one expert observer. He sees a path for how pharma can recognize reps’ contributions within this changing landscape.
DTC and field reps: complementary, not competitive
Manufacturers can still ensure their field forces are properly incentivized and rewarded, according to Rohit Gupta, a partner at Beghou, which specializes in commercial operations for biopharma, including incentive compensation (IC) design and administration.
“Rep activity and DTC are not in conflict,” he notes. “When planned well, they can complement each other and work together to drive brand success.”
IC, at its most basic level, is designed to ensure reps enable final sales in their sales territory. So, DTC or a subset of it—i.e., telehealth —isn’t necessarily orthogonal to this enablement. In fact, it could provide a tailwind to reps’ efforts to help move HCPs faster through the sales funnel.
Trump is pushing for more companies to go direct. The administration recently sent letters to 17 drugmakers asking them to allow direct sales of their products at the lowest price offered in other developed countries, in line with his Most Favored Nation executive order from May.
Expanding patient access via new channels
Manufacturers had already been launching their own DTC platforms. Sites like PfizerForAll, LillyDirect and NovoCare create a one-stop shop combining education, telehealth and mail-order pharmacy.
Many have deals with telehealth companies, as well. Populus, for instance, works with Pfizer on migraine meds. Ro has a deal with Lilly on obesity drugs.
Both of these avenues may open a path to previously untapped patients. Some may be completely new to treatment or previously less engaged due to location, stigma or other barriers. Indeed, direct sales should not be thought of as a mere replacement for the rep channel but a way to expand the reach of the brand.
“Before [these channels] came along, there were gaps in the patient journey between education and prescription fulfillment, so you lost a lot of patients across the journey,” Gupta recalls. “But telehealth platforms fill such gaps by providing end-to-end solutions across the continuum.”
Evolving incentive compensation models
DTC doesn’t mean no HCP. The models still involve physicians, though it may be via telehealth.
Novo allows cash-paying patients who take GLP-1 drug Wegovy to have their prescription sent directly to the company. But in most other cases, prescriptions are written by an independent doctor on a consumer-facing telehealth platform.
As such, doctors stand to be nudged twice, by both rep and patient. That double-nudge may help HCPs move more quickly along the sales funnel, potentially enhancing rep impact. IC goals may need to be adjusted accordingly for fairness, ensuring benchmarks are performance-based so the field force retains confidence in the IC plan.
As to how this will work in practice, it’s important to keep in mind that reps do more than deliver sales pitches to doctors. They often influence decision-makers across the healthcare system including KOLs, institutions and payers.
Capturing the 'halo effect’
That “halo effect,” says Gupta, is key. Let's say a prescription comes in on a DTC website. Prior to that patient-DTC engagement, the patient may have had a touchpoint with the brand via a local physician who had been influenced by a rep.
In other words, not all patients who engage with DTC platforms are naïve patients (those who have not been influenced by their PCP/HCP). These efforts shape patient access and awareness and should not be ignored when evaluating overall contribution.
Gupta predicts reps will remain a vital part of pharma’s commercial engine, even as the direct sales channel further takes root.
To be sure, having direct access to the patient at scale is a new phenomenon for pharma. But while pharma IC plans may bend, DTC certainly won’t cause them to shatter.
As published here