Ask an Account Manager anything...

[RealAM]

Finally, I feel for you guys on the NSR/ANSR side. In their infinite wisdom they have decided to keep you and your managers out of Thebe and that creates a lot of confusion.
Here’s the deal on “self reported intakes.” I’ve been in this business a long time. I can’t tell you how many times a doc will say “I write your product all the time” or I just started someone on it” but you know he is lying because it does not show in the data. This is no different. Unless you are there, have reviewed that it is complete and watched it get faxed in you are just taking their word for it. So you go and put it on your tracker because your manager is hot to get that up to Jen and then the IC comes out and you are like WTF! Most cases than not, the doc didn’t really send it in. And even if you went in with your manager and they told you both that they sent it in they are likely lying because they are a. trying to tell you what you want to hear b. have no idea how tightly these are tracked.
So what can you do? Build a relationship with you AM. I check Thebe for all my NSRs. While it may not be what they want to hear, I can show them what they got paid on and what is not showing up. There are going to be a few random cases where an SRF came in off-label (which do not show up in Thebe) but again, your AM can ask their CM to see if an office sent one in off-label.
It sucks, the process sucks and most of all you guys not having visibility sucks the most but I can tell you, if you had 8 self reported intakes and got paid on two here is what I would do. Ask your AM for their help. First they can tell you is you really had 8. Then thing they can tell you is which two you got paid on and which were incomplete. Work on the incomplete ones and those will at least count for the next quarter. If there is still a missing script or two, ask them to ask their CM is any came in off label. If there is still a missing script, the doc lied.
Problem is, the company did everything they could to build walls between AMs and NSRs and fuck up any collaboration there might have been. Build a relationship. Don’t treat your AM like your administrative assistant - quickest way to never get a returned phone call. We know you guys need the info and most of us would like to help.
Last - Vanda has changed IC so many times. The only thing that counts now is complete intakes. When we were paid on triages, yes an incomplete that triaged (which meant dispensed back then) counted as complete. That does not matter anymore. We get paid on paper getting faxed in, not product going out the door.

 

[anonymous]

realAM can you explain why there appear to be such large differences in the sales numbers that vanda reports to investors with intakes and actual fills? when you said we get paid on paper being faxed in and not product shipped, what do you mean? NSRs are paid on paper faxed in? or the company is somehow able to report revenue based on intakes vs actual product shipped and rxs filled?

 

[RealAM]

realAM can you explain why there appear to be such large differences in the sales numbers that vanda reports to investors with intakes and actual fills? when you said we get paid on paper being faxed in and not product shipped, what do you mean? NSRs are paid on paper faxed in? or the company is somehow able to report revenue based on intakes vs actual product shipped and rxs filled?

Vanda reports total revenue, not number of scripts. That number is obviously broken down for each product and meets expectations for the most part with constant price increases which by last count makes a year of therapy well over 200k a year. Also through overhead reduction including associate reps being hired at nearly a third of the salary compared to experienced reps (who ask too many questions about the grey area Vanda loves to play in.) I’d love to have an investor ask a question about the wisdom surrounding bucking the entire industry by hiring recent college graduates to sell in the rare disease/orphan drug space, a space where 10+ years specialty experience is the norm not the exception. I digress. We get paid on paper. That means the script faxed in, not the dispense. They are playing a numbers game though. AM goals are going to 8 per quarter. Not sure about NSR goals, but they pay less for each intake now knowing full well only a small percentage will ever get filled. It’s after 11, getting late. Busy day tomorrow putting together ridiculous, micromanaging spreadsheets for senior leadership. Maybe I’ll find time to go sell something?

 

[anonymous]

Is there any explanation why a fax will be faxed in when I am in the office with a confirmation page shown to me to prove it and have the powers that be say that it was complete only to then hear it was incomplete later on and not get any bonus?

Asking the manager or a regional is no help because they have actually said "We will never know why it was marked as incomplete after being marked initially as complete."

 

[anonymous]

like he said it is a numbers game. They are loosing patients because of efficacy and not getting enough approved to replace the patients falling off. So they demand more sales to hope that if we increase your goal then that will increase scripts being filled. But they don’t want it showing that they are paying reps to sell off label, so they say it is incomplete even if it was filled. This is saving them millions of bonus payouts a year to off set the loss of money coming in from product. The financials would look much worse with the old sales force and bonus structure. It is a numbers game they will
Continue to do. It is not about the patient.

 

[RealAM]

Is there any explanation why a fax will be faxed in when I am in the office with a confirmation page shown to me to prove it and have the powers that be say that it was complete only to then hear it was incomplete later on and not get any bonus?

Asking the manager or a regional is no help because they have actually said "We will never know why it was marked as incomplete after being marked initially as complete."

I don’t have good news for you on this. I have no idea. I feel for you because I can tell by the question you are an NSR and I know it sucks not having a definitive answer. Here is the problem. Your manager does not have access to thebe. Neither does your regional. They get some insight into data, but why don’t they have access to such essential information and I do? Lol. Crazy but true. Because of that, anything they say to try and explain it just speculative, or, umm... bullshit.
Again, from what I can see (and your not going to like this either) this never happens. They don’t just suddenly become incomplete. If there is one specific intake you can think of, go back to that office and take a look at the form yourself, re-check the basics. Easiest thing, ask your AM.

 

[RealAM]

It is a numbers game they will
Continue to do. It is not about the patient.

It hasn’t been about the patient in a long time. I remember the recruiter coaching me through the interview process, “talk about your passion for patients, striving to be patient centric in all you do because that’s what they want to hear.” I had a lovely conversation with Mohamed about Vanda’s commitment to patients during my interview. It felt that way for a few years.
Then somehow if changed. Greed corrupts.
How is underselling the dispense probability patient focused? If a doc knew 90% of scripts go unfilled would they waste their time prescribing or miss the opportunity to treat the patient with something they’d actually get?
How is dumbing down the message so much docs think they are writing for sleep instead of an incredibly rare circ disorder patient centric?
How is coaching us to not get into the retail cost of therapy patient centric?
If we know this doesn’t work for insomnia, why are we wasting patients time trying something we already know will be a treatment failure? That’s not patient centric. And to top it off, with the push being selling to psychs got their bipolar patient population doesn’t that make it even more fucked up? How is messing with people that have a difficult mental disorder patient centric?
Sick.

 

[anonymous]

I don’t have good news for you on this. I have no idea. I feel for you because I can tell by the question you are an NSR and I know it sucks not having a definitive answer. Here is the problem. Your manager does not have access to thebe. Neither does your regional. They get some insight into data, but why don’t they have access to such essential information and I do? Lol. Crazy but true. Because of that, anything they say to try and explain it just speculative, or, umm... bullshit.
Again, from what I can see (and your not going to like this either) this never happens. They don’t just suddenly become incomplete. If there is one specific intake you can think of, go back to that office and take a look at the form yourself, re-check the basics. Easiest thing, ask your AM.

Thanks. This is going back awhile and all was well and good until Jan Brady said it was incomplete and no AM was around to assist.

The office did everything right and I'm tight with them.

 

[anonymous]

It hasn’t been about the patient in a long time. I remember the recruiter coaching me through the interview process, “talk about your passion for patients, striving to be patient centric in all you do because that’s what they want to hear.” I had a lovely conversation with Mohamed about Vanda’s commitment to patients during my interview. It felt that way for a few years.
Then somehow if changed. Greed corrupts.
How is underselling the dispense probability patient focused? If a doc knew 90% of scripts go unfilled would they waste their time prescribing or miss the opportunity to treat the patient with something they’d actually get?
How is dumbing down the message so much docs think they are writing for sleep instead of an incredibly rare circ disorder patient centric?
How is coaching us to not get into the retail cost of therapy patient centric?
If we know this doesn’t work for insomnia, why are we wasting patients time trying something we already know will be a treatment failure? That’s not patient centric. And to top it off, with the push being selling to psychs got their bipolar patient population doesn’t that make it even more fucked up? How is messing with people that have a difficult mental disorder patient centric?
Sick.

Who is Mohamed here at Vanda again?

 

[RealAM]

Who is Mohamed here at Vanda again?

Lol. Damn auto correct. That would be Mihales, not Mohammed. My final interview.

 

[anonymous]

It hasn’t been about the patient in a long time. I remember the recruiter coaching me through the interview process, “talk about your passion for patients, striving to be patient centric in all you do because that’s what they want to hear.” I had a lovely conversation with Mohamed about Vanda’s commitment to patients during my interview. It felt that way for a few years.
Then somehow if changed. Greed corrupts.
How is underselling the dispense probability patient focused? If a doc knew 90% of scripts go unfilled would they waste their time prescribing or miss the opportunity to treat the patient with something they’d actually get?
How is dumbing down the message so much docs think they are writing for sleep instead of an incredibly rare circ disorder patient centric?
How is coaching us to not get into the retail cost of therapy patient centric?
If we know this doesn’t work for insomnia, why are we wasting patients time trying something we already know will be a treatment failure? That’s not patient centric. And to top it off, with the push being selling to psychs got their bipolar patient population doesn’t that make it even more fucked up? How is messing with people that have a difficult mental disorder patient centric?
Sick.

If Vanda was patient centric, Hetlioz would be sampled, available at your retail pharmacy and be affordable. Vanda is Poly-centric only.

 

[RealAM]

If Vanda was patient centric, Hetlioz would be sampled, available at your retail pharmacy and be affordable. Vanda is Poly-centric only.

True.
Poly-centric
Ego-centric
There have been a lot of strong experienced people in senior leadership who have left through the years who just could not work where their voices are not respected. That is where the downturn happened. Once the company became a cadre if yes-men, sycophants and survivors we were doomed. He has his hands in everything, will not be disagreed with and disregards salient business advice from the very people he pays to give it. So now you have a group (GP, Tom, Jen, Christine) who roll out every bullshit idea instead of pushing back where their own experience tells them they should or others that know just how to work him (Jan) so they can continue for another paycheck.

 

[anonymous]

why are so many AM’a leaving? heard it’s more than a handful.

 

[anonymous]

REALAM, why oh why is the Q3 Goal for Hetlioz prescriptions going up to 8 Intake prescriptions per AMs and NSRs? Did Vanda change the Orphan Drug designation? Did we get Insomnia indication?

 

[RealAM]

why are so many AM’a leaving? heard it’s more than a handful.

It is more than a handful, more resignations to come and the rest, myself included, are actively looking.
Why? I could make you a list.

• How many times can a sales team get screwed over on IC? In 2015 the annual IC plan of 30k paid semiannually (outlined in our employment contract) was pulled after a handful of reps made out really well with a weekly SPIFF contest. Erratic plans after that until Q3, 4 of 2017. That one saw illegal behavior on behalf of the company when they “retroactively” changed the plan and did not pay what we delivered on. Since then the IC plans have been extremely poor, effectively continuing the 2017 retroactive take back.
• Complete disregard for the needs of the field. This is a small, experienced team. Regardless of how many town hall phone calls Tom has hosted, advisory boards convened or feedback provided it has become apparent that our voice means nothing.
• Continued push to work in not-so-grey areas to get intakes. For those of us who’ve been here from the beginning we know Non-24 is rare. Why is the focus now on psych pats and not on blind or PDP targets anymore? Reps I have talked to feel dirty, I know I do.
• Ineffective leadership. I’m not talking about Mihales, we already know the problem there. I’m talking about Christine and the three stooges. How many bullshit, micromanaging exercises do we have to endure before any of them go to Tom and say no? Instead of advocating for us they cheerlead everything coming out from senior leadership. I could picture Christine on the desk of the Titanic telling everyone, “isn’t this great! We get to go swimming tonight too! Now get in the water, this is going to be awesome!”
• This last point is related to the last one. It’s bad enough MP came up with the associate rep idea, but the fact that Tom allowed that to come to fruition tells me how weak a leader he is. That Christine originally sold us on this as a “pilot program” and now continues to sell us on how great it is to have our entire sales force turned over to college grads with no experience is essentially saying “fuck you and fuck what you bring to Vanda. You do not matter and can and will be replaced.” There is no future here for older reps. That is abundantly clear. Tom and Christine even stated on several occasions how great the “youthful energy” the associates bring to the company is. Sounds an awful lot like age discrimination to me. Sad.

 

[RealAM]

REALAM, why oh why is the Q3 Goal for Hetlioz prescriptions going up to 8 Intake prescriptions per AMs and NSRs? Did Vanda change the Orphan Drug designation? Did we get Insomnia indication?

You already know the answer to this. Pro tip, forget the orphan drug designation and don’t worry about what the actual indication is. That’s how we are being coached.
My thoughts on this are outlined in my other responses. It is a combination of them not wanting to pay us so the goal line keeps moving. The dispense rate is dropping so the company is getting paid less and less on intakes so we are feeling that to. Finally, they are turning over the sales team through attrition. If they make people unhappy, people leave. The combined US sales force is now greater than 50% associates. If this company is still operating at the end of 2019 that will likely be 75% no experience, first job outta college reps. That’s what they want and it is working.

 

[anonymous]

Ouch.

 

[anonymous]

But it isn't working. They are getting .ore I takes, but Vanda now has the lowest triage rate since launch. They are garbage off label scripts that will do nothing in the long run but piss off doctors and frustrate patients. You know who else sees this? The financial market.

 

[anonymous]

But it isn't working. They are getting .ore I takes, but Vanda now has the lowest triage rate since launch. They are garbage off label scripts that will do nothing in the long run but piss off doctors and frustrate patients. You know who else sees this? The financial market.

I’ve got the numbers, I will post soon. You are correct, the triage rate is dropping. don’t forget what everyone has been saying tho, it’s not triage anymore - that’s what they say on earnings calls or what your manager says because they don’t know better. It’s about dispense rate which is dropping fast after we started doing our own PA and appeal processing. dispense rate is down year after year since launch. The actually number of shipments has dropped too, down from last year despite more intakes. The hpi push is not helping. more intakes yes, but less product going out the door. When you see the data it makes sense. More intakes, fewer approvals, decline in dispense all barely off-set by price increases to keep rev in the black. Will not be possible to hide much longer.

 

[anonymous]

Dear Ask an AM, Can you put the price of Hetlioz each year starting in 2014 (2015. 2016, 2017. 2018 and current year 2019).. I was curious on the original price and current price and percent markup. And can you tell me who approves the price increase each year??? How much becomes the burden of the patient and how much is taken on by insurance? I had a Doctor tell (yell) at me about our ever increasing price but I do not remember Management giving us the price or the reasons for the increase. (Has anyone else ever been berated by a Physician because if pricing? How do you handle it?)