What does future of internal medicine look like?
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Let’s look at several facts that are influencing the PC/IM market, then you decide.
1. Most PCP providers are now employees; part of a large group or IHS. As an employee they most often do not have the latitude to decide under what context (if any) they will see reps. Well established reps with strong past relationships may be able to navigate around this to some degree, but overall the potential for reps tp consistently see prescribers has eroded and likely will continue to, especially as tenured reps retire or leave. Specialists have been more effective in maintaining their own groups and thus have more autonomy.
2. Many routine primary care functions are being handled by NP/PA providers; and yes in many cases there are good generic options for routine conditions. Our doctors serve more as a quarterback/gatekeeper to specialists; the real branded product opportunities lie in the specialty fields.
3. Between guidelines, ins formularies and institutional pressure/incentive to prescribe what is cheap, (not to mention patient requests) it’s a wonder that IM/PC prescribes any branded drugs. You should feel good about the business you get because if not for a rep I don’t believe hardly any brand would be written in primary care.
4. As for PFE specifically, look at the pipeline; not much coming for PCP world.
So, are there other counterbalancing factors omitted? If you wanna stay with PFE I would strive to get into a specialty role. Just my opinion based on the above facts.
1. Most PCP providers are now employees; part of a large group or IHS. As an employee they most often do not have the latitude to decide under what context (if any) they will see reps. Well established reps with strong past relationships may be able to navigate around this to some degree, but overall the potential for reps tp consistently see prescribers has eroded and likely will continue to, especially as tenured reps retire or leave. Specialists have been more effective in maintaining their own groups and thus have more autonomy.
2. Many routine primary care functions are being handled by NP/PA providers; and yes in many cases there are good generic options for routine conditions. Our doctors serve more as a quarterback/gatekeeper to specialists; the real branded product opportunities lie in the specialty fields.
3. Between guidelines, ins formularies and institutional pressure/incentive to prescribe what is cheap, (not to mention patient requests) it’s a wonder that IM/PC prescribes any branded drugs. You should feel good about the business you get because if not for a rep I don’t believe hardly any brand would be written in primary care.
4. As for PFE specifically, look at the pipeline; not much coming for PCP world.
So, are there other counterbalancing factors omitted? If you wanna stay with PFE I would strive to get into a specialty role. Just my opinion based on the above facts.
I’m a nurse practitioner working solo in a clinic for a large employer. All of my patients have the same insurance. I’m happy to write whatever medications my patients can get. If it’s not covered by their insurance, they’re not getting it. It’s as simple as that. The insurance companies / PBMs have patients and prescribers by the balls.
Your fancy medication may be a great drug, but if my patient’s insurance won’t cover it at all, and your competitor’s drug is covered and $0 with the savings card, that’s what they’re going to get. No amount of lunches, pleading, pressure is going to change that. I might try to jump through some hoops to get a few of them covered through step therapy, but I’m too busy to do all that for the hundreds of patients I see per month.
The PBMs are a serious problem.
Your fancy medication may be a great drug, but if my patient’s insurance won’t cover it at all, and your competitor’s drug is covered and $0 with the savings card, that’s what they’re going to get. No amount of lunches, pleading, pressure is going to change that. I might try to jump through some hoops to get a few of them covered through step therapy, but I’m too busy to do all that for the hundreds of patients I see per month.
The PBMs are a serious problem.
If you're an NP, why are you on our site posting in a thread about future of Pfizer's IM division? What made you come here?
The first response is spot on. Not sure the np really is one. Our pipline for IM sucks. The future at Pfizer is in oncology or specialty. Use your I M experience to springboard out to one of those.
It’s ridiculous how we are expected to see 10 HCP ‘s a day, use all our materials and buy lunch about every day. If I were to buy that many lunches I would be so far out of compliance on the once a month limitation the lawyers would be calling. Then to top it off there’s ar 5 of us “ selling” cologuard to the same doctors. 4 of us selling Chantix. Two on Eucrisa the good drug no one wants because of the prior auth.
It’s ridiculous how we are expected to see 10 HCP ‘s a day, use all our materials and buy lunch about every day. If I were to buy that many lunches I would be so far out of compliance on the once a month limitation the lawyers would be calling. Then to top it off there’s ar 5 of us “ selling” cologuard to the same doctors. 4 of us selling Chantix. Two on Eucrisa the good drug no one wants because of the prior auth.
In a word, bleak.
They’ve become mostly groups and owned by hospitals in my area. Too busy to see reps, and hospitals restrict access.
They’re medical mills, get em in and get em out. Insurances dictate prescribing, and remember. docs are incented on compliance to formularies.
Have 20 yrs. in and hoping for 5 more.
Not optimistic.
well, when your parents get old and sick, hopefully their provider treats them the same way, provides them with the cheapest covered option instead of the best treatment
In a dystopian future, the totalitarian nation of Panem is divided into 12 districts and the Capitol. Each year two young sales representatives from each district are selected by lottery to participate in The Hunger Games. Part entertainment, part brutal retribution for a past rebellion, the televised games are broadcast throughout Panem. The 24 participants are forced to eliminate their competitors, at random, in a fight to the death while the citizens of Panem are required to watch. Winning means fame and fortune, while losing....
This is why the job is not Sales anymore it's Customer Service. About the best information you can bring an office anymore is a Managed Care update and it better not be biased because if you are telling a practicioner that something can be wrote and it can't you will be called out and trust lost. Do that a couple times and there will no more reason for you to show your face in the office anymore. The fancy iPad is worthless if an office can't write the med. And if you tell them to write DNS, DO NOT SUBSTITUTE you will sound like a fool in 2020, this is a Management suggestion that used to work in 2001 in the Lipitor vs. Zocor but not anymore. When Middle Management realizes that the Pharma Market has changed 180' from the 90's this job might have a chance to be Sales again but until then the best job you can do is Service your offices, give a sound Managed Care update and build trust. If you are lucky enough to last 5 years in the position and get a drug that can be written your territory will do well.
No, this is exactly why it IS sales. If left to all the background forces a primary care physician would seldom if ever choose a brand over a generic. A good rep is able to convince and persuade a provider to “fight the system” based on the merits of the product and by leveraging their relationship, which includes trust. And by the way if you are going in promoting a broad formulary message like “all your UHC patients can get product x” then you are not credible; there are almost always carve out and exceptions; again if you have sold the provider they have in their mind resolved that the benefits outweigh the potential hassle factor in prescribing.
I wish you were my DM! What great coaching advice!
Stop! Pharma reps are not salespeople. What you just described is "influencing," to impel. Only the pharma industry believes that the sales reps are salespeople. You all are told what to say, when to say it, how to say it, and to whom. There's little thinking involved. You're a marketer. Nothing, more.
You are describing a very “average” rep who’s ideal of a “good year” is being in the top half. Not all people in sales are salespeople, regardless of the industry. Pharma just tolerates mediocrity more than most industries.
Right..... as if in 2020 a MD working for one of these Hospital groups is going to have time to fight the system when he is booked a patient every 10-15 minutes and his staff the same for a me too drug when he can easily sub a generic or something that is already preferred.
You stand there and piss him off...because that's about all you are doing. If it isn't easy it's not getting written. Show him the path of least resistance and you made a relationship...ie' Help HIM Out... provide good customer service.
Nice try DM. Kool Aid Hound.
This is perfect and well said.... Stand there and convince him w/ your 5 page iPad because you can't go off message .... But Md.... It says "right here on pg 3!!!" PFE says so!!!! oh and it's Prior Auth too.... SUNK....
Not all people in sales are salespeople. Makes it possible for me to win trips !
Internal Medicine in the future looks the same as it is today. It’s 6 x 6 x 6 and has the biggest check mark 
right next to it.
right next to it.