Sales Force Sizing in Oncology
The sales force is by far one of the most impactful promotional drivers available to biotech / pharma organizations and is often the first choice in allocating brand promotional spend. Therefore, it is critical to appropriately resource sales force teams to maximize share of voice in the market and adequately support customer needs and requests. Traditionally, there have been four approaches to sizing a sales force:
- Analog based: A simple and fast approach that resources the sales team in line with competitors in order to match their share of voice in the market.
- Workload build-up: A simple sales force sizing approach based on effort required to cover physicians under assumed reach and frequency across key segments.
- Affordable coverage: Workload build-up layered with financials by evaluating depth of coverage based on profitability set against a desired return of investment (ROI).
- Sales response: Most robust and complex method that sizes the sales force by directly linking sales force effort to product sales in response curves for each key segment.
The above approaches offer a range of solutions to sizing the sales force. However, due to the dynamic and complex nature of the Oncology market, one must consider more than the approach and ensure to also examine the many drivers and factors that have significant impact on the sales force size and deployment.
- Patient dynamics: The high patient value in Oncology can skew the analysis towards overestimating the sales force size. For example, in using affordable coverage, due to the high patient value, penetration into low value segments remains ROI positive for an expanded coverage of the market, which will drive up the sales force size. Also, in low incidence tumors, the dispersed patient population and infrequent office visits add challenge to how to best size and structure the sales force.
- Physician access: Access limitations have been a growing trend over time, and among all specialties, Oncologists have the highest access restrictions, which significantly impact opportunities for sales reps to engage with customers. In addition, the growing implementation of pathways as established clinical guidelines to treatment and product utilization drives level of control at accounts. Pathways are mandated in hospital systems through centralized decision making, which can prevent or limit product utilization across network accounts and hinder promotional opportunities for sales reps.
- Account management: In the growing environment of access restrictions and pathways, effective account management is critical for Oncology companies in order to engage with and influence decision makers at key accounts. Account managers are critical in identifying and building relationships with key decision makers in each account in order to establish dialogue around pathways and physician access. In this process, brand leadership must ensure that the account management team is adequately resourced, which in situations of constrained budget, may translate into a smaller sales force size.
- Evolving rep role: With the evolving Oncology market and expanding complexities, the sales rep role is also evolving. Sales reps increasingly act as quarterbacks in leveraging company resources in addressing customer needs. Roles such as Nurse Coordinators, Reimbursement Managers, Medical Science Liaisons, and Thought Leader Liaisons have all emerged as critical field roles in adequately supporting customers. Upon launch of biosimilars, without advantage of clinical differentiation, the sales rep role will evolve further to emphasize support and services. In these circumstances, the brand leadership must evaluate the sales force size with all other roles in mind and ensure to establish the appropriate field mix and presence based on customer needs and requests.
- Non-Oncologist specialties: Specialties other than Oncologists have an increasing role in the Oncology buying process. With focus on biomarkers in product development and use of companion diagnostics for informing treatment eligibility and assignment, sales reps now have to target Pathologists and test labs to deliver messages specific to testing, which may warrant creation of a stand-alone diagnostics team. In breast cancer, Surgeons play an important role in early stages of the disease and drive referrals to Oncologists for drug treatment. In skin cancer, in addition to Oncologists, Dermatologists are included in the target list, so the sales force must be sized accordingly to cover both specialties.
- Alternative channels: Customer experience has become increasingly important in the optimal design and deployment of promotional efforts. Meanwhile, there has been a wide adoption of technology platforms and online resources among physicians for obtaining and sharing treatment information and clinical data. Therefore, it is critical for brand teams to reach physicians according to their preferred channel(s) in the setting and time frame most convenient to the customer. This means that for some physicians, alternative channels such as video conferencing, non-personal promotion, and inside sales may be more effective engagement platforms, which may Impact the overall sale force size.
- Portfolio view: For organizations with a collection of Oncology products, it is critical to approach sales force sizing at portfolio- rather than product-level. This is due to the fact that the customer universe for all Oncology products is the same ~10K physicians with significant overlap among target lists. This means that there are synergies and efficiencies in evaluating the sale force at the portfolio level that will impact the overall team size. At the end, the goal is to ensure adequate coverage of products among all targets without jeopardizing physician access and engagement due to excessive number of touchpoints.
With the above drivers in mind, sales force sizing in Oncology requires an increasingly targeted approach, informed by a robust and actionable market segmentation, in order to best support customers at the local level. In this set-up, one should also incorporate payer dynamics by geography and gain an understanding of payer mix across accounts to best address customer needs. After all, the sales force sizing framework must align with the evolving Oncology market and the drivers that define customer satisfaction and shape decisions behind product utilization.