Interest Grows in Handling Physicians' Samples Electronically

Like many other parts of the pharmaceutical sales process, sampling is under some duress these days. Access to physicians’ offices is being restricted at many locations; legislators are looking more closely at any exchange of value between the industry and physicians; and in academic circles, there is talk of the presumed impropriety of any type of sampling at all.

Nevertheless, sampling is generally considered one of the most effective methods for pharmaceutical marketing, and a key factor in reps’ access to doctors. Survey data from IMS Health estimated that sampling was worth around $16 billion at mid-decade (based on retail value of the samples), which would represent nearly half of the overall marketing budget for the industry. And while some physicians may be critical of the practice, it is undeniable that samples provide a way for both physicians and patients to gain experience in new drugs, and to accelerate the education of both parties in the newest treatment alternatives.

The question, then, is what to do? For a number of years, marketing service providers to the pharma industry have provided voucher programs that can act as an alternative to direct sampling. Various forms of “tele-sampling” and online sampling have been offered. Initial industry reaction has been muted, but these alternatives are getting a new look as more physicians become comfortable with e-detailing and other online resources.

Physicians’ use of the internet continues to expand, making e-sampling a natural extension of physicians’ online activities. Also, pharmaceutical companies have been overcoming their unease about accepting orders online—one factor that contributed to the initial slow adoption of e-sampling, which has been around for more than five years.

“I think you’re seeing more uptake, especially among large pharmaceutical companies, because everyone’s looking at the most cost-effective way to distribute samples,” says Bill Buzzeo, VP and GM, compliance solutions at Cegedim Dendrite (South Bedminster, NJ). Even so, he says, e-sampling is just one more technique available alongside more traditional low-cost methods such as faxing or mailing sample requests. “This is just an additional option—to gain access to practitioners by another method.”

Rick Keefer, president of Publicis Selling Solutions (Lawrenceville, NJ) can view sampling from both the traditional rep-driven perspective as well as the various e-alternatives. Publicis Selling is part of a larger group (Publicis Strategic Solutions) that includes a call-center-driven service company (Arista Marketing Associates) and a sample-delivery service (Pharmagistics). “In today’s environment, pharma companies have to do everything—live sampling, e-sampling, vouchers and other fulfillment systems,” he says. “One size doesn’t fit all situations.” He notes that restricted visiting by reps is not new—it has flared up at various times in the past—and the problems of reduced selling staffs and vacant territory coverage are now affecting sales campaigns.

Publicis recently won a contract with a manufacturer to provide multi-product, “multichannel” physician access through its Arista unit. It will deploy live phone calls, live, Web-enabled video detailing (see Pharmaceutical Commerce, April, p. 17), e-mail, direct mail, fax-on-demand and sample and literature fulfillment.

Trend lines

Market data are hard to come by, but research by SDI Health (Plymouth Meeting, PA), as part of the company’s 2008 ePromotions study suggests many physicians are already using e-sampling to a limited extent—though reps still account for the bulk of samples distributed. In an online survey of 1050 physicians, SDI asked whether the doctors utilized cost-saving measures including sampling. SDI received 2031 responses, indicating that many of the physicians use multiple methods; online ordering of samples was mentioned 341 times, while requesting samples from reps was mentioned 887 times—more than twice as often. Of those physicians ordering samples online, 59% said they get less than 10% of their samples by that route, according to Elizabeth Bond, Product Manager- Promotion Solutions at SDI.

The key attraction of e-sampling is cost. Including sample delivery, e-sampling usually is 1/6 to 1/10 of cost of a rep visit, says Cecil Kost, president and CEO of MedManage Systems Inc., the most established of the e-sampling suppliers. MedManage was acquired last year by Physicians Interactive, a company that operates a website offering a number of services to physicians.

MedManage offers what Kost describes as a sample utility service. Pharmaceutical companies determine which physicians should receive samples of specific brands, and in what quantity. MedManage stores that information in its physician database and tracks the sample orders. Physicians access the service via portals such as Physicians’ Interactive and the Thomson Reuters Physicians Desk Reference website PDR.net ; they perceive the service as a virtual sample closet containing samples from multiple suppliers.

After authenticating the physician’s identity, Medmanage passes the sample orders to warehouses that actually ship the samples. “Everything that we do presents to the prescriber a personalized sample closet based on a set of business rules determined by the pharmaceutical company,” says Kost. “It’s brand-specific, pharma-rule-driven—which is important because it ensures pharmaceutical companies utilize e-sampling in a way that is complementary to other marketing tactics and channels.” Kost claims that most of the top 15 pharma companies use the service for at least one brand.

Ryan Luce, director of product management for Physicians Desk Reference, says PDR.net has seen the e-sampling service grow rapidly. “The number of physicians using this service has increased significantly over the past year and a half,” he says. “Some of this stems from our increased focus on the e-sampling service, but it also stems from general trends in physician behavior. Increasingly, physicians are turning to online tools to help them in their workflow. Additionally, pharmaceutical companies are finding it increasingly difficult to visit physicians in person.”

There’s no single agreed definition of e-sampling, but most offerings have common elements. Physicians’ participation typically starts with an invitation to participate in an email or other communication from the pharmaceutical company.

Physicians may order samples using a fully electronic process that requires the physician to enter an electronic signature—a combination of identifying information and password—for authentication. Systems providing this capability must be validated to show they meet the electronic signature requirements specified in Title 21 CFR Part 11, a process that can take several months. There Cegedim Dendrite’s Buzzeo says pharmaceutical companies were initially hesitant to use electronic signatures: “Some of the slow adoption has been based on the pharmaceutical companies, and I think it was around the uncertainty of using a true electronic signature to request a sample,” he says.

Some suppliers also include in the definition of e-sampling various hybrid paper-electronic approaches that are easier to implement, such as allowing physicians to print vouchers on demand or mailing paper vouchers in response to online requests. An even more basic approach is to publish an online form that physicians print and fax.

With all these methods, the order typically finds its way to a warehouse that, as with any sample-ordering system, must once again verify the physician is a legitimate prescriber before shipping the samples.

The duty of validating electronic signatures has been looked on as a burdensome, problematic task by pharma marketers, according to several sources, but the trend is clearly in going in this direction. One significant shortcoming of paper-based techniques is that the paper itself becomes a problematic form of data storage; the same logic that is being applied to electronic medical records in the healthcare arena applies here.

Some companies that offer warehousing and sample-management services—and already have systems in place to ship samples to reps, and to physicians using more traditional methods such as faxes to request samples—are directly implementing their own e-sampling systems. An example is Knipper & Co. (Lakewood, NJ). Michael Laferrera, SVP, sales and marketing, says the company’s e-sampling business has grown considerably since it because available about two years ago; the company now has just under 10 pharmaceutical companies using the system, most of them small to medium-sized. “Some of that [increase] is out of necessity,” he says. “There are a lot less sales reps than there were a year ago.”

He says e-sampling, like other alternative sampling request methods, is used to cover territories temporarily left vacant when reps leave the company; and to cover territories that are too large, with doctors too far apart to justify rep visits. In addition, some customers use alternative methods for OTC products that are too weighty, in volume, for reps to lug around.

E-sampling can also be used as a low-cost method for products that are nearer the end of their product lifecycle, says Kelly Gratz, president inVentiv Interactive Group. However, she says that pharmaceutical companies still want the flexibility to offer additional alternative methods, such as business reply cards. Inventiv offers a range of pharmaceutical services including warehousing and e-sampling. Though e-sampling is growing, “we don’t see a wholesale shift,” adds Steve Gornto, COO at another inVentiv company, PRS/Franklin Group.

The growth is attributed partly to demand from doctors, who are conducting more and more of their interactions with pharma online. That’s driving a trend to combine e-sampling with other services such as e-detailing. SDI’s 2008 ePromotions study asked physicians which follow-up activities they were most likely to do after completing an e-promotional activity such as an e-detail; 54% said they were most likely to request samples.

Aptilon, a software company in Montreal, is one company that has added e-sampling to its suite of e-detailing and other services. Mark Gleason, SVP, corporate development, says the company recently licensed its software to Triple i, a pharmaceutical

services company that is part of MediMedia (Chatham, NJ). E-sampling can become part of an online physician-rep interaction, Gleason says. For example rep may perform an online video detailing session that includes opening up an online sample ordering form, which is subsequently faxed.

Another example of this trend is Physician Interactive’s acquisition of MedManage. PI offers a portal with a growing range information and services aimed to provide physicians with more reasons to use the site—and keep using it over time. “What keeps me up at night is, ‘How do we keep physicians coming back.’” says Donato Tramuto, CEO and vice chairman of PI in Libertyville, IL. His goal is to continue to build out this “digital mall,” to include other online information and services that physicians traditionally received in other ways. “Whatever physicians receive in person, we are going to do through online channels.”

In the final analysis, the communication channels to reach physicians are not dictated by what new technologies provide, but by what the “customer base”—physicians—want to tap into. “Physicians are getting their educational info in many ways: they will continue to see reps, they are getting more comfortable with the Internet,” says Publicis’ Keefer. “As an industry, we will have to meet our customer demands.” PC

BOX: TEACHING HOSPITALS CAST A CRITICAL EYE AT SAMPLING

Experimental program in Pittsburgh shows limited success

The clinical settings that are most uncomfortable with current sampling practices seem to be academic teaching hospitals. In April, Johns Hopkins adopted a policy that limits rep-physician interactions (banning gifts and food) and plans to ban free samples in 2010. In January, the University of Iowa instituted a ban on physicians dispensing free samples to patients (which would appear to make the samples unavailable to the physicians themselves). In February, a conflict-of-interest task force of the University of Wisconsin system recommended a ban on nearly all physician samples. A database at the Institute of Medicine (imapny.org) lists many types of conflict-of-interest policies; in June, 34 centers, nearly all of them teaching hospitals, listed restricted sampling, although the majority of these prohibitions were to prevent physicians or their families from making use of free samples.

Another indication of the mood within parts of the medical community is an Institute of Medicine report issued early this year, which suggested that “free samples may contribute to inappropriate prescribing practices … and increased drug costs,” and recommended that medical centers should “limit use of drug samples to patients who lack financial access to medications.”

However, one closely watched alternative approach, at the University of Pittsburgh Medical Center recognizes the value of samples—and uses e-sampling as a way to deliver them. Last year, the center adopted a policy that noted that while sampling has been shown to boost sales, it also “provides invaluable assistance to some patients to quickly begin a course of treatment or to determine which therapeutic option is most beneficial for that patient.”

The center decided to continue to allow reps to visit physicians, by appointment only—but in an effort to focus these visits on education, did not allow them to hand out samples. Instead, it provided a new application, known as the eSample Center, based on the service from MedManage Systems. The application allows physicians to order available samples, vouchers, and coupons via a Web-based system accessible through UPMC’s intranet. The center made this system the exclusive mechanism for physicians to obtain samples as of April this year.

According to a UPMC spokesperson, by early June—more than six months after the system began operating—131 physicians had registered to use the system, and only 46 had placed orders. That’s a fraction of the approximately 2,700 physicians employed at UPMC, although the spokesperson says at least half of those physicians were not providing samples even before the new policy took effect. PC