The Wall Street Journal has a smart piece looking at how pharmas are rebalancing their sales forces to focus more on the people drawing up the formulary lists that increasingly guide physicians prescription decisions. In the old days, The Journal says:

Doctors were often more interested in a drug's clinical-trial results than cost. Reps could generate hundreds of millions of dollars over the few months after a drug's introduction.

But doctors are losing influence. Hospital systems are growing more powerful as they bulk up by buying doctors' practices, nursing homes, urgent-care centers and other hospitals. Insurers and the federal health-care overhaul are squeezing hospital and doctor payments and shifting reimbursement from how much care is given to how effective it is.

And where physicians were chiefly interested in efficacy, the pharmacy and therapeutics committees that decide what's on formulary are equally concerned with a drug's cost:

Ms. French urged the administrator in the system, Sharp HealthCare, to consider the two drugs' effectiveness. It was the kind of pitch she once used to persuade doctors to write prescriptions.

The administrator, Electa Stern, said she would run the effectiveness data by doctors who are helping decide what to put on a systemwide formulary. "And then we will be taking a look at cost."

But cost isn't the only way to a P&T committee member's heart. Hospitals and health systems are increasingly concerned with meeting qualitative measures, such as reducing hospital readmissions or improving population health, and there's been a lot of buzz in the pharma industry of late around pill-plus service offerings that aim to improve patient adherence, thereby improving patient health and saving payers money in the long run, even as they list a newer and more expensive treatment.

At Manhattan Research, we've just published our 2014 Taking the Pulse® Formulary Decision Makers report, for which we surveyed 214 P&T committee members from hospitals, pharmacy benefits managers and managed care organizations about their decision-making process and how they interact with pharma. One of the more exciting findings from this year's survey was the number of these decision-makers agreeing that pharma patient support programs and resources can or have motivated them to list a treatment. This was particularly true of hospital P&T committee members, nearly nine out of ten of whom agreed that pharma support programs had or could sway their decision-making.

We also learned that P&T committee members rely heavily on digital sources of information in making formulary decisions. That means that in addition to key account managers, brands need to strategize about how to make sure that these decision-makers can find the digital resources they need, whether that means building dedicated resources for formulary decision makers or making cost and other relevant information more readily accessible through their HCP sites and service portals.

As our VP Research Monique Levy says, Payer marketing teams charged with influencing these customers can't afford to drag their feet when it comes to digital investment. Formulary decision makers are online daily and expect pharma to show up.

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