While the pharmaceutical industry is still just skimming the surface when it comes to developing therapies to address the 7,000-plus known rare diseases, drug development is only half of the battle. Organizations that have successfully gained approval for their therapies in the U.S. and abroad face significant challenges when planning their commercial efforts and developing incentive strategies for the field force. To succeed, they often have to get creative.
Like all strategies in the promotion of rare disease therapies, incentives for the field force need to be designed with a fundamental understanding of the patient journey. What do patients (along with caregivers and families) endure, from both a clinical and an emotional standpoint? How do their diseases impact their daily lives and, therefore, their abilities to gain access to treatment and remain committed to longer-term therapies? This fundamental understanding of the patient journey allows companies to comprehend the interaction between patients, families, healthcare providers, nursing staff, payers and other stakeholders critical to their success. It also helps pharmaceutical organizations determine the impact that the field force can have on improving patient care—and increasing sales.
When designing an effective incentive plan for rare disease teams, organizations typically face three challenges:
1. Aligning incentives to the field force’s point of impact: While this seems like an obvious success factor for designing an incentive plan, this tends to be more easily understood and implemented for mass market brands. On the retail side, there’s a fairly close relationship between field force activity, customer decision-making and the ability to measure success (metrics such as volume, growth and market share). However, in the rare disease space, a rep’s success metrics can differ greatly, even varying by disease state.
In many rare disease markets, a brand’s success is largely dependent on increasing diagnosis rates and broadening the patient identification efforts. In these cases, measurements such as new patient enrollments, start form volume or patient starts can be effective incentive measures. However, in other disease states, patients may start quickly on a therapy, but they might not continue to comply with the therapy because of factors such as reimbursement problems, injection or infusion issues, etc. In these cases, it may be more challenging to effectively align field force incentives to the success of both the patient and the brand, so sales leaders should be looking at alternative performance measures such as second or third shipments, or patients’ time on therapy.
Regardless of the specific situation, field force incentives need to balance the measurable impact of the field force at the right point of the patient journey with the success of the brand’s objectives.
2. Timing: As is often the case with rare disease brands, the lead time from when a patient is diagnosed to when she is “on therapy” can be long, so sales organizations need to take this into account when designing incentive components and determining payout structures. Longer lead times can make it challenging to tie the data to the field force’s quarterly incentive payouts, so companies should consider plan components that allow for some level of payout during the quarter, itself, such as MBO programs, guarantees on portion of payouts, or reward and recognition contests.
Often, one of the most critical elements of a successful incentive plan, and overcoming these types of challenges is communication. Transparency around the plan structure, mechanics and timing—along with a robust (and ongoing) communication strategy for field force incentives—can help drive continued motivation even when the field force is confronted with complex challenges such as they often are in rare disease markets.
3. Managing through data limitations: Data limitations and other data-related issues affect virtually every aspect of managing and measuring commercial efforts in the rare disease space. For incentives, though, organizations do typically know the volume of outbound shipments via specialty pharmacy or hub service data. This allows them to more effectively manage incentive plan components such as commission, rank and MBO programs—but this data is not without its own set of timing and coverage challenges. In many cases, patients will seek treatment outside of their typical healthcare market, as the number of treatment centers that specialize in the disease may be limited. When designing incentive plans and rules, organizations should approach sales crediting with the same focus on understanding how patients are treated and cared for within the context of their specific patient journeys.
Data limitations might present yet more challenges when organizations are working to set fair and balanced quotas. Often, companies focus on establishing quotas based on both historical sales and some measure of opportunity or potential. Both of these may pose challenges and require a broad-stroke view of what “potential” truly means in regard to our patient population and disease state.
Ultimately, as with most aspects of the commercial model for rare disease brands, companies need to consider the many limitations and challenges when creating rewarding and motivating incentive plans. They need to explore how to leverage various methods, to remain flexible as their markets mature, and to create and nurture open communication with the field force. Add in a fundamental understanding of the patient journey and rare disease leaders can, ultimately, tailor their sales comp plans for success.
Michael Thomas Is managing Principal, Philadelphia at ZS Associates