Japan’s pharmaceutical industry has long been dominated by commercial channels. However, a number of forces have come into play more recently: innovation has seen the emphasis of portfolios migrate away from primary care toward specialty therapies; at the same time, the focus on compliance has increased—the Clinical Research Law was promulgated in April1 ; meanwhile doctors’ expectations of their interactions with pharmacos have expanded, so that scientific and peer doctor-to-doctor interactions have assumed more importance as sources of reliable information. These changes have prompted pharma companies in Japan to chart a similar course to that followed in the United States and Europe over the past decade: companies are investing more resources in medical activities, and particularly in the work of the medical science liaisons (MSLs) who target opinion leaders. Yet companies often find it difficult to judge how effective and competitive their activities are in this area.
To shed light on this growing channel, we conducted a survey of key opinion leaders (KOLs) in Japan (see sidebar “About the research”). We explored the demand for medical activities among KOLs, the factors that influence their satisfaction with MSL interactions, and the nature and extent of capability gaps between companies.
The medical channel is valued but could do more
The role of the medical channel in Japan continues to evolve. Even though most KOLs in our survey took part in multiple medical affairs–related activities—for instance, scientific information exchange with an MSL, speaking at a company-supported congress or conference, and participating in an advisory board—only about 70 percent drew a clear distinction between MSLs and sales reps. This indicates that the role of medical affairs has yet to reach full maturity in Japan despite increasing attention and investment.
When we asked KOLs how many times they were visited by MSLs from each company, they reported a range of average frequencies from one to five times per year.2 The average duration of a visit was 16 to 25 minutes, depending on the degree of specialization of the disease area and the company’s strategy and portfolio. We also asked KOLs whether they felt the number of MSL visits from each company was appropriate. The average responses of appropriate number of visits ranged from two visits per year in one disease area to five in another. This variation may be driven by differences in the level of specialization for a particular disease area or in the scope of new products and evidence for it.
Interestingly, many of the KOLs surveyed expressed a desire to increase their interactions with MSLs, and none thought current visits were too frequent. Indeed, 62 percent of KOLs considered visits to be at an appropriate frequency, 13 percent too infrequent, and 23 percent somewhat infrequent; meanwhile, only 2 percent considered them somewhat frequent (Exhibit 1). Similarly, none of the respondents felt that MSL visits took too long: for 85 percent the duration was appropriate; for 9 percent somewhat short; and for 6 percent somewhat long.
Coverage varies from company to company
The survey revealed that perceptions of the quality and helpfulness of medical affairs and MSLs vary considerably across disease areas and companies.
We observed coverage differences of over 20 times among the companies in our sample of opinion leaders. No company covers all KOLs in a given disease area (Exhibit 2). The median coverage of MSLs was roughly 50 percent: that is, for every KOL covered by one company’s MSL, another KOL is left uncovered, but covered by an MSL from another company.
Customer satisfaction depends on the quality not quantity of interactions
Another area where there are clear differences between companies is in the level of satisfaction KOLs experience from their interactions with medical affairs (Exhibit 3).
We investigated what factors correlate with levels of satisfaction in the context of academic and medical interactions; the impact that medical and scientific information provided by pharma companies had on the safe and appropriate use of drugs; and the willingness of KOLs to recommend an MSL to their peers. Satisfaction, impact, and willingness to recommend KOLs were more strongly correlated with quality measures—the MSL’s process-management skills, level of scientific and medical knowledge, and interpersonal communication skills—than quantity measures such as the number of MSL visits, average duration, and number of MSL-related activities (Exhibit 4).
The implications for pharmaceutical companies
The lessons from our survey suggest that medical affairs leaders and pharmaceutical companies should ask themselves four questions:
What is the right size for our medical affairs function in the disease areas we cover?
Our findings suggest that KOLs in Japan recognize the value of the medical channel and feel it broadly meets their needs, but would prefer on average to intensify their interactions with MSLs. Any company that lags in building out its medical affairs function is failing to maximize its relevance. As regulations tighten and KOLs’ expectations continue to rise, the medical channel’s role will become even more important. When companies reflect on their portfolio plans, they should continuously revisit whether the resource allocation to medical affairs is sufficient to meet the growing market demand.
Do we provide KOLs with enough touchpoints and support to ensure we are relevant to them?
Each company can be expected to vary its KOL coverage in line with its medical strategy and targeting, its product life cycles, and its relative resource allocation to medical and commercial activities. Even so, the survey findings suggest that companies have a sizable opportunity to improve capacity among MSLs. Companies would be well advised to review their competitive coverage plans across disease areas and product life cycles; assess how effective their MSLs are at targeting the right KOLs; and consider the full range of outreach instruments that medical affairs could deploy. Such outreach instruments might include congresses; online and digital channels, including virtual MSL channels such as medical information carried on sales reps’ iPads; medical information; data-generation programs; and not forgetting traditional MSLs.
Are we onboarding and developing MSLs fast enough to keep up with demand?
Medical affairs is not so much about building a bigger and more productive organization as about obtaining great talent—focusing both internally and externally through recruitment events, including on an industry-wide basis—and providing the right training to hone their capabilities that deliver KOL satisfaction. Equally, attention needs to be paid to retaining ambitious high performers. An in-depth review of MSLs’ knowledge and process-management and communication skills should uncover opportunities to improve customer satisfaction. Putting in place core scientific and medical knowledge is important; so is training MSLs in “softer” skills such as interpersonal communication, as well as “harder” process-management skills. Training needs to be tailored to each individual MSL, with content geared to their background and skill set. Investing in managerial capacity and capability to enable these changes will be critical.
Do we use the right indicators to measure and evaluate our performance?
The KPIs used for evaluating MSLs should not be based on criteria such as number of visits, as activity levels are not correlated with impact. Instead, we propose that KPIs should be based on perceived influence and physician satisfaction: impact such as the number of publications by KOLs that mention the company’s drugs; satisfaction measured through surveys of KOL opinions; and capabilities measured through training exit surveys, role-playing “exams,” and other methods. Additionally, more advanced companies are actively looking beyond simple quantity metrics into quality measures that are more directly linked to medical impact.
Medical affairs is rapidly growing into a “third pillar” for pharmaceutical companies next to R&D and commercial. It is clear that KOLs would like more exposure to medical activities and MSLs. However, coverage and targeting varies substantially among companies, as does the quality of interaction experienced by the KOLs. A strong recruitment engine, a development program centered on high-quality MSLs, and developing the right KPIs for the organization are critical for success. Measuring real performance and impact will continue to increase in importance as the role and weight of medical grows within the industry.