A descriptive survey of specialty pharmacy team members’ perceptions of interactions with field representatives from pharmaceutical companies

Abstract

BACKGROUND: It is not well understood in literature what the time spent between health care professionals, including pharmacists and pharmacy technicians, and pharmaceutical field specialists equates to in terms of changes in productivity or lost time, the educational value provided, or the nature of the resources provided in terms of improving patient care.

OBJECTIVE: To evaluate the volume of, and time spent in, pharmaceutical field representative (PFR) meetings by members of an integrated specialty pharmacy team at a large academic medical center.

METHODS: A 16-item survey tool used skip and branching logic comprising binary, multiple-choice, multiple-select, and open-ended items was distributed to pharmacists and pharmacy technicians at a health-system specialty pharmacy on the south side of Chicago, Illinois. The survey assessed locations of interactions with PFR, who initiated the request, reason for interaction, time spent, whether the participant felt the interaction provided value, and whether it contributed to them working a longer shift or compromising time spent on patient care that day.

RESULTS: There were a total of 108 responses. Of those, 44 responses documented having an interaction with a PFR, and the remaining responses indicated no interaction that week. Only 5 (11.4%) of the interactions were pharmacy team member initiated. Among the pharmacy team member–initiated meetings, all respondents stated that the interaction had provided value, and none reported that it led to a longer workday. Conversely, of the 36 pharmaceutical representative–initiated interactions, 15 (41.6%) found value and 5 (13.8%) said that their workday was elongated because of these interactions.

CONCLUSIONS: Our findings demonstrate that the majority of encounters taking place between our specialty pharmacy team members and PFRs did not result in knowledge gained or provision of tools and resources to support our patients. The next steps include 3 specific proposed changes to how our team responds to meeting requests from PFRs, specifically aimed at reducing pipeline presentations, reducing meetings pertaining to limited distribution drugs not accessible to the specialty pharmacy, and reducing meetings with the intent of introduction or pass off of contacts between PFRs.

Plain language summary

We surveyed a health-system specialty pharmacy team on the south side of Chicago to collect information about their interactions with pharmaceutical company field representatives. Of those who did have interactions during the 6-week period, we found that pharmacy team member–initiated interactions were more likely to provide value and not result in longer workdays compared with those initiated by pharmaceutical field representatives.

Implications for managed care pharmacy

Further research should be done to determine the value of interactions with pharmaceutical field representatives for front-line staff at health-system specialty pharmacies and to identify opportunities for reducing the volume of lower value meetings.

In 2012, it was estimated that the pharmaceutical industry spent 89.5 billion dollars on pharmaceutical sales representatives and their interactions with physicians, which accounted for 60% of global sales and marketing spending.¹ Pharmaceutical companies, such as Pfizer, Eli Lilly, AbbVie, AstraZeneca and Merck, are among the top spenders.² Approximately $8,000 to $13,000 is spent every year, per physician, with the cost of each sales call ranging from $50 to $500.^2,3 Pharmaceutical sales representatives serve the primary role of informing and educating clinicians about the medical benefits of treating patients with their pharmaceutical company’s product. These representatives will meet with clinicians in various settings, both in person and virtually. Meetings may last 15 minutes or more,⁴ and this time, additively, could be significant. Further, pharmaceutical sales representatives are no longer the only clinician-facing roles or “field specialists” employed by large pharmaceutical companies. Clinicians may also interface with Medical Science Liaisons (MSLs), Reimbursement and Access Specialists, and at times Clinical Coordinators or Clinical Nurse Educators, who may also interact directly with patients.^5,6

It is not well understood in literature what the time spent between health care professionals (HCPs), including pharmacists and pharmacy technicians, and pharmaceutical field specialists equates to in terms of changes in productivity or lost time for the HCP, the educational value provided to HCPs, or the nature or quantity of the resources provided in terms of improving patient care. A cross-sectional survey study in 2021 by Yimenu et al revealed that the majority of HCPs agree that the information provided by drug representatives is important for continuing education purposes of medical personnel.⁷ However, the time spent with these representatives and how this equates to productivity is unknown. Many HCPs, including nonphysician personnel, find the overall interactions to be positive, but as demonstrated by Tejani et al, the time spent speaking with representatives does not influence clinical decision-making for hospital pharmacists, raising the question of the value of these interactions and whether this time spent is improving patient care.^8,9

The University of Chicago Medicine (UCM) Specialty Pharmacy uses an integrated pharmacy model to serve patients with complex and high-cost disease states. Pharmacists focus on patient education with some embedded physically within specialty clinics for part of their time and having a more ambulatory pharmacist role, including Oncology, Pulmonary Medicine, Gastroenterology, and Infectious Disease, and others following more of a call center model, including Dermatology and Neurology.^10-12 A full list of service lines can be found in Supplementary Table 1, available in online article. All pharmacists have a Standing Order Agreement that permits them to prescribe the medication for which the patient is referred to them, and in some instances, an alternative based on predefined reasons, such as insurance formulary restrictions or clinical need for interchange, but most members of the team do not have separate, more expansive Collaborative Practice Agreements or wider prescriptive authority. The certified pharmacy technician team handles benefits investigation, prior authorization initiation, and other administrative burdens associated with specialty therapies. Certified pharmacy technicians also coordinate financial assistance, such as copay card enrollment, obtaining grant funding, or applying for patients to receive therapy at no cost directly from the manufacturer through Patient Assistance Programs. This robust program allows for a patient-centered approach and is shown to decrease financial toxicity and improve adherence to specialty medications.¹⁰

In this study, we aimed to evaluate the volume of, and time spent in, pharmaceutical field representative (PFR) meetings by members of an integrated specialty pharmacy team at a large academic medical center.

Methods

A longitudinal, anonymous survey was distributed via e-mail to 39 pharmacists and pharmacy technicians weekly from August 1, 2022, to September 9, 2022. Participants included only individuals who provide direct patient care. Pharmacy leadership team members were excluded. Pharmacy students or residents were also excluded from participating in the survey, although they may have been present with their preceptors at the time of interactions described in this article. Initial e-mail distribution occurred on Friday of each week during the active study time frame and a verbal reminder was provided the following Monday during a standing virtual team meeting. The 16-item survey tool used skip and branching logic comprising binary, multiple-choice, multiple-select, and open-ended items. The tool was pretested by pharmacy students to ensure appropriate branching logic. The survey assessed locations of interactions with PFRs, who initiated the request, reason for interaction, and time spent. It also assessed whether the participant felt the interaction provided value and whether it contributed to them working a longer shift or compromising time spent on patient care that day. All questions included on the survey tool can be found in Table 1.

TABLE 1.

Questionnaire: Pharmaceutical Representative Meetings Survey

Survey questions	Possible responses
Did you have at least 1 interaction with a representative from a pharmaceutical company this week?	Yes
	No [END SURVEY]
Please enter date of interaction.	Free text
What drug was this contact regarding? [Please enter drug name or state UNKNOWN if no context was given]	Free text
Where did the interaction take place?	E-mail
	Telephone
	In person (scheduled meeting)
	Virtual (scheduled meeting)
	In person (unplanned or drop-in)
	At a conference
	Other
Who initiated contact?	PharmD
	CPhT
	Representative from drug company
	Other
PharmD or CPhT: Why did you initiate contact? (Option for multiple selections)	For a general clinical question
	For a patient-specific clinical question
	To obtain access to tools or resources, including but not limited to cost-related tools (eg, vouchers or copay cards) and patient education materials, general
	For a patient-specific access question
	Other
PharmD or CPhT: Did this led to a resolution of your question/request?	Yes (completely)
	Yes (partially)
	No
Representative from drug company: Was there a clear reason for the outreach (eg, FDA label update, change to product, change to copay card program)?	Yes
	No
Did the encounter provide NEW information that will impact your clinical management of patients OR provide access to tools or resources (physical or electronic) that you plan to use for patients or incorporate into your workflow?	Yes
	No
How long IN MINUTES did the interaction last?	Free text
Who was your interaction with? (Option for multiple selections)	Drug sales rep
	Medical Science Liaison
	Reimbursement specialist
	Patient-facing clinical educator
	Other
Who else was present at the meeting?	Free text
Do you feel this interaction provided value?	Yes
	No
Did this interaction contribute to you working > 8 h today in order to finish necessary tasks for patient care?	Yes
	No
Please enter any narrative comments you would like to include. (eg, no. of patients impacted/# of vouchers provided, other benefits gained from the interaction)	Free text

For all questions with a response of “Other,” the option to enter additional details in a free text box was provided.

CPhT = certified pharmacy technician; FDA = US Food and Drug Administration; h = hour.

This project was formally determined to be quality improvement, not human subjects research, and was therefore not overseen by the institutional review board, per institutional policy. Data were collected and managed using REDCap electronic data capture tools hosted at UCM. REDCap11.1.7 (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies, providing (1) an intuitive interface for validated data capture, (2) audit trails for tracking data manipulation and export procedures, (3) automated export procedures for seamless data downloads to common statistical packages, and (4) procedures for data integration and interoperability with external sources. Data were analyzed in a descriptive nature. Open-ended question responses were reviewed for themes.

Results

A total of 39 UCM Specialty Pharmacy team members were asked to complete and submit weekly surveys consisting of the questions presented in Table 1 over the course of 6 weeks. There was a total of 108 responses. The responses were further compared, analyzed, and categorized as shown in Table 2. Of those, 44 responses documented having an interaction with a PFR. It was found that only 5 (11.4%) were UCM team member initiated. Among the pharmacy team member–initiated meetings, all respondents stated that the interaction had provided value, and none reported that it led to a longer workday. Conversely, of the 36 pharmaceutical representative–initiated interactions, 15 (41.6%) found value and 5 (13.8%) said that their workday was elongated because of these interactions. Some primary reasons for outreach documented by respondents included PFRs wanting to present a new study or guideline update, provide individual introductions, or ask direct questions regarding patient information. Of the 3 meetings initiated by “other personnel,” only 1 concerned a product that the UCM Specialty Pharmacy had access to. The other 2 were preapproval information engagement (PIE) or “pipeline presentations” that, based on survey responses, led to a longer workday and did not provide value to the individual who was prompted to attend. The pharmacy team member noted in the narrative comments section that of the 5 questions they asked of the presenter, only 1 was able to be answered and that they then felt “pressured” to schedule an additional follow-up with a representative, leading to increased work time constraints.

TABLE 2.

Interactions Between UCM Specialty Pharmacy Team Members and Pharmaceutical Field Representatives (n = 44)

	UCM Specialty Pharmacy team member–initiated interactions(n = 5)	Pharmaceutical field representative–initiated interactions (n = 36)	Other personnel-initiated interactions(n = 3)
Interaction pertained to a drug or product to which that UCM Specialty Pharmacy has access, n (%)	5 (100)	31 (86)	1 (33)
Location of interaction, n (%)
E-maila	4 (80)	15 (41.6)	0 (0)
Telephone	0 (0)	3 (8.3)	1 (33.3)
In person (scheduled meeting)	0 (0)	3 (8.3)	0 (0)
Virtual (scheduled meeting)	1 (20)	13 (36.1)	2 (66.6)
In person (unplanned or drop-in)	0 (0)	1 (2.7)	0 (0)
At a conference	0 (0)	1 (2.7)	0 (0)
Other	0 (0)	0 (0)	0 (0)
Did the encounter provide NEW information that will impact your clinical management of patients OR provide access to tools or resources (physical or electronic) that you plan to use for patients or incorporate into your workflow? Response of yes, n (%)	NA	14 (38.8)	NA
Time, minutes, median (range)	15 (2-20)	15 (1-120)	40 (10-60)
Field representatives present at the meeting, n (%)
Pharmaceutical sales representative	1 (20)	13 (36.1)	0 (0)
MSL	1 (20)	14 (38.8)	1 (33.3)
Reimbursement specialist	2 (40)	7 (19.4)	1 (33.3)
Patient-facing clinical educator	1 (20)	1 (2.7)	0 (0)
Other	0 (0)	1 (2.7)	1 (33.3)
Do you feel this interaction provided value? Response of yes, n (%)	5 (100)	15 (41.6)	1 (33.3)
Did this interaction contribute to you working > 8 h today in order to finish necessary tasks for patient care? Response of yes, n (%)	0 (0)	5 (13.8)	1 (33.3)

Participants were able to log the time required to read and respond to the e-mail in “How long IN MINUTES did the interaction last?” question (shown in Table 2); this was not a separate branching item with further instruction.

^a E-mail was included as a location to capture all types of interaction including virtual.

MSL = Medical Science Liaisons; NA = not applicable; UCM = University of Chicago Medicine.

Although almost half of respondents had found some value in interactions with PFRs and only 13.6% reported that elongated their workday, only about a third of interactions initiated by a PFR involving sharing of information that respondents felt provided new information that actually had the potential to impact clinical management of patients or provided access to tools or resources (eg, vouchers for free medication for patients).

Of the 36 pharmaceutical representative–initiated interactions, 6 (16.6%) did not specify which drug it was regarding. For the 38 interactions in which the drugs in question were known, only 3 (7.9%) were pertaining to medications that either UCM Specialty Pharmacy had access to through a wholesaler or an alternate channel, were not available on the market, or were not a specialty drug.

Of the 16 interactions that specifically included an MSL, survey participants were more likely to report they provided value (n = 11, 68.8%) as compared with the overall dataset in which less than half of all interactions were perceived to provided value.

Overall, it was found that most encounters were initiated by PFRs, with a majority consisting of MSLs or sales representatives, and a median time spent of 15 minutes, which did not result in a longer workday for most participants (Table 2).

Discussion

To our knowledge, this is the first study that was conducted to evaluate the volume of, and time spent in, PFR meetings by members of an integrated specialty pharmacy team at a large academic medical center.

Pharmacist workdays consist of high-performance tasks with growing responsibilities to ensure excellent patient care. In narrative comments shared by the respondents, we discovered that team members felt pressured to provide availability for PFR-initiated meetings. This was concerning in light of rates of burnout among hospital pharmacists as high as 66%, which has been attributed to emotional exhaustion, depersonalization, and decreased personal accomplishment.^13,14

Other narrative comments addressed the limited value of PIE, commonly known as pipeline presentations, which focus on medications in phase 2/3 and phase 3 studies. Although there can be value in gaining information about new drugs, it is unknown at the time of these presentations if the drug will actually come to market, at what price point, and in some cases whether or not it will have a specialty designation. In fact, only 59% of medications in the pipeline make it past phase 3 and only about 12% of drugs in clinical trials actually make it to US Food and Drug Administration approval.^15,16 Even if the drug does come to market, only about a third of health care decision-makers report frequently or always using this information in their formulary decision-making, and best practices for designing PIE do not focus on interactions with front-line HCPs with direct patient care responsibilities.¹⁷ In our survey specifically, pharmacy team members reported attending presentations that were not relevant to the patient population they served, as the individual on the pharmacy leadership team sending out invites may not have been familiar with each pharmacy team member’s specific area of practice. This means pharmacy team members may be taking time away from patients and other responsibilities to listen to medication information on drugs they will never see, prescribe, or practice with.

An additional pain point, based on narrative comments, was that meetings were oftentimes not clinically focused. For example, pharmacists report requests for meetings strictly for introductions to new or additional PFRs. This trend could have been due to poor planning on the PFR side in which introductions did not align with presentations of new clinical data, new guidelines, or tools or resources that would be applicable to pharmacists’ practice or workflow. Strengths of this project include anonymity for participants, ease of survey distribution and collection by using an online design, and cost-effectiveness. Anonymity was particularly important in the effort to gain honest feedback as well as the ability to take the survey remotely without internal pressures that could waver answers. Additionally, questions were nonleading, which allowed for impartial data collection. Finally, the survey was distributed to pharmacy team members across a variety of practice specialties, which strengthens its external validity by becoming applicable to various patient management sites and other pharmacy specialties.

LIMITATIONS

Limitations of this research include the inability to calculate response rates accurately. The number of responses stating that there was not an interaction with a PFR during a given week was 64 out of 108 total responses to the survey. However, given that we permitted participants to log more than 1 interaction per week, the number of respondents who logged the 44 interactions is unknown. By reviewing the dates of survey completion for each response, we were able to estimate that the response rate was between 29.9% (if only 1 team member was logging all interactions in each survey week) and 46.1% (if no team member logged > 1 interaction each survey week). The physical setting of the UCM Specialty Pharmacy is also a potential limitation to its external validity because it is not easily accessible to the public like many community or health-system pharmacies. This may have minimized the number of drop-in visits from PFRs, which can be an issue and distraction for pharmacy teams in other settings. Additionally, as with most surveys, there is likely a respondent bias; however, it is unclear as to which direction it leaned toward. Respondents may have been hesitant to share that they were making time for these interactions if it was reducing their time for direct patient care activities. On the other hand, respondents may have felt it important to capture the lost time and productivity as a result of these meetings in hopes of future systematic changes to minimize the number of interactions and improve their utility. Interestingly, the results were split close to 50% on whether meetings with PFRs provided value. However, the majority of respondents reported neither no new information learned nor impact on their practice. The vague interpretation of value as described in Table 1 could have led to these results. Another hypothesis is that survey takers could have felt indifferent, and a neutral answer choice would have been more appropriate. Additionally, there could have been preexisting personal relationships among the encounter participants that could have limited critical feedback. Future studies could address these limitations by providing robust definitions that allow for succinct interpretations, as well as opening the survey to outside organizations and different practice sites to greatly expand on its external validity.

Next steps for our team include proposing the following changes: (1) requests for attendance at PIE meetings should be only made by the pharmacy leader who the team member directly reports to, with the intention of minimizing pipeline presentations attended by team members that do not relate to their area of practice; (2) requests for meetings from PFRs pertaining to limited distribution drugs that the UCM Specialty Pharmacy does not have access to should be rerouted to the person on the pharmacy leadership team responsible for contracting, if the company is open to expanding access, otherwise these meetings should be declined; and (3) meetings with the intent of introduction or pass off of contacts between PFRs should be deferred until there is a clinical update (eg, new study or guideline) or tools or resources (eg, vouchers) are being provided. If there is not an opportunity to align these items prior to the departure of the outgoing PFR, the information about the new contact can be provided via e-mail. Outside of our team’s scope of influence, but a potential consideration for PFRs, would be to include the drug(s) in question in their requests.

Conclusions

Our data demonstrate that the majority of encounters taking place between UCM Specialty Pharmacy team members and PFRs were not perceived to result in knowledge gained or provision of tools and resources to support our patients. Without a clearly defined purpose of collaboration, the time spent engaging with PFRs could be redirected to patient care or other organizational initiatives and priorities. Further research is needed to evaluate the true benefit of interactions between HCPs and PFRs.