As more pharmaceutical companies prepare to bring new oncology drugs to market, their sales representatives face a rising hurdle—oncologists are reducing the number of times they will see them.

According to the spring 2012 AccessMonitor, a report from global sales and marketing consulting firm ZS Associates, about 61% of oncologists placed moderate-to-severe restrictions on visits from pharmaceutical sales reps. This makes oncology the most restrictive of the 20 most common medical specialties measured in the report. By comparison, about 47% of cardiologists and only 38% of primary care physicians restrict rep access to the same degree.

Oncology is the fastest-growing specialty therapy area in the world and accounted for 10 percent of global pharmaceutical sales in 2011. Currently, there are about 1,000 oncology drugs in the pipeline—almost twice the number in any other field.

"Sales reps equip oncologists with data on evolving science, access to financial assistance for patients, and help with reimbursement support and patient support materials," said Ganesh Vedarajan, principal and leader of the oncology and specialty therapeutics practice at ZS Associates. "Regulatory constraints, however, are increasingly restricting these offerings. Physicians also are able to access scientific data in real time through other channels."

Vedarajan continued, "While oncologists still see some value in rep visits, increased patient load and more time spent on reimbursement issues limit the time they have available. Most practices now require reps to schedule appointments in advance—and generally provide only two or three potential openings per week."

The report examined how often 350,000 physicians and other prescribers meet with pharmaceutical sales representatives who visit them. It then classified those doctors into one of three groups: "accessible" (physicians who met with more than 70% of reps); "access restricted" (physicians who met with 31%-70% of reps); and "severely access restricted" (physicians who met with no more than 30% of reps).

According to the report, only 39% of oncologists were "accessible," compared to 65% of all prescribers. Moreover, 11% of oncologists placed severe access restrictions on reps, compared to just 9% of all prescribers. About half of oncologists placed moderate access restrictions on reps compared to 26% of all physicians.

"While reach seems to have stabilized, the frequency with which an oncologist will see a rep has declined at a steady pace," said Jon Roffman, associate principal and leader of the oncology practice's field force strategy work. "For the first time since AccessMonitor began tracking physician access in 2006, oncologists who placed moderate-to-severe restrictions on rep visits outnumbered those with relatively few access restrictions."

According to AccessMonitor, an overwhelming majority of oncologists (79%) saw even their best reps only up to 12 times each year—and almost no specialists allowed reps to visit them more than 24 times per year. This compared to 3% of primary care physicians and 13% of all specialists who will meet with their best reps more than 24 times a year.

"With the increasing number of approved oncology drugs and the active pipeline, properly introducing these therapies to physicians is going to get more complicated. Indeed, within just a few years, the average rep may be unable to meet with a doctor face-to-face more than four times each year," said Roffman. "It's hard to be effective with so little interaction. To meet this challenge, pharmacos must rethink their approach to engaging with this physician group. Both the offering and selling model must dramatically shift to adjust to the constraints and needs of oncologists."

Because many oncologists limit the number of times they see any single rep each year, pharma companies are tempted to secure more doctor visits by sending several different reps to promote the same drug.

"These conditions are ripe for a new pharma sales rep 'arms race,'" said Vedarajan. "Pharma companies that hire more reps must be careful not to overwhelm prescribers with sales calls."

This is why Maria Whitman Mumm, associate principal and leader of East Coast marketing solutions in the oncology practice at ZS Associates, encourages companies to focus on the customer experience. "This requires a mind shift for pharmacos," said Whitman Mumm. "Instead of designing their field organization based on, 'How many sales reps do I need?' pharmacos should ask, 'What is the physician experiencing, and how can I help improve the experience by bringing the most value to him or her?'"

According to Whitman Mumm, sales reps must understand the physician's needs and preferences and use a mix of services and tactics—including new technologies—to improve the overall experience. Pharmacos must also encourage reps to remain at the center of communication and provide a personal touch to these doctor interactions where possible. ZS research, in fact, indicates higher physician open rates for emails sent by reps compared to those sent by the head office.

"The sales model also must evolve to take a different sales approach to institutions," added Vedarajan. "Some institutions do not allow sales reps at all. As the industry consolidates and more physician practices are acquired by institutions, this problem will become worse. Companies should think about steps to adapt for continued success."