shutterstock_285181445.jpgSarah Jarvis and Sunil John co-wrote this blog post with Jon Gonzales. 

The medical affairs organization has seen a rapid increase in both growth and prominence in recent years, evolving from a minor support function to an integral strategic partner. Today’s complex healthcare ecosystem, along with a decline in physician access, means that pharmaceutical companies have become increasingly reliant on field medical teams to deliver scientific information to a growing base of stakeholders. Yet despite this increase in importance, only 23% of companies believe that they have a “very well defined” strategic plan when it comes to the organizational and business aspects of their medical affairs organizations, according to new ZS research.  

Pharmaceutical companies are struggling to bridge the gap created by nearly a decade of increasing compliance and complexity that’s separating medical and commercial teams. Compliance has driven these groups into separate silos (if not buildings), and we see examples of inefficiency and ineffectiveness all of the time: Resources are duplicated, information is poorly collected, and insights are generated but not shared internally.

Yet while the industry as a whole needs to make major strides in improving the strategic direction of medical affairs, the oncology space is leading the way—and other pharma companies should be paying attention.   

Growth in Oncology Field Medical

The ZS Medical Affairs Outlook 2017 survey, conducted in March 2017 among 72 respondents from more than 30 pharmaceutical companies, shows that oncology medical science liaison (MSL) team sizes have had the largest growth among different therapy areas, increasing by 31% over the past two years. (The overall industry-wide growth of MSL teams was 12%.) It’s noteworthy that this growth only considers reported team sizes for traditional MSL roles across the industry and doesn’t account for the addition and expansion of new field medical roles, such as HEOR/payer liaisons. Moreover, the median oncology sales rep to MSL ratio was lower than industry norms at 7:1 in oncology vs. 9:1 industry-wide. In 2014, the ratio in oncology was 8:1, showing an increase in the number of oncology MSLs per sales rep from the available data in 2014 and 2016.

As oncology field medical, in particular, continues to grow, it also continues to be part of the leading edge in industry trends as it faces a crowded and changing landscape. Much of this is the result of the major drivers in this space, which include:  

  • Physician access: In 2016, only 17% of oncologists were generally accessible to sales reps, according to ZS’s AccessMonitor™ survey. This is far below the 44% rate of accessibility across all physicians, which in itself has declined from 77% in 2008.
  • Increasing scientific complexity: Oncology has the single richest pipeline among all drug classes covering a number of distinct disease types. Around 80% of oncology therapies have the potential to become first-in-class medicines.
  • Asking for real-world evidence from physicians: Field medical is uniquely suited to both help generate and be a delivery mechanism for real-world evidence, which is especially critical within oncology.
  • Expanded audience: The rapidly evolving landscape has led to the emergence of new stakeholders who are becoming increasingly important and have specialized information needs. For oncology especially, these new stakeholders include patient advocacy groups and payer stakeholders (accountable care organizations, integrated delivery networks, etc.).

These factors, along with the shift to evidence-based medicine and value-based care, will require much closer coordination and collaboration across medical and commercial to meet the needs of the expanding stakeholder audience. In response, many oncology organizations are expanding the roles and responsibilities of their field medical teams and even creating separate, specialized teams to meet customer demand. Others have begun to explore opportunities for appropriate collaboration, from insights to resource sharing across their organizations. We believe that many more will begin to seek these opportunities as they recognize that by striving to do what they believe is the “right” thing (like remain compliant), most companies are hurting patients—and themselves—by not working in appropriate partnership across their entire organization.


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