Improvement in antimicrobial sales practices, especially from generics companies
Companies can minimise the risk of overselling antimicrobials by removing the link between sales volume and financial rewards.
- More generic medicine manufacturers are taking action to reduce overselling
- Progress in improving sales practices is not always consistent
When sales agents’ bonuses are linked to how much antibacterial and antifungal medicine is sold, this acts as an incentive for these staff to oversell in order to increase their own pay. Companies can minimise the risk of overselling by removing the link between sales volume and financial rewards, or – going further – by stopping the use of sales agents for antibacterial and antifungal medicines altogether.
In 2020, the Benchmark reported progress in this area, namely a jump from five companies to ten companies that stopped the use of sales agents altogether or are decoupling bonuses from sales volume of antibacterial and antifungal medicines.
In 2021, data shows that more generic medicine manufacturers are taking action to combat overselling with three additional companies putting policies in place, namely Abbott, Aurobindo and Viatris. Moreover, among the large research-based companies, Sanofi updated its policies around promotion of its antibacterial and antifungal medicines outside of its home country, France. However, progress in improving sales practices is not always consistent, and company behaviour around promotion can quickly change, so complacency should be avoided.
How many companies progress to the next step?
Full decoupling means that no component of a sales agent’s incentives is linked to that agent’s volume of sales. Partial decoupling means that a proportion of the agent’s pay is variable and depends on incentives linked to sales volumes.
Variable pay can be linked to performance targets (related to behaviour or education) or sales volumes. The higher the percentage of variable pay linked to sales volumes, the more incentive there is to increase sales volumes
Incentives for sales agents can be awarded at individual, smaller group or national level. When incentives are awarded at national and smaller group (rather than individual) level, they are linked less directly to total pay, so that when an individual agent sells a higher volume of products, this does not directly increase that person’s total pay
Which companies are decoupling financial incentives from sales volumes?
Teva, Aurobindo and Shionogi go the furthest towards ensuring that sales agents’ financial incentives are not tied to sales volume, either by not promoting their products or by fully decoupling such incentives. Johnson & Johnson, Otsuka and Viatris do not promote their tuberculosis medicines, with the exception of Johnson & Johnson, which promotes its multidrug-resistant TB medicine bedaquiline (Sirturo®) in at least one country.
Abbott, Aurobindo, Sanofi and Viatris have newly taken steps in this area. A range of strategies are being implemented, for example pilots for full decoupling, or no promotion in some countries and/or for some products. However, the true impact of these pilots remains unknown. Further progress is still needed toward full decoupling or towards a policy of no promotion to healthcare professionals globally.
Progress on sales practices has proven to be inconsistent throughout the Benchmark iterations as GSK regressed in this area in the 2020 Benchmark, but the group of companies as a whole has progressed as more generic medicine manufacturers are starting to get more involved in this area.
These firms mostly focus on developing new, innovative medicines. These are typically promoted after receiving market approval because they still need to be implemented in daily medical practice, treatment guidelines or medical formularies.
These companies are focused on producing and manufacturing generic medicines that are launched after the patent on innovative medicines has expired, with the exception of when production of an on-patent product is licensed to that manufacturer. Generic medicines, with the exception of branded generics, are typically not promoted on a product level as the product is already implemented in daily practice. However, generic medicine manufacturers usually compete in government or hospital tenders to sell generic medicines.
Reimbursement schemes could help companies make progress
There are gaps in standards on advertising, marketing and sales of antimicrobials, but there are also new approaches being used which could lead to improvements.1
These include the use of reimbursement schemes, which aim to remove the component of sales volumes entirely.
As part of pilot schemes ongoing in the UK and Sweden2, promising new antibacterial medicines that are about to reach the market are selected, and the schemes ensure that reimbursement by the government is not related to the volume of medicines sold or used.
This aligns with stewardship practices, as new antibacterial medicines should be used sparingly and only as a last resort to avoid the emergence of resistance against the newest antibacterial medicines on the market.
These new reimbursement schemes provide an opportunity for pharmaceutical
companies to completely break the link between sales volumes and financial incentives, while still retaining an appropriate revenue. Going forward, this could be an especially helpful model to apply to low and middle-income countries.
* Antibacterial and/or antifungal medicines.
** Alkem, Sun Pharma and Hainan Hailing do not disclose their sales practices.
1. Van der Heijden M. Strengthening the regulation of antimicrobial use to mitigate drug resistance. Global Antibiotic Research and Development Partnership (GARDP). https://revive.gardp.org/strengthening-the-regulation-of-antimicrobial-use-to-mitigate-drug-resistance/. Published July 16, 2021. Accessed August 31, 2021.
2. Gotham D, Moja L, van der Heijden M, Paulin S, Smith I, Beyer P. Reimbursement models to tackle market failures for antimicrobials: Approaches taken in France, Germany, Sweden, the United Kingdom, and the United States. Health Policy (New York). 2021;125(3). doi:10.1016/j.healthpol.2020.11.015