Progress in how pharma companies tackle overselling antimicrobials
10 companies decouple bonuses from sales volume or avoid using sales agents altogether, up from 5 in 2018.
- By decoupling bonuses from sales volumes, or not using any sales staff at all, pharma companies mitigate against overselling antibiotics and driving resistance.
- Three companies have no sales agents promoting antibiotics or antifungals.
- Seven companies fully or partially decouple sales agents’ bonuses from volumes.
The 2020 Antimicrobial Resistance Benchmark finds that responsible sales practices are gaining traction among pharmaceutical companies, when it comes to antibacterial and antifungal medicines. The number of companies engaging in responsible promotional practices has risen from five in 2018 to 10 in 2020, with six companies demonstrating best practice for at least some medicines.
What does a responsible promotional practice look like?
The Benchmark looks at whether or not pharmaceutical companies use sales agents to promote their antibacterial and antifungal medicines. By avoiding the use of sales agents, companies reduce the risk of overselling to healthcare professionals. For companies that do still have a sales force, the Benchmark looks at whether they have removed the incentive to oversell by decoupling their sales agents’ financial rewards from the volume of antibacterial and/or antifungal medicines they sell.
How do the companies’ practices compare?
Teva demonstrates best practice in this area, as it does not have a sales force to promote any of its antibacterial or antifungal medicines. Otsuka and Johnson & Johnson also apply this stewardship practice to their tuberculosis medicines, delamanid (Deltyba™) and bedaquiline (Sirturo®) respectively. Given the comparatively wide spread of extensively drug-resistant and multi-drug resistant tuberculosis strains, the stewardship of tuberculosis medicines is prioritised by global health and national public health bodies. As a result, tuberculosis medicines are generally not promoted by companies. Political attention and public concern about antimicrobial resistance is rising, meaning the pharmaceutical industry can anticipate this level of stewardship in the future for all antibacterial medicines.
When it comes to decoupling, three companies – Cipla, Shionogi and Wockhardt – fully decouple sales bonuses from volumes in the antibacterial and antifungal medicines space, with Cipla as the first generic medicine manufacturer identified by the Benchmark to fully decouple. Through pilots established in 2019, Pfizer and Merck & Co, Inc have fully decoupled such bonuses in the UK. Pfizer also partially decouples bonuses from sales volumes in other countries. Novartis partially decouples bonuses, maintaining the practice it reported to the 2018 Benchmark. GSK is the only company to have regressed in this area since the 2018 Benchmark. It was a pioneer in 2013 when it fully decoupled all sales agent bonuses globally from antibacterial sales volumes, but the 2020 Benchmark reports it now embraces partial decoupling rather than full decoupling.
How can sales bonuses drive resistance rates?
One of the main drivers for the emergence of AMR is the inappropriate use of antibacterial and antifungal medicines This includes when doctors prescribe them when they are not needed. Inappropriate use has been shown to cause antimicrobials to become ineffective more rapidly. In India, for example, resistance already exceeds 70% for many bacteria, including E. coli and K. pneumonia, and has one of the highest rates of antibacterial consumption. Addressing inappropriate use is one of the pillars of global efforts to curb AMR.
Pharmaceutical companies should adopt responsible promotional practices to help ensure their antibacterial and antifungal medicines are prescribed appropriately and only when needed, in order to prolong their effectiveness. The current best practice is to stop deploying sales agents to sell antibacterials and antifungals to healthcare professionals. For companies that retain a sales force, fully decoupling agents’ financial rewards from sales volumes will remove the financial incentive to oversell. Where decoupling is policy, companies must take steps to ensure the policy is implemented in all territories.