Price Accountability Comes to Sales Reps via Affordable Care Act

The Affordable Care Act’s (ACA) ride through legislative and judicial hurdles has focused on the high profile aspects of the law including the insurance mandate and state Medicaid responsibilities.  However, one part of the law that will have a major impact on both patients and pharmaceutical sales forces is the establishment of accountable care organizations (ACOs) that bring physicians, hospitals and pharmacies together to create a more cohesive healthcare package for patients.  This means that doctors would be made aware of potentially conflicting medications a patient may already be taking and be able to recommend a less risky course of a treatment and introduce a level of price accountability for sales reps.


By Jacob Presson,
Research Analyst

ACOs will bring positive changes to patients but will require a shift in how sales reps conduct themselves under the new model.  Doctors will be more skeptical of some sales reps’ claims so reps will need to come prepared for different kinds of questions.  Companies have already begun preparing for this shift but with 10% of the US population now served by doctors under ACOs there will need to be many more significant changes.

Pharmacoeconomics will dominate the new discussions between sales reps and ACO committees.  The requirements for sales reps have been changed to include substantial business knowledge in order to sell doctors on the economic logic alongside the clinical benefits.  As ACOs begin to create their own formularies, some doctors who were once smaller targets but now have influential seats on the formulary committee will require more detailed attention from sales forces.

Specialist sales reps will have more influence under the ACO structure as they will have the necessary knowledge to make the dual economic and clinical arguments to physicians.  Understanding hospital pharmacies’ priorities will be very important for sales reps, especially in terms of the needs driving formulary decisions.