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Imagine you’re a busy physician at a crowded urban hospital. You’re on the tail-end of a 12-hour shift without a nap or a proper meal since putting on your scrubs. As you dart between curtained-off hospital beds from one room of patients to the next, you spot him out of the corner of your eye. He’s sitting at the edge of the waiting room with his suit and briefcase full of new drug samples – the pharma sales rep. As soon as your eyes meet, he’s already dashing across the tile floor with a business card in hand. “Hey doc, got a minute?” You don’t, but you agree to chat after making the final rounds. Looks like dinner and sweet, elusive sleep will have to wait a while longer.

Pharma sales representatives are an important intermediary between doctors and the manufacturers of drugs their patients rely on. Some patient’s lives literally rely on them – but doctors are busy people, and squeezing in time for a face-to-face meeting at a busy clinic or hospital can be difficult. Moreover, skilled salespeople command high salaries, and hiring a top-notch team of drug reps can cost pharma firms a small fortune.

In Japan, the world’s second-largest market in terms of branded (non-generic) pharma sales, a new medtech startup hopes to streamline the process by putting meetings online – at the doctor’s convenience and at a fraction of the cost to drug makers.

“Right now, the entire promotional model of Japan’s pharma industry has to change,” Marty Roberts, the founder and CEO of EnTouch, tells Tech in Asia. “There are 29 salespeople for every single doctor, compared to nine in the US and two in the UK. It’s an insane army of sales reps saying ‘yoroshiku onegaishimasu’ [a common Japanese phrase that roughly translates, in this case, to ‘nice to meet you’] hoping it will increase product sales.”

The rise of generic drugs

Japan’s pharma companies are bracing for massive policy changes that will open the floodgates for cheaper, foreign-made generic drugs. In 2013, the most recent year that data is available, less than 47 percent of all drugs sold in Japan were generics. This past July, Japan’s health ministry set an ambitious goal of increasing that figure to 80 percent by 2020 – even higher than current adoption rates in the US and much of Europe.

The move is meant to address the country’s steadily rising healthcare costs, an urgent social issue as the population rapidly ages and shrinks. Japan’s big pharma will feel the burn from an influx of generics – despite its high position in overall pharma sales, not even one of the world’s top 10 generic drug makers is Japanese.

“Domestic pharma companies must massively reduce their costs to stay competitive, and the biggest cost is their salesforce,” Marty says, referencing the 2020 deadline. “It’s nearly impossible to fire people in Japan, so many firms push early retirement. Many of the best salespeople, who are nearing retirement age anyway, accept these offers – and they’re exactly who we recruit.”

EnTouch, founded in September, hires these highly-skilled drug reps directly and allows them to work from home with a workstation that it provides (it includes a computer, webcam, phone, and backdrops with EnTouch and client logos). The startup is also encouraging professional women who have left the workforce after having children to join up, as their schedules tend to work with the very early or very late hours required to call doctors.

The startup’s sales rep hiring strategy also follows the Japanese government’s push to increase participation by both groups. Older workers who remain in the workforce reduce strain on pensions and healthcare. A staggering 70 percent of Japanese women never return to the workforce after childbirth, eliminating a huge number of highly-educated potential taxpayers.

Distractions

The EnTouch website, expected to go live next month, allows doctors to prearrange meeting times so they’re not blindsided by in-person visits. It also gives pharma companies a more effective way to communicate their products to a captive audience, free of the distractions that can arise in a doctor’s office or hospital.

“About five years ago, all the big pharma companies bought their sales reps iPads,” Marty says. “They can command so much more attention from doctors with interactive graphs, animations, and stuff like that. But they didn’t solve the main problem, which is that docs don’t have time to play with an iPad at work.”

Remote sales pitches can include all of the fancy visuals without overburdening a doctor at his or her workplace or forcing a sales rep to hunker down in waiting rooms all day. They also lead to a higher rate of success by allowing doctors to take calls before work, after work, or during meal breaks.

“About 40 percent of doctors agree to prescribe increased quantities of a drug or adopt a new one after a face-to-face meeting,” Marty says, citing data presented at a meeting of Japanese pharma delegates earlier this year. “That figure increases to more than 60 percent when done online.”

On the sales rep side, the EnTouch platform displays presentation slides, a script, clinical trial data, and other drug-specific information. Doctors see the presentation, and in some cases, see the sales rep (pharma companies can choose whether to use the webcam or just display slides).

Pitches made on EnTech are recorded so that doctors can go back and review details at their leisure. It also has a matching system so that pharma companies know which health care practitioners to pitch specific products to.

All-in-one remedy

The concept of moving pharma sales online isn’t new, but – as evidenced by the crazy ratio of sales reps to doctors – has yet to truly catch on in Japan. The biggest barrier to mass adoption on the medical care provider’s side is fragmentation.

Three of the world’s leading drug makers – Pfizer, GlaxoSmithKline, and Lilly – each tried bringing teleweb (the industry term for online sales) to Japan. Because each system was built in-house, doctors complained that it was cumbersome to switch between multiple interfaces. EnTouch was designed to streamline the experience by allowing pharma companies to subscribe to a single system.

“These in-house solutions are not competitors,” Marty says. “In fact, many of these companies would prefer to outsource such projects to a provider such as EnTouch. It was actually the pharma companies that came to me to talk about building it,” Marty says.

Attitudes toward the digital approach to pharma sales are changing, despite the early hiccups. Marty explains that back in 2008, the year he arrived in Japan, only 5 percent of interactions between pharma companies and doctors took place online. In 2014, that number skyrocketed to one in three.

Marty worked as a clinical psychologist in the US before getting headhunted into a French market research firm that specializes in the healthcare sector. He was sent to Japan in 2008, where he also ran the firm’s in-house software company, which supplied SalesForce automation to pharma sales reps. In eight years, the founder has cultivated all of the necessary connections – both with pharma companies and fellow doctors – to turn his startup into an industry disruptor.

“We’re not only solving problems for pharma companies and doctors, but also solving Prime Minister Abe’s problem by getting older people and women back to work,” he says.

The startup is currently bootstrapped with Marty and co-founder David Liebreich’s own funds. David is a serial entrepreneur with three exits in Japan, so attracting venture capital shouldn’t be difficult. Marty says that they’re already in the midst of raising seed funding from domestic VCs and angels, but declined to discuss terms or investors as the deal is pending.

Perhaps more importantly than fundraising, EnTouch has attracted the interest of three major Japanese pharmaceutical companies that will likely launch pilot programs in January.

“We’re a startup, so we can move or pivot fast,” the CEO adds. “Bigger companies are trying to do what we’re doing by buying brick-and-mortar call centers or partnering with outsourcing firms, but they can’t match our speed or network.”

Does it make sense to move pharma sales – and perhaps other sales gigs – online? What other medtech innovations are disrupting your local market? Tell us below.

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