Pharma’s Apollo 13 moment

How commercial leaders can respond to disruption

By Jon Hesby, Partner, Kevin Frymire, Associate Partner, and Robert Lien, Associate Partner, Beghou Consulting

“Houston, we’ve had a problem.”

Jack Swigert’s famous words signaled the beginning of a pressure-filled and high-stakes crisis response on board the Apollo 13 spacecraft and at NASA Mission Control in Houston. The astronauts and scientists who responded so heroically to that crisis confronted a barrage of critical decisions and fast-changing challenges. While pharmaceutical commercial teams navigating the COVID-19 pandemic don’t face the same life-or-death decisions the Apollo 13 team did 50 years ago, they are still responding to rapidly evolving circumstances in an uncertain environment. While we’re confident the industry will weather this storm, bad decisions companies make today could meaningfully damage commercial efforts for some time to come.

The coronavirus pandemic has disrupted pharma companies’ commercial operations. Most sales representatives can’t visit health care professionals in person. Routine checkups, screenings, and elective procedures were put on hold, delaying diagnoses and treatments. In response to these market disruptions, companies have had to lower forecasts, change incentive compensation plans, delay clinical trials and more. 

We see three lessons from the Apollo 13 story that can help pharma companies lay the groundwork for lasting commercial success in a post-COVID-19 world.

1. Don’t panic

Calmness under pressure was a hallmark of the response aboard the spacecraft and at Mission Control during the Apollo 13 mission. The lack of panic enabled the collective team to make wise decisions under immense pressure. 

The spaceship had two oxygen tanks which not only supplied oxygen for the crew, but also powered the three fuel cells that generated the spacecraft’s electrical power. The cells also produced water to cool electrical components and for the crew to drink. So, when one of the oxygen tanks ruptured, a smooth mission was suddenly plunged into crisis. The crew and Mission Control team had to quickly collect information and accurately diagnose the status of the oxygen tanks.

The team soon realized that one oxygen tank was empty, and the other was leaking. The team responded quickly, shutting down one of the fuel cells and some systems in the control module. Then, they shut down the second fuel cell. This immediate conservation of power was crucial to the crew’s eventual safe return to Earth. When the command module splashed down in the Pacific Ocean, it had about 20 percent of its battery power left.

During the coronavirus pandemic, pharmaceutical companies have performed admirably and without panic. They should continue to take a measured approach to the current disruption while also looking for opportunities to revise commercial strategies to adjust to the new reality they face. For example, as the ability of sales reps to visit physicians in person remains limited, companies need to look beyond the physician more than they have in the past. Today, there’s an opportunity for more patient contact and outreach. Direct-to-patient activities (e.g., disease awareness, patient support) can help companies boost brand awareness and get life-saving treatments in the hands of the patients who need them. These efforts will be especially important in the rare disease space, where patients can search unsuccessfully for effective treatments for long periods of time.

Further, non-personal promotion (e.g., email campaigns, social media efforts) has taken on elevated importance during this time. Some companies still aren’t committing to it, though. For example, a one-off email to a list of HCPs very likely won’t make any impact. But a coordinated approach that features clear and powerful messages and taps multiple marketing channels will result in a higher return on investment. And thorough tracking of campaign performance can help the company refine its approach over time.

In a world where rep access was already declining, companies should have been building sophisticated non-personal promotion operations. The pandemic has highlighted the value of these efforts. Pharma companies must strengthen their non-personal promotion capabilities or risk falling behind their competitors.

2. Collect information 

Mission Control had to make important decisions about the Apollo 13 spacecraft’s path back to Earth. Given the dwindling resources, total time to splashdown was a crucial consideration. But so was the location of splashdown. The main recovery force was stationed in the mid-Pacific Ocean, so landing in the Atlantic or Indian Oceans was far from ideal. 

NASA evaluated five options. Though a couple options offered a return time of 118 hours (the shortest of the options considered), they both required the use of almost all available propellant – giving the crew essentially no chance for last-second course corrections. The team crunched the numbers and debated the pros and cons of each option for more than five hours before deciding on a splashdown in the mid-Pacific at 143 hours. By combining data analysis with a comprehensive assessment of logistical factors, the team maximized the chances of success. 

During this unprecedented time, commercial leaders should seek to collect as much information as possible to gain insights that then enable them to make informed decisions. Marketing research studies can help commercial leaders understand the current market environment and identify future opportunities. For example, these studies can help them learn:

• How physicians prefer to interact with sales reps moving forward.

• What non-personal promotion channels physicians prefer.

• Changes in patients’ journeys to diagnosis and treatment.

Additionally, while data collection and analysis in the industry continues apace, companies must interpret the commercial data they do collect during this time through the lens of COVID-19. Even the most successful non-personal promotion program will have a muted impact during this time because of the decrease in diagnoses and treatments. So, companies should put an asterisk next to data collected during the pandemic and account for the impact of COVID-19 when using this data to inform commercial planning.

3. Embrace teamwork

NASA marshaled all available resources to help the Apollo 13 crew. Off-duty flight controllers and spacecraft systems experts came to Mission Control to help. Having these resources available allowed the team to effectively evaluate and test procedures before providing guidance to the crew. This teamwork paid off throughout the rescue operation. Teamwork fostered creativity, which resulted in workable, potentially life-saving solutions. For example, to remove a buildup of carbon dioxide from the module, a team in Mission Control created a makeshift air purifier using only materials they knew the crew had in the spaceship. Then, they told the crew how to build it.

Since the onset of the pandemic, pharma companies have focused on keeping sales teams intact and sustaining morale. One way they have done this is by eliminating goals and commissions and moving to target payouts or MBOs. While this approach largely worked during the most fraught days of the pandemic, companies need to get out ahead of coming “tipping points.” For instance, when will reps begin to feel that these plans are hindering their earning potential? To identify these “tipping points,” commercial leaders must solicit input and ideas from their sales teams. These sales professionals are best positioned to identify the proper time to reinstate more traditional incentive compensation plans.

Current shifts in patient treatment may also impact how pharma companies construct and motivate their sales teams. For example, the rise in the use of telehealth could force companies to change incentive compensation plan design, sales force design and sales force alignment. According to Seema Verma, administrator of the Centers for Medicare and Medicaid Services, there are currently more than 1 million telemedicine visits a week, compared to about 12,000 before the onset of the coronavirus pandemic in the United States in March.

If a physician in Idaho is treating patients from across the country via a telehealth app, prescription data the company receives might show the telehealth company’s ZIP code in California. The pharma company needs to properly classify this data for sales reporting and incentive compensation plan administration purposes. Additionally, the company needs to determine how to properly credit the rep for prescriptions from this physician’s telehealth visits. After all, can the rep who calls on this physician credibly claim to be responsible for all the physician’s telehealth prescriptions? In some cases, companies may see value in creating dedicated “telehealth” teams to call on these physicians, which will impact incentive compensation plan design, sales force structure and targeting.

Creating a stronger pharma industry amid disruption

While COVID-19 has disrupted the pharma industry, the sales rep will remain an essential piece of companies’ commercial efforts. However, some dynamics of commercialization are changing with the move to more telehealth on the physician side and more non-personal promotion on the pharma company side. These changes raise a series of questions pharmaceutical commercial leaders must consider, as they plan for a post-COVID-19 world. For example, how can they most effectively coordinate non-personal promotion with in-person promotion? How can they ensure sales force effectiveness in an environment dominated by virtual rep-physician interactions and digital engagement with HCPs? Can they create new commercial structures and redefine sales roles to address increased access challenges? 

There are no simple answers to these questions. But the lessons of Apollo 13 offer a way forward as companies look to devise creative solutions to today’s evolving challenges.