Future of Medical Affairs (Part 1)

A conversation with Sarah Jarvis and Jennifer Curtis

Earlier this year, I had the opportunity to have an interesting conversation with two of my colleagues as part of ZS' podcast series Inside Global Pharma (Episode 9 - Future of Medical Affairs)

In the episode, we explored the role of medical affairs in shaping stakeholder engagement strategies across both traditional and digital channels.

Jennifer Curtis: So Sarah, Bora, let's start with some foundational understanding. When we're talking about medical affairs within a biopharma organization, what does that include and how has that function typically engaging with stakeholders outside the organization?

Sarah Jarvis: Yes, absolutely. This is one of those areas where when we look at what I'll call the typical medical affairs, you can think of it as really sitting between the development organization and the commercial organization. And I like to think of it as that bridge between the two where on the one hand, you've got overlap with the development organization because they've got evidence generation responsibilities. But the part we're really going to talk about today is what I consider the overlap with the commercial organization. You have medical folks who are really the, what we call sometimes, the scientific face of the organization who are engaging externally with key stakeholders. And those folks can range from KOLs, Key Opinion Leaders that are physicians and HCPs, all the way through nurse practitioners, payers, decision-makers and IDNs, and other organizations all the way through to, in some cases, patient advocacy groups. These are the folks who are really, as you start to think about external engagement, both bringing ideas back in-house from those customers, but also making sure that the key customers understand the science and have the education about their company's products.

Medical Affairs as the insight generation machinery

Jennifer Curtis: And Bora, what are your thoughts on it?

Bora Erdemli: So, Sarah really built a good foundation around what medical affairs organizations do today. And I think in the future, the other role that medical affairs organizations are going to play is to become the insight generator for the broader organization. The role that they play as a bridge between development and commercial gives them a unique position to be able to participate in a lot of the activities throughout the life cycle of a molecule. As well as the main bridge between external stakeholders and new bridges with new stakeholders, like patient advocacy groups, social and online influencers. It will give them an opportunity to understand and identify insights that would help really design the strategies that the organizations are deploying today. Not only the medical affairs strategies but also have an opportunity to impact how commercial or broader franchise strategies should be shaping up for the lifecycle of a product.

Sarah Jarvis: And I think even feeding back into the development, right, Bora, I think that's what's so exciting about this middle position if you will. We've heard it called the third pillar as well, but this ability to bring those insights back to development and to commercial.

Bora Erdemli: That's an excellent point. What we are seeing across the spectrum, that medical affairs organizations are looking for ways to be able to get in close to the patients, really bringing that patient insight into the development process so that they can design and develop molecules that would help patients in the way that they really need it. Because going back to our insight generation machinery, the medical affairs organization is the one that has a true understanding of where the medical unmet needs are. And I think they are in a unique position to be able to make these connections for the betterment of the patient.

Jennifer Curtis: Yeah. I mean, it is interesting, right? Obviously, they're in this really critical role between development and commercial. And I think what's really interesting is that we're seeing medical affairs and MSLs in particular, becoming increasingly influential in really engaging key opinion leaders and physicians versus kind of the standard commercial customer-facing roles. I think you touched on it a bit, but what do you think is really driving this shift?

Sarah Jarvis: I can jump in on that one, Jen. Definitely, we've talked about this a lot. COVID has been a huge accelerator for medical. We've talked about it as the roadmaps that cross medical and especially for supporting medical science liaisons, the roadmaps that were in place for the next three to five years, companies are now being asked to get them done in 12, 18 months. And they've really pivoted to make sure that that external engagement largely because of COVID and not being able to be in person, that's been a big shift. One of the amazing things we've seen is the access for MSLs, in particular, remaining by the end of the summer of 2020, it was basically back up to what it was prior to lockdowns everywhere. Whereas the data we've seen on the sales side saw a much more precipitous and longer-term drop-off, MSLs have maintained 30 to 60 minutes with HCPs and external stakeholders even virtually. And really, I think that's very much because of a lot of the impact that MSLs have had historically and continue to have with these stakeholders in terms of being a trusted resource and again, the scientific face of the company.

Bora Erdemli: And so I think if I might, I want to add on to what you just described, we've been doing a lot of research talking to KOLs and physicians about the value that they are seeing in interacting with the medical affairs organizations and particularly with MSLs. But we have seen that very close to 90% of KOLs value MSLs as a reliable source of scientific information. And I think most importantly, again, almost 90% of these KOLs take an action after interacting with an MSL.

Jennifer Curtis: Yeah. Sarah, I know you had some interesting research on the ratio of sales reps to MSLs. Could you share a bit more on that?

Sarah Jarvis: Sure. It's one of the measurements we've been keeping track of actually for a few years now. Back in 2014, when we first looked at it, we saw 10 sales reps to every one MSL, and over time we've tracked it. And actually, we have the most recent data in 2020 holding steady to where it was in 2018, which is eight to one. And I think it's really a recognition, especially in today's environment of what MSLs are being asked to do for their customers in terms of sharing data, the increasing scientific complexity. The other point, I'll just add, at least in our experience with the 50 plus companies we've worked with since the start of COVID in March 2020 only two have actually decreased their MSL team size. And one of those, they recognize the MSLs shouldn't actually get smaller, but they realized they needed to because of a proportional response to how much smaller the commercial team was getting.

Medical Affairs with a voice at the table

Jennifer Curtis: Kind of building on that point, how is this shifting and reshaping expectations of what the role of medical affairs in MSLs is, or should be? Bora, I think you had some interesting ideas on that.

Bora Erdemli: Absolutely Jen. I think what we are seeing across the industry, that the demand for medical affairs organizations and roles are growing and growing at a very fast speed. I think this is a testament to what different stakeholders that the organizations are engaging with think. The amount of demand for the medically driven scientific conversation is unprecedented. And that creates a lot of pressure on the medical affairs organizations to really start thinking about how the role should be changing for the future, right? Where is the value that medical affairs organizations can create the most?

A lot of organizations are looking into really understanding what are the skills and capabilities that are needed for the medical affairs professionals to be really effective in this new normal that we are working towards. One of the realizations that the organizations have, the role of the future is going to be able to only be effective if they are able to use different tools, technologies, and channels that are available to them. There is really no one MSL that can do all. I think the key is to be able to really understand where they can provide the most value and how they can be supported by other tools and technologies to be able to do the work that needs to be done and the interactions that need to be had with the external stakeholders.

Sarah Jarvis: And I'll add onto that Bora. I think one of the biggest changes for medical and really all of us, but definitely fo medical and MSLs are virtual and digital. And I think the virtual piece of it everybody's shifted and made that pretty much successful. I think there are still some elements of EQ that companies are still looking into further supporting their MSLs in that engagement. But the digital piece I think is really exciting because if you think about external engagement that can come in bite-sized educational pieces, digitally. It can certainly come virtually or face-to-face, or as some MSL leadership has shared mask-to-mask in the near term. But I think with that, what we're also seeing is some of those more specialized roles, which are certainly emerging. The payer-focused medical roles have been around for a while, but we've seen an increase in the last three years of about 20% in size, which I think is a recognition of the asks for that type of information. Then, I would just say from a field medical perspective, it's figuring out how to work across the entire medical organization to make sure that the right information is going to the right stakeholder in the right way. And so maybe that's a person, or maybe it's a bite-sized educational piece online. It's exciting to see.

Bora Erdemli: If I just build on that Sarah, I think we talked a lot about how the role is changing externally and what the role needs to do. Also internally, what we've been seeing is the work-integrated is actually happening, whether it is about building integrated strategy for the franchise, or whether it's building an integrated evidence strategy for your therapeutic care, or whether it's in an appropriate way, creating an integrated way of engaging your customers and the planning process. I think there's a lot of demand for both development and commercial organizations to pull medical in and be an actual player in the development of these critical pieces because they've seen the value. They've heard it from their stakeholders, now they would like to be able to make use of the great knowledge and insights the medical organizations are bringing in. And I think it's similar to the external skill that Sarah talked about. I think now there is a lot of emphasis on how does medical affairs professionals can do a better job about thinking about the strategy, right? And how can they pressure test it? How can actually they bring different sorts of information as good insights to the evidence generation process?

Sarah Jarvis: I love that Bora. I will say I've heard it described as medical now has a seat at the table, but what internal stakeholders really want is for them to have a voice at the table because they recognize the value that they bring.

Special thanks to Matilda Males and Sophie McManus for their contributions to the design and production of this episode.