US pharmaceutical companies have for decades relied on the "pinball wizard" sales model: sales representatives bounce from one doctor’s office to another in hopes of catching a few moments with physicians and influencing which drugs they prescribe. The model has without doubt been successful, increasing the physician’s awareness of the range of medicines available and providing pharmaceutical companies with rising sales and the highest margins of any mainstream industry. But in recent years the changing dynamics of the business have prompted a massive expansion of sales forces. The resulting system is costly, inefficient, and rife with dissatisfaction.¹ Sales representatives complain that they are undertrained and underrewarded; district managers are overburdened; physicians feel under constant assault; and drug companies face escalating costs. On top of all that, medical-ethics committees and the media criticize sales practices such as taking physicians to dinner or to the theater and underwriting weekends at resorts as training seminars.

For these reasons, pharmaceutical companies are considering what can be done to transform their sales model. The solution, we believe, lies in one that reemphasizes the importance of forming lasting relationships with physicians. At some point—as the portfolio of drugs expanded, competition intensified, and sales forces...