Late last year, New Jersey drugmaker Amarin won a long-sought U.S. approval for its pill Vascepa, allowing the company to market the drug for reducing heart risk.
It was a major milestone for the company, validating the decision to run a lengthy and expensive cardiovascular outcomes study, which had delivered positive results in 2018. Eager to sell the drug to a now much wider group of patients, Amarin doubled the number of sales representatives it employs to reach out to doctors and other healthcare professionals.
But the outbreak of the new coronavirus across the U.S. has upended those plans, forcing the company to suspend face-to-face meetings for at least the next two weeks. The virus, now known as SARS-CoV-2, is highly infectious, and can quickly spread through close contacts.
Sending sales representatives into hospitals and doctors' offices, Amarin decided, was too risky, both for its employees and for the dozens of people they might interact with in healthcare settings now preparing to handle a flood of coronavirus cases.
"There's critically ill people, lots of chaos. Do you really need other people floating around in the mix?" Craig Granowitz, Amarin's chief medical officer, said in an interview.
Amarin's not the only company to reach that conclusion. Larger drugmakers Amgen, Pfizer and Merck & Co. have all also halted face-to-face meetings between their sales teams and doctors, telling representatives to work from home and move their interactions online. Global Blood Therapeutics, a smaller biotech with a newly approved sickle cell disease drug, said Tuesday it would suspend its field team from all in-person interactions.
Pharma companies may not have a choice. Hospitals, conscious of the infection risk, are closing down access, too.
MD Anderson Cancer Center in Houston, Texas, for example, has barred from its campus all visitors who are not caregivers or don't have "mission-critical" business, a spokesperson confirmed. Earlier this month, CommonSpirit, the largest Catholic health system in the U.S., issued a memo restricting vendor representative access without approval from an area director or vice president of operations.
"Measures regarding vendor access will remain in effect indefinitely," the March 3 memo states.
Sales representatives are a major part of pharmaceutical marketing efforts, even as regulations have limited how they're able to interact with doctors. Their role is particularly pronounced in therapeutic fields that feature complex or biologic drugs, such as in oncology or in specialty medicine.
"Switching to virtual is a significant change in the way the representative would work," said Pratap Khedkar, a managing principal at the consultancy ZS Associates, in an interview.
According to Khedkar, most pharma sales representatives make about seven calls to doctors or other healthcare professionals each day. Should coronavirus-related disruption persist for some time, that's hundreds of meetings that won't happen, potentially resulting in significant impacts to drugmakers' business.
Email or virtual meetings could be a replacement, but not all companies will be equally prepared, Khedkar said.
"I think people have their head in the sand about what's coming up," said one pharma sales representative, who asked to remain anonymous, in an interview with BioPharma Dive. "The next six weeks are going to be more restrictive, more challenging," she added, estimating she visits on average five healthcare facilities per workday.
How long the current outbreak continues to disrupt life in the U.S. and around the world is unknown, but most experts see the virus' impact extending well into the summer and likely throughout the year as well.
Amarin set a two-week timeline for grounding its sales teams, but Granowtiz acknowledged that is subject to change.
"We want to have a national policy in general, but also allow flexibility where possible in regions of the country where for whatever reason these things are allowable and appropriate," he said.
Global Blood set its suspension a bit longer, through April 7, at which point the company said it would reevaluate.
Reduced marketing activity might be only one of the first impacts felt by drugmakers, many of which have asked a large portion of their employees to work remotely.
So far, outbreak severity has varied by city and state, with California, Washington, New York and Massachusetts experiencing the heaviest impact. In the Bay Area, shelter-in-place warnings are in place across five counties, while cities across the country are shutting down restaurants and bars.
Such drastic measures aim to suppress viral transmission, but they may, if extended, have an impact on the delivery of healthcare more broadly as people reconsider routine appointments.
"Patients don't want to turn up. New patients are getting turned away. Adherence will drop," said ZS' Khedkar.
"Regular healthcare will need to get some proper attention once we get past this initial period," he added. "That's when pharma really needs to embrace this opportunity. That will probably leave a lasting impact."