From Rep to Router: A Life-Cycle Channel-Allocation Framework for Pharmaceutical Physician Engagement and Its Implications for Drug Affordability

Background. Pharmaceutical promotion is among the largest discretionary cost categories in the U.S. health-care economy, and the spending is recovered through the price of medicines. Total U.S. medical marketing reached $29.9 billion by 2016, of which physician-directed promotion was $20.3 billion [11]. The in-person sales visit has lost efficiency: access fell from ~77% of prescribers in 2008 to a pandemic low near 20%, recovering only partially, per ZS Associates AccessMonitor and Veeva Pulse data. Methods. Narrative review of open-source evidence (peer-reviewed literature, U.S. government data, named-consultancy analyses), modeled on Hashimoto et al. 2024 [1]. Eighteen sources (seventeen with verified DOIs) across six themes. Results. The evidence converges on several consistent findings: remote detailing can match in-person on outcomes at lower cost [3, 5]; in-person retains an advantage at launch [6, 7]; access is scarce and selective, making segmentation decisive, per Veeva Pulse field data; well-executed hybrid models report 10-20% efficiency gains, by McKinsey and Veeva Crossix analyses. From this the review derives PACE-Rx and applies it to the GLP-1 market. Conclusions. PACE-Rx offers a replicable model consistent with a lower cost per effective contact; because promotional cost is embedded in drug prices, the efficiency is a plausible lever for restraining U.S. drug costs without curtailing innovation or access.