Pharmaceutical and device companies are an integral part of modern eyecare. Without them, we wouldn't have the medications, devices, diagnostics, and technologies that allow us to care for our patients the way we do today.
They also play an important role in supporting continuing education through grants, exhibits, and sponsorship of local, regional, and national meetings. While maintaining appropriate boundaries, these partnerships help make high-quality education more accessible to clinicians.
Understanding the infrastructure
Yet for many eyecare providers, the inner workings of these companies remain a bit of a mystery. Have you ever wondered why you receive emails from multiple people at the same company? Or why your sales representative tells you they'll connect you with someone else to answer a clinical question? It can feel like no one is talking to each other.
In reality, these interactions are the result of a thoughtfully designed organizational structure. Pharmaceutical and device companies are made up of multiple teams, each with distinct responsibilities, objectives, and regulatory requirements. Understanding who these teams are, how they work together, and why certain conversations happen with certain individuals can help you navigate these relationships more effectively.
In this article, we'll take a look behind the curtain at how industry is structured and why that structure ultimately benefits both clinicians and patients.
Why am I hearing from so many different people?
One of the biggest misconceptions is that everyone who works for a company knows what everyone else is doing. They don't.
Pharmaceutical and device companies are intentionally divided into separate departments, each with distinct goals, regulations, and responsibilities. While these teams collaborate, there are strict boundaries regarding what each can discuss and how they interact with healthcare professionals. This is why you may be invited to two different dinners or lectures, or to meet with two different people from the same company.
Those boundaries exist for good reason—they help ensure scientific integrity, regulatory compliance, and appropriate promotion of medical products. Industry position statements explicitly separate the roles of medical science liaisons (MSLs) and sales representatives, distinguishing scientific exchange from promotional messaging.1
The Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Health Care Professionals is a voluntary standard, but several states, including California, Massachusetts, and Nevada, as well as Washington, D.C., require companies to adopt a consistent code.2,3 Oversight has also tightened in recent years.
The Department of Health and Human Services Office of Inspector General (OIG) has warned of fraud and abuse risks tied to company speaker programs, noting that drug and device companies reported paying nearly $2 billion to healthcare professionals for speaker-related services over a 3-year period.4
While each company's structure is different, we will break it down into the most commonly encountered departments: commercial, medical affairs, and clinical development.
The commercial team
This group is often the sales and marketing side of the company and can include:
- Marketing
- Sales
- Regional Sales Directors
- District/Regional Managers
- Local Sales Representatives
- Market Access
- Reimbursement/Payer Access Support
- Commercial Operations/Strategy
- Compliance (depending on the company structure)
The medical affairs team
Medical affairs has a very different mission. Rather than promoting products, medical affairs focuses on the scientific and clinical evidence surrounding a therapy and, often, the company's pipeline.
This group often includes:
- Chief Medical Officer (CMO)
- Medical Directors
- Regional Medical Directors
- Medical Science Liaisons (MSLs)
- Medical Strategy and Education
- Medical Information Specialists
Clinical development/R&D
When it comes to research and pipeline, many companies have an entire team devoted to that as well, which may include:
- Clinical Development
- Clinical Scientists
- Clinical Operations
- Clinical Science Liaisons (CSLs)
- Medical Strategy and Education
- Biostatistics/Data Science
But here's the catch: The organizational chart isn't always this clean. Don't assume that because someone works for Tarsus, Alcon, Bausch + Lomb, Dompé, or another company, they have the same role as the person with that title at another company. The MSL role alone goes by more than 30 different titles across the industry.1
Companies organize their teams differently, titles can mean different things, and organizational structures can change as a company grows, launches products, acquires another company, or moves from clinical development into commercialization. The title is a starting point. The important thing is understanding what that person actually does.
Your boots-on-the-ground team
In our offices and on clinic days, our most frequent encounters are with our local sales representatives, market/field access managers, and local MSLs. One important thing to understand is that you generally won't find all of these people in the same place at the same time. Many companies maintain compliance policies that prevent members of different teams from attending the same dinner, lunch, or office visit together.
Industry standards shape these events as well. The PhRMA Code limits speaker program invitations to clinicians with a bona fide educational need and prohibits companies from providing alcohol at these programs. It also restricts sales representative meals to in-office or in-hospital settings where a substantive discussion takes place.2
Your local sales representative
Our local representatives can help us with many of our day-to-day logistics related to prescription medications, OTC drops and vitamins, and contact lenses. This can include obtaining samples, coupons, patient materials, and in-office advertising for their company's products. Need a fit set for a new-to-market contact lens or need to fill an old set back up? This is your person.
However, keep in mind that the person representing a company's contact lenses or devices may be different from the person representing its OTC products or prescription medications. This depends on the company and how it has divided up its products and sales teams. And if the company reorganizes, your contact may change.
Don't hesitate to ask who your local representative is for a particular product.Your local representative can also be a great resource for helping your office navigate some of the practical aspects of prescribing medication. They may be able to help with things like prior authorizations, EHR prescribing updates, and office training. That support matters.
In a 2025 survey of 1,000 physicians, practices reported completing an average of 40 prior authorization requests per physician each week, consuming 13 hours of physician and staff time. Moreover, 40% of physicians employed staff who worked exclusively on prior authorizations.5 Your representative can set up time with you or the staff members who handle these processes to walk through forms, prescribing systems, or other logistical questions.
Field access manager
This is also where a field access manager may come into the picture. Some companies use field access teams specifically to help offices navigate access and reimbursement issues. Depending on the company and the situation, they may be able to look into a specific patient's access issue and help your office understand why a medication was denied or what steps may be needed next.
Your local sales representative generally cannot access that patient-specific information, but they can often connect you with the right person at the company who can.
Medical science liaison
The MSL is part of the medical affairs team and is essentially your connection to the scientific and clinical side of the company. Unlike your local sales representative, the MSL operates in a noncommercial, scientific capacity and is not there to sell you a product or provide samples.6 Their role is to have scientific and clinical conversations with healthcare providers and to help connect clinicians with the appropriate medical and scientific resources within the company.
This is the person you want to talk to when your question goes beyond the product information your sales representative can provide. This may include questions about clinical trial data, study design, mechanism of action, published literature, safety or efficacy data, or how a therapy was studied in a particular patient population.
It also includes questions about unapproved uses. MSLs can respond to unsolicited requests for off-label information with objective, balanced, evidence-based answers.1 The FDA outlined its framework for these communications in final guidance issued in January 2025.7 Your MSL will also keep you up to date on new studies.
Ready to research?
The MSL can also be a great resource if you are interested in research. Clinicians appear to recognize this. In a survey of healthcare professionals in Spain, 77.6% could distinguish the MSL role from marketing and sales, and support for research projects was rated the most valuable MSL activity (70.8%).8
Have a great idea for a small post-FDA-approval study? This is a good person to start the conversation with. Depending on the company, there may be opportunities for investigator-initiated research, including potential funding or grants to support a study. The MSL can help you understand what the company is currently interested in supporting and connect you with the appropriate people to determine whether your idea fits within those opportunities.
Interested in having your office become a site for a future clinical trial or larger FDA study? Tell your MSL. They may not be the person who ultimately selects the sites, but they can make sure the appropriate people within the company know that you and your practice are interested.
The opportunity is substantial and growing. Reported industry research payments to ophthalmologists rose 203% between 2014 and 2020, from about $63 million to $191 million. That funding is concentrated, however, with the top 10% of recipients receiving 65.7% of it.9 Making your interest known is one way to get your practice on the radar.
This is one of the reasons I think it is worth getting to know your MSL. You don't have to have a research program or work at an academic institution to have a conversation with them. If you have a thoughtful clinical question, an interesting research idea, or an interest in participating in future clinical trials, they can often help you figure out where to go next.
Final thoughts
At the end of the day, you don't need to memorize every department, title, or organizational chart. You just need to understand that the person standing in front of you may be one piece of a much larger team, and each has a different role to play.
Your sales representative may be the person who gets you samples, your field access manager may help navigate a difficult coverage issue, and your MSL may be the person to call when you have a clinical or research question.
Knowing who to ask can save you time, help you get the information you actually need, and ultimately make these relationships more valuable for both you and your patients.
