For Those Considering CSO Services in Japan for the First Time

MR in Japan

Sales and Distribution System in Japan

Almost all prescription pharmaceuticals in Japan are distributed through pharmaceutical wholesalers, known as “Oroshi.” These wholesalers are responsible for purchasing, storage and quality control, delivery, price negotiations, and the provision of certain product and market information to healthcare institutions.

This distribution structure has also shaped the way pharmaceutical companies engage with healthcare professionals in Japan, with wholesalers and their Marketing Specialists (MSs)  playing an important role alongside pharmaceutical company MRs.

Role of MRs in Japan

The main roles of the MRs include the following:

• Visiting healthcare facilities such as hospitals, clinics, and pharmacies.
• Providing scientific and product information to healthcare professionals, in person or through digital channels.
• Collecting and reporting information on the efficacy and safety of pharmaceutical products.
• Conducting information sessions for healthcare professionals.
• Supporting company-sponsored seminars and educational meetings.
• Liaising with pharmaceutical wholesalers (Oroshi) and their MSs.

Typical Profile of MRs in Japan

• Most MRs are university graduates, with more than half having a liberal arts background. The proportion of MRs with science backgrounds is increasing.
• The majority of MRs are male, although the proportion of female MRs is increasing.
• Around 9% of MRs hold pharmacist qualifications.
• Around 1% of MRs work exclusively via web or telephone.
• MRs are employed by either pharmaceutical companies or CSOs.
• MR certification is not legally required, but is generally regarded as a practical requirement in the industry (see below).
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Job Characteristics

• MRs do not negotiate prices, conclude sales contracts, or deliver pharmaceutical products; these commercial and distribution functions are handled by pharmaceutical wholesalers (Oroshi).
• Pharmaceutical companies are responsible for collecting and reporting safety information, including adverse drug reactions, and MRs play an important role in collecting such information from healthcare professionals.
• MRs provide information primarily to physicians, as well as to pharmacists, nurses, and other healthcare professionals.
• Most MRs cover an assigned geographic territory and typically travel by car to visit healthcare facilities.
• MRs may be reassigned to different territories every few years.
• MR activities are subject to laws and regulations, official and industry guidelines, and company promotion codes.
• Accordingly, MRs generally use promotional and informational materials that have been prepared and approved by their companies rather than producing such materials themselves.
• As healthcare institutions have introduced stricter rules governing MR visits, appointments are increasingly required for in-person meetings.
• The number and format of face-to-face calls have changed significantly in recent years, with greater use of digital channels alongside in-person visits.

MR Accreditation Scheme

In Japan, the MR Education & Accreditation Center of Japan is responsible for the MR accreditation system. Although MR accreditation is not a legal requirement for employment as an MR, it is generally regarded as a practical requirement in the pharmaceutical industry.

Since April 2026, the former MR Certification Examination has been replaced by the MR Basic Examination. Eligibility requirements for taking the examination have been abolished, allowing individuals to take the examination before joining a pharmaceutical company or CSO.

Practical training is provided by accredited companies under programs recognized by the MR Education & Accreditation Center of Japan. These companies are responsible for providing practical education and evaluating whether MR candidates and existing MRs have acquired the required competencies.

MRs are also required to take greater responsibility for their own ongoing learning and accreditation procedures through the MR Portal, including examination applications, learning records, and accreditation renewal.

Why Are There So Many MRs in Japan?

It is believed that the large number of MRs in Japan can be attributed to a variety of reasons. The main factors are described below:

• Direct-to-patient promotion of prescription medicines is strictly regulated, making information provision to healthcare professionals particularly important
• As prescribing decisions are made by physicians, direct engagement with physicians has traditionally played an important role in pharmaceutical promotion.
• Japan has a large number of healthcare institutions, requiring broad geographic coverage by field-based MRs.
• Physicians have historically faced heavy workloads, limiting the time available to gather and assess pharmaceutical information. Measures to reform physicians’ working hours have been in effect since April 2024.
• Face-to-face detailing has traditionally played a significant role in Japan, although the use of digital channels has expanded in recent years.
• The number of MRs increased significantly in the early 2010s, particularly during the launch of major products for lifestyle-related diseases.
• Competitive pressure among pharmaceutical companies also contributed to the expansion of MR field forces, including a strong emphasis on share of voice.
• MRs have traditionally been an important and trusted source of pharmaceutical information for healthcare professionals.
• Although digital channels are now widely used, MRs continue to play an important role in supporting healthcare professionals with product information and treatment-related discussions.

In recent years, however, pharmaceutical companies have increasingly restructured their field organizations, and the total number of MRs has continued to decline, as shown in the trend data above.

CSO Services: Dispatching and Outsourcing

In Japan, CSO human resource services are generally provided through two main models: personnel dispatch and outsourcing.

Personnel dispatch has traditionally accounted for the majority of CSO engagements. This model is often used by large pharmaceutical companies that already have an established sales organization and management structure and use contract MRs to supplement their internal field force.

However, it is important to choose a partner with sufficient knowledge and experience to ensure compliance with Japan’s worker dispatch laws and related regulations.

Outsourcing is increasingly used for piloting new initiatives, launching new sales forces, and managing sales operations for smaller pharmaceutical companies. Compared with personnel dispatch, outsourcing can provide greater flexibility in the design and management of operations, although it currently accounts for a smaller share of CSO engagements.

CSO companies can propose contractual and operational models tailored to the specific needs and challenges of each pharmaceutical company.

Contract MR Services with Personnel Dispatch

Implementation Schedule and Costs

For personnel dispatch services, if the client already has an established sales organization and management structure, implementation typically requires around three to six months after the contract is awarded. If a company is using CSO services for the first time, additional time may be needed to prepare the organization to receive and manage dispatched personnel.

For outsourcing arrangements, the implementation timeline varies depending on the scope and complexity of the services. In our experience, establishing a new sales organization can take approximately one year from the start of preparation.

Costs also vary depending on the service model, scope, and implementation timeline. Early consultation with a CSO provider is therefore recommended.

Related Services

Learn more about our services across four key areas:

Japan Healthcare Environment

Features of the Japanese Healthcare Environment

• Japan has a universal health insurance system.
• A large proportion of hospitals and clinics are privately operated.
• Physicians generally have considerable discretion in treatment decisions, while the roles and authority of other healthcare professionals vary by setting.
• Patients have traditionally tended to rely heavily on physicians in treatment decision-making, although patient involvement and shared decision-making are becoming increasingly important.
• The concept of a primary care or family physician is less firmly established than in some other countries, and patients generally have broad freedom to choose healthcare providers.
• Work-style reforms for physicians, including limits on overtime, have been in effect since April 2024. 
• The use of formularies is expanding, although adoption varies by region and healthcare institution. 
• Japan has a rapidly aging population.
• Healthcare delivery often involves complex networks and referral relationships among hospitals, clinics, and other providers.

Pharmaceutical Industry Environment

• Prices for prescription medicines are set under Japan’s National Health Insurance (NHI) drug pricing system.
• NHI drug prices are subject to regular revisions, creating continued downward pressure on prices.
• Drug lag and drug loss remain important issues, particularly when clinical development or regulatory submission in Japan is delayed or not initiated.
• Market entry requires compliance with Japan-specific regulatory and manufacturing and marketing authorization requirements.
• The volume share of generic medicines under Japan’s official generic utilization metric has reached around 90%. 
• The government continues to pursue healthcare reform while promoting pharmaceutical innovation and stable drug supply.
• Digital transformation is accelerating across the healthcare system, including electronic prescriptions, online eligibility verification, and standardized health information infrastructure.

Employment Practices

Japan has traditionally had employment practices based on long-term employment, although job-based employment models are becoming more common.

Under Japanese labor law, dismissal is not permitted without objectively reasonable grounds and must also be considered socially acceptable. As a result, employers need to exercise particular care when making decisions about permanent hiring and workforce planning.

Conclusion

 Establishing and operating a pharmaceutical business in Japan requires careful consideration of local laws, regulations, industry codes, and business practices. Working with a partner that has a strong understanding of these requirements can help ensure an appropriate and compliant operating structure. 

Preparing Systems to Meet Japanese Legal and Regulatory Requirements

• Compliance with GVP/GPSP requirements, the JPMA Code of Practice, the Code of Promotion for Prescription Drugs, and relevant fair competition codes.
• Establishment of appropriate systems for safety management, quality assurance, distribution, compliance, and sales operations.

Developing Marketing Strategies and Allocating Resources for the Japanese Market 

• Understanding local requirements and business practices, including healthcare institution structures, KOL engagement, and relationships with pharmaceutical wholesalers (Oroshi).
• Selecting appropriate touchpoints for physicians, other healthcare professionals, and patients, including in-person and digital engagement, third-party channels, and seminars.
• Allocating resources appropriately based on geographic and institutional characteristics, including differences between metropolitan areas and specialist facilities.
• Adapting strategies to local business practices, culture, and communication norms.

Preparing and Managing Diverse Human Resources 

• Securing the professionals needed to execute commercial and medical strategies, including MRs, Managers, Trainers, MSLs, and Nurse Educators.
• Establishing appropriate systems for labor management, MR accreditation, sales effectiveness measurement, and safety information management.

Responding to Healthcare System and Market Changes 

•  Maintaining organizational flexibility to respond to NHI price revisions, regulatory changes, evolving market conditions, and unforeseen developments. 

CMIC Inizio Supports Your Success

CMIC Inizio is part of Inizio Engage, a global commercialization partner supporting life sciences and healthcare companies across markets.

Our support in Japan includes:

• Adapting and implementing global marketing strategies for the Japanese market
• Supporting commercial operations from contract sales to the establishment of in-house sales organizations
• Establishing and strengthening Medical Affairs functions
• Developing patient-centered programs and engagement initiatives
  
  

By combining global expertise with deep knowledge of the Japanese healthcare environment, CMIC Inizio provides practical solutions tailored to each client’s business needs.

CMIC Inizio is also part of the CMIC Group, which provides a broad range of services in Japan across the pharmaceutical value chain, from research and development through manufacturing and commercialization.

Support available through the CMIC Group includes:

• Establishment of Japanese legal entities
• Support for Marketing Authorization Holder (MAH) functions and applications
• Regulatory affairs and pharmaceutical application support
  

By collaborating with the specialized functions of the CMIC Group, we can support clients across multiple stages of market entry and business development in Japan.