Sunday, November 19, 2017

Training continuum

'Tell me and I forget, teach me and I may remember, involve me and I learn'
- Benjamin Franklin

Among all the organizational activities, training is a crucial intellectual on-going process that helps to align organizational members to the vision and mission of a firm, this is in terms of the employee's KNOWLEDGE, SKILLS AND ATTITUDE.

Knowledge is gathered through experience, listening, discussing and reading.  Knowledge is vital as it forms the basis of skills.  For example, knowledge of a product's talking points is the foundation, however, it's application through extempore detailing in a prospect's clinic, and highlighting only the relevant points, is the skill of a 'detailman'.  Application of knowledge in tactical activities for producing the relevant outcome is a person's skill set.

Attitude is 'response behaviour'.  The pharmaceutical and healthcare product market is full of opportunity and challenges, verily, the market is the workplace of a field person, which is aided by the resources provided by his employers.  The attitude of an MR (Medical Representative), determines his involvement in field activity.  This involvement is not only due to his/her behavioural disposition, it is also due to the company's resources, image, MIS system (Management Information System ie., reporting system), and strategy (direction of application of the resources and use of time), AND, finally, VERY MUCH DUE TO the TRAINING system of the company.  Hence, to get productive attitude (response behaviour) of a field marketing person, three main factors are influential:

a) Resources (such as samples, literature, videos and other collaterals, including the complimentaries)
b) Strategy (direction of application of resources and use of time; the planning or blue-print based on which the field person works; and other strategic aspects such as the reporting system etc)
c) Training (system that empowers the field person with internal resources, including knowledge and skill sets for producing required behavioural work outcomes)

The training approach can be broken down into clearly defined steps as shown in above graphic entitled: training continuum.

The training elements present in the training continuum are:

a) Confidence: which is the absence of fear.  This can be a major a stumbling block for the employee or person in his quest to provide his best productive behaviour.  The fears could be: inability to strike conversation with strangers, hesitation to make an enthusiastic sales pitch, or a wave of panic when setting out to meet the high and mighty (example rich, authoritarian and qualified doctors) or other 'gremlins'.  Hence, the company training program should be so designed that it anticipates such fears and helps remove them, to create confidence or fearlessness in the trainee.  Absence of fear energizes the field person.

b) Motivation:  After addressing the fears of a MR or field person, through discussions and training modules, it is vital to give motivation, provide external inputs that he or she is on the right path, aligned with his company and  personal career goals.  This helps him generate enthusiasm since his life-occupational goals are synchronous with that of his employers, and there is all round progress in his life.

c) Guidance: After providing impetus to his morale, one should come to the brasstacks: provide specific guidance on various things that need to be done to gain the knowledge and skills, as per job requirement.

d) Material support: Many activities require suitable collaterals, adequately designed spaces and other paraphernalia (infrastructure).  This ensure training outcomes are delivered.

e) Modelling: is a crucial training exercise.  It is one thing to say how a pitch is to be delivered, and it is another thing to actually demonstrate in-clinic activity, in-stall activity and in-pharmacy activity.  Modelling provides a template for the MR or trainee to execute job activities in his style.  Many a trainer fails to provide sufficient modelling inputs and this can become the training program's Achilles heel.

f) Practice sessions: are the cake of any training session.  After gaining confidence of the trainee, motivating him, giving guidance, ensuring material support and infrastructure, and showing how the job work is to be done... the actual intense sessions start with simulation/practice sessions.  This ensures discipline, skill build-up and supreme confidence.  After all, it is in playing with the football that makes aspirants great players.

g) Evaluation: is the process of transparently measuring progress of a trainee on mutually known parameters.  Evaluation provides the basis for knowing 'where we are' and 'where we should go'...it creates seriousness and ensures the trainee adapts to training schedules vigorously.

h) Feedback: is a strategic input provided by the trainer to the trainee, this has to be done objectively and the intent is to make the trainee feel comfortable with his progress report.  It is not to humiliate or demotivate.  Feedback also strengthens the sense of purpose in a trainee.

Philosophical closing remarks:

Training programs are crucial events in a trainee's life.  If the seriousness, sense of purpose and utility value are high, the training/learning sessions can be life-transformational events.  Training program experiences have a life-long bearing on the trainee, and the trainee always titrates to his training learnings in future time.  For a trainer it may be a routine or mundane activity of his professional life, but for a trainee, the impact is often humongous, provided the training experience is nonpareil.

In life we are subconsciously or consciously working ceaselessly for strengthening:

a) Self-identity: our occupation, material acquisitions, academic qualifications, knowledge level, skill sets, relationships (including marital and with relatives/family members) and other socio-materialistic procurements are meaningless if they do not in some way or the other add to our self-identity.  We value most of those things that strengthen our self-esteem and self-identity.

Imagine the hardwork, risk, concentration and 'joyful pains' the Haryanvi medical student Ms. Manushi Chhillar has undergone to obtain the Ms. World 2017 title in Sanya, China.  This drive of Ms. Chhillar is probably related to her youthful need to obtain maximum self-identity.  It is human to feel great when one's identity is reinforced.


Above foto from here (please click)

b) Self-realization: is about going beyond self-identity and working for self-realization (God realization).  It is about understanding the importance of non-materialistic non-Earthly pursuits of life.  Self -realization refers to the spiritual basis of one's life.  One is empty if there are no spiritual activities and goals.


The foundational feeling is absence of fear (ie., confidence) for pursuing goals related to self-identity and self-realization.  Presence of fear retards or halts progress in above two dimensions of the life continuum.  Hence, in the book: SONG OF THE DIVINE (Bhagavad Gita), the guide Lord Krishna reiterates that the first trait of an ideal man is ABSENCE OF FEAR.  So be confident, but do not throw caution to the winds, in your goals of life!

I wish each reader of this blog ALL THE BEST in his journey of self-identity and self-realization goals.

Thanks for reading this blogpost, kindly go through all other blogposts, and please recommend this blogpost to your colleagues.

Saturday, October 14, 2017

PV era begins?!

PV (or pharmacovigilance) era is stuttering to a start and is looking to stay forever in India.  As per WHO, PV (pharmacovigilance or drug safety) is 'the science and activities relating to the detection, assessment, understanding and prevention (DAUP) of adverse effects or any other drug-related problem'.

The above interesting image from here.

So here is my viral post on whatsapp:

IMPORTANT PHARMA NUGGET REGARDING PHARMACOVIGILANCE (drug safety) in India (13.10.17, Sunil S Chiplunkar)

Union Health Ministry has issued pharmacovigilance (PV) guidelines to be implemented by MARKETING AUTHORISATION HOLDERS (MAHs).  

The guidelines are issued in 
Oct 2017 and Govt of India has given 6 months time for its implementation by the MAHs.

Govt of India has released the PV guidelines in form of a pdf document for Marketing Authorisation Holders (MAHs) (Manufacturer and/or importer of drug) of Pharmaceutical Products of India:

The guidelines are issued in Oct 2017 and Govt of India has given 6 months time for its implementation by the MAHs.

Govt of India has released the PV guidelines in form of a pdf document for Marketing Authorisation Holders (MAHs) (Manufacturer and/or importer of drug)  of Pharmaceutical Products in India.

ipc.nic.in/writereaddata/mainlinkFile/File740.pdf

This is also called Draft Version 1.0

MAHs should now have a  pharmacovigilance cell or department to fulfil the legal tasks related to: 

- ADRs (Adverse Drug Reactions) reporting,
- PSUR (Periodic Safety Update Report) updates
- ICSR (Individual Case Study Report) timelines and checklist
- PBRER (Periodic Benefit Risk Evaluation Report)
- PADER (Periodic Adverse Drug Experience Report)
- AE (Adverse Event) reporting
- Product Quality Complaints Management
- Medical Inquiries Management
- Signal Detection for Risk-Benefit Evaluation
- Risk Management Programmes (RMPs)
- Literature Monitoring for ADR case reports
-Training employees for ADR reporting
- Global compliance monitoring, audits and inspections
- Post marketing surveillance.

The pharma company is expected to meet the PV legal requirements thru' complete in-house department or have arrangement with PV specialist CROs (CRO = Contract Research Organization) or mix of two with clear demarcations in responsibilities.

Each pharma company shall have a PvMF (Pharmacovigilance Master File) located in India, which shall document the PV system for all the marketed products.

Now as per Schedule Y of the Drugs and Cosmetics Act, 1945 each pharma company ie., MAH shall appoint a trained PvOI (Pharmacovigilance Officer-In-Charge) who will be responsible for collection and processing of AEs/ADRs following administration of drugs...the PvOI shall be a medical officer or pharmacist trained in collection and analysis of ADR reports.

Currently scope of PV system as per the pdf document are for:

a) New drugs, subsequent drugs approved after 4 years
b) Biologics
c) Radiopharmaceuticals
d) Phytopharmaceutical products

(Veterinary products and Medical Devices are excluded).

PV structure should be clearly defined...the departmental responsibilities and CRO responsibilities should be clearly demarcated in case of PV CRO arrangement.

The pdf also gives details on PV activity required  for pediatric and geriatric usage of products.

PV concept is now a legal requirement and the  UCPMP (Uniform Code of Pharmaceutical Marketing Practices) is also on the anvil of becoming a law...both these will have a mega impact on pharma marketing activities (PCD or propaganda and distribution companies and small pharma marketers/manufacturers will feel the impact significantly).

NEVER A DULL DAY IN PHARMA FIELD!!  Please scroll down to read all other posts, and kindly do recommend this blog to your colleagues.

Sunday, June 25, 2017

WORK AND EUPHORIA

Show up, work hard, be kind and take the high road!
– George Meyer (American producer and writer)


Euphoria!

It is the need for euphoria that is driving many dedicated people to work!  Euphoria is a heady feeling of enjoyment.  For pharmaceutical marketers, field-work is euphoria.  Doctors too work for long intense hours in surgical and clinical practice, it is euphoria for them!  Euphoria of course cannot run without the material rewards!!

Trending in euphoria!

The constant flux of events, the reality of MR-brand-company clutter, the need for differentiation, hunt for breakthrough disruptive practices, and newer market dynamics (like the current GST challenge), create work opportunity and more euphoria moments.

Essences of pharma business

There are several things happening in companies at various departments, and all company activities, actually, are geared towards increasing consumption of the value offerings…this is the core of all business goals in a firm.  To increase sales, pharma companies work on messaging and relationship management.

Nevertheless, for a company to be a market-stable and a potently expanding force, three essences are there:

a)      Rack stock management
b)      Collection
c)      Product messaging and promotion

Rack stocks refers to the inventory of a company’s product(s), in units, which are present in the central warehouse, C and Fs or regional hubs/depots, at distributor (stockist spots) places, and shelves of the retailer or dispensing doctor.  Those companies that have real-time or periodic robust data of rack stocks at the above points will naturally undertake various programs to ensure healthy rack stocking (at all the above points) through either liquidation programs or returning of stocks.

If a MR is monitoring the stockist rack stock continuously, he will ensure to focus on liquidation programs for specific SKUs or will ensure indenting of relevant SKUs from C and Fs to the stockist points. 

Similarly, such a rack stock monitoring at chemist shelves and dispensing doctor level is vital for ensuring consumption specific activities.

In fact, Pfizer has a mobile app for their MRs, and they get the stock level at stockist (wholeseller) level through this method.  This helps Pfizer MRs launch marketing programs, liquidation of goods and optimal inventory level.

Collection refers to the money flow from market to company coffers.  Timely and sizeable collections on a daily basis is the dream of every company management.

Product messaging and promotion is the vital essence of marketing to ensure demand creation.  The main approach for product messaging and promotion, in pharma marketing continues to be the MR’s focus on doctors and chemists (pharmacies) … however; patient-centric communication and activities are also roped in to ensure demand creation.  Digital and other non-MR approaches for product messaging and promotion play a complementary and supportive role.

If any company manages above three essentials, surely it will be in the pink of health!  This requires new dimensions of thought and activity, for rack stock management and fund transfer to company treasury; along with this the core activity of product messaging and promotion.


Thanks for reading this blogpost, please do read all others by scrolling down and clicking on older posts…do recommend this blog to your acquaintances.

Wednesday, May 10, 2017

TIME FOR LOGO BASED MARKETING

The logo defined

A logo (or logotype) is a design or symbol used by an organization to identify its products, programs, corporate identity and so on.  The graphical mark called logo helps identify a company, product, brand, or organization.  A logo may be a wordmark or shape or combination…it is used to help impress target audiences, create a memory hook, build trust, strengthen brand registration and recall, provoke purchase-pull, and adds to the intangible assets of a company.  A logo is part of the overall branding process and the brand itself.

A logo is responsible for recognition and trust building, when appropriately used in marketing communication.  TV channels have standardized logos to help viewers locate and stay on with the broadcast content.  Logos of TV channels build up a reputation for standing up to certain values and offerings.  Egs.,: the logo of MTV stands for English music and is youth-centric nature.  CNN stands for accurate and stylish newscast.  Recognition through logos makes a customer or prospect comfortable with the offered product or service.

Logo marketing for differentiation

Logos can go a long way in creating differentiation, trust and market-pull.  The best logo example is the green dot for vegetarian food packs and red dot for non-vegetarian food packs.  This has helped customers make their choice.  Similarly, ISI is a special mark indicating the acceptable and approved quality of a product.  The logo concept builds identity, trust, and reputation, and has helped in consumption of products.

The marketing of products with logos that stand for a certain assurance of quality or function helps in strengthening customer choice towards the marketed brand.  A logo is a graphical representation of a brand promise.  The successful marketing of a product is boosted by a recognized and trust-inspiring logo.

A new market segment and a new logo based system of marketing

Pharma companies have to make the inevitable choice to offer lower priced branded generics (these can be through umbrella branding or individual product branding), given the push for such products by Governmental policy makers.  There is sufficient evidence that an ecosystem for ‘lower priced branded generics or unbranded generics’ is being encouraged by the Govt. of India.  Hence, it is essential to wise up to this new market trend.  To enable brands, in this new market segment, gain recognition and trust at patient level, uniform brand colours, fonts and brand presentation needs to be done.  Along with this, the development of a logo will go a long way to sustain repeat purchases by customers and attract prospects towards the promoted branded or unbranded generic range of a company.

If the government is serious on building a “low cost generic (branded or unbranded) market” it can also launch a logo similar to ISI and encourage pharmaceutical suppliers to use this logo on their products to enhance patient/customer trust

IT IS LOGO TIME!

The logo concept does to this new generic pharma market segment, what the MTV logo does to their TV channel.  NEW MARKET CHANNEL … NEW LOGO!!

Tidbits:

One interesting logo concept used by Bangalore based Group Pharmaceuticals:


The above is a logo for assurance of quality and reinforces brand identity of the dental range from this company. 

The following are interesting newspaper article foto posts on the raging generic medicines issue, a logo concept will certainly help differentiate low cost branded or unbranded generic medicine offerings by various companies (including Jan Aushadhi) for ensuring quality, trust, purchase-pull, and building reputation.






The first one is from Deccan Herald, page no. 11, second and third ones are from Business Standard, 4.5.17, page no. 12

Thanks for reading this logo concept in pharma channel; please scroll down to read more articles and click on older posts for reading other posts.

Wednesday, May 3, 2017

The whey forward! Emotional triggers!!

Interesting article on whey from this link: click here!

Emotional triggers hold the key for sales.  For example, consider a milk-mix beverage like Horlicks: when a person uses/buys the brand, he or she is emotionally triggered positively by the aroma, warm memories of the brand, taste, health benefits (such as strong bones or energy or boost to immunity), and other confidence generating features of the brand, and so on… It is the marketer’s challenge to create such emotional triggers in the marketed brand so that prospects are converted to customers, and customers stay with the brand.

How to keep triggering the emotions to ensure successful purchase of the brand?

Companies and brands need to ride with the trends to ensure they keep prospects & customers emotionally interested in the offerings.  Positive emotions need to be generated by the brand – this keeps the brands fresh in minds of the target audience.  Thus, more prospects get converted and the customer bandwagon keeps on increasing.

Keeping with the contemporary trends by tweaking the brand messaging, packaging, creating line extensions etc, means the brand remains ceaselessly relevant to the customer.  Trends should match the core benefit of the brand.  All brand positioning and promotional activities are meant to strengthen the trust on the marketer’s brand(s).

Trust: cornerstone of pharma brand success

Pharma brands of the off-patent generics are successful in India, as they have won the trust of doctors (influencers) and patients.  Trust and feel-good factor make the pen habits.  Continuous product promotion to feed the trust and feel-good factor on the brand, reinforces pen habits of doctors.

Today, a welter of conversations on pharma brands is sabotaging the success of pharma brands.  It is the most CREATIVE OPPORTUNITY for pharma marketers to come out with campaigns to reinforce doctor’s pen habits and patient confidence.

Each brand is built on a foundation of trust (reliability) and brand benefits.  Contributors to this brand salience are -

a)      Quality – that the product meets certain predetermined standards (eg., uniform content tablet to tablet, amount of active ingredient in each unit dosage form, quality and type of excipeints in the formulation etc)
b)     Consistency – is another brand expectation.  Patrons, patients and doctors always choose time-tested moieties and brands to deliver therapeutic benefits
c)     Value for money – this is the point that needs to be emphasized upon.  It is time for pharma brands to talk on the brand attributes and service inputs, and justify the price for the brand.  Justification of price comes through convincing communication to doctors and patients.  For eg., when a patient buys brand A of paracetamol, the pack or strip or labeling or pack insert should reinforce the value of brand A: this can be done through reinforcing messages like: EACH SECOND SOMEONE SOMEWHERE - A PATIENT IS BUYING A TABLET OF BRAND A…trust Brand A. 

Today it is the time for brand reinforcing messages at level of patients also.  For which, technology needs to be used.
 
There are several challenges to trust building on the pharma horizon, the chief three being:

a)      US FDA Form 483 observations on manufacturing operations
b)      Policy shift regarding branded generics (non-patented drugs)
c)      GST implementation

Let us focus on the 'whammo (b)', with high cost branded generics now being bandied as a bad idea for patient economics - so what is the way forward for the multitude of pharma companies ?

1)      Trust building communiques (perhaps in packaging and pack inserts itself for patients and other collaterals for doctors) regarding the technological advantages, clinical case studies and trials on the brand, and brand surety - is certain to protect brands
2)      Launch of products that do not have much me-too competition and at the same time having growth potential (to gain scale) is another approach
3)      Another is 'going along with trends'…

One such novel idea is looking at whats’ trending in the marketplace: THE VMHS opportunity  

A McKinsey report of Dec 2013 says, (even at that time 4 years back) the global VMHS (Vitamins, Minerals, Nutritional and herbal supplements) market was valued at 82 billion USD.  EU, Japan and America are big nutraceutical markets.  Electronic developments like the internet have caused the collapse of information float, creating the empowered patient and customer, who uses word-of-mouth and internet based knowledge for choosing health promoting products.  There is an overall emphasis on preventative health (this is an important point for promoters of DENTAL CARE PRODUCTS).  This is the opportunity that business models can bank on and recreate a positive pathway for business success.

There are many nutraceutical concepts: polyphenol based formulations, health beverages, vitamin-mineral formulations, green tea concept (EGCG polyphenol)… and one can also see a WHEY FORWARD!

Dairy industry: milk and milk derived products are traditionally popular in India.  Lord Krishna was “maakhan chor” (he liked butter), and, in contemporary times, paneer (cottage cheese) is popular too for daily use.  India is the largest producer of milk in the world.  India accountsfor 9.5% of world’s production of milk!  In 2015 – 2016 financial year, India produced 155.50 tonnes of milk.

Milk offers an interesting culturally popular basis for nutraceuticals in India: whey, lactose, milk mineral concentrate, and milk proteins are part of the dairy industry products.

Milk is a good source of protein containing 9 essential amino acids - 82% of milk protein is casein and remaining is serum whey protein (18%).  

Casein is a collection of phosphorous containing casein subtype proteins (eg., alpha – s1 etc), casein proteins are suspended in milk.  Phosphoprotein casein is richly present in cheese.  Hydrolyzed casein is used to some extent in nutritional powders, however, it has a taste problem

The serum whey proteins do not contain phosphorous, this family of proteins contains subtypes like lactoglobulin, lactoferrin, alpha lact albumin etc.

Whey is largely produced as a liquid offshoot of cheese production (upto 95%), and whey is also obtained when casein is produced (upto 5%).  Whey is the liquid left over, after milk has been curdled and strained.  Whey is incorporated into products of various categories: infant nutrition, sports nutrition, clinical and medical nutrition.

The dominant type of whey production is in form of Whey Powder (WP) (about 70% of world production is WP, excluding lactose powder and permeate powder), and a fast growing type is Whey Protein Concentrate (WPC) – the latter has a protein concentration of 50 to 89%.  The globally well accepted form of WPC is WPC 80 (ie., 80% protein).

While WPC 80 is a popular form of whey protein - WPI (Whey Protein Isolate), also has high acceptance in milk based formulations.

Lactose powder or milk sugar is a disaccharide – contains two sugar molecules (glucose + galactose).  This milk derived product is used in infant formulae, animal feeds, for standardization of milk, pharmaceutical uses (diluent and for compressibility of tablets), confectionary and chocolate…Lactose (2 to 8% of milk) is extracted from whey.

Milk mineral concentrate (MMC or milk calcium) is also derived from pasteurized whey.  This form contains milk calcium and other minerals in optimal amounts:  magnesium, phosphate, potassium, iron, copper, zinc, and vitamin D. 

Milk permeate powder is derived from skimmed pasteurized cow’s milk and protein is extracted from this.  Similarly there is whey permeate powder. 


So milk is not just about healthy taste, it is very much about offering well absorbed milk proteins for growth, development and immunity 

WHERE ARE MILK PROTEIN PRODUCTS USED?

A)    Elderly, for helping avoid muscle loss
B)    Children, for health and growth
C)    Dieters, since milk proteins are a source of lean nutrition and increase satiety (also decrease cravings, hence useful in diabetics too)
D)    Sports personnel, for muscle building and recovery from work-outs.

Best of all, it is the unbeatable cultural acceptance of milk and milk-derived ingredients across India that makes this concept attractive.

While there may be a shift from high cost branded generics to low cost branded and low cost unbranded generics - in the pharma market, a concomitant development will be a growing nutraceutical market in India.  Indian pharma companies will surely weather this storm (in a tea cup?) and continue the winning streak through generics (formulations) and nutraceuticals in the global market.

However, a word of caution: it is wise if policy makers tread with care when changing policies.  And any policy change should be delivered with care…and the policy should not become a bull in a China shop.

Emotional triggers are very vital for any purchase or prescribing decision.  Emotional triggers need to be thoughtfully delivered.  Milk and milk derived ingredients are culturally acceptable; hence, there is an emotional trigger in-built in this category.  Similarly, herbs have good cultural acceptance and positive emotional appeal.  Thus products designed with in-built emotional triggers is the whey forward!!

Thanks for reading this blogpost, please read other posts by scrolling down, and click on older posts to read further; kindly recommend this blog to your acquaintances!

Thursday, April 20, 2017

April 2017: Marketing in a generics-rich environ

The above image from here: Yellow bulbs!

There is never a dull day in the pharma marketer’s life!  Respected Mr. N Modi, PM of India, has sent shivers down the spine of pharma marketers - on 17.4.17 at Surat during a hospital inauguration: Mr. Modi announced in his speech there that the central govt. will bring in a law to ensure doctors prescribe generic drugs (Ref.: The Times of India, page no. 1 headline, Ahmedabad edition).  The reference was that doctors should write unbranded generic drug names on prescriptions ie., for example, doctor will not prescribe Dolo 650, he has to prescribe paracetamol 650 mg! 

Now let us remember, almost entire of Indian pharma market is the branded generics market, which is promoted to doctors.  Pharma companies have built their fortunes and gained huge shareholder value on the basis of pen habit of doctors to prescribe branded medicines (me-too products) and earned profits.  This has helped pharma companies to recruit field personnel to expand operations, ensured market penetration of quality products to the nook and corner of Indian pharma market; this has helped pharma companies build manufacturing set-ups, and export products to almost every country of the world.  And pharma companies have also started R and D endeavours.

Overnight, with the PM's announcement, this pharma business model is under threat by the envisaged law.  No more will a doctor prescribe Taxim, he will write cefixime 500 mg, it is upto the patient and pharmacist to ensure the consumption of this drug, either unbranded generic or any one of the branded options available with the pharmacist.

Now, if the law that is to come, allows the doctor to prescribe both paracetamol 650 mg and his recommended brand in brackets eg., (Dolo 650), then there is some steam left in the branded generics pharma market space promoted to doctors.

Background

During 1950s, the medical representative (MR) visit was a most welcome entry for the doctor.  Probably he would get one medical representative visit every day in urban areas, and in semi-rural and rural visits, if at all a MR would visit, the doctor would get a MR visit may be once a week.  Hence, the MR with his product updates and samples was a welcome presence to the doctor.

From 1970s, with product patent regime being abandoned (thanks to the Indian Patents Act, 1970), (the product patent was re-introduced in 2005), me-too product manufacturers and marketers burgeoned.  More medical representatives started entering the doctor’s clinics, bonus offers earlier unheard off…became a rage, pharmacies also started pushing brands that offered better margins or free goods (sales promotional offers).  As the number of medical representatives started increasing, the leverage was with the doctor, and he started gratefully accepting various quid-pro-quo gifts from pharma marketers.  Those who were aggressive in gifting grew rapidly…this story continued into 1980s.  However, there were also some pharma marketers who were not gifting or providing sponsorships adventurously.

The late 1980s, and 1990s saw the earlier conservative companies, shed their shyness, throw their ethics out of the window, since they saw their counterpart companies who provided gifts and bonus offers growing humongous, and got into the gifting and sponsoring of doctors gameplan.  Various wannabe biggie companies also started playing with penetration pricing to garner market share.  CRM (customer relationship management) was the core of pharma marketing.  PCD (propaganda cum distribution) companies started taking root and gained traction in the first decade of 21st century.  The party has become bigger and bigger.

Doctors are splurged; several unconfirmed legendary CRM activities make rounds during marketing “gupshup”:

a)   After the formal cocktail dinner launch of a breakthrough brand of antiulcerant, important doctors were given keys to a luxury car… and prescribers who were gifted their four wheels left broadly smiling
b)      Another leading doctor working for psycho-somatic health of patients, was given enough cars by various companies – one car for each day of the week!  And the day the doctor takes out a certain car, on that day the pharma brands belonging to the car gift-giver would roll out of the pen of the doctor
c)   Sponsored foreign tours for families and other indulgences in the foreign tours engrossed doctor fraternity and brands paraded in their minds
d)     Sponsorship of get-togethers, cocktail dinners and various other meetings masqueraded under the garb of CMEs (Continuing Medical Education)

And it goes on and on and on…each pharma marketer vying with each other to give and take…for mutual gains with the medical fraternity.

WHY DO PHARMA MARKETERS ‘GIVE’ TO THE DOCTOR?

Consumption of medicines is decided by the doctor, in the current situation, it is by prescribing the branded generic.  If a doctor prescribes brand X, the patient buys it.  The patient has implicit trust on the doctor (the medical professional earlier definitely had a demi-God status in Indian society) and obediently goes with the doctor’s brand recommendation.  The result is pharma marketers who take care of doctor’s needs enjoy better sales outcomes and profits.

In this business, the patient does not make any choice between brands with the same generic drug.  It is the doctor’s business to choose the pharma brand for the patient.  But the payer is the patient!

Ignorance of brand options with same generic drug, lack of will by patient to exercise brand options, and non-encouragement by the environment to choose alternative brands or unbranded generics are the main reasons why patients go along obediently with the doctor’s brand recommendation.

This pussy footing by the patient provides an opportunity for the doctor to use his influence with patients and encourage consumption of his favoured brands.  And this gives an opportunity for the doctor to strike quid-pro-quo relationships with pharma brand marketers!  And both the pharma company and doctor enjoy the benefits of pharma brand sales, thanks to a very co-operative attitude of the patient.

WHY DO PHARMA MARKETERS PROMOTE PRODUCTS TO DOCTORS?

Pharma brands are built by the doctors prescriptions, if a doctor gets 1000 to 2500 patient visits per month (average of 40 to 100 patient visits per day; 25 working days per month), and prescribes an average of four assorted pharma brands per patient, then, 4000 to 10000 pharma brand purchases have happened (it will not be 4000 to 10000 different brands, there will certainly be a number of repeated overlapping brands) - a doctor after all, may be able to remember maximum 100 to 200 different pharma brands? 

So the idea for the pharma marketer, is to be among the 100 to 200 brands or so,  which a doctor remembers (certainly some brands are etched permanently in the doctor's mind ‘non-volatile ROM brands’ and others are ‘volatile RAM brands’, the latter are the brands that float in and out of the doctor’s mind, depending on the regularity of product promotional activity). 

It is then vital to gain patronage of the doctor, and ensure the promoted pharma brands sell.  Thus, prescribing the pharma brand name is key to commercial success of a pharma company.

GENERIC PRESCRIPTIONS: death-knell for the pharma brand business

The ruling BJP party and Mr. N Modiji are focused on winning elections, the next big one is the Lok Sabha elections of 2019.  To gather votes, they need to say a story of doing good to their voters, mainly the middle class and poor sections of society.  Capping the prices of stents has endeared the govt. to the masses.  Now ensuring purchase of unbranded generic medicines, which are available at rock bottom rates will further make the government voter friendly.  There is a good talking point here for the ruling party.


a)    Branded generics promoted to doctors (these carry maximum premium (high MRP) and are hugely prescribed by doctors)
b)      Branded generics not promoted to doctors, sold by pharmacies to patients, and also purchased by dispensing doctors who sell them to patients
c)  Unbranded generics not promoted to doctors sold by pharmacies to patients, and also purchased by doctors who sell them to patients.

In developed countries, the patient is not ignoramus.  The doctor has to justify his recommendation to patients.  Normally, prescriptions are for unbranded generics in developed countries.  Many of these unbranded generic medicines sold in developed countries are manufactured in India and marketed abroad.

However, in India, it is a time-honoured practice to manufacture and market, branded generics and the prescriber chooses to patronize certain brands of his choice based on the doctor’s experience with the technology and quality of the brand, and marketing inputs provided by the pharma marketer.  The Indian patient is ignorant of his ability to make a choice between branded and unbranded generics.

ARE PHARMA BRANDS EQUIVALENT?

The answer is yes and no!  Brands of the same category are chemically equivalent (contain the same quantity of the active ingredient).  However, there can be important differences.  This is with the excipients and the manufacturing process parameters of the brand.  For example, if you compare the dissolution profile of albendazole tablets, you may be surprised; Zentel from GSK is said to have the best profile.  Similarly, Advanced Crocin has certain excipients to improve dissolution and consequent absorption of paracetamol into the bloodstream, when ingested.

Pharma brands are also presented in unique differentiating ways that improves patient acceptance and brand salience.  The shape at the mouth of bottle in oral pharma formulations may aid pourability, use of certain permitted colours and flavouring agents also enhances patient acceptance, use of Alu-alu pack by certain pharma brands (may not be used by plain vanilla unbranded generic medicines) enhances patient compliance and patient acceptance.  Pharma brand marketers work on differentiating their products through value added excipients to improve organoleptic qualities (improved patient acceptance through mouth-feel, flavour, texture, odour, colour and taste); these are not a consideration in plain vanilla unbranded pharma products.

Though brands may be chemically equivalent, or even proven to be bio-equivalent, yet brand performance may not be same; and brand acceptance at patient level will not be same.  Furthermore, doctor’s confidence will not be same on each brand.  It depends on the doctor’s experience with the brand, technology used in the brand, and patient feedback to the doctor on the brand.

IS IT RIGHT TO DO ‘DEBRANDIZATION’ (brand-bandi in doctor's prescriptions) OF INDIAN PHARMA MARKET? 

Patient health, recovery and well-being are paramount for medicine marketers and doctors.  Quid-pro-quo relationships are at one level, but patient recovery & well-being (public health) is the non-negotiable foundation where pharma marketers, doctors and other stakeholders such as regulatory agencies agree to be on one page.

So the fundamental question to ask is, whether promotion of unbranded generic medicines - will improve public health?

The merits of ‘debrandization’ in pharma market:

a)      People will come to know of availability of unbranded generic and branded generic medicines (which are not promoted to doctors), so this option will gain traction; and patients can exercise this option if they wish
b)      Doctor-pharma marketer relationship will become “cleaner”
c)   PCD (propaganda cum distribution) companies who are known to offer robust services to doctors in exchange for their prescription or purchase support, will end
d)     Accessibility will improve
e)      Cost of therapy will come down.

The demerits of ‘debrandization’ in Indian pharma market:

a)      The current pharma marketing business model will collapse
b)    Shares of big pharma listed companies whose business depends on pharma brands will fall steeply
c)      Industry turnover will fall
d)     If the doctor stops prescribing branded medicines, medical representatives will not meet them, many medical representative jobs will be lost
e)      Companies will reduce jobs in marketing (particularly field jobs)
f)     Field personnel will focus on chemist retailers than doctors, offer incentives and freebies to retailers to stock and push their products (as per the Times of India, 19.4.17, page no. 19, Mumbai edition, retail margin on drugs may be as high as 1000%, this will stress pharma marketers, as they have to offer competitive margins and offers, this will erode financial strength of pharma companies)
g)   Innovation and technology improvements will not occur, all pharma companies will go for manufacturing the plain vanilla formulations (without any improvements), it will become a commodity game
h)      Quality will become a question issue.  For instance drugs (APIs) and excipients are available at various crystalline purities, and the manufacturer will go in for lowest acceptable crystal purity (only economy will weigh on the mind of manufacturer)
i)        Packaging will be passé and will not offer any improved benefits to patients
j)    With profit margin squeeze, companies will not have adequate surplus monies to invest on geographic expansion, export ventures, product development, R and D, new molecule research, social marketing etc
k)   Companies will reduce emphasis on launch and marketing of modern medicines, they will prefer to invest on nutraceuticals and Ayurvedic formulations.  These will not be affected by the proposed law (in fact, Himalaya Drug Company and other such companies will go laughing all the way to the bank, while rest of pharma will be stressed).  Besides Ayurvedic formulations and nutraceuticals can be advertised.  We will lose our standing, competence, global edge and knowledge of manufacturing and marketing of modern medicines
l)      In case of branded formulations containing multiple ingredients such as Becosules Z, it will be virtually impossible for the doctor to write names of generic drugs or vitamins/minerals included in the formulation on his prescription
m)  Monitoring the implementation of this ‘generic name only law’ for prescribers is nearly impossible…let us say there are about 10 lakh active prescribers (across India), and let us assume, every working day these 10 lakh active prescribers write about 50 prescriptions each.  This means 5 crore prescriptions per day!  And for 25 working days, it is 125 crore prescriptions per month!!  Are you going to monitor this?!!
n)      If a doctor writes some brand names, and in India where there is a situation of less number of doctors, and more patients, what punishment are you going to administer?  Prevent them from practising?
o) If medical representatives and field personnel lose jobs, in a country where under/unemployment is high, is this initiative worth it?  Please remember marketing creates more jobs than manufacturing or R and D (in pharma field)
p)    Doctors may give oral recommendations for brands, or unsigned slips containing brand names, or pharmacies will push certain brands on oral recommendation of doctors … there are ways to beat this law…
q)  There could be legal challenges to this ‘debrandization’ as it takes away the freedom to promote branded products and recommend them
r)   Patients may be unhappy with the generic name prescriptions since the doctor is not prescribing “quality brands” (it is a matter of freedom of choice and many patients want quality brands…brands are the covenants of trust)
s)    Patients and patient attenders may be upset with the tongue twister and complex generic names of medicines, in comparison to cute, easy to recall, easy to pronounce and easy to remember brand names of medicinal products.

HOW MAY PHARMA COMPANIES MANAGE THE NEW CHALLENGES?

PESTEL standing for political, economic, social, technological, environmental and legal environment is always in a state of flux, depending on the various happenings on the PESTEL front, pharma organisations will respond in various ways: 

a)  Some will adopt the wait and watch, others will lead a counter response through various forums like IDMA and KDPMA; few others will use their good offices with various authorities and present their viewpoints.  Some others will present their take on social media and talk to the media
b)    Companies will start investing on new marketing technology to strengthen their patient-centric communication, and strengthen CORPORATE EQUITY and PRODUCT EQUITY at patient-level.
c)      There will be a rise in OTX (over-the-counter and prescription) route of marketing (including communication/advertising/digital messaging to patients) to strengthen sales outcomes; also OTX products will be launched in a rush: ayurvedic, dental, nutritional powders, nutritional supplements, health soaps, and other nutraceutical products (including in unique packaging like Tetra Pak based products or products with unique concepts like virgin coconut oil)
d)  A chemist-focused and dispensing-doctor focused working will be emphasised to ensure product availability
e)   Companies will go in for umbrella branding, umbrella brand colour concept, and uniform packaging for creating market identity for their products; so that chemist/pharmacy retail-push/pull will start; pharma marketers will also go in for launch and pushing unbranded generics and branded generics (low cost, that are not promoted to doctors)
f)     Companies will increase no. of medical representative calls to pharmacies (eg., 15 per day) and reduce doctor calls (to say 5 per day)
g)      Companies will probably rationalize field personnel count and coverage, and consolidation of divisions/SBUs etc., to reduce costs
h)    Companies will invest more on chemist coverage, example: paying chemists/pharmacies to book shelf space for their products, offer freebies to chemists, & having field personnel to cover more chemists/pharmacies and dispensing doctors
i)   Some companies with deep pockets may start their chain of pharmacies (for eg., Cipla pharmacy), and will also emphasize online pharmacy marketing toos
j)   Companies will invest more to make patented medicines, products with novel drug delivery systems or products that do not have many me-too products...

What may the Govt. do?

a)      Govt., may tighten doctor-pharma marketer relationships with new laws
b)      Govt., may ask doctors to write generic names only on prescriptions
c)   Govt., may ask doctors to write the generic names and the brand name alternative (in brackets), so that the patient will have an option to buy the generic name product if he wants or go ahead with the doctor’s choice of a branded product or the patient may choose another branded product, a company of his choice.

It would be prudent to go the option C, since it meets governmental requirements, patient psychology, doctor’s confidence and liberty, and Indian pharma industry traditions.

Thanks for reading this blogpost, please read other posts by scrolling down, and click on older posts to read further; kindly recommend this blog to your acquaintances!