Study the prescription behavior of doctors towards Azithromycin and Anti-acne drugs

By GAURAV GUPTA

June 2010

Study the prescription behavior of doctors towards Azithromycin and Anti-acne drugs

By

Gaurav Gupta

Under the guidance of Mr. R. K. Sachdeva ZSM Wockhardt Ltd. Mr. Dhruv Chak Professor BIMTECH

June, 2010

Certificate of Approval

The following Summer Project Report titled "Study the prescription behavior of doctors towards Azithromycin and Anti-acne drugs is hereby approved as a certified study in management carried out and presented in a manner satisfactory to warrant its acceptance as a prerequisite for the award of Post-Graduate Diploma in Management Full Time for which it has been submitted. It is understood that by this approval the undersigned do not necessarily endorse or approve any statement made, opinion expressed or conclusion drawn therein but approve the Summer Project Report only for the purpose it is submitted. Summer Project Report Examination Committee for evaluation of Summer Project Report Name Signature

1. Faculty Examiner

_______________________

___________________

2. PG Summer Project Co-coordinator

_______________________

___________________

~i~

Certificate from Summer Project Guides

This is to certify that Mr. Gaurav Gupta, a student of the Post-Graduate Diploma in Management-Full Time, has worked under our guidance and supervision. This Summer Project Report has the requisite standard and to the best of our knowledge no part of it has been reproduced from any other summer project, monograph, report or book.

Mr. Dhruv Chak Professor BIMTECH Greater Noida Date:

Mr. R. K. Sachdeva ZSM WockhardtLtd. Ghaziabad Date:

~ ii ~

Acknowledgement

Without a proper combination of inspection and perspiration, its not easy to achieve anything. There is always a sense of gratitude, which we express to others for the help and the needy services they render during the different phases of our lives. I too would like to do it as I really wish to express my gratitude toward all those who have been helpful to me directly or indirectly during the development of this project. I would like to thank my Principal Mr. R. K. Sachdeva, ZSM, Wockhardt Ltd., & also I would like to thank my Faculty Guide Mr. Dhruv Chak, who is always to help and guide to me when I needed help. Her perceptive criticism kept me working to make this project more full proof. I am thankful to him for her encouraging and valuable support. Working under him was an extremely knowledgeable and enriching experience for me. I am very thankful to him for all the value addition and enhancement done to me. No words can adequately express my overriding debt of gratitude to my parents whose support helps me in all the way. Above all I shall thank my friends who constantly encouraged and blessed me so as to enable me to do this work successfully.

Date: June 20, 2010

GAURAV GUPTA

~ iii ~

Abstract Study the prescription behavior of doctors towards Azithromycin and Antiacne drugs
By Gaurav Gupta
Marketing strategies will play an important role if Asia is to realize its potential. These strategies, however, should be tailored to the region and its countries. Moreover, they will need to encompass not only the physician audience but also increasingly the influencers who have the power to make or break a product. Finally, pharmaceutical companies will need to become experienced in navigating the consumer space with prescription products and ultimately turning pharmaceutical marketing into brand marketing. This report helps us to understand various terminologies in Marketing. This report gave me opportunity to have complete idea about Promotional strategy and tools. This project report helps in following aspects, Build understanding of central ideas and theories of Promotional strategies. Develop familiarity with the analysis of tools and strategies. This project will guide to marketer of Pharmaceutical industry. This project deployed a lot time for collections of information from various sources. This project will be very helpful to know the promotional tools and strategy used and the personal selling involved in it. The objectives of the study were to Study the prescription behavior of doctors towards Azithromycin and Anti Acne topical. To suggest sales promotional strategies. To find alternative channel of communication. To find out various roles played by medical representative to enchase the sale. To find out product which are doing well in the market for Azithromycin and anti acne topical with their market share.

~ iv ~

The methodology for research in order to accomplish the objective is decided to undertake a visit to the Chemists in the Noida region. The type of study can be descriptive in nature. The primary data required for the research will be obtained through questionnaire. The questionnaire, close-ended questions, and need based exploratory questions will also be included. Besides primary data, secondary data was also collected from the brochures, website.

~v~

Table of Contents

Certificate of Approval....................................................................................................................i Certificate from Summer Project Guides.......................................................................................ii Acknowledgement.........................................................................................................................iii Abstract..........................................................................................................................................iv Table of Contents...........................................................................................................................vi List of Figures...............................................................................................................................vii List of Tables...............................................................................................................................viii Abbreviations.................................................................................................................................ix INTRODUCTION...........................................................................................................................1 Indian Pharmaceutical Industry: An Overview..............................................................................2 ADVANTAGE IN INDIA..............................................................................................................3 Organizational Information: Introducing Wockhardt.....................................................................4 WOCKHARDT ADVANTAGE....................................................................................................5 WOCKARDT IN INDIA................................................................................................................6 Beyond the 4Ps: The Basic Tenets of Relationship Marketing......................................................9 Influence of WOCKHARDT on Healthcare Practitioners Prescribing Habits...........................12 Direct and indirect marketing to health care providers................................................................16 Channel by which Physician influence.........................................................................................17 Prescription-products promotion..................................................................................................19 The changing environment impacting treatment decisions..........................................................19 Marketing strategies for influencers.............................................................................................19 Anti Acne Drugs............................................................................................................................20 Research Methodology.................................................................................................................22 .......................................................................................................................................................25 .......................................................................................................................................................27 Recommendation & Conclusion...................................................................................................41 REFERENCES..............................................................................................................................47 Refrences..48

~ vi ~

List of Figures

Figure 1 : Wockhardt Advantage....................................................................................................5 Figure 2 : Indian Partnership...........................................................................................................8 Figure 3: Retailers Density in Merrut...........................................................................................25 Figure 4: Azithromycin market share...........................................................................................27

~ vii ~

List of Tables
Table 1 : Anti Acne Details.....................................21 Table 2: Azithomycin Brands.......................................................................................................26 Table 3: Anti Acne Brands...........................................................................................................26

~ viii ~

Abbreviations

API IPA DTC TRx NRx

Active pharmaceutical ingredients Indian Pharmaceutical Alliance Direct-to-Consumer Total prescriptions New prescriptions

~ ix ~

INTRODUCTION
The Indian Pharmaceutical Industry today is in the front rank of Indias science-based industries with wide ranging capabilities in the complex field of drug manufacture and technology. A highly organized sector, the Indian Pharma Industry is estimated to be worth $ 6 billion, growing around 10 percent annually. It ranks very high in the third world, in terms of technology, quality and range of medicines manufactured. From simple headache pills to sophisticated antibiotics and complex cardiac compounds, almost every type of medicine is now made indigenously. Established forty years ago, Wockhardt has evolved into one of India's top five research-based pharmaceutical companies and is amongst the top seventy-five in the world. The group now employs over 7000 people globally. The Company has a market capitalization of over US$ 1.02 billion and an annual turnover of US$ 766.8 million. Wockhardts pace of growth and momentum permeates every mindset, system and technology within the organization. Wockhardt today, is distinguished by a strong and growing presence in the worlds leading markets, with more than 65% of its revenue coming from Europe and the United States. Wockhardts market presence covers formulations, biopharmaceuticals, nutrition products, vaccines and active pharmaceutical ingredients (APIs). The Company has its headquarters in India, and has 14 manufacturing plants in India, UK, Ireland, France and US. Subsidiaries in US, UK, Ireland and France. Marketing offices in Africa, Russia, Central and South East Asia.

In Wockhardt, as a summer trainee my work was to know about the prescription behavior of Doctors for antibiotics in NOIDA region. I have also collected the data by the help of retailers (chemists) that which brands are prescribed by Doctors. This provides insight knowledge about the product information of other competitors in market. On the basis of these data company can make a strategy that how they can increase their sales & can expand their product line in the market.

~1~

Indian Pharmaceutical Industry: An Overview

The Indian pharmaceutical industry is a success story providing employment for millions and ensuring that essential drugs at affordable prices are available to the vast population of this sub-continent. The Indian Pharmaceutical Industry today is in the front rank of Indias science-based industries with wide ranging capabilities in the complex field of drug manufacture and technology. A highly organized sector, the Indian Pharma Industry is estimated to be worth $ 6 billion, growing at about 10 percent annually. It ranks very high in the third world, in terms of technology, quality and range of medicines manufactured. From simple headache pills to sophisticated antibiotics and complex cardiac compounds, almost every type of drugs made indigenously. Playing a key role in promoting and sustaining development in the vital field of medicines. Indian Pharma Industry boasts of quality producers and many units approved by regulatory authorities in USA and UK. International companies associated with this sector have stimulated, assisted and spearheaded this dynamic development in the past 53 years and helped to put India on the pharmaceutical map of the world. The Indian Pharmaceutical sector is highly fragmented with more than 20,000 registered units. It has expanded drastically in the last two decades. The leading 250 pharmaceutical companies control 70% of the market with market leader holding nearly 7% of the market share. It is an extremely fragmented market with severe price competition and government price control. The pharmaceutical industry in India meets around 70% of the country's demand for bulk drugs, drug intermediates, pharmaceutical formulations, chemicals, tablets, capsules, orals and injectibles. There are about 250 large units and about 8000 Small Scale Units, which form the core of the pharmaceutical industry in India (including 5 Central Public Sector Units). These units produce the complete range of pharmaceutical formulations, i.e., medicines ready for consumption by patients and about 350 bulk drugs, i.e., chemicals having therapeutic value and used for production of pharmaceutical formulations.

~2~

Following the de-licensing of the pharmaceutical industry, industrial licensing for most of the drugs and pharmaceutical products has been done away with. Manufacturers are free to produce any drug duly approved by the Drug Control Authority. Technologically strong and totally self-reliant, the pharmaceutical industry in India has low costs of production, low R&D costs, innovative scientific manpower, strength of national laboratories and an increasing balance of trade. The Pharmaceutical Industry, with its rich scientific talents and research capabilities, supported by Intellectual Property Protection is well set to take on the international market.

ADVANTAGE IN INDIA
Competent workforce: India has a pool of personnel with high managerial and technical competence as also skilled workforce. It has an educated work force and English is commonly used. Professional services are easily available. Cost-effective chemical synthesis: Its track record of development, particularly in the area of improved cost-beneficial chemical synthesis for various drug molecules is excellent. It provides a wide variety of bulk drugs and export sophisticated bulk drugs.

Legal & Financial Framework: India has a 53 year old democracy and hence has a solid legal framework and strong financial markets. There is already an established international industry and business community. Information & Technology: It has a good network of world-class educational institutions and established strengths in Information Technology.

Globalization: The country is committed to a free market economy and globalization. Above all, it has a 70 million middle class market, which is continuously growing. Consolidation: For the first time in many years, the international pharmaceutical industry is finding great opportunities in India. The process of consolidation, which has become a generalized phenomenon in the world pharmaceutical industry, has started.

~3~

Organizational Information: Introducing Wockhardt

Established forty years ago, Wockhardt has evolved into one of India's top five research-based pharmaceutical companies and is amongst the top seventy-five in the world. The group now employs over 7000 people globally. Wockhardt's insight into evolving global markets has resulted in a dramatic increase in international business. Wockhardt is a global, pharmaceutical and biotechnology company that has grown by leveraging two powerful trends impacting the world of medicine - globalization and biotechnology. The Company has a market capitalization of over US$ 1.02 billion and an annual turnover of US$ 766 million. Wockhardts pace of growth and momentum permeates every mindset, system and technology within the organization. Wockhardt today, is distinguished by a strong and growing presence in the worlds leading markets, with more than 65% of its revenue coming from Europe and the United States. Wockhardts market presence covers formulations, biopharmaceuticals, nutrition products, vaccines and active pharmaceutical ingredients (APIs).

Shaping the Future

Techniques have resulted in a world-class pharmaceutical force. The Wockhardt facility supports a multidisciplinary research Programme involved in biotechnology, super-generics and new chemical entities. Key research areas include bio-generics, antibacterial and nutrition. Wockhardt is the first company outside of the USA and Europe to manufacture recombinant insulin and the launch of hepatitis B vaccine was the most successful in Indian history.

~4~

Investment in Research & Development has reached $43million in the last 5 years alone. Wockhardts policy is to maintain an annual R&D spends approaching 8% of sales, a figure on par with the worlds elite pharmaceutical companies. Wockhardts ambition is to refine and develop a global supply chain competence, offering a truly integrated service.

WOCKHARDT ADVANTAGE

Figure 1 : Wockhardt Advantage

Wockhardts manufacturing facilities in India, UK, Ireland, France and US have the approval of major regulatory bodies, including US FDA and UK's MHRA, with capabilities for both Finished Dosage Formulations and APIs. The output includes Sterile (Injectibles) Biopharmaceuticals Orals (Tablets & Liquids) Topicals (Creams & Ointments).

Wockhardt is a partner of choice for manufacturing, having entered into manufacturing ~5~ alliances with leading pharmaceutical and biotechnology majors, including

Astra Zeneca Aventis Schering-Plough Cell Therapeutics AFT, New Zealand

Lab Aguettant Amylin Eisai LSI, UK Ebewe, Austria

A key growth driver at Wockhardt is its state-of-the-art, multi-disciplinary research capability backed by a team of 500 skilled scientists. Consistent efforts have resulted in six breakthrough biotechnology products, 750+ patent filings and a pipeline of promising new molecules.

WOCKARDT IN INDIA
Wockhardts strategies are aligned towards being a significant player in the emerging global biopharmaceuticals market. In order to achieve this goal, the company has set up the

~6~

Wockhardt Biotech Park, Indias largest biopharmaceuticals complex, with six dedicated plants built to international standards. Wockhardt has build strong presence in the Indian market with focused efforts on high growth chronic therapeutic segment. Wockhardt has a 1,500-strong field force covering over 2, 00,000 medical practitioners. The Company's strong focus covers 50% of the therapeutic segments through six therapyfocused marketing divisions. Wockhardt's has a significant presence in pain management, cough therapy, psychotic drugs, diabetology, vaccines, nutrition and animal health. Our focus on Power Brands has helped push the growth further, with some of our brands having strong leadership profiles. Some of Wockhardts Power Brands include: Diabetology Wosulin (Recombinant Insulin) Mopaday (Oral Antidiabetic) Glimaday (Oral Antidiabetic) Nephrology Wepox (Recombinant Erythropoietin) Pain Management Proxyvon Spasmo-Proxyvon Nutrition Methycobal Dexolac Decdan Neuro-Psychiatry Libotryp Tryptomer Cough Therapy Zedex Bro-Zedex Viscodyne

~7~

The Company enjoys excellent brand and customer equity, which has given it leadership positions in its chosen areas of focus. Wockhardts forte in the Indian market has made it the partner of choice for reputed international companies. Today, Methycobal, which is licensed from Eisai, Japan, is the largest selling brand in the segment and features amongst the Top 50 brands in the country. Wockhardt offers the requisite resources, distribution & marketing infrastructure, and brand equity in the Indian market to make it the ideal partner. Partnerships for the Indian market

Figure 2 : Indian Partnership

CHAIRMANS PROFILE

Habil Khorakiwala
Chairman-Wockhardt

~8~

Mr.Habil Khorakiwala, the Chairman of Wockhardt Limited, founded the company in the early 1960s.Under his dynamic leadership, Wockhardt has emerged as a leading biotechnology capitalization of over $ 1 billion. Mr. Khorakiwala leads a team of 7000 employees based in India, UK, Ireland, Germany, USA, France and in emerging market. MANAGEMENT STYLE Mr. Khorakiwala advocates a customer-centric approach that has filtered down to every decision and action in Wockhardt. His signature style is much evident in the management processes at Wockhardt: an open culture, participative management practices, innovation, continuous improvement, speedy response, empowerment of individuals and enjoyment of ones job and contribution to the community - all hallmarks of Wockhardt's culture.

Industry-level representation:
Past President of FICCI (Federation of Indian Chambers of Commerce & Industry). President of the Indian Pharmaceutical Alliance (IPA), the organization of research-based pharmaceutical companies in India. Panel member of the National Manufacturing Competitiveness Council, a high-level thinktank established by the Government of India.

Accolades received:
Elected as the FICCI president in Feb 2007.
Ernst & Young Entrepreneur of the Year Award in Healthcare & Life sciences (Year 2004).

The Giants 2003 Award for outstanding contribution to business and industry. Lifetime Achievement Award by the International Medical Integration Council in 2003. Award for Excellence as Top CEO for the year 2002 from the Institute of Marketing & Management (IMM), New Delhi. Lifetime Achievement Award by the Indian Analytical Instruments Association (ANACON) for his Contributions in Research and Industry. Shiromani Vikas Award for his Outstanding and Inspiring Contribution towards National Development in 1992, at the hands of Mother Teresa. Lifetime achievement award from Express Pharma

Educational qualifications:
A Masters degree in Pharmaceutical Science from Purdue University, USA. An Advanced Management Programme from Harvard Business School, USA.

Beyond the 4Ps: The Basic Tenets of Relationship ~9~

Marketing
Traditional marketing has followed a set of principles called the 4Ps. These basic principles remain important components of any pharmaceutical care marketing plan and have been extensively reviewed elsewhere. Relationship marketing does not replace these basic principles, but rather offers a fresh perspective through which to view and implement them. Briefly, the 4Ps refer to:

Product -- This is the item or, in the case of pharmaceutical care, the service being marketed. Although relationship marketing can be applied to any service, it is best suited to programs that involve repeated interactions between the pharmacist and patient, such as disease state management or pharmacotherapy assessment and monitoring.

Price -- Setting the appropriate price for a product or service is essential to marketing it successfully. Here, relationship marketing can be used to assess patients' price sensitivity and willingness to pay for a service before it is implemented.

Promotion -- In addition to advertising, promotional activities include publicity, public relations, and personal selling. The latter is especially crucial to the success of relationship marketing, which emphasizes one-on-one interactions between patients and pharmacists.

Place -- Making the product available at the right time and the right place is also important to the success of pharmaceutical care. From a relationship marketing perspective, pharmacists need to know their target markets well enough to tailor place considerations to patients' needs.

In addition, a fifth P, positioning, which addresses how the product or service will be viewed in the minds of prospective patients, is also important to consider. Positioning involves identifying and evaluating the niche for the service, which is another key element in relationship marketing. As a philosophy, relationship marketing moves beyond these basic principles to embrace several other key concepts.

~ 10 ~

One-on-one marketing. Whereas traditional promotional tactics such as running advertisements in newspapers are aimed at a mass market, relationship marketing tactics target selected customers. Using this approach requires the pharmacist to pay greater attention to relationship building and personal selling.

Identifying groups of like-minded customers who share a common desire or concern. Instead of trying to be all things to all patients, pharmacies that engage in relationship marketing focus on providing high-quality services to carefully selected groups of patients or other partners.

Retaining patients. Pharmacies often focus their promotional efforts on one-time events or services, such as a blood pressure screening day, a month-long diabetes awareness campaign, or a seasonal influenza vaccination program. Although these activities may work well for drawing customers to the pharmacy, they typically offer little incentive for patients to return on a regular basis to take advantage of other, longer-term clinical services. Relationship marketing offers tools to build and sustain relationships with the pharmacy's existing customers, such as patients who come in for a medication refill then choose to participate in a drug therapy assessment program.

Taking a longer-term view. Instead of a narrow, one-sale-at-a-time view of organization-client interactions, relationship marketing emphasizes developing close and continuing collaborations between an organization (the pharmacy) and its target markets (patients) and various stakeholders in patient care (physicians, insurers, and suppliers). Relationship marketing also requires recognizing that relationships take time to grow and mature.

A 2000 estimate of pharmacy patronage showed that the equivalent of the entire U.S. population (approximately 275 million people at the time) visited pharmacies each week. Pharmacists' remarkable access to patients gives them numerous opportunities to initiate and build therapeutic relationships. However, for these bonds to form, interactions between patients and pharmacists must be meaningful, with each meeting building on the previous interaction. For relationship marketing to succeed, interactions between pharmacists and patients need to represent more than discrete transactions so that patients can understand the value of the services pharmacists can provide, be they disease management services or

~ 11 ~

regularly performed drug regimen reviews.

Influence of WOCKHARDT on Healthcare Practitioners Prescribing Habits

Fortune magazine has reported that in 2008, the pharmaceutical industry continued to be in the top three most profitable industries in the United States for the past two decades. It is a lucrative industry that utilizes different strategies to gain revenue. Companies manufacture drugs that are developed from research. After FDA approval, these drugs are patented which can last up to 20 years. This allows them to keep exclusive rights to selling these brand name

~ 12 ~

drugs. It is only after these patents expire that other drug companies can use the formulas to be manufactured as generic drugs. This allows the drugs to be bought at greatly discounted rates in comparison to the brand name drugs. A company makes the majority of profits during the times they hold this drug patent. Money and time are invested into marketing these medications from many different angles. Large percentages of a companys budget are allocated for this because these strategies work. INTRODUCTION Pharmaceutical companies in a given year will allocate more than a billion dollars in the marketing of medications. This is distributed through a number of different venues reaching a wide range of people. This includes Direct-to-Consumer (DTC) ads used in television and magazines to inform people of the most recent drugs. DTCs many times are presented with vibrant colors, impressive large print statistics and basic information about certain illnesses. Pharmaceutical companies also utilize these to provide education and awareness of conditions. This empowers people to take responsibility of their own health. Between 1991 and 2003, spending on DTC ads in the United States increased 58-fold reaching $3.2 billion a year. This has lead to more than one third of patients asking their healthcare providers about medications they have seen through the media such as Mucinex, Lamisil, and Celebrex. As a result, when a patient asked for a drug by name, they were more likely to receive a prescription for it from their healthcare provider three times out of four.This shows the pharmaceutical companies advertisements have an influence on the consumer. The reason why these companies allocate such a large percentage of their budget on marketing is because it has been proven to influence the consumer. Pharmaceutical companies also employ representatives to visit healthcare practitioners in hospitals and offices to educate, update and provide samples of recent drugs their companies have produced. As experts on these drugs, they present their products with confidence, assurance and with the ability to answer questions about side effects, insurance coverage, microbial coverage and more. With the understanding that pharmaceutical companies play active roles in marketing their products, it is important to ask, how much influence these companies have on healthcare practitioners prescribing habits. There has been some controversy with the idea of healthcare providers having periodic contact with pharmaceutical company representatives. Every year more than $11 billion is spent on drug marketing, with half of the budget funding sales representative work. It is important to

~ 13 ~

identify the extent of this relationship and its ultimate impact on providers attitudes, behaviors, and knowledge. It is also important to understand how this potentially affects the patients.

Methods of influence
There are different strategies that are used in marketing drugs. Food, flattery and friendship are all powerful tools of persuasion, particularly when combined. Shahram Ahari, a former pharmaceutical sales representative for Eli Lilly, and Adriane Fugh-Berman, a physician/researcher on the pharmaceutical industry have both examined these strategies through the Attorney General Prescriber and Consumer Education Grant Program. Pharmaceutical sales reps are hired for their personalities and based on criteria that would make them excellent sales people. They are trained to observe and understand the best approaches to take when interacting with a healthcare provider. They use information they gather and understand what it takes to sell the drugs they represent. Not all practitioners have the same attitude toward sales reps, thus conversations and pitches need to be tailored to fit the particular personality type. Ahari testifies that Eli-Lilly delegates eight different categories that a physician could fit into: 1. Friendly and outgoing, 2. Aloof and skeptical, 3. Mercenary, 4. High-prescribers, 5. Prefers a competing drug, 6. Acquiescent docs, 7. No-see/No-time docs, and 8. Thought leaders. Each category is different and the company provides descriptions to determine the best ways to approach a sale. Pharmaceutical companies can also gain influence through research and prescription tracking. Information about prescription purchases can be bought by large health information organizations like IMS Health, Dendrite, or Verispan. These companies keep track of prescriptions filled in a given community. These records are then sold by pharmacies with details of personal information excluded. The pharmaceutical companies are the largest buyers of this information, which can be used to monitor marketing trends as well as identify which

~ 14 ~

drugs need a different marketing approach. Representatives see how many of a physicians patients receive specific drugs, how many prescriptions the physician writes for targeted and competing drugs, and how a physicians prescribing habits change over time. In addition, this information allows representatives to see how easily providers can be influenced. They not only figure out who the healthcare providers are, but what drugs are being prescribed, and how. A tremendous amount of information can be gathered and used. As a result, some practitioners who do not meet standards set by the company may not get the attention that other high-prescribers would. Studies have shown that samples influence prescribing choices. These can be used in a number of different ways to benefit not only the doctor but the patient as well. Samples allow practitioners to provide certain medications to their patients free of charge. The trial doses allow the patient an opportunity to see if the particular medication works or not. It is obvious that the only medications that can be given are the ones that companies leave as samples. Some problems may arise when patients find out these medications are too expensive when paying out of pocket. Studies have also shown that small gifts could have some type of influence on behavior. A physician who is the recipient of a gift may recommend products made by the gift-giver without due consideration of other cheaper or more effective options. Gifts have encompassed a broad range of items from pens and pads to medical reference books and continuing medical education trips. Some aspects of this have changed through recent guideline updates that prohibit the distribution of small gifts-explained later. Food has always been a source for common ground. People have the natural tendency to relate to one another while eating. To find the best and most convenient ways to present their products, representatives provide restaurant-catered foods and deliver onsite so practitioners can eat and obtain some education and updates on drugs as well. This is yet another way that companies use to gain influence. All providers admitted to the fact that interactions with representatives would decline if there were no gifts or meals. However, all the influence does not come from the giving of small gifts. They also come from the advice and talks given by physicians. Practicing licensed physicians have agreements with pharmaceutical companies all across the country to speak on behalf of the company for what can be a modest honorarium. These companies provide information and even specially designed presentations for these physicians. They stand before their colleagues and introduce a drug that is subtly presented within a health education talk. It may not be uncommon for key

~ 15 ~

information to be conveniently left out in order for the focused drug to stand out. Many times there is no direct push for these medications to be used but subtle nuances or messages are used to send the message across.

Challenging the influence

Studies have shown that roughly 90% of physicians interact with pharmaceutical representatives even though the evidence shows the information they provide is skewed (even slightly) in favor of the drug being promoted, resulting in inappropriate prescribing habits. Interactions with some providers show a preference for new products even though there is no demonstrated advantage over existing medications. The pharmaceutical industry has been using money to influence not only prescribing practices but also in teaching and research. Interest groups like Pharmaceutical Research and Manufacturers of America (PhRMA) have responded to these influencing trends. They have recently passed updates that prohibit the distribution of small gifts. PhRMA and their marketing code have recognized the fact that certain gifts and dinners impede on ethical practices and that professional unbiased relationships need to be fostered. The revised, voluntary code, which took effect January 1, 2009 reaffirms that interactions between pharmaceutical company representatives and healthcare professionals should be focused on informing the healthcare professionals about products, providing scientific and educational information, and supporting medical research and education. Many companies have realized the benefits of opting into voluntary program as good public relations. A total of 45 pharmaceutical companies as of February 24, 2009 have committed to this agreement. With pharmaceutical companies working to find open doors within healthcare some have even began targeting medical schools. Although there are few that welcome pharmaceutical representatives, others have stricter policies. Medical institutions such as the University of California San Francisco (UCSF) have had a reputation as having one of the strictest policies for monetary funding and sponsors. It is because some have viewed representatives as being regarded as the industrys favorite marketing tool. 5 Policies like those of UCSF, University of Pennsylvania, Stanford, and Yale have been created to limit the amount of contact and influence the pharmaceutical companies can have on future medical professionals.

Direct and indirect marketing to health care providers

Physicians are perhaps the most important component in pharmaceutical sales. They write the prescriptions that determine which drugs will be used by the patient. Influencing the physician is the key to pharmaceutical sales. Historically, this was done by a large pharmaceutical sales force. A medium-sized pharmaceutical company might have a sales force of 1000 representatives Sale representatives called upon physicians regularly, providing information and free drug samples to the physicians. This is still the approach today; however, economic pressures on the industry are causing pharmaceutical companies to rethink the traditional sales process to physicians.

~ 16 ~

Wockhardt will adopt new guidelines prohibiting physicians and researchers from accepting gifts from pharmaceutical manufacturers. This will include meals or individual drug samples, and also drug samples left by companies will be distributed through a centralized system, while educational programs and fellowships will also be required to be centrally reviewed and approved Pharmaceutical companies are developing processes to influence the people who influence the physicians.

Channel by which Physician influence a)

Peer influence

Key opinion leaders - KOL or "thought leaders", are respected individuals, such as prominent medical school faculty, who influence physicians through their professional status. Pharmaceutical companies generally engage key opinion leaders early in the drug development process to provide advocacy and key marketing feedback. Some pharmaceutical companies identify key opinion leaders through direct inquiry of physicians (primary research). Colleagues - Physicians acquire information through informal contacts with their colleagues, including social events, professional affiliations, common hospital affiliations, and common medical school affiliations. Wockhardt identifies influential colleagues through commercially available prescription writing and patient level data. Doctor dinner meetings are an effective way for physicians to acquire educational information from respected peers. These meetings are sponsored by some pharmaceutical companies.

b) Direct physician contact with pharmaceutical sales representatives

A Wockhardt representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200 physicians with 120 targets that should be visited in 1-2 week cycles. Because of the large size of the sales force, the organization, management, and measurement of effectiveness of the sales force are significant business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness. A few pharmaceutical companies have realized that training sales representatives on high science alone is not enough, especially when most products are similar in quality. Thus, training sales representatives on relationship selling techniques in addition to medical science and product knowledge, can make a difference in sales force effectiveness. Specialist

~ 17 ~

physicians are relying more and more on specialty sales reps for product information, because they are more knowledgeable than primary care reps.

c)

Physician Targeting

Marketers attempt to identify the universe of physicians most likely to prescribe a given drug. Historically, this was done by measuring the number of total prescriptions (TRx) and new prescriptions (NRx) per week that each physician writes. This information is collected by commercial vendors. The physicians are then "deciled" into ten groups based on their writing patterns. Higher deciles are more aggressively targeted. Some pharmaceutical companies use additional information such as: Profitability of a prescription (script), Accessibility of the physician, Tendency of the physician to use the pharmaceutical company's drugs, Effect of managed care formularies on the ability of the physician to prescribe a drug, The adoption sequence of the physician (that is, how readily the physician adopts new drugs in place of older, established treatments), and The tendency of the physician to use a wide palette of drugs Influence that physicians have on their colleagues. .

d)

Opinion Leader Influence Mapping

Alternatives to segmenting physicians purely on the basis of prescribing do exist, and marketers can call upon strategic partners who specialize in delineating which characteristics of true opinion leadership, a physician does or does not possess. Such analyses can help guide marketers in how to optimize KOL engagements as bona fide advisors to a brand, and can help shape clinical development and clinical data publication plans for instance, ultimately advancing patient care. e)

Private and Public insurers

Public and private insurers affect the writing of prescriptions by physicians through formularies that restrict the number and types of drugs that the insurer will cover. Not only can the insurer affect drug sales by including or excluding a particular drug from a formulary, they can affect sales by tiering, or placing bureaucratic hurdles to prescribing certain drugs.

f)

Direct marketing to patients

Many patients will inquire about, or even demand to receive, a medication they have seen advertised on television. In the India, recent years have seen an increase in mass media advertisements for pharmaceuticals. Expenditures on direct-to-consumer (DTC pharmaceutical advertising) have more than quintupled in the last seven years since the FDA changed the guidelines, from $700 million in 1997 to more than $4.2 billion in 2005,

~ 18 ~

Prescription-products promotion
Promotional marketing strategies are impacted by factors such as product lifecycle stage, market position, disease area and competitive activity. The one constant factor is that physicians will ultimately have to write the prescription. Physicians have therefore been the focus of most marketing campaigns. But, today, the environment in which physicians are operating is changing and they are increasingly influenced by many different groups and individuals with a stake in the choice of treatment.

The changing environment impacting treatment decisions

Payers, reimbursement decision-makers and governments can all impact treatment availability and patient access. Nurses, pharmacists and other healthcare professionals can influence physician perceptions. Professional organizations developing treatment guidelines can influence best practice. Patient organizations can influence patients, governments and physicians. Retailers can interpret generic prescriptions and influence customers. Finally, patients, their families and caregivers, are becoming pro-actively involved in researching disease areas, learning about treatments and discussing options with their physicians. This changing environment means that marketing strategies cannot just focus on physicians rather they need to address the broader group now influencing treatment decisions.

Marketing strategies for influencers

Effectively navigating the influencer group needs in-depth, in-country market research. Each countrys healthcare system, legal and regulatory environment, culture and socio-economic differences will impact the influencer group. But research in the following areas will help to define, understand and target them effectively: Who are the influencers, what is their role and at what stage of the treatment decision process are they involved? What motivates each group? Which information channels do they routinely use? How do they like to be talked to? For example hypertension, morbidity and mortality may mean a lot to physicians, but to most influencers who are not medically trained high blood pressure may be more relevant.

Brands, not just drugs

Pharmaceutical products are no longer just drugs they are brands. Lipitor, Viagra, Prozac are all widely recognized pharmaceutical products that demonstrate the effectiveness of branding. Through a brand it is possible to communicate a promise, an essence, and aspiration. And, branding builds loyalty. In most cases brands are created by the global team, but local market strategies must continue to build upon this promise by carrying the brand through all elements of the marketing mix.

~ 19 ~

Anti Acne Drugs

Acne is the most widespread skin disorder in the world, according to statistics. Experts spend a lot of time doing research to determine how acne forms and how it is eliminated. Different treatments, medicines, and products have been produced to help control and eliminate this skin disorder. There exit about 7 different treatments that are used in prevention and elimination of acne. There are also much different products that use these treatments in one way or another. Some of these acne treatments that help to reduce or eliminate acne problems are: Accutane, antibiotics, Benzoyl Peroxide, herbal remedies, Retin-A and Salicylic Acid, among others.

~ 20 ~

Accutane (Isotetinoin) is a powerful drug that is normally prescribed for severe acne in cases where other treatments have failed to work. It is normally taken for a 4-6-month period. Antibiotics were designed to fight bacteria. These are used to control acne mainly from the inside. Some topical antibiotics (clindamycin) are applied directly to the skin. Other antibiotics (tetracycline) are in pill form. Benzoyl Peroxide is an anti-bacterial agent that has been used to control acne for many years. It has been proven to work very well in the elimination and prevention of acne. Herbal Remedies are a relative newcomer to mainstream acne fighting. It is thought that certain herbs are effective in regulating oil levels and other bodily functions that are part of acne. Retin-A (tretinoin) is a combination of retinoic acid and vitamin A acid. It was designed to treat acne, sun damage, and wrinkles. It unplugs follicles and turnovers over dead skin cells. Salicylic acid helps to slow down the shedding of cells inside the follicle and it is available in many treatments purchasable without a doctor's prescription.

Table 1 : Anti Acne Details

Medication Type

Products Acne-aid bar Acnederm Facewash Clean & Clear Clearsil Clean skin

Source

Mechanism of Action

Type of Acne

Salicyclic Acid Sulphur Teatree Oil

OTC

Remove blackheads & whiteheads Antibacterial

Minimal

~ 21 ~

Benzoyl Peroxide Adapalene Topical Isotretinoin Retinoic Acid Topical Antibiotics Oral AntiAndrogen Hormone Therapy

Benzac AC Clearsil Oxy Panoxyl Brevoxyl Differin Retin-A Isotrex Stieva-A Clindatech Clindamycin 1% Soln Androcur Dianne Doxycycline Tetracycline Erythromycin Sulphonamides Minocycline Accure Roaccutane

OTC

Antibacterial Anti-inflammatory

Mild

Prescriptio n only Prescriptio n only Prescriptio n only

Remove blackheads & whiteheads

Mild, Moderate Mild, Moderate Moderate in females only

Anti bacterial Reduce sebum secretion

Oral Antibiotics Oral Retinoids

Prescriptio n only Dermatolo gist Only

Antibacterial Anti-inflammatory Reduce sebum secretion

Moderate, severe Severe

Research Methodology
Research can be defined as the careful investigation or inquiry especially through search for new facts in any branch of knowledge. Market research is a systematic and objective study of problems pertaining to the marketing of goods and services. It is not restricted to any particular area of marketing but is applicable to all its phases and aspects. In other words it is the function

~ 22 ~

that links the customer and the general public that comes under the purview of the target audience. Objective of Study To know prescription behavior/habits of the Doctors for antibiotics azithromycin in Noida region. To find out the most selling drug in the market regarding with antibiotics. To find out the prospective doctors for the company on the basis of their prescription habit. To find out the whether the chemist are aware about these salt or not? To find out whether tablets are prescribed more than liquids among patients?

METHODOLOGY: Research Design The research design is exploratory in nature. A questionnaire was prepared and distributed to retailers. The users profile is based on the results of a questionnaire that the users complete. Sources of Data Collection Primary Data - Data were collected through survey in whole Noida region. Secondary Data Internet, Articles, Newspapers, Sample Design - Judgmental and Convenient Sampling. Sample Size : 152 retailers Sample Place : Noida(U.P.)

Field Work
The data collection is through the response of questionnaire and personal interviewing. Even through personal interviewing is time consuming process as compared to other methods

~ 23 ~

available. The chance of getting more accurate results is more than that of other methods. The questionnaire constituted closed ended questions. The data collection was over a period of 60 days. The delay was due to the fact that data collection was on shop-to-shop personal interview basis. Date collection efforts were carried out from:11: 00 A.M. to 6:00 P.M. Precautions: Following of right respondent Following the right sequencing of question.

~ 24 ~

Figure 3: Retailers Density in Merrut.

~ 25 ~

Table 2: Azithomycin Brands

Azithromycin Brands Azithral Azilide Azee Aziresp Zathrin Azicure Zeethrom Zady Azitus Azuma Aziwok Zither Zithium Zithromax Azibact Azopan

Table 3: Anti Acne Brands

Anti-Acne AB Gel Aclin Gel Acnelak Acnesol Gel Acnicin Benzoic AC Betnovate Caladryl Cicilac Cream

Brands Eraser Erytop Etaze Faceclea nA Melacare Nadibact No-Marks Oracel Pernox Gel Persol Clean 3 Gel Clean Gel Purepen Cleana Retin-A Clear Gel Retino AC Clindac A Revoxyl Clinguard Smile Gel Clinicsa Sofrodex Deriva C Sorfil-S Ultraclear Differin Gel sil

~ 26 ~

Emadol Lotion

Ultravex

Figure 4: Azithromycin market share

~ 27 ~

Data Analysis & Interpretation Questionnaire for Chemist Name of the medical store:Chemists Name:Address:Ph. No. :-

Q1. Do you keep Antibiotics (Nadifloxacin and Azithromycin) medicine in your shop? (a) Yes 85% (b) No 15%

Q2. Which are the major companies in this market? 1.cipla 30% 2.glenmark 27% ~ 28 ~

3.Dr. Reddy 15% 4.wockhardt 28%

Q3 The availibilty of (Nadifloxacin and Azithromycin) medicine of different companies ? Company Yes Wockhardt 76% Glenmark 73% Cipla 81% Pfizer 67%

~ 29 ~

Q4 The price of wockhardt for above medicine is competitive with other companies? If NO than what price? (a) Yes 73% (b) No 27%

Price

~ 30 ~

Q5 Are the anti acne cream sold as OTC product or major on prescription.? Yes 80% no 20%

Q6 Expectations from the company Distributor/Sales force (Tangible/NonTangible)? Tangible 69% Non-Tangible 31%

~ 31 ~

Questionnaire for Doctors

1. Percentage of prescription for Anti Acne? CREAM85% TABLET15%

2. Percentage of prescription for Anti-acne and Azithromycin ?

ANTI-ACNE CHILD (Age upto 18) ADULT (age upto 40) ELDER (Age upto 60)

AZITHROMYCIN 45.. % 33 % 22.% 34% 42% 34%

~ 32 ~

3. Which are the important factors for prescribing these medicine? 1. Formulation 2. Availability 3. Price 4. Packaging 5. Field force 6. Promotional material ~ 33 ~

Descriptives

Descriptive Statistics N Formulation Availability Price Fieldforce Promotion Packaging Valid N (listwise) 145 145 145 145 145 145 145 Minimum 0 0 0 0 0 0 Maximum 1 1 1 1 1 1 Mean .42 .51 .68 .55 .50 .61 Std. Deviation .495 .502 .470 .499 .502 .489

Crosstabs

Case Processing Summary Cases Valid N Formulation * Price * Promotion Formulation * Price * Fieldforce Formulation * Packaging * Promotion Formulation * Packaging * Fieldforce Availability * Price * Promotion Availability * Price * Fieldforce Availability * Packaging * Promotion Availability * Packaging * Fieldforce 145 Percent 92.9% N 11 Missing Percent 7.1% N 156 Total Percent 100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

145

92.9%

11

7.1%

156

100.0%

~ 34 ~

Formulation * Price * Promotion Crosstabulation Count Price Promotion 0 Formulation 0 1 Total 1 Formulation 0 1 Total 0 10 0 10 29 8 37 1 27 35 62 18 18 36 Total 37 35 72 47 26 73

Formulation * Price * Fieldforce Crosstabulation Count Price Fieldforce 0 Formulation 0 1 Total 1 Formulation 0 1 Total 0 18 0 18 21 8 29 1 27 20 47 18 33 51 Total 45 20 65 39 41 80

~ 35 ~

Formulation * Packaging * Promotion Crosstabulation Count Packaging Promotion 0 Formulation 0 1 Total 1 Formulation 0 1 Total 0 11 17 28 13 15 28 1 26 18 44 34 11 45 Total 37 35 72 47 26 73

Formulation * Packaging * Fieldforce Crosstabulation Count Packaging Fieldforce 0 Formulation 0 1 Total 1 Formulation 0 1 Total 0 12 11 23 12 21 33 1 33 9 42 27 20 47 Total 45 20 65 39 41 80

Availability * Price * Promotion Crosstabulation Count Price Promotion 0 Availability 0 1 Total 1 Availability 0 1 Total 0 10 0 10 21 16 37 1 30 32 62 10 26 36 Total 40 32 72 31 42 73

~ 36 ~

Availability * Price * Fieldforce Crosstabulation Count Price Fieldforce 0 Availability 0 1 Total 1 Availability 0 1 Total 0 10 8 18 21 8 29 1 22 25 47 18 33 51 Total 32 33 65 39 41 80

Availability * Packaging * Promotion Crosstabulation Count Packaging Promotion 0 Availability 0 1 Total 1 Availability 0 1 Total 0 18 10 28 12 16 28 1 22 22 44 19 26 45 Total 40 32 72 31 42 73

~ 37 ~

Availability * Packaging * Fieldforce Crosstabulation Count Packaging Fieldforce 0 Availability 0 1 Total 1 Availability 0 1 Total 0 13 10 23 17 16 33 1 19 23 42 22 25 47 Total 32 33 65 39 41 80

4. Which Company offers best Availability and Professionalism of company representative? (Tick Any) WOCKHARDT CIPLA PFIZER GLENMARK Dr. REDDY ~ 38 ~

In this hypothesis Wockhardt is compared with its competitor brands on the bases of Availability and Professionalism of company representative.. SOLUTION: Ho: 1 = 2 = 3 NULL HYPOTHESES No difference among ranking given by people to different brands. H1: 1, 2 and 3 are not all equal ALTERNATE HYPOTHESES Significant difference among ranking, given by people to different brands.

Anova: Single Factor SUMMARY Groups Wockhardt Cipla Pfizer Glenmark Dr. Reddy ANOVA ~ 39 ~ Count 215 215 215 215 215 Sum 53 59 34 38 29 Average Variance 0.246511 0.1866116 6 1 0.274418 0.2000434 6 7 0.158139 5 0.13375353 0.176744 0.1461856 2 1 0.134883 0.1172353 7 8

Source of Variation Between Groups Within Groups Total

SS 3.05674 4 167.7395 170.7963

df 4 1070 1074

MS

0.764186 4.87469499 0.156765 9

P-value 0.00067 3

F crit 2.38024 8

As the value of F >F crit so the null hypothesis is rejected. It can be seen from the above table that there is a significant difference between the ratings received by different brands.

~ 40 ~

Recommendation & Conclusion

Wockhardt play a vital role in healthcare. They invest tremendous amounts of money in research, development and marketing. It is through marketing, that healthcare providers and patients can be influenced into prescribing or wanting these medications. Whether deliberate or not, they develop a type of quid pro quo understanding which may not represent innocent business practices all the time. Several aspects of healthcare are driven by financial gain, and boundaries must be set on all levels when the welfare of patients and professionals are at stake. Wockhardt providers must uphold the fiduciary relationship they have with patients and be held to a higher standard in earning the trust and confidence of others while avoiding conflicts of interest. There are programs and organizations that have taken proactive steps toward limiting the amounts of influence pharmaceutical companies may have. Further research may be required to understand exactly how much influence and to what degree this issue extends. Designing an Effective Personal Selling Strategy A personal selling strategy works best for a complex, technical, unique, customized product with a poorly informed client. That's why our multimillion dollar electronic imaging product is perfect. It's so complex and technical you need a trained, informed person to explain it to its highly specialized customer. It's likely to have to be customized for each individual sale, and its client doesn't have the time to read up on all the different ones on the market and why yours is better (and is thus uninformed). To address all of these unique needs, you have to design your personal selling strategy to have three key elements: a knowledgeable salesperson or sales team, an understanding of your client, and a sales structure designed to give the salesperson enough power to make an irregular sale but still get rewarded for it.

~ 41 ~

The Salesperson The salesperson is the key to your personal sales strategy. So when you're recruiting salespeople, you should be willing to recruit the best and expect to pay them a premium. There are two routes you can follow: You can hire someone with a good sales background and teach them about the science (or product); or you can hire someone with a good scientific background and teach them about sales. Usually, the choice you make will depend on how complicated your product is and who your customers are. An electronic imaging product is likely to be pretty technical, and your customer will likely be a doctor or a scientist, so you'll want a scientist to be your salesperson, both for credibility reasons and to give the customer what they're looking for. If the person buying your product is a hospital administrator, you might think about hiring someone with sales experience instead, because the administrator will be used to buying from nontechnical people and will likely be more bottom-line oriented. The salesperson is your only link to the client. This means that they need to know the product inside and out, so that when the customer has a question or an issue with the product, it can be addressed immediately and not shuffled off to another staff person. They also need to know the competitors' products, so they can give accurate representations of why your imaging technology is better. So to allow the salesperson to do their job well, you need to give them lots of information. You also need to give your sales force considerable power. Power to make a deal. Power to say "yes" to needed product customizations. And, of course, the power to say "no" to a deal that won't make the company money. Remember, also, that the salesperson is more than just a sales agent: They're a research and development tool. Their interactions with customers give you more information about what modifications need to be done to your product than any other source. They're market intelligence (because they know what other products are being sold, and why) as well as a way of making your own product more customer-oriented. The Client Throughout the marketing section, we've used the phrase "Know your client." It's just as important here as anywhere else. By understanding what your client needs in a product, you can better give the salesperson the tools they can use to fulfill that need. By understanding what a customer wants in a salesperson, you can tune your sales team to be just that. Do they want a half-hour presentation or just a 12-second pitch? A customized product they help design (and maybe write a paper on) or a ready-to-use product, in their lab, tomorrow? Or maybe the

~ 42 ~

purchaser isn't the user at all: A hospital administrator makes the purchase decision, and a doctor uses the machine. Understanding this will help keep you from wasting salesperson time on selling the machine to the doctor, who's not authorized to buy it anyway.

The Sales Structure Remember: In a personal selling strategy, your salesperson is your best friend. But, depending on the system you've set up for them, that person can also be your worst enemy. Determining an appropriate incentive system for a sales force can be the most difficult job you'll have as a business person. The key is to keep your sales force motivated, without any loopholes that they can use to take advantage of the system. For example: By giving quarterly sales quota-based bonuses but also giving the salesperson the authority to make big discounts, chances are, you're going to get a lot of sales late in the quarter (as the salesperson desperately tries to make their quota). But you'll also see a cost to those sales: Chances are, they'll be discounted quite significantly, affecting your company's profits. Determining a good incentive system for your sales force is very difficult and depends very much on what you're trying to do and the product you're trying to sell. You can reward the sales team based on short-term sales goals, long-term sales, repeat sales, customer support, number of new prospects, under budgeted expense reports, or a whole lot of other things, but chances are, you'll have to fine tune this structure as your business evolves, to emphasize what you want your sales force to do. Above all else, remember that your sales force isn't stupid and that they spend about as much time thinking about their paycheck as they do trying to sell your product, so the incentive structure you design will determine the behavior your customer sees. As per looking all the aspect which are discussed above I have got view of all the promotional strategy and the can be used how these strategy useful of the marketing the product of the company From global to regional to local The pharmaceutical industry is globally driven. Diseases and epidemics are global and prescription products designed to treat them are necessarily researched and developed by central teams, although it should be noted that clinical trials are being carried out and the drugs themselves being manufactured in the region. Global marketing teams are also tasked with developing the business plans and strategies that include marketing elements such as product proposition, branding and pricing parameters. Of

~ 43 ~

the four marketing Ps (product, price, place and promotion), this essentially leaves local marketers with Place and Promotion to strategize. But, pharmaceutical product distribution channels are generally consistent for all companies within each market so promotion is the avenue where marketers can truly have an impact in the local market setting.

Prescription-products promotion Promotional marketing strategies are impacted by factors such as product lifecycle stage, market position, disease area and competitive activity. The one constant factor is that physicians will ultimately have to write the prescription. Physicians have therefore been the focus of most marketing campaigns. But, today, the environment in which physicians are operating is changing and they are increasingly influenced by many different groups and individuals with a stake in the choice of treatment. The changing environment impacting treatment decisions Payers, reimbursement decision-makers and governments can all impact treatment availability and patient access. Nurses, pharmacists and other healthcare professionals can influence physician perceptions. Professional organizations developing treatment guidelines can influence best practice. Patient organizations can influence patients, governments and physicians. Retailers can interpret generic prescriptions and influence customers. Finally, patients, their families and caregivers, are becoming pro-actively involved in researching disease areas, learning about treatments and discussing options with their physicians. This changing environment means that marketing strategies cannot just focus on physicians rather they need to address the broader group now influencing treatment decisions. Strategies for influencers Effectively navigating the influencer group needs in-depth, in-country market research. Each countrys healthcare system, legal and regulatory environment, culture and socio-economic differences will impact the influencer group. But research in the following areas will help to define, understand and target them effectively: Who are the influencers, what is their role and at what stage of the treatment decision process are they involved? What motivates each group? Which information channels do they routinely use?

~ 44 ~

How do they like to be talked to? For example hypertension, morbidity and mortality may mean a lot to physicians, but to most influencers who are not medically trained high blood pressure may be more relevant. Brands, not just drugs Pharmaceutical products are no longer just drugs they are brands. Lipitor, Viagra, Prozac are all widely recognized pharmaceutical products that demonstrate the effectiveness of branding. Through a brand it is possible to communicate a promise, an essence, and aspiration. And, branding builds loyalty. In most cases brands are created by the global team, but local market strategies must continue to build upon this promise by carrying the brand through all elements of the marketing mix. Prescription products in the consumer world Prescription products are no longer the domain of physicians and healthcare professionals. Many who influence treatment decisions are not medically trained and prescription products must now be positioned within a wider consumer environment. This is, however, at odds with the legal restrictions around the promotion of products as consumer marketing and direct to consumer activities are still prohibited in much of the world the US being the obvious exception. The challenge is that prescription product information is already available to the general public in the majority of countries. This is mainly due to globalization of the worlds media and accessibility of the Internet through which information from the US is shared. Availability of this information is not going to change, we cant turn the look back, but pharmaceutical companies can develop strategies that support educational initiatives by other organizations and ensure accurate information is in the public domain. The power of the media Consumer media, such as newspapers, magazines, radio and television, reach millions of people throughout Asia on a daily basis and the media is increasingly interested in reporting on disease trends, drug developments and pharmaceutical company activities. With the increasing level of media interest, it is necessary to develop both proactive and reactive media strategies to ensure that accurate information is reaching the right people at the right time. Pharmaceutical companies can particularly play a role in educating journalists about diseases and treatment options. In Asia, there are fewer healthcare-specific journalists, but this does not make the media any less influential. This knowledge gap provides a real opportunity. The Internet explosion

~ 45 ~

One billion people use the Internet and Asia accounts for the largest percentage of these users 36 percent. Without a doubt, the Internet is readily available, much used and a major source of healthcare information. Patients sitting anywhere in the world can find out about their disease and treatment options. Not all information, however, is equal. Many sites are inaccurate and it is prudent for companies to develop Internet strategies and alliances that direct patients and physicians to credible websites with accurate information. And, as if websites werent enough, blogging now adds another dimension to the online patient experience. Patient empowerment Patient organizations are growing in number across Asia in many disease areas. These groups represent patients interests in many ways, be it providing disease and treatment information to individuals or representing patient perspectives in the media, with governments or physicians. These groups, however, need funding and this comes from a variety of sources, including the pharmaceutical industry. As a minimum, companies should work with third party organizations to ensure that the information they are providing patients about treatment options is accurate. But, more effective partnerships can be developed when common areas of focus between company and organization marketing strategies can be identified and cosponsored programs conducted. Back to the industry-physician relationships Against this backdrop of increasing influence, interference and awareness physicians still need to be in a position to treat patients with the best available medical care. Ultimately, the prescription they write is their decision and unless that situation changes, physicians must remain at the heart of prescription- product marketing. Marketing to physicians is not new, but the interaction and co-dependent relationship between industry and physicians is complicated, often criticized and has raised ethical concerns within the profession. But while physicians need new products to treat their patients and pharmaceutical companies are able to develop such products, the two groups will need to interact. Pharmaceutical companies and physicians do interact frequently and in a number of ways sales representative visits, medical conference attendance, research funding, speaker engagements and continued medical education (CME) funding, to name a few. These tactics, however, need to be part of an overall strategic approach that can be determined by gaining a greater understanding of physician attitudes, beliefs, needs, motivators, prescribing habits and preferred information channels through research.

~ 46 ~

Sales representatives will remain the most important vehicle for communicating with physicians - they are the face of the company and are able to provide individualized information that drives prescriptions. Much has been written about sales force effectiveness too much to cover here - but marketing teams can support their representatives by implementing strategies that create an environment that removes potential prescribing barriers and surrounds physicians with positive product reinforcement.

REFERENCES

Books Pharmaceutical Sales Force Strategies by By Steven Seget Pharmaceutical Marketing by Dimitris Dogramatzis

Internet The Pharmaceutical market research company data http://www.imshealth.com/ http://www.orgims.co.in/ http://www.aiocdawacs.com/ Wockhardt website http://www.wockhardtin.com/ Indian Pharmaceutical Industry KPMG Report http://www.in.kpmg.com/pdf/Indian%20pharma%20outlook.pdf http://en.wikipedia.org/wiki/Pharmaceuticals_in_India

~ 47 ~