Promotion of Pharmaceutical Product & its Impact on
Patient Level Activity:
With Reference to Merck Ltd. in Indore Division


By

Mr. Nitin Kothari
Product Manager
McW Health Care Pvt. Ltd. Indore

Mr. Upendra Singh Panwar
Asst. Professor
Ms. Prachi Sharma
Asst. Professor
Dr. Punit K. Dwivedi
Sr.Lecturer
Modern Institute of Professional Studies
Indore
 


Overview:- Pharmaceutical Industry is one of the most intense knowledge driven industry, which is continuously in a state of dynamic transition. Currently, India's largest selling medicines are anti-infective agents, but the fast growing areas are the lifestyle-related diseases, the foreign multinational companies will benefit from selling innovative treatments for these conditions.

With increasing prevalence of diseases of aging and lifestyle-related diseases associated with greater affluence, India's pharmaceutical market will continue to increase steadily in sales value from 2008 onwards. Furthermore, with rapid increase in drug resistance for anti-infective agents like Anti-TB, Anti-malarial and other Antibiotics, there will be a particularly strong market for most types of pharmaceutical agents –both new and established - from 2008 to 2023.

Indian pharmaceutical industry is climbing up the value chain from bringing a pure reverse engineering industry focus on domestic market. The industry is moving towards basic research driven expert oriented global presence and providing wide range of value added quality product and services.

In order to remain in the competitive industry, given the changes and challenges, pharmaceutical companies need to identify new competitive advantages to succeed.

Company Overview: Merck is a global pharmaceutical and chemical company with total revenues of € 7.1 billion in 2007, a history that began in 1668, and a future shaped by 31,681 employees in 60 countries. Its success is characterized by innovations from entrepreneurial employees. Merck's operating activities come under the umbrella of Merck KGaA, in which the Merck family holds an approximately 70% interest and free shareholders own the remaining approximately 30%. In 1917 the U.S. subsidiary Merck & Co. was expropriated and has been an independent company ever since.

WHO Estimations: The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030. Almost 80% of diabetes deaths occur in low and middle-income countries. Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women. In relation to this prevalence of diabetic neuropathy has been found through Diabetic Neuropathy Arrest (DNA) programme which is almost 65% in contrast to data available of 50%.The programme was done under specialty division of Merck Serono at Indore (M.P.).

WHO Estimation of prevalence of diabetes worldwide:-

Table No.1     Estimation of diabetes

  Geographic

2000

2030

World

171,000,000

366,000,000

India

31,705,000

79,441,000

China

20800000

42300000


Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcer and eventual limb amputation.

Objectives of Study:

1. To analyze the Effect of camps (Patient level activity) on sales of product.
2. To see effect of patient level activity on relationship with physicians.
3. To do market and competitor study through survey in physicians and chemists.  .
4. To study the market potential of neuropathy drugs through prevalence rate of diabetic peripheral neuropathy in diabetic patients.

The Study:

Product – Met-neurobion OD

Forms Available- Soft Gelatin Capsule and Injection

Active Ingredient – Methylcobalamin (1.5 mg) + Alpha lipoic acid (300mg)

Diagnosing Machine Used – Biothesiometer (Vibrometer)

Use – It is used in treatment of diabetic peripheral neuropathy.

To see impact of patient level activity on product sale, the ideal study would be to use data on actual prescribing before and after documented exposure to promotion whilst keeping other influences on prescribing constant. In this report there was a robust growth found in sales of product.

The report also include market and competitor study through survey among chemists which shows that small company's brands are moving due to high commission and low price. In Pharma marketing where funding, gifts, sponsorships, conferences trend is on high this type of patient level activity will bring a change in market on ethical ground.

Consumer-oriented promotion in form of patient level activity is a profitable approach as we have seen growth in sales of Met-neurobion OD in two months of activity. The Pharma Marketing is a persuasive phenomenon in which you have to give physician a reason to prescribe. Physicians have accepted the importance of patient level activity because it brings awareness in patients and helps in treatment. The activity has also helped in strong relation building between sales force and physicians.

The product is having support of strong neurobion group and dedicated sales force with proper marketing strategies. There are opportunities for product due to increase in lifestyle diseases particularly in India since awareness level of patients are increasing with high disposable income and insurance policies. Although, it is having some threats from low priced products and non ethical promotions.

The research recommended continuous patient level activity by sales force at least once in month. It was advised by physicians also during discussion. It will help sales force to make better and stronger relationship with physicians. The activity will help them for sales of overall product mix.

The number of diabetic patients is highest in India so it is a potential market for diabetic products. Major population of India resides in rural areas where awareness level about diabetes and its complications is very low. In order to this Patient level activity in rural area will not only bring awareness among large population; it will help in covering untapped market.

Company Overview: Merck is a global pharmaceutical and chemical company with total revenues of € 7.1 billion in 2007, a history that began in 1668, and a future shaped by 31,681 employees in 60 countries. Its success is characterized by innovations from entrepreneurial employees. Merck's operating activities come under the umbrella of Merck KGaA, in which the Merck family holds an approximately 70% interest and free shareholders own the remaining approximately 30%. In 1917 the U.S. subsidiary Merck & Co. was expropriated and has been an independent company ever since.

The Portfolio:

Pharmaceuticals: Merck India's pharmaceuticals business comprises two divisions, viz. Ethicals (Merck Serono) and Consumer Healthcare (CHC). Together, their products cover various therapeutic segments, like :-

Antibiotics ,Anti-malarials ,Cardiologicals (Concor) ,Cough & cold formulations (Nasivion), Dermatologicals (Evion Cream) ,Haematinics (Livogen) , Non-steroidal anti-inflammatory drugs (NSAID) ,Neurologicals, Oncologicals (Erbitux, UFT) ,ORS (Electrobion) ,Vitamins (Evion, Neurobion, Polybion)

 Chemicals: The Company's chemicals business in India comprises the Performance & Life Science Division, which focuses on high-quality and innovative products for technically demanding applications in R&D, quality control and healthcare laboratories. They include:-

Reagents, Biosciences & Chromatography products, Food & Water Analysis and Microbiology products, Pharmaceutical Raw Material and Bulk Chemicals , Specialty Pigments , Laboratory Glassware ,Diagnostics.

Research Methodology

The research carried out is "applied" type of research. It is a mix of descriptive and exploratory research study. The Diabetic neuropathy arrest programme and impact study is a qualitative exploratory research. On the other hand survey and market potential study is a quantitative descriptive research.  

Source of data collection

For study of the impact of patient level activity on sales the Diabetic neuropathy arrest (DNA) programme was performed. Secondary data related to sales   generated in particular months was collected from stockist. The Primary data was collected from retailer/chemist nearby clinic.

To study the market potential for neuropathy drug primary data was collected through Diabetic Neuropathy Arrest programme. In which 54 free check-up camps had been done by me in two month duration.

To assess market and competitors the primary data was collected for which survey was undertaken with retailers. The data was collected from different area of Indore.

For analyzing effect of patient related activity on relationship with doctor the media was observation and discussion with sales force. 

Sample Design

The Diabetic Neuropathy Arrest programme was performed on clinic of 13 physicians as directed by area sales force. The number of camps performed was 53 in which 254 patients had been checked by me.

* Sample unit- Doctor's clinic (13),53 camps
* Sampling frame- Diabetic patients
* Sample size- 254.patients

To do market study 25 chemist shops were chosen by simple random sampling for survey.

Research Instrument

The Diabetic neuropathy arrest programme was itself a research instrument to see impact of patient level activity on Pharma product promotion. We observed changes that occurred before, during and after promotional activity. Drug promotion can take on many forms. Overt ways of plugging new product lines are common place, but we are increasingly seeing more subtle, inconspicuous forms of promotion. On the face of it, these methods might not seem to be promoting a product at all.

Survey is one of the most important tools of measurement in applied social research. The broad area of survey research encompasses any measurement procedures that involve asking questions of respondents. For survey a set of structured questions were prepared for chemists. A set of 5 questions related to movement, offer, and competitor was prepared for chemists. The questions for chemists were open ended to get insight of market thoroughly. 

In set of question for doctor the four questions were asked about efficacy, prevalence   and preference. Four questions were asked on his opinion and feedback for camps. One question was about rating of Met-Neurobion OD and other one was open ended question on other drugs in diabetic neuropathy.

In set of question for chemists the first two questions was asked brand leader and movement of brands. Third question was related to offer chemist getting from companies and fourth was for rating of Met-Neurobion OD in market. Fifth question was about injectable brand movement in neuropathy segment and last one was about prescription selling.

To study the impact on relationship with doctors the discussion with area sales force was research instrument. In this discussion we have asked sales force to give information regarding change in doctor's response to their calls after and during promotional activity. The discussion with physicians during patient level activity in which they used to   give their feedback about activity was also one of the research instruments.

Analysis:-

To see impact of patient level activity on product sale, the ideal study would be to use data on actual prescribing before and after documented exposure to promotion     whilst keeping other influences on prescribing constant. The number of prescription generated in result of activity is almost 90-92 which was calculated in relation to free sample distributed. The data collected from stockist of secondary sales generated in months of March, April and May are as follows:

Figure No. 1


Table No. 2   Sales figures

Month/
Brand

March

April

May

Met-Neurobion OD

90 Boxes

106 Boxes

138 Boxes


The data clearly indicate that there is robust increase for sales of Met-Neurobion OD in month of April and May. The growth in percentage is 17.77% and 30.18% in month of April and may respectively. If we evaluate on the basis of before and after activity than there is tremendous increase in sales of Met-neurobion OD with the 53.33 % up to May end only. The number of camps as patient level activity was 53 up to Mid June. To analyze the market potential through prevalence rate study the "Diabetic neuropathy arrest" programme was performed. The details of DNA programme is as follows:-    

Table No.3   Prevalence rate

     S.No.

Category

No. of Patient

Diabetic neuropathy Patient

Prevalence rate   %

1.

Total Patient

       254

     163

      64.17%

2.

Above 50 years

       177

     119

      67.23%

3.

Below 50 years

        77

       44

      57.14%

4.

Male Patient

       139

       93

      66.90%

5.

Female Patient

       115

       70

      60.86%

6.

Male above 50 years

        97

       66

      68.04%

7.

Female above 50 years

        80

       53

      66.25%

8.

Male below 50 years

        42

       27

      64.28%

9.

Female below 50 years

        35

       17

      48.57%


The data collected shows that there is almost 65% prevalence rate of diabetic neuropathy patient in diabetic patient. It includes those patients also which have not done blood sugar test but having symptoms of diabetic neuropathy. The prevalence of diabetic neuropathy is more in patients above 50 years in comparison to below 50 years. It is higher in males in comparison to females. It shows difference with secondary data which tells that prevalence rate of diabetic neuropathy is 50% in diabetic patients.   In Diabetic neuropathy patients the severity of patient is as follows:-

Table No.4   Severity of Patients

Severity

    Severe

Moderate

Mild

Total Diabetic Neuropathy Patient

No. of Patient

    67 (41%)

24 (15%)

72 (44%)

163 (100%)


Out of total diabetic neuropathy patient 41% were severe, almost 15% were moderate and remaining 44% were mild. The data shows that almost 50% of diabetic neuropathy patient require urgent attention and treatment to secure them from diabetic foot or amputation.

If we generalize the above data to all diabetic patient of India only we will get a rough picture of diabetic neuropathy patients require attention.

According to data published by WHO for estimation of diabetic patients in 2030 there will be almost 50 million diabetic patients in 2010 in India. As per our study there will be almost 32 million diabetic neuropathy patients in which 16 million will be in severe or moderate condition.

If the basis of data collection is survey, the research analysis involves estimating the values of unknown parameters of the population and testing of hypothesis for drawing interferences. Hence analysis is classified as Descriptive and Statistical analysis.

Suggestions and recommendation

1. There should be continuous patient level activity by sales force at least once in month. It was advised by physicians also during discussion. It will help sales force to make better and stronger relationship with physicians. The activity will help them for sales of overall product mix.

2. There should be a campaign to differentiate product from old products that will help to make a brand image of product itself. With patient level activity there should be strong back up of reasonable and ethical promotion.

3. On price front if possible there should be consideration since there is flood of low priced products in market.

4. Patient level activity can be performed on high level with pre planning and proper advertisement of activity. There is correlation between blood sugar level, number of year with diabetes and diabetic neuropathy. So there should be blood sugar monitoring also during patient level activity.

5. The number of diabetic patients is highest in India so it is a potential market for our product. Major population of India resides in rural areas where awareness is not high about diabetes and its complications. Patient level activity in rural area will not only bring awareness among large number population, it will help in covering untapped market.

Limitations of the Study

1. To fulfill our objective of studying impact of patient level activity we had only one approach of observing the changes before and after activity. It would be more accurate and reliable if some factor could be considered like other promotional tools, calls to doctors, etc.

2. There was not a single mathematical method to study impact of activity on product promotion besides one econometric model which is very difficult to interpret for non econometricians.

3. During activity sometimes it had been seen that patients were reluctant to get check up due to fear of diagnosed as a diabetic neuropathy patient.

4. We had limitation in case of performing camps to particular doctors only. It would have been much better if we had opportunity to plan camps with physicians.

5. The growth in sales figure is result of patient level activity and sales force working. It was difficult to make a documented effect of activity only because many times we were unable to see prescription. So we had to make calculation of prescription in relation to free samples distributed.

6. During activity if we had been told to cover some hospitals than we would be having large sample patients to calculate diabetic neuropathy prevalence rate.

7. We can not claim to generalize our data of impact on sales since the performance, relation and experience of sales force also matters which may be different for different areas.

8. In performing patient level activity we had little opportunity to learn management aspect of Pharma marketing, it would have been much better if we had more managerial learning.

9. There was very little information available in secondary sources about patient level activity being a new trend for product promotion.

10. As of scope for further study there is good opportunity to perform in case of making a mathematical model which include all variable factors like season, sales force performance etc.

11. For studying particularly impact of patient level activity in Pharma marketing and its welfare aspect should be studied thoroughly.

References:

* Madhavan, S.Amonkar, M.M. Elliott, D.Burke, K.Gore, P. The gift relationship between pharmaceutical companies and physicians: an exploratory survey of physicians. Journal of Clinical Pharmacy and Therapeutics 1997; 22:207-215.

* Palmisano, Paul. Edelstein, Joan.  Teaching drug promotion  abuses to health profession students. Journal of Medical Education 1980; 55:453-455

* Pitt, Leyland. Nel, Deon. Pharmaceutical promotion toolsĄtheir relative importance. European Journal of Marketing 1988; 22-:714.

* Petroshius, Susan M. Titus, Philip A. Hatch, Kathryn J. Physician attitudes toward pharmaceutical advertising. Journal of Advertising Research 1995; 35:451.

* Advertising of prescription drugs in Canada: its potential effect on patient physician interaction. Journal of Pharmaceutical Marketing & Management 1997; 12:1-21.

* Rockwell,Tom. The Lifetime experience with prescription drug advertising exposed to consumers. Journal of Pharmaceutical Marketing & Management 1986; 1:1318.

* Dwivedi, Amit Kumar & Dwivedi, Punit Kumar, Global Mergers & acquisitions Special reference to pharma industry Faculty Column, IndianMBA.com
 


Mr. Nitin Kothari
Product Manager
McW Health Care Pvt. Ltd. Indore

Mr. Upendra Singh Panwar
Asst. Professor
Ms. Prachi Sharma
Asst. Professor
Dr. Punit K. Dwivedi
Sr.Lecturer
Modern Institute of Professional Studies
Indore
 

Source: E-mail November 1, 2010

          

Articles No. 1-99 / Articles No. 100-199 / Articles No. 200-299 / Articles No. 300-399 / Articles No. 400-499 / Articles No. 500-599
Articles No. 600-699 / Articles No. 700-799 / Articles No. 800-899 / Articles No. 900-1000 / Articles No. 1001-1100
Articles No. 1101-1200 / Articles No. 1201 Onward / Faculty Column Main Page