The Case of ‘Ja’alee’ (spurious) Drugs – Pharma Marketing - Blog Post #286 by Asrar Qureshi

Dear Colleagues!  This is Pharma Veterans Blog Post #286. Pharma Veterans shares the wealth of knowledge and wisdom of Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. If you wish to share your stories, ideas and thoughts, please email to asrar@asrarqureshi.com for publishing your contributions here.

Continued from Previous……

Pharmaceutical companies have always relied on Marketing to introduce their drugs. Over time, marketing strategies and plans help to build big brands and contribute to the success and profitability of the company.

Following is a list of five top selling drugs worldwide based on last year sales.

1.     Humira (adalimumab) – by AbbVie – for Autoimmune Diseases – Sales 19.9 Billion USD

2.     Eliquis (apixaban) – by BMS/Pfizer – for cardiovascular Problem – Sales 9.8 Billion USD

3.     Revlimid (lenalidomide) – by Celgene – for Lymphomas – Sales 9.7 Billion USD

4.     Keytruda (pembrolizumab) – by Merck – for 11 types of cancer – Sales 7.1 Billion USD

5.     Enbrel (etanercept) – by Amgen/Pfizer – for Autoimmune Diseases – Sales 7.1 Billion USD

This was the picture worldwide. To put it in perspective, World Pharma market is touching one trillion (1000 Billion) USD.

Pakistan with 3 billion USD market is 0.003% of world market; may be a little more. However, Pakistan Pharma has its own Big Brands. Top 5 are given below.

1.     Augmentin (amoxiclav) – by GSK – for Infections – Sales 5.9 Billion PkR

2.     Risek (omeprazole) – by Getz – for acidity/ulcer – Sales 4.6 Billion PkR

3.     Panadol (paracetamol) – by GSK – for pain/fever – Sales 4.5 Billion PkR

4.     Brufen (ibuprofen) – by Abbott – for pain/inflammation – Sales 3.7 Billion PkR

5.     Humulin (human insulin) – by Lilly – for diabetes – Sales 3.1 Billion PkR

You can see that the Big Brands are really large. Such brands are also market drivers. Their growth influences market growth.

How did a single brand become so huge? This is Marketing.

Marketing is defined in many ways. It is taking mind-space; it is persuading to take a buying decision, and it is a process of communicating the value of a product or service through positioning to customers. Positioning is the perception a marketer wishes to build in the minds of customers.

Pharma Marketing is also a regulated area. Pharma companies are not allowed to advertise on public media; be it print, electronic and digital. The only exceptions are paracetamol and aspirin.

Pharma consumers are patients, but Pharma companies do not contact patients; they are not allowed to. Pharma customers are doctors. Most of the marketing is done for doctors; some for patient awareness.

Pharma marketing is aimed at the following areas. Each area has a specific contribution to brand building.

Providing Information – The largest component of marketing is to provide in-depth information. Typically, this role was performed by the MNCs. They still do it because they are the custodians of information. Local Pharma has also become active in this arena and many activities are designed to share information. These may include product presentations, seminars, symposia, round-table discussions, Continuous Medical Education (CME) programs and so on. Promotional folders are made regularly incorporating product information and citing clinical articles and trials.

Creating New Information – when a drug is approved for clinical use, it has limited information (and approval). Later, more clinical trials are organized. These trials are conducted by well-reputed institutional doctors. There are various designs and protocols. Trials are approved and supervised by Ethical Committees. Many international trials are multi-center and may be conducted across many countries. Large scale problems would have large clinical trials involving thousands of patients. Less common problems would have small trials. Most trials, major or minor’ are sponsored by Pharma companies. The benefit is four ways. The drug use is expanded into new indications; new options become available to doctors for treatment; the patients have better choices, hitherto unexplored information is revealed. Creating new information is critical to the longevity of a product.

Promoting Clinical Experience – most physicians are reluctant to rush to a new drug for prescribing it to patients. Few are daring and early adopters and use new drugs quickly. Pharma Marketers make strategies to facilitate clinical use of their new products. These may include seeding (bulk samples to be given free for patients), clinical Observation Projects, and/or becoming part of a larger trial. Clinical experience is important because there may be variations in response among various ethnic groups. For example, it was seen in the case of the blood pressure drugs belonging to ACEI class that the dose-response was different among whites and blacks.

Relation Building – the importance of customer relations is well established and well accepted. Marketing develops plans and activities which help in building relations with the customers. Relation building is done to support business; not as an altruistic activity. Marketing plans are executed through the sales teams which are working in the field. Pharma Selling is personal selling. It is done through person-to-person contact; not through mass campaigns and media advertising. It is also indirect selling. Doctors diagnose the medical condition and prescribe the required drug(s); patient purchases. Sale happens at patient level through doctor, hence indirect selling.

Pharma Marketing world over has been implicated in unethical and undesirable activities to build businesses. Pakistan is also included in the list. During the 44 years of my working, a lot has changed. General public in Pakistan is also quite wary of Pharma companies’ practices, even though they do not know a lot.

Owing to its scale and proportions, there is an international code which defines what can be done ethically and what cannot be done. Pharma Marketing activities can be broadly distributed among following heads.

·      Sponsorships for Attending Medical Conferences at Home or Abroad – it is a large area considering that every specialty is now holding their own conference at least once a year. Most of these are highly educational because the latest information is shared on these platforms. Due to educational value, it is permitted internationally to sponsor doctors for these conferences. Restrictions are that the families should not be sponsored, and leisure trips and shopping trips should not be included in the package. It is understandably a grey areas and things can and do happen.

·      Sponsorships for Organizing Medical Conferences at Home or Abroad – Organizing a conference is an expensive affair. Partly, the money is raised through selling registration to participants, but it is not enough. Pharma companies are asked to contribute and in return they get stall space where they showcase their products. It is a good activity for both as long as it stays on course, and conferences are not used to accumulate large amounts of unaccounted money.

·      Support for Enhancing Facilities for Patients – it is especially done in hospital setting and may include renovations, and installation of some needed equipment etc.

·      Gifts – there are guidelines as to what a reasonable gift may constitute. A decent pen or a good leather wallet set costing a few thousand rupees is a gift; and so is an air-conditioner or something of much higher value. It is the biggest grey area where anything ranging from cash to cars can happen. There can be no end to greed on either side and businessmen are known to have rather weak moral values system. It is well-nigh impossible to document and control this area.

The Pharma-Doctor equation is inevitable; one cannot work without the other. In the context of fake medicines, this equation does not support spurious drugs. No sane doctor would want to destroy his medical practice by giving fake drugs. Fake drugs are sold through other channels; not here, even with great relations.

Continued……