TM

MEDICINMAN
May 2015 | www.medicinman.net
Field Force Excellence
Since 2011

EDITORIAL

A SOCIAL
EXPERIMENT...
AND LESSONS FOR
PRODUCT LAUNCH.

“A
man sat at a metro station
in Washington DC and
started to play the violin;
it was a cold May morning. He played
six Bach pieces for about 45 minutes.
During that time, since it was rush hour,
it was calculated that 1,100 people went
through the station, most of them on
their way to work.
Three minutes went by, and a middle
aged man noticed there was musician
playing. He slowed his pace, and
stopped for a few seconds, and then
hurried up to meet his schedule.
A minute later, the violinist received
his first dollar tip: a woman threw the
money without stopping, and continued
to walk. A few minutes later, someone
leaned against the wall to listen to him,
but the man looked at his watch and
started to walk again. Clearly he was
late for work.
Editorial

The one who paid the most attention was a 3 year

Joshua Bell’s performance in a Boston subway was
mostly ignored by passersby
old boy. His mother tagged him along, hurried, but
the kid stopped to look at the violinist. Finally, the
mother pushed hard, and the child continued to walk,
turning his head all the time. This action was repeated
by several other children. All the parents, without
exception, forced them to move on.
In the 45 minutes the musician played, only 6 people
stopped and stayed for a while. About 20 gave him
money, but continued to walk their normal pace. He
collected $32. When he finished playing and silence
took over, no one noticed it. No one applauded, nor
was there any recognition.
No one knew this, but the violinist was Joshua Bell,
one of the most talented musicians in the world. He
had just played one of the most intricate pieces ever
written, on a violin worth $3.5 million dollars. Two days
before playing in the subway, Joshua Bell sold out full-
house at a theatre in Boston where the seats averaged
$100.
This is a true story. Joshua Bell playing incognito in the
metro station was organized by the Washington Post
as part of a social experiment about perception, taste,
and priorities of people.”
- The Washington Post
Lessons for Pharma: In today’s attention deficit
economy, you can have the best product and a
great story on the latest digital device in the hands
of a well trained field force, but if your don’t create
the right expectation in the minds of busy doctors
through a well thought out multi channel marketing
strategy that creates a pre launch expectation, your
product launch is likely to meet the fate of Joshua
Bell in the Washington DC metro station. -MM

Meet the Editor

Anup Soans is an Author, Facilitator and the
Editor of MedicinMan.
Write in to him: anupsoans@medicinman.net
Connect with Anup Soans on LinkedIn | Facebook | Twitter
 CONTENTS
(Click to navigate)
MedicinMan Volume 5 Issue 5 | April 2015
1. Doctor Profiling for Sales Success.....................4
Editor and Publisher
A Doctor Profile enables the Medical Rep to tailor-
Anup Soans
make his detailing approach to each Doctor,
ensuring sales success. CEO
Chhaya Sankath
RB Balakrishna
Chief Mentor
2. Using Gamification to Achieve a State of Flow
K. Hariram
while Learning..........................................................7
By turning learning into a game, learners enter into Editorial Board
a ‘state of flow’ - a condition where the ‘high’ of the Salil Kallianpur; Prof. Vivek Hattangadi; Shashin
Bodawala; Hanno Wolfram; Renie McClay
game makes learning a habit.
Executive Editor
Rajiv Jayaraman
Joshua Soans
3. The 3 ‘E’s of Sales Leadership: Engage,
Empower & Enable...............................................10
Letters to the Editor: anupsoans@medicinman.net
How to move from being mere sales ‘managers’ to
being sales ‘leaders’.

K. Hariram

4. Focus Feature: Brand Life Cycle Management

.................................................................................12

With few new chemical entities in the pipeline,

pharma companies will have devote more attention
to managing the life cycle of their brands to derive
maximum mileage from existing products.

Vivek Hattangadi

5. Lost Patients......................................................17

By ignoring the pharmacist, pharma companies

are losing out on meeting the health needs of many
Focus Feature
patients.

BRAND
LIFE CYCLE
MANAGEMENT

Vivek Hattangadi

PAGE 12
E
DOCTOR PROFILING
FOR SALES SUCCESS
A Doctor Profile enables the Medical Rep to tailor-make his detailing approach to
each Doctor, ensuring sales success.
RB Balakrishna
T
o assess the likelihood of a Doctor
prescribing any brand, the first and
foremost step for a Medical Rep is to
get acquainted with the Doctor’s profile. Pro-
filing helps the Medical Rep to concentrate
his marketing efforts, maximize the use of
limited resources, plan a competitor strategy,
understand the doctor and touch his heart,
and many more.
The idea behind physician profiling is to
have a different messaging strategy for each
physician. Most physicians are unwilling to
prescribe a new product until it has an estab-
lished post-marketing safety record. Medical
Reps spend one-fourth of their time detailing
new drugs to conservative physicians who
will never prescribe them within the first year
of launch. By targeting sales efforts and de-
tailing to early adopters, who are more likely
to prescribe a new drug, MRs can increase the
number of physicians who prescribe a new
drug. Physicians change their prescription
4 | MedicinMan May 2015
habits after targeted marketing.
Details of a doctor’s profile are dynamic and
a smart Medical Rep will tailor his commu-
nication constantly according to doctor’s
response. A friendly physician makes the
Medical Rep’s job easy, because he or she can
use the “friendship” to gain easy access to the
Doctor and drive prescriptions. Physicians,
who view the relationship as a straightfor-
ward means-of-prescriptions-exchange, must
be dealt with professionally. Sceptical doctors
who favor references and evidences must
be given reprints from the medical journals
and literature. Physicians, who refuse to see
Medical Reps, are detailed by proxy; their staff
is influenced in hopes that they will act as a
messenger for the Medical Rep’s message.
Medical Reps can use the profiling data to im-
prove call prioritization, decision-making and
time allocation, resulting in higher return on
investment from detailing and brand success
for the company.
RB Balakrishna | Doctor Profiling for Sales Success
Medical Reps can use the
profiling data to improve call
prioritization, decision-making
and time allocation, resulting
in higher return on investment
from detailing and brand
success for the company.
”
RB Balakrishna is an Area Manager with a
reputed pharmaceutical company
5 | MedicinMan May 2015
Prescribing data can be a tool used both to identify
high-prescribers and to track the effects of promo-
tions. Ensuring that physicians targeted for detailing
are both high prescribers and early adopters, im-
proves the probability of prescriptions. This cumu-
latively increases the total number of prescriptions
written for a drug, simply by identifying the right
physicians to detail. The benefits of profiling can be
translated directly into profit and growth. Meaning,
this growth is attained without additional investment
in the given territory.
Prescribing data can also be used to see how many of
a physician’s patients receive specific drugs, how many
prescriptions the physician writes for targeted and
competing drugs, and how a physician’s prescribing
habits change over time.
Even for a standard-detailing-visit promoting a mature
product, MRs must identify and document:
1. Which products the physician prefer to use and
when.
2. What their prescribing rate for different diseases
is and how quickly they adopt the use of new
products.
When a product launch approaches, Medical Reps
can consolidate the information recorded of specific
physicians to build a prescriber profile of the key phy-
sicians in their area.
Consider a Medical Rep who doesn’t know the profile
of the doctor whom he is about to meet. He or she
doesn’t know the preferences of the doctor and will
not be able to make an effective call. On the other
hand, a Medical Rep who knows the profile of the
doctor can even manage the time of visit and spend
more time in a given call and build relationship. The
probability of doctor prescribing the requested brand
increases significantly if the required specifics are
mentioned in the detailing.
Conclusion
Doctor’s profiling information improves:
ØØ The possibility of seeing the doctor,
ØØ The probability of doctor prescribing the brand
after detailing,
ØØ Number of prescriptions the doctor is likely to
write and thus
ØØ Number of new prescriptions gained through
detailing alone. -RB
CAREER PROGRESSION
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to gain the Knowledge, Skills and Attitude needed
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sales. Medical Representatives joining the field are
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E
USING GAMIFICATION
TO ACHIEVE A STATE OF
FLOW WHILE LEARNING
By turning learning into a game, learners enter into a ‘state of flow’ - a
condition where the ‘high’ of the game makes learning a habit.
Rajiv Jayaraman
H
ave you ever had an experience where you
lost your sense of self while immersing your-
self in an activity? Have you experienced a
high due to single-minded focus on something inter-
esting? Have you lost track of time while pursuing an
activity that you are passionate about? If the answer
to any of these questions is “Yes”, then you have
experienced the ‘state of flow’. Did any of these ex-
periences happen to you while you were learning in
school, college or at work? I guess not. Most learners
unfortunately tend to look at learning as a laborious
chore. This isn’t how it was meant to be. So how do
we change this situation? How do we make learning
a joy? This article aims to present various ways in
which learning and development professionals can
learn from games and gamification to facilitate the
state of flow for learners.
7 | MedicinMan May 2015
In his groundbreaking classic work, psychologist
Mihaly Csikszentmihalyi reveals that what makes an
experience genuinely satisfying is a state of con-
sciousness called ‘flow’. During flow, people typically
experience total focus, deep enjoyment, creativity,
and complete involvement with whatever activity
they pursue, in fact with life itself. He demonstrates
various ways in which this positive state of mind can
be controlled and not just left to chance.
Flow is understood to comprise of nine dimensions:
Challenge-skill balance, clear goals, control, immedi-
ate feedback, autotelic experience, loss of self-con-
sciousness, time transformation, concentration and
merging action-awareness. Games and gamification
create a conducive environment for many of these
dimensions to manifest in the learning process.
Rajiv Jayaraman | Using Gamification to Achieve a State of Flow while Learning

CHALLENGE-SKILL BALANCE
Games have a concept of levels embedded in the
Every learning structure of the game. This enables players to start at a
intervention needs to simple level and keep progressing to higher levels till
they feel that they cannot proceed anymore. This con-
clearly outline the goals. stant pursuit of mastery is what brings them back to
It is best if the goals are the game every day. Applying this concept to learning,
companies can construct a learning environment that
challenging yet seem
provides the learner the opportunity to make progress
achievable. Getting this by expanding their skill one step at a time.
balance right is immensely CLEAR GOALS
Every game has a clear objective and a set of guiding
important for the learner
rules. Without goals, the player does not get a clear
to have the confidence to sense of direction. The same principle applies to
start and the right amount learners. Every learning intervention needs to clearly
outline the goals. It is best if the goals are challeng-
of challenges to keep going. ing yet seem achievable. Getting this balance right

”
is immensely important for the learner to have the
confidence to start and the right amount of challenges
to keep going.
CONTROL
Games give individuals the power to choose from var-
ious possibilities and alter the course of action within
the game. This gives gamers the sense of control that
is needed to stay engaged in the activity. Research
shows that adult learners learn best when they are
given the autonomy to test their hypothesis and see
the results for themselves.
IMMEDIATE FEEDBACK
Malcolm Gladwell, in his book Outliers, talks about
how assisted practice over a long period of time im-
proves the chances of mastery in a domain. The short
cause and effect feedback loop in games makes the
gamer learn the rules of the game faster. The feedback
also helps to condition the behaviour of gamers within
and outside the game. Case in point, the current COO
of Symantec, Stephen Gillette, is one of the youngest
executives sitting in the board of a large organization.
He is an avid gamer who attributes his leadership skills
to the World of Warcraft game. Real world behaviours
can be shaped by games and simulation through
immediate feedback.
AUTOTELIC EXPERIENCE
Any activity that has a purpose in and not apart from
itself is described as Autotelic. In other words, autotelic
experience is one where the individual does the activi-
ty for its own sake without any inducement of external
rewards. While points, badges and leader boards mo-
tivate the learner to perform well, in most successful
8 | MedicinMan May 2015 games, it is the activity itself that is the reward.
Rajiv Jayaraman | Using Gamification to Achieve a State of Flow while Learning

By making the context of the learning environment

real-world like and by giving the learner the feedback
By using gaming and that he / she is gaining in skill, we can facilitate autotel-
simulations, we can enable ic experiences for the learner.
LOSS OF SELF-CONSCIOUSNESS
learners to completely
Games have the ability to draw us into an alternative
devote themselves to the world and make us lose our sense of self. Quite inter-
learning task at hand. As estingly, after the experience, individuals come out
with a stronger sense of self, one that is integrated and
a result, learning becomes sophisticated. By introducing games and simulations
enjoyable and sheer joy. in the learning process, we can achieve the same result
for our learners.
The high the learners
TIME TRANSFORMATION
experience becomes the Most gamers report that they lose the sense of time
hook for making learning a when they immerse themselves in a game. They are at

”
it for hours on end. By using gaming principles in the
habit.
learning process, we can create a craving for learning
and engage learners in productive skill enhancing
exercises.
CONCENTRATION
The most enjoyable experiences happen to us when
we devote our complete attention to the activity at
hand. The power of concentration frees up our mind
from distractions and enables us to enjoy the quality of
the experience. By using gaming and simulations, we
can enable learners to completely devote themselves
to the learning task at hand. As a result, learning be-
comes enjoyable and sheer joy. The high the learners
experience becomes the hook for making learning a
habit.
MERGING ACTION-AWARENESS
Today, most learning interventions tend to focus
on the cognitive aspects of learning, with very little
attention paid to the motivation of the learner and
the application of learning. By encouraging learners to
apply learning in a safe learning environment, we can
enable them to exercise their muscle-memory, which
comes in handy later when they face real situations.
Combination of action and reflection is vital for learn-
ers to internalize their experience.
CONCLUSION
To sum up, the current learning design doesn’t facil-
itate the state of flow for learners. We need to think
about ways in which learners can escape from the mo-
Rajiv Jayaraman is Founder-CEO, KNOLSKAPE notony and truly enjoy the bliss of learning something
new. By wisely using some of the gaming and gamifi-
cation principles, we can facilitate the state of flow in
learners. Perhaps then, learning will become a joy and
learners will get into the habit of learning daily just like
millions of candy crush and fishville players around the
9 | MedicinMan May 2015 world can’t live without their favorite game. -RJ
E
K. Hariram is the former MD (retd.) at
Galderma India.
He is Chief Mentor at MedicinMan and a
regular contributor. khariram25@yahoo.com
10 | MedicinMan May 2015
THE 3 ‘E’s OF
SALES LEADERSHIP:
ENGAGE,
EMPOWER &
ENABLE
How to move from being mere sales
‘managers’ to being sales ‘leaders’
K. Hariram
I
s there a difference between the Head of Sales/Sales
Manager (SM) and the Front Line Manager (FLM)?
I know this controversial question will raise many eye-
brows. However, I am very clear and what I am refering
to is the mindset and approach to business and people.
More often than not, we are all ready to criticise the
FLMs, their quality, role, responsibilities, and behaviours.
However, when I meet many sales managers leading a
team of sales people and line managers at various levels,
I often wonder the thin line of difference in terms of
their quality, behaviours and managing people.
So, the unasked question is – do you want Head of Sales
to be Sales Leaders (or Leaders of the sales team) or mere
Sales Managers (managing sales)?
What is the difference? Almost always, sales managers
are managing their sales force, allocating geographical
territories, controlling the efforts area, pushing people
to perform, hitting the sales numbers by hook or crook
by the month end and various tasks that come under
the title umbrella.
Leading the sales team takes on a whole different
meaning and with added dimensions. Apart from what
is mentioned above it involves mentoring people, on/off
the job, coaching, influencing/inspiring people, support-
ing and helping them and being a constant cheer leader
for them every day.
K. Hariram | The 3 ‘E’s of Sales Leadership: Engage, Empower & Enable
Leading the sales team ...
involves mentoring people,
on/off the job, coaching,
influencing/inspiring
people, supporting and
helping them and being a
constant cheer leader for
them every day.
”
11 | MedicinMan May 2015
In short, it is practicing 3 ‘E’s – Engaging, Empow-
ering and Enabling the sales team day in and day
out.
How often have you looked at a Sales Manager and
said, “He took his people from GOOD to GREAT”, as
Jim Collins said?
Having been a Sales Head in my career journey,
I know for sure that sales management is not an
easy business and it is not for the weak-hearted.
The responsibility involves acting as a cushion
between organisational revenue objectives and
the sales people who are out on the road, braving
the vagaries of weather and the constant rejec-
tions/objections they face from customers. As their
leader and the Head of Sales you make sure that
they keep going, despite the odds and maximise
their success through performance.
It is time that the sales managers change their
mindset and come out of their intimidating and
negative reinforcement behaviours. These will
not work in the long run and will only add to the
misery of increasing sales force attrition. Equally
important is the need to invest in self-learning and
development through books and attending learn-
ing & development programs besides developing
through work.
As a sales manager, you are not just ‘managing’
them but LEADING them to WIN in a highly com-
petitive environment. In short, you are a SALES
LEADER. -KH
E
Focus Feature
Prof. Vivek Hattangadi is a Consultant
in Pharma Brand Management and Sales
Training at The Enablers. He is also visit-
ing faculty at CIPM Calcutta (Vidyasagar
University) for their MBA course in Pharma-
ceutical Management.
vivekhattangadi@theenablers.org
12 | MedicinMan May 2015
BRAND
LIFE CYCLE
MANAGEMENT
With few new chemical entities in
the pipeline, pharma companies
will have devote more attention
to managing the life cycle of their
brands to derive maximum mileage
from existing products.
Vivek Hattangadi
D
iscovery of new chemical entities is slow-
ing down considerably and hardly any
new blockbuster drug is in the pipeline.
Leading players, which made investments in
market creation, developed differentiated business
models and maintained the momentum through
new product launches1, will be handicapped as this
process is expected to slow down. In India, with
the stringent application of the Indian Patent Act
(IPA), reverse engineering techniques have taken a
back seat. Products of the 1980’s and 1990’s which
were unsuccessful are being dished out as new
products; examples are two CNS drugs amisulpride
and etizolam and a gastro-prokinetic, levosulpiri-
de. Many other factors, such as stricter regulations
and stronger global competition, are also creating
major challenges. If a pharmaceutical company
in India intends to increase its market share and
return on investment, it must consider how to how
to do it in a manner never done before. As new
launch possibilities dwindle, brand building will be
necessary to grow profitably1.
Vivek Hattangadi | Brand Life Cycle Management
...the number of new
chemical entities (NCEs)
has been dwindling,
while formulation and
development costs for
new products are soaring.
Except for a product
here or a product there,
no truly Indian NCE
has been developed.
More than ever, Indian
pharmaceutical companies
need to turn to BLCM in
order to differentiate their
”
products.
13 | MedicinMan May 2015
Brand building via Brand Life Cycle Management (BLCM)
is an excellent option in this regard.
There are several methods for approaching BLCM effec-
tively. What is crucial, however, is to plan for it very early,
preferably even before the product is actually launched
in the marketplace.
The key to successful BLCM is to create and evolve a
proactive strategy for the brand throughout its life cycle,
from launch to long-term growth and acceptance in the
market.
BLCM is an essential part of the success of any brand. But
in the Indian Pharmaceutical Market (IPM), it will now
have a very special place.
Rather than build their existing brands, many companies
have until now relied on their ability to keep the pipeline
filled with new products. But the number of new chemi-
cal entities (NCEs) has been dwindling, while formulation
and development costs for new products are soaring.
Except for a product here or a product there, no truly
Indian NCE has been developed. More than ever, Indian
pharmaceutical companies need to turn to BLCM in order
to differentiate their products.
This also means that getting a product on the market
is no longer enough: keeping it there and managing its
success is crucial. This is where BLCM comes in.
Basically, there are two kinds of markets, each demand-
ing a certain approach.
1. A first-in-class product entering a non-competitive
market – i.e. without any other similar molecule – will
need to be launched quickly and effectively (like
Lipaglyn of Zydus).
2. A simpler form of administration can be chosen, thus
speeding up time to market and keeping costs down.
Once the novelty of first-time launch wears off, or
when more drugs enter the market and becomes
competitive, the real challenge commences. In that
case, the brand will have to have certain qualities
unique to it, like a special form of administration (like
Dynapar QPS).
MAINTAINING A SUCCESSFUL COURSE
Brand managers in IPM hardly invest any time on BLCM.
Once the product is in the market and earning healthy
returns on investment, it is forgotten.
The preferred approach in IPM is to simply focus on the
launch and then turn attention to the next new product
in the pipeline. Companies launch, or rather churn out,
six to eight products every year.
Vivek Hattangadi | Brand Life Cycle Management
BLCM must also be deeply
integrated into the entire
process, which can save
a great deal of money.
... using legal loopholes
or other measures to
prevent competitors from
entering the market is
counterproductive. It is
far more costly and the
outcome is doubtful
”
14 | MedicinMan May 2015
But times will change as fewer NCEs are coming in the
market. Moreover, product development costs have
increased. Hence a pharma company has to draw the
most out of the existing brands it already has in the
market. This means a carefully designed strategy needs
to be elaborated well ahead of time, to extend a drug’s
lifecycle.
The report ‘Vision to Reality - From Market to Discov-
ery and Back’ by Capegemini published in 2006 says
that 90% of pharmaceutical industry brand managers
believed that BLCM is significant for the bottom-line.
60% predicted its importance would grow consider-
ably by the end of the decade. Most of those inter-
viewed for the report had a prime rule: it is crucial to
have a clear concept early on if a company wants to be
successful and maintain a larger piece of the market.
BLCM must also be deeply integrated into the entire
process, which can save a great deal of money. The
authors concluded that using legal loopholes or other
measures to prevent competitors from entering the
market is counterproductive. It is far more costly and
the outcome is doubtful2.
So how early is early enough? Some pharma compa-
nies may well consider planning their brand lifecycle
management in the introductory phase. In other cases,
relatively sudden changes on the market can force a
quick rethinking of a drug’s design.
BLCM OPTIONS
There are several approaches to BLCM that can be
applied depending on need.
1. Developing new markets
If a brand is being released to a limited market, extend-
ing it to other markets is the next logical step. This may
require passing regulatory barriers or forming alliances
with other companies. A case in point is Kusum Health-
care, a Rs. 3000 million New Delhi based company.
They are leaders in Ukraine, Uzbekistan and some other
CIS countries. They are now set to make a formidable
presence in IPM through their brands which are leaders
in CIS countries.
2. Looking for new applications
Sometimes a particular drug will have more than one
indication allowing it to be targeted at a completely
new market. Aspirin, for example, began as treatment
musculoskeletal pain, and was later used to reduce
the risk of death following cardiac events. Clonotril
(Torrent) was launched as an add-on drug in refractory
epilepsy. It is now being very strongly promoted in
anxiety disorders as a ‘rediscovered benzodiazepine’.
Vivek Hattangadi | Brand Life Cycle Management

3. Redesigning the product

Reformulation, as the process is known, involves essen-
tially changing an existing drug to make it more attrac-
tive to users and to make it more competitive. Dynapar
Injections (Troikaa), containing diclofenac sodium
made a very simple innovation. They converted it into a
painless injection using Aquatech technology which is
free from propylene glycol and hence it is as viscous as
water and can be therefore administered by intradel-
toid route, intragluteal and also along with I.V. infusion
of normal saline and dextrose 5%, without using sodi-

um bicarbonate unlike conventional brands, including

the originators – Voveron. It was a planned BLCM. Now,
with introduction of Dynapar QPS, the BLCM of Dyna-
par as a brand has been successfully extended, at least
for another 15 years (that’s my prediction).
Here is how Adalat, the original nifedipine from Bayer’s
was able to extend its Brand Life Cycle by reformulating
it as Adalat OROS, a special form of sustained release
tablet.
Case study – Prefilled Syringes
The delivery system of a pharmaceutical product has a
very important role. To improve in this field of delivery
system requires imagination, technological creativ-
ity and skill. More importantly, it also requires deep
awareness of the market and the trends in the market.
Knowing who the end user is, for example, is a key to
understanding what innovation can be done with the
drug.
Let us take the case of insulin. The current trend is
towards increased self-use at home. This is an indicator
to the pharmaceutical industry to package insulin in a
more patient-friendly manner.
15 | MedicinMan May 2015
Vivek Hattangadi | Brand Life Cycle Management

Bibliography Insulin inhalable (The greatest flop-show of the world-

1) Mckinsey report - India Pharma 2020 Propelling wide pharma industry, Exubera from Pfizer) is a case
access and acceptance, realizing true potential study by itself.

2) Jessica S. Blumstein, Omar Chane, et al. Global With tablets and other delivery forms, the options are
research report; Vision & Reality: 6th Edition, Capegem- fairly simple. In the case of injectables, however, the
ini.2007 situation is a little more complex.

3) Guidance for Industry Allowable Excess Volume and A company might launch a drug in a vial/diluent
Labeled Vial Fill Size in Injectable Drug and Biological system. It can then switchover to an innovative
Products (March 2015) in www.raps.org/regulatoryD- end-user-friendly application system such as prefilled
etail syringes, or cartridge/pen or dual-chamber system (for
lyophilized drugs).
4)http://www.troikaa.com/pfs.html
With the dual-chamber syringes – ideal for sensitive
formulations, a drug can be lyophilized and packaged
with its diluents, permitting the end user to reconsti-
tute and administer the drug. The system is highly con-
venient and allows for far greater precision in dosing.
Added to this is the advantage of increased yield
exploitation due to reduced overfill. USFDA permits
overfill with ampoules and vials to compensate for the
What the Pharma CEO loss of the active ingredient sticking to the container
Wants from the Brand system or the habit of some care givers to expel some
Manager liquid to remove the air bubble3. Vials are overfilled by
up to 25%, especially if the desired dose is very small,
A Book by Prof. Vivek Hattangadi
to ensure that the user may withdraw the desired
dose4. With a prefilled syringe, overfill is hardly 2%
resulting in marked savings of the cost of the active
pharmaceutical ingredient. Prefilled syringes therefore
result in a clear value addition. A drug that is estab-
lished in the market as vials can be repackaged in this
modern and user friendly system.
A company which decides to switch-over their amika-
cin into a prefilled syringe will not only have a marked
edge over competition but will also be able to extent
the brands life cycle. This is an opportunity for the
brand leader in amikacin, Mikacin, (from Aristo).
In the final analysis, BLCM must be made an integral
part of any drug’s development. BLCM should therefore
Available on Flipkart
begin very early on in the process during the formula-
(click to purchase)
tion and development stage with the possibilities to in-
crease the drug’s competitiveness. With a robust BLCM
concept and schedule, pharmaceutical companies can
look to the future with optimism. -VH

16 | MedicinMan May 2015

E
Hanno Wolfram, is the founder and owner
of www.Innov8.de, a Germany based
company offering consulting projects for
pharmaceutical companies.
17 | MedicinMan May 2015
LOST
PATIENTS
By ignoring the pharmacist, pharma
companies are losing out on meeting the
health needs of many patients.
Hanno Wolfram
P
atient centricity is a widely used word today,
but more often than not, an empty and
meaningless phrase.
Delivering support to patients is usually a missing
parameter in an equation designed to create more
sales and increase profitability.
In addition, the pharmaceutical industry’s tradi-
tional sales model, engraved in its DNA, leaves
them in “promotion mode” at any time. As di-
rect-to-patient promotion is forbidden in most
countries, this is one of the reasons why linkages
with patients are missing. However regulatory re-
strictions need not come in the way of patient-cen-
tricity for pharma.
The pharmaceutical industry is sitting on a wealth
of knowledge about the respective disease, its
diagnosis and treatment. Designed to support pa-
tients, this treasure can be leveraged as an import-
ant driver towards improved patient outcome.
Additionally pharma companies could add a lot
to cost-effectiveness of healthcare, which shows
enormous room for improvement. A most inno-
vative and pivotal role for the pharmaceutical
industry could be to support patients, physicians,
pharmacists and even payers in their shared need
to get more for the same.
Hanno Wolfram | Lost Patients
The pharmaceutical
industry is sitting on a
wealth of knowledge about
the respective disease, its
diagnosis and treatment.
Designed to support
patients, this treasure
can be leveraged as an
important driver towards
improved patient outcome.
”
18 | MedicinMan May 2015
It is hardly possible to educate the vast majority of pa-
tients to fully understand all the details around a spe-
cific condition – patients regularly get lost between
tests, lab, x-rays, diagnoses, the prescription of a drug
and other recommendations to considerably change
habits. Receiving a diagnosis for a chronic condition
must be acknowledged as a life-changing event. Be it
an allergy, diabetes, rheumatism, hypertension, COPD
or asthma: any of those diagnosis, even at the earliest
possible stage, changes you from a “normal” human
being to a patient from now on.
After the diagnosis is clear, any physician can only
be successful if the patient adheres to therapy. Only
if and when patients adhere to therapy, payers will
get what they paid for. Adherent patients will usually
turn happy, since the burden of disease is alleviated
or taken away. Pharmacists are happy, when patients
adhere to treatment, since patients will refill their
prescriptions. Politicians are happy, because the mon-
ey invested into the health of their people is paying
back.
There are a number of causes in the fragment-
ed healthcare system or business, preventing
health-care-providers from attaining common objec-
tives.
A root cause for losing out on the patient is structural
in nature. Traditionally, decades ago, pharma separat-
ed their distribution channels. This started long ago
with an inside out-perspective: “Our drugs vary by Rx
vs. non-Rx.”
The subsequent split of channels, activities, depart-
ments or business units almost was unavoidable:
1. Sales channel 1: Physicians, deciding about Rx
2. Sales channel 2: Pharmacists, making recommen-
dations for non-Rx
Both assumptions from those early days do no longer
apply in the 21st century:
1. Rx-decisions today are made by political bodies,
tenders, contracts, guidelines etc.
2. Most purchasing decisions around OTC drugs, are
made by the buyer, driven by TV-ads and other
means, channels and ways of promotion.
In the 21st century the patient journey includes steps
far away from those antiquated structures still prevail-
ing in the industry. How can pharma deliver improved
patient outcome, when they miss the chance to
follow the patient along the patient journey?
Hanno Wolfram | Lost Patients
Very often the starting
point for health advice is
the pharmacist - the most
approachable person in
the healthcare chain...
Being a member of the
highly valued health-
care-provider guild, the
pharmacist plays a most
trusted role for patients.
”
KAM in Pharma 3.0
by Hanno Wolfram
The must-read book on Key Account
Management in Pharma
Available on Amazon
(click to purchase)
19 | MedicinMan May 2015
Very often the starting point for health advice is the
pharmacist - the most approachable person in the
healthcare chain. A patient will ask the pharmacists
for an OTC drug or request the pharmacist’s advice
on his problem. Being a member of the highly valued
health-care-provider guild, the pharmacist plays a most
trusted role for patients. Once a patient perceives his
situation serious enough or has been advised by his
pharmacist to do so, he will see a physician.
The key purpose of a physician is to detect and estab-
lish a diagnosis. Consequently therapy will be started,
following guidelines, evidence or availability of a
therapeutic solution. In the vast majority of cases, ther-
apy will include the prescription of a drug. Again, the
patient will go back to his “low-threshold service point”
pharmacist, asking him to fill the prescription.
Pharmacists are proven to be a central anchor-point to
therapy adherence. Daily-life proves this research, tell-
ing us that pharmacists are actively asked for advice, are
requested to consult, have most regular (low-threshold)
contact and are a most trusted source for patient’s
information.
Given the traditional sales-model and the currently
prevailing structures of the pharmaceutical industry,
pharmacists are outside of the endeavors to improve
patient’s lives.
Usually you will find high and mostly insurmountable
walls between the Rx and OTC business, between phy-
sicians as major targets for Rx and pharmacists for the
OTC business.
This is why it appears normal that 76% of German
pharmacists (n=18,000 pharmacies, Feb, 2015) claim
they are not sufficiently informed by the pharmaceuti-
cal industry about a newly launched antidiabetic drug.
Only 7% said they are well informed.
84% of pharmacists ask for more support from pharma
to better allow them to improve therapy adherence in
patients. Do these results appear astonishing or new to
you?
Pharma’s sales-model is designed to generate revenue
from drugs. By far, most companies employ sales forces
of reasonable size, dedicated to sell drugs to physicians.
These selling attempts supposedly lead to prescrip-
tions, which are filled by patients in their pharmacy. In
this traditional model and paradigm there is no room
for pharmacists and subsequently patients are lost and
patient centricity remains a slogan, usually empty and
meaningless phrase. -HW