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Marketing Mix Model for Pharmaceutical Industry: Promotion-A Pakistani

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 Marketing Mix Model for Pharmaceutical
Industry: Promotion-A Pakistani Perspective

Prof. Dr. Rizwan Raheem Ahmed & Irfan Sattar

International E – Publication
www.isca.me , www.isca.co.in
 Marketing Mix Model for Pharmaceutical
Industry: Promotion-A Pakistani Perspective

By

Prof. Dr. Rizwan Raheem Ahmed & Irfan Sattar

Department of Business Administration & Commerce,

Indus University,Karachi, Pakistan

2014
International E - Publication
www.isca.me , www.isca.co.in
 International E - Publication
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© Copyright Reserved
2014
All rights reserved. No part of this publication may be reproduced, stored, in a
retrieval system or transmitted, in any form or by any means, electronic,
mechanical, photocopying, reordering or otherwise, without the prior
permission of the publisher.

ISBN: 978-93-84648-08-4
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Table of Contents

Page No.
INTRODUCTION………………………………….. 1
1.1 The Product Chain……………………………….. 1
1.2 The Prescription Chain…………………………. 2
1.3 The Marketing Mix at Work…………………….. 2
PROMOTION……………………………………….. 4
2.1 In-Clinic Promotional Mix……………………… 4
2.2 Out-of-Clinic Promotional Mix………………… 6
2.3 Unethical Practices in Pharmaceutical Marketing…….. 12
2.4 The Marketing Communication Mix…………………… 13
2.5 Steps in Developing Effective Communication Mix….. 14
2.6 Integrated Marketing Communications………………… 16
2.7 Pharmaceutical Marketing – Future Outlook…………… 17
ABOUT AUTHOR 18

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1. INTRODUCTION
Marketing is, as in other industries is the driving force in pharmaceutical industry. There is a
clear need for developing literature, which can take into account the needs of pharmaceutical
marketing, and become a basic guide to business graduates majoring in marketing to
understand how things will be when they pursue a career in pharmaceutical marketing.
Although, there is good quality international literature available, but it carries the perspective
of developed countries, where things are very different from a developing country like
Pakistan.

There is no winning formula for pharmaceutical promotion. All one can do is to understand
the purpose of each tool, and then try to create a mix which works well under the given
scenario. In-Clinic Promotional Mix includes detailing aid; leave behind material, samples,
gift/giveaways, and direct mailers.

Out-of-Clinic Promotional Mix includes clinical trials/studies, seminars/symposia/round table

discussion sponsorships, film shows, advertisements, public relations, free medical camps,
corporate marketing, hospital/ward improvement programs, E-marketing. One of the sore
areas in pharmaceutical marketing, especially promotion is the unethical practice, for which
companies and the medical profession are equally responsible.

The development of effective communication mix in pharmaceutical marketing is a complex

task, which goes through identifying the target audience, determining the communication
objectives, designing a message, choosing method of delivery, collecting feedback.
Pharmaceutical marketing professionals are fast becoming aware of the latest development in
the discipline of marketing, and they have also started to adopt latest theories in
communications. Unlike few years back, when all tools were used in isolation from each
other, which messages and format changing as per the requirement of the tool, now we find a
synergy in all marketing activities. Marketers are making all efforts to make sure that each
next step in the communication process adds some value to the previous one. Product
slogans, logos and positioning statements are taking up fast. Product positioning is now being
based on emotional appeals, which is a takeoff from simple no-nonsense kind of approach
pharmaceutical marketing symbolized for long. The line between pharmaceutical marketing
and general marketing is thinning, but still intact and will remain so, considering the peculiar
characteristics of pharmaceutical products, and the dynamics of the industry. The
pharmaceutical industry in Pakistan has gone through a major transformation during the last
five years.

1.1 The Product Chain

The product chain starts with the selection of the molecule(s). The selected molecules are
then passed through the screening process applying the different criteria, then the source of
raw material is identified, pilot batch is manufactured, if needed the company arranges for
test marketing or clinical/user trial, and finally the product is sent into the market, or
commercialized.

When a patient is suffering from an illness, he either goes to a doctor in a hospital, or in his
private clinic. At hospital, when a doctor prescribes a product, the patients may buy it from
the hospital’s pharmacy, or may choose to buy from a retailer outside the hospital. In case of
a private clinic, the patient usually buys either from a retailer in the vicinity, or a shop nears

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his residence. This is how the product chain completes, starting from the hospital, and ending
in the patient’s hands.

1.2 The Prescription Chain

The prescription chain starts with the information to the doctor by the company’s sales team.
The information is communicated through either in-clinic promotional activities, or out-of-
clinic promotional efforts. The doctor, if convinced, prescribes the product and the patient
goes and buys the product, thus making the both Product Chain & Prescription Chain meet in
the end, which was the basic marketing objective.

1.3 The Marketing Mix at Work

Pricing Strategy Distribution

Channels

Wholesales
Pharmaceutical Product
Company

Retail

Commercialization

Promotional
Activities Patients
Test Marketing
Clinical/User Trials
Medical
Practitioners
Marketing/Prom. Pilot Batch Manufacturing
Strategy Development

Sourcing of Raw Material Hospitals

Molecule Screening

Molecule Identification

The Product Chain

The Prescription Chain

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The model for marketing mix is made up of two streams of activities achieving the two
objectives as “The Product Chain”, and “The Prescription Chain”.

The product chain starts with the selection of the molecule(s). The selected molecules are
then passed through the screening process applying the different criteria, then the source of
raw material is identified, pilot batch is manufactured, if needed the company arranges for
test marketing or clinical/user trial, and finally the product is sent into the market, or
commercialized. The pricing strategy is worked out as a parallel process, and decided before
commercialization. The product goes to the distribution house, then either directly to the
retailers, or to wholesale from where the product eventually reaches the retailer. Parallel to
that, the distributor also supplies the product to the hospitals’ pharmacies.

When a patient is suffering from an illness, he either goes to a doctor in a hospital, or in his
private clinic. At hospital, when a doctor prescribes a product, the patients may buy it from
the hospital’s pharmacy, or may choose to buy from a retailer outside the hospital. In case of
a private clinic, the patient usually buys either from a retailer in the vicinity, or a shop nears
his residence. This is how the product chain completes, starting from the hospital, and ending
in the patient’s hands.

The prescription chain starts with the information to the doctor by the company’s sales team.
The information is communicated through either in-clinic promotional activities, or out-of-
clinic promotional efforts. The doctor, if convinced, prescribes the product and the patient
goes and buys the product, thus making the both Product Chain & Prescription Chain meet in
the end, which was the basic marketing objective.

Pharmaceutical industry is one of the most organized industries in Pakistan, employing a

large number of professionals in all areas of operations. The industry currently comprise of
more than 400 companies, out of which around 200 or so can be termed as “Active
Companies” involved in manufacturing & marketing of pharmaceutical products. Karachi is
the city hosting the largest number of companies, but Lahore & Islamabad a emerging fast as
centers for pharmaceutical manufacturing & marketing.

Marketing is, as in other industries is the driving force in pharmaceutical industry. Most of
the people engaged in marketing activities in pharmaceutical industry are business graduates,
with majors in marketing. However, the biggest problem they face, and which in turn
becomes a challenge for human resource function of the company is the distinct character of
pharmaceutical marketing. What these business graduates learn at schools do not encompass
these unique characteristics and as a result, they find themselves inadequately equipped to
handle the dynamics of pharmaceutical marketing.

The very fact that in pharmaceutical marketing, you deal with a customer, who is technically
the most competent person, i.e. the doctor, makes the task very challenging. You have to
convince him to suggest or prescribe your product and this he will due purely on the basis of
merits of the product, which he usually understands better than a common marketer.

The restricted media use becomes a major obstacle as you as a marketer are not allowed to
use the conventional and established media like newspapers, magazines, radio & television,
and instead have to reply upon direct marketing, one-to-one sales calls, medical
journals/newspapers, sponsorships, sampling and other tools. This makes the task not only
more difficult, but also less glamorous.

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Last but not the least, the controls maintained by regulatory bodies leaves very little room for
maneuvering and even lesser for making an error. Whatever you communicate may
ultimately affect the well being of a person and this makes pharmaceutical marketing a tough,
responsible and challenging task.

There is a clear need for developing literature, which can take into account the needs of
pharmaceutical marketing, and become a basic guide to business graduates majoring in
marketing to understand how things will be when they pursue a career in pharmaceutical
marketing. Although, there is good quality international literature available, but it carries the
perspective of developed countries, where things are very different from a developing
country like Pakistan. It is also interesting to note that pharmaceutical marketing is treated as
a separate & specialized discipline in almost all good international business school, yet in
Pakistan no business school offers this area of study. There is a healthcare management
degree being offered at CBM, but that is more focused on the operational side of healthcare
institution, and the material being used for teaching is all international, with very little
relevance to local environment.

The ultimate need is to have a full-scale textbook on pharmaceutical marketing, more in line
with the “Principles of Marketing” by Philip Kotler; something like “Principles of
Pharmaceutical Marketing – A Pakistani Perspective”. However, there has to be a beginning,
which may then lead in fullness of time to a textbook.

2. PROMOTION
Marketing of pharmaceutical product is a unique and fascinating discipline, spiced with
continuous interaction with target audience, and most of the communication taking place on a
one-to-one basis. This, on one hand churns out any noise or interference, which happens
when different channels are involved in the communication process; but on the other hand, it
poses a challenge to marketers of being effective during the few minutes they get from the
doctors.

There is no winning formula for pharmaceutical promotion. All one can do is to understand
the purpose of each tool, and then try to create a mix which works well under the given
scenario.

We will discuss the several tools, which a company may use in promoting its products to the
target audience, and in the process, we will try to understand the characteristics, merits &
demerits of each tool, so as to understand what implications can be expected while
developing a promotion mix using these tools.

2.1 In-Clinic Promotional Mix

The most frequently used tools are those, which a salesperson takes into the doctor’s clinic
for discussing the products. These tools are normally a regular part of a salesperson’s arsenal,
and are provided by the company on a periodic basis. The performance of any salesperson in
pharmaceutical industry largely depends on how well he plans and utilizes the promotional
material provided to him for using during the interview with the doctors.

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2.1.1 Detailing Aid

Detailing aid are the product literatures, folders, brochures or display cards, which are meant
to help the salesperson during the discussion with the doctors. These items usually carry a
visual to attract attention, the core message to be delivered, and the supportive
abstract/reports about the drugs. These detailing aid materials are not supposed to be left with
the doctors, but as the name suggests, are only to facilitate the discussions.

Companies spend lot of time and money for preparing detailing aid. However, it may only
serve the purpose if the message is clear, crisp and effective, and the salesperson is properly
trained to handle that.

2.1.2 Leave Behind Material

Leave behind material is for two main purposes; first, to have something around to keep
reminding the doctor about the products, and second, to leave some detailed material with the
doctor is case he wants to know more details about what was briefly discussed during the
meeting. Companies use folders, brochures, leaflets, prescription pads and stickers to act as a
reminder. These items only serve the purpose if the nature of the product is such that the
doctor needs to refer the material off and on. Otherwise, this forms the junk, which is
eventually thrown out of the chambers. Only general physicians use even prescription pads as
the consultants usually have their own pads, which they use for prescribing medicines.

Companies must be very selective in identifying the products where they need to leave
behind some material. Doing it as routine not only is a waste of resources, but also create
extra burden for the salesperson.

2.1.3 Samples

Probably one of the most misused items in whole pharmaceutical promotional kitty.
Marketers tend to forget that samples are meant to generate trial, and to build confidence of
the doctors. Once the doctor starts prescribing the medicine, the basic purpose of samples is
served. In most of the cases, companies keep on giving uniform quantities of samples to their
field force. There is no doubt, that samples play the most major role in gaining the confidence
of the doctor, but pharmaceutical companies still need to be discrete in the use of samples.

In third world countries like Pakistan, doctors do not need samples just for trying to see the
efficacy. They also ask for samples so that they may give those to such patients who may not
be able to afford the full therapy. Some doctors prefer to give the samples as the “startup”
packs, and ask the patient to buy the future requirement from the market.

What the companies need to keep in mind is that each unit they give as sample to the doctor
replaces the sale of one unit. For this reason, a company should keep on trying to keep on
evaluating the optimum levels of samples at each stage of product life cycle to ensure that
sampling is being done to a level sufficient to generate prescriptions and keep the interest of
the doctors alive without hurting the sale of the product.

One hidden danger of samples is that these provide an avenue for the sales force to cheat, if
they are inclined towards playing unfair. The samples can be easily used for offering “special
benefits” to be shopkeepers, who may stock the product for making extra profit through the

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sale of samples beside the commercial stock. This tendency is widespread; especially in
smaller towns where a chemist has the power to give whatever brand he wants against a
prescription due to illiterate public. For this reason, companies have to be always on guard
and should to always make sure that the samples being provided to the sales team are not
being misused. A regular stock-audit at chemist shops in selected localities can always help
in identifying such practice. Some companies also stamp/mark their sample stock so that it
can be easily differentiated and the chemist might not keep those due to the fear of being
snapped.

2.1.4 Gift/Giveaways

Most of the pharmaceutical companies do give out expansive gifts to the doctors. The
purpose is to establish a relationship, to oblige the doctor, and to ensure support on their
products. However, none of these objectives is achieved unless:

i) The gift is unique in nature and not available from any other source.
ii) It has some direct relevance with the product.
iii) It has some utility in doctor’s clinic.

Most of the companies never keep these things in mind and end up spending millions of
rupees without realizing that the doctor has enough money to buy a Parker pen. However, he
might not have excess to latest medical journals, and if the company subscribe to journals and
then distribute it amongst the doctors, they might really be obliged by this practice and
extend their support. Companies who have tried to be creative in this area have been able to
develop a strong relationship with the medical profession, which shows that a company
cannot be successful only by spending money. It’s basically the concept behind the item,
which works.

2.1.5 Direct Mailers

This is an effective method of sending reminders to the doctor by non-personal means, but
this proves to be effective only if the contents provide something of the value for the doctors
like an abstract of the studies regarding the product etc. Doctor are usually very selective in
seeing their mail and they are quick to observe if something deserves their attention or not.

2.2 Out-of-Clinic Promotional Mix

With the ever-increasing shortage of time and attention inside the clinics of the busy medical
practitioners, pharmaceutical companies are paying more and more attention to activities
performed outside the chambers of the doctors. Some of these activities have been used since
long, and some have just started to gain momentum.

2.2.1 Clinical Trials/Studies

This is a new phenomenon for Pakistan market. Previously the multinational companies used
to conduct some local studies once in a while, and the local industry never even attempted to
do so. One reason was the highly technical nature of the pursuit and requirement of highly
skilled personnel to liaison with the researchers, and other the time it takes for a study to
complete and the results to be available for discussions with the doctors.

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As all local companies depend on marketing of branded generics, and the quality of local
industry has always been a questionable issue with the medical profession, good local
companies have started to focus their attention on conducting and sponsoring clinical studies
for their brands, to stand out from the crowd. However, only those companies are adopting
this technique who are sure about their quality standards, and failure of a drug during clinical
study may result in a way that doctors stop recommending even the other brand so that
particular company. Therefore, companies are always careful before they embark on such
activities.

The advantages of clinical trials are numerous:

• The medical profession gets a first hand experience of the product and if they get
good results, their confidence reaches a height, which ensures long-term success of
the product.
• The brand gets an edge over other brands within the same molecule category, as
others are just claiming the results of molecule, whereas there is no data available on
the results of the brand itself.
• In case of pre-launch trial, the company gets a head start with the pool of doctors who
have been involved in the clinical study.
• The results of the trial provide a very good information base to build the future brand-
communications.
• It adds a lot to the corporate profile of the organization as doctors appreciate an effort
to generate local data, a lot.

The disadvantages of clinical trials are the following:

• The cost is very high, as the company is not only responsible for providing the
medicines, but also has to take care of tests/analysis/tabulation etc. that may be
involved in the process.
• It takes a long time, in some cases several months to even several years to conduct the
trial, tabulate the results and report the findings. A company must be willing to show
patience and wait for the outcome.
• In case a trial fails, it effectively means an end of that particular brand’s life cycle.
• A wrong selection of trial center may result in waste of huge resources, which does
happen in a country life Pakistan too often, where there is no research orientation
even in big hospitals and medical school. For this reason, a company has to be very
choosy while finalizing a trial location.

The multinational companies, which invest a lot in clinical studies, are Eli Lilly & Aventis,
and amongst local companies, PharmEvo is the only company, which has a stream of clinical
trials being conducted on its brands.

2.2.2 Seminars/Symposia/Round Table Discussion

A very popular promotional technique, which was practiced only by multinational companies
until recently, but now more and more national companies are following the suit.

A doctor, who is considered to be one of the opinion leaders, and who is willing to speak on
behalf of the company is provided all the information about the product, and then provided an

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audience to address on the benefits of the product and its comparison with other available
options.

Alternatively, a group of doctors is engaged in a round table discussion about the product.
The doctors who are selected are a mix of those who already have some good experience
with the product, and some for whom it’s a new product. The doctors share their experience
at this forum and as a result, those who had no experience of the product might get influenced
by those who had, and thus the company’s objective may be achieved.

A company has to be really careful, as seminars/symposia/RTD are always tricky businesses.

Doctors do tend to take such activities as an occasion of social get-together, and the company
does not get any benefit out of such activities. A company may ensure maximum benefit of
such activities by considering the following seriously:

• The medicine, which is to be discussed, must have profile where doctor would be
interested to learn. As such, a tried and tested molecule may not be a suitable topic for
such activity.
• The speakers must be selected very carefully. They must have some credibility in
their area of expertise, and must be known for their research and academic activities.
• The speakers should not be politically affiliated with any group, at least not in
practical terms.
• The objectives of the event must be spelt out very clearly, and the proceedings must
be moderated properly.
• The proceedings must be recorded, and communicated in a suitable form to other
target doctors so that the benefit of the activity doesn’t keep confined to the
participants of the event only.

2.2.3 Sponsorships

The medical practitioners throughout the country have their representative bodies, which are
either general medical bodies like Pakistan Medical Association, Pakistan Medical & Dental
Council, Pakistan Islamic Medical Association etc., or related to a particular specialized area
like Pakistan Hypertension League, Cardiology Society of Pakistan, Diabetic Association of
Pakistan, Pakistan Orthopedic Association etc.

All these representative bodies have their quarterly, bi-annual or annual conferences, where
latest research findings are discussed and papers presented. These events provide an excellent
forum to develop a rapport with the leading doctors, and position the company effectively.

Pharmaceutical companies take advantage of such events either by sponsoring the event itself
by putting up a stall at the venue, sharing the organizational cost, placing an ad in the
souvenir and sponsoring a speaker to the event, or by sponsoring the registration of
participants for the event.

The issues faced during such events are very similar to seminars etc., where many doctors
take this opportunity as a free trip to the event, with no academic consideration whatsoever.
However, if effectively planned and executed, participation in such events may yield
enormous benefits for the company.
Other points to be considered are the following:

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• There is a big crowd of companies putting up their stalls and trying to get doctors to
their stalls and spending time with them. Therefore a company has to come up with a
creative idea so as to differentiate their position at the event.
• A careful approach is needed to make sure that the academic discussion may not be
termed as a setup by the company, which is a difficult thing to do as when a company
actively participates in an event, all discussion regarding their product are taken as
“sponsored” by the audience.

2.2.4 Film Shows

The modern audio-visual techniques have also arrived in pharmaceutical marketing, and
progressive companies are adopting this technique and preferring it to seminars and other
forms of direct communication. Companies get films made on their products, and arrange
film show for doctors, usually in wards of hospitals, and for general physicians at hotels.

The advantages of the film shows are the following:

• Highly cost effective as the cost of developing material according to each conference
and sponsoring the speakers is eliminated.
• A consistent message across the country, which is not possible when to arrange
speaker-programs.
• Films, by virtue of the aesthetic possibilities can be made very interesting using latest
animation and editing technique, and can be far more absorbing than listening to a
speaker.
• A copy of the films can be given to the doctors who avoid attending events due to
either their busy schedule, or their personality profile.

The disadvantages are the following:

• Being a non-interactive medium, the doctors might leave the venue with some
unanswered question. The best way to handle this to prepare a FAQ (Frequently
Asked Questions) segments in the film, which provides answers to the most questions
pertaining to the product. Alternatively, a senior doctor present amongst the audience,
with advance permission, can be asked to take questions at the end of the film show.
• Doctors once attended the film show will not be interested to attend a film show on
the same product, whereas, in case of a seminar, they might come over assuming that
the speaker might have something to add to what was previously discussed.

2.2.5 Advertisements

There are numerous medical newspapers/journals published in Pakistan, which provide an

opportunity to communicate to the doctors through advertisements.

This is again an area, which has to be very carefully planned in order to get any advantage.
The major considerations are the following:

• The readership of the journal is never authentic in Pakistan. Publishers claim 20,000
where the actual circulation is not more than 5,000. A company must have its own
source of verifying through surveys etc., before selecting a newspaper or journal for
advertisement.

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• Almost all medical publications survive and thrive on advertisements with their
subscription is usually zero. When doctors are not spending money on getting a
journal, they usually do not take it seriously. Once again, company needs to evaluate
the preferences of doctors and must find out which publications do they actually read.
• Companies must focus on placing the products according to the contents of each
issue. The publications can be asked to provide a copy of the table of contents with
their tariff, which may help the marketing team to identify the appropriate product to
be advertised.
• Publishers usually distribute their magazine randomly. For example, a publisher may
be printing 3,000 copies, whereas he might have a list of 10,000 doctors. So he
randomly selected the doctors to whom the magazine/newspaper will go. This way,
the company may be loosing lots of doctors. The best way to address this issue is to
strike a deal with the preferred newspapers/journals to place advertisements only if a
certain number of the target doctors of the company will get the copy. Publishers
usually have no problem in this because they any way were sending the copies
randomly.

2.2.6 Public Relations

Since pharmaceutical companies cannot directly approach the consumers, they are reverting
more and more to voicing their messages at public forums and through newspapers so that
they can increase awareness amongst the masses about their product.

A recent product launched by MSD called “Vioxx”, has an aggressive PR campaign to go

with the product launch, through which, the worldwide success of the product was
highlighted and an undertone in favor of self-medication was evident throughout the
campaign. However, the medical profession becomes hostile to any company, which the
masses directly because doctors feels as if their authority to suggest a product is being
challenged. In essence, they are right because self-medication should never be encouraged,
especially in a country like Pakistan, where the literacy rate is low, and patients may take a
wrong medicine, or in wrong dosage, which may prove to be fatal.

Pharmaceutical companies are very careful in their PR campaigns as their have been
examples like Disprin which became a total no-no for doctors when the company went on air
through television for their direct to consumer campaign.

2.2.7 Other Activities

i) Free Medical Camps

A company may choose to organize a free medical camp at a hospital/clinic in collaboration

with a doctor where patients diagnosed with a related disorder may be prescribed company’s
medicines and the representatives present there may give a starter dose to the patients. This is
also a highly effective method, especially in poor localities and rural areas where people will
go any distance to save the consultation fee of the doctor is they can.

A problem that arises is always the follow-up purchases. To address this issue, the company
has to make sure that:
• The product being targeted is a low priced product, which the patient can continue
with.

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• The product must be freely available in the vicinity so that the patient can buy it
easily once he is done with the starter doses.
• The doctor involved in the event must be regularly followed up so that whenever a
patient comes back to him, he may ensure that he is continuing with the same brand.

ii) Corporate Marketing

Pharmaceutical companies in Pakistan have historically been brand-oriented. However,

during the last few years, progressive and aggressive companies have started to realize that
it’s basically the corporate profile, which adds value to the brand, and helps the doctor to
identify the brand differently from others.

One glaring example is of PharmEvo (Pvt.) Ltd., a company, which started its operation in
1999, soon becomes one of the fastest growing and widely recognized company only because
of unique corporate marketing activities. The company introduced the concept of “Healthcare
Beyond Physical Health”, and supported it with a corporate slogan, “Our dream, a healthier
society”. The company did away with conventional gifts and giveaways, and started
preparing and publishing beautiful books, information calendars, disease profile booklets, and
the concept gained momentum immediately. This was followed up with organization of
events like an evening with Ahmed Faraz, and now doctors simply love the way the company
operates. In a span of just 3 and half years, the company has crossed 100 million rupees in
sales, with a host of highly successful brands to its credit.

After witnessing the success cited above, more and more companies have started doing this,
and this has brought some added value to the marketing activities being performed.

iii) Hospital/Ward Improvement Programs

The condition of government hospitals in Pakistan is pathetic. There are not even the very
basic facilities are not available. Realizing this, some companies have started to support
hospital/ward development programs, which are being widely appreciated by the doctors
practicing in those institutions and they extend all possible help to the companies.

iv) E-Marketing

Today, not only multinationals, but also local companies are paying much attention to the
wonderful tool of internet marketing. However, the medical profession due to their extremely
busy schedule is not too receptive towards using computers and internet quite often, but
nevertheless, it is gaining ground fast.

Companies are not only placing their promotional literature on the web, but also developing
sites of interest for the doctors, and trying to get them visit those sites. Epla Laboratories,
Pharmatec, Efroze, Hilton and Highnoon are some of the companies, which have reasonably
good website, and they take special care to keep them updated and well maintained. It can be
safely assumed that 3-5 years down the line, web will become of the most widely used and
effective medium for promotion in pharmaceutical industry.

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2.3 Unethical Practices in Pharmaceutical Marketing

One of the sore areas in pharmaceutical marketing, especially promotion is the unethical
practice, for which companies and the medical profession are equally responsible.

Although, it’s a topic worth a separate detailed study, but it seems appropriate to at touch
upon the basic of this critical area, so that the readers of this study can gain some insight of
the darker side of pharmaceutical marketing as well.

We may discuss these practices under two different heads to develop a better understanding
of the concepts and implications:

2.3.1 Practices at Promotional Level

The most commonly adopted unethical methods with medical profession are the following:

• Expensive items are provided to the doctors, and in return the doctor agrees to support
the company by prescribing its products. These gifts are not confined to just items
used in doctor’s own practice like diagnostic equipment, BP apparatus, Stethoscope
etc., which a doctor should be buying from his own money, but also to personal and
household items. There are countless examples where televisions, air-conditioners,
carpets, audio players and even cars have been presented to the doctors.
• Sponsoring doctors to international conferences is another way of bribing them. This
can be a good activity, which may bring latest knowledge to the country, but it
becomes meaningless when a dermatologist is sponsored to attend a cardiology
conference. These trips are not fully paid, but doctors are usually allowed to take their
family along, and all the cost of entertainment and even shopping of the lady are
borne by the company.
• Outstation launch meeting is another face of this menace. Doctors are taken to
Bhurban, Dubai and Bangkok to attend introductory launch meetings for new
products, which can very well be done on location. These are again pleasure trips with
almost no academic value.
• The worst form of unethical practice is where a doctor willingly accepts a cash reward
in return of his prescription. Companies even get receipt from the doctors for this
incentive. Few years back, the whole marketing of Upjohn was fired because the news
of such activity performed in Pakistan reached their corporate offices. A number of
local companies are openly involved in such practices and accept this as a norm.

2.3.2 Practices at Trade Level

Trade oriented policies have become the easiest shortcut for the companies, which do not
want to get into the technical and highly skilled job of detailing their products to the doctors.
These companies dump their stocks with extra discount/bonuses in trade, and expect the
chemists to substitute the prescribed product with another branded generic, where he is
getting extra benefit up to the tune of 30-40% in certain cases. This strategy is extremely
successful due to overall low literacy rate of patients in Pakistan, who are unable to read the
prescription, and take whatever is given to them Another method that these traders adopt is
that they simply do not stock the products for which the companies are not giving any trade
offers, and when a patient comes to them with a prescription, they tell him that the product is
not being supplied and they may take another brand which contains the same ingredient and

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will also save them some money. Most of the patients in rural areas and low-profile localities
do fall in this trap quite easily.

There is another area of concern, which is the association of some doctors with chemists. In
rural areas of Pakistan, it is a common thing to see a cousin or brother of the doctor running a
pharmacy adjacent to his clinic. This cartel act in two three ways:

• The chemist informs the doctor about the brand on which he has got special discount
and the doctor starts prescribing it at any given opportunity.
• The doctor asks the chemist to stock the product for which the doctor has been able to
strike a deal with the company, and the chemist orders extra stock of that brand,
which is liquidated on the doctor’s prescriptions.
• The doctor asks for additional samples from the representatives visiting him, and
gives them to the chemist, who sells them to patients, and the booty is then shared
between the both parties.

The unethical practices are an ever-rising phenomenon in Pakistan’s pharmaceutical

marketing arena. However, over the last few years, there has been a growing awareness
amongst the doctors’ community, which do not indulges in such practice and feel bad when
someone from their community brings bad reputation for doctors. They have started to
strongly condemn the companies who come up to them, with such offers and also try to
influence other doctors to avoid supporting those companies. On the other hand, several
pharmaceutical companies have come up with a clean profile and are spreading awareness
amongst the doctors on how their patients may suffer due to sub-standard products that those
unethical companies market.

There is still a silver lining in the sky, and hopefully as more and more people from the
industry as well as the medical profession become more aware of this evil, things will
improve during the days to come.

2.4 The Marketing Communication Mix

The specific mix of advertising, personal selling, sales promotion, public relations and direct-
marketing tools a company uses to pursue its advertising and marketing objectives.

2.4.1 Advertising

Any paid form of non-personal presentation and promotion of ideas, goods, or services by an
identified sponsor.

2.4.2 Personal Selling

Personal presentation by the firm’s sales force for the purpose of making sales and building
customer relationships.

2.4.3 Sales Promotion

Short-term incentives to encourage the purchase or sale of a product or service.

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2.4.4 Public Relations

Building good relations with the company’s various publics by obtaining favorable publicity,
building up a good corporate image, and handling or heading off unfavorable rumors, stories,
and events.

2.4.5 Direct Marketing

Direct communications with carefully targeted individual consumers to obtain an immediate

response, and cultivate lasting customer relationships.

2.5 Steps in Developing Effective Communication Mix

The development of effective communication mix in pharmaceutical marketing is a complex
task, which goes through several steps, which are discussed below:

2.5.1 Identifying the Target Audience

A marketing communicator starts with a clear target audience in mind. He has to clearly
know the profile of the doctors who will receive the message. A message intended for general
practitioners will be completely different from a message intended to reach a
specialist/consultant.

In case of GPs, the message will be simple, slightly non-technical and clear as the diseases
treated by GPs are usually simpler and nature, and they also avoid high-risk patients.
However, a message focused on specialist has to take into account the knowledge the doctor
himself is supposed to have about the product. Such doctor will be least interested in hearing
about the basic profile, mode of action etc. of the drug, and will be looking for results of
latest trials or abstracts from articles recently published.

2.5.2 Determining the Communication Objectives

Once the target audience has been defined, the marketing communicator must decide what
response is sought. Of course, in pharmaceutical marketing, the final response is prescription.
But prescription is the result of a long process of decision making by the doctor.

The factors, which may affect the communications objectives in context of pharmaceutical
marketing, can be the following:

i) Doctor’s readiness stage

A doctor can be in one of the following stages of readiness at any given time. These stages
include awareness, knowledge, liking, preference, conviction, and prescribe. The marketer
must be absolutely clear about where do the target doctors stand when they will receive the
communication. There is so much in a medicine to talk about in so little time. Therefore, it is
a major issue to be sure of what to communicate and what not. A doctor, who has just the
basic knowledge about the product would be looking for further details, whereas, the doctor
who has already developed a liking for the product may be looking just for one good reason
to prescribe.

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The communication objective will be largely affected by these situations.

ii) Profile of the target doctors

Consultants and specialists usually dislike detailed presentations as they feel the
representative is trying to teach them. Therefore, the objective in such cases should be to
deliver a crisp and direct message. Whereas, in case of junior doctors and general
practitioners, the message must be elaborate and covering all the relevant and necessary
details as this is what the doctors are looking for.

iii) Product profile

For a brand, which contains an active ingredient, which is comparatively newer, the
communication objective must be to take nothing for-granted, and the message should
contain all necessary details. Similarly, a brand to be used in serious medical conditions, like
hypertension, diabetes or blood disorders need to be explained thoroughly. On the other hand,
brand of simple analgesic or multivitamin should be promoted with simple and basic
message.

iv) Product life cycle stage

A product, which has been on the market for long is known fully to the doctors. They are not
interested to know the details and the message should serve just as a reminder to them. On
the other hand, a drug recently launched might still have some areas about which the doctors
are not clear, and information regarding the drug may do well for the brand.

2.5.3 Designing a Message

Having defined the desired audience response, the communicator turns to developing an
effective message. Ideally, in general marketing terms, the message should get Attention,
hold Interest, arouse Desire, and obtain Action (a framework known as the AIDA model).

However, in pharmaceutical marketing communication, the D for Desire should be replaced

with D for Decision; which means that the massage must get Attention, hold Interest,
facilitate Decision, and obtain Action, which in this case is prescription.

Normally, the attention is grabbed in pharmaceutical marketing through starting the

discussion with a real life situation, which can be then related to the profile of the product.
The detailing tools used are usually carrying an attractive visual on the front page, with a
caption, which serves the purpose by getting the attention of the doctors. Sometimes, some of
the major concern of the doctors can be highlighted on the first page, on which the doctors
focus their attention and then they can be taken to the product message.

The interest is held through developing the message in such a way that the doctor feels
interest in the discussion. Normally, those areas are highlighted regarding the product profile,
which are important for the doctor to understand. Use of pictures, graphics and colors help in
retaining the interest of the audience.

The decision is facilitated through anticipating the queries and answering them during the
discussion. If the doctor might be concerned for the price, then the message should take that

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into account, and this objection should be tackled during the discussion before the doctor can
throw the question across. The major concerns usually are regarding efficacy, safety,
comparative data with reference to other treatment options, price and availability of a
product. A good marketer always addresses these concerns in his message.

Finally, the message gives some solid reason at conclusion, which may convince the doctor
to prescribe the product. It can be the major USP of the product, which clever marketers
might save for the closing of the discussion.

2.5.4 Choosing Method of Delivery

The marketing of pharmaceutical entails two sets of tools, in-clinic and out-of-clinic. A
communicator has to choose from the two sets, or may come up with the mix of selected
tools from the two sets. The core message will though remain same, but the communicator
needs to adapt the message according to the medium being used.

The basic tool for communication remains the detailing aid, which the company’s
representative uses in the doctor’s clinic. This detailing aid contains almost all important
details, from which a representative may choose what to communicate and what not
according to the situation and response of the doctor. The leave behind tools usually contain
the core message and support information, which can remind the doctor of the basic stance of
the product and its benefits for the patients.

The press advertisement again repeats the same message, but is focused more on the benefits,
which a doctor can pick while flipping through the pages of a magazine or medical
newspapers. If the communicator feels that there is a need of interactive communication, he
might think of using a forum to put the message across like a seminar or a panel discussion.

2.5.5 Collecting Feedback

After sending the message, the communicator must research its effect on the target audience.
The immediate feedback comes from the sales trend of the product, which tells how effective
the communication has proven to be. Another effective method is the visits from the
marketing and sales management personnel to sample doctors and during discussions, it
becomes evident if the message has been delivered effectively, and did the contents provide
answers to the queries of the doctors. In some cases, the company might also decide to go for
surveys or other formal methods of research, sometimes with the help of outside agencies to
know how well the communication has been designed and delivered.

2.6 Integrated Marketing Communications

Pharmaceutical marketing professionals are fast becoming aware of the latest development in
the discipline of marketing, and they have also started to adopt latest theories in
communications. Unlike few years back, when all tools were used in isolation from each
other, which messages and format changing as per the requirement of the tool, now we find a
synergy in all marketing activities. Marketers are making all efforts to make sure that each
next step in the communication process adds some value to the previous one. Right from the
detailing folder, to leave behinds, to press advertisements, and even to discussion forum, the
same message is presented in different forms.

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Product slogans, logos and positioning statements are taking up fast. One look at the
advertisements appearing in the medical press and you realize that pharmaceutical marketing
has come a long way from the basic, “Panadol for Pain” stage. Now you come across trendy
and catchy slogans just like consumer products. Product positioning is now being based on
emotional appeals, which is a takeoff from simple no-nonsense kind of approach
pharmaceutical marketing symbolized for long.

Today, each product stands for something. A look at a pharmaceutical companies’

communications gives a clear idea of current status of marketing, where the core message is
integrated all across the communication tools and media. The line between pharmaceutical
marketing and general marketing is thinning, but still intact and will remain so, considering
the peculiar characteristics of pharmaceutical products, and the dynamics of the industry.

2.7 Pharmaceutical Marketing – Future Outlook

Things are changing at lightening pace in pharmaceutical marketing, as in all other discipline.
The scenario in Pakistan is very dynamic and evolving rapidly. Things have really changed if
we considered the local pharmaceutical industry. The pharmaceutical industry in Pakistan has
gone through a major transformation during the last five years. The share of MNCs has gone
down from 65% in 1992, to 55% in 2002. The local pharmaceutical companies, which were
previously, consider as low quality and low price options are now rapidly emerging as brand
leaders in several categories.

At present, there are around 450 licensed manufacturers in Pakistan, of which around 300 can
be termed as active players. Out of these, 30 are multinational operations whereas the
remaining are purely local pharmaceutical concerns. The market size in terms of Pakistani
rupees is estimated at around 40 billion for the year 2002, with an estimated growth rate of
6%. This growth has been at this level almost for the past 3 years. Just a decade back, brands
from national companies were considered as appropriate only for patients, who otherwise will
not be able to buy a medicine if not prescribe a brand from local company. The companies on
their part, confined to selling at low cost of institution, and visiting low profile general
physician in semi-urban and rural areas.

Things went through a total transformation during early 90’s, when several local companies
started to hire high-profile professionals with multinational exposure, and also entered into
licensing and similar arrangements with international companies. The quality of medicines
improved remarkably, and the sales & marketing teams became capable of competing with
multinational companies. Today, we find many brands from local companies like Sami,
Hilton, Efroze, PharmEvo & Getz on top of several therapeutic categories rubbing shoulders
with MNCs. The country has now become an equal opportunity arena for all players.

The future of pharmaceutical marketing paints a very interesting picture. Doctors are giving
more importance to product information, and conventional gifts and services are no more an
effective tool. The worldwide emergence of DTC or Direct to Consumer marketing is yet to
gain ground in Pakistan, but soon we will find companies arranging events and launching PR
campaigns to create consumer awareness. One thing is for sure; mediocrity now has no future
in pharmaceutical marketing. Things will keep on becoming tough, and only those companies
will survive who invest a lot in corporate image building, foster a vision, and develop a
winning culture in their organizations.

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About Author

Prof. Dr. Rizwan Raheem Ahmed

Professor (Department of Business Administration & Commerce)

E-mail: rizwan.Raheem@Indus.edu.pk & rizwanraheemahmed@gmail.com

Tel: +92 (300) 829-3560 & +92 (321) 840-0465

Dr. Rizwan Raheem Ahmed holds B.Sc. (Hons.), M.Sc. in Applied Statistics and Master of
Science (MAS) in Human Resource Management from University of Karachi. He also earned
MBA (Marketing) from PAF-KIET and MBA (General Management) from Institute of
Business Administration, Karachi. He also holds MS (Management Sciences) from SZABIST
and M.Phil. (Financial Economics) from Hamdard University, Karachi. Dr. Rizwan earned
his Ph.D. in Pharmaceutical Marketing from Hamdard University, Karachi.

Dr. Rizwan Raheem Ahmed carries more than 19 years of Professional Experience at Senior
Management Positions in Sales and Marketing with prestigious National & Multinational
Organizations in Pharmaceutical Industry. He has been associated with Indus University
since September 2013 as Professor for Business Administration & Commerce department. He
has been visiting Faculty for SZABIST for several years. More than 40 Publications (Peer
reviewed research articles) are on his credit in reputed National & international Journals
including ISI Thomson Reuters indexed & impact factor Journals also. He is also an author of
several News articles, which have published in DAWN, Karachi and Business Recorder,
Karachi.

He has attended several international conferences on Pharmaceutical Marketing, and distinct

therapeutic classes of different Medical Specialties in China, Russia, United States, United
Kingdoms, Italy, Netherlands, Brazil, Malaysia, Thailand, Singapore, Jordan, UAE, Sweden,
Brazil and other parts of the Globe.

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