“Impact study on various promotional practices done by ...

“Impact study on various promotional

practices done by pharmaceutical companies

on doctor's prescription behavior”

A Thesis submitted to Gujarat Technological University

for the Award of

Doctor of Philosophy

in

Management

By

Krunal Shashikant Vishavadia Enrollment No.: 129990992042

under supervision of

Dr. Sandip Solanki

GUJARAT TECHNOLOGICAL UNIVERSITY

AHMEDABAD

December 2021

I

DECLARATION

I declare that the thesis entitled “Impact study on various promotional practices done

by pharmaceutical companies on doctor’s prescription behavior” submitted by me

for the degree of Doctor of Philosophy is the record of research work carried out by me

during the period from November 2012 to December 2021 under the supervision of

Dr. Sandip Solanki and this has not formed the basis for the award of any degree,

diploma, associateship, fellowship, titles in this or any other University or other

institution of higher learning.

I further declare that the material obtained from other sources has been duly

acknowledged in the thesis. I shall be solely responsible for any plagiarism or other

irregularities, if noticed in the thesis.

Signature of the Research Scholar: ……………… Date: 3/12/2021

Name of Research Scholar: Krunal Shashikant Vishavadia

Place: Ahmedabad

II

CERTIFICATE

I certify that the work incorporated in the thesis “Impact study on various

promotional practices done by pharmaceutical companies on doctor’s

prescription behavior” submitted by Mr. Krunal Shashikant

Vishavadia was carried out by the candidate under my supervision/guidance. To the

best of my knowledge: (i) the candidate has not submitted the same research work

to any other institution for any degree/diploma, Associateship, Fellowship or other

similar titles (ii) the thesis submitted is a record of original research work done by

the Research Scholar during the period of study under my supervision, and (iii) the

thesis represents independent research work on the part of the Research Scholar.

Signature of Supervisor: Date: 3/12/2021

Name of Supervisor: Dr. Sandip Solanki

Place: ………………… Pune

III

COURSE-WORK COMPLETION CERTIFICATE

This is to certify that Mr. Krunal Shashikant Vishavadia enrolment no. 129990992042

is a PhD scholar enrolled for PhD program in the branch Management of Gujarat

Technological University, Ahmedabad.

(Please tick the relevant option(s))

He has been exempted from the course-work (successfully completed during

M.Phil Course)

He has been exempted from Research Methodology Course only (successfully completed

during M.Phil Course)

He has successfully completed the PhD course work for the partial requirement for the

award of PhD Degree. His/ Her performance in the course work is as follows-

Grade Obtained in Research Methodology

(PH001)

Grade Obtained in Self Study Course (Core Subject)

(PH002)

BC AA

Supervisor’s Sign

Dr. Sandip Solanki

IV

ORIGINALITY REPORT CERTIFICATE

It is certified that PhD Thesis titled “Impact study on various promotional practices

done by pharmaceutical companies on doctor’s prescription behavior” by Mr.

Krunal Shashikant Vishavadia has been examined by us. We undertake the following:

a. Thesis has significant new work / knowledge as compared already published or

are under consideration to be published elsewhere. No sentence, equation,

diagram, table, paragraph or section has been copied verbatim from previous work

unless it is placed under quotation marks and duly referenced.

b. The work presented is original and own work of the author (i.e. there is no

plagiarism). No ideas, processes, results or words of others have been presented

as Author own work.

c. There is no fabrication of data or results which have been compiled / analysed.

d. There is no falsification by manipulating research materials, equipment or

processes, or changing or omitting data or results such that the research is not

accurately represented in the research record.

e. The thesis has been checked using Turnitin (copy of originality report attached)

and found within limits (8%) as per GTU Plagiarism Policy and instructions issued

from time to time (i.e. permitted similarity index <=25%).

Signature of the Research Scholar: …………………………… Date: ….………


Place: Ahmedabad

Signature of Supervisor: ……………………………… Date: ………………


Place: ………………… Pune

3/12/2021

3/12/2021

VII

PHD THESIS NON-EXCLUSIVE LICENSE TO

GUJARAT TECHNOLOGICAL UNIVERSITY

In consideration of being a PhD Research Scholar at GTU and in the interests of the

facilitation of research at GTU and elsewhere, I,

Krunal Shashikant Vishavadia having (Enrollment No.) 129990992042 hereby grant a

non-exclusive, royalty free and perpetual license to GTU on the following terms:

a) GTU is permitted to archive, reproduce and distribute my thesis, in whole or in part,

and/or my abstract, in whole or in part ( referred to collectively as the “Work”) anywhere

in the world, for non-commercial purposes, in all forms of media;

b) GTU is permitted to authorize, sub-lease, sub-contract or procure any of the acts

mentioned in paragraph (a);

c) GTU is authorized to submit the Work at any National / International Library, under the

authority of their “Thesis Non-Exclusive License”;

d) The Universal Copyright Notice (©) shall appear on all copies made under the authority

of this license;

e) I undertake to submit my thesis, through my University, to any Library and Archives.

Any abstract submitted with the thesis will be considered to form part of the thesis.

f) I represent that my thesis is my original work, does not infringe any rights of others,

including privacy rights, and that I have the right to make the grant conferred by this non-

exclusive license.

g) If third party copyrighted material was included in my thesis for which, under the

terms of the Copyright Act, written permission from the copyright owners is required,

I have obtained such permission from the copyright owners to do the acts mentioned

in paragraph (a) above for the full term of copyright protection.

h) I retain copyright ownership and moral rights in my thesis, and may deal with the

copyright in my thesis, in any way consistent with rights granted by me to my University

in this non-exclusive license.

i) I further promise to inform any person to whom I may hereafter assign or license my

copyright in my thesis of the rights granted by me to my University in this non- exclusive

license.

VIII

j) I am aware of and agree to accept the conditions and regulations of PhD including all

policy matters related to authorship and plagiarism.

Signature of the Research Scholar:


Date: 3/12/2021

Place: Ahmedabad

Signature of Supervisor:


Date: 3/12/2021 Place: Pune

Seal: Symbiosis Institute of International Business (SIIB), Pune

IX

THESIS APPROVAL FORM

The viva-voce of the PhD Thesis submitted by Mr. Krunal

Shashikant Vishavadia (Enrollment No. 129990992042) entitled “Impact study on

various promotional practices done by pharmaceutical companies on doctor’s

prescription behavior” was conducted on Friday, 3rd December 2021 at Google Meet,

online platform of Gujarat Technological University.

(Please tick any one of the following option)

The performance of the candidate was satisfactory. We recommend that he/she be

awarded the PhD degree.

Any further modifications in research work recommended by the panel after 3 months

from the date of first viva-voce upon request of the Supervisor or request of

Independent Research Scholar after which viva-voce can be re-conducted by the

same panel again.

The performance of the candidate was unsatisfactory. We recommend that he/she

should not be awarded the PhD degree.

Dr. Sandip Solanki,

Symbiosis Institute of

International Business,

Pune

Dr. Vinod Mishra

Monash Business School,

Monash University,

Australia

Dr. Madhuri Deshpande

School of Commerce &

Management Sciences, SRTM

University, Nanded

(Briefly specify the modifications suggested by the panel)

(The panel must give justifications for rejecting the research work)

X

ABSTRACT

Pharmaceutical promotion is based on the interaction between pharmaceutical sales representative and

doctors. Pharmaceutical companies use many tactics to engage doctors and find a ways to highlight

their brands. The objective behind these tactics is to give maximum exposure of brand in front of doctor

& get it registered in doctor’s mind. The probability of getting prescription is very high if the brand

name is registered in subconscious mind of doctor. The objective of this study is to check whether

pharmaceutical promotional tactics really change the prescription habit of doctors or not. Medical

representative detailing, Corporate Social activity, Corporate image, Continues Medical Education,

Personal attire of company representative, Sponsorship, Literatures and reminders of Pharmaceutical

companies, Medical representative’s Knowledge, Medical camp and Customer Relationship

Management, these are few pharmaceutical promotional tools to promote their brands.

The study was conducted with self-administered structured questionnaires and data collected till

response rate reach to the desired sample size. Responses asked from the doctors practicing in different

specialties like General practitioners, Physicians, Gynecologists, Pediatricians, and dentists. The study

was conducted in a metro cities of Gujarat, i.e Ahmedabad, Surat, Rajkot and Baroda. The reliability

of questionnaire was tested with Cronbach alpha value. The study covers a comprehensive analysis on

which promotional tool impact more on the prescription behavior of physicians. The multiple linear

regression model used to test the hypothesis. Regression analysis used to check the relationship

between pharmaceutical promotional tool and doctor’s prescription behavior. Data analysis confirms

that variables or promotional tools like Detailing of Medical Representative, Sampling, Continues

Medical Education, Journal Subscription, Corporate Social Responsibility, Patient Education,

Corporate Image, Personal Attire of Medical Representative, Digital marketing, Literatures and

Reminders, Medical Representative’s Knowledge & Customer Relationship Management are

positively impact on doctor’s prescription behavior. While variables or promotional tools like

Promotional Pricing, Product demonstration, Sponsorship & Medical Camp don’t have any impact in

attracting prescription from doctors.

Other relevant and practical recommendations are also made while completing the thesis. This can be

of great help to pharmaceutical marketers to develop their future marketing strategies and prospects.

XI

ACKNOWLEDGEMENT

Words are poor substitute to express one’s feelings especially when one is overwhelmed with

emotions of gratitude. The wisdom, commitment and efforts of many people were a source of

inspiration while completing this thesis. They have given me valuable contributions and expedient

comments. It gives me a great pleasure to acknowledge all those who have contributed towards the

conception, origin and nurturing of this research and who made my task less onerous.

First and foremost, I thank to God, my father and my mother; because of their blessings, I could

successfully complete my research work.

The most importantly, I would like to express my deepest regards and sincere thanks to my

supervisor Dr. Sandip Solanki, Associate Professor, Symbiosis Institute of International Business

(SIIB), Symbiosis International (Deemed University) (SIU), Pune, Maharashtra, India for the

continuous support for my research, for his patience, motivation, enthusiasm, and immense

knowledge. His guidance helped me in all the time of research and writing of this thesis. I could not

have imagined having a better advisor and mentor for my doctoral study.

The completion of the doctoral work could not have been possible without flawless support and

guidance of the DPC (Doctoral Progress Committee) Members: Dr. Jay Badiyani, Asst. Professor,

Department of Business Administration, Bhavnagar University, Bhavnagar and Dr. Vijay H. Vyas,

Professor, Department of Commerce and Management, KSKV Kachchh University, Bhuj and Prof.

(Dr.) K.J. Thankachan, Principal, Christ Institute of Management, Rajkot. Their unconditional

support, cooperation and correct guidance would always be remembered.

I express my sincere gratitude towards my superiors and colleague at Ban Labs Ltd, especially to

Mr. Rajesh Patel, Vice President (sales and marketing), Mr. Harshal Lalwani, Vice President

(sales and marketing) & Mr. N. D. Vora, Manager, Ban Labs, Rajkot. With their able guidance and

support I could able to start my doctorate along with corporate work assignments.

I also express my sincere gratitude towards my superiors at Cadila Pharmaceuticals Ltd, especially

to Dr. Jitendrasingh Huda, Vice President (sales and marketing), Mr. Kaushik Dasgupta,

General Manager (Marketing). With their supportive nature, I could continue my research work

without hurdles.

I also express my sincere gratitude towards my superiors & colleague at Intas Pharmaceuticals Ltd,

XII

especially to Mr. Sunil Panat, Sr. Vice President, Mr. Satish Pandey, Vice President, Mr. Amit

Chauhan, General Manager, Mr. Nishant Singh, Marketing Manager and Mr. Abhinav Mishra,

Therapy Manager. Needless to say that their worthy suggestions, encouragement, support, and

motivation have helped me to complete this research work successfully.

My journey of research was always supported by my parents – Dr. Shashikant Vishavadia &

Mrs. Jayshree Vishavadia, parents-in-law – Mr. Gordhan Jethwa & Mrs. Usha Jethwa, my

brother – Mr. Jignesh Vishavadia, and most of all - my wife. The thesis is dedicated to them for

all their support, love and motivation. Special mention is to be given to my wife – Bina, her

unconditional love & continuous support were the factors that kept me going during the ups and

downs of the doctoral process.

I would like to extend my thanks to Dr. Krishna Murthy Inumula, Associate Professor, Symbiosis

Institute of International Business (SIIB), Symbiosis International (Deemed University) (SIU),

Pune, Dr. Mitesh Dadhania & Dr. Raju Rathod for their support in better understanding the

journey of doctorate. I am also very thankful to my Ph.D. friend Dr. Jaydeep Sheth for his

continuous support during my research work.

I would like to extend my thanks towards Gujarat Technological University (GTU) Vice Chancellor,

Registrar and PHD section for all support during my research work. Also special thanks to all the

expert panel members of each of the research week presentations for their valuable suggestions.

I am also very grateful to all the respondent doctors who have participated in this study and provided

valuable information for completing this research.

I am highly obliged to the past and present authors mentioned in the bibliography, whose

contribution was of a great help to me during this investigation.

Finally, let me seize this opportunity to express my sincere gratitude to all those people who directly

or indirectly helped me in completing this research work.

Krunal Vishavadia

XIII

TABLE OF CONTENT

Sr. No. Content

Page

No.

Title Page

Declaration I

Certificate II

Course-Work Completion Certificate III

Originality Report Certificate IV

Non Exclusive License Certificate VII

Thesis Approval Form IX

Abstract X

Acknowledgement XI

Table of Content XIII

List of Abbreviation XV

List of Figures XVIII

List of Tables XIX

List of Appendices XXII

Chapter

I

INTRODUCTION : PHARMACEUTICAL INDUSTRY 1 – 36

1.1 Evolution of Pharmaceutical industry 2

1.2 Global pharmaceutical market 7

1.3 Global Trend in Pharmaceutical market 11

1.4 Indian Pharmaceutical Market 13

1.5 Opportunities for Indian Pharmaceutical Market 20

1.6 Challenges for Indian Pharmaceutical Market 22

1.7 Uniform Code for Pharmaceuticals Marketing Practices

(UCPMP) 24

1.8 Channel of distribution 28

1.9 Regulations in Indian Pharmaceutical Industry 32

1.10 Rationale of the Study 34

1.11 Statement of the Problem 34

1.12 Scope of the study 36

Chapter

II

REVIEW OF LITERATURE 37 – 70

2.1 Pharmaceutical Marketing 38

2.1.1 Role of Pharmaceutical Marketing 38

2.1.2 Expenditure on pharmaceutical marketing 39

2.1.3 Global Trend in Pharmaceutical Marketing 42

2.1.4 Pharmaceutical Marketing-An Indian Perspective 44

2.2 Types of Pharmaceutical Activities 47

2.3 ROI in Pharmaceutical industry 50

2.4 Pharmaceutical Promotional Tools 51

2.5 Research Gap 69

XIV

Sr. No. Content Page No.

Chapter

III

RESEARCH METHODOLOGY 71-82

3.0 Introduction 72

3.1 Research Objective 72

3.2 Hypothesis 72

3.3 Research Design 73

3.3.1 The Context 74

3.4 Population of the Study 74

3.5 Sample Size 75

3.6 Sampling Technique 75

3.7 Sources of Data 76

3.8 Tools used for Data Collection 76

3.8.1 Tool for doctor's prescription behaviour 77

3.8.2 Pilot Study 77

3.8.3 Reliability and Validity of Tool 78

3.9 Data Processing 79

3.9.1 Questionnaire Checking 79

3.9.2 Data Editing 79

3.9.3 Data Coding 80

3.9.4 Data Transcribing 80

3.10 Theoretical Framework 80

3.11 Statistical Techniques 81

3.12 SPSS Software Used for Analysis 82

Chapter

IV

DATA ANALYSIS AND INTERPRETATION 83 – 124

4.1 General Information 84

4.2 General Profile of Respondents 84

4.2.1 City & Specialty 84

4.2.2 Practicing Experience 85

4.2.3 Average Patients per Day 87

4.2.4 Entertain activities by pharmaceutical companies 88

4.2.5 Preference of Activity Performed 89

4.3 Impact of Specialty on Activities 89

4.4 Hypothesis Testing 94

Chapter

V

FINDINGS, CONCLUSION AND FUTURE SCOPE 125 – 135

5.1 Finding in context of objective 126

5.2 Conclusion and future scope 133

REFERENCES 136 – 152

6.1 List of References 137

6.2 List of Publications 152

APPENDICES 153 – 164

7.1 Questionnaire 153

XV

LIST OF ABBREVIATION

Abbreviation Full form

% MS % Market Share

ABM Area Business Manager

ADHD Attention deficit hyperactivity disorder

AHA African human tripanosomiasis

AI Artificial intelligence

AIOCD All India Organisation of Chemists and Druggists

ANOVA Analysis of Variance

APIs Active Pharmaceutical Ingredients

Apps Mobile Application

AVE Average variance extracted

BC Before Christ

CAGR Compound annual growth rate

Cas9 CRISPR associated protein 9

CDSCO Central Drugs Standard Control Organisation

CFAs Clearing and Forwarding Agents

CHCl3 Chloroform

CME Continuing medical education

CNS Central nervous system

CRISPR Clustered Regularly Interspaced Short Palindromic Repeats

CRM Customer relationship management

CRO Contract / Clinical Research Organization

CSO Central Statistical Office

CSR Corporate social responsibility

Df Degrees of freedom

DM Doctor of Medicine

DNA Deoxyribonucleic acid

DNB Diplomate of National Board

DPCO Drug Price Control Order

DTABs Drug Technical Advisory Board

DTC / DTCA Direct to consumer advertising

DTx Digital Therapeutics

EBIT Earnings before interest and taxes

EU European Union

FDA Food and Drug Administration

FDI Foreign Direct Investment

FMCG Fast-moving consumer goods

GDP Gross domestic product

GI Gastrointestinal

GNP Gross National Product

GOI Government of India

XVI


GP General Practitioner

H2 Histamine type 2 receptors

HCP Health care personnel / professionals

ICMR The Indian Council of Medical Research

IFPMA

International Federation of Pharmaceutical Manufacturers &

Associations

IMS Intercontinental Medical Statistics

IoT The Internet of things

IP In Patients

IPM Indian Pharmaceutical Market

iPSC Induced Pluripotent Stem Cells

IQVIA Quintiles and IMS Health Inc., an American multinational company

IT Information Technology

IV Intravenous therapy

KAM Key Account Manager

KOL Key opinion leaders

MBBS Bachelor of Medicine, Bachelor of Surgery

MCI The Medical Council of India

MDGs Millennium Development Goals

ML Machine Learning

MNC Multinational Corporation

MOHFW Ministry of Health and Family Welfare

MR Medical Representative

MRP Maximum Retail Price

NGB Next Generation Biotherapeutics

NGO Non-Government Organizations

NLEM National List of Essential Medicines

NPPA National Pharmaceutical Pricing Authority

NTDs Neglected tropical diseases

OoP Out of Pocket

OP Out Patients

OTC Over-The-Counter

PhRMA Pharmaceutical Research and Manufacturers of America

PPOI Pharmaceutical Producers Organization of India

PSR Product Sales Representative

PvPI Pharmacovigilance Programme of India

R & D Research & development

RBM Regional Business Manager

RCT Randomized controlled / clinical trial

ROI Return on Investment

RT Resource Transfer

XVII


RWD Real World Data

RWE Real World Evidence

SaaS Software as a service

Sig. Statistical testing of significance

SKUs Stock Keeping Unit

SMS Short message service

SPSS Statistical Package for the Social Sciences

STH Schytosomiasis

SWOT Strengths, Weaknesses, Opportunities, and Threats analysis

TV Television

UCPMP Uniform Code of Pharmaceutical Marketing Practices

UK United Kingdom

UN United Nations

US The United States of America

USD United States Dollar

USFDA United States Food and Drug Administration

Vita. Vitamins

WHO World Health Organization

XVIII

LIST OF FIGURES

Figure

No. Content

Page

No.

1.1.1 FDA approvals & R & D spending: 1995 – 2006 7

1.2.1 Global Prescription Drug Sales (2010-2024) 8

1.2.2 Global Medicine Spending and Growth in Selected Regions, 2018–2023 9

1.2.3 Top 10 Companies as per global prescription drug sales in 2024 11

1.4.1 Indian pharmaceutical industry's projected scale, USD billion 17

1.4.2 Relationship triangle: Pharmaceutical, Physicians, Patients and Chemists 18

1.6.1 Current distribution chain in India 30

1.6.2 Patterns of complex distribution of pharmaceuticals in India 31

2.1.1 Medical Marketing 1997 vs 2016 in US 40

2.1.2 Expenditure spread of large pharmaceutical company 40

2.1.3 Staff participate at different pharmacy network levels 46

2.4.1 Objective of pricing 53

2.4.2 Types of Pricing Strategies 54

3.1.1 Research Design 74

3.2.1 Theoretical framework based on Stimulus - Organism - Response (S-O-R)

Model 81

4.1.1 Frequency of specialty pattern 85

4.2.1 Practicing experience pattern 86

4.2.2 Average Patients per Day 88

4.3.1 Impact of Activities on Dentist 90

4.3.2 Impact of Activities on General Practitioner 91

4.3.3 Impact of Activities on Gynaecologists 92

4.3.4 Impact of Activities on Paediatricians 93

4.3.5 Impact of Activities on Consulting Physicians 94

4.4.1 Regression standardized residual plot for variable detailing 96

4.4.2 Regression standardized residual plot for variable sampling 98

4.4.3 Regression standardized residual plot for variable CME 100

4.4.4 Regression standardized residual plot for variable product demonstration 102

4.4.5 Regression standardized residual plot for variable sponsorship 104

4.4.6 Regression standardized residual plot for variable journal subscription 105

4.4.7 Regression standardized residual plot for variable medical camps 107

4.4.8 Regression standardized residual plot for variable corporate image 109

4.4.9 Regression standardized residual plot for variable patient education 111

4.4.10 Regression standardized residual plot for variable personal attire 114

4.4.11 Regression standardized residual plot for variable digital marketing 116

4.4.12 Regression standardized residual plot for variable MR’s product knowledge 119

4.4.13 Regression standardized residual plot for variable CRM 121

4.4.14 Regression standardized residual plot for variable pharmaceutical promotional

tools 123

XIX

LIST OF TABLES

Table

No. Content

Page

No.

1.1.1 Pharmaceutical product growth milestones 3

1.2.1 Global Spending and Growth in Selected Countries 9

1.2.2 Top 15 OTC therapy & prescription drug categories by global sales,

2016–2022 10

1.4.1 Market shares of Indian pharmaceutical companies versus multi-national

companies 14

1.4.2 Timeline of Evolution of Indian Pharmaceutical Sector 15

1.4.3 Top 10 Indian Pharmaceuticals 16

1.4.4 Top 10 brands of Indian Pharmaceutical Industry 17

1.4.5 Therapy Markets of IPM 18

1.4.6 Specialty wise no of doctors & prescriptions 19

1.4.7 SWOT of Indian Pharmaceutical Market 20

1.6.1 Diverse distribution channel level margins 29

1.7.1 List of Acts Regulation for Pharmaceuticals in India 32

2.2.1 Pharmaceutical promotional tools 49

2.4.1 Eight Millennium Development Goals (MDGs) of UN 61

2.4.2 Available Digital Channels & their impact in Clinical Practices 67

3.1.1 Hypothesis 72

3.2.1 Reliability and Validity Statistics 78

4.1.1 City & Specialty pattern 84

4.2.1 Practicing experience pattern 85

4.2.2 Average patients per day 87

4.2.3 Entertain activities by pharmaceutical companies 88

4.2.4 Preference of Activity Performed 89

4.3.1 Impact of Specialty on Activities 89

4.4.1 Model summary of better the detailing and promotion in front of doctor,

better the prescription support from doctor 94

4.4.2 ANOVA analysis of summary of better the detailing and promotion in

front of doctor, better the prescription support from doctor 95

4.4.3 Regression analysis of summary of better the detailing and promotion in

front of doctor, better the prescription support from doctor 95

4.4.4 Relationship between price of the medicine and chance to get prescribe 96

4.4.5 Model summary of trial packs to doctor and chance to get prescription

support from doctor 97

4.4.6 ANOVA analysis of trial packs to doctor and chance to get prescription


4.4.7 Regression analysis of trial packs to doctor and chance to get prescription


XX

Table

No. Content

Page

No.

4.4.8 Model summary of continues medical education does impact of

prescription habit of doctor 99

4.4.9 ANOVA analysis of continues medical education does impact of


4.4.10 Regression analysis of continues medical education does impact of


4.4.11 Model summary of good demonstration of brand and chance of brand

recall at a time of prescribing medicine 100

4.4.12 ANOVA analysis of good demonstration of brand and chance of brand


4.4.13 Regression analysis of good demonstration of brand and chance of brand


4.4.14 Model summary of sponsorship makes doctor loyal towards sponsored

brand 102

4.4.15 ANOVA analysis of sponsorship makes doctor loyal towards sponsored

brand 103

4.4.16 Regression analysis of sponsorship makes doctor loyal towards sponsored

brand 103

4.4.17 Model summary of renowned journal subscription appreciated by doctors 104

4.4.18 ANOVA analysis of renowned journal subscription appreciated by

doctors 104

4.4.19 Regression analysis of renowned journal subscription appreciated by

doctors 105

4.4.20 Model summary of sampling camp / diagnostic camp at doctor’s clinic,

higher the prescription support of doctor 106

4.4.21 ANOVA analysis of sampling camp / diagnostic camp at doctor’s clinic,

higher the prescription support of doctor 106

4.4.22 Regression analysis of sampling camp / diagnostic camp at doctor’s

clinic, higher the prescription support of doctor 106

4.4.23 Model summary of corporate social activity improves the corporate

image in doctor’s mind 108

4.4.24 ANOVA analysis of corporate social activity improves the corporate


4.4.25 Regression analysis of corporate social activity improves the corporate


4.4.26 Model summary of doctor’s preference goes to brand which provides

better patient education 109

4.4.27 ANOVA analysis of doctor’s preference goes to brand which provides


4.4.28 Regression analysis of doctor’s preference goes to brand which provides


XXI

Table

No. Content

Page

No.

4.4.29 Model summary of corporate image and chance of brand to get prescribes 111

4.4.30 ANOVA analysis of corporate image and chance of brand to get

prescribes 111

4.4.31 Regression analysis of corporate image and chance of brand to get

prescribes 112

4.4.32 Model summary of good personal attire and a better company’s image in

doctor’s mind 112

4.4.33 ANOVA analysis of good personal attire and a better company’s image in

doctor’s mind 113

4.4.34 Regression analysis of good personal attire and a better company’s image

in doctor’s mind 113

4.4.35 Model summary of digital marketing and doctor’s attention towards the

brand 114

4.4.36 ANOVA analysis of digital marketing and doctor’s attention towards the

brand 114

4.4.37 Regression analysis of digital marketing and doctor’s attention towards

the brand 115

4.4.38 Model summary of reminders to the doctor of Brand and chance to get

prescription support from doctor 116

4.4.39 ANOVA analysis of reminders to the doctor of brand and chance to get


4.4.40 Regression analysis of reminders to the doctor of brand and chance to get


4.4.41 Model summary of doctor’s always appreciate a representative with good

product knowledge 118

4.4.42 ANOVA analysis of doctor’s always appreciate a representative with

good product knowledge 118

4.4.43 Regression analysis of doctor’s always appreciate a representative with

good product knowledge 118

4.4.44 Model summary of pharmaceutical companies are good in customer

relationship management 119

4.4.45 ANOVA analysis of pharmaceutical companies are good in customer


4.4.46 Regression analysis of pharmaceutical companies are good in customer


4.4.47 Model summary of pharmaceutical promotional tools helps to get


4.4.48 ANOVA analysis of pharmaceutical promotional tools helps to get


4.4.49 Regression analysis of pharmaceutical promotional tools helps to get


4.4.50 Summary of hypothesis 124

XXII

LIST OF APPENDICES

Appendix A : Questionnaire to identify impact of various promotional

practices done by pharmaceutical companies on doctor's

prescription behavior

1 | P a g e

CHAPTER – I

INTRODUCTION TO THE PHARMACEUTICAL

INDUSTRY

Chapter Contents:

1..1 Evolution of the Pharmaceutical industry

1..2 Global pharmaceutical market

1..3 Global Trend in Pharmaceutical market

1..4 Indian Pharmaceutical Market

1..5 Opportunities for Indian Pharmaceutical Market

1..6 Challenges for Indian Pharmaceutical Market

1..7 Uniform Code for Pharmaceuticals Marketing Practices (UCPMP)

1..8 Channel of distribution

1..9 Regulations in Indian Pharmaceutical Industry

1..10 The rationale of the Study

1..11 Statement of the Problem

1..12 Scope of the study

2 | P a g e

1.1 Evolution of the Pharmaceutical industry

Drugs are the chemical substance, used in the diagnosis, treatment, or prevention of a condition

or disease, which are discovered, developed, manufactured, and sold by pharmaceutical

companies [1]. In the early 1800s, only botanical drugs such as morphine and quinine were

used in the pharmaceutical industry. Morphine was found by German apothecary Friedrich

Sertürner's, the first discovered foreign drug which is isolated from opium. Morphine is named

after Morpheus, the Greek god of the dream. Throughout the mid-1800s local apothecaries

extended their traditional function of selling botanical medicinal products such as morphine

and quinine through wholesale production. The Darmstadt firm Merck, founded in 1668, was

the first local drug firm to venture into the mass production and sale of pharmaceuticals. In

1864, there were 311 plants were incorporated in the first edition of the British Pharmacopoeia.

Which included 103 plants derived substances, inorganics substances such as iodine, iron

sulfate, sodium bicarbonate, and a few animal-derived products such as cochineal, lard &

cantharidin [2]. With notable progress in medical science (and particularly in pharmacology)

& synthetic organic chemicals, the pharmaceutical industry has transformed.

The first synthetic drug synthesized in 1540 was diethyl ether. Humphrey Davy used it as a

surgical anesthetic; it was controversial until the 1840s when chloroform (CHCL3) was

developed, which later became important as a general anesthetic. Simpson highlighted the

benefits of chloroform to reduce labor-related pain, and in 1872 her first patient was Queen

Victoria of England [3]. In 1874 salicylic acid was extracted from willow bark which had been

widely used as a pain killer. By the late 1880s, Germen dye manufacturer Bayer (founded by

Friedrich Bayer) had purified organic compounds from tar and other mineral sources to be used

as a medicinal compound. In 1899, Bayer had marketed acetylsalicylic acid under the brand

name Aspirin, the first blockbuster molecule of the world, which is still in use [4].

Paul Ehrlich and Alexander Fleming are considered as an originator of the modern “antibiotic

era”. In 1904 Paul Ehrlich discovered a drug against syphilis, a sexually transmitted disease

that was endemic and almost incurable at that time. The drug was marketed by Hoechst under

the name Arsphenamine, which had enjoyed the status of most prescribed medication until its

replacement by penicillin in the 1940s. September 3, 1928, was the historical day in the history

of mankind, Alexander Fleming had discovered penicillin, the first of its kind antibiotic that

saved millions of lives worldwide. After 12 years of initial observation, mass production and

3 | P a g e

distribution of penicillin started in 1945 [5]. Table 1.1 resumed some of the pharmaceutical

industry's biggest achievements.

Table 1.1.1 Pharmaceutical product growth milestones [2]

Year Event Notes

1550 BC Ebers papyrus First known medical diagnosis compendium

1540 Synthesized diethyl ether The first synthetic drug could be 'sweet oil of

vitriol'

1668 Establishment of Merck

(Darmstadt)

The pharmaceutical industry was the first big

business in the past (1827).

1763 Lind shows that lack of fruit

causes scurvy

1775 Synthesized nitrous oxide

1785

Withering explains why the

digital extract "dropsy" is

required

The first demonstration of therapeutic

efficacy

1798

Jenner indicates that with

vaccination smallpox can

been avoided

1799

Humphrey Davy has

explained the anesthetic

effect of nitrous oxide

1803

Napoleon set up a doctor

certification and review

scheme

1806

Sertürner cleanses morphine

and demonstrates the strong

opium theory

A big move forward – first evidence of active

chemicals in herbal remedies.

Many other alkaloids have been isolated

1820–1840

1846

In Massachusetts General

Hospital, Morton

administers ether as an

anesthetic

First practical anesthesia test

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1847

Chloroform was

administered to Queen

Victoria to control labor pain

1847 Bucheim founded the first

Pharmacological Institute

mid-19C

The first drug companies

were formed:

Merck (1827)

Squibb (1858)

Hoechst (1862)

Parke Davis (1866)

Lilley (1876)

Burroughs Wellcome (1880)

Pharmacy companies have in many cases

grown from pharmaceutical firms or

apothecaries.

1858 Amyl cell theory is given by

Virchow

1859 Synthesized amyl nitrate

1865

Elucised benzene structure

(Kekule) and the first use of

organic molecules of

structural formulas

Fundamentals for organic synthesis

production

1867

Brunton reveals that amyl

nitrate is used to relieve

angina pain

1878 Pasteur gives germ disease

theory

1898 Bayer-developed heroin

(diacetylmorphine)

The first synthetic version of a natural

product. Heroin is a safe and unsubstantial

remedy for morphine

1899 Bayer-designed aspirin

1903 Bayer's invention of Barbital

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1904

Elliott reveals the biological

function of surface gland

extracts and suggests the

release of adrenaline as a

physiological mechanism

The first evidence for a chemistry mediator-

the main ingredient of modern medicines

1910 Discovered Salvarsan by

Ehrlich The first antibiotic to treat syphilis

1912 The word 'hormone' coined

by Starling

1921 Insulin found by MacLeod,

Banting, and Best

Lilly's pancreas (1925) was produced

commercially

1926

Loewi has explained the

release of ‘Vagusstoff’ from

heart

The First Sign of Chemical Neurotransfer

1929 Penicillin was discovered by

Fleming

Before Chain and Florey struggled with

production issues in 1938, penicillin was not

used widely.

1935 Sulfonamides were

discovered by Domagk

The first effective antibacterial medicines and

anti-metabolite prescriber

1936 Steroid hormones isolated

by Upjohn company

1937 Antihistamines were

discovered by Bovet Then antipsychotic drugs were discovered.

1946

Gilman and Philips prove

that nitrogen mustards have

an anticancer effect

First anticancer drug

1951 Discover mercaptopurine

by Hitchings and Elion The first drug for antimetabolites cancer

1961 Hitchings and Schwartz

discover azathioprine

The first successful immunosuppressant,

which can also prevent transplant rejection

from the antimetabolite system

1962 Black and his colleagues

discover pronethalol

The first β-adrenoceptor antagonist to be used

clinically

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1972 Black and his colleagues

discover burimamide The first antagonist with picked H2

1976 Genentech founded Based on recombinant DNA genetics, the first

biotech firm

c.1990 Combinatory chemistry

introduction

The sale of toxic materials in the United States became limited in the middle of the 19th century

and the United Kingdom, but on 'prescription-only' scheme was implemented in the early 1900s

which required approval from a physician. First, as in the United States, before and all

experimental drugs (including experimental mixtures and formulations) needed approval

before clinical trials could be carried out.

Around the beginning of the 20th century, the pharmaceutical industry as a large organization

started, dominated by the chemical industry for 60 years or more. After the introduction of 1st

biopharmaceuticals in 1982, the market shifts its focus from chemical-induced drugs to

biological drugs. As per IQVIA data, among the top 10 brands of pharmaceuticals globally 7

are biologicals. Humira of AbbVie recorded a sale of $19.94 billion, bigger than the entire

Indian pharmaceutical industry [6]. Most biopharmaceuticals reflect new therapeutic

approaches, and copycat ventures may have less scope. Nearly 50% of all new introductions

are organic medicinal products. Research and development costs and production times

gradually have risen over time – from the discovery of a new molecule to the market, hindering

the introduction into the market of the new molecule or biopharmaceutical. The R&D spending

in the pharmaceutical sector and FDA approvals during 1995–2006 are shown in Fig 1.1.1 [7].

7 | P a g e

Fig 1.1.1: FDA approvals & R & D spending: 1995 – 2006

As far as new product creation is concerned, the pharmaceutical industry faces many obstacles.

Governments are now demanding to reduce the price of a drug to offer chipper medications to

patients to make it affordable to even the poorest person in the country. In such a scenario to

make new drug development more affordable, companies need to identify new avenues of

R&D.

1.2 Global pharmaceutical market

Global health care spending is rising. Between 2018 and 2022, the compound annual growth

rate (CAGR) across 60 countries is predicted to increase 5.4% compared to 2.9% over 2013-

20017. Worldwide prescription drug sale is USD 900 billion in 2019 and is expected to rise

USD 1.2 trillion by 2024 [Fig 1.4]. Challenges to the global pharmaceutical industry are payer

control, generalization market losses, and bio-similar competition [8].

8 | P a g e

Fig 1.2.1 Global Prescription Drug Sales (2010-2024) [9]

A surge of newly introduced groundbreaking drugs is being implemented primarily as a

foundation for the global growth of medicine by 2023. Expanded access to and use of medicines

in major pharmaceutical markets like China, Brazil, Russia, India, Turkey, and Mexico, would

drive global growth, as China alone getting closer to the combined expenditure level of

Europe's five major markets. Emerging technologies and (to a lesser degree than previous

years) market changes will drive growth in the United States and compensate for losses of

exclusivity and the advent and creation of bio-similar. The costs and development reduction of

new products in Europe lead to the 1-4 percent slower growth compared to the 4.7 percent

annual compound growth seen in the last five years (see Fig. 1.2.2) which was substantially

increased by new drugs expenses, especially oncological drugs, and viral hepatitis treatments

[10].

9 | P a g e

Fig. 1.2.2: Global Medicine Spending and Growth in Selected Regions, 2018–2023

2018 spending USD in billion 2014–2018 CAGR constant USD

Global 1,204.80 6.3%

Developed 800 5.7%

U.S. 484.9 7.2%

EU5 177.5 4.7%

Germany 53.5 5.0%

France 36.8 1.5%

Italy 34.4 6.3%

U.K. 28.4 6.2%

Spain 24.6 5.4%

Japan 86.4 1.0%

Canada 22.2 5.0%

South Korea 15.8 4.7%

Australia 13.1 4.3%

Pharmerging 285.9 9.3%

China 132.3 7.6%

Tier 2 67.7 10.7%

Brazil 31.8 10.8%

India 20.4 11.2%

Russia 15.5 9.9%

Tier 3 85.9 11.3%

Rest of World 118.9 3.2%

Table 1.2.1: Global Spending and Growth in Selected Countries [10]

According to IQVIA industry statistics, global pharmaceutical spending exceeds

approximately USD 1204.8 billion. Around 66 percent of global investment, developing

10 | P a g e

countries contributed around USD 800 billion. The US is the world's biggest market in volume

for USD 485 billion with a CAGR of 5.7%, which is much higher than the Pharmerging

countries and the rest of the world in their overall markets. Nearly 60% of US spending comes

from initial labels. Five big countries in Europe, including Germany, France, Italy, United

Kingdom, and Spain, contribute about 15% of overall pharmaceutical spending globally. After

the US and the EU, Japan has the third-largest market with a volume of around USD 86.4

billion worth of 7 percent. The Indian market reported a value of 20.4 billion USD with a

CAGR of 11.2% following tire 3, i.e. 11.3%.

Another way to evaluate the demand is via the therapy field. Oncology will remain a leading

field of care with estimated worldwide sales of 129 billion dollars in 2017–224 and a peak of

233 billion dollars in 2024. It is estimated that the highest CAGR growth in immune

suppressants is 15.7 percent for the period 2017-2024, led by dermatologic drugs (13 percent).

Table 1.2.2: Top 15 OTC therapy & prescription drug categories by global sales, 2016–

2022 [8]

Sr. No Therapy Areas Global Sales 2017

(USD Billion)

Projected Global Sales 2024

(USD Billion)

1 Oncology 104.0 233.0

2 Anti-diabetics 46.0 59.5

3 Anti-rheumatics 55.7 56.7

4 Vaccines 22.7 44.6

5 Anti-virals 42.4 39.9

6 Immunosuppressants 3.7 38.1

7 Bronchodilators 27.2 32.3

8 Dermatologicals 12.9 30.3

9 Sensory organs 21.6 26.9

10 Anti-hypertensives 23.0 24.4

11 Anti-coagulants 16.8 22.9

12 Multiple Sclerosis

Therapies

22.7 21.5

13 Anti-fibrinolytics 12.7 20.4

14 Anti-hyperlipidemics 11.3 16.4

15 Anti-anemics 7.6 15.7

Top 15 445.0 683.0

Other 379.0 567.0

Total Worldwide

Prescription & OTC

825.0 1247.0

11 | P a g e

Fig 1.2.3: Top 10 Companies as per global prescription drug sales in 2024 [11]

In global prescription sales, Pfizer leads the market with 51.2 billion USD sales, expected

CAGR for the 2018-2024 period is 2.1%. Novartis expected to gain rank from Roche with 49.8

billion USD sales at a CAGR of 2.3%. Roche expected to register a CAGR of 0.8% and land

at 3rd rank. Other multinationals among the top 10 include Johnson and Johnson, Merck & Co,

Sanofi, GlaxoSmithKline, AbbVie, Takeda, and AstraZeneca. The total value of the top 10

corporate worth 414.9 billion USD which is around 33% of the worldwide pharmaceutical

market.

1.3 Global Trend in the Pharmaceutical market

The drugs industry is at the intersection. No gradual changes or permanent improvement would

likely avoid the collapse of a conventional pharmaceutical business model in a deeply disrupted

market that includes evolving payer strategies and patient empowerment. Next-generation

biotherapeutics, prescription digital therapy, neglected diseases, Artificial Intelligence, and

new pharmaceutical position the digital revolution and the available biotechnology innovations

will fundamentally change the practice of medicine [12].

Next-Generation Biotherapeutics

Nine biotherapeutics of the next generation (NGB) [13] have already been introduced. Selected

patient cohorts can be treated using CRISPR / Cas9 and other cells or gene editing strategies

triggered by multipotent stem cells (iPSC). The cost and accessibility modalities for these

treatments have yet to be optimized to make them more affordable. To decide better the use of

technologies such as the CRISPR / Cas9, consideration of bioethics is also required. On the

12 | P a g e

other hand, the dynamic nature of the production and distribution process limits competition in

the market.

Prescription digital therapeutics

Digital drug therapy (DTx) [14] may be a whole new way of thinking about a medicinal

product. They are tools that provide new methods of treatment and provide signs and statements

of efficacy in their prescription labels for care for particular diseases. In this group, the number

of mobile apps submitted to the FDA for approval or clearance (under the De Novo route) is

growing. Cognitive processes and behavioral forces, attention deficiency (ADHD), severe

depressive deficiency, as well as schizophrenia are all fields of intervention. IT technology

developers also partner with pharmaceutical firms to support their respective abilities in

designing novel treatment strategies.

Neglected tropical disease

In general, the prevalence of neglected tropical diseases (NTDs) in low populations is

predicted, but evidence remains available. The London Declaration of Improved Regulation

and Elimination included nine NTDs: Lymphatic Filariasis, Onchosocceresis, Schytosomiasis

(STH), Waste, Chagas disease, African human tripanosomiasis (AHA), lepsy, and visceral

leishmaniasis [15]. The London Declaration of Improved Regulation: The activities of

numerous philanthropic organizations whose work programmers are always close to receiving

regulative approval typically cover the area of tropical diseases that have been overlooked.

Millions of people working on diseases were believed to pursue short-term solutions and that

help was supported and provided first in philanthropic organizations.

Machine learning and artificial intelligence

The investment will continue to focus on Artificial Intelligence, Computer and Deep Learning,

which will help identify and develop new innovative therapies, especially in the field of

validation, targeted detection, and efficiency in clinical growth. As AI superannuates more and

more of the average knowledge worker’s monotonous tasks, it may provide even greater value

to pharmaceutical professionals by, helping them parse and interpret data faster, enabling faster

decision-making, allowing them to swiftly visualize, analyze and find patterns in data,

eliminating repetitive processes, reducing human errors [16]. AI’s “value-add” benefits and its

uses in the pharmaceutical industry are limitless. Astounding and previously unimagined AI

applications continue to emerge on the pharmaceuticals landscape on a seemingly daily basis.

13 | P a g e

Real-World Evidence: expanding use and new trial designs

Whereby RCT remains the gold standard of evidence in the regulatory application, Regulators

increasingly recognized the use of real-world (RWE) and real-world (RWD) data. The RWD

level and new conditions to use this knowledge are a stronger basis for decision-making by the

regulator. Using this data, both positive and negative clinical outcomes along with

pharmaceutical products will demonstrate the success of innovators, regulators, clinicians, and

patients.

Patient engagement: Pharmaceutical companies hiring patient advocacy leaders

Pharmaceutical producers slowly grow "beyond the pill" to create a better narrative of

consumer value. They have also built support programs to enhance the health of patients,

strengthen patient recovery and meet special patient groups. Over the next five years,

pharmaceutical firms will continue to hire public affairs and advocacy specialists.

The pharmaceutical industry is witnessing a paradigm shift from the traditional pill-based

approach to the next generation biopharmaceutical and artificial intelligence-based therapies.

Global tech giants like Google [17], Amazon [18], and Microsoft [19] are now entered in the

healthcare sector to bridge the gap between technology and the healthcare sector. Google

working on its artificial intelligence to improve healthcare outcomes. Amazon working on its

cloud technology to provide better healthcare services. Microsoft Genomics service produces

results that help to encode the gene science to beat major diseases like Cancer, Alzheimer and

many more. This collaboration of technology and science will open a new horizon in healthcare

& pharmaceutical sector for the benefit of the patients.

1.4 Indian Pharmaceutical Market

From the Gupta period, Indian pharmaceutical history started, which was about 320 to 550

BCE (Before Common Era). In India, allopathic treatment was introduced under the British

government. Sushruta Samhita & Charak Samhita are two fundamental books of ayurvedic

therapy that explained medicine, pharmaceuticals, and surgeries. But such medicinal products

were not manufactured in the region. International countries use raw materials imported from

India to manufacture their finished goods in their units and re-export those drugs to India. It

was in 1882 that a few Indian scholars such as PC Ray and TK Gajjr set the stage for the

pharmaceutical industry. In 1901, Bangal Chemical started in Calcutta that was Acharya PC

14 | P a g e

Ray's first indigenous pharmaceutical company [20]. A few other Indian businesses established

pharmaceutical companies within a few years. Bengal immunity began in 1907 & at the same

time, Alembic Chemical Works was founded in Baroda, which is considered as the basis of the

Indian pharmaceutical industry. This early practice of the pharmaceutical industry meets the

medical needs of 13% of the countries. During World War II (1939-1945) there was a sharp

decline in the supply of narcotics from foreign companies. Many pharmaceutical firms have

begun in India included Unichem, Chemo Pharmaceutics, Calcutta Chemicals, Cipla, East

India Pharmaceutical Works, Chemical Industrial & Pharmaceuticals Laboratories, and others.

Almost 70% of countries' requirements were met with the production of these modern

pharmaceutical industries before independence.

The global pharmaceutical industry expanded exponentially from the 1950s. The major

countries contributing to global growth were Germany, Switzerland, the United Kingdom, and

to some degree, the United States. A systematic approach to the treatment of diseases itself has

been begun in medicine. As the market saw the invention and commercialization of newly

developed drugs such as penicillin and other synthetic drugs, the industries focused more on

research and development on the production of manufacturing systems. As a result of the

simplification of government policies, many foreign companies have invested in the Indian

market.

Table 1.4.1: Market shares of Indian pharmaceutical companies versus multi-national

companies [20] [21]

Year Indian

Company (%

MS)

MNC (%MS)

1952 62 38

1970 32 68

1978 40 60

1980 50 50

1991 60 40

1998 68 32

2004 77 23

2019 80 20

Currently, the Indian pharmaceutical sector is fragmented with more than 20,000 registered

units and 3000 registered pharmaceutical companies [22]. In India, the pharmaceutical industry

supplies 70% of the national demand for bulk drugs, pharmaceutical intermediates,

15 | P a g e

pharmaceutical ingredients, additives, tablets, capsules, orals, and injection for drugs. It has

grown rapidly over the last two decades. The pharmaceutical industry in India has about 250

large units (including five central government sectors) and 8000 small units [23]. 7 states like

Gujarat, Maharashtra, Andhra Pradesh, Karnataka, Tamil Nadu, Goa, and West Bengal have

over 75% control over drug manufacturing, while 10 states such as Bihar, Kerala, Madhya

Pradesh, Delhi, Haryana, Rajasthan, Andaman and Nicobar Islands, Orissa, Uttar Pradesh, and

Punjab accounted for 20% of drug production units. There are just 5% of the processing

facilities in the remaining 18 states and union territories. Out of 22 pharmaceutical and biotech

products SEZ available in India, the majority of them are located in states like Andhra Pradesh,

Maharashtra, Gujarat, and Karnataka [24].

Table 1.4.2: Timeline of Evolution of Indian Pharmaceutical Sector [22]

Year Event

1970-90 Several domestic firms begin operations

In 1970 Indian Patent Act passed

Programs to export

Infrastructure advancement of production

1990-2010 Indian companies are rapidly starting operations abroad

Liberalized market

Patent approval (amendment) Act 2005 leading to drug

patents in India

India is a crucial destination in the manufacture of generic

drugs

2010 National Pricing Policy 2012 on Pharmaceutical

Adoption of new business models including channel

administration, KAM and CSO

Improved pharmaceutical companies' patent filings

2010- 2015 2014: 100% FDI in the medical equipment industry

allowed.

2015: India has 10,500 production plants and more than

3,000 pharmaceuticals firms

Leading Indian Pharmaceutical companies actively collect

funds to finance their acquirements in Germany as well as

globally

2013: New Drug Price Control Order (DPCO) issued by the

Food and Drugs Directorate.

2016 onwards The Indian government has proposed 'Pharma Dream 2020'

to make India, the leader in the world, for the production of

end-to-end medicines. Time for approval of new facilities

to improve investment has been that.

FDI in existing pharmaceutical firms rose to 74% under the

2016 Union Budget

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After patent expiry, Indian pharmaceuticals promote generic drug with own brand name as a

branded generics. In such conditions, any company can manufacture the drug and promote their

brand in front of the doctor, which makes the pharmaceutical market very competitive in

nature. In 2018, the Indian market was around 18.12 billion USD in absolute value with a

growth of 9.4% year on year, [22] out of it branded generics have 90% share, rest 10% share

taken by generic medicines [25]

Table: 1.4.3: Top 10 Indian Pharmaceuticals [26]

RANKINGS TOP CORPORATES

Nov-19 MAT

MAT Value Crs % MS % Grth

1 SUN 10,931 7.50 8.4

2 ABBOTT 9,271 6.36 9.8

3 CIPLA 7,471 5.13 8.6

4 MANKIND 5,603 3.84 9.5

5 ALKEM 5,498 3.77 17.7

6 LUPIN LIMITED 5,233 3.59 10.6

7 TORRENT PHARMA 4,636 3.18 8.8

8 INTAS PHARMA 4,544 3.12 14.7

9 MACLEODS PHARMA 4,531 3.11 7.0

10 ZYDUS CADILA 4,450 3.05 7.8

MAT – Moving Annual Total, %MS - % Market Share, %Grth - % Growth

Indian pharmaceutical market is smaller in size compared to other industries like automobile,

petrochemical or information technology; but competition is never less than other industries.

The top 10 Indian pharmaceutical companies contribute about 40% of the total sales of the

Indian pharmaceutical market (IPM) & the top 50 companies generate about 83% of the sale

in IPM [27]. In 2030, the industry's annual turnover may rise to about USD 80-90 billion even

at present levels of about 7-8 percent CAGR. It could also set ambitious goals of 11% to 12%

CAGR and raise annual sales by 2024 by about 65 billion USD and by 2030 by about 120

billion USD, to 130 billion USD [28].

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Fig 1.4.1: Indian pharmaceutical industry's projected scale, USD billion

Indian medicine market is known for its branded generic formulations. Companies market

generic formulations with their brand name and also convinced a doctor to prescribe a

particular brand with help of their qualified field force. Millions of such generic brands are

available in the Indian market.

Table 1.4.4: Top 10 brands of the Indian Pharmaceutical Industry

RANKING TOP BRANDS COMPANY

Nov-19 Mat

MAT Value Crs % MS % Grth

1 MIXTARD ABBOTT 717 0.49 6.8

2 GLYCOMET-GP USV 512 0.35 16.0

3 AUGMENTIN GLAXO 489 0.34 26.2

4 LANTUS SANOFI 487 0.33 16.1

5 JANUMET MSD 450 0.31 6.1

6 NOVOMIX ABBOTT 433 0.30 9.0

7 CLAVAM ALKEM 417 0.29 20.8

8 MONOCEF ARISTO 415 0.28 21.2

9 THYRONORM ABBOTT 391 0.27 12.9

10 LIV-52 HIMALAYA 391 0.27 12.7

Cardiac and anti-infective are the leading therapy areas and contributors in the Indian

pharmaceutical industry for years. As per the WHO report 98 million people in India may have

type 2 diabetes by 2030 [29]; which makes India a hub for the anti-diabetic market. Poor

hygiene & careless use of antibiotics makes an anti-infective market, the second-biggest market

in India. Table 1.4.5 describes some major therapy areas of the Indian pharmaceutical market

(IPM).

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Table: 1.4.5: Therapy Markets of IPM [30]

Therapy Area Nov-19 Mat

Val. Cr % Grth

Cardiac 14,579 10.8

Anti-infective 14,441 11

Respiratory 10,297 9.1

Dermatology 9,749 8.8

Oral Anti Diabetic 9,120 12.5

G. I. Market 8,852 9.6

Neurology / CNS 7,294 9.2

Gynaecology 6,256 10.4

Pain Management 5,910 9.5

Vita. /Minerals / Nutrients 5,051 9.8

Ophthalmology 2,111 9.9

Urology market 1,942 13.1

The pharmaceutical industry is closely connected with health care practitioners. The

pharmaceutical industry is different in terms of market dynamics, here customers are not the

consumers and direct reach to the consumer is not allowable as per the regulations set by the

governments. The target audience and customers for the pharmaceutical companies are doctors,

but the real consumers (patients) are out of the reach for drug makers [31]. Drug makers are

indirectly in touch with patients with help of physicians and chemists. The relationship between

pharmaceuticals, physicians, patients, and chemists can be best explained by a triangle theory.

The physician is the center of the triangle and is in touch with all three dimensions of the

healthcare system [Fig. 1.4.2]. Physicians are the power center of the healthcare system and

therefore target audience for all pharmaceutical companies.

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Fig 1.4.2: Relationship triangle: Pharmaceutical, Physicians, Patients, and Chemists

The growth of the pharmaceutical industry also depends on the no of doctors in the county and

the reach of the healthcare system to the patient. As per the IMS prescription data of Dec’19,

in India, more than 3,70,370 doctors are practicing with are generating 2.7 billion prescriptions

every year. Each doctor generates 600 prescriptions every month with an average of 20

prescriptions per day [32].

Table 1.4.6: Specialty wise no of doctors & prescriptions [32]

Specialty No of

Doctors

%

Contribution

Prescriptions

(in Lacs)

%

Contribution

Total 3,70,370 100 26,728 100

GP - Non MBBS 86,032 23 6,642 25

Dentist 53,075 14 2,830 11

GP– MBBS 41,059 11 3,688 14

Consultant Physician 30,957 8 2,249 8

Gynaecologist 29,109 8 1,896 7

Paediatrician 20,786 6 1,965 7

Ophthalmologist 17,954 5 1,043 4

Orthopaedics 15,553 4 1,181 4

ENT Specialist 14,461 4 1,235 5

General Surgeon 13,590 4 840 3

Cardiologist 8,867 2 634 2

Dermatologist 7,020 2 559 2

Chest Specialist 6,746 2 425 2

Nephrologist/Urologist 5,340 1 303 1

Diabetologist/Endocrinologist 5,259 1 349 1

Neurologist/Neuro Surgeon 5,174 1 329 1

Gastroenterologist 4,742 1 285 1

Psychiatrist 3,615 1 224 1

Oncologist 1,030 0 51 0

General practitioners (GP MBBS and GP Non-MBBS) having 34% contribution in total

doctors available in the country which are responsible for 39% of prescriptions. Dentists are

the second biggest specialty with a 14% contribution with a prescription share of 11%, followed

by consultant physicians with 8% contribution and 8% prescription share. Pediatricianss hiving

the highest prescriptions per month with an average of 788 prescriptions i.e. 26 prescriptions

per day.

In the future, the pharmaceutical industry can benefit from many influential factors. Many of

them are nature-intrinsic and others foreign. Indian pharmaceutical has flourished both in India

20 | P a g e

and in developing countries, as in three decades, India has been able to become the world's

leading medicine manufacturer. Any of the key variables are used in a SWOT study.

Table 1.4.7: SWOT of Indian Pharmaceutical Market [33]

Strengths

Design, production and logistics low cost. Growth in the GDP sector has increased the

availability of income in the hands of the

general public and their optimistic spending on

health services is increasing the growing health

care population of patients. Clinical trials data management Intellectual property rights

Weakness

Bad all-around infrastructure is an

incredibly daunting obstacle. Low

investment in advanced R&D.

Most companies lack the opportunity,

because of lack of capital, to compete

with New Drug Discovery of MNCs and

molecular searches around the world.

Low quality in health benefits.

Opportunities

Infrastructure improving public-private

partnerships

Fast OTC global demand and generic market

growth

Major export opportunities.

The expansion of the healthcare market and the

increase in per capita income - the drivers of

growth for the pharmaceutical industry - were

patented by USD 40 billion worth of drugs in

the United States and 25 billion USD in drugs in

Europe.

Threats

Wage inflation

Drug Price Control Order renders drug

costs and competitiveness

unrealistically;

Improper structures complicate the

reach of Indian clinical trials

International players (advanced

technology-based products) enter the

Indian market

1.5 Opportunities for Indian Pharmaceutical Market

In key areas of the value chain, such as growth, product creation and process innovation, the

success of the Indian pharmaceutical industry was based on its distinctive ability. There are

several opportunities for Indian pharmaceutical players to find an accelerated growth path

through new geographies and product categories.

State-sponsored health coverage programs

It is estimated that ten crore vulnerable families (around 50 crore beneficiaries or about forty

percent of the Indian population) benefit Ayushman Bharat Yojana (a centrally funded National

Health Protection Program) [34]. This would allow poorer households access to health services

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and increase coverage of health insurance. This offers the industry an opportunity to help the

underserved masses in India with affordable medicines.

Newer product classes such as bio-similar, gene therapy and specialty drugs

The development of generic medicines was mainly attributed to the Indian pharmaceutical

industry. Being one of the first companies in the industry to initiate bio-like production and

launch on the Indian market, the success of new product classes like gene therapy and specialty

drugs in the next generation product classes was minimal (e.g. the first bio-like one for

Rituximab was introduced by India's Dr Reddy in 2007 [35]) The environment that would be

useful for development support, i.e. biotechnology department and regulatory authorities

would have played a more helpful role but may have been restricted.

A large skilled, yet the cost-efficient workforce

In the Indian education system, more than 2,25,000 [36] pharmacists have graduated (compared

with only about 17,000 pharmaceutical students in the United States). The team comprises

highly qualified doctors and specialists who bring tremendous skills to clinical research and

contribute actively to it. It is assisted by a smart, highly skilled team of people from all over

industry and academia employed in the clinical research sector. Moreover, India becomes one

of the most promising destinations for clinical research through the availability of a diverse

patient pool. Labor cost efficiencies also provide Indian companies with a major competitive

advantage.

Leveraging the patent cliff

Branded molecules patents with total global revenues of over USD 251 billion, which will open

to the market, are set to expire between 2018 and 2024 [11]. The Patent cliff will greatly benefit

the Indian generics market with increased New Drug Application Share. The industry may need

to build a sharp strategy at the molecular level, along with excellent regulatory and market

results.

International markets & exports

The next wave of growth may be the growing export to large traditionally-sustained markets,

such as Japan, China, Africa, Indonesia, and Latin America, as the industry aspires to become

by its volume the world's largest supplier. Entering these markets could require a new business

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model to adapt to local market needs. Aid for government interventions and trade relations

would allow Indian pharmaceutical companies to gain market access to these markets.

1.6 Challenges for Indian Pharmaceutical Market

In the current climate, however, the Indian pharmaceutical industry faces many challenges but

the main challenges are as follows:

Huge ‘Out of Pocket (OoP)’ expense

It limits access to drugs because the Indian Insurance Portion is intended for patients in IP

rather than OP, creating a lot of dents. It is primarily for the following significant reasons [37]:

Poor public health care spends, only 1.1 percent of GDP

Weak healthcare facility & system

Low access to health insurance programs in all sectors of society

NLEM (New List of Essential Medicines) & DPCO (Drug Price Control Order)

The National Critical Medicinal Products List is one of the main instruments in a country's

universal health care program that provides affordable, available, high-quality medicine at all

primary, secondary, tertiary healthcare rates. Achieving this Indian government, Health and

Family Welfare Ministry (GOI, MOHFW) has agreed to provide a list of medicines of

significant value. India's first National Medicines Essential List was prepared and published in

1996. Subsequently, this list was amended in 2003.

The GOI and MOHFW took into account the need to update NLEM [38] in addressing the

issues related to evolving disease prevalence, therapeutics, the implementation of new

medicines and the assessment of an appropriate risk-benefit profile.

NPPA is an Indian Government organization that was created, inter alia, under the DPCO 1995

to set/revise the cost of verified bulk medicinal and preparations as well as to enforce prices

and the availability of medicinal products in the country. Furthermore, the company is

responsible for recovering from customer's overwhelmed volumes by suppliers for regulated

medications. It also tracks unregulated drug prices, so that they are kept at a fair level [39].

DPCO controls the price of drugs on behalf of the government of India and forces

pharmaceutical companies not to increase the price beyond the limit. This cited as a major

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challenge the revenues they earn are essentially peanuts for most pharmaceutical firms, and

such revenue is not enough to allow more investment.

Lack of capabilities in the innovation space

In the field of innovation (e.g. new engines, complex generics), Indian pharmaceutical

companies have been growing slowly, with a small ecosystem of government-supported

research. The college curriculum is also divided into the specifications of the industry.

However, there is room in the research initiatives focused on innovation to strengthen

cooperation between government institutes and industry. The role of government agencies in

clinical trials is frequently questioned for pharmaceutical firms. Approvals for clinical trials

are subject to strict regulatory standards in India.

Dependence on external markets for intermediates and APIs

About 80 percent by volume of India's API requirements are met by China [40], which put

importers in danger of supply disruptions and unpredictable movement of prices. The API

requirements are met by volume by China. Nevertheless, insufficient services such as

uninterrupted supplies of water and power and a lack of scale in 'special economic zones' and

minimal public support in tax incentives, favorable license renewals and capital subsidies have

not been able to capture the API's potential.

Limited presence in markets other than the US

There are also problems with the small presence in main markets such as China and Japan.

Attempts to join those countries have still not achieved the required momentum and scale due

to numerous regulatory obstacles. Even the contribution of non-generic products to the present

sales of pharmaceutical firms is minuscule, despite innovation in new types of medicines, such

as bio-similar and specialty medicines.

Increased scrutiny in quality compliance for exports

As the industry expands in various geographies and the concerns about the quality of imported

medicines are growing globally, regulators will be more vigilant about quality standards. The

largest number of USFDA inspections since 2009 has been faced by India. To order to keep

the promise of a "high quality efficient" supplier of medicines worldwide, the industry needs

to constantly invest in improving quality standards.

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Uniform Code for Pharmaceuticals Marketing Practices (UCPMP) compliance

'Uniform Code of Procedures for Pharmaceutical Promotion' (UCPMP) was issued by the

central government in December 2014 as guidance for the medicinal products and medical

devices promotion and marketing industry. UCPMP in many ways limits pharmaceutical

purchases to physicians. Such recommendations are, however, voluntary and currently have no

force of law.

As the current study is mainly focused on marketing practices and their impact; UCPMP is the

major guideline affecting marketing activities. It’s worthy to discuss UCPMP in detail for

better understanding.

1.7 Uniform Code for Pharmaceuticals Marketing Practices

(UCPMP) [41][42]

The main promotional instrument for the promotion of pharmaceutical products by

pharmaceutical firms is three key codes concerned with the promotion/advertising of medicinal

goods: (1) International Pharmaceutical Manufacturers Federation (IFPMA) code on

pharmaceutical marketing practices; (2) World Health Organization (WHO) ethical code guide

pharmaceutical industry for various promotional strategies & (3) Uniform Code for

Pharmaceuticals Marketing Practices (UCPMP) [43]. The Department of Pharmaceuticals

under the Union Ministry of Chemicals and Fertilizers has submitted the Draft, Voluntary Code

for the Pharmaceutical Industry. The UCPMP was proposed in March 2012 as the Self-Control

Code, requiring all organizations to implement and report to the government. The UCPMP has

been submitted to all stakeholders 'reviews on the departments' websites. The comments

received have been reviewed and the UCPMP Final Drafts prepared for review and circulated

to Pharmaceutical Associations. The Indian Pharmaceutical Producers Organization (PPOI)

called on the government to make its Uniform Pharmaceutical Marketing Practices Code

(UCPMP). Doing so creates a high level of transparency & accountability which eliminates all

confusion between industry, health professionals and patients. UCPMP guidelines covers,

claims, Information on promotional materials, Comparison of drugs, free samples and Gifts

and other benefits [41].

Claims and Comparison

Allegations of drug use must be based on a current evidence evaluation.

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"Fresh" must not be used in India for longer than 12 months for any commercially

accessible medication or medical use commonly supported.

"Safe" should not be used with no qualification and should not imply that the medicine

does not have any addictive, toxic, or risk-dependent consequences.

Comparisons between medications should be accurate, rational and substantiated. A

contrast must be rendered such that contradictions, excessive focus, absence or

otherwise are not fooled.

Associations shall not include certain brand names of firms until the businesses

involved have given their prior permission.

Certain businesses do not implicitly or implicatively denigrate their goods, facilities

and promotions.

Information about promotion materials

When the purpose of advertisement is to provide sufficient information as to which people are

eligible for the product or use, there must be transparent and legible details on the following

minimum information, and the promotional material needs to form an integral part:

o The product involved, name and address of control holder or corporate name of

section of organization responsible for selling the medication;

o The medicinal name and list the active ingredients which are immediately

adjacent to the most popular medicinal name show with a generic name;

o Recommended dosage, application method and, if not obvious, application

method; adverse effects, alerts and precautions and relevant counter-indications

for the product;

o A declaration that additional information on request is available;

o Date of generation or last update of the information listed above.

o Promotional materials such as mailings and newspaper advertisements do not

cover up their true existence. Where a drug company pays for or otherwise

ensures that promotional material is published in journals, this promotional

content should not be editorial.

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Promotional materials in newspapers paid or bought by a client and which relate to any

of the goods of the same enterprise by a brand name shall, as appropriate (the above

requirements) be met, irrespective of the published editorial control of such content.

In-text and illustration, advertising material shall adhere to good-taste canons and

should be presented to consider and be unlikely to compromise the recipients' status

professionally.

The names or pictures of health professionals shall not be used in advertising content.

Advertising materials should not mimic products, phrases or a general style that are

potentially misleading or confusing in other businesses.

Where appropriate (in the area of technical and other data content for instance) the

printing date or the recent review for promotional material should be listed.

No item that may or cannot be called public advertisements includes postcards, other

uncovered mailings, packets, or wrappers.

All the accompanying imprints must endorse audio-visual content to comply with all

applicable Code requirements.

Free Samples

No individual who is not eligible to prescribe such a substance shall be provided with

free drug samples.

If a medical representative distributes samples of the products, a person eligible for the

prescription or a person approved for receipt of the sampling product in his or her name

shall be directly sent to the sample.

The following conditions shall be followed when supplying a person qualified for the

prescription of that drug:

o The following conditions are found in the supply of a patient qualified to

prescribe such a medicine:

o The prescribed dosages for these sample packs for 3 patients shall be limited to

the treatment required;

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o Such specimens must be supplied in response to a request signed and dated by

the recipient;

o The supply of these samples should be maintained through an appropriate

system of control and accountability;

o Each package of samples shall not exceed the smallest pack on the market.

o "Free-to-sell medical research," or a legend of comparable significance is

branded in any research;

o Commodity Information's most up-to-date version (as provided by the Drugs

and Cosmetics Act of 1940) for this drug shall be accompanied by copies of

each sample.

A pharmaceutical firm shall not have a sample of anti-depressant, hypnotic, sedative or

soothing medication.

Organizations must maintain the information, such as product names, physicians'

names, quantities of given samples, date of distribution of free samples to medical

professionals, etc.

Gifts and other benefits

No donation, financial gain or income in kind given or made available to qualified

persons by or from the pharmaceutical company or their workers, i.e. manufacture,

manufacturing, distributors, etc. a drug manufacturer.

No personal donations (including immediate and enhanced entertainment tickets) are

either available or given to health workers or family members (e.g. entertainment

tickets).

Travel facilities: No travel facility in or outside the country or be extended to, for

holiday or to participate in conferences, seminars, workshops, CME programs, train,

shore, airplane or boat tickets, paid vacation programs etc. by corporations or

associations/representatives or by anyone working for them. It is thus clarified that if a

physician is present, it would be at his own expense to advertise a medication or to

disseminate information at any lecture, conference or meeting of the pharmaceutical

industry.

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Hospitality: Organizations or their agents shall not provide healthcare practitioners or

their families with any excuse in the form of lodging, such as hotel accommodation.

Cash or monetary grants: Under no reason shall corporations or organizations pay

individual healthcare professionals no cash or monetary benefit.

Medical research, analysis, etc. funding can only be extended transparently by approved

institutions through modalities provided by legislation, regulations and guidelines

followed by such approved institutions. It is always fully communicated.

1.8 Channel of distribution

India is a geographically diverse country with severe conditions which play a critical role in

distribution. To make the product available at the consumer level; the distribution channel plays

an important role. Pharmaceutical products manufactured at plants and to supply medicines at

every corner of the country is another important aspect. The three main pillars of the

distribution system of the Indian pharmaceutical industry are sorting, forwarding agents i.e.

CFAs (depots and dealers), stockiest (wholesalers) & retailers (pharmacies or dispensing

practitioners). Each pillar plays an important role to make medicines available to patients.

CFA (Clearing and forwarding agents) / Depots and Distributors (stockiest)

There has been a change in the delivery of drugs in India. Before 1990, pharmaceutical firms

used a specific distribution network to create their shops, now substituted for carrying / clearing

and forwarding agents (CFAs). These are primarily responsible for holding the stock of the

company's products (stock) and transfer SKUs on demand. Such businesses form the

distribution chain. In every Indian state, most companies maintain one to three CFAs. The CFA

fee can be a fixed percentage margin, depend on turnover, mostly between 2 and 4 percent. On

average, an average company can operate with a total of 25–35 CFAs [44]. In a high selling

product, it may be 4% to 10% on a low sales product several times [45].

Stockiest/wholesalers

Styles are slightly different from CFAs for the stockiest ship. Contrary to the CFA that can

manage the stock of an enterprise, More than one client (usually 5-15 depending on warehouse

capacity), a contractor (regional distributor) may be worked at the same time. In 30-45 days (a

standard loan or period), the stockiest person pays the drugs on behalf of the pharmaceutical

business. Based on the average sales of goods, the company pays the CFA once or twice a year.

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Some inventories appear to cost retailers up to 6 percent, leaving the dealers just 2-2.5 percent.

Stockiest also collects from businesses 5-10 percent of discounts as free bundles, some of

which are discounted by retailers. In 2006 there were over 60,000 stockiest in India, according

to the All India Organization of Chemists and Druggists, (AlOCD).

Retailers/pharmacies/dispensing practitioners

A significant number of small-scale distributors, who often serve as prescribers and sellers,

make up the remaining sector. According to AIOCD figures, India has a total of over 700,000

retailers with 100sqft [46]. Source of industry estimates that retailers make up about 70–80%

of the country's pharmaceuticals sales. Private practitioners (whether formally trained or

untrained) typically hold stocks of most medicines they expect to prescribe in the rural and

small towns of India (probably represent 25–35 percent of the marketplace). Drug advice of

pharmacists tends to be focused on productivity and the relationship between drug and

substitute goods and members of different enterprises. The retailers are entitled to 16% for

regulated formulations and 20% for Maximum Retail Price (MRP) unregulated formulations.

Nowadays online pharmacy stores like 1mg.com, netmeds.com and pharmeasy.com also act as

a communist pharmacies and supply medicines to the patient with good discounts.

Table: 1.6.1 Diverse distribution channel level margins [47]

Levels Margins

Retailers 16% for the scheduled medicines

20% for the nonscheduled medicines

Stockiest or distributors 8% for the scheduled medicines;

10% for the nonscheduled medicines

CFA (Clearing and

forwarding agents)

1–10% on the total trade volume + other

expenses

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Fig: 1.6.1 Current distribution chain in India

Figure 1.6.1 demonstrates how a manufactured product is supplied to the CFA or super stock

in the central warehouse operated by a corporation. The inventories are supplied by the CFA

to the most plant, sub-stockiest or hospitals. The specialty drugstore obtains the most processed

or sub-structured goods, from which customers (patients) can finally get access to them. Some

small producers supply the super stockiest medicines directly. There is a dynamic path for

many businesses. The picture below demonstrates and fits into all sorts of potential Indian

pharmaceutical distribution networks.

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Fig 1.6.2: Patterns of complex distribution of pharmaceuticals in India [45]

Large Pharma

Producer Small

Pharma

Producer

Clearing and

Forwarding Agent or

Company Depot

Super

Stockiest

Government or

NGO, Agency

Retailer or

Pharmacist

Patient or

Representative

Practitioner

Hospital

Wholesaler

/ Stockiest

Counterfeit

Producer

Main channels

Other channels

Channels for counterfeit drugs

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The pharmaceutical distribution system in India is highly competitive and challenging. Some

studies have shown that when we look at ground level, more complex relationships exist [45].

It may also be more difficult to maintain interactions with the stakeholders in such a dynamic

setting because of the lack of communication & the use of sophisticated communication and

data methods is more unavoidable in these complex structures. Picture 1.6.2 gives one full

description of the Indian pharmaceutical distribution network's supply chain, which reflects

several more latent relationships and sum up the total drug distribution relationships or

networks up to the ultimate customer [48].

1.9 Regulations in Indian Pharmaceutical Industry

The pharmaceutical industry in India was in primary phases until the 20th century. Many

medicines from other countries have been imported. Since the First World War, there has been

a massive rise in demand for pharmaceutical drugs, which contributed to the growth in the

market of falsified medicines. Table 1.7.1 lists some significant actions that have paved the

way for Indian regulatory growth.

Table 1.7.1 List of Acts Regulation for Pharmaceuticals in India [49]

Year Act & Regulations

1919 Poisons Act: Possession or sale of toxins

1930 Dangerous Drugs Act: Origin, history and production of opium, manufacture,

production, sale of opium and opium

1940 Drugs and Cosmetics Act: Drugs are manufactured, produced, distributed and

sold. This action includes allopathic, homeopathic, Unani and Siddha medicines

1945 Drugs and Cosmetics Rules: Drugs production for sale. Not for possession, use

or ownership of drugs

1948 Pharmacy Act: Pharmaceutical occupation in India

1955 Drugs and Magic Remedies Rules: Monitoring of medicine’s advertisements

1970 Indian Patent Act: Regulates patents in India

1985 The Narcotic Drugs and Psychotropic Substances Act: The process of Narcotic

substances and drugs

1995 Drug Prices Control Order: Monitoring maximum retail price of drugs for

customers

1999 India joined Paris Cooperation Treaty: Enforcement of product patents and

regulations

2005 Patent Amendment Act: Facility for black box application

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Clinical Trial Registry-India: Clinical research organization registration in

clinical trials before the first patient

Pharmacovigilance Programme of India (PvPI): Reassurance of drug safety for

Indian patients

The CDSCO, the Indian Medical Research Council and the Minister for Health and Family

Welfare are listed as the regulatory authority for pharmaceuticals in India.

CDSCO (Central Drugs Standard Control Organization) is the central drug authority, the

positions allocated under the Drugs and Cosmetics Act by the Central Government. This works

in the center and the department, ensuring secure, effective and secure medicines given to the

public. The CDSCO inspects the imports, license applications for new drugs, clinical trials,

meetings of DTABs and a public advisory committee. The regulation, marketing and

distribution is the responsibility of the government and central authorities for approvals of

clinical trials, monitoring of the quality of import medicines, the establishment of medication

standards and the implementation of drug testing standards. All licenses shall be provided by

CDSCO by the Central licensing authority, CDSCO. The Indian Drug Controller granted

medication licenses including blood, blood products, vaccines & IV Fluids.

ICMR (The Indian Council of Medical Research), is one of the world's oldest health science

and Indian Apex bodies, sponsored by the Indian government through the Ministry of Health

and Family Welfare, for the formulation and coordination of biomedicine studies. The Council

supports work on diseases that can be transmitted, such as cardiovascular diseases, cancer and

blindness and diabetes, on prevention of communicable diseases, fertility regulation, the safety

of mothers and children, alternative health approaches, the preservation of occupational and

environmental health limits and work on the disease that cannot be transmitted. Such measures

are intended to reduce the overall disease burden and encourage public health and well-being.

The Ministry of Health and Family Welfare is a Ministry of Indian Health Policy Ministry

in India. Two divisions are housed within the Department: the Department of Education and

Family Welfare, and the Ministry of Agriculture. It is also responsible for the family planning

programs relevant to all government initiatives in India. Ministry of Health shall be responsible

for family health aspects, particularly in the fields of reproductive, maternal, pediatric,

information, education and communication; cooperation with NGOs and international

assistance organizations; health and community programs, including awareness-raising,

vaccination initiatives and preventive measures.

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1.10 Rationale of the Study

The researcher chose this subject in research because he has been working in the

pharmaceutical industry for the past ten years in a sales and marketing team. So he has taken a

closer look and observed that there have been a lot of changes in pharmaceutical marketing and

promotional tools over the last decade.

Pharmaceutical companies spend almost 24% of their revenue on marketing activity at various

levels, including stockiest, retailers and doctors. Expenses on marketing activities are the

second biggest cost to the company after manufacturing. So, return on marketing investment

plays a crucial role in the growth of the organization. Selection of the right activity on the right

doctor is very decisive to get the highest return on activity investment. The impact of activity

also varies with the specialty of the practitioner. Pharmaceutical marketers are always in

dilemma for the selection of the right activities for their brand to outperform in the marketplace.

The current research aptly guides marketers to select the right activity for their customers to

gain better mind share for their brands. As a pharmaceutical marketer, he saw the impact of

such activities on sales and prescription. Therefore, he tried to analyze and document the

effectiveness of various pharmaceutical promotional tools and came up with some useful

suggestions for their effects on prescription behavior.

The pharmaceutical industry is more regulated in nature, the industry is concerned with the

lives of the people so the government enforces multiple regulations on the market of

pharmaceutical products along with the manufacturer. The researcher sought to study

government law on the future trends of this industry and the pharmaceutical industry.

Finally, the researcher tries to capture participants and pharmaceutical industry professionals'

expected pharmaceutical marketing strategies by tailoring their future goals and strategic plans

accordingly.

1.11 Statement of the Problem

There is huge potential in the Indian pharmaceutical industry. A big change is happening as

new markets for new products and services grow and some old markets disappear. Many new

pharmaceutical companies have entered the Indian pharmaceutical market with their new

product line. Many combinations and acquisitions are possible. In particular, the marketing

strategy of pharmaceutical companies has also changed over time. Therefore, it is important to

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look at changes in prescription-based drug marketing. In this intense competition,

pharmaceutical companies use their best marketing brains to change doctors for their brand.

In the development or subsequent development of pharmaceutical advertising for prescription-

based drugs, marketers need to know the expectations of their customers. As a marketing

aspect, it is important for marketers to know these expectations as well as future trends in the

industry, to satisfy customers and to plan for other successful marketing strategies in the future.

But for marketers, the desired return on investment is possible only if they have the idea that

the drug promotion tool will have a better impact on prescription behavior. Here the researcher

tried to identify the effect of various pharmaceutical promotional tools on the prescription

behavior of healthcare practitioners.

Healthcare practitioners can be divided into two categories, generalists and specialists.

Generalist covers general practitioners & consultant physicians whereas specialist covers

gynecologist, pediatrician, dentist, surgeons, orthopedic, etc. Super specialists like urologists,

cardiologists, oncologists etc. have been covered under the specialist category only [50].

Science proceeds by replication and by the generalization of individual study result into broader

hypotheses, theories, or conclusions of fact. Establishing study boundaries and conducting

“population-based” research within them enhances both internal validity and the likelihood that

results may apply to similar and dissimilar groups. However, studies of specifically defined

groups may also generalize to extend our knowledge [51]. The current research was conducted

on both the category of a healthcare practitioner to generalize the outcome for the population.

With the above bifurcation, in India, 43% of doctors are generalists where as 57% of doctors

are specialists [32]. All generalists behave similarly while specialists follow their

characteristics. If the sample of study can mimics the population with respect to number of

specialists and generalist, the result of survey can generalize to population, as sample exactly

represent the population. The researcher tried to incorporate the above criteria while designing

a sample group for the study, so that result of the study can be implacable to entire medical

fraternity and the outcome helps pharmaceutical marketer to formulate better strategists to

enhance the ROI of their activities.

Since it is difficult to study the entire Indian pharmaceutical market, the researcher did this

research in metro cities of Gujarat i.e. Ahmedabad, Baroda, Surat and Rajkot.

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1.12 Scope of the study

1. The subject of the study is limited to “Impact study on various promotional practices

done by Pharmaceutical companies on doctor's prescription behavior”

2. The research was conducted in the metro cities like Ahmedabad, Baroda, Surat and

Rajkot in Gujarat, so the scope, results and recommendations of the study are limited

to the metro cities of Gujarat.

3. The researcher selects only limited specialties of healthcare practitioners such as

General Practitioner, Consulting Physicians, Dentists, Pediatrician and Gynecologist.

The range is therefore limited to these specialties only. Other channel

partners/stakeholders such as chemists, stockiest, medical representatives and hospital

nursing staff will not be considered in this study, so this scope is limited to healthcare

practitioners only.

4. The researcher focused on very specific aspects of pharmaceutical marketing, such as

the promotional tools used by drug companies. Product availability or other parameters

leading to a prescription such as tender and corporate business are not taken into

account here.

5. The scope of the study was limited to measuring the effectiveness of pharmaceutical

promotional tools on prescription-based drugs, while other types of drugs such as over-

the-counter were not considered for this study.

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CHAPTER – II

LITERATURE REVIEW

Chapter Contents:

2.1 Pharmaceutical Marketing

2.2 Types of Pharmaceutical Activities

2.3 ROI in Pharmaceutical industry

2.4 Pharmaceutical Promotional Tools

2.5 Research Gap

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2.1 Pharmaceutical Marketing

2.1.1 Role of Pharmaceutical Marketing

Medical marketing or pharmaceutical marketing is also called an advertisement or otherwise

promotion of the selling of pharmaceuticals or medicines. Pharmaceutical marketing has been

criticized for distorting the recommendation made by doctors. An alternative solution is to

enhance customer well-being in the effective marketing of pharmaceuticals by growing

opportunities to invest in R&D and directing research and development to make it more user-

friendly. It is especially important to encourage pharmaceuticals, as information is of great

importance, highly technical and can rapidly alter. The marketing of drugs is necessary (and

perhaps unique) to enable medical practitioners to take a greater interest in the needs of

customers (i.e. preparedness to pay). In this sense, customer advertisement is likely to improve

their wellbeing by improving their compliance with medications. Effective pharmaceutical

commercialization also enhances R&D returns while exploring market demand and

contributing to fundamental research on the role of medicines. This method can also be very

beneficial for consumers [52].

Marketing also plays an important role in influencing or directing operations from

manufacturer to patient. For this, a pharmaceutical marketer is required to know the varied

constituents of the external environment just like the economic environment, the regulatory

environment, the competitive environment, the social environment, the technological

environment and also the ecological environment. GNP rate of growth, personal income,

inflationary pressure, interest rates, industrial growth rates etc. are the indications, which

suggest where the economic environment is heading for. The general economic environment

does affect a pharmaceutical organization because the demand for medicinal products is

certainly associated with the economic conditions prevailing within the marketplace [53].

Pharmaceutical Marketing also plays important role in studying the supply and demand of

medicinal products. Few sorts of demands are often enlisted as [54]:

Negative

Absent

Hidden

Decreasing

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Irregular

High-grade

Excessive

Irrational

Pharmaceutical marketing also includes market research for proper decision-making. Below

listed points mentioned the role of marketing research in pharmaceutical marketing.

Market research is used as an effective decision-matching tool.

It is used to measure market potentials, characteristics of market and market share.

To study the impact of socio-economic changes.

Helps to make a short-term and long-term forecast.

To determine prospects and acceptability of new products and to test existing products

for the products of rivals.

Facilitates designing antibiotics marketing operations and plays a beneficial role in a

segmentation strategy.

Facilitates developing pricing policy and in price discrimination policy.

Facilitates evolving effective distribution strategy.

Beneficial role in promotion strategy to help make better advertising decisions and

appropriate promotional strategy to adopt.

Helps to control adjustments in the market and source of supply to guard against intense

competition.

The customer is not the client, it’s another aspect of pharmaceutical marketing. To determine

prospects and acceptability of new products and to test existing products for the products of

rivals. As a result, Pharmaceutical companies recognize that the prescribing habits of doctors

is very important to control by the use of different forms of advertising methods. Therefore,

most pharmaceutical companies spend more than a third of their sales revenue on promotional

strategies, which is almost double what they spend on R&D to maintain and promote their

market share [55].

2.1.2 Expenditure on pharmaceutical marketing

As per the survey in the US over the last 20 years, 69% rise in medical marketing spends by

pharmaceutical companies. From 1997 to 2016, the total annual expenditure on disease

awareness campaigns, prescription drugs promotion, laboratory testing and health services

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raised from USD 17.7 billion to USD 29.9 billion, out of which 68% of the total cost is for

prescription drug marketing. [56].

Fig. 2.1.1: Medical Marketing 1997 vs 2016 in the US

In India, direct-to-consumer advertisement is not allowed as per regulations set by the Indian

government, still spend on product promotion is not less than 20% of the total revenue of the

company [57]. The objective of such promotion is to change the prescribing habit of doctors

towards the promoted brand.

E. de Laat et.al. [57] studied pharmaceutical companies’ expenditure over various marketing

activities; pharmaceutical branded products are the most heavily promoted products as

companies are spending 20% or more of their revenues on various promotional practices. The

objective behind such expenses is to influence the prescription of healthcare professionals

towards the promoted brands.

Fig 2.1.2: Expenditure spread of large pharmaceutical company [57]

Most countries have in situ legislation to restrict pharmaceutical ads. There are different

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portions under which expenditure of pharmaceutical marketing is often covered.

Healthcare providers

Consumers

Healthcare providers:

Marketing for healthcare professionals takes three primary forms: drug sales representative

operation, product screening service, and continuing medical education (CME) sponsorship.

Since 2008, PhRMA (Pharmaceutical Research and Makers of America) ethics guidelines have

recently banned the use of gifts like pens and bags with pharmaceutical product names [58].

Free samples are demonstrated to influence the actions of the medical practitioner. Free-

sampling doctors are more probable to advise branded drugs for equivalent generic medicines

[58]. The prescription cost is not reduced by getting pharmaceutical samples. Although samples

are received, prescription costs continue to excessively burden recipients of samples [59]. Free

samples immediately give the patient access to the medication, so treatment can begin directly.

This also saves time to go to a pharmacy before care begins. Since all medications are not

working for each other and others, Free trials will help patients figure out what dosage and type

of medication work best before they spent money on a full pharmaceutical prescription.

Physicians spend more time on industry-supported CMEs more than all schools of medicine

[58]. Furthermore, the structure, management and productivity assessment of the sales

department pose essential business problems due to the mass scale of the pharmaceutical

industry. In the realms of physician selection, distribution and organization, distribution

department efficiency, call preparation and sales forces effectiveness, management functions

are typically weakened. A few pharmaceutical companies recognize that the training of sales

officials alone is inadequate, especially if most goods are of similar quality. In addition to life

science and product expertise, sales managers will also contribute to the success of the sales

department. Physicians are more relay on sales managers for scientific material as they are

more experienced than medical representatives.

Consumers:

The purpose of direct ads is primarily to influence the interaction between the patient and the

healthcare professional [60]. Many patients will question or even question a drug that they need

to be seen on TV. Mass media advertising for pharmaceutical products has grown in the US in

recent years. The FDA revised the legislation over the seven years from $1.1 billion in 1997 to

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a good many $ 4.2 billion in 2005, a 19.6% annual rise in line with the Government

Accountability Office [58]. Expenses for direct-to-consumer ads have quadrupled

dramatically.

Drug makers also supply customers with a pharmacy coupon in many countries to help cover

health insurers' copayments for prescription drugs. Such coupons are typically required to

support non-preferred drugs and generic alternatives to minimize or avoid the cost of bags

normally charged by insurers in a non-preferred medicinal drug to the consumers [61].

The advent of new media and technology has changed the pharmaceutical promotional scenario

rapidly in recent years. Doctors & consumers both are increasingly dependent on the web for

health and medical knowledge and are enabling pharmaceutical companies to appear on digital

platforms to large audiences. Sales representatives find it more difficult to urge doctors for

individual details in an equivalent time. Online marketing is being explored by pharmaceutical

companies as an alternative. Video content, online events, Customer services platforms such

as e-sampling and physical services, such as PV, MDLinx, Aptus Health and Epocrates, are the

emerging e-promotional activities. Due to more scratched audiences and the number of news,

entertainment and knowledge access points, users are also aware of the need to move to the

digital channels. DTC advertisement is less important than ever, with companies beginning to

focus more than ever on digitalizing, for example, product portals, internet ads, service

marketing, television promotions, place-base television and health information and mobile ads

to over 1.5 billion U.S. citizens.

2.1.3 Global Trend in Pharmaceutical Marketing

From a splash of AI to automated machine systems, including digital marketing and e-

prescription (telemedicine), pharmaceutical marketing has been evolved with an entirely new

look. The worldwide trends in pharmaceutical marketing which may not be overlooked are:

1. Smart multichannel mix

There is a significant tendency to use online services across multiple channels. Gradually,

the intelligent multi-channel approach often affects HCPs' relationships. Health alerts or

information about drugs could be easily obtained via the Internet at any time. It leads to

more specific digital solutions offered by pharmaceutical products, interactive information

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and e-sampling. A high-performing doctor with no digital display on his / her tablet appears

unlikely to be ascertained.

2. Using big tech- Mobile generation

In recent years, pharmaceuticals have made a significant move to use mobile technologies.

Doctors have access to all clinical knowledge on their smartphones during the day. Just one

button is needed to request the latest sources or to check for any details. It offers doctors

the chance to focus on more complex tasks and to let smart technology solve their simple

tasks. Therefore far superior online pharmacy services are safer for consumers.

3. No way to miss AI and ML

Artificial intelligence is profoundly intertwined, machine learning and massive files.

Today, doctors are working with additional interactivities to find deep, specialized data sets

in real-time. With this in mind, how data is collected and interpreted has changed to the

goal of making it credible and up to date. ML and automated strategies will affect the future

of pharmaceutical marketing from cost reduction, remote monitoring and patient journey

to the integration and optimization of computer functions worldwide, with no need for

human senses.

Nevertheless, every technical process and the automated algorithm requires people. AI and

machine learning can not only be linked to and excluded from any challenges. The triangle

of information, processes and technology also calls for the strategic thought and learning

of humans. Multichannel targeted marketing and value-driven treatment will still matter.

4. Social media networks

Pharmaceutical goods can reach very large markets worldwide and deliver qualified content

precisely when and where it is needed. Please notice that patients can do personal medical

research on any site. Undoubtedly, people often rely on what they hear, whether

scientifically confirmed or not. Digital channels and social media are also better controlled.

In compliance with the existing FDA regulations and other limitations, pharmaceuticals are

not authorized to enter a conversation. As a consequence, a greater number of data are also

both unreliable and adverse. It is therefore important to look at how drug companies grow

their brand and comply with regulatory requirements. In addition, growing numbers of

businesses with ample analytics would have the ability to provide value (including deals

outside the pill) to any kind of public in particular. Simply, great customer service without

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tightly controlled social media work is difficult, and if an organization wishes to stay

relevant, those networks cannot be ignored.

5. From Big data to Internet of Things (IoT) and edge computing

IoT can transform and revolutionize the marketing business of pharmaceuticals completely.

Data will now also be stored in an IoT system itself, not inside the cloud. Lightweight,

small devices would be able to process thousands of data themselves in real-time. The new

medical innovations have already shown a big difference in health and life sciences in the

longer term. Analysts and analysts continually explore how advanced computing can

transform the workings of the pharmaceutical and healthcare industries. The SaaS

(Software-as-Service) program offers a quick solution for pharmaceutical companies where

all apps can be accessed from any computer anywhere. Almost 50% of all drug producers

currently employ a kind of cloud-based technology, according to Insights Pharmaceutical

survey.

2.1.4 Pharmaceutical Marketing-An Indian Perspective

Today, the Indian pharmaceutical industry is in the midst of a 'self-destructing loop' [62] [63]

[64], due to intense rivalry and exceptional growth of local pharmaceutical manufacturers. The

"Ranking of Indian Pharmaceutical Firms" indicates how large national companies compete in

the Indian health care sector with their global corporations. The Government has taken several

big measures since the 1970s: i) allowing domestic companies, in contrast to their previous

repackaging of foreign terminology, to supply generic versions of patented molecules; ii)

offering major monetary encouragements and state grants to local medicines; and, iii). Of

course, this led most local drug firms to gain considerable momentum and soon grew to state

that they had a considerable market share [63] [65]. Due to the strong rivalry between

pharmaceutical firms, most pharmaceutical companies are now extending their product into

ways to market their products and thus to increase their indication, exaggerating the efficacy

of their products, ignoring the contraindications and undercut the negative effects that have

become routine [62] [66]. Besides a few studies [67] that focused critically on problems with

the invasion, in several anthropological studies, international pharmaceutical firms and their

non-ethical marketing strategies have been attempting to catch various "living processes of

medicines." Nevertheless, due to the complex nature of the pharmaceutical links [68] and the

near interconnection of formal and informal sector systems, many researchers were able to

understand the complexity in one dimension alone without understanding the opposite. In

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addition, new issues and an ever-increasing awareness of prescription coverage, the use of

drugs, health costs and non-compliance diagnostics have helped some researchers focus on the

essence of globalization in today's capitalist enterprise [69] [70]. A couple of research studies

have also shown that drug marketing can even work at a deeper level by changing health

experience, politics, ethics, and economics. Therefore, in the majority of the cases, such

research has failed to explain how pharmaceutical products were, or perhaps their role in,

"pharmaceutical," and "improve" health an essence and embodiment of Indian communities.

Another competitive choice, primarily used by Indian pharmaceutical companies, is the

'marketing distinction.' New system of drug delivery, end-use, dose ease, consistency, etc. are

often sponsored for distinction. Some businesses use concentrated marketing as well as

differential marketing to boost the performance of both instruments. In particular, the

"Undifferentiated Marketing," in which the company targets for mass consumers such as

corporations and government hospitals. Generics are promoted by undifferentiated marketing

technology, but certain qualitative distinction or better value may be needed if generic

marketing is being successful.

To understand pharmaceutical promotion, it is important to understand from the sales and

marketing point of view the marketing process & personnel involved in the pharmaceutical

industry. The hierarchy of the sales promotional wing includes workers such as the Medical

Representative (MR), the Area Business Manager (ABM), and the Regional Business Manager

(RBM). Likewise, the production and distribution network outside the business includes

consumers such as inventors, stock owners, chemists, physicians and their final customers i.e.

patients [71]. The rights of intermediaries, including pharmaceutical stores, sub-stock

companies and stock producers are highly hierarchically based upon their rate expenditure. The

doctor and the patient are separate, not a wheel-wheel or an external, but an amazingly critical

cog. A physician may decide on a prescription drug for a patient based on the

indications/symptoms of a specific patient. A business transaction is created between the

patient and pharmacies; the information transaction is created between the MR and doctors.

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Fig. 2.1.3: Staff participate at different pharmacy network levels

In the method, all intermediaries such as chemists, sub-stockers and inventors generate income

and revenue. Because chemists purchase this medicine from sub-stock companies who in turn

purchase medicine from stockholders receiving the same medicine from production companies.

All of them have their own set of goals, physicians, patients and other players involved in a

pharmaceutical industry network. Every individual in the business network must fulfill their

respective duties and obligations for a minimum level of performance. Physicians are

preferably familiar with the "patients' benefit" dimension and patients have remediation steps,

while stockholders are merely profiting. The pharmaceutical sales process and marketing

process is mainly based on the successful management of various direct sale networks driven

by the head office with their marketing strategies.

Controlling and operation of each region and area are often strategically controlled by head

sales and the ABMs and RBMs. The ABMs and RBMs have respectively retained the status of

their revenues and have agreed on the critical strategic needs of all territories and regions.

ABMs/ RBMs discuss the targets and financial objectives with their respective team members

i.e. MRs during their visits to the MR’s territory. The RBM, along with all of its ABM's,

received orders from various sub-stockiest and stockiest of the different areas during the first

four days of a month and then took the pre-determined goal of the previous month into account.

Throughout these meetings, RBM addressed whether there were any differences between its

goals, its successes, and the potential measures for its prevention throughout addition to the

allocation of next month's goal among ABMs and MRs. The main task of the promotional team

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at the company's headquarters is to develop various promotional tools for the brand that the

medical representative can detail or discuss in front of the doctor, to persuade them to produce

a prescription for the brand rather than competitors.

2.2 Types of Pharmaceutical Activities

Pharmaceutical companies are taking on an increasingly active role in engaging with opinion

leaders to fulfill their reputation, identify business opportunities, facilitate product

identification and positioning, and build desire and brand loyalty for consumers.

Product Branding:

Product branding is crucial for any product to become successful. The foremost effective

marketing strategy is cohesion. With a unified branding strategy, the merchandise can more

easily carve out its niche within the marketplace. By maintaining a continuing product “look,”

the buyer more readily identifies with the merchandise, strengthening the brand image and

increasing the product’s marketability. Trademarks also help marketing teams, as they're able

to craft ads that are ready to hit the market before the drug is even launched.

Some key points which should be considered are as:

1. Unify promotional “look” for all stages of product promotion to make the strongest

brand image.

2. Employ cross-functional portfolio teams to oversee product decisions and resource

allocation for branding and marketing.

3. Conduct trademark development activities in early development stages to realize a

status before launch.

4. Use multiple communication channels for both internal and external publicity to create

brand equity rapidly.

To lessen the confusion between the generic or scientific name and therefore the new

trademark, companies mount prominent internal publicity campaigns through:

Newsletters

Meetings

Launch announcements

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Internet site publicity

5. Intensify internal and external publicity to disseminate trademarked names and build

brand identity.

Traditional Pharmaceutical Marketing and Promotion Activities: Techniques and Tools

Various promotional tools have been studied to identify their influence on healthcare

practitioner’s prescribing habits; some of them are Medical representative detailing, Corporate

Social activity, Promotional pricing, Patient Education Program, Sampling, Corporate image,

Continues Medical Education, Personal attire of company representative, Product

demonstration, Digital marketing, Sponsorship, Literatures and reminders, Journal

Subscription, Medical representative’s Knowledge, Medical camp and Customer Relationship

Management [72]. Serhat Vancelik et al. [73] studied the medical representative number of

visits (frequency ) and its impact; moreover, he also studied the effect of GP’s participation in

training courses on their prescription behavior. Pharmaceutical companies offer promotional

and educational courses to physicians which influence their prescribing decisions. Vilte

Auruskeviciene et al [74] had looked at the role of electronic and mobile-based communication

channels in the perception of the general practitioners. Communication from opinion leaders,

articles published in local health journals, conferences organized by local scientific societies,

medical information received by email, phone calls from pharmaceutical representatives and

SMS from pharmaceutical representatives had been studied. International health journals and

international scientific conferences have become more popular and are considered a more

reliable form of communication and have had a greater impact on prescription. Joel Lexchin et

al [75] had studied physician-industry interaction in form of clinical trials and CMEs. The study

concluded physicians are affected by their interaction with the pharmaceutical industry. Roy

H. Perlis et al [76] had observed that payments to physicians were associated with greater

prescribing costs per patient and more number of branded medication prescribing. M. A. Al-

Areefi et al. [77] confirm that regular visits by medical representatives could impact the

prescribing habit of doctors in Yamen. Ishak Abubakar Y. Ibrahim et al. [78] had identified

factors impacting doctor’s brand selection decisions. Prevailing hospital policies and patient’s

financial situation are the most impactful factors, followed by frequent visits from sales

representatives and advertising. Susan Kamal et al. [79] observed that pharmaceutical

promotional tools like detailing, conference invitations, gifts and financial incentives

influenced physician’s prescribing behavior. Farooq M et al. [80] studied the impact of

scientific literature by medical representatives on Indian general practitioners. The study

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concluded scientific literature by pharmaceutical companies is a very important source of

information for physicians and may influence prescribing behavior. Handa et al [81] surveyed

115 physicians of India to identify their perception towards pharmaceutical promotion in India.

The promotional tools covered under study are journal, clinical studies, conference/symposia

participation, medical representative, medical association, direct mail, company website,

sample catch cover & advertisement. The study confirms the positive relationship between the

reliability of promotional tools and the extent to which this affects prescribing behavior.

Shamimulhaq et al [82] cited that sponsorship to conferences, a new drug in the market, brand

prescription and drug samples are the causes that impact the prescription habit of clinicians.

Influence also depends on the salesperson’s promotional tactics while discussing brands. Girish

Taneja et al. [83] surveyed 600 Indian physicians to check the influence of scientific

promotional tools, sponsorships, common promotional tools and personal touch on prescription

behavior. Sponsorships had the highest influence on prescribing decisions; followed by

scientific promotional tools, personal touch & common promotional tools in sequence. Salmi

Mohd Isa et al [84] explain CSR and its influence on loyalty behavior. Joel Lexchin et al [75]

identify Physician-industry interactions in the forms of Clinical trials & CMEs & concluded

that the pharmaceutical company representative’s interactions with clinicians affected them in

terms of their prescribing behavior. Srivastava et al [85] explained the impact of brand equity

on physician prescribing behavior through the application of the theory of planned behavior.

McMullan M [86] studied the use of the Internet for patient health information search and its

influence on a patient-health professional relationship. The study concluded that proper disease

information is a patient’s right and that physicians also accept patient’s search for knowledge.

Physicians should discuss the information provided by patients which they have collected

through their various health sources and also guide them to a more reliable source of knowledge

like health website, patient education posters and literatures. Pharmaceutical companies can

perform a major role in providing patient education materials to spread awareness about disease

conditions.

Table 2.2.1: Pharmaceutical promotional tools

1. Medical representative detailing 9. Corporate Social activity

2. Promotional pricing 10. Patient Education Program

3. Sampling 11. Corporate image

4. Continues Medical Education 12. Personal attire of company

representative

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5. Product demonstration 13. Digital marketing by pharmaceutical

companies

6. Sponsorship 14. Literatures and reminders of

pharmaceutical companies

7. Journal Subscription 15. Medical representative’s Knowledge

8. Medical camp 16. Customer Relationship Management of

Pharmaceutical companies

Pharmaceutical activities can be broadly bifurcated into two categories. First, patient-oriented

activities and second, practice-oriented activities. Patient-oriented activity is defined as an

activity that helps the patient to understand a disease condition or helps the patient for better

treatment like patient education videos, do’s and don’ts of disease etc. Such kind of activity

helps the doctor to oblige their patient pool; in return, it helps to get prescription support from

a doctor for the organizer company. Promotional pricing, sampling, medical camp & patient

education program can be categorized as patient-oriented activities. Practice-oriented activity

helps a doctor to sharpen their expertise for better patient care like CMEs, workshops,

conferences, journal subscription, scientific literatures etc.

2.3 ROI in the Pharmaceutical industry

Return on investment (ROI) is the prime requirement for every business promoter to run their

business. Every company allocatess sum of amount on marketing with an expectation of better

ROI and growth of the business. But to get the proper ROI, the business leaders need to

analyses the market situation, internal strength and capabilities, acceptance at the customer

level and many other internal as well as external factors.

First of all, the knowledge required to make decisions that are analytically educated. Such

information is also gathered from different internal and external sources (e.g. multiple

organizations and data collected on a company level) and is of varying quality. Therefore, all

parties involved find it difficult to believe that there is a "true source of truth." The second

factor relates to the need for a detailed analysis of the present data. With a "test and learn"

approach these insights include diligent stress testing to enhance analytics and draw on the

standard findings needed to support the business decision-making.

The third element is to build the company to use this research and decision-making efficiently

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to optimize business returns. An ideal organization, with management leaders empowered to

decide these analytical results, has properly defined roles and responsibilities. A cultural

change that addresses high-frequency data and transitions from experiential choices to data-

driven choices leads to an improved general confidence in making multiple decisions over the

entire year.

ROI = Assets Turnover X Profit Margin

Assets Turnover = Operating Income X Total Assets

Profit Margin = EBIT X Operating Income

ROI = Rise in profits per extra money spent

A campaign which not able to attract expected ROI is considered a marketing failure; ROI

creates value for shareholders [87]. UCPMP regulation restricts pharmaceuticals to offer gifts

worth more than 1000 INR to any health care practitioner. Indian pharmaceuticals have found

many ways to offer sponsorship for travel, conference, money to the physicians, despite having

strict UCPMP regulations. The major objective behind such bribes is the get physician in their

fold and get the prescriptions from them for the promoted brand. Such a competitive market

makes an entry barrier for a new entrant or smaller firms with less financial power.

2.4 Pharmaceutical Promotional Tools

Pharmaceutical companies apply many promotional tools to attract doctor’s prescriptions.

Narendran et al. [88] and Dey et al. [89] revealed in their studies that pharmaceutical

promotional tools can impact the healthcare practitioner’s prescription habit. Promotional tools

like the quality of the drug & easy to remember the brand name, an image of the company,

launch meetings and rapport of medical representatives with doctors significantly influenced

prescription behavior of doctor while other tools like offering letter pads, brand reminder cards,

advertisement in journals and direct mailers were less effective among Indian doctors. Product

quality and good image/reputation of the company are still influencing factors for a prescription

generation. Marketing strategies by pharmaceutical companies surely influences the selection

of the brand by a physician. Following are 16 different tools has been identified which impacts

the prescription behavior of physicians.

1. Medical representative detailing

Detailing by the medical representative is personal selling, which comes under the category of

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direct marketing. Medical representatives detail the brand, discuss the scientific points &

resolve the doctor’s query. With help of visual aid he/she tries to convince the doctor to start

prescribing his/her brand [90]. It is MRs who do calls of doctors (visit clinics) to highlight their

company's brands, through practices such as, gifting, drug detailing, providing drug samples,

sponsoring Continuing Medical Education & conferences [91]. Singh et.al. [92] had identified

a conceptual model to understand the dual relation between MRs and physician prescribing.

This addressed the three-dimensional model: network interconnection dimensions, resource

transfer probability (RT), successful integration and circular actor relationships as predictors

of action prescriptive medical professionals. RT is closely linked to the high prescribing

behavior, comparable to drug awareness acquired from information / MRs activities. This

found that when the interaction between MRs and doctors is solid, the correlation between

product knowledge and prescribing behavior is robust. Likewise, it also emerged that the high

level of promotion activities, such as the continuing education of physicians provided by MRs

and the launch of recent medications, is also connected to a high rate of medical prescription.

Sufrin et al. [93] investigated the fact that for every 7.9 doctors, the United States has one

medical representative. He thus studied the persistence of pharmaceutical employees as a result

of which physicians are put a huge burden. As the number of representatives grew, the time

spent on medical practitioners dropped and thus resulted in strategic crises. Medical

representatives are the first touch point for medical companies in front of doctors. MRs are

business strategy communicators to physicians and it is therefore important to provide the right

and persuasive message to the medical representative which can be better communicated in

front of doctors. It is estimated that almost 75% of the marketing budget is spent on the medical

representative by pharmaceutical companies [94]. In compliance with M.M. Punchibandara

Tharaka et. al [95] studied factors such as regular medical representative in-clinical meetings,

debate through research materials and CME are more important than information and sampling

but most prescriber groups require effective communication skills and sufficient

documentation from health workers to persuade them to prescribe a supported brand [96]. In

this digitization age, with electronic details; in contrast to conventional information with

written visual aids, MRs will speak more effectively about their products in the medical room

[97]. A professional representative may encourage a doctor to prescribe marketed products by

providing information about the brand with scientific support.

2. Promotional Pricing

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Price is the amount of cash paid for a product or service or the exchange rates for goods or

services for the benefit of consumers. Price is one of the most interesting and controversial

topics in pharmaceutical marketing [98].

Figure 2.4.1: Objective of pricing

The business defines key priorities to ensure optimal pricing, including profit maximization,

revenue maximization, maximum volume, quality leadership, partial cost recovery, survival

and status quo. Once the target is identified, companies can follow any of the pricing strategies

below.

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Figure 2.4.2: Types of Pricing Strategies

Cost-Based Pricing: A benefit factor in the cost of the commodity would be applied to the

price. This pricing policy is enforced in the Indian Drugs Market by Pharmaceutical Price

Control Order.

Customer-Based Pricing: Prices are calculated by the supplier on the basis that what price is

ready for payment by the client.

Competitor-Based Pricing: The biggest impact on the price of the rivalry business is favorable

rates.

Pricing is an integral part of selling a commodity. Too many examples include deals for

reduced-priced items, cash-off vouchers and discount coupons. There are no exceptions.

Promotional pricing is a topic of controversy. This method is not legal in many countries and

legislation regulates the product to ensure that the product is priced at its original higher price

before a discount is possible. Many pharmaceutical companies keep medicines in the premises

of the doctor for sale. The business model is skewed to doctors earning from the vast trade

margin. The cost to the doctors/ hospitals is much lesser than the Maximum Retail Price printed

on the strip or injection (medicine) at which doctors/ hospitals sell the medicines. Thus they

make large profits from such sale of medicines. Sometimes doctors who don't want to be seen

as merchants ask patients to get the vial directly from a particular MR, who collects the money

and passes it to the doctors. Such promotional pricing may influence the prescription behavior

of doctors because doctor’s prescriptions are limited to the brand which is available at a high

discounted price with good MRP [91].

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Two different pricing strategies appear in prescription drug markets where no regulation is

made regarding the company's pricing practice: the Flat Pricing Strategy, where all tablet

strengths are at the same price, whereas the monotonic pricing strategy defined as 'prices are

more or less proportional to the strength of the tablet. [99]. Lexchin et al. [100] state that in the

case of monotonous pricing the expenses are higher, while flat pricing contributes to lower

expenditure and offers more predictability in spending for public drug programs. But

companies who make scored tablets can feel that they 'need to use single pricing since the cost

savings from splitting tablets are not recognized by physicians. The product innovation has a

positive impact on the price level for an early market entrant. Later entries, on the other hand,

frequently lead to a lower price. Despite what Cooper and Kleinschmidt [101] show, a

'economic costing strategy is usually not successful.' This is supported by Lexchin et al. [100],

who says that 'doctors do not usually know the prices of medicinal products both relative and

absolute. In addition, the fact that 'drug pricing sensitivity is typically second regarding product

effectiveness problems and to patient conditions, finds evidence in Gonu ̈l, Carter, Petrova, and

Srinivasan [102]. Nevertheless, Narayanan et al. [103] and Rizzo [104] have shown that

product promotions inhibit pharmaceutical price competition, reduce price elasticity and result

in higher price balances [105].

3. Sampling

Alowiet al [55] has found that comparisons of medications, impact the prescription decisions

of doctors in the United States. Aanandet al. [106] found that medicinal samples have been

positive and strongly influenced by the prescribing decisions of 77 percent of their doctors and

promotions. The study's drawback is that it contains no clear details about how the drug

samples are to be assessed and how their prescription effect is quantified.

De Ferrari et al [107] analyzed the approach of doctors to the pharmaceutical industry and

found that 91.2% of participants received medicine samples. This was found to be ethically

appropriate and to be helpful to patients. Nevertheless, the doctors agreed that the drug samples

did not affect their prescribing behavior. The representatives used different methods for

supporting their results, and it was especially helpful that drug samples, like old ones, were

used regularly. The duration of visits and the delivery of drug samples depended somewhat on

the age of the patient. The conclusion is that medical representatives are viewed by GPs as an

effective method to collect drug knowledge. As for distributing product samples, the one aim

of new novel drugs may be to give the doctor a chance to understand the medication, but other

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reasons for distributing samples might have been already identified and recommended by the

GPs several times. Jesper et al [108] cited the statistically significant effect of drug samples on

the prescription generation but it depends on drug age; however, the drop is small.

The medical use of samples is in divergence. Physicians can benefit by providing immediate

treatment, determining the initial effect or adverse effects, and adjusting prescription doses

before the patient completes full prescription treatment, bearing the cost of patients with

medications for abstinence, and allowing patients appropriate medications use. In the case of

drug trials, on the other hand, dangerous medications can be promoted, evidence-based advice

not being followed, or medications not available in hospitals or controlled health systems can

be recommended. In addition, drug therapy and non-drug interaction recognition cannot help

patients if doctors review drugs. The prospect of a re-sale of drug products and the ethical

ramifications of products for personal use were also discussed by the healthcare professionals.

There have been concerns as well. Many organizations have established guidelines to

encourage the safe use of product samples. A variety of drug sampling policies were established

by health care providers; some prohibit sampling while others do not restrict drug quality or

consumption.

Two experiments indicate that the prescribing of sample medications after the diagnosis would

be increased by the availability of drugs. Morelli and Koenigsberg [109] observed a clear

association between medication sample dispensation and subsequent medication prescription,

which suggests that tests affect physician prescription habits. In a study by Shaughnessy and

Bucci, 55% of participants agreed that the prescription of drugs was affected by sampling

[110]. This work offers an insightful overview of the potential effects of the provision of

prescription samples; however, it doesn't address when and why doctors take medication

samples nor, in some situations, doctors prescribe a medicinal drug originally dispensed as a

sample. Pharmaceuticals companies were used during the procedure to provide prompt

treatment for medication samples, allowing physicians to begin care immediately to relieve

patient symptoms and to prevent potential complications. Sampling is also a good medical

diagnosis technique [111].

4. Continuing Medical Education (CME)

Continuing medical education (CME) is a platform for the medical fraternity to sharpen their

competence by getting knowledge about recent, upcoming and emerging areas of their arena.

Content of CME is designed, reviewed and delivered by expert faculties of respective clinical

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areas. It may be either as a part of a live event or online through webcast, audio, video or other

electronic media. It also can be in the form of written publications. A survey done on 150

doctors in Srilanka; confirms that continues medical education is highly impactful and

positively correlated to influence healthcare practitioner’s prescription habits towards the

promoted drug [95]. Ahmed et al. have established an optimistic association between CMEs

and the prescription habits of doctors [112]. Continuing medical education that augments

participant’s knowledge and offers the opportunity to practice skills can change participant’s

prescription behavior and, on occasion, health care outcomes [113]. Many times, it has been

observed that traditional CMEs and passive distribution of knowledge are not effective. CMEs

that include interactive seasons such as small group conversation or case discussion are

effective in changing healthcare practitioner’s prescribing habits and refining the quality of

care [114]. Pharmaceuticals has also come up with a new concept in CME called webcast;

whereby international or national key opinion leaders (KOL) address the audience through

digital media. The physical presence at the CME venue is not required in webcast and

participants can learn the skills from KOL at his/her place. In webcast concentration of the

listener on speaker remains suboptimal and thereby the learning as well, compared with

physical CME. Continuing medical education provides a platform for the doctors to learn about

the new molecule, new usage of a drug, or new indication from expect of the fraternity.

Pharmaceutical companies can take mindshare of doctors by arranging CMEs for a particular

brand that turns into a prescription.

Rodwin et al. [115] in their article discussed the historical view of the CMEs and their changing

nature. This study revealed parallel issues between advertising and industry-funded CME. The

study concluded that to hinder industry influence and improve the CME experience, there

should be an independent body for funding the medical industry and physicians for education.

The CME syllabus should be developed by independent public and professional authorities and

all institutions should consider allocating funds to educational institutions for this approved

course. Saxena et al. [116] informed with the assistance of the medical marketing team,

marketers should seek out the sources of data preferred by the clinicians. The study was

conducted at CME settings by interviewing the physicians. CME, Medical journals and

therefore the peer interaction were found to be the primary three valuable sources by the

physicians putting the sales representatives on subsequent level of the ladder. Black et al. [117]

in their conceptual paper on the tutorial role of continuous medical education asserts that

pharmaceutical companies should make sure the drug promotion is embedded within wider

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disease management. The author has discussed the role of CME on further three categories of

education: 1. Predisposing 2. Enabling & 3. Reinforcing, which affects the beliefs, attitudes &

behavioral intentions of physicians. He concluded that the credibility factor differentiates the

tutorial detailing & this detailing ultimately decides the integrity of CME. The utility of CME

remains to be assessed in high-risk therapeutic categories.

Dumovic P et al. [118] explored the medical advancement communication methods and their

impact on the prescription habit of the healthcare practitioner. Various methods of imparting

the medical updation like peer-reviewed literature, practice guidelines, interactions with the

opinion leaders, informal exchange with colleagues and postgraduate educational activities

were evaluated supported their simple access and their availability at the doctor's disposal.

Their research projected that referee literature and clinical guidelines were less handy and

suffered the delay as compared to the tutorial activities. The authors also acknowledged the

impact of the pharmaceutical industry's participation within the program on prescription

behavior. One among the result of the study is to encourage the tutorial program to be

conducted by the acridities educational institute.

5. Product Demonstration

Proper usage of the pharmaceutical product is very necessary to ensure the desired action.

Advanced research in medical science enables a novel drug delivery system that requires

technical expertise for drug delivery like insulin pens for diabetics, novel inhalers for asthma

patients and many more. Proper usage demonstration to the patient is required by doctor or

nursing staff or pharmaceutical medical representative to ensure the right usage of product for

the desired action. Sayed Hesam Aldin Sharifnia et al [119] had shown that effective

pharmaceutical product usage demonstration promotes the prescribing of that product as a

refill. Unless available reports of some adverse side effects from the patients, the physicians

usually do not tend to change the prescribed drugs and continue on the same brand. Proper

product usage assistance may be a deciding factor for the physician to choose the brand for

such medications.

6. Sponsorship

Pharmaceutical companies sponsored doctors in many ways, sponsorship for a stay in

conferences, sponsorship for travel expenses in symposiums, high-value gifts or health

equipment as gift or sponsorship for personal tours. The objective behind such sponsorship is

to develop a good rapport with doctor & provide a customized service to the doctor in turn to

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get maximum return on investment. Girish Taneja et al [120] cited that sponsorship of travel

expenses by a pharmaceutical company can change the prescribing habits of a healthcare

practitioner. The impact of sponsorship on physician’s prescribing behavior may vary from one

researcher to another. Saad Shamim-ul-Haq et al [121] concluded that the sponsorship has an

inconsequential impact on healthcare practitioner’s prescription habits; it all depends on how

medical repetitive promote their brand in front of the doctor. Personal relation and value of

medical representative in mind of doctor are more important rather than company’s image or

its investments. Many doctors considered high-value gifts & sponsorships as unethical

practices by a pharmaceutical company and did not accept to encourage ethical promotional of

brands. They also believe that such pharmaceutical activities are not good for the well-being

of patients and society [95]. Muhammad Alshurideh et al [122] confirmed that sponsorships

and medical representative detailing during visits were the lowest influential pharmaceutical

promotional tools.

Taneja et al. [123] reviewed the factors that impact physician's views with various promotional

tactics in five groups: sponsorships, personal sales, promotional tools for the school, research

promotional tools and a private touch. This result is related to research by Arora and Taneja in

2006 in the Haryana state. Doctors' perception of sponsorship factors was found to be

independent of age, gender, legal status, education, area and practice. This study also stated

that government doctors typically receive sponsorships from the government for attending

conferences and are subject to government laws. Pharmaceutical firms typically fund doctors

with more patients than physicians with fewer patients, i.e. a lower income, with higher

incomes. Therefore, doctors who are wealthier than doctors with lower salaries are more likely

to get sponsorship calls from pharmaceutical companies.

In another research by Al-areefi MA et al. [124] Sponsorship promotional tools include travel

sponsorship, conference sponsorship and high-value personal and business gifts. Perlis et al.

[76] confirm that sponsorship influence the prescribing behavior of doctor also because it affect

the doctor’s behavior toward the representative and company. Some countries have strict rules

and regulations to regulate unethical practices for the advantage of the patient. Payment for a

clinical test is another quiet sponsorship promotion tool. Companies pay a grant to the doctor

to conduct a clinical test, but without proper control, this type of grant influences the doctor’s

prescription pattern.

7. Journal Subscription

Scientific journals with good impact factors, always remains the prime source of information

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like new research and trends in the health care sector for doctors. To facilitate this hunger of

knowledge, many pharmaceutical companies provide full-text articles or full journal

subscriptions to greet doctors. Bauer R and et.al [125] in their paper on the Physician and his

source of data about drugs studied various sources of data employed by doctors for acquiring

the new drug/product information and its impact on the adoption of a replacement

brand/product. The target was to review the predominance of the economic or scientific source

of data in physician's awareness and decision. This paper considers mainly journal papers and

articles, a medical journal advertisement, direct mails, doctor’s conversation samples and staff

meetings as the major source of data. The study causes a conclusion that doctors with little

variation have used both commercial and non-commercial sources for acquiring information

but commercial sources convinced them to prescribe a specific brand. The importance of

commercial or scientific sources changes consistent with the severity of treatment. The

national-level survey in which a cross-sectional sample of over 1000 physicians to know the

predominantly used source of data and their relative importance for themselves and for 'most

of the doctors was considered. Detailing Men (MR), Medical journals (papers and articles)

were considered to be the useful sources that are frequently employed by physicians.

Caplow et al. [126] in their research conducted a survey of 182 physicians for understanding

various sources used for the adoption of almost 302 brands from multiple specialty reports that

commercial source acted as the first source of information and the same source convinced them

to prescribe the respective brands. The study does not consider characteristics of the drug under

consideration, the disease for which it is prescribed and its impact on physician's information

need. Providing the latest information to a physician through various means like full-text article

to support brand or journal subscription helps to drag the prescription from a physician for

promoted brand [116].

8. Medical Camp

As a part of patient care initiatives, many pharmaceutical companies organized free health

checkup camps or medical camps; where they offer free diagnostic tests and trial therapy to the

patients. It’s a win-win situation for the doctor as well as pharmaceutical companies. Doctor

gets more numbers of patients and good recognition in area nearby clinic, as well as

pharmaceutical companies, get plenty of prescriptions during the camp. It’s a mutual

understanding between medical representatives and doctors that MR arranges camp at the

doctor’s clinic and in turn doctor gives a prescription of the promoted brand. Shamimulhaq et

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al. studied, medical camps positively impact changing the prescription habits of medical

practitioners [121]. His research also told the factors which influenced the doctors' prescribing

behavior, the questionnaire discusses the price of the goods, the accessibility of the goods, the

contact made by MR, the quality of the products that were being marketed, the brand name,

new research molecule, and the new drug-free study combination samples. The result indicates

that 4Ps related marketing tactics impact the prescribing actions of physicians during this

research.

The variables to be used are brand prescription, advertising resources, conference support, new

drugs and product samples. Those are the independent variable, which was taken as a predictor

and the recommended conduct of a physician was 263. The findings of multivariate analyzes

to assess the influence of the tests used to indicate that new medications, techniques and clinical

samples substantially affect medical prescribing behavior and that there are no major effects

left by residual causes.

9. Corporate Social Responsibility

The conviction that corporations have responsibility for fundamental groups in society other

than certain creditors and beyond the provisions of legislation or the union agreement [127] is

corporate social responsibility. Corporate social responsibility (CSR) helps companies to

develop a positive social profile. The CSR is a separate arm of big pharmaceuticals that offer

various social programs like healthcare, old age care, blood banks, health services, etc.

Throughout the year 2000, the United Nations (UN) and its 189 member states pledged

themselves and subsequently became the eight Millennium Development Goals (MDGs). The

priorities were directed at the well-being of society and the United Nations needs businesses to

play a major role. Many of these programs relate to health and thus need the sponsorship of

pharmaceutical businesses [128].

Goals

Better maternal health

Deal with HIV / AIDS, malaria and other diseases

Support gender equality and empower women

Provides environmental sustainability

Achieve universal basic education

Remove extreme poverty and hunger

Developing global partnerships with organizations for growth

Reduce child mortality

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Table 2.4.1: Eight Millennium Development Goals (MDGs) of UN

Salmi Mohd Isa et. al. [84] researched to define views of physicians about CSR and the

reliability of pharmaceutical corporations. He concluded that social behavior, playing a major

role in his choice of medicines by doctors and pharmaceutical firms. In his analysis, Urquhart

et al. [129] noticed that the relationship between CSR and value for a company was very much

visible. Although patient preference is related to CSR programs, the purpose of medical

physicians to prescribe drugs has not been investigated. Therefore an empirical study was

performed to investigate the effect on doctors prescribing decisions of the CSR activities of

pharmaceutical companies. It has been found that 32.3% of doctors chose to use the medication

of an organization actively engaged in CSR activities using individual data from a web survey

of 300 doctors in Japan. The findings of a two-tailed t-test showed the preferences for medical

professionals in a complex care hospital who frequently attended conferences are substantially

higher. CSR activities improved the company's prestige and made it more possible for

physicians to choose its products.

10. Patient Education Program

Much pharmaceutical promotional activity is patient-centric, patient education program about

disease condition is one of them. Pharmaceutical companies trying to create awareness among

patients about disease conditions to increase the flow of a patient in the promoted therapy area.

In continuation of the same, they prepare disease awareness posters, distribute pamphlets that

highlight the symptoms, or create videos in different languages to show the progress of disease

and its impact on quality of life. They do such activity with help of health care practitioners

and in their clinic to attract the attention of patients. It’s a win-win situation for both doctors

as well as pharmaceutical companies. With patient education programs, the doctor can show

their care and positive attitude towards patients; while pharmaceuticals can attract more

patients by generating awareness about disease conditions.

Kamarudin et al [130] have carried out work that met the inclusion criteria and included a total

of 47 studies in the systematic assessment. The studies have been categorized according to their

assessment process, with 20 studies assessing competency and 27 assessing the efficiency of

prescriptions. A good kind of educational activity with different outcome indicators and

assessment methods was employed. Six studies have in particular demonstrated improved

medication competence in a wide range of settings using a WHO Good Drug Guide. Continued

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medical education and direct reviews from scientific research have also produced positive

outcomes. Only four studies have examined non-medical educational approaches, which

indicates that additional work is needed in this area.

In many countries like USA, UK, Japan, Australia and other European counties where direct

to consumer advertisement (DTCA) is permitted; which serve the purpose of pharmaceuticals

to spread awareness about disease condition. DTCA allows, (i) Patient Education - Informed

patients are more involved in their health care (ii) Dealing with under-treatment is one of the

most serious health problems today. (iii) Improving the economic value of health care -

Treatment drug treatment is more effective than other and subsequent medical interventions

(iv) Treatment improving drug compliance - a major health problem for patients who do not

take prescribed medications. (v) Good Physician / Patient Relations - Information / Involved

Patients Good Patients. Consumers surveyed in Prevention Magazine in 1999 said that DTCA

helped them discuss their health better with their doctor. Thus good patient education programs

by pharmaceuticals always create a positive impression in the mind of doctors which leads to

their prescription support [131].

11. Corporate image

The credibility of the organization can, given its performance with main competitors, be

described as the collective understanding of the past activities of the organization, and its

expectations regarding its future actions [132]. Many scholars claim that the reputation of a

business influences the efficiency of an organization, while others argued the opposite:

corporate credibility is influenced by organizational efficiency. Scholars and managers

consider good credibility as the intangible resource that is the most important in an

organization, for the following reasons:

Benefits of a good corporate reputation [133]

The major advantage of a good corporate reputation are:

Consumer desires to do business with you while other goods and services are available

at the same prices and quality;

The right to charge higher rates at products and services;

Stakeholders help your company in times of crisis;

The financial interest of your company.

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While reputation is an intangible term, research unanimously shows that a good name shows a

significant increase in corporate credibility and the benefit of consistent competition. A

company can achieve its goals more easily if it has a good reputation among its shareholders,

especially its core customers, leaders with business views, suppliers and current and future

shareholders.

The prescription help from the doctor is attracted by corporate prestige in the pharmaceutical

field. The effect that affects the prescription behavior as outlined by Lim et al. [134]: (a) the

importance of brand value in branded items, (b) the importance of brand equity in companies

and (c) the importance of opinion leaders as brand communicators. Corporate brand values

have been improved through their marketing campaigns by companies such as Novartis,

AstraZeneca, Sanofi etc. In an online survey of more than 1,500 practitioners from across the

USA, the United Kingdom, France, Germany, Italy and Spain, TNS Healthcare found that

Europeans ranked Novartis No. 1 in the ranking of service provision and that Merck earned the

leading rank in the United States. The corporate integrity of the company is to the point that

physicians trust and respect it. The credibility of the medical practitioner is likely to affect PSR

beliefs. Since doctors believe that the prestige of the business is well-deserved, they still prefer

to recommend their medications based on the background of effective medicines [135].

12. Personal attire/ personality traits of company representative

The characteristics of personality represent the distinctive patterns of thought, feeling and

behaviors of individuals. Service employees and particularly the leading employees engage

with customers to build a strong brand. The explanation is that consumer expectations of

quality of service, corporate identity, and customer loyalty can influence the attitude, ability,

and actions of frontline employees [136]. Empirical proof shows that dress can directly

influence intent. C.Y. Shao et al. [137] analyzed the relationship of clothing to personal

decisions made in connection with dresses and decisions of the whole company that hires the

person (service companies for example). Therefore, consumers are not only likely to judge

their service workers by their clothing, but even all communications are likely to be proof for

the nature of the service business itself. This indicates that service managers should not take

the problem with lightness about what their workers wear. We find that properly dressed

service contact workers contribute to higher customer satisfaction and a higher desire to buy

service from the company than unsuitable customer service contact personnel.

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Though pharmaceuticals are essential goods when it comes to the brand selection in

prescription, it depends on many factors and medical representative personal attire and

personality traits are one of them. N. Kasliwal et al. [31] revealed that the activities of the medical

representative, his association with the doctors and his personality traits, leaflets & brochures

and free drug samples given by the medical representative were found to be very effective. The

medical representative can create a positive impact with good personality traits and attire which

leads to prescription support from the physician.

13. Medical representative’s knowledge

Pharmaceutical marketing is not only a tactic to draw the attention of customers but it also

needs to be backed with scientific evidence. Medical representatives are the crucial arm of

pharmaceutical marketing; as he/she should be equipped with medical knowledge to have a

fruitful discussion with doctors. But in recent days, doctors complained about the ‘quality of

medical representatives visiting their clinics; according to doctors, majorities of MRs are just

salespersons & only a few maintain their subject knowledge deeply & share the latest updates

in the therapy area [97]. In 1988, the World Health Assembly adopted the World Health

Organization (WHO) ethical standards for the promotion of health drugs, which recommended

that the sales drug sales representative should have an appropriate educational background and

provide information about drugs in important therapies, and must be trained with technology

and reliability, in an accurate, inappropriate and responsible manner. [138]. Rizwan Raheem

Ahmed [139] studied medical representatives detailing knowledge and its impact on

prescribing behavior of doctors; the study confirmed the significance of medical representative

knowledge on prescribing behavior. Pharmaceutical companies should select the appropriately

qualified candidate as a medical representative as well as they should develop a proper training

course for the fortified candidate with proper scientific knowledge before joining the field.

Kasliwal et al. [31] in their study found that The doctors with the age bracket of 41-45 years

age were seen to possess less influenced by the medical representatives (MRs) personality and

MR’s product knowledge and distribution of leaflets and brochures by the businesses. The

promotional efforts done by the businesses didn't influence the prescribing behavior of 41-45

years an aged segment of doctors. MR’s product knowledge, free drug samples, relying upon

the source of latest drug information from colleagues have substantiated positive effect on the

youngest category of doctors with age bracket of 25-35 years, while the foremost senior doctors

within the age group of 61 and above years showed a positive behavior towards the materials

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distributed by the pharmaceutical companies within the sort of leaflets and brochures.

14. Customer Relationship Management

Customer Relationship Management (CRM) is where the company interacts with its customer,

increasing customer lifetime value to the company and increasing customer satisfaction. [140].

This is a new marketing model that allows companies to understand how doctors view MR and

what components affect those perceptions. If certain characteristics of a medical representative

in a physician’s room can positively change these perceptions; companies need to develop

features in their MRs to make them more effective in the clinic. [141]. Effective application of

segmentation and targeting strategies could strengthen the pharmaceutical corporations, to

identify the proper needs of the customer which help in the right investments results in

maximum return on investment (ROI) and also increase efficiency in terms of prescription

generation [140].

To et al. [142] confirmed that the emergence of self-help online websites and portals has forced

pharmaceutical companies to re-evaluate their current sales strategies and develop strategies

such as CRM applications and other IT-based implementation to enhance their relationships

with customers. CRM plays a key role in shaping the pharmaceutical business in India by

gaining the right time market intelligence to create a strategy of building strong relationships

with customers (doctors).

15. Digital marketing

Kumar et al [143] concluded from his research that digital marketing like other markets has

made a good impact on the pharmaceutical industry too. Research done on fifty Super-

specialists doctors who had DM/ DNB degrees, with an in-depth interview format was used. A

complete of fifty websites of varied super specialists’ doctors were inspected and researched

within the study. A survey conducted also included the top 15 pharmaceutical companies, 12

leading chains of hospitals, and 16 stand-alone hospitals. Among the specialist doctors included

within the study, only a few had their websites. Whereas, the hospitals had full-fledged

websites. Though the first objective of those websites was to book appointments, only a couple

had blogs and of interactive nature. On the contrary, the pharmaceutical companies had well-

managed websites, with up-to-the-mark content. Supported results of the study mention that,

despite the very fact that digital marketing is getting used within the pharmaceutical companies,

but it's a lower acceptance rate and its potential is yet to be utilized completely. In India, the

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utilization of digital marketing in pharmaceuticals and allied fields especially the specialist

doctors and application products, it's underutilized. During these tech-savvy times, Digital

marketing is often of great importance in the creation of a brand value and raising equity. The

authors highly recommend digital marketing as an efficient tool to realize a maximum outreach

and gain better outcomes for both the pharmaceutical industry and therefore the super

specialist’s doctors in coordination with minimal efforts and maximum outputs.

Digital marketing replaces conventional marketing approaches in the pharmaceutical industry.

The main reason for this is quick communication with end-users, less time-consuming effort

and high financial efficiency. Jawaid et al. [144] found that WhatsApp (29.94%), Practical

Health Websites (20.6%) and smartphone apps are the most accessible digital marketing

platforms. E-detailing (8.1%), webinars / webcasts (7.7%), tele-detailing (6.0%), site self-

direction (5.2%) and marketing e-mail (4.2%) are the less frequently accessible resources.

Webinars/webcasts were most successful in changing clinical practice (48%) despite limited

use, followed by web pages (42%), smartphone applications (41%), WhatsApp (37%), and

broad-based information (36%).

Table 2.4.2: Available Digital Channels & their impact on Clinical Practices [144]

Digital devices affect the clinical practice of physicians and the relationship between doctor

and patient. In the past, traditional libraries, paper textbooks, scientific journals and CME

sessions were important outlets for improving medical information for a physician. Recently,

however, the search for medical information for physicians who have more time for such work

has improved digital access resources and improved accessibility.

16. Literatures and reminders of pharmaceutical companies

Digital Channel Impact in clinical

practice (%)

E-detailing 36%

Webinars / Webcast 48%

Website 42%

Web Detailing 37%

WhatsApp / SMS 37%

Mobile Apps 41%

Tele Detailing 34%

Marketing Emails 8%

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Ravindra Goyalet al. [145] found that the compliment from the pharmaceutical companies

prompts the physician to the promoted drug's brand & contributes to supporting in terms of

prescription. Nevertheless, these donations cost money which, without their knowledge, is

eventually passed to the patients. When the prescribing habits are compromised, the patient

relationship can also be challenged.

The brief reward is used to promote prescriptions in the promotion of sales. In-clinic branding

can be done with help of letter pads, pens, pen stands, paperweights etc. Sales promotion also

includes high-value gifts. Good interactions with the physician, initial meetings, business

credibility, quality drug quality and brand name significantly affected prescription behavior,

while direct mail, journal advertising and prescription pads and other brand recalls were

successful, but with a limited framework within. [88]. Personal selling factors such as daily

visits of medical representatives/executives, relationships between doctors and medical

representatives, detailed medical stories and medical information received by doctors during

their visits, product literature/reviews and free-samples coupons, can therefore be inferred that

the personalization of specific compliments, most affects physician’s prescribing behavior.

Literature surveys indicate that drug literature and brand records affect the prescribing actions

of the doctor but at different rates, which rely largely on the relationship and personalities of

the doctor's medical representatives [146].

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2.5 RESEARCH GAP

Pharmaceutical promotion and its impact on prescription have been the area of interest for

many researchers and policymakers. The existing studies highlighted the role of different

promotional tactics like Customer Relationship Management, Sponsorship, MR’s Knowledge,

Continuous Medical Education, Detailing by Medical Representative, Sampling, Corporate

Image, Personal Attire of MR, Promotional Pricing, Patient Education, Corporate Social

Responsibility, Digital marketing & Literature and Reminders on healthcare practitioner’s

prescription habit/behavior. The majority of studies are on promotional tools like Sponsorship,

Medical Representative’s Knowledge & Continuous Medical Education, very few of them are

on Patient Education, Digital marketing, Personal Attire of MR & Promotional Pricing. Very

few studies highlighted the role of pharmaceutical promotional tactics on healthcare

practitioner’s prescription habits/behavior in the domestic market.

Indian pharmaceutical market is different in terms of government regulations, price cap, and

availability of branded generics rather than innovative / research products. Unlike the European

and American markets, advertisements for pharmaceutical products are banned in India, so the

conclusion and remarks made by European and American studies are quite irrelevant to the

Indian pharmaceutical market. Due to the UCPMP guidelines and drug price control by DPCO,

the way Indian pharmaceutical companies promoted their brand in front of doctors is very much

different compared to other countries. Branded generic product is another aspect that makes

the Indian pharmaceutical market different from other countries. In such a competitive

environment, pharmaceutical companies are trying innovative promotional tactics to sustain

their business. But very few researchers had tried to recognize the influence of such tactics on

healthcare practitioner’s prescription habit/behavior. This is the reason that despite several

types of research, the area of Indian pharmaceutical promotional tools and their impact has

maintained its importance from the research point of view.

This study would deal with doctors of different specialties (General Practitioner, Consulting

Physician, Dentist, Paediatrician, and Gynaecologist) practicing in metro cities of Gujarat.

Gujarat is the hub for pharmaceutical companies in India, having the corporate head office of

top pharmaceutical companies like Cadila healthcare Ltd, Torrent Pharmaceuticals Ltd, Intas

Pharmaceuticals Ltd, Eris Life Sciences & Cadila Pharmaceuticals Ltd. Apart from these big

corporates, many mid and small-cap pharmaceutical companies are also having their corporate

offices in metro cities of Gujarat like Comed Chemicals & Vasu healthcare in Baroda, Ban

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Labs in Rajkot, Sundyota numandis & Corona Remedies in Ahmedabad and many others. All

major Indian pharmaceutical companies as well as MNCs having their marketing operation in

metro cities of Gujarat through their medical representatives. Such a competitive environment

as well as the availability of India’s top healthcare specialists make metro cities of Gujarat,

preferred choice to analyze the impact of pharmaceutical marketing tactics on healthcare

practitioner’s prescription habits/behavior.

The existing literature though belongs to different countries, would help in building the

theoretical framework. It would also help to develop the indicators and research methodology.

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CHAPTER – III

RESEARCH METHODOLOGY

Chapter Contents:

3.0 Introduction

3.1 Research Objective

3.2 Hypothesis

3.3 Research Design

3.4 Population of the Study

3.5 Sample Size

3.6 Sampling Technique

3.7 Sources of Data

3.8 Tools used for Data Collection

3.9 Data Processing

3.10 Theoretical Framework

3.11 Statistical Techniques

3.12 SPSS Software Used for Analysis

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3.0 Introduction

The whole chapter focused on the research goals, hypotheses, scope, limitations or methods of

data collection, interpretation throughout the research. The success of research varies mostly

on methods used to collect data.

The literature review of the previous section prompted the methodology chapter. This chapter

that following “sections-headings were assembled: Research design, Population, Sampling

including Sampling technique, Instrument Validity, Instrument Reliability, Data Collection

method and data analysis”. A few prominent pieces of the literature surveyed helped

accomplish this process of research [147][148][31][149][150].

3.1 Research Objective

1. To study the current marketing trend in the Indian pharmaceutical industry

2. To identify the various promotional tools used by pharmaceuticals for product marketing

3. To analyze the impact of pharmaceutical promotional tools on doctor’s prescribing behavior

3.2 Hypothesis

Sr. No Variable Hypothesis

1

Detailing of

Medical

Representative

Better the detailing and promotion in front of the doctor, better the

prescription support from a doctor

2 Promotional

Pricing

Lower the price of the medicine, greater the chance to get

prescribe

3 Sampling More number of trial packs to the doctor, higher the chance to get


4 Continues Medical

Education

Continues medical education does the impact of a prescription

habit of doctor

5 Product

demonstration

A good demonstration of the brand improves the chance of brand

recall at a time of prescribing medicine

6 Sponsorship Sponsorship makes doctors loyal towards the sponsored brand

7 Journal

Subscription Renowned journal subscription always appreciated by doctors

8 Medical Camp Better the sampling camp / Diagnostic camp at doctor’s clinic,

higher the prescription support of a doctor

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9 Corporate Social

Responsibility

Corporate social activity improves the corporate image in doctor’s

mind

10 Patient Education Doctor’s preference goes to brand which provides better patient

education

11 Corporate Image Better the corporate image, higher the chance of brand to get

prescribes

12 Personal Attire of

MR

A representative with good personal attire impacts a better

company’s image in doctor’s mind

13 Digital marketing Digital marketing helps to get doctor’s attention towards the brand

14 Literature and

Reminders

Higher the reminders to the doctor of Brand, greater the chance to

get prescription support from a doctor

15

Medical

Representative’s

Knowledge

Doctor’s always appreciated a representative with good product

knowledge

16

Customer

Relationship

Management

Pharmaceutical companies are good at customer relationship

management

Table 3.1.1 Hypothesis

3.3 Research Design

This study is quantitative in nature. The researcher adopted a descriptive survey research design

for this study. Primary data was collected through a well-structured questionnaire. According

to Bakar et al. [151] questionnaires for the collection of primary data, are focused on

exploration, evaluation and survey. In addition, when designing a questionnaire that measures

one’s attitude towards a particular topic, researchers generally prefer asking the subject’s

degree of agreement or disagreement on the topic, instead of giving a dichotomous choice; this

helps in avoiding socially preferred responses [152]. Present research design analyses the

impact of similar promotional activities of pharmaceutical firms on doctor's prescribing

behavior. For the process, random sampling and a structured questionnaire were administered

for data collection. Advanced decisions were made when formulating “objective, designing

method, selecting sample, collecting data”. Finally, data analyses and reporting were planned

with expertise’s approval. Research design follows mainly three phases.

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Fig. 3.1.1: Research Design

3.3.1 The Context

The present research focuses on the doctor’s prescription behavior in four metro cities of

Gujarat - Ahmedabad, Baroda, Surat and Rajkot.

3.4 Population of the Study

The population is indeed a result of people through one feature which sets themselves apart

from most other groups [153]. That target population is the list of sampling units list through

which the sample was chosen [154]. The survey relates doctors of five different specialties:

General Practitioner, Consulting Physician, Dentist, Paediatrician and Gynaecologist. These

specialties are selected because they cover 70% of Indian healthcare practitioners and 72% of

their prescriptions. Therefore, doctors of different specialty i.e. General Practitioner,

Consulting Physician, Dentist, Paediatrician and Gynaecologist has been chosen for the

research. In India, 43% of doctors are generalists whereas 57% of doctors are specialists [32].

All generalists behave similarly while specialists follow their characteristics. If the sample of

a study can mimic the population concerning the number of specialists and generalists, the

result of the survey can generalize to population,

As per the data published in the Journal of family medicine and primary care, there were a total

of 10,22,859 MBBS (Modern Medicine) doctors registered with the MCI or State Medical

Councils as of March 31, 2017 [155]. The same has been considered as a population (N)

Phase 1

• Selection of variables involved in the study

• Construction of validation of the tools

Phase 2• Selection of the sample, Collection of Data

Phase 3

• Analysis of the data using appropriate statistical procedure

• Findings and conclusion

75 | P a g e

3.5 Sample Size

Sample size means the selection of items from the universe to constitute a sample. According

to Levin & Rubin, 2006, pp378 and Kothari, 2004, pp174, the optimal sample is something

that satisfies performance, representatives or reliability criteria. Any measurement error can

occur attributable to all the correct sample size that can also be managed through increasing

the sample size with good accuracy [156][154]. The sample size has been calculation has been

narrated below.

z = 1.96, p=0.05, e=0.03 and N=1022859

By putting above values, we get sample size

n= 1067

3.6 Sampling Technique

To formulate a simple design that truly represents the population both systematic bias and

sampling error are brought to a minimum by following an objective sampling procedure.

Stratified Random Sampling was chosen for the study [157]. The first list of doctors from four

metro cities of Gujrat (Ahmedabad, Baroda, Surat & Rajkot) has been collected. Doctors were

bifurcated into 5 different subgroups according to their specialty. A total of 1100 doctors were

selected randomly from each subgroup, which was a sample of the study. No of doctors selected

from each city was as per their contribution in total doctors of selected cities. The questionnaire

was distributed among selected doctors contacted through personal or email. The majority of

doctors contacted personally, if he/she asked to email the questionnaire to review later, then it

collected through email.

The ideal sampling technique should minimize the selection bias. Self-selection bias refers to

issues of sampling representativeness and generalizability [159]. Research sampling involves

76 | P a g e

identifying a target population, the group about which the researcher would like to make

statements, and collecting data from a sample, the group that participates in the research. When

the sample is representative of the target population, the results of the research are said to be

generalizable to the target population. Bias is introduced if the members of the target population

do not participate. Loss of participants from the target population does not necessarily result in

bias. Whether or not there is bias depends on how well the sample represents the target

population, and some formal procedure is necessary to evaluate this possibility. Selection bias

is usually introduced as an error with the sampling and having a selection for analysis that is

not properly randomized [158]. Evaluating self-selection bias can be extremely difficult

because the researcher typically does not have information about the non-participants and

therefore cannot compare them with the participants [159]. Using random methods when

selecting subgroups from populations can avoid selection biases [158]. To prepare the sample

for the study, a doctor list of selected specialties from identified cities has been collected.

Subgroup created based on doctor’s city and specialty. Random selection is done from the

doctor list based on the weightage of the number of doctors in the city and their specialty among

the population to avoid selection bias & the result of the study can be generalized for the

population.

3.7 Sources of Data

Primary data were initial information gathered by first-hand analysis, although secondary data

is information commonly accessible but collected from several other parties. The researcher

collected the data from the primary source only. Primary sources involve a well-constructed

and self-developed questionnaire.

Secondary data refers to information which someone other than the consumer obtained. A

common example of essential social science data provides censuses, government department-

gathered statistics, internal documents that have been initially collected for most other

academic purposes. Secondary data was obtained from various published articles, research

papers submitted thesis as well as white papers published by government or agencies.

3.8 Tools used for Data Collection

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3.8.1 Tool for doctor's prescription behavior

The researcher used a well-constructed and self-developed closed-ended questionnaire to get

the desired information from the doctors. The questions are formed by the Likert scale. The

questionnaire was built based on current literature, questionnaire, and recent research. Likert

scale is perhaps the most appropriate ranking to be used in the configuration of both the test

questionnaire thus according [160]. A scale of 1-7 was being used to assess the agreement of

the applicant to just the questions posed.

That measure was better suited because it offers participants an assumption that they are solid

or just not. 79 questions were written for this study to assess prescription behavior. Question

1, 2 & 3 narrate his expertise and professional experience. Question 4 gives an idea about

whether he/she entertained pharmaceutical professionals or not. Question 5 talks about which

kind of activity the doctor prefers, either patient-related or practice-related. Question 6 were

related to the detailing of medical representative. Question 7 was related to the promotional

pricing of the pharmaceutical brand. Question 8 was related to sampling. Question 9 was

related to CME. Question 10 was related to a product demonstration. Question 11 was related

to sponsorship. Question 12 were related to journal subscription. Question 13 was related to

the medical camp. Question 14 was related to corporate social activity. Question 15 was related

to the patient education program. Question 16 was related to corporate image. Question 17 was

related to the personal attire of the company representative. Question 18 was related to digital

marketing by pharmaceutical companies. Question 19 was related to literature and reminders

of pharmaceutical companies. Question 20 was related to medical representative’s knowledge

and Question 21 was related to customer relationship management of pharmaceutical

companies.

3.8.2 Pilot Study

Textbook of Educational Research cited “whether you create your instrument or choose to

administer a previously developed one, you need to pre-test or pilot test” [161]. A pilot study

was conducted with 100 doctors by administering the questionnaire. For the pilot study, 4

different variables were identified, that was detailing medical representatives, continues

medical education (CMEs), medical camps, and customer relationship management. For item

analysis, Cronbach Alpha was used to assess the degree of internal consistency, Cronbach alpha

with ‘r’ value lesser than 0.30 were rejected as per the correlation analysis guideline. For

78 | P a g e

Content validation, the researcher requested three experts to validate the tool.

The experts suggested keeping the items specific, relevant and clear of each statement, at the

same time suitability and accuracy of the language used. The Experts’ suggestions were useful

and were accepted; accordingly, distracters were removed from the item. Items were kept

simple and easy for the respondents to understand and answer each section of the questionnaire.

3.8.3 Reliability and Validity of Tool

According to Sekaran and Roger et al [162], this is necessary to ensure that perhaps the

instrument produced for evaluating a specific topic appropriately measures this same

component but instead currently measures this same framework it should be going to measure

within research. Nonetheless, the consistency study relates to determining the degree of

accuracy between several validities of the questionnaires, Although the consistency review

describes the degree to which the model correctly reflects a metric or series of steps [152].

That instrument's precision was calculated through the alpha coefficient from Cronbach.

Furthermore, another scholar e.g. Bagozziet al [163] recommended that almost all metrics or

dimensional measurements would surpass the required value of 0.60. From table 3.1 the

reliability analysis of all the constructs indicates high reliability as it is above 0.6, which is a

good signal.

The validity of the tool is measured by the average variance explained (AVE) which should be

greater than 0.5 according to Hair et al [164]. In table 3.1 the Average variance explained

(AVE) of all the constructs is greater than 0.5 which confirms the validity of the tool.

Table 3.2.1: Reliability and Validity Statistics

Construct Cronbach’s alpha CR AVE

Detailing of medical

representative 0.756 0.735 0.601

Promotional pricing of

pharmaceutical brand 0.781 0.765 0.667

Sampling 0.778 0.789 0.685

Medical education 0.766 0.754 0.586

Demonstration 0.788 0.761 0.623

Sponsorship 0.810 0.786 0.614

Journal subscription 0.796 0.813 0.608

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Medical camp 0.809 0.788 0.629

Corporate social activity 0.818 0.762 0.673

Patient education program 0.765 0.738 0.660

Corporate image 0.771 0.742 0.631

Personal attire of company 0.821 0.780 0.578

Digital marketing by

pharmaceutical companies 0.763 0.749 0.654

Literatures and reminders of

pharmaceutical companies 0.738 0.775 0.589

Medical representative’s

knowledge 0.786 0.746 0.616

Customer relationship

management 0.794 0.773 0.679

3.9 Data Processing

According to Malhotra et al [165], data processing which used for data analysis method which

is come used in a preliminary plan like questionnaire checking, data editing, data coding, data

transcribing and data cleaning.

3.9.1 Questionnaire Checking

In this process when an error arises during the questionnaire is prepared it detected that error

after the process of the questionnaire is completed. This is important because of quality and

completeness process is required. The pilot test is removing all the grammar mistakes and

modify before the actual survey was distributed.

3.9.2 Data Editing

It is a process that will increase the closeness of a measured value to a standard or known value

of the questionnaire. During the survey data is missed to reduce this error it is important to do

the data editing. If any value is identified, incomplete, inconsistent then it is a very important

process [165]. That method should be to reduce the amount of errors that occur [166]. That

editing of data offers retrospective care for unsatisfactory answers such as allocated missed

importance and removed error reporting to receive improved and accurate data. Unfilled and

unappropriated responses were removed, 1000 responses were set as per the data analysis

criteria & considered for further analysis. Out of 1100 filled questionnaire, 9% (almost 100)

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was not filled appropriately. Each question in the questionnaire has 3-4 sub-questions; in

unappropriated responses, doctors had missed to ticked 1-2 sub-questions. The majority of

unappropriated responses were received via email, where the questionnaire was filled without

guidance/supervision. The contribution of the unfilled questionnaire with respect to specialty

was almost similar but the majority of them are from Ahmedabad and Surat city. To avoid any

bias or error in data filling, the majority of questionnaires were filled in presence of the

researcher; so that he can guide respondents in case if required.

3.9.3 Data Coding

Data coding refers that create a code throughout the questionnaire to describe every answer

[165]. That coding of data may have been classified through numerical numbers or some other

character. Data must be reliable so data coding is very important so that the error which occurs

gets minimize.

3.9.4 Data Transcribing

The data collected with the help of the questionnaire will be analyzed with the help of the

statistical package SPSS 22.

3.10 Theoretical Framework

The field of marketing has expanded recently and become of increased importance as one of

the most important activities of any organization or firm. Pharmaceutical marketing seems to

be the advertisement sector, or simply the selling of pharmaceuticals or medications. Instead

of investing in research and development, Indian pharmaceutical companies mainly focus on

creativity and marketing. The pharmaceutical companies invest and spend heavily on

marketing and promotion, up to 10% of the pharmaceutical manufacturing companies are

investing in promotion considering detailing as the most used promotional instrument.

To help explain certain influences affecting decision-making and procedure by doctors, the

associated research suggested how such influences may provide a role to play in shaping the

prescription behavior of doctors. Based on existing literature, the influencing factors that have

been selected are Medical representative detailing, Promotional pricing, Sampling, Continues

Medical Education, Product demonstration, Sponsorship, Journal Subscription, Medical camp,

Corporate Social activity, Patient Education Program, Corporate image, Personal attire of

81 | P a g e

company representative, Digital marketing by pharmaceutical companies, Literature and

reminders of pharmaceutical companies, Medical representative’s Knowledge, Customer

Relationship Management of Pharmaceutical companies which directly influences Physician's

prescribing behavior. Further, a research model was developed as shown in fig. 3.2.

Independent Variables

Medical representative detailing

Promotional pricing

Sampling

Continues Medical Education

Product demonstration

Sponsorship

Journal Subscription

Medical camp

Corporate Social activity

Patient Education Program

Corporate image

Personal attire of company

representative

Digital marketing by pharmaceutical companies

Literature and reminders of

pharmaceutical companies

Medical representative’s Knowledge

Customer Relationship Management of

Pharmaceutical companies

Fig. 3.2.1: Theoretical framework based on Stimulus - Organism - Response (S-O-R)

Model

3.11 Statistical Techniques

This study was analyzing the data obtained using systematic analysis. Even though the

statistical analysis gives the scholar the same opportunity to receive communicative relevant

data via average output [167].

a. Descriptive statistics

This same study utilized mean, standard deviation, mean square error & median methods to

explain the effects for knowledge which helps scholars to arrange vast amounts of information

in even a concise way. In such a way, descriptive statistics in the form of outlining vast amounts

Dependent Variable

Physician's prescribing

behavior

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of data into investigating the research numerical units in order to assist explain outcomes.

b. Cronbach’s Alpha

These are achieved to examine that instrument’s internal durability. That Cronbach's Alpha

value was well above 0.6 is above the normal value indicated through Wim et al [168].

According to Wim et. al.[168] the value of Cronbach’s alpha above 0.6 is acceptable.

c. Pearson correlation

A Pearson correlation analysis among components is often used to perform statistical analysis

of the linear relationship between two and has been referred to as r. A Pearson's correlation

aims to create a line of best fit through their results of two factors and that Pearson correlation

coefficient, 'r' means however far removed from this line of the best match all such results

points were. Pearson correlation of variables was examined with one another and for any

identified variable covariates correctly with other parameters elements in the study. SPSS by

selecting ANALYSIS –> CORRELATE –> BIVARIATE.

d. Regression

Regression analysis is an extension of correlation. Through this analysis one can understand

the Connection between that and a predicted outcome or each or even more risk factors and

ambiguous variables; that independent variables are often called that reaction or predictor

variables or the risk influences, and the determinants and explanatory variable, were called

confuses. It can predict/measure how the extent of change in one or more variables

(predictor/independent variable) jointly affects or changes the other variable (dependent

variable). (Multivariable Methods) This analysis can be performed in SPSS by selecting

ANALYSIS –>REGRESSION –> LINEAR.

3.12 SPSS Software Used for Analysis

SPSS, the name stands for (Statistical Package for the Social Sciences); postgraduate students

at Stanford University developed the statistical software in 1968. It is widely used in both

academic and commercial spheres. SPSS provides a wide range of tools from basic tabulation

to sophisticated multivariate analysis. It is user-friendly software that can be very much handy

to users in statistical analysis.

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CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

Chapter Contents:

4.1 General Information

4.2 General Profile of Respondents

4.3 Impact of Specialty on Activities

4.4 Hypothesis Testing

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4.1 General Information

The prescription-based pharmaceutical market is merely dependent on doctor’s prescription

power. The customer, doctors are in the driving seat, and pharmaceutical companies are

utilizing their best creativity to registered their brand in doctor’s minds and thereby on the

prescription copy. Doctors are the final decision-makers as they advise patients regarding the

medication and even a particular brand that patients should consume to alleviate disease

conditions. Such power of doctors makes them venerable to pharmaceutical companies to

influence their prescribing behavior. Pharmaceutical companies invest heavily in marketing

activities and promotional tools to promote their brand in front of doctors and try to influence

their prescribing behavior, especially towards their promoted brand. This current study

explores the effects of such marketing strategies on doctor’s prescription behavior.

4.2 General Profile of Respondents

A general profile of the respondents is given below to create a background to the data analysis

and interpretation based on objectives.

4.2.1 City & Specialty

In this section specialty of respondents has been explored based on the survey and the results

are shown below.

Table 4.1.1: City & Specialty pattern

Specialty Frequency Percent City Frequency Percent

General

Practitioner 240 24.0 Ahmedabad 530 53.0

Consulting

Physician 180 18.0 Rajkot 120 12.0

Dentist 250 25.0 Baroda 150 15.0

Paediatrician 180 18.0 Surat 200 20.0

Gynaecologist 150 15.0 Total 1000 100.0

Total 1000 100.0

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Fig. 4.1.1: Frequency of specialty pattern

From the above fig. 4.1, it is evident that in sample respondents, 25 percent are dentists, 24

percent are General Practitioner, 18 percents are pediatricians and Consulting physicians, while

15 percent are gynecologists.

4.2.2 Practicing Experience

In this section practicing experience of respondents has been explored based on the survey and

the results are shown below.

Table 4.2.1: Practicing experience pattern

Experience

(years) Frequency Percent

Valid

Percent

Cumulative

Percent

Valid

1.00 16 1.6 1.6 1.6

2.00 48 4.8 4.8 6.4

3.00 56 5.6 5.6 12.0

4.00 70 7.0 7.0 19.0

5.00 126 12.6 12.6 31.6

6.00 78 7.8 7.8 39.4

7.00 50 5.0 5.0 44.4

0

5

10

15

20

25

30

General

Practitioner

Consulting

Physician

Dentist Paediatrician Gynaecologist

Per

cen

tage

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8.00 60 6.0 6.0 50.4

9.00 34 3.4 3.4 53.8

10.00 92 9.2 9.2 63.0

11.00 20 2.0 2.0 65.0

12.00 50 5.0 5.0 70.0

13.00 30 3.0 3.0 73.0

14.00 20 2.0 2.0 75.0

15.00 50 5.0 5.0 80.0

16.00 30 3.0 3.0 83.0

17.00 20 2.0 2.0 85.0

18.00 20 2.0 2.0 87.0

19.00 10 1.0 1.0 88.0

20.00 60 6.0 6.0 94.0

24.00 10 1.0 1.0 95.0

25.00 30 3.0 3.0 98.0

30.00 10 1.0 1.0 99.0

40.00 10 1.0 1.0 100.0

Total 1000 100.0 100.0

Fig. 4.2.1: Practicing experience pattern

0

2

4

6

8

10

12

14

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 24 25 30 40

Per

cen

tag

e

Experience

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4.2.3 Average Patients per Day

In this section average patients per day has been explored based on the survey and the results

are shown below.

Table 4.2.2: Average Patients per Day

Average

Patients per

Day

Frequency Percent Valid

Percent

Cumulative

Percent

Valid 4.00 12 1.2 1.2 1.2

5.00 62 6.2 6.2 7.4

6.00 14 1.4 1.4 8.8

8.00 36 3.6 3.6 12.4

10.00 152 15.2 15.2 27.6

11.00 10 1.0 1.0 28.6

12.00 50 5.0 5.0 33.6

14.00 10 1.0 1.0 34.6

15.00 174 17.4 17.4 52.0

18.00 20 2.0 2.0 54.0

20.00 140 14.0 14.0 68.0

22.00 10 1.0 1.0 69.0

24.00 10 1.0 1.0 70.0

25.00 40 4.0 4.0 74.0

26.00 10 1.0 1.0 75.0

27.00 10 1.0 1.0 76.0

30.00 120 12.0 12.0 88.0

35.00 30 3.0 3.0 91.0

37.00 10 1.0 1.0 92.0

40.00 30 3.0 3.0 95.0

45.00 10 1.0 1.0 96.0

50.00 40 4.0 4.0 100.0

Total 1000 100.0 100.0

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Fig. 4.2.2: Average Patients per Day

4.2.4 Entertain activities by pharmaceutical companies

Many doctors don’t entertain activities by pharmaceutical companies; they don’t want to tag

their name with any companies. In this section entertaining activities by pharmaceutical

companies have been explored based on a survey and the results are shown below.

Table 4.2.3: Entertain activities by pharmaceutical companies

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes 976 97.6 97.6 97.6

No 24 2.4 2.4 100.0

Total 1000 100.0 100.0

It is evident from the table that, majority of respondents (97.6 percent) entertain activities by

pharmaceutical companies while only 2.4 percent do not entertain activities by pharmaceutical

companies.

0

2

4

6

8

10

12

14

16

18

20

4 5 6 8 10 11 12 14 15 18 20 22 24 25 26 27 30 35 37 40 45 50

Per

cen

tag

e

Average Patients Per Day

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4.2.5 Preference of Activity Performed

Patient-oriented activity is defined as an activity that helps a patient to understand a disease

condition or helps the patient for better treatment like patient education videos, dos, and don’ts

of disease, etc. Such kind of activity helps the doctor to oblige their patient pool; in return, it

helps to get prescription support from the doctor for Organizer Company. Practice-oriented

activity helps the doctor to sharpen their expertise for better patient care like CMEs, workshops,

conferences, etc. In this section preference of activity performed has been explored based on

the survey and the results are shown below.

Table 4.2.4: Preference of Activity Performed

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid

Patient

oriented 780 78 78 78

Practice oriented 220 22 22 100.0

Total 1000 100.0 100.0

It is evident from the table that, majority of respondents (78 percent) preferred patient-oriented

and 22 percent preferred practice-oriented.

4.3 Impact of Specialty on Activities

To explore the impact of specialty on activities, the average scoring of each activity was used.

Here used average score of the Likert scale to measure the impact of various activities on each

specialty.

Table 4.3.1: Impact of Specialty on Activities

Activity Dentist General

Practitioner Gynecologist Pediatrician

Consulting

Physician

Customer Relationship Management 5.77 5.75 5.59 5.71 5.65

Sponsorship 5.57 5.51 5.40 5.43 5.57

Medical Representative’s Knowledge 5.27 5.34 5.25 5.15 5.24

Continues Medical Education 5.14 5.07 5.10 5.10 5.19

Detailing of Medical Representative 5.13 5.05 5.04 5.05 5.09

Medical Camp 4.89 4.85 4.85 4.93 4.85

Sampling 4.87 4.84 4.83 4.85 4.82

Product demonstration 4.81 4.80 4.78 4.77 4.77

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Corporate Image 4.68 4.70 4.66 4.70 4.70

Journal Subscription 4.66 4.65 4.52 4.63 4.58

Personal Attire of MR 4.60 4.60 4.49 4.52 4.50

Promotional Pricing 4.42 4.33 4.31 4.33 4.31

Patient Education 4.25 4.25 4.31 4.30 4.25

Corporate Social Responsibility 3.74 3.74 3.81 3.91 3.82

Digital marketing 3.72 3.58 3.50 3.63 3.61

Literatures and Reminders 3.69 3.46 3.41 3.54 3.58

Specialty: Dentist

At the dentist level, customer relationship management is the most accepted activity followed

by sponsorship, medical representative knowledge, Continues Medical Education, Detailing of

Medical Representative, Medical Camp, Sampling, Product demonstration, Corporate Image,

Journal Subscription, Personal Attire of MR, Promotional Pricing, Patient Education,

Corporate Social Responsibility, Digital marketing & Literature and Reminders.

Fig. 4.3.1: Impact of Activities on Dentist

It clearly shows that, if companies want more prescriptions from dentists, they should more

focus on CRM and sponsorship kinds of activities rather than digital marketing or literature

and reminders.

Specialty: General Practitioner

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00 D E N T I S T

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At the general practitioner level, customer relationship management is the most accepted

activity followed by sponsorship, medical representative knowledge, Continues Medical

Education, Detailing of Medical Representative, Sampling, Product demonstration, Medical

Camp, Journal Subscription, Personal Attire of MR, Corporate Image, Promotional Pricing,

Patient Education, Digital Marketing, Corporate Social Responsibility & Literatures, and

Reminders.

Fig. 4.3.2: Impact of Activities on General Practitioner

The result suggests that, if companies want more prescriptions from general practitioners, they

should more focus on CRM and sponsorship kind of activities rather than corporate social

responsibility or literature and reminders.

Specialty: Gynecologist

At the gynecologist level, customer relationship management is the most accepted activity

followed by sponsorship, medical representative knowledge, Detailing of Medical

Representative, Continues Medical Education, Medical Camp, Product demonstration,

Sampling, Journal Subscription, Personal Attire of MR, Corporate Image, Patient Education,

Promotional Pricing, Digital marketing, Corporate Social Responsibility, & Literature and

Reminders.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

GE N E R A L PR A C T I T I ON ER

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Fig. 4.3.3: Impact of Activities on Gynecologist

The study confirms that, if companies want more prescriptions from gynecologists, they should

more focus on CRM and sponsorship kind of activities rather than corporate social


Specialty: Pediatrician

At the pediatrician level, customer relationship management is the most accepted activity

followed by sponsorship, Medical Representative’s Knowledge, Detailing of Medical

Representative, Continues Medical Education, Medical Camp, Sampling, Product

demonstration, Journal Subscription. Personal Attire of MR, Corporate Image, Promotional

Pricing, Patient Education, Digital Marketing, Corporate Social Responsibility, & Literature

and Reminders.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

GY N E C O L OGI ST

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Fig. 4.3.4: Impact of Activities on Pediatrician

The data confirms that, if companies want more prescriptions from pediatricians, they should

more focus on CRM and sponsorship kinds of activities rather than corporate social


Specialty: Consultant Physician

At the Consultant Physician level, customer relationship management is the most accepted

activity followed by sponsorship, Medical Representative’s Knowledge, Continues Medical

Education, Detailing of Medical Representative, Medical Camp, Sampling, Journal

Subscription, Product demonstration, Personal Attire of MR, Corporate Image, Promotional

Pricing, Patient Education, Digital Marketing, Corporate Social Responsibility, & Literature

and Reminders.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

PE D I AT R I CI AN

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Fig. 4.3.5: Impact of Activities on Consulting Physician

The impact of activities on specialty is depicted in fig. 4.1-4.5. It indicates that customer

relationship management is the most impactful activity and the least impactful activity is

literature and reminders on doctors with a different specialty.

4.4 Hypothesis Testing

Hypothesis 1: Better the detailing and promotion in front of the doctor, better the


To examine the impact of detailing and promotion in front of the doctor towards prescription

support from the doctor, regression analysis was fitted.

Table 4.4.1: Model summary of better the detailing and promotion in front of the

doctor, better the prescription support from a doctor

Model Summary

Model R R

Square

Adjusted

R Square

Std. Error

of the

Estimate

(S)

1 .250a .062 .061 .62581

a. Predictors: (Constant), Detailing

R2 value 0.062 implies that is 6.2% of the variation in detailing and promotion in front of the

0.00

1.00

2.00

3.00

4.00

5.00

6.00

C o n s u l t ing Ph y s i c i a n

95 | P a g e

doctor and the remaining 93.8% can be explained by other variables. S must be <= 2.5 to

produce a sufficiently narrow 95% prediction interval [169]. Here the value of S is 0.63, which

confirms the precision of the model.

Table 4.4.2: ANOVA analysis of the summary of better the detailing and promotion in

front of the doctor, better the prescription support from a doctor

ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression 33.543 1 33.543 64.931 .000b

Residual 503.683 975 .517

Total 537.226 976

a. Dependent Variable: Prescription support from doctor

b. Predictors: (Constant), Detailing and promotion in front of doctor

The above table shows that detailing and promotion in front of doctor has an impact on

prescription support from doctor. The F-statistic obtained is 64.931 and the p-value is 0.000.

The p-value is smaller than 0.05 at 5% level of significance.

Table 4.4.3: Regression analysis of the summary of better the detailing and promotion

in front of doctor, better the prescription support from doctor

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients T Sig.

B Std.

Error Beta

1 (Constant) 3.709 .181 20.455 .000

Prescription

support

from doctor .287 .036 .250 8.058 .000


The above table depicts that, the relationship between detailing and promotion in front of

doctor, with prescription support from doctor was proposed positive with path coefficient,

β=0.25 at p<0.05. This makes the findings in the support of the hypothesis. Therefore,

hypothesis is accepted and concluded that better the detailing and promotion in front of doctor,

better the prescription support from doctor.

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Fig. 4.4.1 Regression standardized residual plot for variable detailing

Hypothesis 2: Lower the price of the medicine, the greater the chance to get prescribed.

To find out the type of relationship between the prices of the medicine and the chance to get

prescribed. Karl Pearson’s co-efficient correlation was applied to know the variable’s

correlation [153].

Table 4.4.4: Relationship between the price of the medicine and chance to get prescribe

Correlations

Lower the price of

the medicine

Greater the chance

to get prescribe

Lower the price of

the medicine,

Pearson

Correlation 1 -.286**

Sig. (2-tailed) .000

N 977 977

Greater the

chance to get

prescribe

Pearson

Correlation -.286** 1

Sig. (2-tailed) .000

N 977 977

**. Correlation is significant at the 0.01 level (2-tailed).

In this hypothesis, price of the medicine was correlated with a chance to get prescribed. From

the table, a Pearson correlation coefficient r = -.286; (p < 0.01) is calculated, which shows a

97 | P a g e

negative relationship between the price of the medicine and the chance to get prescribed.

Therefore, the researcher rejects the null hypothesis and concluded that the lower the price of

the medicine, the greater the chance to get prescribed.

Hypothesis 3: More number of trial packs to doctor, higher the chance to get prescription

support from the doctor

To test the above hypothesis, regression analysis was applied.

Table 4.4.5: Model summary of trial packs to doctor and chance to get prescription

support from doctor

Model Summary

Model R R

Square

Adjusted R

Square

Std. Error of the

Estimate

1 .270a .073 .072 .59341

a. Predictors: (Constant), Chance to get prescription support from doctor

R2 value 0.073 implies that is 7.3% of the variation in the chance to get prescription support

from doctor and the remaining 92.7% can be explained by other variables. Here S value is 0.59

which is below the maximum allowable limit of 2.5, henceforth it proved the precision of the

model.

Table 4.4.6: ANOVA analysis of trial packs to doctor and chance to get prescription

support from doctor

ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression 56.360 1 56.360 76.842 .000b

Residual 715.111 975 .733

Total 771.471 976

a. Dependent Variable: Trial packs to doctor

b. Predictors: (Constant), Prescription support from doctor

The above table shows that prescription support from doctor has an impact on trial packs to

doctor. The F-statistic obtained is 76.842 and the p-value is 0.000. The p-value is smaller than

0.05 at 5% level of significance.

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Table 4.4.7: Regression analysis of trial packs to doctor and chance to get prescription

support from doctor

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 2.943 .217 13.550 .000

Prescription

support from

doctor

.390 .044 .270 8.766 .000

a. Dependent Variable: Chance to get prescription support from doctor

The above table depicts that, the relationship between trial packs to doctor with prescription

support from doctor was proposed as positive and the results are admitting the validity of the

hypothesis. The value of path coefficient, β=0.270 at a significant p<0.05. This implies that the

results are strongly supporting the hypothesis. Therefore, the hypothesis is accepted and

concluded that the more the number of trial packs to doctor, the higher the chance to get

prescription support from doctor.

Fig 4.4.2: Regression standardized residual plot for variable sampling

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Hypothesis 4: Continues medical education does impact the prescription habit of doctor.

Regression analysis was applied for testing the above hypothesis.

Table 4.4.8: Model summary of continues medical education does impact of the

prescription habit of doctor

Model Summary

Model R R

Square

Adjusted R

Square

Std. Error of

the Estimate

1 .171a .029 .028 .54633

a. Predictors: (Constant), Medical education

R2 value 0.029 implies that is 2.9% of the variation in the chance to get prescription support

from doctor and the remaining 97.1% can be explained by other variables. S value is 0.546

under the maximum allowable limit i.e. 2.5, which confirms the precision of the model.

Table 4.4.9: ANOVA analysis of continues medical education does impact of


ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression 8.723 1 8.723 29.226 .000b

Residual 291.012 975 .298

Total 299.735 976

a. Dependent Variable: Medical education

b. Predictors: (Constant), Prescription habit of doctor

Above table shows that medical education has an impact on the prescription habit of doctor.

The F-statistic obtained is 29.226 and the p-value is 0.000. The p-value is smaller than 0.05 at

5% level of significance.

Table 4.4.10: Regression analysis of continues medical education does impact of


Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 4.268 .130 32.918 .000

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Prescription

habit of doctor .125 .023 .171 5.406 .000

a. Dependent Variable: Prescription habit of doctor

The above table depicts that, the relationship between medical educations with the prescription

habit of doctor was proposed as positive and the results are admitting the validity of hypothesis.

The value of path coefficient, β=0.171 at a significant p<0.05. This implies that the results are

strongly supporting the hypothesis. Therefore, hypothesis is accepted and concluded that

continues medical education impact on prescription habit of doctor.

Fig 4.4.3: Regression standardized residual plot for variable CME

Hypothesis 5: Good demonstration of brand, improves the chance of brand recall at a

time of prescribing medicine


Table 4.4.11: Model summary of good demonstration of brand and chance of brand recall

at a time of prescribing medicine

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Model Summary

Model R R Square Adjusted R

Square

Std. Error of

the Estimate

1 .046a .002 .001 .53397

a. Predictors: (Constant), Good demonstration of brand

b. Dependent Variable: Prescribing medicine

R2 value 0.002 implies that is 0.2% of the variation in good demonstration of brand and

remaining 99.8% can be explained by other variables. 0.53 is the value of S, which confirms

the accuracy of the model.

Table 4.4.12: ANOVA analysis of good demonstration of brand and chance of brand


ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression .796 1 .796 2.084 .149b

Residual 372.151 974 .382

Total 372.947 975

a. Dependent Variable: Brand recall at a time of prescribing medicine

b. Predictors: (Constant), Good demonstration of brand

The above table shows that good demonstration of brand does not have an impact on the chance

of brand recall at a time of prescribing medicine. The F-statistic obtained is 2.084 and the p-

value is 0.149. The p-value is greater than 0.05 at 5% level of significance.

Table 4.4.13: Regression analysis of good demonstration of brand and chance of brand


Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 5.313 .151 35.148 .000

Medicine -.043 .029 .046 -1.444 .149

a. Dependent Variable: Brand recall at a time of prescribing medicine

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The above table depicts that, the relationship between good demonstrations of brand with

chance of brand recall at a time of prescribing medicine was proposed as weak and positive

and the results are not admitting the validity of hypothesis. The value of path coefficient,

β=0.046 at a significant p<0.05. This implies that the results are not supporting the hypothesis.

Therefore, hypothesis is rejected and concluded that brand demonstration in front of doctor

doesn’t impact of prescription habit of doctor.

Fig. 4.4.4: Regression standardized residual plot for variable product demonstration

Hypothesis 6: Sponsorship makes doctor loyal towards sponsored brand.


Table 4.4.14: Model summary of sponsorship makes doctor loyal towards sponsored

brand

Model Summary


Square

Std. Error of

the Estimate

1 .047a .002 .001 .67252

a. Predictors: (Constant), Sponsorship

R2 value 0.002 implies that is 0.2% of the variation in sponsorship and remaining 99.8% can

be explained by other variables. The model is precise as the value of S is 0.67 which is below

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the maximum allowable limit of 2.5.

Table 4.4.15: ANOVA analysis of sponsorship makes doctor loyal towards the

sponsored brand

ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression .973 1 .973 2.151 .143b

Residual 440.970 975 .452

Total 441.943 976

a. Dependent Variable: Brand Loyalty

b. Predictors: (Constant), Sponsorship

The above table shows that sponsorship does not have an impact on doctor loyal towards the

sponsored brand. The F-statistic obtained is 2.151 and the p-value is 0.143. The p-value is

greater than 0.05 at 5% level of significance.

Table 4.4.16: Regression analysis of sponsorship makes doctor loyal towards sponsored

brand

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 5.373 .201 26.771 .000

Sponsorship -.051 .034 .047 -1.467 .143

a. Dependent Variable: Brand Loyalty

The above table depicts that, the relationship between sponsorship with doctor loyal towards

sponsored brand was proposed as weak and positive and the results are not admitting the

validity of hypothesis. The value of path coefficient, β=0.047 at a significant p>0.05. This

implies that the results are not supporting the hypothesis. Therefore, hypothesis is rejected and

concluded that sponsorship does not make doctor loyal to the sponsored brand. It helps to give

a temporary hike in the prescription but not make doctor loyal towards brand.

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Fig. 4.4.5: Regression standardized residual plot for variable sponsorship

Hypothesis 7: Renowned journal subscriptions are always appreciated by doctors.


Table 4.4.17: Model summary of renowned journal subscription appreciated by doctors

Model Summary


Square

Std. Error of

the Estimate

1 .231a .054 .053 .83291

a. Predictors: (Constant), Renowned journal subscription

R2 value 0.054 implies that is 5.4% of the variation in renowned journal subscription and the

remaining 94.6% can be explained by other variables. 0.83 value of S signifies the precision

level of the model.

Table 4.4.18: ANOVA analysis of renowned journal subscription appreciated by

doctors

ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression 38.228 1 38.228 55.103 .000b

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Residual 675.709 974 .694

Total 713.936 975

a. Dependent Variable: Renowned journal subscription

b. Predictors: (Constant), Appreciated by doctors

The above table shows that renowned journal subscription has an impact on appreciation by

doctors. The F-statistic obtained is 55.103 and the p-value is 0.00. The p-value is smaller than


Table 4.4.19: Regression analysis of renowned journal subscription appreciated by

doctors

Coefficientsa

Model Unstandardized

Coefficients

Standardized

Coefficients

T Sig.

B Std. Error Beta

1 (Constant) 2.717 .244 11.132 .000

Appreciation .374 .050 .231 7.423 .000

a. Dependent Variable: Appreciation

The above table depicts that, the relationship between renowned journal subscriptions with

appreciation by doctors was proposed as positive and the results are admitting the validity of

the hypothesis. The value of path coefficient, β=0.233 at a significant p<0.05. This implies

that the results are supporting the hypothesis. Therefore, the hypothesis is accepted and

concluded that renowned journal subscriptions are always appreciated by doctors.

Fig. 4.4.6: Regression standardized residual plot for variable journal subscription

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Hypothesis 8: Better the sampling camp / Diagnostic camp at doctor’s clinic, higher the

prescription support of doctor.


Table 4.4.20: Model summary of sampling camp / diagnostic camp at doctor’s clinic,

higher the prescription support of doctor

Model Summary

Model R R

Square

Adjusted R

Square

Std. Error

of the

Estimate

1 .045a .002 .001 .49388

a. Predictors: (Constant), Sampling camp / diagnostic camp

R2 value 0.002 implies that is 0.2% of the variation in sampling camp / diagnostic camp at

doctor’s clinic and remaining 99.8% can be explained by other variables. The ideal value of S

to signify the accuracy of the model is below 2.5, here the value of S is 0.49, which confirms

the precession level of the model.

Table 4.4.21: ANOVA analysis of sampling camp / diagnostic camp at doctor’s clinic,


ANOVAa

Model Sum of

Squares Df

Mean

Square F Sig.

1 Regression .489 1 .489 2.003 .157b

Residual 237.578 974 .244

Total 238.066 975

a. Dependent Variable: Prescription support of doctor

b. Predictors: (Constant), Sampling camp / diagnostic camp

The above table shows that sampling camp / diagnostic camp at doctor’s clinic does not have

an impact on prescription support of doctor. The F-statistic obtained is 2.003 and the p-value

is 0.157. The p-value is greater than 0.05 at 5% level of significance.

Table 4.4.22: Regression analysis of sampling camp / diagnostic camp at doctor’s clinic,


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Coefficientsa


Coefficients Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 4.482 .279 16.045 .000

Appreciation -.074 .052 .045 -1.429 .153

a. Dependent Variable: Prescription support of doctor

The above table depicts that, the relationship between sampling camp / diagnostic camp at

doctor’s clinic and prescription support of doctor was proposed as weak and positive and the

results are not admitting the validity of hypothesis. The value of path coefficient, β=0.045 at a

significant p<0.05. This implies that the results are not supporting the hypothesis. Therefore,

hypothesis is rejected and concluded that sampling camp / diagnostic camp at doctor’s clinic

does not impact on prescription support of doctor.

Fig. 4.4.7: Regression standardized residual plot for variable medical camps

Hypothesis 9: Corporate social activity improves the corporate image in doctor’s mind


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Table 4.4.23: Model summary of corporate social activity improves the corporate image

in doctor’s mind

Model Summary

Model R R

Square

Adjusted R

Square

Std. Error of

the estimate

1 .064a .004 .003 .80122

a. Predictors: (Constant), Corporate social activity

R2 value 0.004 implies that is 0.4% of the variation incorporates social activity and the

remaining 99.6% can be explained by other variables. S value of 0.80 confirms the accuracy

of model.

Table 4.4.24: ANOVA analysis of corporate social activity improves the corporate

image in doctor’s mind

ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 2.539 1 2.539 3.955 .047b

Residual 625.902 975 .642

Total 628.441 976

a. Dependent Variable: Corporate image in doctor’s mind

b. Predictors: (Constant), Corporate social activity

The above table shows that corporate social activity improves the corporate image in doctor’s

& patient’s mind. The F-statistic obtained is 3.955 and the p-value is 0.047. The p-value is

smaller than 0.05 at 5% level of significance.

Table 4.4.25: Regression analysis of corporate social activity improves the corporate

image in doctor’s & patient’s mind

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients T Sig.

B Std.

Error Beta

1 (Constant) 3.766 .112 33.603 .000

Corporate image -.059 .030 .064 -1.989 .047

a. Dependent Variable: Corporate image in doctor’s mind

The above table depicts that, relationship between corporate social activities with the corporate

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image in doctor’s mind was proposed as positive and the results are admitting the validity of

hypothesis. The value of path coefficient, β=0.064 at a significant p<0.05. This implies that

the results are supporting the hypothesis. Therefore, hypothesis is accepted and concluded that

corporate social activity improves the corporate image in doctor’s minds.

Fig. 4.4.8: Regression standardized residual plot for variable corporate image

Hypothesis 10: Doctor’s preference goes to brand which provides better patient

education.


Table 4.4.26: Model summary of doctor’s preference goes to brand which provides

better patient education

Model Summary

Model R R

Square

Adjusted

R Square

Std. Error of

the Estimate

1 .097a .009 .008 .62528

a. Predictors: (Constant), Patient education

R2 value 0.009 implies that is 0.9% of the variation in doctor’s preference and the remaining

99.1% can be explained by other variables. 0.62 value of S, confirms the accuracy of the model.

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Table 4.4.27: ANOVA analysis of doctor’s preference goes to brand which provides


ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 3.632 1 3.632 9.288 .002b

Residual 380.810 974 .391

Total 384.442 975

a. Dependent Variable: Doctor preference of brand

b. Predictors: (Constant), Patient education

The above table shows that doctor’s preference goes to brand which provides better patient

education. The F-statistic obtained is 9.288 and the p-value is 0.002. The p-value is smaller

than 0.05 at 5% level of significance.

Table 4.4.28: Regression analysis of doctor’s preference goes to brand which provides


Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 4.906 .107 45.80 .000

Patient

education -.079 .026 .097 -3.048 .002

a. Dependent Variable: Doctor preference of brand

The above table depicts that, the relationship between doctor’s preference with brand which

provides better patient education was proposed as positive and the results are admitting the

validity of hypothesis. The value of path coefficient, β=0.097 at a significant p<0.05. This

implies that the results are supporting the hypothesis. Therefore, hypothesis is accepted and

concluded that doctor’s preference goes to brand which provides better patient education.

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Fig. 4.4.9: Regression standardized residual plot for variable patient education

Hypothesis 11: Better the corporate image, higher the chance of brand to get prescribes


Table 4.4.29: Model summary of corporate image and chance of brand to get prescribes

Model Summary

Model R R

Square

Adjusted R

Square

Std. Error

of the

Estimate

1 .281a .079 .078 .66954

a. Predictors: (Constant), Corporate image

R2 value 0.079 implies that is 7.9% of the variation in corporate image, and remaining 92.1%

can be explained by other variables. S must be <= 2.5 to produce a sufficiently narrow 95%

prediction interval. Here the value of S is 0.669, which confirms the precision of model.

Table 4.4.30: ANOVA analysis of corporate image and chance of brand to get

prescribes

112 | P a g e

ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 37.321 1 37.321 83.252 .000b

Residual 436.635 974 .448

Total 473.956 975

a. Dependent Variable: Chance of brand to get prescribes

b. Predictors: (Constant), Corporate image

The above table shows that doctor’s preference goes to brand which provides better patient

education. The F-statistic obtained is 83.252 and the p-value is 0.000. The p-value is smaller


Table 4.4.31: Regression analysis of corporate image and chance of brand to get

prescribes

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error

Beta

1 (Constant) 2.647 .163 16.245 .000

Chance of

brand to get

prescribes

.281 .031 .281 9.124 .000

a. Dependent Variable: Chance of brand to get prescribes

The above table depicts that, relationship between the corporate image with a chance of brand

to get prescribes was proposed as positive and the results are admitting the validity of



the better the corporate image, the higher the chance of the brand to get prescribes.

Hypothesis 12: Representative with good personal attire impacts a better company’s

image in doctor’s mind.


Table 4.4.32: Model summary of good personal attire and a better company’s image in

doctor’s mind

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Model Summary

Model R R

Square

Adjusted

R Square

Std. Error

of the

Estimate

1 .120a .014 .013 .60892

a. Predictors: (Constant), Good personal attire

R2 value 0.014 implies that is 1.4% of the variation in personal attire, and remaining 98.6% can

be explained by other variables. S must be <= 2.5 to produce a sufficiently narrow 95%

prediction interval. Here the value of S is 0.608, which confirms the precision of model.

Table 4.4.33: ANOVA analysis of good personal attire and a better company’s image in

doctor’s mind

ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 5.240 1 5.240 14.132 .000b

Residual 361.144 974 .371

Total 366.384 975

a. Dependent Variable: Company’s image in doctor’s mind

b. Predictors: (Constant), Good personal attire

The above table shows that good personal attire impacts on better company image in doctor’s

mind. The F-statistic obtained is 14.132 and the p-value is 0.000. The p-value is smaller than


Table 4.4.34: Regression analysis of good personal attire and a better company’s image

in doctor’s mind

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients T Sig.

B Std.

Error Beta

1 (Constant) 5.757 .095 60.771 .000

Company’s image in

doctor’s mind .092 .024 .120 -3.759 .000

a. Dependent Variable: Company’s image in doctor’s mind

The above table depicts that, the relationship between good personal attire with better company

image in doctor’s mind was proposed as positive and the results are admitting the validity of

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the hypothesis. The value of path coefficient, β=0.12 at a significant p<0.05. This implies that

the results are supporting the hypothesis. Therefore, the hypothesis is accepted and concluded

that representative with good personal attire impacts a better company’s image in doctor’s

mind.

Fig. 4.4.10: Regression standardized residual plot for variable personal attire

Hypothesis 13: Digital marketing helps to get doctor’s attention towards the brand.

Table 4.4.35: Model summary of digital marketing and doctor’s attention towards the

brand

Model Summary

Model R R

Square

Adjusted

R Square

Std. Error

of the

Estimate

1 .998a .996 .996 .04270

a. Predictors: (Constant), Digital marketing

R2 value 0.996 implies that is 99.6% of the variation in digital marketing, and remaining 0.4%

can be explained by other variables. S value of 0.042 signify the accuracy of model.

Table 4.4.36: ANOVA analysis of digital marketing and doctor’s attention towards the

brand

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ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 461.663 1 461.663 253.2101 .000b

Residual 1.776 974 .002

Total 463.439 975

a. Dependent Variable: Doctor’s attention towards the brand

b. Predictors: (Constant), Digital marketing

The above table shows that digital marketing helps to get doctor’s attention towards the brand.

The F-statistic obtained is 253.21 and the p-value is 0.000. The p-value is smaller than 0.05 at

5% level of significance.

Table 4.4.37: Regression analysis of digital marketing and doctor’s attention towards

the brand

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) .001 .008 .075 .940

Patient .999 .002 .998 503.2 .000

a. Dependent Variable: Doctor’s attention towards the brand

The above table depicts that, the relationship between digital marketing and doctor’s attention

towards the brand was proposed as positive and the results are admitting the validity of



digital marketing helps to get doctor’s attention towards the brand.

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Fig. 4.4.11: Regression standardized residual plot for variable digital marketing

Hypothesis 14: Higher the reminders to the doctor of Brand, the greater the chance to get

prescription support from doctor.

To test the above hypothesis, a regression test was applied.

Table 4.4.38: Model summary of reminders to the doctor of Brand and chance to get


Model Summary

Model R R

Square

Adjusted R

Square

Std. Error

of the

Estimate

1 .332a .110 .108 1.00439

a. Predictors: (Constant), Reminders to the doctor of brand

R2 value 0.110 implies that is 11% of the variation in reminders to the doctor of brand and the

remaining 89% can be explained by other variables. S must be <= 2.5 to produce a sufficiently

narrow 95% prediction interval. Here the value of S is 1.00, which confirms the precision of

the model.

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Table 4.4.39: ANOVA analysis of reminders to the doctor of brand and chance to get

prescription support from doctor

ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 43.149 1 43.149 101.55 .000b

Residual 413.834 974 .425

Total 456.984 975


b. Predictors: (Constant), Reminders to the doctor of brand

The above table shows that higher the reminders to the doctor of brand, greater the chance to

get prescription support from doctor. The F-statistic obtained is 101.55 and the p-value is 0.000.

The p-value is smaller than 0.05 at 5% level of significance.

Table 4.4.40: Regression analysis of reminders to the doctor of brand and chance to get


Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 2.661 .078 34.030 .000

Prescription

support

from doctor

.203 .020 .307 10.077 .000


The above table depicts that, relationship between reminders to the doctor of brand and the

chance to get prescription support from doctor was proposed as positive and the results are

admitting the validity of hypothesis. The value of path coefficient, β=0.307 at a significant

p<0.05. This implies that the results are supporting the hypothesis. Therefore, hypothesis is

accepted and concluded that higher the reminders to the doctor of brand, greater the chance to

get prescription support from doctor.

Hypothesis 15: Doctor’s always appreciate a representative with good product

knowledge.

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To test the above hypothesis, regression test was applied.

Table 4.4.41: Model summary of doctor’s always appreciate a representative with good

product knowledge

Model Summary

Model R R

Square

Adjusted

R Square

Std. Error of

the Estimate

1 .347a .121 .120 .58453

a. Predictors: (Constant), MR’s good product knowledge

R2 value 0.121 implies that is 12.1% of the variation in doctor’s and remaining 87.9% can be

explained by other variables. S must be <= 2.5 to produce a sufficiently narrow 95% prediction

interval. Here the value of S is 0.58, which confirms the precision of model.

Table 4.4.42: ANOVA analysis of doctor’s always appreciate a representative with good

product knowledge

ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 45.630 1 45.630 133.54 .000b

Residual 332.796 974 .342

Total 378.426 975

a. Dependent Variable: MR’s good product knowledge

b. Predictors: (Constant), Doctor’s appreciation

The above table shows that doctor’s always appreciated a representative with good product

knowledge. The F-statistic obtained is 133.54 and the p-value is 0.000. The p-value is smaller


Table 4.4.43: Regression analysis of doctor’s always appreciate a representative with

good product knowledge

Coefficientsa

Model

Unstandardized

Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1 (Constant) 3.774 .123 30.596 .000

Product .262 .023 .347 11.556 .000

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a. Dependent Variable: Doctor’s appreciation

The above table depicts that, the relationship between doctor’s always appreciate and good

product knowledge was proposed as positive and the results are admitting the validity of



doctor’s always appreciated a representative with good product knowledge.

Fig.4.4.12: Regression standardized residual plot for variable MR’s product knowledge

Hypothesis 16: Pharmaceutical companies are good in customer relationship

management.


Table 4.4.44: Model summary of pharmaceutical companies are good in customer

relationship management

Model Summary

Model R R

Square

Adjusted

R Square

Std. Error

of the

Estimate

1 .213a .045 .045 .55994

a. Predictors: (Constant), Pharmaceutical company’s CRM

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R2 value 0.045 implies that is 4.5% of the variation in pharmaceutical companies and the

remaining 95.5% can be explained by other variables. S value is 0.55 which confirms the

accuracy of the model.

Table 4.4.45: ANOVA analysis of pharmaceutical companies are good in customer


ANOVAa

Model Sum of

Squares df

Mean

Square F Sig.

1 Regression 14.554 1 14.554 46.418 .000b

Residual 305.380 974 .314

Total 319.933 975

a. Dependent Variable: Doctor’s appreciation and support

b. Predictors: (Constant), Pharmaceutical company’s CRM

The above table shows that pharmaceutical companies are good in customer relationship

management. The F-statistic obtained is 46.418 and the p-value is 0.000. The p-value is smaller


Table 4.4.46: Regression analysis of pharmaceutical companies are good in customer


Coefficientsa


Coefficients

Standardized

Coefficients t Sig.

B Std.

Error Beta

1

(Constant) 5.064 .130 39.024 .000

Customer

relationship

management

.160 .023 .213 6.813 .000

a. Dependent Variable: Doctor’s appreciation and support

The above table depicts that, relationship between doctor’s prescription behavior and

pharmaceutical company’s customer relationship management was proposed as positive and

the results are admitting the validity of hypothesis. The value of path coefficient, β=0.213 at a

significant p<0.05. This implies that the results are supporting the hypothesis. Therefore,

hypothesis is accepted and concluded that pharmaceutical companies are good at customer

relationship management.

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Fig. 4.4.13: Regression standardized residual plot for variable CRM

After analyzing individual hypothesis, now it’s time to check the overall impact of

pharmaceutical promotional tools on doctor’s prescription behavior.

Hypothesis: Pharmaceutical promotional tools help to get prescription support from

doctor


Table 4.4.47: Model summary of pharmaceutical promotional tools helps to get


Model Summaryb

Model R R

Square

Adjusted R

Square

Std. Error of

the Estimate

(S)

1 .376a .141 .141 .21871

a. Predictors: (Constant),: Pharmaceutical promotional tools

b. Dependent Variable: support from doctor

R2 value 0.141 implies that is 14.1% of the variation in pharmaceutical companies and the

remaining 85.9% can be explained by other variables. S must be <= 2.5 to produce a sufficiently

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narrow 95% prediction interval. Here the value of S is 0.22, which confirms the precision of

model.

Table 4.4.48: ANOVA analysis of pharmaceutical promotional tools helps to get


ANOVAa

Model Sum of

Squares

df Mean

Square

F Sig.

1 Regression 7.782 1 7.782 162.672 .000b

Residual 47.214 987 .048

Total 54.995 988

a. Dependent Variable: Support from doctor

b. Predictors: (Constant), Pharmaceutical promotional tools

The above table shows that pharmaceutical companies are good at customer relationship

management. The F-statistic obtained is 162.67 and the p-value is 0.000. The p-value is smaller


Table 4.4.49: Regression analysis of pharmaceutical promotional tools helps to get


Coefficientsa


Coefficients

Standardiz

ed

Coefficient

s

t Sig.

B Std.

Error

Beta

1 (Constant) 3.011 .116 25.930 .000

Promotional .300 .024 .376 12.754 .000

a. Dependent Variable: Support from doctor

The above table depicts that, the relationship between pharmaceutical promotional tools and

doctor’s prescription behavior was proposed as positive and the results are admitting the

validity of hypothesis. The value of path coefficient, β=0.376 at a significant p<0.05. This

implies that the results are supporting the hypothesis. Therefore, hypothesis is accepted and

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concluded that pharmaceutical promotional tools have an impact on doctor’s prescription

behavior.

Fig. 4.4.14: Regression standardized residual plot for variable pharmaceutical

promotional tools

Summary of hypothesis

Data analysis confirms that out of 16, 12 hypotheses are accepted and 4 are rejected. It shows

that variables or promotional tools like Detailing of Medical Representative, Sampling,

Continues Medical Education, Journal Subscription, Corporate Social Responsibility, Patient

Education, Corporate Image, Personal Attire of MR, Digital marketing, Literature and

Reminders, Medical Representative’s Knowledge & Customer Relationship Management

positively impacts on doctor’s prescription behavior. While variables or promotional tools like

Promotional Pricing, Product demonstration, Sponsorship & Medical Camp don’t have any

impact in attracting prescriptions from doctors. The final hypothesis was accepted, which

confirms the positive correlation between pharmaceutical promotional tools and doctor’s

prescription behavior.

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Table 4.4.50: Summary of hypothesis

Sr. No Variable Hypothesis Status

1

Detailing of

Medical

Representative

Better the detailing and promotion in front of doctor, better

the prescription support from doctor Accepted

2 Promotional

Pricing

Lower the price of the medicine, greater the chance to get

prescribe Rejected

3 Sampling More number of trial packs to doctor, higher the chance to

get prescription support from doctor Accepted

4

Continues

Medical

Education

Continues medical education does the impact of

prescription habit of doctor Accepted

5 Product

demonstration

A good demonstration of brand, improves the chance of

brand recall at a time of prescribing medicine Rejected

6 Sponsorship Sponsorship makes doctor loyal towards the sponsored

brand Rejected

7 Journal

Subscription

Renowned journal subscription always appreciated by

doctors Accepted

8 Medical Camp Better the sampling camp / Diagnostic camp at doctor’s

clinic, higher the prescription support of doctor Rejected

9

Corporate

Social

Responsibility

Corporate social activity improves the corporate image in

doctor’s mind Accepted

10 Patient

Education

Doctor’s preference goes to brand which provides better

patient education Accepted

11 Corporate

Image

Better the corporate image, higher the chance of brand to

get prescribes Accepted

12 Personal Attire

of MR

A representative with good personal attire impacts a better

company’s image in doctor’s mind Accepted

13 Digital

marketing

Digital marketing helps to get doctor’s attention towards

the brand Accepted

14 Literatures and

Reminders

Higher the reminders to the doctor of Brand, greater the

chance to get prescription support from doctor Accepted

15

Medical

Representative’s

Knowledge

Doctor’s always appreciated a representative with good

product knowledge Accepted

16

Customer

Relationship

Management

Pharmaceutical companies are good in customer

relationship management Accepted

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CHAPTER – V

FINDINGS, CONCLUSION, AND FUTURE

SCOPE

Chapter Contents:

5.1 Finding in context of objective

5.2 Conclusion and future scope

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5.1 Finding in context of objective

Pharmaceutical marketing is more kind of personal marketing, unlike FMCG which enables

pharmaceutical companies to measure proper return on every investment. To measure the

return on investment (ROI) of an advertisement in FMCG is not possible, whereas

pharmaceutical companies can measure ROI of even every visit of the medical representative

to doctors. The major objective of the companies is to get the maximum return on investment

in terms of prescription from the invested doctors. But pharmaceutical companies are always

in dilemma regarding their investments in the doctors; which investment gives maximum ROI

is the key area of concentration for pharmaceutical companies. The current study tried to satisfy

the need of the industry by identifying the promotional tools which impact prescription

behavior at most.

After putting up the results and discussion of the results concerning past relevant studies, this

section of the report summarizes the major findings concerning objectives. The study has been

conducted on three aspects. The first objective is to study the current marketing trend in the

Indian pharmaceutical industry, the second is to identify the different marketing tactics used

by pharmaceuticals for product marketing and the third is to analyze the influence of

pharmaceutical marketing tactics on healthcare practitioner’s prescription habits/behavior.

By analyzing secondary data, we can conclude the first objective of studying the current trend

in the pharmaceutical industry. Biopharmaceuticals are the next generation of pharmaceuticals.

As currently, we are dependent on conventional therapies and formulation, the future of

pharmaceuticals is of Biopharmaceuticals. Digital therapies are another aspect of the next

generation. IT technology developers also partner with pharmaceutical firms to support their

respective abilities in designing novel treatment strategies. Machine learning and artificial

intelligence add value to their benefits and usage in the pharmaceutical industry. Astounding

and previously unimagined AI applications continue to emerge on the pharmaceuticals

landscape on a seemingly daily basis. 3600 Patient engagement is the next level in

pharmaceutical marketing. Pharmaceutical companies hiring patient advocacy leaders to

provide the best patient care in major diseases like Cancer, Alzheimer's, and many more. The

collaboration of technology and science will open a new horizon in the healthcare &

pharmaceutical segment for the benefit of the patients. The Indian pharmaceutical market is

majorly driven by customer services, gifts, and doctor engagement programs. The global

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pharmaceutical sector is moving towards scientific & technology-driven promotion and

reduces the burden on such short-duration promotional tactics like gifts and customer services.

Industries are now moving from customer satisfaction to customer delight concept & the

pharmaceutical industry depends merely on high-level professionals i.e. doctors. To oblige

doctors, just satisfaction is not enough, companies should try to delight their customers to get

maximum return in terms of prescription.

The literature review also provides information about the different tools used by drug

companies to greet physicians. The second objective of the study is to identify the various

promotional tools used by the company & with extensive secondary data analysis, the

researcher had identified 16 various marketing tactics used by the pharmaceutical companies,

which named as Medical representative detailing, Corporate Social activity, Promotional

pricing, Patient Education Program, Sampling, Corporate image, Continues Medical

Education, Personal attire of company representative, Product demonstration, Digital

marketing by pharmaceutical companies, Sponsorship, Literatures and reminders of

pharmaceutical companies, Journal subscription, Medical representative’s Knowledge,

Medical camp & Customer Relationship Management of Pharmaceutical companies. The

structured questionnaire was designed with the above promotional tools to recognize their

influence on physician’s prescription habits, which was the 3rd aim of the research. The analysis

of data offers the following finding and interpretations.

A medical representative’s detailing is personal selling, which comes under the category of

direct marketing. Medical representatives detail the brand, discuss the scientific points &

resolve the doctor’s query with the help of visual aid to convince the doctor, and start

prescribing his/her brand. The finding of this study confirms, by providing them, to the point

information about a brand with scientific backed up, a medical representative can convince the

doctor to prescribe promoted brands. 88% of doctors from the study agreed that pharmaceutical

companies should trained medical representatives properly about the detailing of brand and

product knowledge. Pharmaceuticals can invest in training of medical representatives to

improve their scientific & product knowledge to have a better discussion with doctors, which

ultimately helps doctors to recollect brand while writing prescriptions.

Continuous Medical Education (CME) is a platform for the medical fraternity to sharpen

their competence by getting knowledge regarding the novel, upcoming, and emerging areas of

their arena. The data shows the positive correlation between continuing medical education and

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doctor’s prescribing behavior. 91% of doctors agreed that CME helps to improve their

scientific knowledge and change prescribing behavior. Continuing medical education provides

a platform for the doctors to learn about the new molecule, new usage of a drug, or new

indication from expect of the fraternity. CME allows the organizer company for brand exposure

to doctors by venue branding. Pharmaceutical companies can take mindshare of doctors by

arranging CMEs for a particular brand that turns into a prescription. Pharmaceuticals has also

come up with a new concept in CME called webcast; whereby international or national key

opinion leaders (KOL) address the audience through digital media. The physical presence at

the CME venue is not required in webcast and participants can learn the skills from KOL at

his/her place.

Medical Camp is a part of patient care initiatives, many pharmaceutical companies organized

free health check-up camps or medical camps; where they offer free diagnostic tests and trial

therapy to the patients. The finding rejected the hypothesis of better the sampling camp /

diagnostic camp at the doctor’s clinic, better the chance to get a prescription of doctors. Medical

camps with doctors may help medical representatives to build equity with doctors but it may

not help to convert the same into the prescription. Data shows that doctors usually prescribe

the brand which is there in their mind and not of the camp-sponsored company. In the long

term, it may show a beneficial impact, but in the short term, data don’t show a positive

correlation between medical camp and doctor’s prescription support.

Customer Relationship Management (CRM) is where the company interacts with its

customer, increasing customer lifetime value to the company and increasing customer

satisfaction. The finding supports the positive correlation between customer relationship

management by the pharmaceutical company and its impact on doctor’s prescription behavior.

98% of doctors agreed that pharmaceutical companies are good at customer relationship

management and it leads to a change in prescribing habits. Though pharmaceutical activates

are customer-centric, today’s era is of customized activities. Pharmaceutical companies try to

identify the need for individual doctors and prepared a customized program to satisfy the

individual’s needs. As already we have discussed that today’s time is of customer delight rather

than customer satisfaction. To delight customers and get maximum return on investment from

individual doctors, pharmaceutical companies need to identify the scientific need of individual

doctors and try to satisfy them within the allowable limits by UCPMP guidelines.

Promotional Pricing is a topic of controversy. Many authors cited that a low price strategy is

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generally not successful as doctors do not usually know the prices of medicinal products both

relative and absolute. Drug pricing sensitivity is typically second concerning product

effectiveness problems and patient conditions [101] [100] [102]. Some authors are in favor of

promotional pricing as well. The data from the current study conclude that price lowering may

not lead to prescription support. The hypothesis, lower the price of the medicine, the greater

the chance to get prescribe was rejected. Promotional pricing may have greater acceptance in

tender/institute business, but not in the prescription-based sale. The data confirms that

promotional pricing as a major or only strategy to drive brand in the market may not be the

right move for pharmaceutical companies.

Sampling can benefit by providing immediate treatment, determining the initial effect or

adverse effects, and adjusting prescription doses before the patient completes full prescription

treatment, bearing the cost of patients with medications for abstinence, and allowing patients

appropriate medications use. The hypothesis, more the number of trial packs to the doctor, the

higher the chance to get prescription support from the doctor was accepted and confirms the

positive correlation of sampling on physician’s prescription support. 75% of doctors are agreed

that sampling affects their prescription behavior where 23% of doctors were neutral; only 2%

of doctors deny the correlation between sampling and prescription behavior. One of the reasons

for the positive impact of sampling is maybe it reminds the doctor about the brand as it is

available on the doctor’s desk. So, for the newly launched brand / unestablished brand, huge

sampling may be the right proposition for pharmaceutical companies.

Product demonstration ensures proper usage of pharmaceutical products, which is very

necessary to get the desired action. Proper usage demonstration to the patient is required by the

doctor or nursing staff or pharmaceutical medical representative to ensure the right usage of

products for the desired action. The data is not in favor of the hypothesis, a good demonstration

of the product improves the chance of brand recall at a time of prescribing medicine. The

majority of the time doctors are not allocating sufficient time to a medical representative for

product demonstration, maybe because they are familiar with it or not intended to try any

unconventional product. Product demonstration may be effective for novel therapies, but the

usage of such products seems to be very limited.

Sponsorship can be through various means such as sponsorship at conferences of drug

companies, sponsorship for travel expenses at conventions, in the form of high-value personal

gifts or medical devices, or sponsorship for personal visits to physicians. Pay for the clinical

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trial is another sponsorship promotion tool. Several studies have confirmed the positive effect

of sponsorship on the prescription habit of the clinician. The current finding denies such

correlation as hypothesis sponsorship makes doctors loyal towards the sponsored brand, got

rejected. Doctors don’t want to open up about their relationship with pharmaceutical companies

in front of 3rd person (researcher), which could be the major reason behind it. As per the

UCPMP guideline, to accept any gift or material from pharmaceutical companies valued more

than 1000 is inappropriate. If any doctor is caught for having any such relationship with a

pharmaceutical company, he/she may lose his/her medical practice license. Due to such fear,

doctors had not filled the actual answer but provided an ideal response. Thus, as per the result

from the current study, sponsorship doesn’t make doctors loyal to the sponsored brand. In other

words, we can also conclude that if any other company provides better sponsorship, the doctor

may start writing their brand. So, to make the doctor loyal to the brand, sponsorship is not an

ideal promotional tool.

Journal Subscription is the way to provide authenticated research and trends in the medical

segment to the doctors. Many pharmaceutical companies provide the full-text article which

relates to their promoted brand or provides a full journal subscription to greet doctors. The data

analysis confirms the positive correlation between journal subscription and its influence on

clinician’s prescription habits. 68% of doctors agreed on the latest scientific update by journals

may lead to a change in prescription habits. By providing supporting articles about

brand/molecule from reputed journals always attract the attention of doctor & influence them

to prescribe a particular molecule or brand. Pharmaceutical companies can share journal

articles for their newly launched molecule / fixed-dose combination, also to highlight the new

usage / supporting data of old molecule in front of doctors. It increases the confidence of

prescribers about brand/molecule to prescribe a particular brand/molecule.

Corporate Social Responsibility helps companies to develop a positive social profile. Many

researchers have studied the views of physicians about CSR and the allegiance of

pharmaceutical organizations. They concluded that social behavior, playing a major role in his

choice of medicines by doctors and pharmaceutical firms. The hypothesis, corporate social

activity improves the corporate image in doctors & the patient’s mind was accepted and a

positive correlation between CSR and corporate image has been established. Effective CSR

activity and media coverage help to register a positive corporate image in the doctor’s mind.

The pharmaceutical companies can encash this opportunity with subsequent in-clinic

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marketing activity with the help of their medical representatives.

A patient education program by pharmaceutical companies helps to create awareness among

patients about disease conditions to increase the flow of patients in the promoted therapy area.

A meta-analysis [130] of 47 studies confirmed the positive relationship between patient

education programs by pharmaceutical companies and clinician’s prescription habits. The

finding of the current study supports the hypothesis of a doctor’s preference goes to a brand

that provides better patient education. A good patient education program helps to create

awareness amongst patients regarding when to visit a doctor or how to maintain quality of life

with a disease condition. It helps to increase the trust of patients in doctors while fighting

disease conditions which can attract more patients by word of mouth publicity. In a turn of

such patient education support, pharmaceutical companies can win the prescription of doctors.

Corporate Image is the credibility of the organization that can, given its performance

concerning main competitors, be described as the collective understanding of the past activities

of the organization, and its expectations regarding its future actions. Companies earn a

reputation for their year’s long relationship with customers. The current data shows that the

better the corporate image, the higher the chance of the brand to get prescribes. Corporate

image and change to get prescriptions from doctors are having a positive correlation. Another

advantage of a better corporate image is the reception that medical representatives get in the

doctor’s chamber. Medical representatives get more time to discuss brand/science if the doctor

respects the company. So to get faster acceptance from doctors about brands, companies should

also work to build a better corporate image in the doctor’s mind.

Personal Attire of Medical Representative should be formal and attractive; it’s very

important to build a positive first impression about medical representatives and thereby

company in doctor's minds. Empirical proof shows that dress can directly influence the intent.

Literature review shows that properly dressed service contact workers contribute to higher

customer satisfaction and a higher desire to buy service from the company than unsuitable

customer service contact personnel. The hypothesis, representative with good personal attire

impacts a better company’s image in the doctor’s mind was accepted and confirms the positive

correlation between the personal attire of medical representative and its positive impact on the

doctor’s mind. 69% of doctors agreed-upon personal attire of medical representatives attract

their attention. Formal dress with tie and properly groomed face are the identity of a medical

representative in India. Doctors readily accept MR in this attire. Multinational pharmaceutical

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companies and top-ranked Indian pharmaceutical companies have specially trained their

medical representative on the personal grooming part, as they don’t want to ruin the reputation

that they have built-in doctor’s minds with medical representative’s behavior or attire. Small

and mid-cap pharmaceutical companies should also work on the personal attire of MR if they

want to get good reception from doctors as well as ready acceptance about their brands.

Digital marketing is often of great importance in the creation of brand value and raising equity.

Digital marketing replaces conventional marketing approaches in the pharmaceutical industry.

This is primarily because of quick contact with end-users, less time-consuming effort, and a lot

of economic efficiencies. Studies found that WhatsApp, insightful websites, and smartphone

apps are the most commonly accessible digital marketing platforms. The current study also

supports the fact that digital marketing helps to get doctor's & patient’s attention towards the

brand. With the help of digital marketing as well as conventional marketing pharmaceutical

companies can approach 3600 marketing. They can highlight their brand in front of doctors in

all possible manners. Digital marketing also helps pharmaceutical companies to engage

patients through their scientific patient education program or patient club via website or

application or any social media platform. They can also engage patients by offering customized

patient education platforms to doctors. In turn, they can ask for prescription support from

doctors. Branding on different doctor-centric websites or social media platforms is another

digital tool for pharmaceutical companies. So by increasing the availability of the digital

platform, pharmaceutical companies can register their brand in a doctor’s mind which turns

into prescription later on.

Literature and Reminders are the tools from pharmaceutical companies to their medical

representative to discuss the science behind their brand as well as spend more time in-clinic.

Pharmaceutical literature having much information starting from a range of products/brands,

new articles/information about molecule/brand, a case study from renowned key opinion leader

(KOL), guidelines, infographics, clinical trials, or any other useful information about the brand.

Literature surveys indicate that drug literature and brand records affect the prescribing actions

of the doctor but at different rates, which rely largely on the relationship and personalities of

the doctor's medical representatives. The analysis of the current study suggests, higher the

reminders to the doctor of the brand, the greater the chance to get prescription support from a

doctor. Every pharmaceutical company spends thousands of rupees every month on literature

and brand reminders but only a few of them have an innovative and informative quality that

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can attract the attention of doctors. Rather than preparing only front-back literature or

reminders, companies should focus on innovative and more informative literature.

Medical Representative’s Knowledge is very essential for better and effective in-clinic

discussion. Medical representatives are the crucial arm of pharmaceutical marketing; as he/she

should be equipped with medical knowledge to have a fruitful discussion with doctors. The

majority of pharmaceutical companies are having a dedicated training department to a trained

medical representative about the therapy area, disease conditions, and benefits of brands to

have a better in-clinic discussion. Poor scientific knowledge about brand or therapy area not

only spoils the image of medical representative but also creates a question mark on the

reputation of the pharmaceutical company in the clinician’s focus. The majority of MNCs and

top-ranked Indian pharmaceutical companies restricted entry of medical representatives with

B.Pharma or at least science graduation. The current finding also supports the hypothesis,

doctors always appreciate a representative with good product knowledge. 90% of doctors

agreed on medical representative knowledge is very much important to influence their

prescribing behavior. A medical representative with sound product knowledge can convince

doctors easily for their brand compared to the MR with poor medical / product knowledge.

Pharmaceuticals can invest in training of medical representatives to improve their scientific &

product knowledge to have a better discussion with doctors, which ultimately helps doctors to

recollect brand while writing prescriptions.

5.2 Conclusion and future scope

Every effort made by the pharmaceutical companies to sell their product endorsed by the

doctors plays a crucial role in the widespread acceptance and use of medicines in the public

domain. The relationship between doctors and drug companies should be ethical in practice

and commercially competitive so that medicines reach in right time at the right place, at the

right price. Pharmaceutical promotion is a vast area of research the present study tries to

understand the impact of pharmaceutical promotion tools only from a doctor’s perspective.

This study concludes that pharmaceutical marketing tactics have a positive influence on the

clinician’s prescription habit/behavior in varying proportions. Both patients oriented, as well

as practice-oriented pharmaceutical activities, can influence the prescriber's behavior. The

activities like sampling, CME, journal subscription, CSR, patient education program, digital

marketing, literature, and reminders & CMR help pharmaceutical companies to get more

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prescriptions from targeted doctors. Few employee excellence activities like the detailing of a

medical representative, product demonstration, personal attire of medical representative, and

knowledge of salesforce are also helping pharmaceutical organizations to affect the prescribing

habits of doctors. The long-term relationship with doctors as well as market presence helps

companies to build their equity in the doctor’s mind & which can be encashed further with the

help of various promotional activities. The effectiveness of activity and ROI also depends on

the rapport among MRs and physicians. Few promotional tools like promotional pricing,

product demonstration, sponsorship & medical camp don’t show their effectiveness in

influencing prescription behavior in the present study but some researchers had proven them

effective. The pharmaceutical industry should plan them as per the market move and demand.

Government rules and regulation helps to encourage the ethical promotion of drugs by

pharmaceutical companies; in India, Uniform Code of Pharmaceuticals Marketing Practices

(UCPMP) is already established but the strict monitoring and implantation are required to

restrict the unethical practices to make drugs even more economical to end-users.

Scope for further research can be narrated as below:

1. In the present study, there is only the effect of drug promotion tools on prescription-

based drugs; Therefore another study may be conducted to study the effect of promotion

tools on non-prescription or OTC (over the counter) drugs.

2. In the present study demographic factors of respondents such as age, gender, religion,

socioeconomic status, etc. were not taken into consideration. These factors may affect

the prescribing habit of the clinician. A separate study can be conducted to identify the

impact of promotional tools on doctor’s prescribing habits concerning demographic

factors.

3. This research study was conducted in metro cities of Gujarat; In addition, research can

be done to cover Tier II and Tier III cities in the state of Gujarat or the whole of India.

4. The present study is concerned only with the influence of the promotional tools of the

companies on the practice of allopathic medicine by companies; In addition, another

study may be conducted to evaluate the impact of promotional tools on Ayurvedic,

homeopathic or Unani physicians.

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5. This study will have only the effect of changing the marketing scenario on selected

shareholders, i.e. physicians. In addition, the new research will help other stakeholders

such as chemists, stockiest, MRs, managers like ABMs / RBMs & patients to

understand their expectations and study the impact of drug promotion tools on them.

6. The impact of drug promotion tools on prescription-based medicine alone was assessed

in this study; In addition, a study can be conducted to determine the effectiveness of

non-prescription (OTC) drugs or herbal promotion tools in Ayurvedic, Homeopathic or

Unani medicine.

With the findings and conclusions listed above, presenting them both in light of the limitations

and scope of the study, current research would like to rethink its assumptions with a good hope

of influencing factors not included in the current study in the context of further research. Ending

the concept is not the end of the research, but it is the beginning of future research.

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List of Publications

1. S. Sandip and K. Vishavadia, “Impact Study on Various Promotional Practices Done

by Pharmaceutical Companies on Doctor ’ s Prescription Behavior : What Does

Literature Say ?,” Int. J. Econ. Res. (ISSN : 0972-9380), vol. 14, no. 14, pp. 15–22,

2017.

2. Vishavadia Krunal, Solanki Sandip (2020) “Does pharmaceutical promotional tactics

change the prescription habit of doctors?”, Journal of Critical Reviews (ISSN- 2394-

5125), 7 (12), 2980-2992. doi:10.31838/jcr.07.12.453

3. Krunal, Vishavadia; Sandip Solanki; Krishna Murthy Inumula. “Impact study of

various pharmaceutical promotional practices on Indian doctor’s prescription

behavior”, European Journal of Molecular & Clinical Medicine (ISSN: 2515-8260),

vol. 7, no. 8, 2020, pp. 4198–208, https://ejmcm.com/article_6805.html

4. Vishavadia Krunal, Seema Singh, Sandip Solanki (2021). Personal & Professional

Qualities of Medical Representative and Impact on Doctor's Prescribing Behavior.

Universal Journal of Public Health (ISSN: 2331-8880), 9(6), 385 - 391. DOI:

10.13189/ujph.2021.090605

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APPENDICES

Chapter Contents:

Questionnaire

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Questionnaire

IMPACT STUDY ON VARIOUS PROMOTIONAL PRACTICES DONE

BY PHARMACEUTICAL COMPANIES ON DOCTOR'S

PRESCRIPTION BEHAVIOR

Explanatory Notes:

Coverage

The survey relates doctors of five different specialties: General Practitioner, Consulting

Physician, Dentist, Pediatrician and Gynecologist.

The Opinion

Questions related to specific activities performed by pharmaceutical companies that affect your

prescription pattern only require your perceptual feedback. Please keep in mind the activities

of the pharmaceutical companies while filling out this questionnaire and read the statements of

the questionnaire and circle the appropriate number against each one. No correct or incorrect

answer or numerical information required. Your opinion is very justifiable.

Some queries may seem similar, but the answer to each of your questions will help us to

scientifically evaluate the response and formulate proper conclusions. Provide your answer

from 1 to 7 whereas 1 indicates strongly disagree & 7 indicates strongly agree.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Neutral

5. Slightly agree

6. Agree

7. Strongly agree

Privacy and data access

Please ensure that your responses are completely confidential and that the data collected will

only be used for the entire analysis without identifying you as the respondent. Your

participation is voluntary, but we request that you participate for the success of the research.

155 | P a g e

Section I

Kindly furnish the basic information about your self

Q.1. Specialty: __________________________

Q.2. How long you are practicing? _______ Years

Q.3. How many average patients per day? _______

Q.4. Are you entertain activities by pharmaceutical companies?

⃝ Yes ⃝ No (If no, please go directly to section II)

(If yes, kindly answer the questions no. 5)

Q.5. Which kind of activity is more preferred by you?

⃝ Patient oriented ⃝ Practice oriented

Section II

Q.6. To what extent do you agree / disagree with the subsequent statements? "Please keep

detailing of medical representative in your mind while you fill up this questionnaire"

It’s my belief that….

a. Detailing of Medical representative helps

to choose brand.

1 2 3 4 5 6 7

b. Medical representative discuss scientific

points during detailing.

1 2 3 4 5 6 7

c. Medical representative helps to improve

knowledge.

1 2 3 4 5 6 7

d. Medical representatives are properly

trained for detailing.

1 2 3 4 5 6 7

e. Detailing through visual aid is a right

method to discuss brand.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________

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promotional pricing of Pharma brand in your mind while you fill up this questionnaire"

I believe that….

a. Promotional price impacted my

prescription habit.

1 2 3 4 5 6 7

b. Promotional price helps my patient to get

medicine economic.

1 2 3 4 5 6 7

c. Brands with lesser price are inferior in

quality.

1 2 3 4 5 6 7

d. It’s only applicable for limited

molecules/ therapies.

1 2 3 4 5 6 7

e. Promotional price are more incline to

injectable.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


sampling in your mind while you fill up this questionnaire"

I perceive that ….

a. More number of samples changes

prescription habit.

1 2 3 4 5 6 7

b. Trial packs help to check the effect

of brand.

1 2 3 4 5 6 7

c. Free samples help to serve needy

patients

1 2 3 4 5 6 7

d. Trial packs are more prone to use in

govt. hospitals rather than private

clinics.

1 2 3 4 5 6 7

e. Medical representative should know

how to use samples and what is

1 2 3 4 5 6 7

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doctor’s need.

Comments (If any):

________________________________________________________________


Continues Medical Education in your mind while you fill up this questionnaire"

I believe that ….

a. Scientific CME with good speaker is

really helps to improve knowledge.

1 2 3 4 5 6 7

b. CME with MCI accreditation is only

useful CME

1 2 3 4 5 6 7

c. CME with my interest topic only

attracts me to attend.

1 2 3 4 5 6 7

d. A good CME can change

prescription pattern.

1 2 3 4 5 6 7

e. CME with international speakers is

always better.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


demonstration in your mind while you fill up this questionnaire"

I believe that ….

a. Product usage demonstration creates

an impact in brand recall.

1 2 3 4 5 6 7

b. Product demonstration is required

for some brands.

1 2 3 4 5 6 7

c. Product usage demonstration for 1 2 3 4 5 6 7

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patient / chemist helps my practice.

d. Pharma companies should give

proper training to their field force for

product usage demo.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


sponsorship in your mind while you fill up this questionnaire"

It is my opinion that…

a. Sponsorship to me in any way affects

my prescription pattern.

1 2 3 4 5 6 7

b. Sponsorship which helps my patient

is more grace me.

1 2 3 4 5 6 7

c. Sponsorship to conference is good to

attract attention of doctors

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


Journal Subscription in your mind while you fill up this questionnaire"

It’s my belief that…

a. Renowned journal really helps to

improve my knowledge. I required it.

1 2 3 4 5 6 7

b. I should keep supporting company

which helps me to get international

journals.

1 2 3 4 5 6 7

c. Journals keep me updated with

current trend in health care.

1 2 3 4 5 6 7

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d. Medical representative has very less

knowledge about articles and journals

1 2 3 4 5 6 7

e. Pharmaceutical companies are the

only source to get renowned

international journals.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


medical camp in your mind while you fill up this questionnaire"

I believe that…

a. I appreciate medical camps in my

clinic.

1 2 3 4 5 6 7

b. Free sampling camp helps my

patient and its gain my trust.

1 2 3 4 5 6 7

c. Free diagnostic camp helps to get

more patients to my clinic.

1 2 3 4 5 6 7

d. Free medical camp improves Pharma

company image in front of patient.

1 2 3 4 5 6 7

e. Medical camp at my clinic leads my

prescription support.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


Corporate Social activity in your mind while you fill up this questionnaire"

I believe that…

a. Corporate social activities help to

change the corporate image

1 2 3 4 5 6 7

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b. Every corporate should engage with

some social activity for well-being of

society.

1 2 3 4 5 6 7

c. Corporate social activities create

positive image in the mind of

consumers

1 2 3 4 5 6 7

d. CSR builds confidence among the

consumers while selecting a brand.

1 2 3 4 5 6 7

e. Companies which are more engaged

in CSR activities, they are in my first

preference while selecting brand for the

prescription.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


Patient Education Program in your mind while you fill up this questionnaire"

I believe that…

a. Patient counseling is required in

some disease condition or while taking

some medications.

1 2 3 4 5 6 7

b. Pharma company person can do

better patient counseling compared to

para-medical staff.

1 2 3 4 5 6 7

c. Pharma companies which are engage

in patient education program can take

my prescriptions.

1 2 3 4 5 6 7

d. Patient education initiate by Pharma

companies help patient for better

understanding of disease condition.

1 2 3 4 5 6 7

e. Online patient education is a better 1 2 3 4 5 6 7

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option now days.

Comments (If any):

________________________________________________________________


corporate image in your mind while you fill up this questionnaire"

I believe that…

a. I prescribe brands which are from

well-known Pharma house.

1 2 3 4 5 6 7

b. Good & well known Pharma

companies has better quality product.

1 2 3 4 5 6 7

c. Brands from good corporate image

gets faster acceptance.

1 2 3 4 5 6 7

d. It takes years to build good corporate

image.

1 2 3 4 5 6 7

e. Good corporate image builds when it

offers better product and service for the

consumers & customers.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


personal attire of company representative in your mind while you fill up this

questionnaire"

I believe that…

a. Representative of MNC’s are

always well dressed and well

disciplined.

1 2 3 4 5 6 7

b. Good attire of company 1 2 3 4 5 6 7

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representative catches my attention

toward his communication.

c. Well-dressed means educated,

good company and good brands.

1 2 3 4 5 6 7

d. Good attire has impact on by brand

selection for prescription.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


digital marketing by Pharma companies in your mind while you fill up this

questionnaire"

I believe that…

a. Pharma product websites are very

much useful for patients to improve

their knowledge.

1 2 3 4 5 6 7

b. Pharmaceutical company’s patient

education applications are useful in

patient’s wellbeing.

1 2 3 4 5 6 7

c. Pharmaceutical industry has very

less scope for digital marketing.

1 2 3 4 5 6 7

d. Pharmaceutical companies itself

very less active towards digital

marketing.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________

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Literatures and Reminders of Pharma companies in your mind while you fill up this

questionnaire"

I believe that…

a. Pharma literature helps me to remind

brand.

1 2 3 4 5 6 7

b. Hand written reminders create

positive impact.

1 2 3 4 5 6 7

c. Impact of reminders and literatures

are depends upon the regularity of the

representative.

1 2 3 4 5 6 7

d. Daily reminders help me to recollect

brand while prescribing medication.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________


Medical Representative’s Knowledge in your mind while you fill up this questionnaire"

I believe that…

a. Doctor’s always appreciate

representative with good scientific

knowledge.

1 2 3 4 5 6 7

b. Because of lack of knowledge, MR

has a fear of scientific discussion with

doctors.

1 2 3 4 5 6 7

c. Medical representative are still

source of knowledge for doctors in

some context.

1 2 3 4 5 6 7

d. Pharmaceutical companies should

give good scientific training to MR for

1 2 3 4 5 6 7

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discussion with doctors.

Comments (If any):

________________________________________________________________


Customer Relationship Management of Pharmaceutical companies in your mind while

you fill up this questionnaire"

I believe that…

a. Pharma Companies are good in

customer relationship management

1 2 3 4 5 6 7

b. I feel good when I get good service

on demand and on time.

1 2 3 4 5 6 7

c. I feel good when I and my patients

get good service from Pharma

company.

1 2 3 4 5 6 7

Comments (If any):

________________________________________________________________

Thank you very much for your valuable time and participation.

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