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Continued from previous……

Phase III. Getting into Chronic Care Segment

Very late 1990s and 2000s. The most promising time for Local Pharma to establish their strength in the marketplace. Generic drugs got into chronic-care segment.

Acute-care is different from chronic-care.

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Acute-care medicines include pain-killers, antibiotics, anti-emetics, digestive-aids etc. The drugs are typically given for a day or max a few days. The condition is usually not serious and drug plus body’s own immunity take over and provide relief. For example, it is a common complaint that patients do not complete the antibiotic course of five days. It is because they feel better in two days and do not feel like taking drug unnecessarily. This gesture may not be justified scientifically but it makes practical sense. Similarly, if someone has headache, she/he will take a pain-killer like paracetamol once only and may not need to repeat the dose. The consideration of treating physician is that the patient gets better as soon as possible. Each prescription of acute-care drug leads to one-time purchase only. From business point-of-view, a new prescription is needed to sell each pack. The business is relatively easier to get, but quicker to lose. The entire emphasis of marketing & sales team is to get more and more new prescriptions. There are also other ways to sell which we do not consider here.

Chronic-care medicines include all those which have to be taken for a life time, such as those for Diabetes, Hypertension, Heart, etc.; or at least for several months or years such as those for Psychiatry, Neurology, Rheumatology etc. The patient has to follow the physicians’ prescription seriously. If they are irregular, they will not be able to achieve desired control or lose control if they have already achieved one. Uncontrolled Diabetes, Hypertension, and other such conditions are likely to cause serious complications; and they do. The consideration of treating physician is to achieve control and maintain it. The former is easier than the latter. Physicians therefore are careful about choosing and/or changing drugs for these patients. From Business point-of-view, one prescription leads to sale of several packs over time. You build layer upon layer of patients and the business keeps growing steadily. The business is harder to get, but stays and pays longer. The emphasis of marketing & sales team is to get more and more new patients.

While Local Pharma Generics had gained reasonable respect in acute-care category and had made inroads into medium-term category, they were not yet accepted in chronic-care. It started with statins, then antihypertensives, antidiabetics, and finally cardiac medicines. Psychiatry and Neurology followed suit.

One real case will show clearly what the perception initially was.

The anti-platelet clopidogrel was not registered in Pakistan until 2004 probably. The innovator brand PLAVIX was smuggled into the country and sold at selected places. The price was 100-125 rupees per tablet, depending upon the availability. Cardiologists and Cardiac Surgeons prescribed it after angioplasty (stents) and Bypass surgery (CABG). In the last quarter of 2002, two local companies Pharmevo and CCL almost simultaneously launched generic clopidogrel. Price was 15 rupees per tablet. The cardiologists refused to accept that it would do much. They said they may use generic clopidogrel in place of aspirin, but not in place of Plavix. It took several years before this perception changed in favor of generics. Presently, there are many generic brands of clopidogrel, while the first two are multi-million brands.

Getting into and getting accepted into chronic-care influenced generic industry positively and in many ways.


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