Parallel Session 2 Five Pillars to succes A framework for approaching market research in Emerging Markets Steve Kretschmer, Ipsos, Turkey and Beyza Ozel, Novartis, Turkey
5 Pillars to Success: A Framework for Approaching Market Research in Emerging Markets Steve Kretschmer & Beyza Özel
The world we live in has changed radically over the past 10 years even over the past 10 months!
Over the past few years, we have been adjusting strategies to leverage the RISE of Emerging Markets in Pharma 5
IMS Institute for Healthcare Informatics The Global Use of Medicines: Outlook Through 2015 http://www.imshealth.com/deployedfiles/imshealth/global/content/ims%20institute/static%20file/global_use_of_medicines_report.pdf
Growth Drivers: 17 Pharmerging Markets Compound Annual Growth Rate (CAGR) 2010-15 MATURE MARKETS 1-4% PHARMERGING 13-16% Tier 1 Pharmerging Tier 2 Pharmerging Tier 3 Pharmerging Mexico, Turkey, Poland, Venezuela, Argentina, Indonesia, South Africa, Thailand, Romania, Egypt, Ukraine, Pakistan & Vietnam China 19-22% Brazil 10-13% Russia 11-14% India 14-17% 10-13% Rest of World 3-6% Pharmerging countries are defined as those with >$1Bn absolute spending growth over 2011-15 and which have GDP per capita of less than $25,000 on a purchase-price parity basis (PPP).
Our world is transforming!
Each emerging market is UNIQUE DYNAMIC AND CHANGING QUICKLY!!
You are asked to assess the opportunities across 5, 10 or even 17 Pharmerging Markets WHERE DO YOU START?
You need a structure to guide the evaluation
5 Pillars to Understanding Emerging Markets The Opportunity Government Influence Pricing & Reimbursement Stakeholder Influence Marketing A framework for organizing information & achieving understanding and insight
The Opportunity The Opportunity Who are the patients who can benefit & what are their needs?
I. The Opportunity The obvious starting points Population Demographics What are the trends? particularly for age & SES Disease Burden What are leading diseases, and why? But often overlooked Attitudes & Behaviors toward Healthcare These can differ significantly between markets They are often major factors influencing brand opportunities or challenges
I. The Opportunity Who are the patients? Don t rely too heavily on any one source Population Demographics & Disease Burden statistics are best triangulated across sources Assess risk factors e.g., smoking Global Sources: WHO, CDC, etc. Local Sources: MoH, Govt. Stat. Offices, Physician Associations
I. The Opportunity and what are their needs? Perceptions, attitudes and behaviors about healthcare are critical and need to be measured with market research Cross-market comparisons make it easier to identify key unique barriers / opportunities
I. The Opportunity Key Risk Factors Undiagnosed chronic diseases Heavy abuse of tobacco and alcohol Unhealthy diets & low levels of physical activity According to FSSS: Federal State Statistics Service, 2009
For example Preparing launch for the only oral MS drug therapy Many global MR studies were completed, including Turkey, prior to launch Expected oral formulation would be viewed as benefit by physicians, based on research results Local Wargaming research revealed physician concerns about patients compliance with oral formulation Many lower SES patients view oral meds as for lowrisk diseases
Government Influence Government Influence How does it impact the market?
II. Government Influence How does it impact the market? Assess the following: Assume the perspective of the ruling party What are their goals? What are their challenges? Who are their key constituents? What s happening with the healthcare system? What is the state of the system and what changes are planned? What is the level of democracy? More democratic = lower risk of sudden and/or significant change
II. Government Influence Get to know the local market Follow the news! Most major emerging markets have English newspapers, blogs, etc. that are easily accessible People s Daily & China Daily (China) The Moscow Times (Russia) The Turkish Daily News (Turkey) With today s communications and media access, it s possible to virtually live in a country This doesn t replace strong local contacts get to know them and use them!
For example Turkish Govt s price discounts in 2009 Need to understand the needs & expectations of govt. without underestimating importance of access for patients Govt s Priority: Stabilize their drug coverage costs Novartis Approach: Partner with govt., and provide alternative cost reductions that don t remove drug access Have now improved business and increased # of launches every year
Pricing & Reimbursement Pricing & Reimbursement What are the mechanisms and drivers?
III. Pricing & Reimbursement First overcome any mental block! In emerging markets, P&R is often the #1 underresearched & under-resourced area yet it has become THE LEADING HURDLE in some markets This appears to stem from several misconceptions: 1. A belief that market research in P&R is not feasible or must belong to niche consultants 2. A view of P&R as a zero sum negotiation process, rather than an opportunity for long-term collaboration to benefit the patients/citizens, the govt. and the marketers 3. View the process as ad hoc for each product, rather than an ongoing partnership
III. Pricing & Reimbursement Overcoming these misconceptions opens the door to expanding your perspective: View your brand from their perspective seek to truly understand the viewpoints and objectives of the P&R authorities Their goal is not usually to just reduce cost they seek savings in total cost of care and the greatest overall VALUE for patients/citizens BE PATIENT DRIVEN not product focused You must identify and understand the mechanisms of P&R in each market
For example Establishment of Novartis Turkey Brand Access Mgrs Needed to better engage govt. in access, pricing & reimbursement Established Brand Access Manager role & added BAMs to brand teams to manage product in pre-launch phase Goal = Create Win-Win-Win for patients, govt. & Novartis First priority of BAM provide access to new treatments for patients
Stakeholder Influence Stakeholder Influence What is the balance of influence?
IV. Stakeholder Influence What is the balance of stakeholder influence? Regulatory Groups People Dr. Watson?? Physicians Pharmacists Public Health Patients Family and Friends Patient advocacy groups Other Healthcare Professionals Payers Government organizations
at each stage in the patient journey? Physician Pharmacist Other HC Provider or Caregiver PERSON Access & Reimbursement Authorities Perception Is a health problem perceived? Origination Who initially consulted about the problem? Patient Flow Evaluation - Who evaluates the problem? Diagnosis - How is the problem identified and confirmed? Treatment - What treatments are available? Delivery Prescription reimbursed? Filled? Switched? Compliance Treatment taken as prescribed? Follow-Up - Is treatment successful; does the problem still exist?
IV. Stakeholder Influence Where are the centers of influence? Who are the thought leaders? Centers of excellence? How does this balance of influence differ regionally? Particularly urban vs. rural settings? Which stakeholders are hubs of influence For example, rural PCPs treating higher patient volumes How do you economically meet the unique needs of these centers of influence?
IV. Stakeholder Influence What dynamics might be changing the balance? Implementation of PCP gatekeepers? Loosening or tightening of advertising laws and retail access? Increased HCP access to information via new channels? Increased patient access to information via the Internet or advertising?
For example Impact of Family Practitioner program in Turkey PCP gatekeeper system just implemented fully in Turkey Patients must go to FP first or visit not covered Govt s goal is to lower total costs of healthcare through more effective use of specialists FPs awareness is crucial in order to refer patients to the correct specialty for diagnosis & treatment Since prescribing for many drugs is limited by specialty Novartis focuses special efforts to understand FPs as key stakeholders
Marketing Marketing How do you most effectively influence the stakeholders?
V. Marketing Now you know who to market to next you need to know how to best market to them Three factors are important: 1. Identify cultural differences in language, in relationships and their influence, in perspective of health and healthcare 2. Identify individual differences in attitudes and needs (customer segmentation) 3. Identify which channels are available, and which work best for each stakeholder?
Identifying cultural differences This is often best done through a combination of intraand inter-cultural primary research Comparison of top two box purchase intent by database ranking
V. Marketing The channels available for marketing are changing rapidly Patients accelerating access to information and increasing self advocacy offers unique opportunities for direct communication IF direct communication is not restricted! Penetration of the Internet and mobile technologies varies across emerging markets and HCP groups These also offer unique opportunities to leverage alternative channels for targeted messaging
V. Marketing BUT, it s necessary to know which channels are preferred by the stakeholders, and why? Use stakeholder segmentation to prioritize and target efforts based on needs, attitudes and behaviors
For example Alternative detailing channels in Turkey Market research has identified differing attitudes and behaviors toward technology and pharma marketing that allow for targeted use of alternative channels Turkish physicians carry among the highest patient loads, e.g. BUSY HEALERS Now the hours for Sales Rep visits at hospitals has been limited by new legistation Efficient physician detailing is even more crucial
5 Pillars to Understanding Emerging Markets The Opportunity Government Influence Pricing & Reimbursement Stakeholder Influence Marketing A framework for organizing information & achieving understanding and insight
The pace of change is unrelenting 1990 Shanghai 2010
It s now increasingly being LEAD by emerging markets Istanbul in 2020?
When will China become the largest economy in the world? We will need to invest the necessary time energies resources and budgets to really understand these markets
But we hope these 5 Pillars are a useful framework to guide you The path to understanding these markets is not simple
Thank you for your time and attention! Steve Kretschmer & Beyza Özel