|Year : 2020 | Volume
| Issue : 5 | Page : 11-17
Adaptation of pharmaceutical marketing and drug promotion practices in times of pandemic COVID-19
Sunil S Chiplunkar1, D Vishkanthe Gowda1, HG Shivakumar2
1 Department of Pharmaceutics, JSS College of Pharmacy, JSS AHER, Mysore, Karnataka, India
2 Department of Pharmaceutics, College of Pharmacy, JSSATE, Noida, Uttarpradesh, India
|Date of Submission||03-May-2020|
|Date of Decision||04-May-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||04-Jun-2020|
Mr. Sunil S Chiplunkar
Department of Pharmaceutics, JSS College of Pharmacy, JSS AHER, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
Pharmaceutical marketing is an essential societal activity that ensures the availability of medicines at the right time and place. Pharmaceutical marketers also provide timely information, perform after-sales service in the distribution chain, and organize medical conferences and seminars. Thus, therapy and product updating, ensuring availability, and usage of medications are catalyzed by pharmaceutical marketers; this also ensures access to medicines in society. Medical representatives are critical elements – they inform and persuade adoption of various products for patient welfare. To complement and supplement the ground-level pharmaceutical marketing activity, a host of digital marketing initiatives is also accoutering the pharmaceutical marketing process. During pandemics like the COVID-19 infection, face-to-face pharmaceutical marketing approach is thrown out of gear and digital marketing has gained increased adoption. This article reviews the adaptive response of pharmaceutical marketers during COVID-19 times.
Keywords: COVID-19, digital marketing, pandemic, pharmaceutical marketing, SARS-CoV-2
|How to cite this article:|
Chiplunkar SS, Gowda D V, Shivakumar H G. Adaptation of pharmaceutical marketing and drug promotion practices in times of pandemic COVID-19. Int J Health Allied Sci 2020;9, Suppl S1:11-7
|How to cite this URL:|
Chiplunkar SS, Gowda D V, Shivakumar H G. Adaptation of pharmaceutical marketing and drug promotion practices in times of pandemic COVID-19. Int J Health Allied Sci [serial online] 2020 [cited 2020 Aug 6];9, Suppl S1:11-7. Available from: http://www.ijhas.in/text.asp?2020/9/5/11/285972
| Introduction|| |
In the information continuum, pharmaceutical marketing is the last element and transforms research concepts into practical therapeutic tools. Pharmaceutical marketing or medico-marketing may be defined as “the business of advertising or otherwise promoting the sale of pharmaceuticals or drugs.” Pharmaceutical marketing is well organized and is a comprehensive information system to update doctors about safety, efficacy, availability, side effects, hazards, and methods of medicine usage. The global body World Health Organization defines drug promotion as “…all informational and persuasive activities by manufacturers and distributors, the effect of which is to influence the prescription, supply, purchase or use of medicinal drugs.” The role of medical representatives (MRs) in the Indian context has been studied. Doctors felt that MRs influenced prescribing, and as per the research study, each MR ideally should be regular, be sincere in claims, provide brief detailing, and have good education, good product knowledge, and courtesy, personality, and salesmanship. The doctors opined that not medical literature but samples were useful. Thus, MRs are very useful links in the pharmaceutical marketing approach.
Pandemics throw a spanner in the works of regular daily MR activity. COVID-19 coronavirus infection due to SARS-CoV-2 is the most contagious infection seen perhaps in the history of humankind. Transmission of this virus occurs through invisible respiratory droplets from an infected person that are spread through coughing, sneezing, speaking, and exhalation. Contact also occurs when these droplets fall on surfaces and are viable for various lengths of time. Compared to MERS and SARS in terms of morbidity and mortality, the SARS-CoV-2 virus shows less virulence but more infectivity. COVID-19 infection is more fatal in the vulnerable sections of the population such elderly, people with smoking history, and patients with comorbid conditions such as diabetes, cardiovascular disease, and liver disease.
| Pharmaceutical Marketing|| |
Pharmaceutical marketing is a major job creator in India, of which MR jobs are a big chunk. There are estimated 6 lakh MRs in India. In any major town, there will be anywhere between 300 and 600 MRs, contributing to growth of industry to become shortly a 100 billion USD. MRs form a critical link – they convert all product concepts, produced medications, and years of research and development (R and D) into a commercial success.
The perceived value offered by pharmaceutical sales representatives (PSRs) and physicians has been explored – PSRs focused on detailing of established and new products and presenting research studies. However, physicians valued the role of PSRs for recruiting physicians to participate in the US Food and Drug Administration (FDA)-approved drug studies. One contrarian dimension is that busy physicians value the information provided by medical colleagues maximum, compared to advertisements and MRs. Hence, MRs target and build key opinion leaders or key opinion builders (noted doctors), who advocate right usage of products. Another challenge area highlighted is the fact that the tools available to assess physician interactions with pharmaceutical companies is not of high reliability, so the quality of data is low. Hence, it is vital to continuously research this area. Although pharmaceutical marketing is a major impact area, the studies need to be robust, particularly in lower-income and middle-income countries, since systematic review of the knowledge, belief, and attitude of prescribers in these geographies is not robust. Further investigators reiterate in their systematic review and meta-analysis; there is moderate-quality evidence that prescribing habit or pattern is correlated to pharmaceutical company activities toward them. Another study opined confidently of the pharmaceutical marketing strategies that influence physician-prescribing habits, through MR visits, samples that are used for patients' trials, and gifts that influence. Hence, there is significant scope to uncover facts of the marketing and communication dimension of pharmaceutical operations.
National occupational standard, as per the Life Sciences Sector Skills Development Council of Government of India, lays down the job profile aspects of an MR as follows (LFS/Q0401):
- To gather data on company products and competitors
- To promote and sell products to potential customers and provide after-sales service
- To organize promotional events and medical seminars/conferences.
Continue Medical Education (CMEs) contribute as a sharing platform for clinical wisdom. Regarding this CME activity, surveyed physicians said that past experience of the drug was primarily influential on them; hence, drug samples were important, published articles on drugs and in journals were useful. Drug price and patient financial situation are also vital in the prescribing decision. MRs provide information; however, doctors opine that alternative sources of information are also available; this is an important trend, so digital is equally important. The touch provided by the MR was valuable and satisfying. Gifts are also influential tools that have been researched for its impact. The search of electronic database 1992–2016 in an analysis has revealed that physician-prescribing behavior has been influenced by gifts provided by MRs, so this too has an impact on sales outcomes. Investigations in the Indian context, of the activities performed by pharmaceutical marketing agents, have revealed informative effect by detailing and samples, and price sensitivity was not found to be major.
| Detailing the Traditional Pharmaceutical Marketing Practice|| |
Pokharel stated that detailing to doctors is the most effective tool in product promotion to doctors. The next significant tool to benefit the marketer is product sample. CME and health camps (particularly, for antidiabetics, antipsychotics, and cardiac products) are also positively influencing pharmaceutical marketing. The correlation coefficient between sales and profit is seen as positive, so increasing sales means increasing profits.
| Covid-19 Contagion: a Game-Changer in Messaging Practice|| |
COVID-19 is the most contagious disease humankind that has ever known. The spherical COVID-19 virus has a fat-protein coating with protein spikes. This spike protein structure gives the appearance to the virus as a crown; hence, such viruses are called coronavirus. These spike proteins of COVID-19 virus attach to receptors in the respiratory and other cells. This way COVID-19 virus infects the body. A minimum amount of the virus particles called the lethal dose is required for the infection to occur. However, in the case of COVID-19 virus, the lethal dose is not known. All coronaviruses like the COVID-19 virus cause respiratory infection. In review of epidemiological studies, it was seen that older patients are more vulnerable to severe diseases, and it is seen in COVID-19 too.
| Ground-Glass Appearance|| |
COVID-19 infection causes fever, dry cough, tiredness with or without diarrhea, and later breathing difficulty, after usually by the 8th day. If the viral infection gets controlled, there is no progression to lung disease. If lung disease occurs due to this virus, the lungs become hard with fibrosis and nonfunctional; the lungs have a typical ground-glass appearance. COVID-19 viral disease in such patients usually causes death.
| Social Distancing and Other Measures Stop Face-To-Face Detailing Practice|| |
To prevent the spread of Covid -19 disease – the most potent method is isolating the affected patients and the general practice of social or physical distancing along with hygiene measures. A distance of 1–1.5 m between individuals helps avoid transmission of the virus. Social distancing and isolating infected patients from the rest of the population (quarantine) bearing in mind the social consequences have been reiterated as effective by scientists. However, such measures that have flattened the curve of epidemic stopped the movement of MRs in the market – leading to stop pharmaceutical product promotion.
| Selling Activity and Covid-19|| |
COVID-19 infection has paralyzed normal socio-econo-cultural life. Sales and marketing promotional activity has come to a seeming halt. Face-to-face marketing efforts have come to a naught. For the first time ever, the dynamic field salesperson has been tethered to his/her residence. Face-to-face detailing is the fulcrum of the pharmaceutical marketing process.
| Digitalization to the Rescue|| |
The advent of digitalization has carved a sophisticated role in the hi-touch and hi-tech era of pharmaceutical marketing. The present digital spurt has happened due to the stop of market movement by field personnel. This has led to pharmaceutical companies looking to engage doctors with MRs through the digital route. This trend is called omnichannel (groundwork + digital) constellation of services focusing on digital reach and smart technology [Figure 1].
Digital media facilitates access to end-users and physicians in an economical way. In a cross-sectional study by Muacevic et al., involving 718 physicians, the digital habits of physicians to gain medical information were studied. In this study, it was seen that 76.20% of the physicians used Facebook as the preferred social media platform. Instagram users were 18.40%, Twitter users were 18.00%, and ResearchGate users were 9.30%. Digital doctor–patient interactions were also on: 44.47% was on WhatsApp and 13.10% was on short messaging service. Among the pharmaceutical industry digital tools, WhatsApp was the medium with extent of 29.94%, informative websites 26.70%, and mobile applications 20.60%. E-detailing, tele-detailing, webcasts, podcasts, self-directed web detailing, and marketing e-mails were used to lesser extent. Interestingly, webinars and webcasts had the highest influence for inducing change in clinical practice (up to 48%), websites influenced to 42%, mobile applications influenced to 41%, WhatsApp influenced to 37%, and self-directed web detailing 36%. WhatsApp engagement through images and videos by pharmaceutical marketers has emerged as a top tool of pharmaceutical digital engagement in the present context. This study on digital habits has revealed that doctors use WhatsApp as the medical digital communication tool. Less frequently available tools were e-detailing (8.1%), webinars/webcasts (7.7%), tele-detailing (6.0%), self-directed web-detailing (5.2%), and marketing e-mails (4.2%). This study was focused for Pakistan market. Social media is highly influential because posts get repeatedly shared with thousands viewing these posts from the pharmaceutical company and thus influence; further, it is possible that internet surfers are exposed to illegal pharmacies, which is dangerous.
Another adaptation available for pharmaceutical companies in times of COVID-19 or other pandemics, where face-to-face selling is disturbed, is e-detailing, which has proved valuable in certain contexts. In a study conducted on e-detailing in Iowa, USA, virtual interactive e-detailing and video e-detailing formats were assessed for their impact on physicians. The physicians' adoption of e-detailing was studied mail survey, random sampling of 2000 physicians; through logistic regression and Rogers model of adoption analysis, it was seen that 21.00% of physicians adopted e-detailing, which is statistically significant. This e-detailing is an adaptation available for tough times like COVID-19 to pharmaceutical marketers.
Chat messengers and social media networks are vital adaptation strategies in COVID-19 times. As per Said et al., digital social media and chat messengers are most effective for direct-to-consumer (DTC) advertising. Information from healthcare websites was also contributing to the empowerment of the consumer. It is to note that pharmaceutical marketers in India like Cipla have increased DTC advertising in COVID-19 times, to targeted viewers, like affordable customers watching YouTube, where mouthwash gargles are being advertised. This is clearly a good adaptation, and for DTC – chat messengers and social media messengers need to be used for viral marketing.
The beauty of internet is that this is an information superhighway that combines several communication tools of which social media is popular. It is surmised that pharmaceutical companies have more scope to use social media for building corporate and product image and thus reputation. There is scope for social cause marketing ensuring building reputation and product and/or corporate image using social media and internet – this is an ideal adaptation strategy in COVID-19 times. Recognizing the power of internet, the US FDA too underlines the importance of internet-based communication; this lead can be used by companies for building sales. This is because people generally use the internet for gaining healthcare information. However, online information can also be misleading warns a study. People can fall prey and are vulnerable to misleading online pharmaceutical marketing. This can happen due to excess blind trust and reliability, internet dependence, pharmaceutical firm influence, social isolation, and excess interest in details. Kim has written a paper on the trouble spots in online prescription drug promotion, and this can be globally accessed by netizens and not just by the USA citizens. This paper highlights that fair and balanced presentation of health and drug information is required so that customers do not get misleading data. As social media messaging is increasing by pharmaceutical companies, the US FDA is facing challenges to monitor this flow of information. In this regard, the accountability on messaging about a drug in social media is being highlighted by the US FDA. Electronic DTC marketing in the free internet information superhighway has resulted in unhindered messaging, so posing a threat to public health and safety. This is a global genuine concern.
Pharmaceutical companies have launched repurposing clinical trials for drug repositioning in COVID-19 treatment. This is an amazing pharmaceutical response with alacrity to the changing situation; it is based on sagacious marketing of a product responding to market requirements. In March 2020, 24 repurposing clinical trials for COVID-19 treatment have been identified involving 20 medicines. However, a danger of overzealous pharmaceutical marketers is the havoc of illegal online pharmacies that are internet dangers to world public health, safety, and cybersecurity. Hence, an international consensus is needed to tackle this problem, since gullible patients can be exploited in times of pandemics.
Pharma consultants opine that pandemic COVID-19 has shifted engagement with doctors to digital detailing mode. Leading pharmaceutical company's MRs leveraged on digital tools and reached out to doctors. There has been an unprecedented rise in omnichannel marketing and medical education; digital adoption has increased exponentially. Thus, there are remote online product launches, launch meetings, representative detailing, and other engagements being digital. The other trending is patient-centric pharmaceutical marketing with digital engagement strategies on therapy engagement and lifestyle modification. This has led to better health outcomes. Personalization of messages is possible through digital reach out; pharmaceutical companies have been advised to flip the digital switch. While using digital, the challenge is ability to indulge in DTC messaging; this however causes increased drug cost.
Digital has become a supportive alternative to face-to-face engagement with target market audiences. Digital trend in society that has increased due to COVID-19 disruption is in line with the trend in movement of doctors and patients to the internet, for satisfying their information needs through web platforms, medical websites, e-detailing, e-CMEs, webinars, video conferencing, telemedicine, and the like. There are clear trends of pharmaceutical companies integrating social media such as YouTube, websites, and other digital tools in their wider marketing strategy. Thus, right initiatives have contributed to the development of a digital strategy in pharmaceutical marketing processes. Digitization of organizational processes including R and D has added to the marketing muscle of Novartis, an MNC for the elderly segment. For adaptation to COVID-19 disruption, digital culture of pharmaceutical companies has certainly helped.
IQVIA, a market research agency has also put out an interesting graphic describing the digital engagement of doctors by pharmaceutical marketers during the COVID-19 lockdown. The infographic highlights that doctors wish to remain connected to the MRs/pharma companies through digital means.
Although pharmaceutical marketing is a legitimate and well-accepted professional activity, there are criticisms of overzealous marketing efforts, leading to accusation of disease mongering. However, patient-centric marketing has taken off only due to digital tools and gained traction in COVID-19 era. Patient centricity of information and communication has gained through social media and apps. There is requirement for a reliable platform and channel that provides adequate quality information to patients to improve benefits and reduce risks. Otherwise, in pandemic season, such misinformation may create havoc in society through propagation of wrong medicinal and healthcare information in the name of patient centricity. It is interesting to note that an interdisciplinary approach helps provide a reliable proper informational channel to patients during the times of COVID-19 pandemic when digital tool use is more. Librarians can collaborate with physicians and healthcare workers to provide patient-centric healthcare. Online pharmacies have become saviors for those who are too busy or are ailing and elderly. Door delivery of prescription medicines is a convenience of digital era. During pandemic season, it is online pharmacies that provide succor. If regulators monitor properly, consumers can benefit significantly through online pharmacies. It is essential to monitor the media as a whole to avoid the possible bias it can create. Over-reporting of health hazards and trending diseases is an unhelpful approach of the mass media. Hence, wholistic approach will help pharmaceutical marketing in trying times like COVID-19.
| Conclusion|| |
Outlier events like COVID-19 infection test the robustness of businesses. Companies with strong processes have the wherewithal to take on the challenge of COVID-19 through digital means and other modern technologies. Being digital is an important approach in sales and marketing, which complements ground-level foot soldiering activity. COVID-19 pandemic has taught pharmaceutical companies to adapt and synergize digital messaging and nondigital traditional sales and marketing approaches. It appears “phygital,” which is mix of physical and digital marketing is the way forward in pharmaceutical marketing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Levy R. The role and value of pharmaceutical marketing. Arch Fam Med 1994;3:327-32.
Patel AJ, Dumatar CB. Influence of medical representative on knowledge, attitude & practice of medical practitioners in private setup. Int J Sci Res 2014. p. 442-6.
Ankush C, Virendra SL, Kiranshanker K, Sreedhar D, Manthan J, Muragundi PM, et al
. A survey on doctor's expectation from medical representative in Karnataka State. Int J Curr Res Rev 2015;7:75.
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al
. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-An update on the status. Mil Med Res 2020;7:11.
Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of underlying diseases in hospitalized patients with COVID-19: A systematic review and meta-analysis. Arch Acad Emerg Med 2020;8:e35.
Indian Pharma Market gains Double-Digit Growth of 10.4% in April, 2019. Available from: http://bit.ly/2LF5K0P
. [Last accessed on 2019 Dec 10].
Gaedeke RM, Tootelian DH, Sanders EE. Value of services provided by pharmaceutical companies: Perceptions of physicians and pharmaceutical sales representatives. Health Mark Q 1999;17:23-31.
Beltramini RF, Sirsi AK. Physician information acquisition and believability. A field experiment on source and type of information. J Health Care Mark 1992;12:52-9.
Lotfi T, Morsi RZ, Zmeter N, Godah MW, Alkhaled L, Kahale LA, et al
. Validity of tools used for surveying physicians about their interactions with pharmaceutical company: A systematic review. BMC Res Notes 2015;8:720.
Lotfi T, Morsi RZ, Rajabbik MH, Alkhaled L, Kahale L, Nass H, et al
. Knowledge, beliefs and attitudes of physicians in low and middle-income countries regarding interacting with pharmaceutical companies: A systematic review. BMC Health Serv Res 2016;16:57.
Brax H, Fadlallah R, Al-Khaled L, Kahale LA, Nas H, El-Jardali F, et al
. Association between physicians' interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis. PLoS One 2017;12:e0175493.
Khazzaka M. Pharmaceutical marketing strategies' influence on physicians' prescribing pattern in Lebanon: Ethics, gifts, and samples. BMC Health Serv Res 2019;19:80.
Spiller LD, Wymer WW Jr. Physicians' perceptions and uses of commercial drug information sources: An examination of pharmaceutical marketing to physicians. Health Mark Q 2001;19:91-106.
Anadaleeb SS, Tallman RF. Relationships of physicians with pharmaceutical sales representatives and pharmaceutical companies: An exploratory study. Health Mark Q 1996;13:79-89.
Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians' attitudes and prescribing habits: A systematic review. BMJ Open 2017;7:e016408.
Gönül FF, Carter F, Petrova E, Srinivasan K. Promotion of prescription drugs and its impact on physicians' choice behavior. J Mark 2001;65:79-90.
Pokharel PR. Promotional tools effect on pharmaceuticals marketing. Saptagandaki J 2017;8:79-84.
Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020;215:108427.
Bernheim B, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al
. Michael Chung Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Available from: https://pubs.rsna.org/doi/10.1148/rad iol. 2020200463
. [Last accessed on 2020 Apr 19].
Koo JR, Cook AR, ParkM, Sun Y, Sun H, Lim JT, et al
. Interventions to mitigate early spread of SARS-CoV-2 in Singapore: A modelling study. Lancet Infect Dis 2020. pii: S1473-3099 (20) 30162-6.
Muacevic A, Adler JR, Jawaid M, Ahmed SJ. Pharmaceutical digital marketing and its impact on healthcare physicians of Pakistan: A national survey. Cureus 2018;10:e2789.
Tyrawski J, DeAndrea DC. Pharmaceutical companies and their drugs on social media: A content analysis of drug information on popular social media sites. J Med Internet Res 2015;17:e130.
Alkhateeb FM, Doucette WR. Influences on physicians' adoption of electronic detailing (e-detailing). Inform Health Soc Care 2009;34:39-52.
Said YB, Bragazzi NL, Pyatigorskaya NV. Prevalence and Perceived Effectiveness of Pharmaceutical Digital Marketing among Community Pharmacies in Saudi Arabia: A Cross-Sectional Questionnaire-Based Survey. Pharmacy 2020;8:9.
Brown JL. Physician Exposure to Direct-to-Consumer Pharmaceutical Marketing: Potential for Creating Prescribing Bias. Am J Med 2017;130:e247-e248.
Syrkiewicz-Świtała M, Romaniuk P, Ptak E. Perspectives for the use of social media in e-Pharmamarketing. Front Pharmacol 2016;7:445.
De Freitas J, Falls BA, Haque OS, Bursztajn HJ. Vulnerabilities to misinformation in online pharmaceutical marketing. J R Soc Med 2013;106:184-9.
Kim H. Trouble spots in online direct-to-consumer prescription drug promotion: A content analysis of FDA warning letters. Int J Health Policy Manag 2015;4:813-21.
Carpentier FR. Considering the future of pharmaceutical promotions in social media comment on “trouble spots in online direct-to-consumer prescription drug promotion: A content analysis of FDA warning letters. Int J Health Policy Manag 2016;5:283-5.
Mackey TK, Liang BA. Pharmaceutical digital marketing and governance: Illicit actors and challenges to global patient safety and public health. Global Health 2013;9:45.
Rosa SG, Santos WC. Clinical trials on drug repositioning for COVID-19 treatment. Rev Panam Salud Publica 2020;44:e40.
Mackey TK, Nayyar G. Digital danger: A review of the global public health, patient safety and cybersecurity threats posed by illicit online pharmacies. Br Med Bull 2016;118:110-26.
Brown JL. Physician exposure to direct-to-consumer pharmaceutical marketing: Potential for creating prescribing bias. Am J Med 2017;130:e247-8.
Bhole L and Verma S. Digital marketing: A road ahead to pharmaceutical selling. IOSR J Bus Manag. p. 61-5.
Ray S. In sickness and in health: Clinical research and social media. Perspect Clin Res 2017;8:73-8.
] [Full text]
Kopilaš V. Person-centered care and access to drugs in the digital environment: To cure or to sell. Croat Med J 2019;60:174-6.
Wagner KC, Byrd GD. Evaluating the effectiveness of clinical medical librarian programs: A systematic review of the literature. J Med Libr Assoc 92 (1) January 2004. J Med Libr Assoc 2012;100:J.
Desai C. Online pharmacies: A boon or bane? Indian J Pharmacol 2016;48:615-6.
] [Full text]
Young ME, Norman GR, Humphreys KR. Medicine in the popular press: The influence of the media on perceptions of disease. PLoS One 2008;3:e3552.
Bomlitz LJ, Brezis M. Professor of medicine. Misrepresentation of health risks by mass media. J Public Health (Oxf) 2008;30:202-4.