Four Digital Saviors Of Indian Pharma During COVID-19
New Guidelines Aid Telemedicine
Executive Summary
From digital marketing to payment systems, electronic solutions are aiding Indian pharma to ensure business continuity during the lock-down. As new guidelines spur adoption of telemedicine and digital tools connect a company to its distribution chain and healthcare professionals, experts say some changes are here to stay, while others might not stick.
As private clinics shut down across India, patients couldn’t get to healthcare facilities due to strict restrictions on movements and hospitals were hit by a government-mandated cessation of elective procedures as well as incidences of COVID-19 among staff. The pharmaceutical industry has witnessed an unprecedented crisis during the pandemic-led lock-down in the country.
Acute and sub-chronic segments saw a sharp dip in sales while the chronic segment also suffered. A report on the impact of COVID-19 on the practice of healthcare professionals (HCPs) by Cognitrex Consultants and SIHMRACI Educations Pvt. Ltd. showed gynecologists saw a 40% decline in their patient base, while plastic surgeons saw a 90% fall.
An initial assessment by IQVIA estimates that growth in the Indian pharmaceutical market could slide to 1-5% in 2020 from earlier predictions of over 10%, against the backdrop of the demand and supply disturbances. (Also see "COVID-19 Disruptions Could Lead To Sharp Slowdown In India Pharma Market" - Scrip, 8 May, 2020.)
Hit by the business disruptions, Indian pharmaceutical companies are now more willing to adopt and invest in digital solutions that will allow them to continue operating during such crises than they were in the pre-pandemic era.
While cloud-based services and data helped continuation of clinical trials, and use of medtech like remote monitoring devices in a healthcare setup ensured that risk to lives of the medical community minimized, the focus in this article is on the use of digital enablers aiding pharma firms’ sales during the pandemic. (Also see "Coronavirus Pandemic Accelerating Shift To Digitally-Enabled Innovation" - HBW Insight, 2 Jun, 2020.)
Digital modes of communication between a company and its distribution chain, its field force and HCPs, and HCPs and patients, have helped. While some of the tools or practices might be here to stay, others are unlikely to entirely stick after conditions return to normal, say experts.
Scrip delves into four such solutions that have helped the industry maintain business continuity.
Digital Marketing
Unlike certain developed markets, companies in India depend to a significant extent on prescriptions by HCPs, given that there are multiple companies selling a generic drug. The traditional reliance on HCPs has resulted in a model which leverages a large sales/field force to drive sales.
While some companies have invested substantially in digital marketing tools, others haven’t and so have been unable to quickly pivot to them at a time when physical visits by their medical representatives (MRs) are not possible given the lock-down.
The initial assessment by IQVIA revealed that while 77% of HCPs believe it is important to maintain contact with pharma companies during the COVID 19 phase, only 64% of them were contacted by these companies. The data would have changed since, nevertheless it reveals gaps in digital marketing strategies.
Most companies are using simpler tools like text and WhatsApp messages as well as emails to communicate directly with HCPs while webinars are being organized to provide HCPs with updates in their fields of specialization along with information on the relevant products of the sponsor.
“A vast majority of pharma still believes that the crisis is short-lived, and life will go back to normal very soon. Hence, they are not yet convinced about digital transformation which is capital intensive in companies that do not have that infrastructure. Companies that do, are also still making half-baked attempts at engaging customers online with the belief that their sales forces will return to the market soon enough,” Salil Kallianpur, a former executive vice-president at GlaxoSmithKline PLC in India who now runs a digital health consultancy, told Scrip. (Also see "COVID-19 and What Doctors Expect From Pharma In India" - Scrip, 1 Jun, 2020.)
“In a situation where brand recall is the only differentiator, MRs play a significant role in what a doctor prescribes. They develop a personal rapport with physicians and have deep insights. Then you have the issue of offering incentives to doctors, which might not be ethical but it’s a practice that is deeply entrenched in the system." - industry expert
“Companies are taking a multichannel rather than single channel approach during this time. However, in a country like India where labor costs are economical, companies have always maintained a substantial field force and this is unlikely to change in the near future despite the current challenges,” said Anup Soans, a former industry professional who is currently a digital media enthusiast and author of multiple books.
“Information has always been available to HCPs, whether it’s via a website or product brochures, however access and attention have been deficient,” he observed.
Dr Vivek Shetty, joint replacement surgeon and consultant orthopedic at P D Hinduja National Hospital in Mumbai, told Scrip that a few companies like Zydus group's Cadila Healthcare Ltd. have sponsored webinars and it came to a point where two to three were being organized every day, but he feels that this strategy has run its course as fatigue for the medium has set in.
Digital modes of marketing are more likely to find favor among the newer generation of HCPs while the older generation might find it difficult to adapt, experts say.
Online pharmacies and consulting platforms
Online pharmacies like Netmeds, 1 mg, Medlife and PharmEasy offer customers the convenience of door-step delivery. Along with deep discounts, delivery has been a draw for customers who worry about exposure to COVID-19 during a physical trip to the chemist.
Medlife serves customers in 29 states and 4,000 cities fulfilling over 25,000 deliveries daily. CEO Ananth Narayanan recently told local media that the online pharmacy is looking to hire delivery staff as there has been an up to 200% upsurge in the number of orders, while deliveries are at 60-70% of what it used to fulfill.
In fact, demand has surged to an extent where online pharmacies are now cutting marketing spends and even offering lower discounts to customers as they are assured of sales. Strong growth has been forecast for the e-pharmacy market in India.
Digital platforms like Practo, Lybrate, Ask Apollo and Just Doc have helped HCPs who run private clinics to keep consultations going at a time when clinics are shut or patients are unable to reach them due to restrictions on movements. Even online pharmacy 1mg, which now also offers remote consultations, has seen a quantum jump in the number of paying customers.
RedSeer Consulting has upped its estimate of the global digital health market to $25bn in FY25, compared with its pre-COVID-19 estimate of $19bn, with medicine delivery continuing to comprise a large share of the market. India’s digital health market will expand to $4.5bn in this fiscal year, compared to $1.2bn in FY20, the consultancy said.
While regulation is still developing, most leading e-pharmacies claimed to transact with customers through offline pharmacies and comply with the current laws. (Also see "India Pharma 2020: Trends That Can Change Business Tempo" - Scrip, 8 Jan, 2020.)
Digital Payment Solutions
Digital payment gateways within teleconsulting and online pharmacy apps as well as independent digital payment apps have kept transactions within the healthcare system going.
Normally, private clinics prefer cash payments, but patients are insisting on using digital apps since the lock-down has made cash withdrawals difficult. The Cognitrex-SIHMRACI study shows Google Pay and Paytm are preferred while internet banking is barely used.
Apart from this, digital solutions are also being adopted in the pharmaceutical distribution chain. A recent service by AIOCD-AWACS offers stockists of pharmaceutical companies the option of using a digital payments system instead of physical checks that are currently in use.
Apart from avoiding visits to a bank or ATM to physically deposit the checks, the free service also helps avoid charges on bounced checks and payments made via cards. Additionally, reminders are sent to stockists to maintain an account balance in line with the credit limit assigned to them by a clearing and forwarding agent (CFA) appointed by the pharmaceutical company.
“Normally, a CFA has post-dated checks given by stockists based on the credit limit fixed for each stockist. If a CFA sells products of 50 pharma companies and supplies to 50 stockists of each company and there are two to three billing cycles in a month, which is generally the case, the CFA has to deposit 5,000-7,500 checks at a bank in just one month,” Rakesh Dave, president of market research agency AIOCD AWACS, told Scrip.
“Imagine the hardship of doing so these days and the time taken for a check to clear. Instead of that, we have details of each stockists’s current account details on our portal, a CFA raises an invoice, the stockist gets an alert and dues are cleared smoothly,” he added.
Stockists of some top pharmaceutical companies like Sun Pharmaceutical Industries Ltd., the Indian subsidiary of Abbott Laboratories Inc., Mankind Pharma Ltd. and Cadila Healthcare are using this service and more are exploring the option driven by operational continuity concerns, he added.
Teleconsulting
Telemedicine is not new to the country, with Apollo Hospitals’ Apollo Telemedicine Networking Foundation having been set up in 1999, however telemedicine practice guidelines issued by the government on 28 March have helped drive its adoption during the nationwide lock-down.
So far operating in a regulatory grey area, telemedicine has gained credence as registered medical practitioners are free to consult patients via phone, video, and chat applications including telemedicine platforms and WhatsApp. The guidelines, formulated by the government think tank NITI Aayog, were notified under the Indian Medical Council (Professional Conduct, Etiquette, and Ethics Regulation, 2002).
Experts say teleconsulting has helped to keep sales going during the current lock-down when new prescriptions dropped. IQVIA’s survey of 500 HCPs during 5-9 April, showed that while HCPs use multiple channels of communicating with customers, telephone calls and WhatsApp are preferred.
Conducted among over 2,300 doctors in 16 Indian cities between 24 March to 2 May, the Cognitrex-SIHMRACI study shows that among the general practitioners surveyed
- 60% communicated with their patients over the phone
- 22% via mobile applications (apps) like WhatsApp, Google Duo and Facebook messenger
- 15% through live video calling apps like Zoom, Skype and Microsoft Teams
On the other hand, hematologists interacted with patients on the phone 45% of the time while 35% were contacted via mobile apps and 20% through live video apps.
In fact, state governments have been urged to drive telemedicine use. Tweets from twitter handles of several state governments have shown or mentioned such consultations even in remote areas. With a physician-population ratio of 7.6 per 10,000 of population against the 10 per 10,000 recommended by the World Health Organization, telemedicine’s potential in India is huge.
“Teleconsulting is a useful tool, especially for senior citizens and for those who have had surgical procedures recently. It’s particularly handy now for other patients as well who need follow-ups – in fact, my colleagues tell me that they’re likely to continue with this practice as it saves time and money for patients,” said Dr Vivek Shetty of P D Hinduja National Hospital.
However, it’s important that they have already met the medical professional earlier and a physical examination has been done, he said.
Setting up good teleconsulting facilities needs large investments, which is easier for larger hospitals to do rather than smaller set-ups. Besides, patients’ unfamiliarity with technology is a barrier to adoption, he added.
Dr Rakesh Ranjan, consulting neurosurgeon at Aditya Birla Memorial Hospital and Jupiter Hospital in Pune, agrees, saying it’s easier done at hospitals where payments are handled smoothly and the patient-doctor interaction is recorded, but it’s not feasible if proper data cannot be maintained, which is important from a legal point of view. It also doesn’t work if payments can’t be made by patients remotely.
So, while telemedicine will not “substitute physical visits completely, more people will be forced to adopt it in some form.”