Brand Project-RosulipSwapnil Waichale

Project OutlineSecondary Research Primary Research Findings &

Recommendations

Objective of Secondary Research:1) To find out indications in which the molecule Rosuvastatin is

used2) To find out what other substitute molecules can be used under

same indications3) To find out competitive brands in the market, their shares and

growth rates, size and growth rate of the market4) To Understand the types of doctors involved 5) To understand current Cipla strategy for Rosulip6) To understand the way it is implemented in the fieldSources of Information:1) www.CiplaMed.com 2) Online Journals 3) Rosulip ORG Data4) Vitalis PPT 5) Rosulip PMT, Mr. Vishal Kucheriya 6) SM/BM

Vitalis

Project OutlineSecondary Research Primary Research Findings &

Recommendations

References Used:1) http://ciplamed.com/articles/dyslipidemia-essence-series-0?spec=

12) http://ciplamed.com/slide-library/diabetic-dyslipidemia?spec=13) http://ciplamed.com/articles/atherogenic-dyslipidemia-questions-

and-answers-dr-abhimanyu-garg-usa?spec=14) http://www.apiindia.org/pdf/medicine_update_2010/diabetology_2

5.pdf5) http://www.ijem.in/article.asp?issn=2230-8210;year=2012;volum

e=16;issue=2;spage=240;epage=245;aulast=Dalal6) http://www.who.int/gho/publications/world_health_statistics/EN_

WHS2013_Full.pdf7) http://www.biomedscidirect.com/download/IJBMRF2011208/13/o

besity_and_dyslipidemia

Project OutlineSecondary Research Primary Research Findings &

Recommendations

References Used:1) http://www.ncbi.nlm.nih.gov/pubmed/236445552) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582048/3) http://www.ncbi.nlm.nih.gov/pubmed/223608204) http://www.ncbi.nlm.nih.gov/pubmed/214989065) http://www.mdpi.com/2072-6643/5/7/27086) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656667/7) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681027/

Findings of the Secondary ResearchNCEP Guidelines: All adults over the age 20

should have a 12 hour fasting lipid profile once in 5 years

Overall prevalence of dyslipidemia in India ranges from 10-73% (Dibetology Medicine update 2010, API India)

Prevalence of Hypercholesterolemia: 28% in Urban subjects and 22% in Rural subjects

ADA Guidelines TargetsLipid TargetTriglyceride (TG) < 150 mg/dlLDL Cholesterol < 100 mg/dlHDL Cholesterol > 40 mg/dl

Findings of the Secondary ResearchIn urban New Delhi, Prevalence of Hypertriglyceridemia

was 61% in non-obese subjects, and 73% in obese subjects

24% of urban population of north India had low levels of HDL Cholesterol

Population based studies: High triglycerides in upper SEC due to high fat intakeHigh triglycerides in lower SEC due to high carb intake

Type-2 Diabetes pattern Dyslipdemia (Parikh et al)High LDL, Low HDLHigh LDL in males, Low HDL in females as bigger

threat

Findings of the Secondary ResearchTypes of Dyslipisemia

Manifestations of DyslipidemiaNo SymptomsMay be diagnosed after a myocardial infarction or strokeXanthomas : intra- and extra-cellular deposition of

cholesterol

Type CausesPrimary Several monogenetic disordersSecondary •Non-genetic

•Hypothyroidism, Obstructive Liver Disease, Nephrotic Syndrome, etc. (Hypercholesterolemia)•Obesity, Diabetes, Pregnancy, Chronic Renal failure, Alcohol, etc. (Hypertriglyceridemia)•Type-2 Diabetes mellitus, Rheumatoid arthritis, Malnutrition, Obesity, Cigarette Smoking, etc. (Low HDL)

Findings of the Secondary ResearchConsequences of Lipid Abnormalities• Coronary Heart Disease (CHD)• Stroke• Peripheral Artery Disease (PAD)

Management of Dyslipidemia• Therapeutic Lifestyle Changes (TLC)

• Reduced intake of saturated fats (<7% of total calories) and cholesterol (<200 mg/day)

• Therapeutic options for enhancing LDL lowering such as plant stanols sterols and increased viscous fiber

• Weight reduction• Increased physical activity

• Drug Therapy

Findings of Secondary researchDrugs affecting Lipoprotein Metabolism

Fibric Acid Brand: FenolipCombinations: Atorlip-F, Rosulip-F

Drug Class EffectsHMG-CoA Reductase Inhibitors (Statins)

LDL Lower 18-55%HDL Rise 5-15%TG Lower 7-30%

Fibric acids (Fibrates) LDL Lower 5-20%HDL Rise 10-20%TG Lower 20-50 %

Nicotinic Acid (Niacin) LDL Lower 5-25%HDL Rise 15-35%TG Lower 20-50%

Cholesterol Absorption Inhibitors (CAL)

LDL Lower 17%HDL Minimal ChangeTG Minimal Change

Bile Acid Sequestrants LDL Lower 15-30%HDL Rise 3-5%TG No change or Rise

Statins Cipla Brands

Simvastatin Simcard

Atorvastatin Atorlip

Rosuvastanin

Rosulip

Lovastatin

Pravastatin

Fluvastatin

Secondary Research on StatinsRosuvastatin is more effective compared to

Atorvastatin in reduction of sdLDL levels.Most Effective LDL-C Reduction Doses

All three safe in muscular and hepatic functionsRenal Safety: Atorvastatin > Rosuvastatin > PravastatinRosuvastatin is most effective statin at reducing

LDL-C, Triglycerides, and total cholesterol at lowest dose of 10 mg.

Moreover, it reduces HDL-C the least, compared to other statins

Rosuvastatin 10

Atorvastatin 40

Pravastatin 20

29.03% 22.8% 20.3%

Secondary Research on Statins Patients with Acute Coronary Syndrome are recommended for early

aggressive low-density lipoprotein (LDL) cholesterol-lowering therapy. 

LUNAR study: RSV40 more effectively decreased LDL cholesterol, increased HDL cholesterol, and improved other blood lipid parameters than ATV80 in patients with acute coronary syndrome.

Patrol Trial: The safety and efficacy of these 3 strong statins are equal. It is suggested that the use of these 3 statins be completely dependent on physician discretion based on patient background.

In patients with the metabolic syndrome, despite attainment of LDL cholesterol goals, these patients may retain considerable residual coronary heart disease risk.

Patients with the metabolic syndrome may have relatively normal LDL cholesterol when LDL particle concentration is elevated because these patients have a preponderance of small, cholesterol-poor LDL particles.

Thus, LDL cholesterol may underestimate risk in patients with the metabolic syndrome.

RSV was more effective than ATV in reducing LDL cholesterol (P < 0.001), LDL particle concentration (P < 0.05), and non-HDL cholesterol (P < 0.01) after 6 and 12 weeks.

Secondary Research: Stroke & StatinsLarge clinical trials have shown that statins reduce the incidence of

cerebrovascular events. In addition to their cholesterol lowering properties, statins exert a

number of pleiotropic, vasculoprotective actions that include improvement of endothelial function, increased nitric oxide (NO) bioavailability, antioxidant properties, inhibition of inflammatory responses, immunomodulatory actions, regulation of progenitor cells, and stabilization of atherosclerotic plaques.

long-term statin treatment reduces stroke riskCombined data from 9 trials including 70 070 patients indicated

relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins

Rosuvastatin reduces by more than half (51%) the incidence of ischemic stroke among men and women with low levels of LDL-C levels who are at risk because of elevated levels of high-sensitivity C-reactive protein.

Sources: Stroke, Journal of the American Heart Association 2004, 2010, 2103.

Project OutlineSecondary Research Primary Research Findings &

Recommendations

Objectives of Primary Research:1) To understand the level of awareness in public regarding

Dyslipidemia2) To understand the therapy choice of doctors 3) To understand affinity of doctors towards brands, and reasons

behind them4) To understand how Cipla can partner with Doctors, in order to

enhance timely detection of Dyslipidemia5) To understand the purchasing and compliance behavior of

patientsMethodologies to be used:1) Public awareness survey 2) Patient Survey 3) Discussions with Doctors 4) Lipid Profile Check-up Camp Observation 5) Retail Survey

Interaction with Doctors in EASD WebcastDr. Mahendra Wawhal, Asst. Professor, MGM

After 3 months, repeat lipid profiles are checked, and doses are adjusted/titrated according to lipid levels and patient compatibility (Side effects, etc.)

Percentage ratio in Practice: Atorvastatin : Rosuvastatin :: 60 : 40

Atorvastatin: Good ResultsRosuvastatin: Less Dose, better resultsConcern area for Rosuvastatin: Safety in Elderly Patients

Indication DrugChronic Stable Angina Rosuvastatin 40 mgUnstable Angina Rosuvastatin 40 mgTriple Vessel Disease Rosuvastatin 40 mgAfter Heart Operative Procedures

Rosuvastatin 40 mg

Interaction with Doctors in EASD WebcastDr. Amit Choradiya, Sr. Resident, MGMAcute Coronary Syndrome: Rosuvastatin 40 mg or

Atorvastatin 80 mgSurgical Intervention: In Clinic (7-15 days) & 1 month,

Rosuvastatin 40 mg or Atorvastatin 80 mg is prescribed.After one month, lipid profiles are rechecked, and depending

on results and patient compatibility, further doses are decided.

Transient Ischemic Attack (TIA) & Cerebrovascular Accident (CVA): 10mg & 5 mg are preferred (Lower Doses)

Depending on TG levels, Fenofibrate Combination is prescribed.

When asked on selection between Atorvastatin and Rosuvastatin, he says, “It’s like choosing between Maruti 800 and Swift. Both serve the purpose.”

Interaction with Doctors in EASD WebcastDr. M. B. Pisolkar, Sr. Physican (Old Doctor)Atorvastatin is molecule of choice, Rosuvastatin has

more side effectsStarting Dose he prescribes is Atorvastatin 80 mg. Lipid Tests every monthWithin 3-4 month, Patient comes to maintenance dose

of 10 mg.Conducted study on 200 patients, in which he started

statins. Statins he continued for 15 years. 90% of patients did not suffer any problems, and he found their angiography to be perfectly normal.

Interaction with Doctors in EASD WebcastDr. R. Kharkar, Sr. Physician (Old Doctor)Individualized Treatment plan for every patient,

according to lipid profiles3 Month Repeat check-ups for further titrationAtorvastatin as molecule of choiceRosuvastatin is unsafe due to renal and other

Side-effectsOther Doctors:

Young Doctors preferred Rosuvastatin more compared to old doctors, who preferred Atorvastatin

Interaction with Cardiologists during callsDr. Magarkar Dr. Shirish

DeshmukhDr. Deodhar Dr. Kalbande

• After procedures (Peripheral Coronary Intervention, Angioplasty, etc.), A high dose of Atorvastatin 80 mg is used for a period of 7-30 days.

• After further lipid tests, dosages are lowered to 20/40 mg as per patient needs.

• Lifelong maintenance dose: Atorvastatin/Rosuvastatin are used in small dosages.

• No one preferred Rosuvastatin 40 mg.• Dr. Magarkar, however mentioned that he is on shift to

Rosuvastatin.

Interaction with Nephrologists during callsDr. Borkar S. S., Kamal Nayan Bajaj HospitalLow doses of Atorvastatin are prescribed in patients with

CKDPrefers monotherapy to combinationsShifting focus on Rosuvastatin (Low dosages)Does not need Atorvastatin 80 mg or Rosuvastatin 40 mgDr. Sudhir Kulkarni, MGMCustomized treatment according to lipid profilesAtorvastatin 10/20/40 are used mostly. Concerned about renal safety in Rosuvastatin usage

Synopsis of Insights from doctorsPhysicians & Diabetologis

ts

• Low shares of 40 mg Rosuvastatin• More shares of 5/10/20 mg• Young Doctors preferring Rosuvastatin

Cardiologists

• Interventions: 40 mg rosuvastatin• Also 5/10/20 mg• Young Doctors preferring Rosuvastatin

Nephrologists

• 5/10 mg most common• Concerned about renal side effects

Competition is huge, and every company is offering Lipid Profile Test Coupons, Expensive Gifts, Conferences Invitations, etc.

Doctors are not brand loyal. They prescribe as per the activities/expenditures by companies on them.

Retail Survey of Chemists with Neurologists and Neuro-SurgeonsSM Vitalis noticed potential for statins at a

neurologist, Dr. UkadgaonkarHe has added him in MSLHowever there is no focus on other

neurologists and neurosurgeonsIn order to assess neuro-potential of statins

and competitive status, we are carrying out this Retail survey

Results: Refer Next Slide

Neurologist Retailing FindingsChemist Statin Monotherapy CombinationShree Medical, Dr. Majid

70 strips-Atorvastatin (10/20/40)10 strips-Stator 80 mg200 Strips-Coltro (Rosuvastatin)30 Strips-Novastat 10

150 strips-Atorfit CV

Max Medical, Dr. Devdatt Deshmukh

40 strips-Rosuvas 90 strips-Ecosprin 75/150

Bajaj Medical 30 strips-Tonact 10/2030 strips-Tonact 80 mg30 strips-Rosuvas

40 strips-Ecosprin 75/150

Dr. kanjalkar, Manik Hospital

40 strips-Atorva 10/2010 strips-Stator 1040 strips-Rozavel 10/20

Sachin Medical, Dr. Panse

20 strips-Atorvastatin 10/2010 strips-Rosuvas 10

Dr, Anand Soni, MGM Hospital

10 strips-Tonact 10/20 20 strips-Ecosprin 75

Brain Medical, Dr. Ukadgaonkar

180 strips-Atorvastatin 10/20/4020 strips-Rosuvas 10

Patient Awareness Survey Conducted a survey among 50 OPD patients in Hedgevar Hospital All patients more than 40 yrs age selected (Range: 40-72 yrs)Findings: 29 people with no Lipid Profile Test (LPT) so far 12 people with Associated Risk factors (Family History, Obesity, etc.) Among 21 who did LPT, 16 cases were recommended LPT by doctor when

they approached Doctor for 10 cases with Diabetes & Hypertention 6 cases with Unrelated ailments (Allergy, Foot Ache, Stone Operation, etc.)

Patient Age (Some Cases) First LPT72 (Diabetes, Hypertention) After Angioplasty (At age of 56)

66 (Diabetes, Hypertention) Last Week! (At age of 66)

63 (Diabetes, Hypertention) 2 months back (At age of 63)

51 (Diabetes, Hypertention) 3 months back (At age of 51)

55 (Hypertention) 3 yrs back (At age of 52) Regular Since then

50 (Hypertention) 4 yrs back (At age of 46) Regular Since then

50 Female (Foot ache Visit: => LPT)

At the age of 50

What is the need to do LPT? When I am absolutely fine?

We do not know such things

Patient

Patient Segmentation

Urban• More Awareness in higher Income groups• Access to healthcare

Rural

• Unaware mostly• Lack access to Healthcare, need to visit cities• Try to avoid Dr. visits due to economic troubles,

unawareness, etc.

Unaware

At risk

• In spite of family history, diagnosed diabetes/hypertention, obesity, etc.

• Lack of knowledge, Lack of access, etc.

Competitive Price Analysis

Strategic Pricing of DRL:• The 40 mg and 80 mg Doses are priced minimum

• These are the doses, given first time to the patient• Atocor 80 mg comes in pack of 30 tablets, while Atorlip 80

comes in 3 strips of 7 tablets (21 tablets)(less value/Converted prescription)

• The patient are then titrated to lower doses, which are priced higher

• 5 mg and 10 mg are lifelong maintenance doses• Acquire Patient at cheap price, maintain at higher

price!Low Pricing of Abbott• Showing great growth as compared to market

Atorvastatin 5 10 20 40 80 Share Growt Value Units STORVAS Ranbaxy 6.29 9.792 18 24.7 29.4 17.31 2.95 1,15,64,70,155 1,05,84,511 ATORVA Zydus 3.652 10.45 19.85 25.35 36.95 11.35 11.99 75,82,51,099 80,36,016 AZTOR Sun 4.011 6.206 15.9 22.9 28.39 9.61 15.99 64,24,07,473 74,44,298 TONACT LUPIN. 6.615 12.9 21.51 17.64 27.37 9.01 14.69 60,18,91,549 52,48,818 LIPICURE Intas 4.4 7 17.33 21.4 27 6.57 -3.58 43,91,18,320 32,72,262 ATOCOR DRL 6.35 9.2 10.77 16.28 16 4.88 6.71 32,62,95,220 41,52,502 ATORLIP CPL 5.2 9.4 17.3 19.96 23 4.35 -0.91 29,08,10,923 31,95,744 STATOR Abbott 4.22 7.7 16.8 3.65 17 24,36,16,861 59,13,855 Lipikind Mankind 1.9 3.8 1.45 5.84 21,38,45,018 24,95,872Atorvastatin Market 100 6.66 6,68,24,12,146 9,30,39,715

Share Eaters• Zydus

Cadilla• Sun• Lupin• Dr. Reddy’s

Competitive Price Analysis

Strategic Pricing of DRL & USV• Both showing above market growth•Great Pricing strategy for foray into Rural market, which is as good as White Field, due to very less competition•Converting City Doctors Vs. Acquiring Rural Doctors/ young PGs•Cipla CEO Vision: To develop a Reach as good as Hindustan Unilever, to make avaiable medicines to everyone who needs them•Cipla’s Differentiation: Field Force, Portfolio, Pipeline

Rosuvastatin 5 10 20 40 Share Growth Value Units ROSUVAS RBY 6.83 9.50 26.54 39.90 22.64 18.65 65,40,79,646 63,05,564 ROZAVEL SPI 6.19 11.20 20.64 30.20 12.48 38.03 36,05,70,954 43,59,098 CRESTOR AZN 13.09 18.10 32.47 52.75 8.17 17.22 23,58,52,043 15,57,212 ROZUCOR TNT 5.95 11.80 22.40 30.00 7.71 47.34 22,26,60,512 24,60,918 ROSEDAY USV 3.59 5.99 11.99 7.38 54.39 21,32,60,165 51,01,614 NOVASTAT LU. 5.84 10.61 18.59 38.00 5.67 36.46 16,36,74,989 17,11,201 RAZEL GMK 6.60 13.20 23.70 35.00 5.08 46.73 14,67,77,754 16,16,897 ROZAT DRL 3.99 5.85 10.80 18.00 3.64 53.08 10,51,05,181 22,30,254 CREVAST ELS 5.50 10.00 21.60 32.50 2.84 36.02 8,20,99,063 10,94,525 ARVAST IN9 7.20 10.50 23.00 35.00 2.79 16.91 8,04,85,207 7,51,029 ROSULIP CPL 5.60 9.90 15.00 28.00 2.73 29.90 7,87,93,701 10,54,545 ROSAVE AMB 6.10 11.70 22.50 2.37 43.30 6,85,76,723 9,10,412Rosuvastatin 100 31.23 2,88,84,77,298 3,68,30,682

MRP/Tablet

Share Eaters• Sun• Torrent• USV• Lupin• Glenmark• Dr. Reddy’s• Alembic

Competitive Strategies from FieldUSV: Doctor’s Choice Program: 5 top prescribing Doctors are chosen per TM,

and they are given a choice to choose from a list of 5 Gifts/Medical equipment etc.

Conferences: Either Travelling or Stay Costs of Doctors are born Lipid Profile Camp CouponsPiramal: (Old Strategy from Ex-Piramal Cipla person) Their per tablet price was Rs. 3. So they created a buzz around the number

3. They gifted Doctors everything that came in Rs. 3, like balms, pens, etc. 25%, 50%, 100% Lipid profile Test Coupons given to Doctors, depending on

Doctor profiling Conferences, Expensive Gifts to select Doctors LBLs, patient education materials, campsRanbaxy: Lipid profile camps, Diabetic Camps, Multi-Speciality Camps Talk about Legacy Conferences, Expensive Gifts to select Doctors, CMEs, etc.

Everyone is doing the same things!

SWOT Analysis of RosulipStrengths• Descent Prices• Cipla Equity: Quality, Several

Firsts• Camps, Activities: RED4U• Academic Inputs: CMEs,

Conferences• Distribution & Field Force Reach

Weaknesses• Late Market Entry• Less Focus on Rural patients• Me too Brand Strategy: Camps,

Academics, Gifts• Neurologists: Neglected

Segment• So far less focus on Patient

AwarenessOpportunities• Patient Awareness: To enable &

drive patients for regular check-ups

• Rural India: Awareness & Diagnosis

• Pricing Tactics

Threats• Already established competitors• Threat from brand substitution• Highly competitive Market in

Cities• Brand Shifting among Doctors

Strategy RecommendationUrban: Fight It! Rural: Win It!

• Current Strategy is Recommended

• Additionally, More Focus required on getting New patient Share through Diagnosis Camps, & Direct Patient Awareness

• Know Number of new Cipla patients, Number of old patients, their purchasing frequency. Refer to Next slide to know how!

• More focus required on generating relationships with new PGs (0-5 years of practice)

• More focus on Neurologists and Neurosurgeons Segment required

• Urban India: Highly competitive Market! Fight It!

• Align with Mr. Subhanu Saxena’s Vision: To have distribution reach as good as Hindustan Unilever!

• Really make the drugs required by them, affordable! Reduce Prices if needed! (Ref. DRL Pricing Strategy in previous Slide)

• Create awareness in public regarding health check-ups, healthy life-style

• Attach with young PGs to do Diagnosis Camps, Mobile Clinics in rural areas: Provide access to Healthcare

• Rural India: White Field Business Opportunity! Win It!

Patient Loyalty: How to Measure Chemist will handover Discount coupons for repurchase to the

patients, in every New Prescription. These coupons will have a code written over them, which will tell us the

number of New patients. To avail discount, the patient will give one coupon at every repurchase to

the chemist. Company will reimburse the discounted money to the chemist, when the chemist gives these coupons to company. This will tell us number of times of their repurchases.

Business Sense: Discounts will keep people stuck to Cipla brand. In fact they will insist Doctor, that some of my coupons are remaining, kindly do not change my brand!

Connect to patients through Coupons: Take their Contact numbers or ask them to register online on a website, provide them information, services, advice. Biocon provides 24 hrs facility and Diabetic Advisor reach to patient

at home within 2 hours of complaint from patient, especially for Insulin

Chemist Relation: Advice Chemist on getting these patients back to their counters (Their contact numbers, home delivery options, etc.) Develop relationship with the chemist, and enjoy it in Acute therapies’ OTC Sales!

Acquire & Retain your patients!

Thank You