The future has bewildered man ever since he walked the Earth. The absence of the ability to see the future forced us to learn from history. Observing events unfolding in chronology and consequence can teach us to expect what tomorrow may hold for us as a consequence of our doings today. As more lies at stake, our eagerness to know increases many fold. This phenomenon gave rise to an entire industry which now capitalizes upon that basic need. Aptly called business intelligence, it is an oxymoron to few and inconsequential to others. However, to the majority of business leaders it serves as a vital crutch.
The pharmaceutical industry has billions of dollars at stake in India and analysts estimate the size of the opportunity to accommodate tens of billions more as diseases and disorders threaten human life with pain, discomfort and death. From this springs the bewilderment of what the Pharma Future will hold for the industry in the days, weeks and years ahead. Conclaves are one way to assemble the more knowledgeable executives of the industry and pool their wisdom of the past and understand how they see the future unfold. At one such conclave, titled Pharma Future Knowledge Conclave 2011, organized by Indegene Lifesystems, at the Four Seasons hotel in Mumbai, interesting insights emerged as executives who spent over two decades bounced off ideas and insights with young and eager ones who will eventually receive the baton of the industry in a few years.
Disappointingly, most executives believed the future would not be too different from the present especially since nothing much changed over the last two decades. The pharmaceutical industry inIndia is considered a slow adopter of new technology, new media and – simply put – new ways of doing things. The inertia is more obvious on the commercial front given the dynamism of its customer-facing nature. On the more strait-jacketed back-end, the industry has been fast to adopt best practices in functions such as managing the supply chain and formulation R&D etc. After all, reverse engineering and the expertise that India demonstrated in producing low-cost and high quality products and services resulted in rapidly making it the chosen destination for manufacturing, R&D and medical value travel (also known as medical tourism).
Does this mean that while the Indian industry is quick to improve on existing processes, it is not so quick to establish new ones? That India is a unique market has been stated ad nauseum by industry leaders at almost every forum. Despite this, little progress is seen to leverage the uniqueness. Emerging markets is a buzzword at global headquarters of every MNC. Yet, every business model developed by every company looks and feels the same. Foray into branded generics, expand into the rural hinterlands and expand sales forces to increase reach. Hardly anything novel here, excepting that novelty will lie in execution. Companies, when faced with the same environment, challenges and opportunities chose to react to it in almost the same way. The actual execution of those plans will set the men apart from the boys.
So, if field forces expand and companies bring in more generic brands instead of novel products will that not mean more pharma reps discussing more brands with the same doctors? This means a sharp reduction in access to doctors as they restrict the number of days they would see reps and the number of reps they see on those days. How should pharma react? Should it adopt technology? What role will technology play? Will companies reduce field forces as cost effective alternatives to technology? Will e-detailing and e-marketing replace pharma reps? Not quite it seemed. Access to the clinic is limited. Access to mindshare is not. If companies demonstrate a willingness to work with doctors to improve outcomes for their patients, doctors are likely to accept the company as a partner and not view it as an infringement on his time and decision making. This seems idealistic just yet as this approach is a long drawn one. Doctors inIndia seldom practice in groups. Every doctor, even when attached to private hospitals, is an independent consultant. This increases the complexities of the partnership equation as each doctor has unique needs and requirements. Can pharma evolve to a mass customization model? If so, how quickly?
From its current focus on products and productivity the transition of the pharmaceutical business model to one that bundles products with services, customizes offerings to each individual customer and leverages technology to reach out to many more customers than now opens up the need for vast amounts of data. How much data is enough? Data, sometimes, never seems enough. Most often data that gets you to a “yes-no” decision is enough. Can executives differentiate when to ask for more and when to use what is available when business models move from being product focused to becoming customer focused? The critical difference is between data and insights. We may sometimes have an overload of data and a deficit of insights. Knowledge of the customer and insights that you derive from that knowledge can never substitute business intelligence tools, however sophisticated. In-depth understanding of customers can only happen from more and more face-to-face interaction requiring human intervention. Technology therefore, will augment the sales force effort and not substitute it.
Yet why is technology adoption so poor in the Indian pharmaceutical industry? Most business practices that have been adopted inIndiahave at some point been tried and tested in the West. Does this makeIndiaa wait-and-watch market? Even if it does, technology has been tried and tested in the West for many years now. So, let’s just go ahead and adopt it. If we do, does that make us seem as if we’re aping the West? Should iPads be used as detailing tools inIndiajust because reps in the West use them? The point here is that technology should be used only if it makes sense. There is little to gain if we tweak existing and time-tested processes that continue to deliver results, just for the heck of it. Technology is simply an enabler, not a means in itself. Ask yourself how long the novelty of detailing with an iPad last if the content on it remained stale. Now ask yourself how easy it becomes to quickly update the latest clinical data on the iPads of the sales force using technology.
It seemed from the discussion that the Indian Pharmaceutical industry did not expect too much to change. Whether or not it allowed its processes to be technology enabled, its focus on core marketing, alliances, M&A and other ways to create more value for the patient was heartening. The little or no demonstration of understanding technology and imagining the wonders that it would help create across the continuum of patient care was disappointing. The use of genomics and personalized medicine (despite Pfizer being close to launching Crizotinib, its first personalized drug for lung cancer) was completely overlooked.
The focus lay too much on discussing the adoption of technology rather than on what new processes would evolve from path-breaking technology. Despite India being the capital of chronic diseases (CVD, diabetes, smoking) there was little or no discussion on how health leaders will become agile caretakers of interdependent networks (referral physicians, tertiary care specialists, pharmacists, fellow-patients, colleagues & peers, family, friends etc.) that grow smarter as they get to know and support each individual patient. Both the young and the old are developing chronic diseases in record numbers, leading to explosive growth in the consumption of resources that is driving up spending and creating liabilities for future generations (ask survivors of cancer patients). It is widely accepted that chronic diseases are associated with behavioral, socio-economic, and genetic factors that are not within the control of today’s medical delivery system. There is a lot that the pharmaceutical industry can do in this relevant area considering that one of the ways in which the Indian market is unique is that it’s a self-pay market.
The pharmaceutical industry can explore robust value creation and revenue generating opportunities in areas that will help prevent onset of chronic diseases or assist chronically ill patients manage their disease in cost efficient ways. What is happening to healthcare is no different from other industries—the power of the individual is increasingly influencing how healthcare is directed and delivered, enabled by the technological and the virtual world we live in. And this is by no means a Western phenomenon. This is the future of the pharmaceutical industry in India. The Pharma Future.