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Cipla

Life care

Medico-marketing module
Cipla
Life care

Let us talk pride, lets talk Rabicip

Recognition

Loved
Rabicip Success
Priority

10% Cont.
Cipla
Life care

Our learning objectives today


How common is ARD (Acid Related Disorder)?

Types of ARD and how it happens?

Opportunity for our brand

Market scenario

Molecular Unique Selling Proposition (USP)

Brand USP

In clinic situations and conversion tips

Our objective for coming months


Cipla
Life care

Symptoms of Acid Related Disease…

Heartburn 95%
Nausea Feeling of abnormal Lifetime
slow digestion

60-70%
Stomach discomfort ARD Abdominal Month
pain bloating.

Excessive burping Early satiety 5-10%


belching Daily
Acid regurgitation

NOT VERY UNCOMMON


Cipla
Life care

Fire…Burning…Pain

Affects quality of life

Significant work days loss and long term


treatment

Hospitalization as 25% of peptic ulcers


develop complications

Definitely Not A Pleasurable Experience


Cipla
Life care

Lets understand
Acid Related Disorders
Cipla
Life care

Parts of Gastro Intestinal System


Cipla
Life care

Mechanism of Acid Secretion


Cipla
Life care

What Is the Optimal Gastric PH for healing

pH 4 Ulcer healing above 4


pH > 5 to 7 For hemostasis: blood clotting and
platelet aggregation

pH > 7 Optimal for preventing ulcer


rebleeding
Cipla
Life care

Acid Related Disorders: Types

Gastritis Acute, Chronic

Duodenitis

GERD (Gastroesophageal Reflux disease)

Gastric ulcer, Duodenal


Peptic Ulcer disease
ulcer

Hypersecretory conditions Zollinger Ellison


syndrome
Cipla
Life care

The Medicines

Antacids
Prostaglandins e.g. Misoprostol
H2-receptor Antagonists
Cimetidine,Famotidine,Ranitidine

Proton Pump inhibitors


Omeprazole,Pantoprazole,Lansoprazole,
Esomeprazole, Rabeprazole
Cipla
Life care

Who Treats
Typical gastro intestinal General practitioner or
symptoms.. Indigestion,Pain in the Gastroenterologists
abdomen, loss of appetite, gas,
abdominal distention etc

GERD asthma, Chronic cough Chest physician

Non cardiac chest pain Cardiologist

Drug induced ulcers


Orthopaedician

Stress ulcers Surgeons and


Intensivists

Opportunity Everywhere
Cipla
Life care

Point need to remember Till Now

Acid related disorder and types

Who treats acid related disorders

How PPI is better than H2 RA


Cipla
Life care

Acid Related Disorders


Focus on the Hospital
Setting
Cipla
Life care

Acid Suppression in Critical Care Settings

1. Bleeding acid peptic disease


Accounts for > 150000 hospitalisations and 8-12000
deaths per year.
2. Stress induced mucosal injury
Usually seen in ICU patients.
3. Acid Inhibition During Surgery

4. Severe Reflux Esophagitis


Cipla
Life care

Point need to remember Till Now

Indication for Rabicip I.V.


Cipla
Life care

Molecular
USP
Cipla
Life care

Are All PPIs (Oral,i.V.) The Same

NO
Cipla
Life care

Pharmacodynamic Differences

Activation
Cipla
Life care

Pharmacodynamic Differences (Cont.)

Proton Pump Inhibition After One Dose


Cipla
Life care
Pharmacodynamic Differences (Cont.)

Metabolism

• Genetic polymorphism
• Inter-patient variability
• Fast or slow metabolisers
Cipla
Life care

Pharmacodynamic Differences (Cont.)

Unique Property

Enhances gastric mucin secretion


Cipla
Life care

Molecular USP

Fastest activation among all PPIs

100% inhibition of Proton Pump in just 5 minutes

Increases gastric mucin secretion by 41%

Greter antisecretory effect over a 24hr period than any other PPI

Efficacy of Rabeprazole is not affected by genetic


polymorphism

Minimum drug to drug interactions


Cipla
Life care

Point need to remember Till Now

Molecular USP of Rabicip.


Cipla
Life care

Market
Cipla
Life care

Key Insights - Anti-ulcerant Market


Doctors’ prefer newer PPI’s (especially Pantoprazole &
Rabeprazole)


Constant ‘hammering’ I.e brand reminder is the need of
the hour
Cipla
Life care

The Market

Total market = 415 Cr


Growth = 9 %
Players = 200 +

138 Cr 118 Cr 109 Cr 27 Cr 23 Cr


6% 14% 18% -2% -14%

Omeprazole Pantoprazole Rabeprazole Esome Lansoprazole


Cipla
Life care

Know your competitor

Omeprazole Pantoprazole Rabeprazole


Omez (DRL) Pantocid (SUN) Razo (DRL)
Ocid (ZYC) Pantodac (ZYC) Rablet (Lupin)

Protoloc (USV) Pan (AK) Rekool(ALMB)


Ometab (INT) Pantop (ARIS) Happi (GR)
Ocid DSR (ZYC) Pantium (INT) Rabeloc (ZYC)

Brands for retailing : All Rabeprazole and


highlighted omeprazole &
pantoprazole brands
Cipla
Life care

What Competitors Are Doing


In clinic PDA, DMC, Gifts

Academic Journals (Am J Gas. – Sun, Endoscopy


clinic - Cadila)
Books – Sun, Cadila
Updates - (Recent advances in
Gastroenterology – Alkem)

Special activity GET cool with REKOOL, Letter campaign


(FDC)

Sponsorship Academic

CME Cadila, Sun, Intas

Gastro club Sun


Cipla
Life care

Targets - Rabicip

Audience
− Gastros, Cons./Chest Phy, Gen. Surgeons, Ortho &
Top GPs
Molecules
− Pantoprazole,Omeprazole & other brands of
Rabeprazole
Indications
− GERD / Reflux Esophagitis
− Acid peptic disorders
− Drug induced gastritis
Cipla
Life care

Pricing and Packaging


Rabicip 20 (15’s) – Rs. 48.58

Rabicip 10 (15’s) - Rs. 34.13

Presentation

Sale pack: Strip of 15 tablets
Cipla
Life care

Point need to remember Till Now

Name of my competitors.

Target specialty and indication for me


Cipla
Life care

How Do We Tackle Competition


Cipla
Life care

Conversion Aid Cum Brand Reminder


Frequency / Qty – In every 2 month / 4-5

Audience - Gastros, Cons.Phy (Selected)

Must communicate:
Reviews 27 of the top general and specialty
medical journals to keep clinicians up to date on
the most important research appearing in the
literaturer
Only Cipla is authorized to provide this
valuable (Rs. 700 / copy) journal to the doctor
Cipla
Life care

Conversion Aid Cum Brand Reminder


Frequency / Qty – In every 3 month

Audience – Only Gastros

Must communicate:
Provides comprehensive information on a
single topic, hence highly respected
worldwide
Only Cipla is authorized to provide this
valuable (Rs. 4000 / copy) journal to the
doctor
Cipla
Life care

Lets Practice

Input handling – GCNA, Journal watch

How to emphasize on importance?

How to take commitment for support?

Some common practices (Pre announcement,


Prior appointment)
Cipla
Life care

Additional Support


Interesting & innovative literature (DMC, 4 pager…)


Gifts
Cipla
Life care

Brand
USP
Cipla
Life care

Brand USP

1.3 minutes
Our strong campaign on activation time

Product services
Revolutionize Hep B mgmt. (1st time in India- Lamivudine, Adefovir,
Lansoprazole, Hydrocortison foam)

Academic services - GCNA,, Journal watch

Personal touch - Visit, Activity, Need based sampling


Cipla
Life care

In clinic
Situations
Cipla
Life care

How Do We Convert Pantoprazole Prescribers

Pantoprazole Rabicip Winner

Activation time is 4.6 mins. Just 1.3 mins. Rabicip

Just 20% inhibition of proton pump in 5


100% Rabicip
mins.

Anti-secretory effect is moderate Significantly higher Rabicip

Increase in intra-gastric pH (2.2) is (3.4) significantly


Rabicip
moderate higher

Metabolism affected by CYP2C19 enzyme Unaffected Rabicip


Cipla
Life care

How Do We Convert Omeprazole Prescribers

Omeprazole Rabeprazole
Activation time is 2.8 mins. Just 1.3 mins.
Only 47% inhibition of proton pump 100% inhibition of proton pump in
in 5 mins. 5 mins.
Inadequate acid suppression over 24 Adequate & sustained acid
hrs. suppression
Anti-secretory effect is moderate Significantly higher
Only 32% patients got complete As high as 65% patient got
heartburn relief on day 1 complete heartburn relief on day 1
Cipla
Life care

Targets – Rabicip I.V.

Hospital Doctors
•All ICUs, ICCUs, SICUs and Intensivists
•All doctors attached to Gastroenterology, Surgery and
Medicine department

Trade Doctors
•Gastroenterologists
•General Surgeons / Gastro Surgeons
•Cons. Physicians
•All doctors attached to Polyclinics / Nursing Homes
Cipla
Life care

Pricing and Packaging

Price:
•Rabicip I.V. 20 mg- Rs 60.99

Presentation:
•Each 10 ml vial contains Rabeprazole
Sodium for Injection 20mg with 5ml of
sterile water for injection.
Cipla
Life care

A COMPARISON WITH PANTOPRAZOLE I.V.

Rabicip IV Pantoprazole IV
IV 20 mg 6 hourly in upper 80 mg stat followed by 8
gastrointestinal bleed , 20 mg OD mg/hr, i.e. 272 mg/day
– all other indications

100% inhibition of proton pump 49% inhibition of proton


at 32 min even in presence of pump at 342 min if pH 5.1 due
blood in stomach to presence of blood

pH > 6 for 100% of 24 hr at 20 Median pH 2.2 for 24 Hr at 40


mg 6 hourly mg IV OD. Wide variation
even at 272 mg/d infusion
Cipla
Life care

Rabicip I.V
Similar efficacy why change ?
Talk about slow on set of action when blood in the
stomach, follow with genetic polymorphism.

Pantoprazole is better
Acknowledge individual opinion, give reference, request
to try your brand

Rate
Don’t encourage beyond the stipulated norm, seek
BM participation for entry
Cipla
Life care

Let’s Revisit the Highlights


Rabicip- An Ace Mover Cipla
Life care

Feature Benefits
Starts action in just 1.3 mins Fastest onset of action amongst all other PPIs

Complete inhibition of Proton Pump in just 5 mins. Rapid relief of symptoms

Sustained acid suppression over 24 hours Day & Night acid control

No inter patient variability More predictable effect

Only PPI to increase gastric mucin secretion Succesfully prevents reccurence


of ulcers

Significantly increases intra- gastric Ph Greater anti- secretory effect

Not metabolised by CYP 450 enzyme system Least drug- drug interaction
Cipla
Life care

The coming months with


Rabicip
Cipla
Life care

Will you be there?

Territory Avg.YPM Gr%

Shrikaulam 1504 12
Bhimabharan 1428 23
Sikar 1295 295
Tiruvalla 1140 22
Kolar 1051 74
Cipla
Life care

Believe in you

With will
you can
write the
future