rabicip & i.v

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Medico-marketing module

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Let us talk pride, lets talk Rabicip

Rabicip Success

Recognition

LovedPriority

10% Cont.

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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

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Symptoms of Acid Related Disease…

ARD Abdominal bloating.

Stomach discomfortpain

Heartburn

Acid regurgitation

Nausea

Early satiety Excessive burpingbelching

Feeling of abnormal slow digestion

95%Lifetime

60-70%Month

5-10%Daily

NOT VERY UNCOMMON

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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

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Lets understandAcid Related Disorders

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Parts of Gastro Intestinal System

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Mechanism of Acid Secretion

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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

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Acid Related Disorders: Types

Gastritis Acute, Chronic

Duodenitis

GERD (Gastroesophageal Reflux disease)

Peptic Ulcer diseaseGastric ulcer, Duodenal ulcer

Hypersecretory conditions Zollinger Ellison syndrome

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Antacids

Prostaglandins e.g. Misoprostol

H2-receptor Antagonists

Cimetidine,Famotidine,Ranitidine

Proton Pump inhibitors

Omeprazole,Pantoprazole,Lansoprazole,

Esomeprazole, Rabeprazole

The Medicines

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Opportunity Everywhere

Who Treats

Typical gastro intestinal symptoms.. Indigestion,Pain in the abdomen, loss of appetite, gas, abdominal distention etc

General practitioner or Gastroenterologists

GERD asthma, Chronic cough Chest physician

Non cardiac chest pain Cardiologist

Drug induced ulcers Orthopaedician

Stress ulcers Surgeons and Intensivists

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Point need to remember Till Now

Who treats acid related disorders

Acid related disorder and types

How PPI is better than H2 RA

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Acid Related Disorders Focus on the Hospital

Setting

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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

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Point need to remember Till Now

Indication for Rabicip I.V.

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Molecular USP

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

NO

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Pharmacodynamic Differences

Activation

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Proton Pump Inhibition After One Dose

Pharmacodynamic Differences (Cont.)

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Metabolism

• Genetic polymorphism

• Inter-patient variability

• Fast or slow metabolisers

Pharmacodynamic Differences (Cont.)

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Unique Property

Enhances gastric mucin secretion

Pharmacodynamic Differences (Cont.)

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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

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Point need to remember Till Now

Molecular USP of Rabicip.

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Market

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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

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The Market

Total market = 415 Cr

Growth = 9 %

Players = 200 +

138 Cr6%

118 Cr14%

109 Cr18%

27 Cr-2%

23 Cr-14%

Omeprazole Pantoprazole Rabeprazole Esome Lansoprazole

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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

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What Competitors Are DoingIn 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

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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

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Pricing and Packaging

Rabicip 20 (15’s) – Rs. 48.58

Rabicip 10 (15’s) - Rs. 34.13

Presentation

Sale pack: Strip of 15 tablets

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Point need to remember Till Now

Name of my competitors.

Target specialty and indication for me

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How Do We Tackle Competition

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Conversion Aid Cum Brand Reminder

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

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

Audience - Gastros, Cons.Phy (Selected)

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Conversion Aid Cum Brand Reminder

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

Frequency / Qty – In every 3 month

Audience – Only Gastros

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Lets Practice

How to emphasize on importance?

How to take commitment for support?

Some common practices (Pre announcement, Prior appointment)

Input handling – GCNA, Journal watch

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Additional Support

Interesting & innovative literature (DMC, 4 pager…)

Gifts

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Brand USP

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Product services

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

1.3 minutes

Our strong campaign on activation time

Academic services - GCNA,, Journal watch

Personal touch - Visit, Activity, Need based sampling

Brand USP

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In clinic Situations

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How Do We Convert Pantoprazole Prescribers

WinnerRabicipPantoprazole

RabicipUnaffectedMetabolism affected by CYP2C19 enzyme

Rabicip100%Just 20% inhibition of proton pump in 5 mins.

RabicipJust 1.3 mins.Activation time is 4.6 mins.

RabicipSignificantly higherAnti-secretory effect is moderate

Rabicip(3.4) significantly higher

Increase in intra-gastric pH (2.2) is moderate

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How Do We Convert Omeprazole Prescribers

Omeprazole Rabeprazole

Activation time is 2.8 mins. Just 1.3 mins.

Only 47% inhibition of proton pump in 5 mins.

100% inhibition of proton pump in 5 mins.

Inadequate acid suppression over 24 hrs.

Adequate & sustained acid suppression

Anti-secretory effect is moderate Significantly higher

Only 32% patients got complete heartburn relief on day 1

As high as 65% patient got complete heartburn relief on day 1

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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

Targets – Rabicip I.V.

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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.

Pricing and Packaging

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A COMPARISON WITH PANTOPRAZOLE I.V.

Rabicip IVRabicip IV Pantoprazole IVPantoprazole IVIV 20 mg 6 hourly in upper IV 20 mg 6 hourly in upper gastrointestinal bleed , 20 mg OD gastrointestinal bleed , 20 mg OD – all other indications– all other indications

80 mg stat followed by 8 80 mg stat followed by 8 mg/hr, i.e. 272 mg/daymg/hr, i.e. 272 mg/day

100% inhibition of proton pump 100% inhibition of proton pump at 32 min even in presence of at 32 min even in presence of blood in stomachblood in stomach

49% inhibition of proton 49% inhibition of proton pump at 342 min if pH 5.1 due pump at 342 min if pH 5.1 due to presence of bloodto presence of blood

pH > 6 for 100% of 24 hr at 20 pH > 6 for 100% of 24 hr at 20 mg 6 hourlymg 6 hourly

Median pH 2.2 for 24 Hr at 40 Median pH 2.2 for 24 Hr at 40 mg IV OD. Wide variation mg IV OD. Wide variation even at 272 mg/d infusioneven at 272 mg/d infusion

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Rabicip I.V

Rate

Don’t encourage beyond the stipulated norm, seek BM participation for entry

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

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Let’s Revisit the Highlights

CiplaLife careRabicip- An Ace Mover

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

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The coming months with Rabicip

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Territory Avg.YPM Gr%

Shrikaulam 1504 12

Bhimabharan 1428 23

Sikar 1295 295

Tiruvalla 1140 22

Kolar 1051 74

Will you be there?

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Believe in you

With will you can

write the future