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Paradigm shift in consumer healthcare practices in India

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As consumers are becoming more imperative, effective brand strategies to work alongside traditional pharma marketing tools that are more centred on doctors are devised. An insight by Sreedevi Yallamrazu, Business Manager, CubeX

Sreedevi Yallamrazu

With a rapidly evolving self-medication landscape in India, CubeX – a division of Sorento Healthcare Communications, Nicholas Hall’s Network Partner in India – has revisited its highly popular Mirror OTC Report 2006, with the latest all-encompassing version tracking the changing trends over the last 10 years. Through 920 face-to-face interviews, the 2016 edition has deciphered the beliefs and practices of consumers, doctors and chemists in order to provide a fresh outlook and attainable strategies for pharma marketers in India. The team at CubeX outline the key findings in this article.

Consumers: Evolving trends in health behaviour

“May you cure sometimes, treat often, comfort always” is a piece of advice Hippocrates shared for healthcare professionals in the 4th century BC and it still holds relevance in the information age. The digital revolution has led to the emergence of Dr Google as a key healthcare influencer and the “zero moment of truth” – a term coined by Google where a consumer becomes aware of a brand through online communication. Over time consumers’ circle of influence has expanded beyond the traditional point of care, the family physician, to include multiple touch points for varying needs ranging from information to healthcare solutions and even compliance enhancing tools such as smartphone apps. This has empowered ‘patients’ with sufficient knowledge to self-medicate to assume the role of “active consumers,” especially for common ailments where they can bank on the trust and endorsement of brands by healthcare professionals. In this context, knowing the consumer is becoming imperative in devising effective brand strategies to work alongside traditional pharma marketing tools that are more centred on doctors.

Self-medication doubles

Self-medication rates have almost doubled in the last ten years – 23 per cent of interviewed consumers reported that they self-medicate in 2006 vs 41 per cent in 2016 – and is likely to continue increasing at a rapid pace. For common illnesses such as pain, cough and cold and indigestion, self-medication is the primary treatment approach and consumers tend to recycle older prescriptions or recall a previously prescribed brand.

Where possible, they also try to avoid doctor visits for common ailments, believing that buying medicines OTC helps to save time and money. This indicates immense potential to drive consumption of deemed OTC brands not included in Schedule H and X that can be advertised to consumers. The role of digital – and the rise of smartphones – is evident in this shift. Consumers are seeking answers to their health problems with minimal intervention from healthcare professionals. Health-related websites, many of which are written in consumers’ language, help to impart confidence in understanding their health better and at leisure, which is not always possible with physicians.

Chemists used for validation

In the process of going digital, the role of chemists – a major touch point for consumers ten years ago – is being challenged. Chemists are no longer seen as an advocate empowered with brand information to engage with consumers. Rather than seeking a brand recommendation from chemists, consumers now turn to them to validate the brand choices they have already made. However, chemists are also expected to provide general advice about a medicine, such as contraindications and possible side-effects.

Natural ingredients preferred

More than 50 per cent of consumers report to opt for natural ingredients, which are perceived to be safer than allopathic rivals. As a result, brands such as Eno (GSK), Kayam Churna (Sheth Brothers) and Dabur Chyawanprash (Dabur), which contain natural ingredients in convenient formats, continue to be popular with consumers.

Additionally, for some ailments – such as insomnia and anxiety – consumers are unaware of how to seek appropriate solutions owing to many concerns. A lack of awareness of a condition might mean a sufferer dismisses symptoms as general stress, or there may be a social stigma associated with visiting a therapist. Often in these instances, natural solutions are preferred to lower the risk of dependence. As the awareness of the importance of good health increases, consumers are shifting their priorities from treating illness to maintaining wellness, for which sustainable natural solutions are sought.

HCPs still important for child illnesses

Parents exhibit different behaviour when their child is ill, with the key objective to get the right diagnosis and treatment so that the child can return to normalcy as quickly as possible. Doctors are the most influential healthcare advisors in this case with the majority of mothers responding that they prefer taking a doctor’s advice. However, in terms of children’s wellness needs, friends, family and the media are major influences.

Marketers: Identify winning strategies

Almost 60 per cent of India’s $2.6 billion OTC market consists of deemed OTCs according to Nicholas Hall’s DB6 Global OTC Database. Yet pharma companies are still skeptical of promotional switches despite possessing many heritage brands and the need for such products as self-medication continues to take precedence. The key is to identify opportunities to strategically engage with stakeholders.

Promotional switches enjoy strong equity

HCPs are more supportive of OTCs when they are still promoted to them or, even better, they are given the choice of a superior brand to prescribe. This can be seen in the case of Novartis’ Otrivin nasal decongestant (now a GSK brand), where Otrivin is promoted to consumers and sister product Otrinoz was launched to be promoted to doctors only. In these examples there may not necessarily be any difference in efficacy – although Otrinoz has the additional ingredient sorbitol that lines the mucous membrane to avoid irritation – but the strategy helps to appease doctors and consumers alike. Indeed, over 40 per cent of doctors agree to continue prescribing a brand if it is also promoted to them or an alternative product is offered. It is no accident that brands which continue to be promoted to doctors, such as Volini (Sun Pharma), Digene (Abbott) and Ostocalcium (GSK), feature among the products with the highest top-of-mind recall. However, doctors believe that marketers should also provide complete information in A+P to promote the brands responsibly.

Responsible education and engagement

Consumer education through digital education is crucial as healthcare brands need to have more than just a social media presence. A brand that can help consumers to make healthcare choices – either self-medication or to seek professional help at the right time – will stand to enjoy long-term success in an intensely competitive environment. This will also promote responsible self medication, a key concern of HCPs and regulators.

Additionally, while TV continues to be the lead awareness medium, consumers are actively seeking more information through packaging and digital media, meaning marketers may need to rethink conventional resource allocations.

Leverage HCPs’ equity to build trust

A key deciding factor for consumers choosing a brand while self-medicating can be a doctor’s influence owing to wariness of side-effects of allopathic medicines. Building on a brand’s doctor equity to provide professional advocacy and communicate the safety profile of OTCs will further reinforce consumers’ belief in the benefits of these products. It will also be important to identify innovative line extensions of the brand exclusively for HCPs.

Re-strategise chemist engagement methods

Marketers need to re-strategise their chemist engagement strategies in light of consumers’ increasing confidence to self-medicate. Chemists tend to use other patients’ experiences to convince potential new consumers about a product. It may therefore be beneficial to share brands’ success stories with chemists to enable them to assure new users. It would also be favourable to empower chemists with brand/ therapy information that would be relevant in the context of different consumer profiles that they encounter to engage more effectively.

Explore virgin opportunities

Marketers can also leverage the growing self-medication trend in emerging categories, such as sleeps aids and eye care. Consumers are not as aware of how to treat these conditions or are seeking natural alternatives to allopathic medicines, which represent virgin opportunities for marketers. Within existing categories, increasing usage occasions and purchase touch points are also becoming critical to stand out from rivals and expand the consumer base further.


It is time for marketers to embrace change and pave the way for Rx brands in the OTC space. Some of the recent promotional switches such as VWash (Glenmark), Benadryl (J&J), Dulcoflex (Boehringer Ingelheim) and Nicotex (Cipla) have overcome various barriers and are reaping success with renewed vigour in the Indian OTC market.

(CubeX is the Strategic Consulting and Business Intelligence division of Sorento Healthcare Communications)

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