MUNDIPHARMA DISTRIBUTION GmbH(Philippine Branch)
Tramal®2014 PROGRAM OF ACTION
Ellaine P. AducalSenior Product Manager
January 2014
TABLE OF CONTENTS
AGENDA PAGEITEM NUMBER:
I. MARKET OVERVIEW 3II. MARKET ANALYSIS 4
A. The Plain Tramadol Market 5B. The Total Tramadol Market (W/ Fixed-Dose Combinatio
ns) 5C. The Expanded Market 6D. The Prescriptions 7E. The Prescribers 8
III.2014 OBJECTIVES 9IV. KEY STRATEGIES 10V. PROGRAMS 11
A. Brand Messaging 11B. OS, Rheuma, Surgeons Program and KOL Expansion 13
VI. DETAIL MATERIALS AND DETAILING SPIEL 16VII. SUMMARY OF PROGRAMS PER REP 22VIII.SUMMARY OF PROMO MATERIALS PER REP 22
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I. MARKET OVERVIEW
The Pain Market in the Philippines, comprised of 3 therapeutic classes --- the Anti-Rheumatic Non-Steroid Drugs (M1A), Narcotic Ana
lgesics (N2A) and Non-NarcoticAnalgesics (N2B), is valued at Php 9.3 bio. Of the defin
ed market (N2B + N2A + M1A), theNon-Narcotic and the Anti-Rheumatic Non-Steroid Drugs o
wn 98.2% while the remaining1.8% is owned by the Narcotic Analgesics. Among the class
es of analgesics, the traditionalNSAIDs (ibuprofen, mefenamic acid, naproxen, diclofenac, me
loxicam, etc.) and COX2s holdthe biggest chunk which is 58.9% of the pain business.
The total tramadol market valued at Php 545.6 million, is 5.9% of the total Non-Narcotic(N2B) + Anti-Rheumatic (M1A) analgesics segment (IMS Comb
Q3 2013 MAT data). Of thismarket, the fixed-dose tramadol-paracetamol combination
s (FDCs), valued at Php 332.6million, hold 61.0% while the plain tramadols with a value
of Php 213.0 million has 39.0%share.
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The plain tramadol market is declining by 6.4% while the FDC market is growing by 5.7%.Together, this resulted to a minimal growth of the total tr
amadol market (Gr of 0.6%).
Of the two general dosage forms of tramadol, the oral form is more widely used with 80.7%share while the ampoules have 19.3%. Of the total tramadol
oral forms including FDCs,Tramal® has 17.0% while the market leader Dolcet® has 43.9%
. Of the ampoules, Tramal®
holds a good 56.2% market share (MS).
II. MARKET ANALYSIS
As a measure of performance, three defined markets of Tramal® are being looked into:1) the plain tramadol segment, 2) the total t
ramadol market (with the fixed-dosecombinations), and 3) the expanded market which i
ncludes 78% of M1A (based onprescription audit, analgesia is the desired effect in 78%
of NSAIDs/COX2s prescription).
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A. The Plain Tramadol Market
The plain tramadol market, with three brands accounting for about 95%, registered a
6.4% decline in Q3 2013 (IMS Comb MAT data). Tramal®, carrying bulk of this market,
drives the behavior of the segment. In 3rd quarter of IMS, Tramal® reflected a decline
of 4.3%. This is due to Mercury Drugstore’s (MDC) below-regular-quantity-order in
September when they had warehousing issues. The 4th quarter is expected to reflect a
positive growth since Tramal® grew by 12% based on yearend sales.
Despite the perpetual challenges faced by the brand, such as the attitude and practice
of both doctors and patients in the use of plain tramadols and the promotional effort of
twenty-two (22) other tramadols, Tramal® continued to sell and gain market.
B. The Total Tramadol Market (w/ Fixed-Dose Combinations)
With fixed-dose combinations (8 brands), Tramal® is relegated to the second position
with 24% market share.
Fixed-dose combinations are eroding the plain tramadol market, as reflected in the
decline of plain tramadols. Generally, there is a good acceptance of FDCs among
doctors due to the following:1. Good analgesic property resulting from the syne
rgistic effect of tramadol andparacetamol combination
2. Better tolerability due to low-dose tramadol content
3. Perceived anti-inflammatory effect of paracetamol4. Fast onset of action which can be accounted t
o the paracetamol component(onset of analgesia - 11 mins) and prolonged actio
n which can be accounted totramadol
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Among the eight (8) brands of FDCs, Dolcet® (Janssen) has the biggest chunk of the FDCmarket, followed by AlgesiaTM (Biomedis of Unilab). Dolcet® registered a decline of 3%and this is due to Algesia’s aggressive promotions, which resulted to Algesia’s 6% MSgain in its market.
C. The Expanded Market
NSAIDs/COX2s, despite its controversies, remain to be the preferred analgesic, hence
competing with Tramal®. Recognizing this, Tramal® market is redefined to include high
dose NSAIDs and COX2s. However, since NSAIDs and COX2s have anti-inflammatory
effect which Tramal® lacks, only 78% of its total value is considered to account for the
analgesic effect desired (IMS PMDI). In this segment, NSAIDs/COX2s have 83% share of
the Anti-Rheumatic and Non-Narcotic segment while Tramal® has 3.7%. The top ten
(10) NSAID/Coxib brands account for about 80% of the market, with Alaxan® (Ibuprofen
+ Paracetamol), Arcoxia® (Etoricoxib), Celebrex® (Celeco
xib) and Flanax® (Naproxen) inthe lead.
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D. The Prescriptions
The prescription audit (PMDI) of 1st semester 2013 shows that 86% of the scripts (Rx)are new, 6% are switch and 8% are repeat Rxs. For all types of prescriptions, NSAIDsand COX2s, have the biggest chunk which only means that doctors and patients aresatisfied with them. Of the new Rx, Tramal® only has 1%
, presenting a big opportunityfor growth. Increasing the share of Tramal® in the new Rx segment means increasingthe brand’s chance of being prescribed again by MDs, and being used again by patientswith or without prescriptions.
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Musculoskeletal diseases, health services involving exam and investigation proceduresand injuries are the top three indications for tramadol.
E. The Prescribers
The biggest source of tramadol prescriptions are the general practitioners or GPs. GPs
are followed by the general surgeons (GS), then the orthopedic surgeons (OS) and the
internists (IMs). It is worth noting that Dolcet® is the most prescribed brand across all
specialties, followed by AlgesiaTM.
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In terms of productivity, however, OS and rheumatologists generate the most number ofscripts for tramadols. They are followed by the GS and the urologists. An orthopaedicsurgeon and a rheumatologist generate 6 times more than what a GP generates.
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III.2014 OBJECTIVES
For 2014, the objective is to make Tramal® the top-of-mind analgesic for moderate pain ---
despite the good acceptance of FDCs and the strong confidence of doctors in prescribing
NSAIDs and COX2s.
Sales objective is Php 127.5 million, which is a 2% growth compared to 2013 sales. Market
share is expected to increase by 1 percentage point in both plain tramadol (from 62% to
63%) and total tramadol (w/ FDCs – from 24% to 25%) markets. Reach and penetration of
the two most productive specialists will be increased: orthopaedic surgeons -- 80% reach vs
universe of 774, and rheumatologists -- 100% reach vs universe of 83.
For 2014, the objective is to get a small percentage of the bigger NSAID/Coxib market by
increasing Tramal’s prescription share. This will materialize through a program that will
make the target MDs step up from NSAIDs to Tramal®, specifically after two weeks of
treatment with NSAIDs, or when dealing with post-operative pain and other acute
moderate pain conditions. Essentially, this will displace
NSAIDs and FDCs as the choice drugfor step 2.
Another objective is to ensure that at least three (3) SKUs of Tramal® are included in the
hospital where Tramal® is in the formulary (344 hospitals).
Target Sales: Php 124 million (Aspirational Target)Target Growth: + 2%2014 MS: 63% (Plain Tramadol Market)
25% (Total Tramadol Market – including FDCs)
Primary target specialties: Orthopedic Surgeons, Rheumatologists, Surgeons,
Anesthesiologists
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IV. KEY STRATEGIES
There are three main issues facing Tramal®:1. Overstaying of doctors with NSAIDS/COX2s due to:
a. better perception of NSAIDs/COX2sb. the satisfactory experience of doctorsc. hesitancy of doctors to use tramadol due to the
side effects in the initial phase2. Preference for FDCs in step 2 (ex. Dolcet® an
d Algesia®) due to tolerability/safety
concerns, thus, repositioning plain tramadols3. “Beyond ethical“ promotions of competition
To address these issues and to achieve the brand objectives above, three strategies will be
adopted:1. Clear, simple and resounding brand messaging2. Strengthening of Ortho Surgeon and Rheuma franchise3. KOL expansion
V. PROGRAMS
A. Brand MessagingThe analysis of the market shows that NSAIDs rem
ain to be the strongly preferredanalgesics. While it is true that NSAIDs/COX2s have a
role though, there is a need tomake the doctors realize that there is a right time an
d right reasons to STEP UP, andthat Tramal® is the fit choice to STEP UP to.
What is the right time? The right time to STEP UP is: After two weeks of NSAIDs/COX2s use When pain becomes moderate or persistent When there is NSAID failure (due to inefficacy or
insufficiency) When NSAIDs are contraindicated or are poorly
tolerated by the patient
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What are the right reasons to STEP UP to Tramal®? Tramal® is effective Tramal® is safe
For 2014, the communication campaign for Tramal® is simple and clear – STEP UP! Thecampaign is a call to action, an advocacy to encourage target MDs not to overstay withNSAIDs and to step –up to Tramal®.
The brand creative features 4 elements:1. Message – encourages the doctors to STEP UP to
Tramal® because Tramal® is
safe and effective2. Stepthoscope – represents the doctors or treatment3. 3-step Stairs – represents the WHO ladder; level
of pain and treatment4. Shoes w/ T- represents Tramal®
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In the Philippines, NSAIDs have been accepted as the strong 1st line analgesics, whether
for mild, moderate or severe pain. Because of the perceived better tolerability against
tramadols and other opioids, doctors tend to overstay w/ NSAIDs and COX2s despite
safety issues with its chronic use. To a good extent, NSAIDs/COX2s compete with
Tramal® in terms of its usage for moderate to severe pain.
The STEP UP campaign aims to address this. Through the campaign, we will reinforce to
doctors the need to STEP UP to Tramal® oral forms after two weeks of NSAIDs/COX2s
use in order to avoid gastrointestinal pathological changes.
For postoperative pain and other moderate acute pain conditions, we will use the STEP
UP campaign to encourage doctors to prescribe Tramal® injections and immediate-
release oral forms at the onset of moderate pain. For post-operative pain conditions,
to delineate promotions from OxyNorm® Injection, Tramal® will be promoted for minor
and medium surgeries. Examples of which are appendectomy, laparoscopy, biopsy,
incision and drainage, chest tube thoracostomy, herniorrhaphy and hemorrhoidectomy.
Since orthopaedic surgeons are the primary target for the brand, Tramal® will also be
promoted for use in the treatment of pain due to orthopaedic surgeries (ex. joint
replacement surgery).
B. OS, Rheuma, Surgeons Program and KOL Expansion
The STEP UP message will be echoed in activities that are meant to strengthen the
brand’s relationship among high yielding specialties such as the OS, rheumatologists and
Surgeons. Activities that are intended to build relationship and give an opportunity for
MRs to discuss with doctors will be implemented:
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Program Target1. Strengthening of OS& Rheuma a. For OS, Surgeons & Anesthesio
1) The Clinical Exchange – Panel
Discussion (min 60 MDs) or a Lecture(min 30 MDs) on either Chronic Low
No. of Act: 22 (11/Unit)Min. No. of MDs/Act:30Total No. of Target MDs: 660Timeline: Feb -Oct
2) Joint Talks – Quarterly Disease
and/or Product Discussions amongselect OS/GS Depts during
No. of Act: 252 (1/MR/qtr)Min. No. of MDs/Act:10Total No. of Target MDs: 2,500Timeline: Feb -Nov
3) Surgical Summit – Company-initiated
half-day scientific conference, inpartnership w/ the Societies ofSurgeons and Anes, which focuses on
No. of Act: 1Min. No. of MDs/MR:4Total No. of Target MDs: 400 (forAll Units)Timeline: June (tentative – may
be moved dependingon the launch of
4) Life without Pain (Through the Eyes
of a Surgeon – an activity that willserve as a discussion opener duringcoverage; a photo contest
No. of Act: 1Total No. of Target MDs:1,200 (for All Units)Timeline: Feb-Dec
5) Morning Talks – Product iscussions
among select Anes Depts (mayinclude ER Depts; goalis to catch
No. of Act: 198 (1/MR X11 mos)No. of MDs/Act: 10Total No. of Target MDs: 180Timeline: Feb –Nov
b. For Rheuma/Rehab, GPs/FMs, In1) The Clinical Exchange – Panel
Discussion (min 60 MDs) or Lecture(min 30 MDs) on either Chronic Low
No. of Act: 22 (11/Unit)Min. No. of MDs/Act: 30Total No. of Target MDs: 660Timeline: Feb -Oct
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2) Pain Summit – Company-initiated
educational conference (mini-convention), in partnershipw/ thePain Soc, which will provide
No. of Act: 1No. of MDs/MR: 4-8Total No. of Target MDs: 400 (forAll Units)Timeline: May
3) Rheuma Talks – At least once a Sem
1-on-1 product discussion amongRheumas
No. of Act: 166Total No. of Target MDs: 83 MDsTimeline: Feb- OctBudget: 60
2. KOL Expansion1) The Advocates - Development of 2nd
tier speakers
No. Target MDs: 63 ( Rheuma/IM/GS/
OS)No. of Speaking Engagement: 1Timeline: Feb– Sept
2) Pain Management Booklet - Creation
of a booklet in partnershipw/ PhilSoc of Gen Surgeons
No. of Act: 1Target MDs: 300 Officers &
Members of the PSGSTimeline: Feb
3) Sponsorship to Local Conventions
a) Phil Academy of Rehabilitation
Medicine (PARM) in Febb) Phil Rheumatologists Association
(PRA) in Febc) Pain Soc of the Phils (PSP) in Mayd) Phil Soc of Gen Surgeons (PSGS)
No. of Conventions: 6Type of Participation:Booth and D
SponsorshipsNo. of MDs to Sponsor: At least 0Timeline: Feb, Aug, Nov, Dec
4) Sponsorship to Local Conventions
a) International Association for the
Study of Pain (IASP)b) World Institute of ain Congress
No. of Conventions: 3Type of Participation: MD SponsorshipsNo. of MDs to Sponsor: 3 for WIP/IASP; 3 for
AAFPSTimeline:
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VI. DETAIL MATERIALS AND DETAILING SPIELA. STEP UP Clip Board version 1
Target MDs: For Orthopedic Surgeons, Rheumatologists, Rehabilitation
Medicine, Oncologists, Internists, General Practitioners
Usage: Feb - Mar
Message Highlight: More than two weeks of NSAID use may lead to gastrointestinal
pathological changes. STEP UP to Tramal®!
Detailing Guide:
Dr., we recognize the roles of NSAID/COX2s in pain management but there comes a timewhen you have to STEP UP! Dr., after two weeks of NSAIDs, STEP UP! to Tramal®.
Studies have shown that more than two weeks of NSAID use may lead togastrointestinal pathological changes so STEP UP to Tramal®!
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Tramal® is effective and safe in the management of moderate or persistent pain.
Tramal® is effective in the treatment of (mention one only):
- Chronic low back pain- Osteoarthritic pain- Neuropathic pain- Cancer pain- Postoperative Pain- Pain due to traumas and injuries.
In addition, Tramal® is safe (mention one only):- It has no Prostaglandin-mediated effects (eg
GI bleeding, renal and hepatictoxicity) of NSAIDs
- The common adverse reactions such as nausea and dizziness are transient and
manageable- It has no known association with CV problems-
Dr., we challenge you to STEP UP to the challenge of pain… with Tramal® (mention
product form)!
B. STEP UP Clip Board version 2
Target MDs: For Orthopedic Surgeons, General Surgeons and
Anesthesiologists, Internists and General Practitioners
Usage: Feb - Mar
Message Highlight: For post-operative pain and other moderate acute pain
conditions, STEP UP to Tramal®!
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Detailing Guide:
Dr., we recognize the roles of NSAID/COX2s in pain management but there comes a timewhen you have to STEP UP! For post-operative pain and other moderate acute painconditions, STEP UP to Tramal®.
Tramal® is effective and safe in the management of moderate acute pain conditions.Tramal® is effective in the treatment of (mention one only):
- Postoperative Pain- Pain due to traumas and injuries- Abdominal pain (renal or biliary colic)- Labour- Breakthrough pain
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In addition, Tramal® is safe (mention one only):- It has no Prostaglandin-mediated effects (eg
GI bleeding, renal and hepatictoxicity) of NSAIDs
- The common adverse reactions such as nausea and dizziness are transient and
manageable- It has no known association with CV problems
Dr., we challenge you to STEP UP to the challenge of pain… with Tramal® (mention
product form)!
C. Guess the Words and STEP UP!
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Detailing Guide:Level 1Instructions: The doctor will be presented with four pictures and be tasked withguessing the specific word that fits the theme of the photos presented. Upon guessing,the MR will say something about the words relevant to Tramal®. The 10 words to guessare:
a. Dispersible – Tramal® 50 mg Dispersible Tablet is the only tramadol tablet that
can be dispersed in water for easier swallowing; especially beneficial to patients
with difficulty swallowing such as the elderly and those who are sick.
b. Scored – Tramal® 50 mg Dispersible Tablet has a scoreline which allows the
tablet to be broken into two for:
i. initial low dose administrationii. gradual/slow titration to improve
tolerabilityiii. combination with step 1 analgesicsiv. low dose rescue medication
c. Retard – Tramal® 100 mg Retard Tablet offers better Quality of Life to patients
with chronic pain by providing:i. Better sleep and ability to do more
activities of daily living with itssustained pain relief for 12 hours
ii. Better patient compliance with its convenient twice daily dosing
iii. Better tolerability with its less serum peak-trough fluctuation
d. Flexible – Tramal®:i. is the only brand of tramadol available in
wide range of formulationsii. has a dispersible tablet that has a
scoreline to allow the tablet to bebroken into two, making possible a “start low
, go slow” administrationiii. can be given alone or in combination with
step 1 drugsiv. can be taken whole, or dissolved in water
for easier swallowing
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e. Innovator – Tramal® is:i. the first brand of tramadol in the Philipp
inesii. clinically proven in the Philippines for
more than 20 years in the relief ofmoderate to severe pain
f. Tolerable – Tramal®
i. common adverse reactions are transientii. has no Prostaglandin-mediated effects (eg
GI bleeding, renal, and hepatictoxicity) of NSAIDs
iii. has no known association with CV problemsg. Effective – Tramal® is effective in various acute
and chronic moderate to severepain conditions
h. Trusted – Tramal® clinically proven in the Philippines for more than 25 years in
the relief of moderate to severe paini. Matrix –Tramal®100 mg Retard Tablet contains 100 m
g tramadol hydrochlorideincorporated in a hydrophilic matrix. As mat
rix hydrates, it forms a gel fromwhich tramadol is released over a period of 12 hou
rsj. Convenient – Tramal®100 mg Retard Tablet encourages
better patientcompliance with its convenient twice daily dosing
Level 2After detailing the guessed fit word, to end the detailing, the medical representative willchallenge the doctor to STEP UP the game by guessing the phrase that is beingdescribed by the 4 pictures/images. The phrases are:
a. Step up to Tramal®
b. Step up your pain controlc. At the onset of moderate pain, step up!
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Activities for 2014 Jan Feb Mar Apr May JunES Unit 1 & 4Clinical Exchange 1/MR for the Year(Min of 30 MDs/Joint Talks 4/MR -- 1/Qtr for the Year (10 MDs perThe Advocates 1 MD /MRLife Without Pain At Least 2 Entries/MRRheuma Talks 2/MR -- 1/Sem for the Year (All ES Unit 2Clinical Exchange 1/MR for the Year (Min of 30 MDs/Joint Talks 4/MR -- 1/Qtr for the Year (10 MDs perMorning Talks 10/MR fro the Year(Min of 5 MDs/The Advocates 1 MD /RepLife Without Pain At Least 2 Entries/RepAll UnitsPain Summit 4-8 MDs/MRSurgical Summit 4-8 MDs/MRLocal ConventionsInternational Conven c/o Mktg
Promotional Tools for 2014 Jan Feb Mar Apr May June-detailer (to be uploadedPlanner /CalendarClip BoardPatient RecordGuess the Words and Step UpMedical Tool Kit OrganizerPedometerSampling/Starter Kit (For ES 1 & 4Patient Info LeafletPost-op Ampoule Guide
CME Kit with Ballpen, Notebook,Convention String Bag
VII. Summary of Programs per MR per Month VIII.Summary of Promo Materials per MR per Month ( January to June 2014)
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