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Ben Steele speaks with Alberto James Trujillo, Director of Sales at Mexico’s Aspen Labs, about the rise of ‘prescription-switching’ in Mexico, and how his company is trying to combat the threat of generics by educating pharmacists and taking a KAM approach.

By Ben Steele on Jun 10, 2013

Alberto describes the situation in Mexico ten to fifteen years ago, where “patients didn’t really question what physicians prescribed. People went with a prescription to an independent pharmacy and mainly bought whatever the doctor was prescribing.” Then everything changed, with the introduction of a certain mind-set that saw switching your prescription to a generic at the point-of-sale (POS) as a good way to save money.

“Generics companies used the national television and other media networks to spread the idea that generics were exactly the same as branded molecules”

“Generics companies used the national television and other media networks to spread the idea that generics were exactly the same as branded molecules. This led to people asking people at the POS about cheaper options for treatment. Nowadays, patients usually ask first their doctors, and then their pharmacists, what their options are in terms of price. Partly this trend has arisen due to the increase in chronic illnesses such as diabetes and heart conditions, which a patient will have to continue buying medication for their whole life. At the same time generics firms figured out that it was easier to visit pharmacists and try to persuade them of the benefits of generics than it was to convince physicians of the same thing. Another thing that changed was that the government introduced legislation requiring doctors to include the name of the generic molecule on every branded prescription they write, making it easier for pharmacists to substitute medications at the POS.”

Alberto described how physicians will often try to influence patients not to switch on to a generic version of their prescription, but that this is counteracted by the rise of smarter, more outspoken patients. “Doctors in Mexico tend to be quite receptive to visits from sales reps, and are likely to see eye to eye with them on the problem of ‘prescription-switching.’ Yet while physicians are spending time with their patients to try and persuade them not to switch their prescription, they also have to recognise that patients are smarter now than some years ago. They know the patient will be listening to the doctor but also considering their own household economy. This may mean that on a prescription with multiple drugs, a patient will partially accept the doctor’s advice and purchase one or two of the medications yet seek to bargain for a generic substitution on the third medication, both with the physician and at the POS. You could say that the patient has just ‘woken up,’ and that pharma needs to understand and react to this awakening.”

“We ourselves provide training courses for POS workers. On weekends we gather groups of POS staff from different pharmacies across the country and try and teach them about why it is important to honour the prescription the doctor has written”

Aspen Labs’ fight back against the rise of generics and ‘prescription-switching’ has involved educating pharmacists on the health benefits of branded medication and also stressing how selling more brands makes good business sense. Alberto says that “one way of changing the pharmacists’ minds is by pointing out the difference in profit margin on the sale of a branded drug versus a generic. It seems like an obvious point, but when a pharmacy believes it can attract more customers by pushing the cheaper options then the choice isn’t that simple. Yet our strategy cannot just be about appealing to the pharmacy as a business – instead, we are exploring two avenues at once with the pharmacists, the one stressing profit margins while the other involves appealing to their medical role by convincing them that branded medicines get results.”

For Alberto, this dual strategy is important because “we should accept that pharma companies need to turn a profit, but we should also recognize that we need to justify this profit through providing services to the physician and the POS worker that go beyond the pill. Pharma companies with a research component, employing scientists as well as business people, should demonstrate to pharmacists the work they are doing to improve patients’ health and livelihood.” One way Aspen Labs is trying to bring added value to the POS is through education: “We ourselves provide training courses for POS workers. On weekends we gather groups of POS staff from different pharmacies across the country and try and teach them about why it is important to honour the prescription the doctor has written. We also teach them basic medical concepts and discuss typical questions a patient might ask about our medication and how to respond to those questions.”

“We are working with pharmacy chain Benevides to introduce a loyalty card program, where a patient gets every third prescription free”

Avoiding prescription-switching has meant a refocusing on the POS as a major stakeholder in the Mexican market. Aspen is pursuing a multi-directional strategy by seeking to provide added value to pharmacies through education, while also seeking to demonstrate value in other areas too. This has led to a growth in the importance of the Key Account Manager (KAM). Alberto explains that “previously, KAMs were only visiting wholesalers to oversee the flow of medication down the supply chain. In recent years their role has become much more important, as they are now involved with managing relationships with supermarkets and pharmacy chains, developing projects such as co-advertising initiatives. We also use the KAMs to negotiate discounts and build loyalty programs with certain chains. For instance, we are working with pharmacy chain Benevides to introduce a loyalty card program, where a patient gets every third prescription free. A business-orientated engagement with pharmacies is really what our KAM approach is about.”

Alberto observes that the role of pharmacies in Mexico’s healthcare system is changing, which he thinks is not necessarily for the better. “We have a phenomenon here in Mexico where many pharmacy chains and some supermarkets are incorporating a physician into their POS operations. This means that the pharmacies themselves can give patients a prescription, and perform consultations. These consultations are often advertised at ridiculous prices, sometimes only a few dollars per appointment. In a situation where pharmacies own brands, generics, and employ physicians who write prescriptions they have a power that can be abused. At some point, pharmacos need to ally with physicians to fight back against this unwelcome trend.”

The rise of generics and ‘prescription-switching’ may seem daunting news for pharma companies looking to market brands in Mexico. However, Alberto is confident that Aspen can weather the storm due to their diverse portfolio, which includes both generics and branded medications. “We are not too concerned that generics are taking a huge chunk of the market at the moment, as we are able to compete in this market. When looking towards the future, we can conclude that while generics will make up a larger proportion of units sold, the real profits will still be found on the brand side.”

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Alberto will be sharing more insights and dispelling some of the myths surrounding prescription-switching practices at this year's Sales & Marketing Excellence Latam Summit in Miami, USA. For more information on his presentation or to find out which other industry executives will be speaking, visit the official website.