Reliability and validity

Noble and Smith (2015) define validity as “the precision in which the findings accurately reflect the data.” Using the triangulation method of data collection will assure reaching data saturation. To ensure the `trustworthiness' of the findings, I will scrupulously keep all the records to demonstrate a clear decision trail and ascertain that data interpretations are transparent and consistent. Furthermore, I acknowledge the possible biases in sampling to ensure sufficient depth and relevance of data collection and analysis. Moreover, I will ensure the respondent validation inviting participants to comment on the interview transcripts. Additionally, I will demonstrate clarity in terms of thought processes during data analysis and subsequent interpretations so that the final concepts adequately reflect the phenomena being investigated.

As Leung (2015) puts it, in quantitative research, reliability refers to exact replicability of the processes and the results. Thus, to make the findings of a qualitative research reliable one should ensure data consistency. Silverman (2013) offers five approaches in enhancing the reliability of results: constant data comparison, comprehensive data use, inclusive of the unusual case and use of tables. To improve the dependability of the study, I will carefully review the transcripts, draw up protocols of the interview and direct observation, and validate the interview questions in accordance with experts' opinion.

Chapter 3. Data analysis and findings

In this section, I will give an overview of the process of organizing the data obtained. During my qualitative research, I used the coding technique to sort and compile the data. The coding procedure allows to summarize and synthesize all the information linking data collection and its interpretation. The central goal of data coding is to develop a storyline which presents the analytic thread integrating the major topics altogether. To develop the storyline I ascertained that it would align with my research questions. When planning this qualitative research, I wanted to find out what the difference between patient journey for prescription and non-prescription drugs is, how marketing managers of Abbott interact with Russian customers and what factors affect international pharmaceutical companies located in Russia.

Coding can be done in any number of ways, but it this case it involved assigning words and phrase to each coding category. I went through all textual data (interview transcripts, direct observations, etc.) in a systematic way coding the ideas, concepts and themes so that they would fit the categories, as follows: special aspects of patient journey mapping in pharmaceutical industry, patient journey for prescription drugs and non-prescription drugs, macro-environmental factors influencing patient journey in Russia and other factors that affect patient buying decision on drugs. As the data was coded, the coding scheme was refined by adding, expanding and revising the coding categories.

Special aspects of patient journey mapping in pharmaceutical industry

As in any other industry, customer journey in pharmaceutical business comprises key points where the promotional activities are to be applied. It is necessary for marketing managers to understand where and in what situation they can change the consumer behavior. However, according to the respondents' opinion, there is a crucial difference of customer journey initiation in terms of buying incentive: “Any drug is always a negative story. A person buys it because he or she is sick. For example, shampoo is a thing which a nice to have, while medicine is always a problem” (see Appendix 8). Thus, the patient journey is the way from the moment of problem recognition to the purchase of medicine. The search for the right medicine starts with a symptom. At this point, the advertiser has the opportunity to be useful in solving a particular problem. As for the visual part, the patient journey can be presented as a scheme, a graph, or anything suitable for the brand team.

The second distinction that has to be mentioned is the government control of pharmaceutical industry in Russia: “Pharmaceutical marketing is very complicated. We have to cover our back everywhere” (see Appendix 4). This intends the price regulation for drugs on the VED list (Vital and Essential Drugs), the proscription of any direct communication with customers and various restrictions in the segment of prescription drugs which will be discussed in details hereafter. Furthermore, customer journey in pharmaceutical is considered difficult to create. Patients do not immediately come to the right doctor, their path inside the clinic is difficult to track, and often impossible due to the non-disclosure of information. And, on the top of that, customer journey mapping usually requires qualitative marketing research, such as focus groups, which are quite expensive to run.

Mapping patient journey for prescription (Rx) drugs

Pharmaceuticals have traditionally been among the product categories where "everything is complicated." In recent years, pharmaceutical companies in Russia have constantly been confronted with stricter legislation and a reduction in the opportunities for promoting both the content of advertising messages and distribution channels. The pharmaceutical business is a highly specific branch in terms of marketing. One of the key tools for promotion there is opinion leaders, namely, doctors and pharmacists. After all, it is their appointments and recommendations that largely determine which drug consumers will eventually buy.

In the section to follow I will introduce the results of the coding procedure about on mapping patient journey for Rx drugs. Based on the analysis, for main stages of the patient journey to Rx medicine have been highlighted: problem awareness, treatment choice, purchase decision, and compliance (see Figure 8).

Problem awareness. In 2015, the population of Russian Federation accounted for 146, 3 million people. The share of individuals with diseases of the digestive system amounted to approximately 4%. On a scale of the whole Russian population, this is a significant figure. Although it may seem that the market potential is huge, it is not the case, for most of the potential patients are simply unaware of the disease, so they are sure that they do not need any kind of treatment. The first point of the patient journey enables marketing managers to estimate the gap between the potential number of patients and the real one.

Pharmaceutical companies have to raise the problem awareness, or the disease awareness, improving the level of diagnostics. Abbott product managers cooperate with the Ministry of Health of the Russian Federation that has which has certain KPIs for life expectancy of Russians. Explaining that life expectancy depends on the level of cholesterol, they raise the level of diagnostics for diseases of the digestive system and potentially increase the sales volume of gastroenterological medicine.

Treatment. The next stage of the journey is the choice of medicine that largely depends on the physician if we are talking about the prescription drugs. At this point, the key task is to explain to the doctor, what medicine is best to be prescribed in each case. For many years, working with doctors through medical representatives has been one of the key promotion tools for pharmaceutical companies. Nevertheless, there was no clear and transparent regulation of this instrument, and various incentive programs for doctors led to an unjustified increase in the number of imported expensive drugs, as well as to a significant increase in their share in the VED list.

Russian government eventually took control of the situation, and in 2011 Federal Law No. 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation" was adopted. [1] Its provisions governing the interaction of medical practitioners with pharmaceutical companies (Article 74) entered into force on January 1, 2012. Since that moment, the leaders of medical organizations and other medical workers could no longer accept money and gifts from the employees of pharmaceutical companies, participate in entertainments at the expense of enterprises, obtain samples of drugs for transfer to patients, and conclude agreements on the recommendation and appointment of any medicines. The opportunities for promoting pharmaceutical products during the visits of medical representatives and the visits themselves have become severely limited. Today medical representatives only indirectly can stimulate the sale of certain medications. Usually, they visit doctors in both public and private health care facilities with the highest patient flow, asking them what the most frequent patient complaints are, which medicine they recommend in each case and why, why they do not recommend the X medicine, and how many visits per day they have. Their task is to inform fully the physician about the product being promoted, to provide the results of the studies and to convince them of its effectiveness. Direct stimulation of appointments does not occur, at least, openly.

With tightening of the legislation, pharmaceutical companies began to look for new channels of communication with medical workers. Every year, the role of digital channels is growing: the pharmaceutical companies are finding new ways of using them to communicate with physicians. They use remote communication through social networks and Skype, make individualized email-lists, actively use the format of video presentations. A significant role in this work is assigned to the communication of medical representatives with physicians via E-Detailing. E-Detailing is the marketing communications model, which implies that medical representatives interact with doctors using the Internet and electronic media.

Types of E-Detailing:

· Virtual Details (information programs on the Internet or on CD (without the personal presence of a medical representative);

· Video Details (virtual sales presentations accompanied by a medical representative via the Internet, phone, personal contact);

· Online Events (webinars, educational CME-programs, online seminars and lectures of leading specialists).

There are two scenarios of how a Rx drug may be prescribed. The first one is the outpatient reception hours and the second one is hospitalization. While the patient is in the hospital for treatment, he is given medicine for free. Once he has checked out, he is given a prescription for the same drug he has been treated at the hospital. After that, the tree of patient journey bifurcates into two variants of purchase, reimbursement and out-of-pocket expenses. If a patient is eligible for the benefit, he must be given the drug for free. As a rule, physicians do not recommend drugs that are not on the special list. Hence, there appears another need of collaboration with Russian Ministry of Health. If the patient is in the hospital, then at the time of discharge he is prescribed the same drug that he took while in the hospital. The reimbursement scenario is lucrative for the pharmaceutical company, as patient simply continue to receive the drugs from the health care organization paid by the state. However, the reimbursement channel has a significant problem - generics since state purchases are made at the lowest price. Pharmaceutical companies invest millions of dollars in the development of new drugs and subsequently put a high price on them when entering the market. When the patent ends, a generic company comes to the market, takes a molecule without investing a penny in development, and eventually seizes the entire state channel. In this respect, retail is a more stable channel. It is harder to work here, but there are no ups and downs.

Purchase. The second scenario is out-of-pocket. During the appointment, a person receives the prescription and then buys the medicine for his own expense. According to the Ministry of Health Order No. 1175 of December 20, 2012, physicians should use the international non-proprietary name (INN, the name of the active substance of the drug recommended by the World Health Organization).[3] If there is no INN, a "group name" is used (it is received by medications that are grouped according to the composition of the active substances). Only in the case of absence of INN and the group name the doctor can indicate the brand name in the prescription. Also, the commercial name can be stated if the patient does not tolerate any analogs or in other exceptional cases. In this case, the decision to prescribe the drug by brand is taken at a special medical commission.

The new order of the Ministry of Health inserts an amendment for inpatient facilities. It states that "the prescribing of medicines in the provision of medical care under stationary conditions is carried out according to an international non-proprietary, grouping or trade name." At the same time, it is not indicated when and which name should be used, so physicians can decide on their own. According to the law, a doctor should write INN on a particular form, but lots of doctors use ordinary pieces of paper (Basharova, 2015). If this rule were strictly observed, all power would shift to pharmacies and pharmacists. However, this is not the case, as doctors continue to write the brand names in the prescriptions. Their choice depends on how loyal they are to the brand, the company or the specific medical representative.

Let us suppose that a physician writes the INN on the prescription and the patient heads to the pharmacy. If the pharmacist does not care, he will simply list all the drugs available with the molecule. Yet, in most of the cases, pharmacists do care because they have sales KPIs set by their managers. Moreover, as physicians, pharmacists are subject to the influence of medical representatives from medical representatives of the competitors. Unfortunately, despite all the regulations, some companies bribe pharmacists and pay for their “loyalty.” As a rule, these tend to be Russian generic companies. Furthermore, pharmacists may switch a person to another drug simply because of their bias to the specific medicine or business. In addition, it is quite common for the pharmacist, as well as for the doctors, to put themselves in the patient's place depending on their own financial circumstances and recommend less expensive medicines.

Senior product manager of Abbott gastroenterology and hepatology department claims that, according to the company's research, a patient may suddenly feel better on his way to the drugstore, which is typical of gastroenterology (see Appendix 4). Curiously enough, sometimes a friendly doctor and a bit of empathy may relieve the symptoms. Some patients may come to the pharmacy and make a judgment call not to buy the specific drug due to side effects.

Compliance. Many Rx drugs are prescribed in cases of chronic diseases, such as arthritis, asthma, cancer or diabetes. A chronic condition is a health condition that is persistent or otherwise long-lasting in its effects. The term chronic is usually applied in the course of the illness. Patients with chronic diseases should take medicine continuously. However, according to statistics, even in the case of chronic diseases the average duration of therapy is 3-4 months (the figure may vary depending on the type of illness) (see Appendix 2). Pharmaceutical companies use such figures to forecast sales volume or conduct the research themselves. Compliance is higher for diseases that make patients feel constantly uncomfortable (e.g. asthma).

In the Rx segment, it is illegal to communicate to the patient directly, even after the purchase. The only thing that is possible here is the development of various tools that would remind the patient that he needs to continue to the treatment course. Nowadays there are many mobile applications (pill-reminders), but they cannot be considered pay-your-way in terms of ROI. Therefore, in the Rx business, the pharmaceutical companies focus their promotional activities on doctors.

Summing up the previously mentioned, in case of prescription drugs various scenarios of patient journey are possible:

1. Physician > Pharmacy > Purchase > Effective Treatment > Compliance

2. Physician > Pharmacy > Purchase > Ineffective Treatment > Physician > Pharmacy > Compliance

3. Physician > Pharmacy > Switching > Refusal to purchase

4. Physician > Pharmacy > Judgement call no to buy the drug > Refusal to purchase

The example of the patient journey: HRT case

As mentioned before, the patient journey may vary depending on the specific disease. In order to provide a deeper understanding of this model in the case of prescription drugs, I asked one of my respondents to tell me about the qualitative study they conducted in their brand team (see Appendix 1). The “F” medicine is a drug for hormone replacement therapy (HRT) widely used for the women who have entered menopause. Traditionally, the journey starts with the problem recognition when a woman recourses to self-treatment, such as taking vitamins, herbs, etc. Once she decides to visit a doctor, chances are high she will not go straightly to the gynecologist. Instead, she may visit a cardiologist or neurologist, as menopause is characterized by various symptoms typical of other diseases, such hypertension or a headache. Hence, she is prescribed antihypertensive, nootropic, and chondroprotective drugs. Cases of self-prescription are rare, but they do happen in practice. Such women search for the information online, ask for friend's or pharmacist's advice and do not visit a gynecologist. Finally, there are those who visit a gynecologist and starts HRT.

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Figure 8. The map of the patient journey for prescription (Rx) drugs.

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Figure 9. The example of the patient journey for Rx medicine “F.”

Mapping patient journey for non-prescription (OTC) drugs

The key difference of non-prescription drugs also called as over-the-counter (OTC) is that they can be legally sold without any recommendation from a physician. As opposed to Rx patient journey has more stages since the treatment choice here can be made not only by a doctor but also by a pharmacist (legally) or by a patient himself (see Figure 10). An example of the patient journey for OTC medicine is introduced in Figure 11 presenting the stages a person with irritable bowel syndrome (IBS) goes through towards the purchase of “D” and factors influencing him on each stage.

Problem awareness. As opposed to Rx segment, in OTC business marketing managers can drive both brand awareness and disease awareness. All the respondents claim that the best way to do that is the TV commercials. For this reason, national and regional TV remains the most popular media channel among pharmaceutical advertisers for many years. Table 2 presents the data on the advertising budgets split by media type in the category of OTC and BAA in 2016 on the Russian market. The share of spend for TV accounts for 42, 5% (Mediascope, 2016).

Table 2. Budgets split by media type in the category of OTC and BAA in 2016.

Media type	Cost, RUB	Percentage
TV	7 294 424 551	42,5%
Radio	5 553 781 741	32,3%
Press	4 136 920 083	24,1%
Cinema	102 638 223	0,6%
Internet	43 360 89	0,3%
Outdoor	33 308 061	0,2%
Digital Indoor	16 130 545	0,1%
Total	17 180 564 095	100,0%

Information search. TV placement provides OTC brands with a high reach of the target audience and drives the interest. However, it is quite expensive and complicated in terms of key message delivery. The maximum duration of a TV spot is 30 seconds, which not long enough to tell the story to the consumer. To promote an OTC drug, a marketing mix is used, as a rule. TV placement is usually supported with a more “detailed story on the Internet” (Appendix 7). This includes a broad range of marketing communication instruments, such as paid search, SEO, educative videos on YouTube, contextual advertising, banner placement, special projects in mobile, and product websites. Product websites usually contain a section on the disease, a section with general information about the drug, and articles with related content.

Treatment choice. All the above-mentioned activities are oriented to drive the personal decision to buy the drug. As for physicians and pharmacists, pharmaceutical companies apply the same marketing techniques as for the Rx drugs. This implies organization of conferences, seminars, lectures and other information and scientific events, communicating with physicians via telephone, e-mails or personal visits, and conducting research, surveys, and questionnaires.

Purchase. Regardless of who makes the decision, a number of factors influence it. In the case of individual treatment choice, patients are affected by the information they read on the Internet, the advice from relatives and friends, personal biases, and the advertisement in general. If we consider e-commerce, it is easy to track the consumer journey and estimate the conversion rate. In pharmaceutical business it is impossible to follow the patient from a website to the pharmacy: online sales are not entirely integrated with the rest, at least yet. Brand manager monitor consumer behavior but the chain of actions is often interrupted on the stage of “information search.”

Compliance/Loyalty. Brand managers in pharmaceutical companies, even in OTC departments, do not work directly with consumers do evaluate the loyalty index. For this purpose, Abbott has a special department of marketing research, which provides data on the number of prescriptions and recommendations from doctors. “If the number of prescriptions grows, then we are working well” - states the junior brand manager from the consumer health care department. The same scheme is applied to pharmacists. However, in case of OTC drugs, some communication with patients is possible. Brand managers conduct focus groups with consumers and ask them what medicines they prefer, why they choose them, what they pay attention to when choosing a drug and which sources of information are most important for them.

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Figure 10. Patient journey map for non-prescription (OTC) drugs.

The example of the patient journey: IBS case

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Figure 11. The example of the patient journey for OTC medicine “D”.

Macro-environmental factors influencing patient journey in Russia. PESTEL analysis

In part to follow, I will apply the well-known technique of PEST analysis broadening it to the PESTLE configuration. The given framework, which is widely used in strategic management, describes macro-environmental factors influencing a company and its business activities. The model's factors may vary depending on a given company based on its industry and the goods it produces. This strategic tool will help me understand the potential of the pharmaceutical market in Russia, Abbott's business position on the market and further direction for the firm.

Political factors

· The policy of import substitution (the procurement law" two's company, three's a crowd." During public tenders, pharmaceuticals of foreign origin are not able to participate if there are two or more applications for the drug supply originating from the countries of the Eurasian Economic Union (EEU). [2] The decision has limited the access of foreign manufacturers to state purchases and, consequently, has narrowed the reimbursement sales channel for them.

· The state program "Development of the pharmaceutical and medical industry" for 2013-2020 ("Pharma-2020" and "Medprom-2020"). [4] This program is aimed at propelling Russian pharmaceutical and medical industry to the international standard level. By 2020, the authorities plan to increase the share of medicines of domestic production in the total consumption by 50%. The targeted volume of investment in research, development, technological innovation and re-equipment of production of drugs account for 112.4 billion rubles.

· Foreign pharmaceutical companies are granted benefits, depending on the degree of localization of production in Russia.

· Tax incentives for investments in R&D (Russian companies involved in research and development of innovative pharma products are given benefits).

Economic factors

· The price of the drugs of foreign origin is subject to the fluctuations of exchange rates.

· Consumption habits. Russian consumers are used to buying medicines in a pharmacy while in Europe and the US BAA (biologically active additives) and OTC drugs can be purchased in supermarkets.

· The decline in income among Russian population and, as a consequence, switching to generics.

· Increasing popularity of shop-in-shop. In September 2016, Mega Pharm entered into a cooperation agreement with X5, according to which the company will receive a priority right to place more than 3,300 pharmacies in the cash zone of all three networks under the direction X5 until the end of 2020 (Burlakova, 2017).

· The segment of non-prescription drugs is highly subject to the season's fluctuations of demand.

Social factors

· Unfortunately, the majority of Russians are prone to self-treatment. This happens for various reasons, such as the reluctance of people to spend money on expensive medicines, the lack of habit to take care of their health or the fear of losing a job. People usually do not take medical leaves and try to stay home and recover in a couple of days turning to folk medicine or asking their family or friends for advice.

· Demographic factor. According to the analytical center under the Government of the Russian Federation, in 2016 the share of the population older than the working age accounted for 24.6% of the total population of the Russian Federation. According to forecasts of Rosstat, the aging of the population will continue, and in 2031, the share of the elderly will amount to 28.7%, which implies the potential for growth of the pharmaceutical market. [67]

· Russian consumers are becoming more competent and demanding on the quality of medicines and services in pharmacies.

· Despite the fact that medical insurance in Russia is compulsory nationwide, the diagnosis level leaves much to be desired. Voluntary health insurance and paid medical services are not as common as in EU or the US, and less affordable.

Technological factors

· Unlike other product categories, for example, FMCG, in the pharmaceutical industry, the development of a new product (an innovative drug) takes about 10-15 years on average from the research stage till the moment of market launch.

· Low quality of generics of Russian origin. When creating a drug, is not only the presence of a molecule important but also the presence of other additional substances that provide the necessary effect by interacting with the active agent. Respondent state that sometimes generics have to be prescribed in greater dosage to achieve the same effect as from the original drug.

· The level of R&D in Russia lags far behind western countries. However, over the past few years, Russia has experienced the development of the production of active pharmaceutical ingredients (APIs).

Environmental factors

· In the production of dangerous pharmaceutical substances, which can damage workers in production, are sometimes used (e.g. viruses for the manufacture of vaccines).

· To extract substances that have a therapeutic effect, large amounts of natural materials can be processed (plants and animals).

Legal factors

· According to the Russian legislation, the markup level of drugs which are on the VED list (Vital and Essential Drugs) can be regulated by the government. Price regulation for medicines included in the VED list is carried out by state registration of the maximum sale price of Russian and foreign manufacturers of medicinal products. [5]

· Generics appear to be the main problem of the reimbursement sales channel of international pharmaceutical companies located in Russia. This is primarily the case of foreign pharmaceutical companies that invest millions of dollars in the development of new medicines.

· Any type of direct-to-customer communication is strictly prohibited in terms of prescription drugs. Therefore, pharmaceutical companies focus their marketing activities on educational programs for physician and pharmacists.

· Violation of the antimonopoly legislation. Some Russian companies enter into illegal bonus agreements with pharmacists to recommend or even publicly advertise their drug to the consumer. Physicians often switch patients from antibiotics to BAA and, at the worst, to other antibiotics, which quite dangerous, as a person may end up with non-response (insensitivity to the drug).

· In July 2015, amendments to the law "On Health Protection" came into force. Since then, the distance selling of medicines is prohibited. Nevertheless, online pharmacy windows are operating legally: the buyer can independently pick up the medicines ordered by him in a particular pharmacy. Pharmacy chain “36, 6” and the online retailer Ozon.ru will conduct a joint project for drug trade via the Internet (Demidova, 2016). Consumers will be able to pick up the from any of the the 1,740 pharmacies of “36, 6.”

Digital instruments of marketing communication in pharmaceutical business

In recent years, the role of digital channels in the promotion of pharmaceutical products has grown significantly in Russia. According to Cegedim Strategic Data, in 2013 the volume of this segment amounted to $ 1.5 million, whereas in 2011 it did not exist at all. Most likely, this is happening for the following reasons: the growing popularity of digital channels in the world and the legislative restrictions on communication between medical representatives and doctors.

The top trend among pharmaceutical companies is creating special websites advertising medicines and forums for doctors. On these websites, when accessing the prescription drugs section, the user is asked to confirm that he is a medical or pharmaceutical worker and only after that information is provided. Usually such websites provide a general description of a drug and contain articles on the subject of the disease. A great example of digital special project is the website "Women First" by Abbott (see Figure 12). [69]



Figure 12. Women First website

The second digital instrument, which is rapidly gaining popularity, is social networks for physicians. As a rule, these are independent projects, which actively cooperate with various pharmaceutical companies. On their basis, pharmaceutical companies organize online seminars, training on the use of new drugs, place articles about drugs and conduct various studies. Social networks help pharmaceutical companies to get the feedback from doctors, while those can share their experience in the use of specific drugs and participate in online conferences. One of the most popular social networks for doctors is Doctor at Work. The network numbers 370 000 registered users-doctors. The administration takes seriously the verification and authorization of users and does not allow the registration of medical students and nurses, unlike other networks. Other examples of social networks are ivrach.com, evrika.ru and mirvracha.ru. All social networks for physicians require detailed information about medical education and the specialization of a doctor when registering to make the community as professionally closed as possible.

Managerial implications and recommendations

Based on PESTEL analysis, the immediate problems for all players in the pharmaceutical market can be identified. The first problem is generic companies, which win away the whole reimbursement channel from foreign pharmaceutical companies. From this perspective, retail sales channel (pharmacies) appears to be more stable. To keep pace with the times, pharmaceutical companies should take into account the national characteristics of drug consumption in Russia and the emergence of new formats: shop-in-shop (pharmacies inside grocery stores, for example, “Pyaterochka”) and online stores that allow consumers to order with one click and pick up drugs in a certain pharmacy.

The second problem is the propensity of Russian consumers to self-treatment. Since in Rx segment companies are not allowed to directly contact consumers and promote the brand or a specific drug, instead of not brand awareness marketers may increase problem awareness, that is, consumer awareness of a particular disease. This is done by creating special websites containing relevant articles on the topic of the disease, interesting facts and links to clinics where a consumer can make an appointment with a doctor or have his tests. The brightest examples are the websites womenfirst.ru and проверь-печень.рф. However, despite the rapid growth of digital share in the marketing mix of pharmaceutical companies, the main item of expenses is still the activity of medical representatives. As this communication channel also tends to be digitized, pharmaceutical companies should pay more attention to e-detailing - a form of communication between medical representatives and doctors using the Internet and electronic media (virtual sales presentations with personal presence of a medical representative, webinars, online lectures of famous specialists, etc.).

All the respondents claim that it is crucial to use a 360-degree marketing approach including ATL, BTL and other possible marketing instruments. As in the FMCG sector, not only are the contents of a drug important, but also the packaging. For example, when designing an ordinary nasal spray one should consider that it should be easy-to-use for all possible groups of patients, even those with arthrosis. The integrated marketing communication approach implies the usage of TV placement, digital channels, trade marketing, educational programs for physicians and pharmacists, in-store, pricing strategy (special offers, discounts), and category management (different SKUs, eye tracking, and multi-placing). The last but not the least is the inventory management. Abbott's trade marketing manager argues that “if a TV a campaign is launched and the distribution network numbers 60 000 pharmacies throughout Russia, there cannot be any out-of-stock. If a consumer comes to the pharmacy and does not find there what he wants, he will never come back”.

Summary and conclusions

Based on the extensive literture review the comparative analysis of the sales funnel andcustomer journey models have been made. Althoigh these models may seem quite similar at first glance, they are some crucial differences between them to be noted. First, the purchase funnel appears ti be somehow outdated since it fails to recognize that the journey of today's customers is no longer linear. As the number of decision influencers increases from day to day, the funnel logic is has to face serious transformation. Customer experience and decision-making become multichannel, creating additional opportunities for the companies to influence purchases. The customer journey is a strategic model that helps companies to pinpoint the key stages of the consumer route and maximize relevant marketing metrics for success. As opposed to the sales funnel, which is mostly based on the number of potential or actual customers, consumer journey model implies both qualitative and quantitative validation of a company's strategy. In other words, customer journey includes numerical performance indicators, as well as key points where the company should focus on. In general, the sales funnel is used to measure the volume of customers through different stages of the selling process, while the consumer journey is aimed at understanding consumers' behavior, informing decision making, and analyzing their experience to provide a better product or service.

In accordance with the study results, customer journey appears to be highly applicable to pharmaceutical business. However, Abbott workers argue that this framework is rarely used mainly due to its expensiveness and the difficulty of execution. The patient journey is an irreplaceable planning tool in case of product launch but it is uncommon in practice. More often, when the headquarters initiate products launch, they send the key message and sales volume KPIs to the local market without any preliminary research, which is fundamentally wrong.

The key goal of my project was to define the difference between patient journey for prescription and non-prescription drugs. Overall, the patient journey for Rx and OTC drugs seems to be relatively similar, apart from number of stages a consumer goes through. The Rx drugs are prescribed by a physician and are bought by a person at the stage of an acute disease, or in case of a chronic disease (repeated purchase). Hence, the journey in Rx segment and the treatment choice largely depend on the physician. As the main decision makers, doctors are highly subject to the influence of medical representatives, so the companies who aspire to be the market leaders should seek the new ways to communicate with physician bearing in mind numerous legal restrictions. Since the penetration rate the Internet among doctors continues to increase, it seems appropriate to adapt the existing formats of communication using e-detailing, social nets and other digital activities to interact with doctors more efficiently. In the case of OTC drugs, the stage of information search is added, shifting the focus of attention to consumers. When buying OTC drugs patients make the decision on their own and rarely turn to doctors for an advice, so their influence of physicians in this case is almost minimal. Thus, pharmaceutical companies should interact more with consumers using an integrated marketing communications approach including traditional media placements, as well as special digital activates aimed at increasing both the disease and brand awareness.

What should we expect in the nearest future? The lion's share of the marketing budgets of pharmaceutical companies will continue to fall on medical representatives, as well as on conferences and other events for doctors and pharmacists. Most likely, companies will use digital channels much more actively for the flowing reasons:

· Digitilization of all marketing chanels is a growing trend, which has been increasingly noted worldwide in recent years

· More and more physicians use the Internet, and more health care organizations are switching to electronic systems of accounting and patient flow management;

· The economic crisis pushes pharmaceutical companies to optimize their marketing budgets, so using the digital channel can reduce the number of expensive personal visits of medical representatives.

In terms of the study limitations, I fully acknowledge that it might be impossible to extrapolate the results obtained in respect to all pharmaceutical companies operating in the Russian market, as many of them simly break the existing laws and apply back-alley business scemes. As for the foreign pharmaceutical enterprises, the results of the following study may be of interest for brand managers and trade-marketing managers. The obtained models of the patient journey will serve as a guide for the marketers and provide them with a consistent framework. In addition, the research findings may be of primary significance for top managers in pharmaceutical corporations, as they offer the rationale of how creating such models contributes to evaluating the sales volume, NPS (net promoter score), and return on marketing investment (ROMI).

References

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Appendices

Interview № 1

Добрый день! Меня зовут Кувшинова Анастасия, я являюсь студенткой 4 курса Высшей Школы Экономики факультета менеджмента и сегодня я хотела бы провести с Вами интервью на тему «Планирование пути пациента в фармацевтической отрасли». Хотелось бы Вам заранее сказать, что это студенческий исследовательский проект, и вся информация строго конфиденциальна: она будет использована только мной и никуда не будет вынесена.

Хорошо!

Итак, давайте начнем. Расскажите, пожалуйста, поподробнее о вашем препарате.

Наш препарат входит в группу препаратов МГТ (менопаузальная гормональная терапия). В данной нише всегда была проблема: в России женщины очень боятся гормонов. Хотя все знают, что со временем у всех наступаем климакс, снижается уровень женских гормонов, но женщины всегда сопротивлялись и сопротивляются тому, чтобы начать пить гормоны. Они боятся рака, что у них будут расти волосы… Это связано с различными страхами. Поэтому прежде чем женщина попадает к гинекологу, который может назначить ей этот препарат, она проходит очень длинный путь. Исторически, работа в нашем отделе велась с врачами различных специальностей. В прошлом году, когда я сюда пришла, я и моя руководитель поставили цель - построить patient flow на основании исследования пациентов и той информации, которую мы можем собрать от врачей. Собственно мы инициировали данное исследование.

Расскажите, какие стадии у пути пациента. С чего все начинается?

Начинается все с того, что пациентка испытывает определенные симптомы, которые в случае с МГТ она не хочет признавать, потому что это симптомы того, что она стареет, и занимается самолечением. Чаще всего данные симптомы появляются после 40 лет, когда женщина может еще не думать о том, что у нее климакс. Мы определили, что чаще всего это травы, седативные безрецептурные таблетки и анальгетики, потому что у женщин в этом возрасте часто начинаются мигрени. Соответственно, они пытаются вылечить эти симптомы препаратами, никак не связанными с гормонами. Но у них ничего не получается, и они идут к врачу. Сначала они идут к терапевту. У нас рецептурный препарат, сама его себе пациентка назначить не может, и терапевт тоже. Поэтому нам очень важно, что пациентка пришла именно к гинекологу. Сама она не готова признать и не всегда знает, что все эти симптомы (головные боли, раздражительность) ей может помочь вылечить гинеколог. Она идет к терапевту, скорее всего у нее уже начинает повышаться давление, и ей ставят какую-нибудь гипертонию первого уровня, и лечат само давление. Его снижают, со временем повышая дозу препарата, и до гинеколога женщина может так и не дойти. Также, женщины обращаются к неврологам с бессонницей и депрессией. С сердечно-сосудистыми проблемами они попадают к кардиологам. Еще они попадают к хирургам, потому что у них начинают болеть суставы и кости. В общем, ходят ко всем подряд. И, конечно, когда появляются первые морщины, все идут к косметологам. В общем, мы получили такую вот информацию.

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