Natrixam Case Study

Ahmed Ibrahim Salem

Senior Medical Rep Oct 2018
Executive Summary
Natrixam Vision:
To establish Servier as the most innovative and diversified company in the Egyptian Hypertension market

Target
• Moderate HTN Patients / Cardio, IM
• Severe HTN Patients / Cardio

Patient Opportunities Strategic Drivers

• Moderate HTN Patients taking CCB+DIU • Differentiating Natrixam as the best treatment for
• Severe Uncontrolled HTN Patients that needs Add on moderate HTN pts on CCB with Diuretics.
therapy • Establishing Natrixam as the best add on therapy in
Severe uncontrolled HTN patients.
Experience plan Brand Positioning
• Launch Event
• Standalone. Natrixam is The First and only fixed dose combination of
• PSP. Calcium Channel Blocker and diuretic drug for the
• Meet the Expert. treatment of essential Hypertension recommended by the
• Speaker Tour. Joint National Committee.
• Advisory Boards.
• RLM, SLM.
• CME

Sales Ambition: 12.4 m EGP / Volume Ambition 400 k

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 Uncover Opportunities
is about understanding the
market, our potential patient
populations, payer and HCPs
in order to determine where
the opportunities lie. By
uncovering relevant insights
we can start to think about
how these opportunities could
be un-locked

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 Market Analysis
HTN Value IMS

HTN Market value Sales Mono vs comb. Cont.

2,620,63
3,000,000,000 1,938,4 6,633 3,000,000,000.0
2,500,000,000 1,674,08 85,177 2,500,000,000.0
1,458,56
2,000,000,000 6,043 2,000,000,000.0 1,373,987,
5,684
2013;
1,500,000,000 1,500,000,000.0 1,013,839, 567
1,323,83 892,348,5
1,000,000,000
8,087 1,000,000,000.0 740,528,6 793,083,3 25 651 1,246,649,
500,000,000 500,000,000.0 583,309,4
35 665,482,2 781,737,5 924,645,5 066.0
86
0.0 52.0 98.0 18.0 26.0
0
2013 2014 2015 2016 2017 2013 2014 2015 2016 2017
Combined Monotherapy

Mono vs comb. ppg.

2017 1,246,649,
1,373,987,
924,645,5
1,013,839, 066.0 567
2016
892,348,5
2015 781,737,526.0 651
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793,083,3 18.0
665,482,2
2014 2013;
86 2013 2013;
98.0
583,309,4 740,528,6
63%
65%

52.0 35
- 500,000,000 1,000,000,000
37%
1,500,000,000
Combined Monotherapy

HTN market growth is driven by fixed dose combination

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 Market Analysis
HTN classes Value IMS

C02C
C02D
RAUWOLF

VB
RAUWOLF
ALK+OTH
ANT (Non
ALK+OTH
A-HY
PPG
CCB ; HER )Plain;
CCB Comb;
COM+DIUR
HERB; 0.0;
7.84%
1.9; 1.91% TOTAL ANTI-HTN MARKET 35.0
ARBS Plain; 0.2;
;0.01%
0.1;0.21%
0.11%
8.16% -9.0
CCB Comb

ACEI Plain; ANT (Non HER )Plain 20.0

B-Blockers 6.75%
ARBS ACEI Plain 32.4
Comb;
Comb;
9.28%
24.49% CCB 33.5

Duiretics; ARBS Plain 30.8

10.45%
B-Blockers Comb 40.6

Duiretics 31.6
ACEI Comb; B-Blockers
11.56% Plain;
ACEI Comb 31.2
19.24%
B-Blockers Plain 44.0

ARBS Comb 35.6

B-Blockers plain, and ARBS comb represents 44% of total HTN Market.
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 Market Analysis
Calcium Channel Blockers Value IMS

205 m EGP VB PPG

NORVASC;
29.59%
CCB 33.5
Others;
31.35%

PLENDIL 17.3

ISOPTIN 70.2

PLENDIL; ALKAPRESS 36.3

6.65% ALKAPRESS;
21.16%
ISOPTIN;
11.25% NORVASC 39.1

Amlodipine is the preferable molecule in the CCB market.

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 Market Analysis
Diuretics Value IMS

273 m EGP
Others;
VB PPG
EXAMIDE;
14.02% 23.87%
C03A DIURETICS 31.6

ALDACTONE ALDACTONE A 32.1

A; 6.05%

LASIX 76.8
LASIX; 8.07%
TORSERETIC 35.1

NATRILIX;
20.14% LASILACTONE 25.8
TORSERETIC;
11.26%
NATRILIX 18.9

LASILACTONE EXAMIDE 34.6

; 16.58%

Examide is the market leader

Natrilix is the 2nd leading product in the diuretics plain market
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 Market Analysis
Proj. RX

Per Spec. Per Class

6 m Rx

ARBS Plain; 5.5

B-Blockers COMB; 5.9
CARD.; 21.3 ARBs COMB; 17.4
ACE INHIBITORS
PLAIN; 7.5
IM; 52.8
DIURETICS; 7.5
G.P.; 20.1
CCB Plain; 7.8 16.2
PLATELET
AGGREG ACE COMB; 10.7
INHIBITRS; 8.5

IM and Cardio are the main source of Rx generation.

ARBs comb., BB plain, and ACE Comb represents 50% of the total Rx.

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 Market Understanding Key Findings

PATIENT MARKET Competitors HCPS, PAYERS AND KOLS Brands

•HTN is cons. Elevation of art. •HTN Market is dynamic •Norvasc (By Pfizer) is the •Natrixam is fixed dose comb,
Blood pressure. market, 336 product with 600 main competitor and the CCB •53% of RX from IM. amlopdipin and indapamide.
SKU. market leader = 60 MIO EGP
•Classified into mild moderate with PPG% of 39% •Cardio 21%. (Influencers). •Indicated for Essential HTN.
and severe •MAT 2017, MKT value is 2.6 B
 Mild HTN 24%. EGP, PPG 35%, •Natrilix is diuretic that cont. •20% from GP, •2 SKUs: 1.5 mg/5 mg & 1.5
 Mod. HTN 43%. with 2.1 MS with PPG % 18.9. mg/10 mg.
 Severe. HTN •HCP prefers Brands with low
33%. •Market Driven by Brands cost than generics. •Recommended by JNC
guidelines .
•91% of HTN pts have conc. •RX tends towards Fixed Dose •HCP select efficacy, CV prot.
disease. Combinations. and safety •USA and EU recommend,
 ACEIs + CCB +
•Pt are 1/3 newly diagnosed, •Efficacy driven RX. Diu
2/3 uncontrolled.  ARBs + CCB +
•Market tends towards Diu
•Essential HTN pts. Represent combinations with CCB.  Diu + CCB
about 6 MIO Rx/Year.

•Patients usually treated by

diff. classes. Taken once daily.

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Patient Journey

Diagnosis Initial 2nd

Referral 3rd Treatment
Treatment Treatment

IM
(3.2 m RX)
Non Black: General
Population, with or
52% without Diab: Controlled Controlled Controlled
Target • CCB, Diuretics,
Patient Cardio ARBs, or ACE,
(6 m RX) (1.3 m RX) alone or 30%
combined.

Reinforce
21% medication and
Add and titrate CCB, Reinforce
Black: General Diuretics, ARBs, or medication and lifestyle adherence
Sufferin Population, with or ACE. lifestyle adherence
g HTN, without Diab: Add additional
91% • CCB, Diuretics, Add and titrate CCB, medication class (ex,
with alone or Titrate CCB, Diuretics, ARBs, or β-blocker,
concomi combined. Diuretics, ARBs, or ACE.(not used aldosterone
tant 20% antagonist, or
ACE to the max. before)
Disease 70% others)
GP
(1.2 m RX)
CKD pat.: If not controlled, add
• ARBs, or ACE, again.
alone or
combined with
other class.

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SWOT
Strengths Weaknesses
(Prioritise current internal strengths) (Prioritise current internal weaknesses)

1. Natrixam is the first Diu/CCB combination in the market 1. Not recommended for CKD pts.
2. Heritage and brand equity of Natrilix efficacy, and CV protection. 2. Not intended for initiation therapy.
3. USA and EURO and JNC guidelines endorse CCB+DIU
4. The only preferred CCB to be used in combination is Amlodipine
5. Only recommended for Black Pts.
6. Servier rapport and engagement with HCPs.
7. Affordable Price suits large patient segments

Opportunities Threats
(Prioritise externally driven
(Prioritise externally driven competitor or environmental threats)
competitor or environmental opportunities)

1. Rarely patients are controlled by monotherapy. 1. Declined CCB market.

2. Mod. HTN has the higher prevalence 43% share. While Severe HTN pt.s 2. Entry barrier and low patient follow up.
33%. 3. Fierce Competition of established competitors.
3. Uncontrolled pts are the majority 2/3.
4. Market tends towards Fix comb.
5. RX is driven by efficacy , CV protection and safety
6. HCPs prefer brands.
7. Market tends towards combinations with Amlodipine.

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 Defining winning
strategies is about
prioritising our patient
opportunities and identifying
the critical factors required to
address them through
developing bold strategic
drivers which will result in
benefits for our patients and
AstraZeneca.

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Brand Strategy

 Establish a strong brand equity of Natrixam by being the first and only
fixed dose combination class of Amlodipine and Indapamide for the
treatment of essential hypertension for moderate and severe patients.

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Strategies to Realise the Patient Opportunities

Patient Opportunities Strategic Drivers

(The critical strategies that will realise the patient opportunities)

1. Differentiating Natrixam as the best treatment for moderate HTN

pts on CCB with Diuretics.
Moderate HTN patients

2. Establishing Natrixam as the best add on therapy in Severe

uncontrolled HTN patients.
Severe HTN Patients

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Brand Positioning
What is the Strategic Insight?
• Black HTN patients that needs only CCB and Diuretics as treatment.
• Non Black HTN patients that need CCB and DIU as treatment.
• All uncontrolled patients that need titration with an add on therapy CCB+DIU.

Core Differentiating Benefit Brand Values

First fixed dose comb of CCB and Diuretics for patient Efficacy of Amlodipine and Indapamide.
compliance. Cardiovascular protection
Patient Compliance.
Affordable price.

Natrixam is The First and only fixed dose combination of

Calcium Channel Blocker and diuretic drug for the treatment
of essential Hypertension recommended by the JNC.
Brand Positioning

Target
• Moderate and severe HTN pts.
• Card, IM

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 Planning the right
experiences means we
unleash our creativity to
translate the strategies we’ve
developed into bold ideas that
will deliver holistic and
motivating integrated
experiences.

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Communication Objectives

Target audience SMART communication Key and supporting

Strategic Drivers messages
(patient, payer, HCP, KOL) objective
(for each audience)
• Substitute the multiple • Convenience and patient
Highlighting the benefit • Moderate HTN patients. therapy of moderate HTN compliance.
of Natrixam as the patients taking Amlodipine • Affordable monthly cost.
best treatment for • IM and Cardio with indapamide by
• Guidelines
moderate HTN pts on simplified approach to
CCB with Diuretics. • Hospitals and Contractual write a fixed dose recommendations.
commination at the launch
• Health Insurance. year..

Establishing Natrixam • Benefits of augmenting

• Severe Uncontrolled HTN • Add on therapy for
as the best add on a diuretic and a CCB to
Patient uncontrolled severe HTN
therapy in Severe the current therapy to
patients that needs
uncontrolled HTN reach control status.
• Cardio. CCB+DIU
patients. • Guidelines Recom.

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Identified tactics to Deliver Experience Ideas

• Highlighting the benefit of Natrixam as the best treatment for moderate HTN pts on CCB and
Strategic Driver Diuretics

Communication target
audience
(patient, payer, HCP,
• Moderate HTN patients. / IM and Cardio / Hospitals, Contractual and Health Insurance.
KOL)

Communications initiatives

Targeting 500 Class A and B of Cardio and IM with

Conducting Mega Launch Event
international speaker.

Standalone 2 standalones (Upper Egypt and Delta)

Partnership with MOH in 100 Million Health Program for screening.

Patient Support Program
Screening Campaigns for Early detection in the Mega Contractuals.

Develop an advocate group of KOLS to make 2 speaker tours to

Speaker Tour
promote combination therapy.

RLM, SLM Targeting IM and Cardio

Identified tactics to Deliver Experience Ideas

Strategic Driver Establishing Natrixam as the best add on therapy in Severe uncontrolled HTN patients..

Communication target
audience
(patient, payer, HCP,
• Severe HTN patients. / Cardio / Hospitals, Contractual and Health Insurance.
KOL)

Communications initiatives

Targeting top Cardio KOLs To promote HTN management

Advisory Boards
Guidelines.

Meet The Expert International speaker to highlight the guidelines, to the Cardio.

CME Targeting Cardio KOLs. As Speakers to class B IM audiences.

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Operational Plan
Spendin
Strategic Driver Key Initiative Owner Timing
g
Conducting Mega Launch Event Marketing 2m Q1
Sales
Medical
Standalone Marketing 2m Q2 and
Highlighting the benefit Sales Q4
of Natrixam as the best Medical
treatment for moderate Patient Support Program Market 200 k Q3
HTN pts on CCB and Access
Diuretics monotherapy Speaker Tour Marketing 1m Q3
Sales
Medical
RLM, SLM Sales 500 k All year

Advisory Boards Marketing 100 k Q1

Establishing Natrixam as Medical
the best add on therapy Meet The Expert Marketing 1m Q2
in Severe uncontrolled Sales
HTN patients.. Medical
CME Sales 1m All year

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Pricing

 Penetration pricing strategy (High Quality with low price).

 Establishing an estimated Price of

 1.5mg / 5mg SKU :33 EGP
 1.5mg / 10mg SKU:47 EGP

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 Entrepreneurial
execution means we seize
opportunities, act with urgency
and take smart risks. We work
with our agencies to develop
compelling creative and we
inspire our colleagues to help
us execute the plan brilliantly.
We monitor our plan and
whether we succeed or
encounter challenges, we use
the lessons to help us improve
in the future. We are relentless in
pursuit of excellence.

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Field force Structure

 Co-promoted with Procorlan.

 Targeting 4,000 HCP

 3,000 IM
 1,000 Cardio.

 Total number of FTEs: 40.

 Fixed Cost: 2.5 m.

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Ambitions summary
Total
Year Ambition MS SKU Unit Total Sales
Unit
Targeting 10% of
Norvasc +DIU Units 1.5mg/5mg SKU:
Year 132,000
MS 0.5 % 400,000 12.4 m EGP
1
Targeting 10% of 1.5mg/10mg:172,000
Natrilix +CCB Unit MS
1.5mg/5mg SKU:
215,000
Year
Targeting 25% PPG 0.7% 500,000 14,8 m EGP
2 1.5mg/10mg:165,00
0

1.5mg/5mg SKU:
Year 290,000
Targeting 35% PPG 0.8% 675,000 20 m EGP
3 1.5mg/10mg:223,00
0

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P&L
Year Profit Fixed Costs Revenue Profit Margin

FTEs: 2.5
Year 1 12,4 m EGP Marketing, Medical, and Sales: 3.1 m 25%
6.8 m

FTEs: 2.5
Year 2 14.8 m EGP Marketing, Medical, and Sales: 7.5 m 50%
4.8 m

FTEs: 2.5
Year 3 20 mEGP Marketing, Medical, and Sales: 12.7 m 64%
4.8 m

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