You are Mariana Echeverri, head of the cardiovascular unit at Quindara Pharma in Bogotá. Your new blood-pressure drug reaches doctors' offices this week, and the regional office wants the February plan by 9:00 on Friday. It is the first of twelve.
The situation
The product combines three active ingredients in one daily tablet, for hypertensive patients not controlled on two drugs. It is prescribed by some 680 cardiologists, 2,400 internists and 14,000 general practitioners, but the bill is almost always paid by the patient's EPS, the health insurer: if the drug is not on its formulary, most patients do not buy it. Today only 10% of target physicians know the product and only 5% of patients have an EPS that covers it.
The subsidiary starts with US$500,000 of cash and a regional credit line of US$300,000 at 2% a month. The brand and market-access teams cost US$20,000 a month, sales or no sales, and each prescription, one month of treatment, lists at US$85. The regulatory compliance index stands at 70 out of 100 and the reputation with physicians and insurers at 50. In January an agency brochure came back with a sentence outside the approved indication; it was caught before distribution.
The plan the region approved puts US$15,000 a month into medical reps, a 15% discount to the EPS and US$5,000 into compliance. Rodrigo Salas, the regional CFO, defends it: "Every point of discount is margin that never comes back." Three of your colleagues want something else. Hernán Gutiérrez, the commercial director, asks for US$45,000 for reps. Paola Zuluaga, in market access, wants to accept the 30% the large EPS are asking for. Andrés Becerra, the compliance officer, asks for US$15,000. The regional vice-president, Lucía Arango, will judge the year on reach, compliance, reputation, profit and solvency. "Don't bring me only sales," she wrote.