印度尼西亞被認為是亞洲發展中國家中有著積極的經濟增長趨勢的一個國家，盡管在過去的5年里美國和歐洲爆發了經濟危機，但是在印度尼西亞，包括醫療保障行業在內的企業仍然保持持續發展的態勢，絲毫沒有受到政府預算的醫療保健配置與其他東南亞國家相比相對較低的影響(SMERU, 2012, p.16)。這可能會導致高的人口率和相對價格較高的藥物，而我們知道印度尼西亞有一個低比例的衛生保健專業人員團隊，在總人口數中其中只有一個是醫生或醫學博士生。根據2005年的數據顯示醫生和患者之間的比例是1:5000，這比其他的國家要高，例如馬來西亞的比例是1:700(Adzim, 2011)。

醫療業務部分具有很高的保健專業的影響是醫藥商業。根據國際商業觀察（2010），印度尼西亞制藥企業的價值在2005年的時候保持在4.83億美元到20億美元，2006年上升到22億美元，2009年的時候印尼醫藥市場價值達到27.9億美元，這是基于歐洲自我藥療協會（AESGP）、IMS亞洲健康、印尼制藥協會（GP Farmasi）和AC尼爾森統計的數據(2010)所得出的結論。

 

Indonesia is considered as one of several developing countries in Asia with positive economic growth despite crisis in US and Europe in the last 5 years. Business is growing including the healthcare business, despite low allocation of healthcare budget in government budget compares to other South East Asia countries (SMERU, 2012, p.16). This may contributed due to high population and relatively higher priced drugs, while as we know Indonesia has a low proportion of health care professional, which one of them is physicians or medical doctor, compare the total population. Data from Indonesian Medical Association in 2005 show that the ratio between doctor and patients is 1: 5.000, much higher than other country like Malaysia which is 1:700 (Adzim, 2011).

Part of healthcare business which has high influenced by health care professional is the pharmaceutical business. According to Business Monitor International (2010), in Indonesia pharmaceutical business value is keep rising from US$ 483 million to US $ 2 billion in 2005, US $ 2.2 billion in 2006 and In 2009, the value of the Indonesian pharmaceutical market has reached US $2.79 billion, based on figures from the Association of the European Self-Medication Industry (AESGP), IMS Health Asia, the Indonesian Association of Pharmaceutical Companies (GP Farmasi) and AC Nielsen (2010).

Pharmaceutical business is divided to two segments, non-prescription or commonly known as over-the-counter (OTC) drug and prescription drug category. OTC drug category means the drug can be sold without restrictions in grocery, department store or even small kiosk while prescription drug category means the drug should be prescribed first by physician for patient to buy and the drug itself should be distributed and sell only in pharmacy. This category is based in the efficacy and safety of the drug which is assessed by Indonesia National Drug and Food Commission (NADFC) or known in local language as Badan Pengawas Obat dan Makanan (BPOM). The business contribution of OTC drug to total pharmaceutical business market in Indonesia is around 40% while prescription drug is 60%.

For prescription drug business, one of the most challenging area for the development of drug is for the treatment of cancer or commonly known as oncology therapeutic area. Unlike other disease such as diabetes or cardiovascular where the introduction of new drugs is very common, oncology is one of several therapeutic area with neuro-science which has the least number of new product introduced in the last 10 years. Due to the natural of disease, up to 70% drugs which has successfully completed early phase of the research, failed in the late-stage of research as it is not demonstrating enough meaningful survival or extending live for the patients, the main outcome to measure one drug is working or not, as shown in Figure 1.1 the success rate of Oncology drug compare with other therapeutic/ disease area (Kola and Landis, 2004, p.712). With this high risk and also enormous cost of research compare with other diseases, only several companies are considered big player in the business, particularly company who have strong financial power to do extensive research.

Source: Kola and Landis, 2004, p.712

Figure 1.1: Drug Success Rates by Therapeutic/ Disease Area

Having success in registering the drug and obtain approval will need to be continued with a strong product pipeline. This is very important considering the product lifecycle in pharmaceutical business which very dependent on patent period and usually vary from 8-10 years after drug arrives in the market (Baerga, 2010). As shown in Figure 1.2. during this period the inventor will have the exclusive right to decide the price and sell the drug in the market, however as the patent ends, other companies will be able to make the copy drug or known as generic drug, thus the right promotion activity during the patent protection period will be important.

Source: Holland and Batiz-Lazo, 2005, p.197

Figure 1.2: Prescription Drug Lifecycle

Due to its strict regulations, prescription drugs are having a different way of promotional activities, unlike the OTC drugs. The dominance position of physician in the prescription beside the drug profile are playing importance part of the road to purchase of this drug category as no public promotion, advertisement or introduction is allowed through any type of media. Pharmaceutical companies who do this prescription drug business only can introduce, inform and promote the drug to health care professionals such as physicians in an ethical way, which means no payment or bribery-associated activities are allowed in the promotional activities. Thus, communicating the drug or product promotion directly to the physicians and other HCPs is become extremely important; this activity is commonly referred as pharmaceutical detailing. As shown in figure 1.3. Traditional detailing, meeting and medical journal is a common type of pharmaceutical marketing for prescription drug, with the domination remain in detailing.

According to Banerjee and Dash (2011, p.204) detailing in pharmaceutical industry is defined as the process of communicating the pharmaceutical product message to HCPs. As a marketing communication tool, it has been regarded as a strong and lasting positive effect on physicians’ prescription behavior. The traditional tools used by the pharmaceutical companies for communicating and promoting product messages to HCPs were visual aid, detail aid, and leave behind literature (LBC). These are the promotional tools used by the medical representatives to communicate the product message which relate to the disease and therapy during face-to-face detailing with physicians.

According to Thu (2012, p.11) the term “medical representative” or “pharmaceutical sales representative” refers to people who are hired by pharmaceutical companies based on some specific criteria suitable for working as seller. They interact with healthcare providers such as physicians through activities of providing drug’s information and persuading to use their drugs, commonly refers as detailing activities. As most of the time is spent on the field, recent survey show that medical sales representatives profession is dominated by male with average age of 40 (MedReps.com, 2012, p.3).

Bernewitz (2001, p.1) mention that face-to-face detailing is the dominant product promotion tool for pharmaceutical companies, often making up 60-70 percent of their total promotional budget. In the US alone, pharmaceutical companies spend more than $ 10 billion on product promotion by field force and it’s considered giving a good result. And their surveys are showing that time after time, the strong correlation between face-to-face detailing effort and product sales remain strong.

A survey which conducted in 2010 shows face to face detailing is still regarded as the most effective way to influence physician intent to prescribe with nearly 40 percent of physicians having an increased intent after sales  representative visit while tele-detailing has the least influence, with intent decreasing to 12 percent in 2010 from 35 percent in 2009 (Cegedim, 2012, p.2). Thus giant pharmaceuticals are engaging and investing in larger number of sales representatives to do this kind of product promotion or detailing by crowding physicians’ offices.

Source: Montoya, 2008, p.2

Figure 1.3: How Pharmaceutical Companies Market Their Drugs

Despite detailing so far still able to deliver the biggest return on promotion investments by pharmaceutical companies, many companies are finding that although the spending is increasing on product detailing however actual bottom-line results are not growing at the expected rate. Market challenges make it increasingly difficult to get product information through to doctors with traditional detailing tactics. This statement is supported by the following facts (iAnywhere, 2003, p.3):

The number of sales representatives has doubled in the past five to eight years, according to Cap Gemini Ernst and Young.

But at the same time, Forrester Research claims the number of details has risen by only 15 percent.

Each year, nearly 100 new ethical drugs are approved based on the US FDA reports which mean making staying up-to-date much more complex for physicians.

Boston Consulting Group estimates 66 percent of physicians have instituted some sort of barrier for sales reps, such as an appointment policy, restricted timing, limits on the number of reps seen, etc.

A physician can expect to receive, on average, 2.2 visits per week that last 6.2 minutes, with a mean of 3.3 products promoted by pharma reps during each visit.

With high-prescribing physicians having more than 50 sales representatives from multiple companies are visiting on a regular basis, very few is establishing meaningful dialogues with them. Pharmaceutical companies start to think how to improve this detailing method, and advance in information technology apparently become one of the possible solutions.
 

The use of the latest information technologies for promotional activities of pharmaceutical products is now growing very fast. Various factors such as the decreasing effectiveness of face-to-face promotion by sales representatives, increasing costs of traditional face-to-face product promotion detailing and the busy schedule of physicians are thought to be responsible to this growth. One of the technological-driven promotions is what called as e-detailing.

E-detailing can be best described as the use of information technology in the field of pharmaceutical detailing. E-Detailing is not a single entity but can take many different forms from virtual live meeting between sales representatives with doctors until simply just add face-to-face detailing with the latest technological advance. It is once said that the true form of e-detailing will eliminate the need of sales representatives on communicating the product, however one pharmaceutical company in the UK measured impact on physicians’ prescriptions based on four groups of sales representatives and e-detailing which are (Bates, 2008, p.2, p.3):

Group with no sales representatives or e-Detailing

Group with only sales representatives

Group with only e-Detailing

Group with a combination of sales representatives and e-Detailing.

The fourth group (the combination of sales representatives and e-Detailing) was found to be the most effective one with 71% more effective than the baseline group (not seeing neither sales representatives nor e-Details) and 39% more effective than the groups where traditional sales representatives detailing was done . This clearly shows sales representatives are still needed in the pharmaceutical product promotion, and e-detailing the other way around should be positioned as an effective tool for them which can be delivered using mobile device or other innovative medium.

The advance of communication technology also led to innovation of mobile devices. Various mobile devices such as smartphones and data devices like tablet have been introduced to market. One of the popular tablet currently is iPad which marketed by Apple Inc. In the context of doing e-detailing, iPad offers a lot of benefit for the pharmaceutical sales force/ representatives.

From physical benefit, the iPad device is lightweight and slim, weighting in at 0.7 kg, making it easy to carry. An iPad’s battery life can be measured in days rather than hours; the iPad’s touch screen is sleek and makes for an intuitive user interface. It’s considered small enough to be used by sales force within physician’s office or hospital setting and the large screen is an ideal platform to show interactive content to the physician.

Other important factor for sales force is that iPad is always connected, facilitate them to communicate with head office all over the time, can instantly send any emails and compared with other laptops, is relatively in expensive and can facilitate additional cost and significant space saving by replacing paper-based sales materials (Niles, 2011, p.2). While for physician, product promotion using iPad provides multimedia-rich content which is more interactive and also faster response from the sales representatives every time they have questions, request or inquiries which need to be decided or provided by the head office.

This model of face-to-face detailing by combining iPad and e-detailing concept is being applied by PT XYZ in the middle of 2011 to improve the company sales performance, this decision is taken by the headquarters in response to the competition and PT XYZ regarded as the first International pharmaceutical company in Indonesia which applies this concept. This is applied in all business units in PT XYZ including Oncology Business Unit.

As seen in Figure 1.4 and Figure 1.5 promoted products (which means product that actively being promoted by sales representatives to physician through detailing) sales of PT XYZ from Q3 2009 until Q3 2012, the growths is increasing from 2009 15%, 2010 17%, however it decrease very significantly in 2011 by 7%, and start to increase again in 2012 by 12%, this impacting sales number which tend to be flat in 2011 compare with 2010 but increasing again in 2012.

Comparing with the growth of International Pharmaceutical Manufacturing Group (IPMG), a group of Multinational Pharmaceutical Companies in Indonesia, as seen in Figure 1.4, the growth of PT XYZ is above the market growth during 2009 and 2010 however fall below in 2011 and start to improving again, although it still below market growth in 2012. However looking in the Oncology Business Unit, it’s always performed above market growth rate with an exception in 2011 and significantly driving PT XYZ’s promoted product business increase its contribution from 48% to 52% in 2012.

Source: Internal Company XYZ

Figure 1.4: Promoted Products Sales (M.A.T.) From Q3 2009 - 2012

Source: Internal Company XYZ

Figure 1.5: Promoted products growth (M.A.T.) compare with market growth

We can also see in Figure 1.6 the sales force cost in Oncology business unit is increasing quite high in 2011 and 2012 with significant additional cost from investing them with iPad and e-detailing applications which start in middle 2011.

Source: Internal Company XYZ

Figure 1.6: Sales force cost from 2010 – 2012 Oncology business unit PT XYZ

The change between slow growth rate in 2011 and becomes double digit growth in 2012 by the time of implementation of iPad e-detailing for the Oncology business unit in PT XYZ become the background to conduct the research, to find out if there is impact by changing product promotion, from traditional face-to-face detailing to using iPad e-Detailing, to performance of sales representatives in Oncology business unit PT XYZ and to investigate the influencing factors of iPad e-detailing use by sales representatives.

Company Profile, PT XYZ

PT XYZ, is a Swiss company. PT XYZ in Indonesia has two divisions: Pharmaceutical and Diagnostics. Pharmaceuticals divisions are divided by three major business units (BU): Oncology, Specialty Care and Mature products. Oncology is business unit which sell all drugs used to treat cancer, specialty care is business unit which sell drugs to treat infection, anemia and obesity, while mature products are business unit which sell old products which no longer being actively promoted. Except for Mature products, the other two business units are actively and using sales representatives in promoting their product, thus all of their products referred as promoted products while mature products referred as non-promoted due to its nature of business which only sales passively based on customer request.

Oncology Business Unit is contributing nearly 50% of the business while specialty care is around 45% of the business. Figure 1.7 and 1.8 is showing the business segmentation and organizational chart in Oncology business unit, while Figure 1.8 shows Oncology business unit is the biggest contributor for the revenue of pharmaceutical division of PT XYZ.

Source: Internal Company XYZ

Figure 1.7: Business Segmentation of PT XYZ

Source: Internal Company XYZ

Figure 1.8: Organization Chart in PT XYZ Oncology Business Unit

Source: Internal Company XYZ

Figure 1.9: 2012 Business Unit Revenue Contribution in PT. XYZ Pharmaceutical

Figure 1.10 and 1.11 show performance by products in Oncology business unit from 2010-2012 based on annual sales, the common pattern is almost all products experience
negative or even small growth in 2011, and delivers positive growth in 2012.

Source: Internal Company XYZ

Figure 1.10: Oncology Business Unit’s Sales to Date by Products

Source: Internal Company XYZ

Figure 1.11: Oncology Business Unit’s Sales Growth to Date by Products

Problem Identification

Many pharmaceuticals companies now see Oncology as the new opportunity despite limited number of drugs which success on gaining approval to be marketed, several strategies to overcome the high cost of research are being applied by giant pharmaceutical company start from acquisition (Pfizer with Wyeth for anti-cancer drug Temsirolimus) and co-marketing agreement between companies with smaller biotech company (BMS and Merck Serono with ImClone for anti-cancer drug Cetuximab).

In Indonesia, the competition is fierce with the local companies also enter the oncology market, most of them contributes in increasing number of branded generics chemotherapy which offering up to 50% cheaper price than the originator which usually a multinational pharma company. The local companies is gaining market share very significantly from multinational pharma which most of them are European and US company. Thus most European and US companies are really counting on innovative drugs which is still protected by patent and also more difficult to be copied, however this innovative drugs are also competing between one and another as one product in Oncology is usually can be used to treat more than 1 type of cancer disease.

Unlike some other disease such as cardiovascular, research in Oncology is very extensive, new data of existing product and also upcoming products are eagerly awaited by physicians, either new success story or another fail story will determine the position of that product in the latest treatment guidelines. Thus the speed of information for oncologist (physician who specialized in treating cancer) is very crucial for them to stay updated on the latest treatment paradigm, nevertheless in Indonesia some oncologists are also known for very pragmatic type which tend to wait for wealth of data available before he/she adjust the treatment practice while usually their behavior is more passive on waiting for information in meeting or congress instead try to search for it over internet or online journals.

The competition to establish a meaningful conversation between company representatives with Oncologist in Indonesia is also very high as limited number of Oncologist currently in Indonesia. With only total around 200 oncologists across Indonesia for more than 200 million population makes the ratio of doctor to patients is very small, only around 1 oncologist per 1 million populations. While oncologist has so many patients in their daily practice, they also receive a lot of sales representatives from many pharmaceuticals companies which result that time allocation per sales representatives to see a doctor is very short. Currently there are more than 30 pharmaceuticals companies doing product promotion to Oncologist. This is the situation which being faced by PT XYZ in the oncology market, despite the innovative products which their market, the sales representatives should establish a meaningful conversation with the oncologist in a very short time including responding very quickly to questions, inquiries as well as delivering the latest information. They will also need to capture the information received by the customers and enter it in the CRM system. The use of iPad and e-detailing apps is expected to facilitate this model of interaction and later being fully implemented in PT XYZ by October 2011.

This research will examine the influencing factors for sales representatives in using iPad e-detailing and whether it positively impacts their performance:

What are the influencing factors for medical/ sales representatives to use the iPad detailing in their activities
 

Whether using iPad e-detailing is positively impact medical/ sales representatives’ performance from their standpoint
 

Whether implementing the iPad e-detailing method is effective for PT XYZ Oncology

Research will be conducted in the Oncology business unit of PT XYZ as the main business driver of the company and has shown a good trend in sales growth after implementation of iPad e-detailing, with aim to analyze the influencing factors and impact of using iPad e-detailing to performance of the sales representatives.

Problem Statement

Therefore, the research problem of this study is:

“What will be the influencing factors and impact of iPad e-detailing use to performance from sales representatives’ standpoint of Oncology division in PT XYZ”
 

There are three areas of research problem:
 

What are the influencing factors of sales representatives in using iPad?
 

Does iPad e-detailing impact positively to sales representatives’ performance from their standpoint?
 

Does implementing iPad e-detailing is effective for Oncology division of PT XYZ?

Research Purpose

Based on the problems identified above, the purpose of this research is to analyze the influencing factors and impact of using iPad e-detailing to performance from sales representatives of Oncology Division of PT XYZ standpoint.

To identify and explain the dominating factor that influence iPad e-detailing use by sales representatives.

To identify and explain several factors such as perceived usefulness, perceived ease of use, perceived self-efficacy and internal support that influence iPad e-detailing use by sales representatives.

To analyze the impact of using iPad e-detailing to performance of sales representatives of Oncology division PT XYZ from their standpoint.

To analyze whether implementation of iPad e-detailing is effective for Oncology division PT XYZ.

Significance of the Thesis

This study is significant because it provides information which will be helpful:

The study is significant in understanding several factors that influence iPad usage and which factor is influence the most.

The study is significant in understanding the impact of iPad e-detailing use to performance from their standpoint.

The study is significant in assess whether implementation of iPad e-detailing is effective in improving sales call numbers and achievement in Oncology division of PT XYZ.

The study may be useful for many interested parties, especially:

Pharmaceutical industry, in particular for Oncology business. They may use this research as consideration to start or continue implementing iPad e-detailing as part of their marketing strategy.

The researcher. The results of this research can be used to enrich my knowledge and to enable me to contribute more to the company.

Academics. The result of this research can be used to do further research in the pharmaceutical industry and IT subject. This research also can be used as a reference for lecturers and other students to conduct further research.

Scope and Limitation of the Thesis

This research will study the influencing factors and impact of iPad e-detailing use to sales representatives’ performance. The scope of this research will be focused on:

Implementation of iPad e-detailing

Sales/ medical representatives in Oncology division PT XYZ.

Sales representative’s performance since August 2011 until August 2012 as the full implementation of detailing using iPad in Oncology division PT XYZ.

This research has some limitations; first this research is only done in Oncology division of PT XYZ, not the whole pharmaceutical business and second, not includes the analysis of the other marketing programs, such as sponsorships and medical education activities impact to sales performance (e.g. sales representative’s achievement) due to limitation of data and time. This may limit the application of the research to all division of PT XYZ or pharmaceutical industry itself.