UNIVERSITATEA “TRANSILVANIA” BRASOV

UNIVERSITATEA “TRANSILVANIA” BRASOV
FACULTATEA DE STIINłE ECONOMICE
SCOALA DOCTORALĂ
DOMENIUL MARKETING
NEW MODELS WITHIN THE HEALTH CARE VALUE CHAIN
AND IMPLICATIONS ON
THE INTERNATIONAL PHARMACEUTICAL SECTOR
MODELE NOI ÎN LANŢUL VALORIC AL ÎNGRIJIRII SĂNĂTĂŢII
ŞI IMPLICAŢII ÎN SECTORUL FARMACEUTIC INTERNAŢIONAL
Scientific Coordinator:
Prof. univ. dr. ec. Liliana DUGULEANĂ
Summary of PhD Thesis
Rezumatul tezei de doctorat
Braşov, 2010
Doctoral Student:
Thiemo HAFEMEISTER
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MINISTERUL EDUCATIEI, CERCETĂRII, TINERETULUI SI SPORTULUI
UNIVERSITATEA TRANSILVANIA DIN BRASOV
BRASOV, B-DUL EROILOR NR.29, 500036,
TEL. 026841300, FAX 0268410525
RECTORAT
CĂTRE...................................................................................................................................
Vă aducem la cunostinţă că în data de 25 noiembrie 2010, ora 12.30, în corpul U, sala U II 3, la
Facultatea de Ştiinţe Economice şi Administrarea Afacerilor va avea loc susţinerea publică a tezei de
doctorat intitulată:
”NEW MODELS WITHIN THE HEALTH CARE VALUE CHAIN AND IMPLICATIONS
ON THE INTERNATIONAL PHARMACEUTICAL SECTOR”’/
„MODELE NOI ÎN LANŢUL VALORIC AL ÎNGRIJIRII SĂNĂTĂŢII ŞI IMPLICAŢII ÎN
SECTORUL FARMACEUTIC INTERNAŢIONAL”,
elaborată de doctorand Thiemo Hafemeister, în vederea obţinerii titlului stiinţific de doctor, în
domeniul MARKETING.
COMPONENŢA COMISIEI DE DOCTORAT
Numită prin Ordinul Rectorului Universităţii Transilvania Brasov
Nr. 4184 / 10.09.2010
PREŞEDINTE
Prof. univ. dr. ec. Ileana TACHE
Prodecan la Facultatea de Ştiinţe Economice şi Administrarea Afacerilor
Universitatea “Transilvania” Brasov
CONDUCĂTOR STIINŢIFIC
Prof. univ. dr. ec. Liliana DUGULEANĂ
Universitatea “Transilvania” Brasov
REFERENŢI ŞTIINŢIFICI
Prof. univ. dr. Aurelia Felicia STĂNCIOIU
Academia de Studii Economice Bucuresti
Prof. univ. dr. Ilie ROTARIU
Universitatea “Lucian Blaga” Sibiu
Prof. univ. dr. Niculaie ANTONOAIE
Universitatea “Transilvania” Brasov
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”NEW MODELS WITHIN THE HEALTH CARE VALUE CHAIN AND IMPLICATIONS
ON THE INTERNATIONAL PHARMACEUTICAL SECTOR”
Scientific coordinator: Prof. univ. dr. Liliana DUGULEANĂ
Doctorand: Thiemo Hafemeister
.
ABSTRACT
In all Western European Nations public health care systems are regulated by the state due to the fact
that no free market exists in terms of independent customer decisions. On this base the
pharmaceutical market is analyzed considering increasing healthcare costs, the major pharmaceutical
protagonists, as well as different pricing strategies, in Chapter 1.
The distribution channel from the pharmaceutical manufacturer up to the pharmacist will be analyzed
concerning actual structures and future potentials, in Chapter 2. Based on this analysis considering
concentration processes within the pharmaceutical sector future structures and developments are
forecasted, in Chapter 3. To understand and intensively reflect the upcoming trends it is necessary to
understand these changes from a theoretical perspective. Present marketing models are being
discussed and analyzed in Chapter 4. Next to the marketing models the different selling behaviours
are introduced as well, since the field force as the sales vehicle for the pharmaceutical companies
will be significantly affected by these changes as well.
The pharmaceutical environment is pretty well established. Nevertheless in terms of Marketing
models or deeper strategic analysis this area has not been widely covered yet from a theoretical base.
The thesis analyzes on an empirical base future distribution models and hereby assessing in how far
these models can be realized, what burdens and challenges will be faced and if the necessary support
by the key stakeholders is given, in Chapter 5.
Due to the lack of data an empirical study will be necessary to find a base what changes can be
realistically supported and in how far implementations are realistic.
Within this thesis the theoretical frame is given for the changes happening within the pharmaceutical
sector. After the theoretical foundation the implications mainly for the pharmacy landscape are
analyzed empirically, in Chapter 6. Based on a questionnaire an evaluation is done within the supply
chain and clearly analyzing key trends as well as future models. The market changes are happening
presently even faster and more aggressively, then originally expected. Several trends are moving into
the direction which was forecasted and the model created has a high probability to forecast upcoming
trends and developments, since margins are shrinking and horizontal integration especially is being
done to realize synergies. This prediction will be a chance for all market stakeholders to prepare
themselves and undertake preventive actions to react specifically to market changes. Just with the
help of these parameters are the effects and implications within the healthcare sector assessable.
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„MODELE NOI ÎN LANŢUL VALORIC AL ÎNGRIJIRII SĂNĂTĂŢII ŞI IMPLICAŢII ÎN
SECTORUL FARMACEUTIC INTERNAŢIONAL”
Coordonator ştiinţific: Prof. univ. dr. Liliana DUGULEANĂ
Doctorand: Thiemo Hafemeister
ABSTRACT
În toate ţările Vest Europene, sistemele publice de îngrijire a sănătăţii sunt reglementate de stat,
pentru că nu există piaţă liberă, în sensul existenţei deciziilor independente ale clienţilor. De aceea
piaţa farmaceutică este analizată considerând atât creşterea costurilor în sănătate, protagoniştii
majori în domeniul farmaceutic, cât şi diferitele strategii de preţuri, în cadrul capitolului 1.
Canalul de distribuţie, de la producătorul farmaceutic până la farmacist, este analizat pe baza
structurilor actuale şi viitor potenţiale, în capitolul 2. Pe baza acestor analize, considerând procesele
de concentrare din intreriorul sectorului farmaceutic, se previzionează viitoarele dezvoltări şi
structuri, în capitolul 3. Pentru a înţelege şi a reflecta intensiv la următoarele trenduri, este necesară
înţelegerea schimbărilor din perspectivă teoretică. Actualele modele de marketing sunt discutate şi
analizate în capitolul 4. Odată cu modelele de marketing sunt prezentate diferite comportamente de
vânzare, pentru că forţele de vânzare, care constituie forţa motrice a companiilor farmaceutice, vor fi
în mod semnificativ afectate de aceste schimbări.
Mediul farmaceutic este destul de stabil. Fără îndoială, în termeni ai modelelor de marketing sau a
unei analize strategice mai profunde, acest domeniu nu a fost încă larg acoperit cu o bază teoretică.
Teza analizează, pe baze empirice, modele noi ale distribuţiei, stabilind în ce măsură pot fi realizate
aceste modele, cu ce sarcini şi provocări se confruntă şi dacă este necesară implicarea principalilor
părţi interesate, în capitolul 5.
Datorită lipsei de date este necesar un studiu empiric pentru a stabili baza unor schimbări care să fie
în mod real suportate şi în ce măsură acestea pot fi implementate.
Teza conţine cadrul teoretic al schimbărilor care au loc în sectorul farmaceutic. După fundamentarea
teoretică sunt analizate empiric implicaţiile, în principal, în mediul farmaceutic, în capitolul 6. Pe
baza unui chestionar, s-a realizat o evaluare a lanţului de aprovizionare şi o analiză clară a trendurilor
cheie precum şi modele viitoare.
Schimbările pieţei au loc în prezent, chiar mai repede şi mai agresiv, decât cele iniţial aşteptate.
Câteva trenduri acţionează în direcţia previzionată şi modelul creat poate previziona trendurile şi
dezvoltările viitoare, pentru că marjele sunt în scădere şi integrarea orizontală este, în mod special,
menită să realizeze sinergii. Acestă previziune va fi o şansă pentru toţi participanţii pe piaţă pentru a
se pregăti şi a întreprinde acţiuni preventive de reacţie specifică la schimbările pieţei. Numai cu
aceşti parametri, efectele şi implicaţiile din domeniul sănătăţii sunt comensurabile.
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CONTENTS
SYNTHESIS ...................................................................................................................................... 8
CHAPTER 1 – THE PHARMACY MARKET................................................................................ 8
1.1 Increasing healthcare costs across the world··············································································8
1.1.1 Health Care costs are a severe business problem........................................................... 8
1.1.2 Opt-Out Incentives.......................................................................................................... 9
1.1.3 Manage Supplier Performance ....................................................................................... 9
1.1.4 Disease Management options .......................................................................................... 9
1.2 Pharmaceutical Market Analysis································································································10
1.2.1 Major therapeutic areas................................................................................................ 10
1.2.2 Ten companies dominate the worldwide pharmaceutical market............................... 10
1.2.3 The US market as the most lucrative market............................................................... 10
1.2.4 Blockbuster drugs are dominating the market ............................................................ 11
1.2.5 Pharmaceutical growth ................................................................................................. 11
1.3 Health Care market ······················································································································12
1.3.1 Expenses increase within the pharmaceutical sector ................................................... 12
1.3.2. Sales share across the major regions throughout the world....................................... 12
1.3.3 Health Care expenditure growth across the countries................................................. 12
1.4 Major pharmaceutical protagonists···························································································13
1.4.1 Pharmaceutical Manufacturing – Start of the process chain ...................................... 13
1.4.2 The physician – intermediate within the centre of interests ........................................ 14
1.4.3 Pharmaceutical wholesalers.......................................................................................... 14
1.4.4 Pharmacists and the portfolio of a pharmacy .............................................................. 14
CHAPTER 2 - CONCENTRATION PROCESS ........................................................................... 15
2.1 The structure of pharmaceutical markets·················································································15
2.2 Measures affecting prices internationally ·················································································15
2.3 Types of intervention in pharmaceutical markets ···································································16
2.4 Concentration process within the pharmaceutical field force environment························16
2.5 Concentration process within the wholesale sector ·································································17
CHAPTER 3 - DISTRIBUTION DEVELOPMENTS .......................................................................
WITHIN PHARMACEUTICALS.................................................................................................. 18
3.1 Characteristics of pharmaceutical distribution········································································18
3.1.1 The wholesaling reimbursement system is "fundamentally weak”............................. 18
3.1.2 “Specialty" pharmaceutical distribution...................................................................... 19
3.1.3 Technological changes................................................................................................... 19
3.2 Terminology of Health care chain ······························································································19
3.2.1 Existence and objectives of a value chain..................................................................... 20
3.2.2 Relationship with Consumers ....................................................................................... 20
3.3 Logistic problems within the health care distribution chain··················································21
3.4 Distribution challenges within the health care market in Europe·········································22
3.4.1 Background of the distribution challenges................................................................... 22
3.4.2 Potential reforms of the supply network ...................................................................... 22
3.4.3 Structure of the work analysis ...................................................................................... 22
3.4.4 European regulations and trends ................................................................................. 23
3.4.5 Goal and Principles of the European pharmaceutical strategy................................... 23
3.5 Distribution network and simulations ·······················································································24
3.5.1 Distribution within the micro and macro economic environment............................... 24
3.5.2 Distribution logistics...................................................................................................... 25
3.5.3 Logistics costs ................................................................................................................ 25
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3.6 Basic conditions and development tendencies around the globe ···········································26
3.7 Conclusion concerning distribution challenges in Europe ·····················································26
CHAPTER 4 - NEW CONCEPTS WITHIN......................................................................................
PHARMACEUTICAL MARKETING........................................................................................... 27
4.1 Pharmaceutical marketing mix···································································································27
4.2 New concepts in pharmaceutical marketing ·············································································28
4.3 Social Marketing····························································································································28
4.4 Integrated Customer Marketing·································································································29
4.5 Limited product opportunities in pharmaceuticals·································································30
CHAPTER 5 - NEW DISTRIBUTION MODELS.............................................................................
WITHIN PHARMACEUTICALS.................................................................................................. 31
5.1 Cost evaluation as the base for new distribution models ························································31
5.2 Increasing control of drug distribution to enhance patient safety ………………………33
CHAPTER 6 - MARKETING RESEARCHES CHARACTERIZING THE DISTRIBUTION
WITHIN THE PHARMACEUTICAL MARKET.............................................................................
IN GERMANY ................................................................................................................................ 33
6.1 Questionnaire conception·············································································································33
6.2 Evaluation and interpretation·····································································································34
6.2.1 System changes and cost reductions implications ........................................................ 34
6.2.2 Openness for changes in the distribution cycle in the enterprises............................... 34
6.2.3 How high are the following cost factors being rated? .................................................. 34
6.2.4 Physical structure and controlling of the supply chain................................................ 35
6.2.5 Equipment of the national and/or European central storage depots .......................... 35
6.2.6 Trends in the outsourcing process ................................................................................ 36
6.2.7 Supply chain co-operations ........................................................................................... 36
6.3 Expectations and openness for new models in the pharmaceutical sector···························36
6.4 Key results of empirical study·····································································································37
6.5 Interpretation of the key trends – based on the findings of the empirical study ················38
CONCLUSIONS AND PERSONAL CONTRIBUTIONS............................................................. 39
ILLUSTRATIONS OVERVIEW ................................................................................................... 41
LITERATURE OVERVIEW ......................................................................................................... 43
INTRODUCERE............................................................................................................................... 8
CAPITOLUL 1 – PIAŢA FARMACEUTICĂ ................................................................................. 8
1.1 Creşterea costurilor de sănătate în lume .···············································································8
1.1.1 Costurile în sănătate reprezintă o serioasă problemă de afaceri .......................................... 9
1.1.2 Stimulente Opt-Out .......................................................................................................... 9
1.1.3 Managementul performanţei furnizorului .......................................................................... 9
1.1.4 Opţiuni de management al bolii ........................................................................................ 9
1.2 Analiza pieţei farmaceutice ···········································································································10
1.2.1 Arii terapeutice majore ................................................................................................... 10
1.2.2 Zece companii domină piaţa farmaceutică din toată lumea ............................................. 10
1.2.3 Piaţa Statelor Unite, ca piaţa cea mai lucrativă ................................................................ 10
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1.2.4 Medicamentele cardiovasculare domină piaţa ................................................................. 11
1.2.5 Creşterea domeniului farmaceutic ................................................................................... 11
1.3 Piaţa în sistemul îngrijirii sănătăţii································································································.12
1.3.1 Cheltuielile cresc în sectorul farmaceutic ........................................................................ 12
1.3.2 Cota de vânzări în marile regiuni ale lumii ...................................................................... 12
1.3.3 Creşterea cheltuielilor cu îngrijirea sănătăţii la nivelul ţărilor ......................................... 12
1.4 Marii protagonişti în domeniul farmaceutic ·················································································13
1.4.1 Prelucrarea în domeniul farmaceutic – Începutul lanţului de proces................................. 13
1.4.2 Medicul – intermediar întrun centru de interese ............................................................... 14
1.4.3 Angrosiştii în domeniul farmaceutic ............................................................................... 14
1.4.4 Farmacişti şi portofoliul unei farmacii ............................................................................ 14
CAPITOLUL 2 – PROCESUL CONCENTRĂRII........................................................................ 15
2.1 Structura pieţelor farmaceutice ···························································································15
2.2 Măsuri care afectează preţurile internaţionale······································································15
2.3 Tipuri de intervenţie în pieţele farmaceutice ·······································································16
2.4 Procesul concentrării forţelor din domeniul farmaceutic·······················································17
2.5 Procesul concentrării în sectorul vânzărilor angro ·······························································17
CAPITOLUL 3 – DEZVOLTĂRI ALE DISTRIBUŢIEI ÎN DOMENIUL FARMACEUTIC.... 18
3.1 Caracteristici ale distribuţiei în domeniul farmaceutic ································································18
3.1.1 Sistemul de rambursare în vânzarea angro este ................................................................ 18
3.1.2 Distribuţia farmaceutică de „specialitate” ........................................................................ 19
3.1.3 Schimbări tehnologice .................................................................................................... 19
3.2 Terminologia lanţului valoric în sănătate ·····················································································19
3.2.1 Existenţa şi obiectivele lanţului valoric ........................................................................... 20
3.2.2 Relatia cu consumatorii ................................................................................................... 20
3.3 Probleme logistice în interiorul lanţului de distribuţie în sănătate ··············································21
3.4 Provocări ale distribuţiei pe piaţa sănătăţii din Europa ·······························································22
3.4.1 Concepte de bază pentru provocările din canalul distribuţiei............................................ 22
3.4.2 Reforme potenţiale al reţelei de aprovizionare ................................................................. 22
3.4.3 Structuri ale analizei muncii ........................................................................................... 23
3.4.4 Reglementări europene şi trendinţe ................................................................................. 23
3.4.5 Scopul şi principiile strategiei europene în domeniul farmaceutic .................................... 23
3.5 Reşeaua de distribuţie şi simulări ··································································································24
3.5.1 Distribuţia în mediul micro şi macroeconomic ................................................................ 24
3.5.2 Logistica distribuţiei........................................................................................................ 25
3.5.3 Costuri de logistică ……………………………………………………………………………………………………… 26
3.6 Condiţii de bază şi tendinţe de dezvoltare pe întreg globul ·························································26
3.7 Concluzii despre provocări ale distribuţiei în Europa···································································26
CAPITOLUL 4 - NOI CONCEPTE ÎN MARKETINGUL FARMACEUTIC............................. 27
4.1 Mixul de marketing farmaceutic ····································································································27
4.2 Aplicarea analizei cost beneficiu şi a eficienţei costurilor în domeniul farmaceutic··················28
4.3 Marketing social……………………………………………………………………… 28
4.4 Forţe de influenţă în marketingul farmaceutic ·············································································29
4.5 Opportunităţile limitate de produs în domeniul farmaceutic ·······················································30
CAPITOLUL 5 – NOI MODELE DE DISTRIBUŢIE ÎN DOMENIUL FARMACEUTIC ........ 31
5.1 Evaluarea costului ca bază pentru modelele noi ale distribuţiei ·················································31
5.2 Natura şi evaluarea costurilor în sănătate ······················································································33
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CAPITOLUL 6 – CERCETĂRI DE MARKETING PENTRU CARACTERIZAREA
DISTRIBUŢIEI PE PIEŢA FARMACEUTICĂ DIN GERMANIA............................................. 33
6.1 Conceperea chestionarului·············································································································.33
6.2 Evaluarea şi interpretarea··············································································································. 34
6.2.1 Schimbări de sistem implicatii ale reducerii costurilor..................................................... 34
6.2.2 Deschiderea pentru schimbări în canalul de distribuţie al întreprinderilor ........................ 34
6.2.3 Cum sunt cotaţi factorii de influenţă ai costurilor?........................................................... 35
6.2.4 Structura fizică şi controlul lanţului de aprovizionare ...................................................... 35
6.2.5 Echipamentul depozitelor centrale de naţionale şi/sau europene ...................................... 36
6.2.6 Trendinţe în procesul de externalizare ............................................................................. 36
6.2.7 Colaborări în lanţul de aprovizionare............................................................................... 36
6.3 Aşteptări şi deschidere pentru noile modele din sectorul farmaceutic·········································36
6.4 Rezultate cheie ale studiului empiric ·····························································································37
6.5 Interpretarea trendurilor cheie – pe baza rezultatelor studiului empiric······································38
CONCLUZII ŞI CONTRIBUŢII PERSONALE ........................................................................... 39
LSTA FIGURILOR ........................................................................................................................ 41
BIBLIOGRAFIA............................................................................................................................. 43
SYNTHESIS
CHAPTER 1 – THE PHARMACY MARKET
The pharmacy market undergoes dramatic changes. One of the key questions within this changing
environment is to determine what products should be manufactured offshore and if in which way.
When deciding the most appropriate products to manufacture offshore, products in the mature phase
of their lifecycles are obvious candidates. The shift offshore presents less Intellectual Property IP
(IP) risk as it has largely been depreciated, and improves the product line’s competitive positioning
as costs are lowered. Taking into consideration the increasing wealth in China and other Asian
countries this growth will continue and be therefore stronger than other industries.
1.1 Increasing healthcare costs across the world
Employers across the United States are grappling with continually rising healthcare costs, but none
more than manufacturers.
While employers understand what is driving health-care costs upward, there is little they can do
about it. How can they counter government mandates or inflation? And unlike companies in
industries such as banks or professional services, unionized manufacturers do not have the option of
passing along the rising costs to employees. But there is a way to bring down drug and hospital costs,
keep health-care provider costs in balance and manage demand. 1
1.1.1 Health Care costs are a severe business problem
1 see ABDA bzw. Instituts für Handelsforschung in Köln 2004
8

The experience showed that too many companies treat the problem of soaring health-care costs as a
benefits problem rather than a business problem.
A perfect example recently appeared in The Wall Street Journal. After spending a year devising
ways to reduce health-care costs, an executive with a major automotive manufacturer remarked that
“the solution wouldn’t come any time soon.” Would shrinking market share be treated soglibly?
Would declining revenues or profits provoke such a cavalier response?
1.1.2 Opt-Out Incentives
In millions of working families across the United States, both husband and wife are eligible for
health coverage. Each of these families represents a potential savings for one employer. But how
does Company A make Company B’s health plan more attractive? Leading companies are answering
this with novel strategies that influence employees’ coverage elections.
One solution is simply to require working spouses to use their own employer’s health-care programs.
1.1.3 Manage Supplier Performance
Supplier management never stops. The cycle begins with the contract and continues with monitoring
performance, enforcing guarantees and resolving problems; then it begins all over again. In our
experience, strong performance guarantees that focus on the right metrics will generate higher levels
of satisfaction among employers and employees. At the same time, performance guarantees assure
that companies do not lose substantial sums through financial or procedural inaccuracies.
Companies can be considerably more aggressive in negotiating guarantees by implementing an atrisk
compensation strategy, in which the provider places a %age of administrative service fees paid
to the benefits administrator at risk. Following an acquisition, the company decided it was a good
time to address performance issues with one of its key health-plan providers.
1.1.4 Disease Management options
The top-five chronic diseases in the United States—cardiovascular disease and stroke, cancer,
diabetes, obesity and asthma—are responsible for approximately 75% of health-care costs, according
to the DHHS. In many cases, patient behaviour contributes to the disorder and can just as effectively
contribute to the recovery.
Disease-management services can be divided into three phases:
− Phase one aims to keep employees healthy through education and behaviour modification.
− Phase two tries to slow or reverse the progress of chronic conditions, and the third phase focuses
on managing acute episodes.
Strong efforts in phase one will result in huge cost savings in phases two and three. The key to costeffective
disease management is selecting the right service provider
9

1.2 Pharmaceutical Market Analysis
While looking deeper into the data of the different therapeutic areas it is absolutely important to
manifest where the most research is being conducted and where the highest need for the patients
exists.
1.2.1 Major therapeutic areas
The central therapeutic areas being Cardiovascular and CNS, which are rising in significance.
Cardiovascular drugs include cholesterol-lowering agents
Central nervous system (an area that remains poorly understood in medical terms) recently
driven by the emergence of important drugs for treating mental illnesses such as depression
and schizophrenia
Anti-infectives (predominantly antibiotics) retain high importance, despite the age of many of
the key products
Gastrointestinal treatment showed a strong growth, most significantly those for ulcers and
acid reflux
Respiratory treatments stagnating
Especially Cardiovascular will be the number one syndrome in future where pharmaceutical
companies put a lot of energy in.
1.2.2 Ten companies dominate the worldwide pharmaceutical market
Two major trends are being viewed within the last years. On the hand side the big companies are
getting even bigger and increase their market shares by either internal growth or external growth via
acquisitions. Around 45% of the worldwide sales are being made by the 10 leading companies listed
below 2 and half of them are coming from the US based market. These companies are looking for
further synergies and the expectation is that further acquisitions in the coming years will increase
their market share even more. Small companies will struggle in this enormous competition for
innovative drugs and efficient cost bases.
Despite a decade of mergers, the research-driven industry remains highly fragmented
The largest 5 players have together less than 30% market share
This will change as part of the concentration process in the world within the next years dramatically.
1.2.3 The US market as the most lucrative market
As follows the markets should be analyzed based on the key facts.
North America
– North America has the least restrictions, larger funding and higher R&D investment than
European and Asian countries; growth is expected to continue
2 Analysis of 2009 annual released reports (http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies)
10

– Companies in the US show increasing export sales. The ban on drug imports from Canada is
believed to have resulted in windfall profits of $150 billion for the US pharma industry
– Saturation in the North American market has led all pharmaceutical companies to focus on the
EU market
Europe
– European market influenced by restrictions on pricing and profits of pharmaceutical
companies: the market has been affected by the new refund list, cuts in regulated drug prices,
growing market competition, and tax cuts
– Poland expected to be one of Europe's most attractive drug markets
Rest of World / Asia
– Companies in Asian countries are mainly focusing on generic and biogeneric drugs
– Only a few Asian companies are entering the US market
– India is regarded as a major outsourcing hub for pharmaceutical research and clinical tests
– Chinese market is growing at double-digit rates and within a decade is likely to be the world's
third largest, after the US and Japan
1.2.4 Blockbuster drugs are dominating the market
The pharmaceutical companies are looking for blockbusters to increase their sales situation overall.
Blockbuster drugs continue to dominate the market worldwide and this trend will definitely increase
over time. Specifically the impact of persons increasing their life expectancy contributes to the
above sales increase forecast. The fact that the pharmaceutical industry especially invests in areas
where high return of investments are being seen, the more they look at the drivers where profits can
be generated as cardiovascular and Oncology. The growth rates and blockbuster successes can only
continue, if the investments are being done in the right categories.
1.2.5 Pharmaceutical growth
Health care costs are rising across the world – since all countries are facing the same challenges and
problems. Especially when you compare this development with the GDP it is obvious that the health
care costs are increasing intensively and the governments have to find ways of financing these
additional costs. Looking now at Romania especially the situation is as follows:
11

Source: World bank indicators 2009
Figure 1: Romania – Health expenditure; Total (% of GDP)
This page includes a chart with historical data for Health expenditure; total (% of GDP) in Romania.
Romania is an upper-middle income economy. In recent years, domestic consumption and foreign
direct investments have been stimulating Romania's GDP growth.
1.3 Health Care market
The health care market is growing intensively across the world. Maintaining and recreation health is
one of the major functions of the public financed health care system. The health care market is not
consistently defined, but it comprises all products and methods, which are in some way characterized
by prevention, diagnosis, and post operative treatment.
1.3.1 Expenses increase within the pharmaceutical sector
Research, development, production and marketing are subject to safety and regulation requirements
and are therefore regulated by the state. For the pharmaceutical manufacturers this Pharmaceuticals
account already for 50% 3 of the world’s greatest market the telecommunication market. Both
industries are still growing intensively.
Having analyzed the global trends of course the view in the rest of the world has to be made by
country. In nearly every country the spending has increased.
Therefore the trend to reduce pharmaceutical expenses to reduce governmental budgets is the same
intention in all industrialized countries 4 . A huge factor for this deviation is the fact that
pharmaceutical prices vary significantly around the world – moreover as expressed before the GDP
and personal income of the inhabitants vary also and contribute to the above significant difference in
absolute spending.
1.3.2. Sales share across the major regions throughout the world
Sales share across the major regions throughout the world are increasing significantly with shares of
more than 5%. The impact per country, especially in the context of financing these additional
expenses will be a tough burden for all countries world-wide.
1.3.3 Health Care expenditure growth across the countries
The following factors contribute to the fact that the pharmaceutical sales are increasing presently and
will probably increase in the next years as well in the same style: roughly one additional year has
been added to life expectancy at birth every five years since 1965; baby boomers will turn 65 form
2010 onwards; Healthcare expenditures fore people 65+ are estimated to be nearly 4 times those of
people under 65
3 IMS Deutsche Bank research 2004, PWG
4 OECD Data analysis 2005
12

Market penetration: More rapid broad penetration of markets: seeking as many medical indications
for a drug as possible, better marketing of products.
Innovation: Increasing number of targets for drug interaction
In terms of Health care budgets Pharmaceutical companies represent a very cost-effective means for
governments or insurance companies to contain the healthcare costs of an ageing population.
1.4 Major pharmaceutical protagonists
To be able to understand the characteristics of this market the major participants will be analyzed
below. The focus will be put on finished pharmaceutical goods – services offered, therapies and
further utilities and hospital processes will not be covered. Below a short summary, covering the
main stakeholders of the pharmaceutical process chain:
Key Stakeholders within the pharmaceutical sector
Key
Participants
Government/
regulation
(1) HMO = Health Maintenance Organization;
(2) PBM = Pharmacy Benefits Management
Health
insurance,
HMOs 1)
Physicians
Clinics &
rehabs
Pharmaceutical
companies
Pharmacies
&
PBMs 2)
Medical
devices
ource: Fourth Report of Session 2004-05, Volume 2
Figure 2: The influence of the key stakeholders within the pharmaceutical industry
Patients
These key participants are key protagonists for the upcoming changes. Especially pharmaceutical
companies try to increase their influence.
1.4.1 Pharmaceutical Manufacturing – Start of the process chain
In Germany around 1.100 companies are registered as “Pharmaceutical enterprise”. Looking at
pharmaceutical manufacturers there are 4 main forms to be differentiated between:
• Companies carrying out fundamental research
• Companies researching in narrow therapeutic areas
• Companies who are looking for the further development of already existing actives, but do
not maintain any basic research
• Companies without own R&D, who are only giving patent expired products a new name and
market them under their own name in the form of generic products
S
13

All the above mentioned companies are on the one hand in a tough competition under a free
enterprise system with the intention to maximize their profits
1.4.2 The physician – intermediate within the centre of interests
The physicians are the key partner for the industry, since their prescriptions are the base for their
sales. They are the opinion leaders making the decisions concerning kind, frequency and intensity of
the medicine being prescribed. The patient has to rely on the judgement of the doctor and takes the
recommended product. But the freedom of the doctor is reduced by the health insurance funds, who
limit him by giving a financial budget for his prescriptions. It can therefore be stated that the
autonomy of decision making is limited significantly and this process will continue in the future.
1.4.3 Pharmaceutical wholesalers
Wholesalers have the function of the physical distribution of the pharmaceutical products. In
Germany most pharmacists receive between 1 and 5 deliveries per day. The trend in most countries
is towards only one delivery per day to reduce the costs incurred at wholesaler level, since margins
were reduced significantly as part of national healthcare reforms. To increase their power
wholesalers are trying to expand especially into Eastern Europe. Germany’s largest wholesaler
Celesio has reached agreement with the Slovenian manufacturer Lek to acquire its stakes.
Furthermore they prepare to buy stakes of Kemofamacija which has 2 subsidiaries Unipharm and
Pharmafarm in Croatia and Romania respectively. The plan is to build up a pan- European network
involved in wholesale, logistics and Marketing.
The pharmaceutical wholesaler landscape will tremendously change within the next years. Some key
points are the base for the analysis below. Key trends will be analyzed deeper over the next
chapters. Clearly the forward integration of wholesalers plays a major role in this trend.
1.4.4 Pharmacists and the portfolio of a pharmacy
The classical pharmacist’s function exists already since the 13th century in Europe. Pharmacists had
the right to produce pharmaceutical products and the physician was responsible for the therapy and
the diagnosis. This principle of mutual supervision prosecutes the legislator till today 5 . The
pharmacist has two main functions which are supply of products and a consulting function.
Based on a small sample the following analysis was conducted in Germany. RX products are
identical in price – nevertheless OTC products can be sold at any price and are not related to a fixed
price regulation policy – the drug price ordinance. Therefore two major components have to be
analyzed when comparing the portfolio being offered by pharmacists: Consultancy and the perceived
price level.
5 Gaude, W. 1986; p. 13
14

CHAPTER 2 - CONCENTRATION PROCESS
Markets for pharmaceutical products differ from markets for consumer goods to their high level of
regulation. Some of these regulations are an absolute imperative to ensure public health. But other
regulations are the consequence of inefficient structures within the whole health sector.
2.1 The structure of pharmaceutical markets
Pharmaceutical products are different consumption goods for several reasons. From a theoretical
perspective the question lays on the table what the background for merger waves is. As stated by
Brealy and Myers 6 , merger waves are one of the ten unsolved puzzles in economics and finance. At
present, there is not an accepted theory that can simultaneously explain why firms merge, what are
the characteristics of merging firms and, more importantly, what are the effects of these operations
on firms performance.
Among the many limitations of these empirical works, three are worth to point out. First, recent
findings show the existence of industry clustering in merger activity (Andrade, Mitchel and Stanford,
2001). This suggests that the use of cross-industry data might be responsible for the inconclusiveness
of previous studies and calls for an analysis that is based on a well-defined industry. Second,
although there is a vast literature studying the short-run effects of Merger and acquisition firms,
prices, products and market value, little attention has been devoted to the long-run assessment of
dynamic efficiency. The traditional static analysis of the effects of mergers on firms, market power
and efficiency shows some important limitations when applied to those R&D intensive industries
where both margins and costs are largely determined by innovation. Finally, there has been little
effort to link the ex-post effects of mergers to the ex-ante observable characteristics of merging
firms. But it is likely that the degree of successful of a merger depends largely on these
characteristics.
2.2 Measures affecting prices internationally
Which measures affect the price? Price authorities generally face difficulties whether the launch
price set by a manufacturer is appropriate or not. The more it needs to be justified in how far
measures are in place and how prices are being affected?
A small but affluent country is especially at risk of being exploited by the drug manufacturer who
may charge more to that small country, than to a country with a comparable GDP per capita but a
much higher population. Many countries are taking into account the prices charged in other countries
when negotiating an appropriate launch price of a new drug. International price comparisons are also
6 Brealy and Myers 2003
15

made when a government wishes to re-evaluate the price of a drug after it has been on sale for a
while. These strategies apply to branded and patented drugs and branded off patent drugs.
2.3 Types of intervention in pharmaceutical markets
For a variety of reasons governments are intervening in the health care market – the most frequent
reasons are the following:
A) Concern over monopolistic pricing
Patented pharmaceuticals do not face any direct competition - that is the reason why many
governments fear that this apparent monopolistic situation will be exploited. Moreover neither
prescribing physicians nor patients have any incentive to act in a price sensitive manner, since
someone else is obviously paying the bill. The purchasing decision lies however solely in the hands
of the physician and the patient. Governments believe that the prices charged by pharmaceutical
companies are negatively correlated with co payment rates of consumers. Price interventions are
therefore regarded as a legitimate way to induce market like prices.
B) Concern over excessive demand & expenditures
A patient rationally acting buys a product as long as marginal costs do not exceed marginal utility.
Marginal costs to the patient are only a minor proportion of marginal costs to society. A patient may
therefore require a produce whose marginal utility exceeds his marginal costs (co-payment) but not
the marginal costs to society. The physician who wishes to maintain his business relation with that
customer will readily prescribe the product. Prescription guidelines are a common tool used to
impede uneconomical prescriptions.
Concerns over excessive expenditures are typical for countries with a tax funded NHS system. In
order to procure added funds for the health sector such governments can only: increase taxes,
increase indebtedness, cut expenditures in other sectors.
Increasing taxes or indebtedness negatively influences the attractiveness of that country for investors
and its long term economic growth expectancies. Cutting costs in other government sectors will
generally meet resistance in the affected departments and is difficult to implement. Therefore
healthcare and pharmaceutical budgets are generally the response used by these governments.
C) Concern over equity and access
Some diseases that can be cured by the pharmaceuticals have a significant impact on society. The
most recent examples in history are the therapies found to combat HIV that can be expected the
productive lifetime of affected patients by years or even decades. Governments may intervene in the
pharmaceutical markets to make such products as available as needed on a socially equitable basis.
Concerns over excessive pricing, prescribing and spending have led all western governments to
implement cost containment strategies. Cost containment strategies may either apply to the
reimbursement price the overall volume consumed or to overall spending on pharmaceuticals.
2.4 Concentration process within the pharmaceutical field force environment
16

The pharmaceutical industry is undergoing a fundamental transformation. Unprecedented
competition, diminishing margins, public scrutiny, and ever increasing regulation now characterize
the industry 7 . As a response to the changing dynamics of the business, particularly heightened
competition, many pharmaceutical firms have radically increased the size of their sales forces. The
underlying assumption is the existence of a direct correlation between sales force size and market
share. This widely held belief that the bigger the sales force, the bigger the market share, has long
dominated pharmaceutical sales and marketing strategy. But now, with the sharp rise in the number
of sales representatives and significant changes in the work environment of most physicians, the
logic has to be questioned. Physicians today are facing a rapidly changing work environment
characterized by strict reimbursement policies, extensive budget pressures, and a shortage in
qualified personnel. As a result, their workload has increased significantly. Pharmaceutical firms'
efforts to throw an increasing number of sales representatives at the physicians make the situation
even worse. Many physicians, especially the top prescribes, feel under constant assault. They also
perceive that sales representatives do not provide the necessary information and their knowledge is
often limited to the sales pitches devised by marketers at corporate headquarters. As a result,
physicians have started to limit the number of sales representatives they admit each day 8 . Under
these circumstances, it becomes increasingly difficult for sales representatives to get an opportunity
to speak with a physician.
2.5 Concentration process within the wholesale sector
Pharmaceutical-wholesale industry, and their control over the market is drawing the attention of
lawmakers, the scrutiny of regulators and the wrath of smaller rivals who intensively watch the
market developments and the concentration process within the big wholesalers, whose market share
is increasing over the last years and the potential of new logistic models.
The transition from a central planning to a market economy in Central and Eastern European
countries has led to major and rapid changes in society. Democratic liberalization has empowered
citizens through basic rights, freedom and the development of civil society rights. Economic
liberalization has bought the promise of improved living standards and granted individuals increased
choice in consumption, education, health and employment. The changing norms and values of
society are moving towards Western European ideas and standards. The changing economic
framework and income expectations of health care professionals were the major driving factors for
health financing reforms. All health care financing reforms in CE countries are in the mainstream of
the European tradition, which includes the ideas of solidarity, universal coverage and active health
policies. The CE countries shifted from a strong hierarchical Semashko model to a more regulated
market model.
7 e.g. Puschmann et al. 2002
8 i.e. Elling et al. 2002, 89
17

The new system being developed right now encompasses the influence of western European
marketing models. The effects western countries are facing apply to Eastern countries as well – only
the magnitude differs. But within the next two to five years the same challenges will be faced – for
that reason are the changes being discussed relevant for the East European markets as well.
Health care financing has been an important topic on the political agenda worldwide in recent
decades. For every government it is a subject of continuous concern that costs of health services are
increasing. Health care costs form a substantial burden of the national economy. Every government
is eager to keep this burden as low as possible by implementing cost containment policies. Due to
these severe reductions the financial pressure on pharmaceutical companies is increasing worldwide.
New marketing concepts are being looked for, in order to survive in an intensive competition to
sustain or increase market shares at the cost of competitors. Only the innovative companies with
new, flexible and creative concepts are able to master the increasing challenges all companies are
facing.
CHAPTER 3 - DISTRIBUTION DEVELOPMENTS
WITHIN PHARMACEUTICALS
The goal of this section is to analyze a large segment of the health care industry that is getting more
and more attention within the academic world – the health care value chain. What does this term in
detail contain? Trading relationships are being analyzed between producers (manufacturers) of health
care products, purchasers of these products (wholesalers, distributors) and health care providers
(hospital customers) that are the end users of these products.
3.1 Characteristics of pharmaceutical distribution
The following analysis is more strategic than operational. The goal is to understand the bases of
cooperation and competition along the value chain, the sources of efficiency in contracting between
suppliers and providers and the emerging best practises and strategic alliances along the value chain.
3.1.1 The wholesaling reimbursement system is "fundamentally weak”
New industry studies see a transition to fee-for-service relationships between manufacturers and
distributors. Furthermore the pace in which wholesalers are running is and has to increase
significantly in future to stay in place. Health care distributors have had phenomenal organic growth
relative to almost any other distribution industry being tracked and analyzed. This has been driven by
growth in end-use consumption, growth in the product prices, and growth in distribution's share of
the channel. Health care distributors now handle the majority of overall market consumption in the
health care supply chain. In fact, their aggregate share of channel volume is up dramatically over the
18

past 25 years. Alternative channels have not been as much of a threat here compared to retail and
technology channels.
3.1.2 “Specialty" pharmaceutical distribution
Especially with regard to biopharmaceuticals this business is different from traditional
pharmaceutical distribution. A crucial difference between conventional drugs and new
biopharmaceuticals have created wholly distinct marketing and distribution channels, leaving
incumbent wholesalers poorly positioned in the commercialization of new biotechnologies.
Pharmaceutical manufacturers have found themselves ill-equipped to deal with the new sales and
marketing challenges, leading to broken alliances and even litigation between former alliance
partners. Traditional wholesalers, busy pursuing scale economies through consolidation, ignored the
opportunity to take a leadership position in the fast growing, higher margin business of bringing
biopharmaceuticals to market. Today, biopharmaceutical manufacturers rely on the support of the
new channels to remain focused on research and free of burdensome alliances. Operating margins for
specialty distributors are four to five times as large as traditional pharmaceutical wholesalers due in
large part to their many value-added services within the health care system.
3.1.3 Technological changes
The bar-code/electronic product code/RFID movement is changing a lot of business practices in
pharmaceutical distribution. How is this going to play out in the pharmaceutical field? Are
distributors in the lead position in adapting to this, or are they simply following the instructions of
the manufacturers?
The customer is driving most change in the supply chain right now. Wholesalers with ties to buyers
are experimenting with RFID [radio-frequency identification], such as Wal-Mart and the Department
of Defence, are actively assessing the potential impact and getting ready for implementation.
3.2 Terminology of Health care chain
The term value chain was popularized by Michael Porter among academic circles – he means
herewith the entire production chain from the input of the raw materials to the output of the final
product consumed by the end users 9 . The chain is called a value chain because each link in the chain
adds some value to the original inputs.
Within the industry the term supply chain tends to be used more frequently than value chain. A
supply chain is a virtual network that facilitates the movement of a product from its earliest point of
production through packaging and distribution up to the ultimate point of consumption 10 . The supply
chain is thus the path travelled by the product, each stop along that path defines a link in the supply
chain. A marketing term forming the strategic goal from push to pull can be seen in this environment
9 Enzyklopedie – in vierundzwanzig Bänden, neunter Band GOT – HERP, 19. völlig überarbeitete Auflage, 1989
Mannheim, p.445
10 Wöhe, G. (2002): Einführung in die Allgemeine Betriebswirtschafts, 21.neubearbeitete Aufl., München 2002
19

as well. Supply chain networks may operate to both “push” manufactured products through the
chains using intensive field force activities and promotional campaigns, and “pull” products through
the chain to continually replenish retailers inventories and meet customer demands.
The “push model” is thereby characterized through manufacturers who promote and sell as much
product as they can to the consumers. According to the “pull model” customers’ demand products
from the preceding link in the chain. Those vendors then become responsible to manage the
customer’s inventories.
3.2.1 Existence and objectives of a value chain
Supply chains exist because there is little vertical integration of manufacturers into the distribution
and delivery of their products up to the end customer. Vertical integration is so far relatively low,
since manufacturers believe that the costs of transacting with the marketplace for distribution and
delivery are much less than the costs of attempting to take distribution in-house and coordinating all
of these changes using hierarchical means. And this is the major reason why manufacturers believe
that it is cheaper for them to buy distribution services from product wholesalers in the marketplace
rather than make distribution services in-house. Consequently, manufacturers have elected not to
enter the distribution business but rather let specialist firms produce these services for them.
After having described the details of the value chain the questions arises what the objectives of a
value chain are. Attached a comprised overview of the major objectives:
Optimizing the overall activities of firms working together to create bundles of goods and services.
Managing and coordinating the whole chain from raw material suppliers to end customers rather than
focusing the interests of one player
Developing highly competitive chains and positive outcomes for all firms involved. The goal is
establishing a portfolio approach to work with suppliers and customers, deciding which players to
work with most closely and establishing the processes and information technology (IT) infrastructure
to support these relationships 11 . Value chains are supposed to be collaborative partnerships between
players engaged in economic exchange.
3.2.2 Relationship with Consumers
What the consumers need, and how they get it, are some of the questions that guide the wholesaler in
providing the service. Effectively, the retailer shapes his service and image in the manner that
responds to consumer needs. This is because consumer places value on the retail experience, and not
just on the product he purchases. While price is an important decision factor, the shopping
experience in itself could significantly affect purchasing behaviour. Some individuals may prefer a
particular geographic location, or put a high value in stores with large product portfolios, or simply
go for stores that provide the best retail service (like fast movement in the queue, properly ventilated
11 Sterzel, A. (2002): Deregulierung des Arzneimittelvertriebs in Deutschland –
Versandapotheken als Reformoption? – Eine ökonomische Analyse, Berlin 2002
20

stores, and credit card acceptance even for small purchases). It is very rare that shoppers would visit
a retailer on a purely lowest price service. For this reason, retail competition not just takes place on
the pricing aspect, but also on non-price dimension. 12
Non-price dimension, from the consumer’s viewpoint, can come in the form of: convenience,
product range/ selection, quality, cleanliness of retail outlet, friendly staff, convenient operating
hours, store design and atmosphere.
Retailer image and advertising are the other factors that affect consumer relationship. In most cases,
the image is built through the products the outlet carries, the store design, and quality of retailer
service.
3.3 Logistic problems within the health care distribution chain
Product demand is heavily based on the clinical preference of the physician but not based on a
formal cost-benefit analysis or budgetary constraint.
Professional training in procurement and logistics has never been a hallmark among providers, given
the prominent role of clinicians and their preference for branded items 13.
Despite of all consolidation processes taking place the industries along the value chain are still very
fragmented with no clear leadership at any stage. The fragmentation complicates therefore the
difficult task of connecting thousands of different parties involved at each stage of the value chain,
standardizing the ordering process formats and the content of business transactions.
Providers have historically made their technological investments rather in patient care than in
information systems and infrastructure.
As a consequence of the mentioned factors above the health care sector has been rather slow in
changes. The health care industry is often being analyzed via porter’s 5 forces model, which
emphasizes competitive rivalry, supplier and customer bargaining power and the threat of product
substitutes and new entrants to industry. Having analyzed this chain the question arises who the real
customer is. Given the complexity of the flows of the value chain it is evident that there are multiple
customers in the value chain. Hospitals, health care systems and nursing homes are institutionally
based customers – within these institutions there are multiple customers who are directly or
indirectly responsible for the product ordering 14 .
Based on the ordering process the role of the wholesalers and distributors is classified as following.
Wholesalers are independently owned and operated intermediaries in the distribution channel. As
independent intermediaries they also operate their own warehouses for product inventories.
12
Raff, Daniel M. (2003):’The Wholesale and Retail Trade in the United States’, The Wharton School
University of Pennsylvania , Reginald H. Jones Centre Working Paper WP 2003-07
13
Schöffski, O. (1995): Die Regulierung des deutschen Apothekenwesens - Eine
ökonomische Analyse, Baden-Baden 1995
14
Pfohl, H.-C. (2004a): Logistikmanagement: Konzeption und Funktion, 2. überarbeitete und
erweiterte Aufl., Berlin et al. 2004
21

Wholesalers are firms that sell products to another intermediary. The typical case is that a
pharmaceutical wholesaler purchases drugs from a manufacturer and resells them to a pharmacy,
which in turn sells them to the end customer directly. The basic function of distributor is therefore to
satisfy customer needs and to match supply and demand.
3.4 Distribution challenges within the health care market in Europe
Into the structures of the German medicament distribution significant movement has been coming
within the recent years. Mainly the apparently inexorably rising expenditures of the health insurance
companies for medicaments force the legislator to measures, which are intended to limit the
increasing costs in this sector in a long-term basis.
3.4.1 Background of the distribution challenges
These efforts are executed in the light of the background of an increasing average age and an
associated increase usage of medicaments – especially for people in the ages above 65 years. The
permission of the internet pharmacies, the abolition of reference prices and the existence of
pharmacy chains has taken place recently. Application of fixed prices for certain products and the
permission of small chains represent thereby only the beginning of the changes within a former very
regulated market. The mentioned changes will affect substantially the health care system in the
European countries.
Moreover stores or supermarkets attached pharmacies for the near future are quite conceivable. The
question arises which consequences will have these modifications for the health care system 15. And
how they are viewed by the fact that an increasing part of the population is dependent due to
advanced age, increasing immobility and the need of a surface covering supply to evaluate?
3.4.2 Potential reforms of the supply network
In the media and the relevant literature completely different opinions are being expressed concerning
further reforms on the supply network. Certain market studies and strategy papers are based on a
long-term reduction of the pharmacy numbers of up to 30%. Usually these statements are based on
expectations of market participants being questioned via market research. A goal of this paper is to
examine a model which is based on mathematical relations how future reforms and changes affect
the pharmacy net in Germany and Europe. Since the changes are actually happening simultaneously
across the countries the same effects and impacts are being discussed.
3.4.3 Structure of the work analysis
The focus lies apart from the definition on the impact of the medicament distribution. In addition the
initial position and foreseeable developments are described and analyzed. Special attention is put on
the commercial stages. A view in the order-political context of the medicament trade follows. The
third subsection is concerned with the economic situation of the pharmacy and wholesale level under
15 Kotler, P. et al. (2003): Grundlagen des Marketing, 3. überarbeitete Aufl., München 2003
22

the influence of the political conditions. The structure of the model and its variants are described on
the basis of the model in this segment. The following section determines the premises and the
acceptance which can be met regarding the model and the regarded market. The used parameters,
their sources and data, are stated in detail. In addition the description of the used simulation area,
economical characteristic numbers and the regulation of two parameters critical for the model results
are being validated. The model validates the conclusion, by means of one confrontation of results of
the two model variants.
Constructing on the bases a scenario is simulated and their results are being analyzed. Thereby the
determination of effect strength and effect tendencies is certainly the centre of attention, which the
direct consequences of a certain development (e.g. a rising market share of the dispatch pharmacies
or a trade profit margin sinking by increasing competition) represent. This places a payment in
advance for the development of the total scenarios 16 .
3.4.4 European regulations and trends
As already pointed out within the European countries different trends can be analyzed. Therefore the
European perspective of the pharmaceutical forum and working group on pricing will be analyzed
and described below.
The overall goal is to ensure that more competitive and dynamic markets are put into place.
Innovations and forward oriented market mechanisms should be supported and rewarded across the
member states.
3.4.5 Goal and Principles of the European pharmaceutical strategy
The goal of for the European pharmaceutical strategy should be to ensure that every European has
timely access to safe and effective prescription drugs, and that all patients in the member states of the
European Union are deprived of needed prescription drugs because of his or her states inability to
pay for this medication. To achieve this goal the following principles to frame the strategy’s
development, implementation and evaluation are being proposed:
All policy decisions, including drug approval and program coverage, are based on an impartial
review of the best available scientific evidence and on the adoption of best practices nationally and
internationally. All initiatives are carefully assessed in accordance with a comprehensive evaluation
strategy. Pharmaceuticals are evaluated not in isolation but as an integral part of the health system.
Health care providers and health organizations have access to the knowledge and information
necessary to facilitate optimal and appropriate pharmacotherapy.
Appropriate use is made of the knowledge and skills of physicians, nurses, pharmacists and other
health care providers. The decision-making process is open, transparent and accountable, and
16 Gersch, M. (2004):Versandapotheken in Deutschland – Die Geburt einer neuen
Dienstleistung – Wer wird eigentlich der Vater? - in: Marketing Zeitschrift für Forschung
23

incorporates the active, meaningful participation of patients, health professionals, and other relevant
stakeholders including public and private insurers.
Toward a unified, aligned and prospective oriented European Pharmaceutical Strategy the above
principles, and the following recommendations, apply broadly to any pharmaceutical strategy,
including the nine-point National Pharmaceuticals Strategy (NPS) proposed by governments. The
elements of a comprehensive Canadian pharmaceutical strategy are interdependent and should be
developed concurrently to ensure that the strategy is coherent and holistic. In addition, they should
form part of a broader framework that encourages research and development of new medicines all
across Europe’s Drug Coverage principles.
Coverage should be based on optimal and appropriate standards of treatment for all Europeans. It
should be comparable across the country, minimizing disparities between provinces and territories.
Coverage plans should include coverage for catastrophic drug costs.
As a first step, governments should adopt a common operational definition of “catastrophic”. In
order to find a common formulary the following principles should be adhered to:
Governments should work toward national harmonization of formularies, based on optimal and
appropriate standards of treatment. Decisions regarding inclusion of drugs in formularies should be
based primarily on scientific evidence of their impact on health outcomes, and informed by evidence
regarding their cost-effectiveness.
A process should be in place for allowing patients to access non-formulary agents in cases of
medical necessity.
3.5 Distribution network and simulations
For the classification of the distribution term it is expedient to differentiate in a micro economic and
a macro economic dimension of the expression.
3.5.1 Distribution within the micro and macro economic environment
The macro economic distribution is seen as an economic activity of three branches. Production
covers the range of the goods production, the consumption, the goods consumption for need
satisfaction and the distribution, which represents the link between the two first mentioned ones, is
responsible for the goods transmission and/or the goods conversion. The term of the distribution as a
micro economic term is determined as marketing activities, which concerns the ways of the goods
transmission. From the view of the marketing theory the distribution politics decide the place about
the fourth „P “marketing-mix, the place.
The distribution, or even in the broader sense the selling, has the organization of the product
paragraph on the markets to contents. Two components leave themselves being differentiated: the
acquisition and the physical component. The acquisition stands for the preparation of sales. To it the
determination of the selling ways belongs and their organization. Generally it can be differentiated
between two basic types of selling. Here the enterprise without detour sells directly to the final
24

consumers and the indirect selling. The latter marketing agents are used, like for example the single
selling agents and the wholesalers. The simplest characteristic of a distribution channel is its length;
it is also determined by the number of stages. All paragraph-intermediate, those to one commercial
level belong to the retail trade, exactly these stages are added. Manufacturers and final users are
regarded in this structure as terminator points. They do not count as own stages, the direct sale
between manufacturers and customers contain no commercial stages. A distribution channel, which
includes gross and retail trade, represents a two-stage channel.
In the special case of the trade with medicaments the freedom of election is reduced concerning the
selling ways. The delivery of pharmacy-requiring medicaments is regulated by the legislator. The
delivery to the patients as their customers may only happen via a pharmacy or professionally via the
physician respectively via a hospital. Thus a zero-stage channel - as the direct paragraph of an
enterprise to the final consumer - is not possible yet. At least one marketing agent must be included
into the delivery of the medicaments. Under normal conditions it includes at least the pharmacist in
his role to distribute the product based on the medicament prescription by the doctor. The physical
component has the distribution of the products and goods up to the place of the final usage 17.
3.5.2 Distribution logistics
With distribution logistics it concerns a market-connected logistic-system. It connects the production
of the enterprise with the demand level. The major task lies in the bypass of temporal, quantitative
and qualitative differences between the goods production and the consumption. Main parameters of
the organization are planning, the execution and control of the achievement processes. Therefore the
physical availability of the products and goods for the customer is located in the centre of the
activities of distribution logistics. One of the most important fields of activity becomes the choice of
location of the distribution storage places, the storekeeping, the job execution, the commissioning
and packing, the goods despatched. Those charge security as well as transport parameters being
encountered. The optimization of the logistics achievement, with the dimensions logistics service
(delivery service) and logistics costs, is the goal of distribution logistics in the special one and
logistics in general. Regarding the market it can be described as follows: It is intended for the use of
the customer„… as good, competitive considering a one as possible use cost relationship of the
goods transfer. “
3.5.3 Logistics costs
The logistics costs represent one of the major components of the logistics achievement, which can be
divided into the following major cost blocks: System costs, Control costs, Storekeeping /inventory
costs, Storage costs, Transport costs.
17 Dambacher, E./Schöffski, O. (2002): Vertriebswege und Vertriebswegeentscheidung, in:
Schöffski, O. (Hrsg.): Pharmabetriebslehre, Berlin et al. 2002, S. 243 – 270
25

It concerns handling costs with the system costs the costs of the organization, planning and control of
the flow of material as well as the pertinent information flows. Under the control costs one
summarizes the expenditures for planning and controls of certain sub functions, like for example
those for the arrangement or the job execution. Stock program costs cover capital freeze costs of the
reproached materials and products as well as of insurance and devaluations of the existence. The
costs of the supply of storage capacities as well as in and paging procedures in the camp are added to
the storage costs. The transport costs block re-clamps the costs of internal and external
transportation. Under the handling costs the loads for packing, the commissioning and the handling
of the products are being summarized 18.
3.6 Basic conditions and development tendencies around the globe
The health care systems and services in Europe and the US are under constant reform pressure. The
composition of the payers and recipients, the technical progress and the strong load of the social
security systems, new records of unemployment rates require a change of the past system. One of the
recent measures relevant for the topic is the law for the modernization of the legal health insurance
(GMG). It is in effect since January 2004. Part of these legislature changes are among other things
the basic conditions for the medicament distribution and the selling conditions. Small distance trade
with medicaments was now made possible by certified pharmacies as well as the operation of small
chains by an individual pharmacist. In the following the used data originate from the year 2004 and
consider the changed basic conditions and regulations 19 .
3.7 Conclusion concerning distribution challenges in Europe
The substantial consequences of rising expenditures per head, sinking trade profit margins and rising
market shares by mail order pharmacies are indicators for a reduction of pharmacies. On the other
hand it was shown that the existence of multi-possession increases the number of pharmacies.
Therefore both mechanisms have to be monitored in parallel closely to draw a combined result.
Especially the abolition of the multi possession case represents the possibility via stronger
competition to lower fixed costs and to ensure a stable supply at the same time. For these particular
pharmacists the expected changes mean a rising competition pressure, which could endanger
enhance or danger their independence. Altogether the simulations show that also further a certain
stability is to be expected regarding the pharmacy number.
In the long run however it might lead to a market dominance of large pharmacy chains. Individual
pharmacies and the small chains are usually only regionally located and in certain niches. While
specialization on a certain therapeutic areas they can bring in added value and remain to disease
pictures a certain perspective. As consequence of an abolition of multi-possession prohibition is
18 Goeke, C. (2005): Presseinfo 258 - Versandapotheken: Neue Perspektiven
19 Kaapke, A./Hüsgen, U. (2004): Neue Rechtliche Rahmenbedingungen für die Preispolitik
26

further a re-organization of the mail order segment. It is expected that the market entrance is
accompanied by large and financially strong multi national companies. After a necessary
standardisation the pharmacy industry might then be consolidated on a new level. From the
circulations mentioned also the wholesale and its logistics are strongly involved. The permission of
pharmacy chains places the wholesale before a dilemma. On the one hand side the conversion
becomes the entrance for the large companies. Chains or other pharmaceutical wholesale dealers
threaten the rest of the market. On the other side the establishment of its own pharmacy chain
becomes a substantial drift for the remaining individual pharmacies lead. A consequence would be
an extent of utilization reduction for existing systems. The logistics share of the cost might in such a
case substantially rise, which could draw again the service level down to a degree that is already
established in Scandinavia and the Eastern European countries. Pharmacies would then only be
delivered once a day by the wholesalers. The cost avoidance for wholesalers would give them the
chance to fight against mail order pharmacies and furthermore limit them in their goal to extent their
business model on the costs of the well established small pharmacies in the market.
The re-organization of the medicament distribution can then be carried out in two steps. A regional
under delivery which is counter measured via rolling pharmacies. Legal basic conditions have to be
created but first analysis shows that this concept is feasible.
CHAPTER 4 - NEW CONCEPTS WITHIN
PHARMACEUTICAL MARKETING
Based on the changes discussed above, new marketing concepts have to be worked out in order to
react in line with the developments within the market. Perfect marketing organizations have to take
the following pillars into consideration. All points are related with each other and form a well
operating unit.
4.1 Pharmaceutical marketing mix
For the companies within the pharmaceutical industry the competitive strategy is the base for all
marketing concepts. This strategy was in the past dominated by the development and consequent
introduction of new products. Private and public health care systems were obliged to pay for these
products.
The insurers (public and private health care systems) and patients’ willingness to pay for higher
priced products erode and costs of product research and development reduce financial returns.
Therefore pharmaceutical companies are forced to change their traditional approach and are
beginning to make fundamental competitive changes.
27

Pharmaceutical companies have to move away from merely focusing on the product itself. One the
hand side the number of product innovations are decreasing and on the other side the magnitude of
product innovations is declining. So called “me too” products (products being a copy of other
products) are increasing in the market. Since the companies have realized that they cannot rely on
their product advantages alone, they have to change their marketing focus.
New focus groups are especially patients, pharmacists and wholesalers - that’s why long term
relationships with customers have to be built up. Closer relationships mean intensive dialogues and
finding out what is the core customer need, where can it be added value better to the patient than
competitors can?
4.2 New concepts in pharmaceutical marketing
Most of the stringent evidence comes from the USA. This is mainly to the fact that pharmaceutical
companies are responding to the changing conditions in the US market.
The US market has been for long times one of the most liberal environment for pricing.
Pharmaceutical companies were able to require a price which was by definition fully reimbursed by
the state. The US market is now moving inexorably towards a managed care market. But there is
overall considerable evidence that pharmaceutical companies in Europe and Japan are also
rethinking their approach to marketing to adjust to a new and unpredictable, competitive
environment.
4.3 Social Marketing
Most of the concepts being described apply to all industries and are therefore relevant from a
marketing perspective. One central feature is different to other concepts, since pharmaceuticals are
part of health care, which is in fact a pure social market with implicit rules of social responsibility
involving humanitarian issues which are becoming more difficult for the industry to rationalize.
From a global perspective multinational companies are still having difficulties adopting standardized
approaches across the world.
Therefore a strong and sustained program to market their contributions and targets to society would
be a good approach. New social marketing initiatives are emerging to reflect the concerns of the
industry’s primary and secondary publics.
28

Pharmaceutical companies and industry associations are developing social
marketing initiatives
Local community
Regulators
Insurers
Physicians
Patients
Patient groups
Professional
Associations
Universities
Employees
Shareholders
Primary public
Source: Kotler, Philipp; Roberto, Ned; Lee, Nancy
Social marketing
initiatives
Secondary
public
Figure 3: Social marketing initiatives
General public
Competitors
Educators
Media
Consumer organizations
Environmental groups
Politicians
Unions
Financial community
4.4 Integrated Customer Marketing
The conventional way was looking at the product as the sole personification of value. This approach
was highly successful in the 90’s as an environment existed in which the following attributes existed:
product choice was limited to a range of brands rarely identical; the patient did not pay for the
products; prescribing decisions were not based on the price; insurers were relatively unsophisticated.
The following indicators are examples for the major changes within the market: Deregulation
activities, generic competition, fixed reference prices, higher competition, substitution of higher
priced therapies through lower cost treatments, patients becoming responsible to bear costs of their
treatments as co payers. These indicators are only a sample of challenges the companies and patients
are facing at the moment. The companies have to react immediately in a world wide increasing
competition. Therefore focus groups are being identified and strategies are developed. The patient is
moving from buying what was presented to being a competent purchaser. The more the patient is
relying on the recommendation of the pharmacist, who has the partner role for the patient. Based on
this point the overall question arises, if a brand focused or a customer focused approach is the better
advertising approach. Having decided this approach it can be answered which strategic channel is
appropriate overall.
29

Source: Merkle - a new prescription for the pharmaceutical industry, 2009
Figure 4: Integrated Customer Marketing (ICM)
Simultaneously social trends towards health awareness and the need for individuals to take more
responsibility for their own health, coupled with insurers’ interest in promoting patient education and
screening for diseases. Prevention of disease began to broaden customer perceptions, which is going
far beyond the mere product 20 . As indicated above pharmaceutical companies are reacting in several
ways. One important strategy is to concentrate on the emerging focus groups as patients, pharmacists
and wholesalers. For each of them a new strategy has to be developed to be successful in this
changing market environment.
4.5 Limited product opportunities in pharmaceuticals
Since more than 5 years the immense growth opportunities in the pharmaceutical market are limited.
Growth in the major markets is slowing down across the world. The continuing emphasis on cost
containment by favouring generic substitution for existing products and by introducing therapeutic
substitution for new products in some managed care programs may create a decline in the value of a
number of large volume therapeutic segments. Value maturity and even marginal decline in mass
therapy markets crowded with too many competitors will inevitably lead to fierce and costly market
share battles as companies attempt to maintain sales. Most market segments can only support a
leader, a second and third product to expand and develop the market, and a fourth and fifth product
to saturate remaining demand. With more, the whole market suffers, even the leader.
The indicated models are describing how some companies are changing the marketing approaches in
a more vivid, flexible and competitive market environment. This is the only way changing customer
needs are met and to address the growing primacy of customers. The balance of market power shifts
towards the industry’s customers.
20 B. James, 2000, p.39
30

CHAPTER 5 - NEW DISTRIBUTION MODELS
WITHIN PHARMACEUTICALS
At the moment one has to differentiate between a large variety of health care insurances which all
maintain large administration, Marketing and sales departments. Competition has to increase in order
to increase innovations within this sector and reduce spending as well. This will be the only way the
patient has the feeling that his money is invested in the most efficient way for him.
5.1 Cost evaluation as the base for new distribution models
Within an economic evaluation costs and benefits of different alternatives and scenarios have to be
evaluated. Major cost components will be analyzed. True economic cost is concerned with the
opportunity cost of that process or intervention. All costs associated with an intervention are
evaluated – not just pure market prices.
Prices for pharmaceutical products are based on 3 major components:
• Ex factory price (Price to which products are actually sold to the wholesaler in the local market)
• Distribution costs (they encompass all related costs for the physical distribution of the product
from the manufacturer up to the wholesaler)
• Taxes (They are depending on the country legislation and vary in Europe by country).
All three elements should be analyzed in detail in order to have a fair view on the cost structure.
Due to different reimbursement levels the patient as the last element of the chain questions what he
finally has to pay. Especially when considering the development of shipping the products directly to
the patient distribution costs will be a more important factor when determination the final consumer
price. Based on the need to save costs in all areas within the pharmaceutical sector the need to save
costs along the health care value chain arises as well. Herewith different models are possible.
5.2 Increasing control of drug distribution to enhance patient safety
The pharmaceutical distribution market is becoming increasingly consolidated. A few players control
more than 60% of the distribution market, with combined sales of more than 50 billion euros. These
players have grown as a result of local market consolidation (purchase of domestic competitors) and
horizontal integration (cross-border acquisitions). They have used their substantial profits to fund
vertical integration by building pharmacy chains and financing pharmacies where chains are illegal.
These players have also vertically integrated by building generic-pharmaceutical companies.
The time has come for the pharmaceutical industry to change its distribution model like many other
high-value industries (e.g., automotive) have successfully done. Full control of and visibility into the
pharmaceutical supply chain by manufacturers is the only way to accurately determine product
movement and gain strategic access to retail outlets. It also presents a tested framework in which to
31

instigate the change. Pharmaceutical manufacturers’ failure to act will severely hinder their
commercial activities in Europe, resulting in profit erosion. Today’s pharmaceutical-distribution
landscape is characterized by a mix of route-to-market strategies with wholesalers taking the central
position (see Exhibit). Almost three-quarters of all medicines sold in Europe are distributed via
wholesalers. They, in turn, sell to retail pharmacies and dispensing doctors. On the other hand,
pharmaceutical companies distribute directly to hospitals in major markets like Germany, Italy, and
France. Mail-order pharmacies are emerging as a new route for marketing pharmaceuticals. Drug
distribution via mail order is legal in six European countries: Denmark, Germany, the Netherlands,
Sweden, Switzerland, and the United Kingdom.
Pharmaceutical companies need to react to increasing environmental pressures to preserve their
profit margins. Given the trends described, it is reasonable to conclude that pharmaceutical
companies are under attack from all sides. The vertical integration of wholesalers into retail
pharmacy chains means they may request higher discounts, or product rebates, or a listing fee. If they
do not get their way, they could take numerous other actions to the detriment of pharmaceutical
companies (see Exhibit). In most European countries, wholesalers could exclude pharmaceutical
products from their product portfolios (i.e., “listing out”). They might increase their involvement in
parallel importing and exporting.
Overall it needs to be examined, if alternative distribution models are feasible and what Pros and
Cons need to be evaluated overall. They might also seek to form collaborations with generic
suppliers and parallel importers. For their part, however, pharmacists could rally patients and
physicians against pharmaceutical companies through aggressive lobbying. They would be well
placed to promote competitors’ products to patients, and they could aggressively substitute on-patent
pharmaceutical products with parallel imports. What should pharmaceutical companies do? Gain
more control and visibility of the supply chain! Without a doubt, pharmaceutical companies are
under increasing pressure. How can they reassert themselves as key players in the distribution
process? Classic marketing and sales initiatives and supply policies alone will not get to the root of
the problem.
If the wholesaler controls the point of sale by owning the pharmacy, the pharmaceutical company’s
marketing effort will have no effect. Several other viable options exist to address the problem
effectively. One would be for pharmaceutical companies to introduce a new distribution model to
increase their control over the supply chain (see Exhibit). In another option, pharmaceutical
companies might consider acquiring one or more wholesalers. This would certainly give them
greater supply chain control, but the wholesale business is not a pharmaceutical company’s core
competency and it would require hefty investments. Still another option would be to contract a thirdparty
logistics provider, as Biogen has done with Arvato healthcare service, part of the Bertelsmann
group, for the distribution of its product Avonex®.
32

In terms of evaluation criteria for strategic options the above mentioned criteria need to be evaluated.
Getting wholesalers to act as agents might also be an option. And some manufacturers might want to
consider building their own direct-to-pharmacy distribution network. All these options have pros and
cons; pharmaceutical companies must assess their long-term sustainability. Overall it can be
summarized that one should recommended that pharmaceutical companies act quickly to take more
legitimate control of the drugs supply chain to enhance patient safety.
CHAPTER 6 - MARKETING RESEARCHES CHARACTERIZING THE
DISTRIBUTION WITHIN THE PHARMACEUTICAL MARKET
IN GERMANY
In the context of the theoretical analysis the formulation of theses are the bases of the empirical
analysis. These are to be verified in the context of an explicative investigation. The investigation
took place in Germany between January and May 2007.
In the context of standardized written questions different wholesale dealers were asked. A condition
for the investigation was that the asked ones operate as wholesalers. Response behaviour from both
parties is separately analyzed from each other. According to the analyses of other studies wholesalers
based on their size and market power have different goals they are pursuing. The more interesting
was the analysis of their results.
6.1 Questionnaire conception
The questionnaire to answer took 25-minutes and covered an extent of approx. 6 pages. The question
form was predominantly the closed question. The measurement of the answers is to take place
thereby in particular by means of a metric scale.
The questionnaire in the apron with participants of a course in the people's university in Germany
tested concerning the consistency of the questions, difficulty as well as the duration of the
questioning. This critical evaluation serves for it a specifying of the main theses and/or their
indicators to cause.
In the context of a sample selection some students of the university in Karlsruhe of higher semesters
were asked in the canteen. In the final concept 20 wholesale dealers and 150 pharmacists were
questioned. Whether a problem concerning representativity exists, has to be examined by means of
non response bias a test after Armstrong/Overton. The sample selection took place in the context of a
not coincidental selection, as ratios are assigned, which correspond proportionally to the distribution
of the population.
A coding of the questionnaires was not necessary, since the investigations between the selected
groups were not totally independently in each case, so that the allocation of the groups had to be
marked. For the participants of the questioning the anonymity of the answer remains ensured. Before
33

the background of the interesting topic hope exists that one wins the participants without monetary
incentive for questioning.
For practical decisions it is not however only of importance like the decision in the long run
precipitates, but also as durable the result is. In the context of an analysis of sensitivity is to be
examined, how strongly the decision result reacts to slight changes of the model parameters.
6.2 Evaluation and interpretation
The challenge of the work lies to ask the positions of the groups who will take part in the future
reform process and their answers in the direct comparison, to evaluate as well as the categories
defined above against each other. Different attitudes, trend, expectations and role changes were
expected. The analysis was even more interesting, because the same question at culturally very well
comparable groups represents a scientific novelty in this area.
To position the wholesaler in a competitive environment, characterized by concentration processes
and significant savings within the pharmaceutical sector the following model should prove the
interdependencies.
6.2.1 System changes and cost reductions implications
In the following chapter results of a self conducted empirical research are introduced and discussed.
One could assume that international operating large-scale enterprises, in particular with foreign
origin, initiate no reduction of cost cutting initiatives due to national legislation adaptations.
Reductions of costs or Supply chain Management activities take place usually based on national
activities or decisions. As a consequence rather small and medium-size enterprises with high
turnover of prescription-requiring medicines would act upon legislative changes more sensitively.
This would therefore lead more easily to cost cutting initiatives.
6.2.2 Openness for changes in the distribution cycle in the enterprises
In the Pharma industry the logistic department is in most enterprises an executive committee
directorate. However the responsibility for logistics lies predominantly on the 2nd Management level
and reports directly to the executive committee. Only in one questioned enterprise it was reported
that logistics are on the third leadership level –this statement is rather exceptional. The usage of the
hierarchical level as an indicator for cost optimization steps is however limited. Regarding the
organizational structure the accomplished interviews resulted in a reference to a substantial potential,
which can be obtained by a process orientated organization of the supply chain. This structure is in
the pharmaceutical industry however still an exception in Germany.
6.2.3 How high are the following cost factors being rated?
The significance of administrative expenses as well as the costs of the order handling is always
evaluated very low. As a consequence for cost optimization purposes this should not lead to high
inventory levels especially not for inferior packaging material, samples and finished goods. Looking
at the valuation of transport costs the result shows a mixed picture. For some companies this point is
34

egarded as not influence able and does therefore have no importance in the sense of cost reduction
options. The different meaning, which is related to transport costs, is very transparent. The reason for
this lies obviously in different transportation solutions. Some companies undertake the distribution
transportation with a third party solution. In other cases the contractors are directly assigned with
these tasks – as a consequence a higher internal effort for the transportation management is needed.
Production and inventory costs are rated within my interview series with the highest factors. All
asked enterprises quote here at least a medium relevance, the majority even a high significance. The
high product value and current inventory coverage of finished goods from usually 4-6 months have
to be considered. This fact offers potential for inventory optimization. The challenge is even higher
because of the actual need of aligned inventory planning as well as the increase of transparency and
flexibility in the supply chain.
6.2.4 Physical structure and controlling of the supply chain
The data situation concerning the Supply chain structure is not-consistent; due to different
production, customer and order structures this result was already expected.
In Germany a central storage depot structure without regional storages and without national cross
docking was established. The pharmaceutical companies supply wholesalers with finished goods
usually locally or even internationally. The present condition of wholesale dealers guarantees a high
delivery service in the German market towards pharmacies, so that none decentralized, regionally
operating stores of the pharmaceutical companies - apart from production locations are necessary.
The wholesale dealers provide an assortment of articles of about 75,000 different articles (stock
keeping units of pharmaceutical products). Its stock turn rate range amounts to about roughly one
month. Delivery service of several times per day is usual and often carried out with an own fleet 21 . It
was questionable if due to rising health care costs the system of direct supplies towards pharmacies
and hospitals with finished goods stores increases. The questioned enterprises seem to look for a cost
optimization within the range of European distribution nets. Today widespread national logistics
structures exist, even if thinking in regions, like e.g. Northern Europe, Central Europe the same
statement can be made. The European market and in particular the European Union today and in the
near future is served over a central storage depot and several regional storages. In enterprises with
several production locations (usually specialized according to production engineering a structure
with several product group-specific storage depots is the favoured alternative.
6.2.5 Equipment of the national and/or European central storage depots
Existing national central storage depots in Germany have predominantly a high degree of automation
regarding commissioning and radio data transmission. Nearly everything was constructed newly or
automated during the last 10 years. The high degree of automation does not surprise. Not only
21 source: www.phagro.de
35

personnel savings and compact flow of material was established. Operating regulation for
pharmaceutical entrepreneurs and GMP is being considered. At production locations automated
logistics concepts, which integrate flow of material and storage of raw material, packaging means
and finished goods were integrated to secure an optimized product flow. Since incoming goods and
samples are temporally decoupled, material release becomes more important.
6.2.6 Trends in the outsourcing process
The outsourcing of storekeeping and logistics increase in value services is traditionally not in the
focus of the pharmaceutical sector, although with PharmLog a highly considered and valued example
exists already. Also different enterprises cooperate within the operational completion. The feedback
of the interviews show that consequently the task assigned to a third party provider is the pure
transport. The reason lies in the fact that large logistic service providers have very good references in
the pharmaceutical industry. In the course of the last 10 years they have automated their capacities
across the industry.
6.2.7 Supply chain co-operations
Generally the picture is very heterogeneous regarding supplier-lateral co-operations. Different
structures or a minted development projection with some enterprises e.g. by introduction of supplierlateral
vendor management Inventory (VMI) or „sample course “with the supplier can be viewed. As
expected co-operations are rated significantly higher with their main suppliers based on good day to
day relations than with the rest of their business partners. The future trend is that co-operations will
increase with the main suppliers. The results show that enterprises cooperate only with few suppliers
– a trend which is realistic for the future as well.
6.3 Expectations and openness for new models in the pharmaceutical sector
The EU monitors the legislative structure in all EU countries with the clear goal to increase
competition within and across the countries. Both indicators are strong factors for the liberalization
of the pharmacy market all over the world but especially in Europe. Sales of drugs through cross
border internet pharmacies across Europe and American consumers is picking up tremendously.
How strong the competition of the classical pharmacist will be with mail order pharmacies can be
discussed controversially. Above chart expresses the desire to have the product within 3 days. The
experience from other countries expresses that a border of 7-10% will probably not be accessed,
since only this part of the population is affine for this form of the distribution. Mail order pharmacies
are especially interesting for chronically ill or immobile patients. Definitely it can be stated that both
retailers and their customers are brought together much closer as a great achievement of the Web.
They hope to use the new medium to gather detailed data about consumers, so they can then make an
informed sales pitch.
36

Data may range from the very basic (a customer's age and address, for instance) to the very specific
(the customer likes blue flower motifs). The greater the amount of information, the argument goes,
the greater the cross-sell potential
The second trend are the new point of sales as local mail order pharmacies who are also the result of
price comparisons and increasing price sensitivity in all countries, to limit pharmaceutical expenses
around the globe.
6.4 Key results of empirical study
The findings of the empirical study fall into two parts – first the expert meetings and secondly the
analysis of the written feedback from the questionnaires.
A) From the accomplished market analysis and the experts’ meetings the following substantial action
fields in the pharmaceutical industry were derived:
1. A high rating was given concerning the potential of supplier integration. This lies in direct
connection with the supply chain management and the IT support used for it. Objective is primarily
the creation of transparency and flexibility as well as the reduction of the complexity within the
whole process chain in order to achieve cost reduction potentials.
Usually the incoming goods of the raw and semi finished products for the pharmaceutical production
are set together with incoming goods at the own location. Furthermore one has to take into
consideration incoming goods from other locations of the own group and incoming goods of external
suppliers. Overall this mix is very heterogeneous. However even the largest pharmaceutical
manufacturers are overall for the majority of their suppliers still so small customers that in this
regard no negotiating pressure can be exercised- rather collaborative relation ships should be built up
on which base improvements can be reached.
2. Obstructed by national labelling regulations still large potentials lie in the integration of the supply
chain on European level. International pharmaceutical companies avoid possible constraints from
these obligations in the context of their global production. Despite this fact they aim to implement
integrated European logistics structures, since these offer substantial cost advantages for them.
Concepts detached from national borders strive for a centralization of inventories, a concept which
represents best practice. In the context of a European centralization a European production group can
be implemented for each stock keeping unit at several different locations. The supply of
decentralized existence of national wholesale dealers should take place in optimal combination from
Push and Pull concepts.
3. The differentiation of the distribution after different product and customer groups as well as
associated close co-operations with business partners, wholesale dealers and in particular hospital (-
chains) on basis of eProcurement and vendor management seems to be a promising action field. This
field is even more interesting taking the associated inventory reductions into account as well.
37

However the attention of co-operation with suppliers and customers should be intensified. Having
both fields in the centre of interest is for most companies not developed far enough yet.
4. For the realization of the points 1-3 usually appropriate IT systems are needed. Nearly all
participating enterprises see therefore high potentials of implementing EDP-steered processes and
information flows, they already plan the employment of eProcurement, and supply chain
management software usage as well as of RFID. Therein the importance of the supply chain process
is underlined.
5. Apart from „the classical “supply chain management topics specified above in the context of the
study also two organizational approaches with high potential were classified. On the one hand the
process orientated organizational structure and on the other hand the target setting process and the
creation of an achievement transparency is necessary. These topics are interesting, especially
considering that only small investment demand is necessary to realize these topics. The smallest
potential is seen in the cross docking and in the improvement of the contracts with logistic partners.
The latter does not surprise, if one realizes how low the outsourcing process of the asked enterprises
is being rated. The above points are the key results of the empirical study.
6.5 Interpretation of the key trends – based on the findings of the empirical study
The liberalization of the pharmacy market is the cause for the existence of internet pharmacies.
Presently lots of regulations are being closely monitored. The increasing pressure of all countries to
reduce costs in the healthcare segment opens the way for new ideas.
The vision for cross-selling on the Internet was intensively analyzed. Those loyal few are more likely
to shrink than expand in number as the Web makes price research easier. Market transparency has
the potential to destroy entry barriers to online retailers and undermine brand loyalty. Bargain
hunting on the Internet is ballooning, in fact as auction sites gain in popularity.
So far, retailers have comforted themselves with the knowledge that price does not count for
everything. Most consumers will also consider value, service, delivery schedules and other factors in
making a purchasing decision. Through branding, a company convinces a consumer that it can
provide superior value. This is what creates customer loyalty.
Yet greater market visibility on the Web means retailers will be under far greater pressure to provide
better value all the time. That is because consumers are able to build comparisons for service and
quality as well as price. Companies as MySimon, for instance, have plans to extend its research
capability to give consumers a better sense of value. Companies are therefore moving into the next
generation of bots, which will not focus exclusively on price, but on quality, terms of sale and other
factors.
A company using a similar strategy is Insite Marketing Technology. The new company is creating
software to improve retailers' ability to provide information to customers. The idea is being used at
the CompUSA Web site, where a customer can get help from a virtual sales advisor. The advisor
38

asks buyers to prioritize their requirements for a laptop, for instance, including specifications for disk
drive, weight, battery life and other factors. The advisor then makes recommendations based on the
information. Similar questionnaires are used by a number of automobile sales sites.
While recommendation sites share some aspects of tailored marketing, there are key distinctions
between them. First, the consumer's current, not historical, requirements drive the recommendations.
Second, the shopper, not the retailer, is in the driver's seat. Contact is made only at the customer's
bidding.
CONCLUSIONS AND PERSONAL CONTRIBUTIONS
Branded drugs are products with a high degree of confidence and reliability. This quality has to be
guaranteed to the patients. This service includes competent consultancy, just in time delivery as well
as the pharmacist’s discretion concerning patient’s needs.
The market undergoes severe changes and is therefore a highly interesting field for studies especially
within the European context. A number of new models for the pharmacists are under discussion in
Europe and could be the base for the same developments in a number of European countries.
Especially in East Europe where the pharmaceutical companies are realizing high sales growth due
to an increasing growth national product as well as an increasing national income high investments
are made and the base for the above mentioned models is being made. To prove the assumptions an
empirical study was be made with the wholesalers in Germany. Of central interest were the key
trends which are being foreseen and in how far this can be described in a model.
The key trends based on the increasing price sensivity of consumers and national insurances are 2
global developments in the rapidly changing markets. The rise of market imports and exports often
characterized as parallel trade from one wholesaler to the next in different countries to benefit from
price deviations across the world. Especially the common currency in most European markets was
the base for the knowledge where price differences occur and how from them can profited.
The second trend is the also related to the ability of markets growing together based on lower
distribution costs and better IT capabilities around the world. Internet pharmacies are the base for
consumers to offer their products globally while benefiting even from very small price differences.
In the past the absolute value for most products was around 10 -15%, when people decided to go
with a new supplier – today even for margins as small as 1-5% these decisions are being taken.
Within the thesis major processes and structures in the pharmaceutical market were analyzed and the
value proposition of the main protagonists was being described. Considering potential legislative
adaptations as well as the increasing expansion of international operating pharmaceutical companies
the implications for pharmacists will be analyzed in detail, to be able to react to market
developments in time.
39

Pharmaceutical wholesalers use a logistic service supplier to cover the last mile to the patient.
Cooperative solution between the pharmacy and the wholesaler large mail order pharmacies through
cooperation and usage of synergies New market entrants – for example international wholesalers.
Many small mail order pharmacies are a supporting leg for the traditional pharmacy. The above
mentioned tendencies show that no player can act on his own, since he cannot dispose over the
necessary resources and competencies to build up a new distribution system. Restrictions within the
present health care system will only be terminated to allow the above models fulfil cost reduction
potentials for the local governments.
Measures adopted by the European government to cap prescription prices have also put pressure on
the parallel traders. The UK is decreasing prices for branded medicines by 7% over the next five
years, while Italy for example is raising prices of some branded products to bring them in line with
E.U. averages. At the same time, the prices of several products that make the bulk of parallel traders
have fallen as patents have expired.
Personal Contributions
This thesis follows an empirical study based on an intensive theoretical framework within the
pharmaceutical environment. This approach was carefully designed to meet all theoretical
requirements.
A) Scientific contributions
The thesis is a contribution based on an intensive analysis in the pharmaceutical environment. It
included the analysis of the different distribution processes and models, while incorporating the
analysis of present marketing theory.
The analysis is based on an empirical study to see in how far the market is open for new models and
an implementation of a direct distribution model is realistic.
The standard distribution chain was being analyzed and measured in how far other options are
feasible and possible in the complex pharmaceutical environment.
This work demonstrates the advantages of a direct to pharmacy model as well as a direct mail order
pharmacy. The importance of going a direct process chain was clearly shown.
B) Marketing contribution
The work and examples presented in this thesis are the result of a careful marketing analysis.
Present marketing models are the base for the understanding and the foundation for the empirical
assessment.
The mail order pharmacy model is a constant development of the direct to patient relationship and a
similarity to consumer marketing where direct distribution models are already established since a
long time.
C) Further directions for Research
40

The thesis is based on an intensive empirical research which out of which a distribution model was
developed. These potential trends need to be examined in the day to day environment. Especially the
forecast that local mail order pharmacies and drugstores are directly being served by the wholesaler
need to be analyzed closer. The further this direct distribution model is being developed, the more
classical wholesalers will be forced to look for new business models.
This would consequently establish a long arm for the manufactures in future with a potential direct
relationship to the pharmacy or eventually to the patient. This relationship would be a basis for new
marketing models since a DTP (Direct to Patient relationship is established). Moreover the classical
field force approach visiting the doctor could be challenged, since it will be also important visiting
the pharmacy to promote new products or in the long run going for patient events where new
medicines will be introduced and side effects directly presented to the patient.
To fully realize these marketing strategies over the longer term and then sustain this strategy by
addressing anticipated future changes in the marketplace. The marketers will consequently work with
scientific and clinical teams in the pharmaceutical company to plan further clinical development
studies on the product to be able to explain this to patients being the customer for the pharmaceutical
industry.
The promotional strategy is the communication platform. It will be promoted to doctors as being
highly effective and it will have less side effects than current competitors. The new process we will
see over the time is that the promotional strategy flow might now be conveyed to the customers
(patients) based on a direct relationship. These will include more specific statements surrounding its
efficacy. Promotional objectives are the goals the marketer sets for acceptance of the product in the
mind of the customer, or in the minds of customer groups.
The described effects are already realized within consumer marketing where a DTC (Direct to
Consumer) model is state of the art. Thomas Jacobsen with his actual publication - hinting to this
effect - might be a chance for future research. 22
ILLUSTRATIONS OVERVIEW
Figure 1: Evolution of global pharmaceutical sales compared with the relative annual growth of
global markets 1999 - 2007
Figure 2: Global cardiovascular forecast by disease class 2007 - 2015
Figure 3: Worldwide pharmaceutical sales/profits of leading pharmaceutical companies
Figure 4: Global pharmaceutical top markets in % of Sales share
Figure 5: Worldwide revenue of cardiovascular diagnostics drugs and devices 2005 – 2012
Figure 6: Romania – Health expenditure; Total (% of GDP)
Figure 7: Romanian real GDP growth rate during 2003 -2010 (year 2010 data only estimate
Figure 8: Real annual growth in health expenditure and GDP
22 See Thomas M Jacobsen (2010), S. 221
41

Figure 9: Health expenditure per capita, US$ PPP, 2008
Figure 10 : Total unaudited and audited Global Pharmaceutical Market 2002 - 2009
Figure 11: Leading Pharmaceutical Innovation - Trends and Drivers for Growth in the
Pharmaceutical Industry
Figure 12: The influence of the key stakeholders within the pharmaceutical industry
Figure 13: Overview over the top 3 distribution channels
Figure 14: Pharmaceutical distribution landscape is influenced by the illustrated key trends
Figure 15: Top pharmacy customer segments
Figure 16: Portfolio of the pharmacist based model
Figure 17: Drug industry consolidation 1993 – 2010
Figure 18: German cost containment law implications 2005 in Germany
Figure 19: Key cost containment measures in Europe
Figure 20: Comparison of prescriptions and over the counter drugs
Figure 21: Overview of retailers pricing structure
Figure 22: European commission working group results
Figure 23: Member states implanting different cost containment measures
Figure 24: Discussion points of the European Committee; 2007
Figure 25: Wholesaler concentration process
Figure 26: Sales development of the worldwide largest pharmaceutical markets
Figure 27: Five pillars of successful marketing and sales organizations
Figure 28: Successful innovations in the pharmaceutical industry 2008 in %
Figure 29: Pharmaceutical marketing levers
Figure 30: Process ineffectiveness causes within the pharmaceutical industry
Figure 31: Industry lifecycle analysis
Figure 32: Principles of Marketing
Figure 33: R&D expenditures in Europe, Japan and USA
Figure 34: Social marketing initiatives
Figure 35: Integrated Customer Marketing (ICM)
Figure 36: Direct to consumer spending mix analysis
Figure 37: Promotional mix for a world wide operating company
Figure 38: Principles and Practice of Pharmaceutical
Figure 39: Sales and product shares of top pharmaceutical companies
Figure 40: Pharmaceutical markets by region and forecast
Figure 41: The Managerial Grid
Figure 42: WCF-model
Figure 43: Relationship between Salesperson Performance and Understanding of Customer Decision
Making
Figure 44: Forecast model for the behaviour of sales persons
Figure 45: Integrative behaviour oriented sales model
Figure 46: One dimension sales model for straight purchasing processes
Figure 47: Pharmacy trend as part of the consolidation process within pharmaceuticals
Figure 48: Pharmaceutical distribution outlook
Figure 49: Trends within the pharmaceutical distribution landscape
Figure 50: External pressure from wholesales and pharmacies towards pharmaceutical companies
Figure 51: Alternative distribution models under evaluation
Figure 52: Three core phase model for a new distribution model
Figure 53: Relationship between system changes and cost reductions
Figure 54: Importance of central cost factors along the process chain
Figure 56: Single versus several product group-specific storage depots
Figure 57: Allowance of re-imports and local mail order pharmacies will significantly change the
distribution process for pharmaceutical products
Figure 58: A maximum three day delivery period is the key need of the patients
Figure 59: Target groups for mail order pharmacies
42

LITERATURE OVERVIEW
1. Alberti, G. (1981): Der Einfluss der Apotheken auf den Wettbewerb mit Arzneimitteln, in: Röper, B.
(Hrsg.), Wettbewerbsprobleme auf dem Markt für Arzneimittel und staatliche Gesundheitspolitik, Berlin,
S. 57-66.
2. Austin, Richard (1998), The pharmaceutical distribution outlook 1998-2000, Reuters Business Insight
3. Badenhoop, R./ Seiter, S./ Emrich, K. (2002): Versandhandel Arzneimittel in den USA- ein Model für
Deutschland?, Berlin.
4. Bänsch, A. (1998): Verkaufspsychologie und Verkaufstechnik, 7. Aufl., München.
5. Bank for Intl. Settlements, Euromonitor, G MAP European Car Distribution Handbook, Booz Allen
Hamilton Analysis
6. Bauer, H. (1980): Die Entscheidung des Handels über die Aufnahme neuer Produkte, Berlin
7. BCC Research (2008), Internet source; http://www.bccresearch.com/press.php
8. Becker, W. (2004): Verkaufspsychologie, 3. Aufl., München u.a.
9. Behner, Peter; Bünte; Matthias (2007): Getting to Grips with the Supply Chain: How Pharmaceutical
Companies can Enhance Patient Safety and Protect Revenues by Increasing Their Control of Drug
Distribution, Booz Allen Hamilton
10. Berekoven, L. / Eckert, W. / Ellenrieder, P. (2004): Marktforschung. Methodische Grundlagen und
praktische Anwendung, Wiesbaden.
11. Berger, M. (1974): Die Arzneimittelversorgung durch Apotheken, Berlin.
12. Blake, Robrt R.; Mouton, Jane S. (1968) The Managerial Grid III 1985, revised edition, Gulf Pub. Co.
13. Blake, R. R. / Mounton, J. S. (1970): The Grid for Excellence. Benchmarks for Effective Salesmanship,
Ney York u.a.
14. Boles J. et al. (2000): Relationship Selling Behaviors: Antecedents and Relationship with Performance,
in: Journal of Business & Industrial Marketing, Vol. 15, No. 2 /3, S. 141-153.
15. Borkenau P. / Ostendorf F. (1993): NEO-Fünf-Faktoren-Inventar (NEO-FFI), Göttingen.
16. Bortz, J. / Döring, N. (1995): Forschungsmethoden und Evaluation, Berlin, Heidelberg.
17. Boyle, T. / Coffey, J. / Palmer, T. (2004): Men´s Health Initiative Risk Assessment Study: Effect of
Community Pharmacy-Based Screening, in: Journal of American Pharmacy Association, Vol. 44, S. 569-
577.
18. Brock, T. (1965): Communicator- Recipient Similarity and Decision change, in: Journal of Personality
and Social Psycology, 1. Jg., No. 6, S. 650-654.
19. Bultman, D.C. / Svarstad, B.L. (2002): Effects of Pharmacist Monitoring on Patient Satisfaction with
Antidepressant Medication Therapie, in: Journal of the American Pharmaceutical Association, Vol. 42,
No. 1, S: 34-43
20. Busch, P. / Wilson, D. (1976): An Experimental Analysis of a Salesman's Expert and Referent Bases of
Social Power in the Buyer-Seller Dyad, in: Journal of Marketing Research, Vol. 13, S. 3-11.
21. Credit Suisse, company reports; Bloomberg. Reprinted with permission from The New York Times,
March 12, 2009 _ Neue Graphik 19
22. Churchill, G. et al. (1985): The Determinants of Salesperson Performance: A Meta-Analysis, in: Journal
of Marketing Research, Vol. 22, S. 103-118.
23. Churchill, G. / Walker, O. / Ford, N. (1985): Sales force Management: Planning, Implementation and
Control, 2. Ed., Homewood.
24. Crisand , M. (1995): Pharma-Trends und innovatives Pharma Marketingmanagement, Wiesbaden.
25. Crosby, L. / Evans, K / Cowles, D. (1990): Relationship quality in services Selling: An interpersonal
Influence Perspective, in: Journal of Marketing, Vol. 54, S. 68-81.
26. Correll, W. (1976): Motivation und Überzeugung in Führung und Verkauf, München.
27. Correll, W. (2000): Motivation und Überzeugung in Führung und Verkauf, 12. Aufl., München.
28. Dambacher, E. / Schöffski, O. (2002): Vertriebswege und Vertriebswegeentscheidung, in: Schöffski, O. et
al. (Hrsg.), Pharmabetriebslehre, Berlin u.a., S. 243-256.
29. Darlymle, D. / Cron, W. / De Carlo, T. (2004) Sales management, 8th. Edition, Danvers.
30. Davidson/ Geblov, 2005, p. 2 in: Davidson, L/ Greblov G. (2005): The pharmaceutical industry in the
global economy
31. Dichter, E. (1966): How Word-of-Mouth advertising works, in: Harvard Business Review, Vol. 44, S.
147-166.
43

32. Dichtl E. / Lingenfelder, M. (1989): Der Mitarbeiter als Schlüsselfigur im Apothekenmarketing, in:
Dichtl, E. / Raffée, H. / Thiess, M., Innovatives
33. Pharma-Marketing : Marktorientierung als Erfolgsstrategie der 90er Jahre, Wiesbaden, S. 419-434.
34. Dietz. B et al. (2002): Strategische Marktbearbeitung nach dem Erlass der Autidem- Regelung, in:
Pharm. Ind., Vol. 64, Nr. 12, S. 1212-1216.
35. Duguleană, L., “The Prices Dispersion of European Countries”, Ed. Infomarket, Braşov, 2005, ISBN
973-8204-70-4, 973-8204-70-2 (Vol. I), pag. 117-122
36. Duguleană, L.,“The Coming Disaster of Marketing Industry in Digital Era”, Bulletin of the
TransilvaniaUniversity of Braşov• Vol. 14(49), Seria B, 2007, ISSN 1223-964X, pag. 409-413
37. Duguleană, L.,"Approach of Human Capital Index Using the Chaos Theory”, The Journal of Romanian
Managers and Economical Engineers Association, Ed. Technical University of Cluj-Napoca, 2007, ISSN
1583-624X, pag. 239-242
38. Duguleană, L., ”A Marketing Approach - A Dynamic Open Complex Adaptive System”, Ed.
Universitaria Craiova, 2007, CD, ISBN 978-973-742-843-1, p. 725-730
39. Duguleană, L., Duguleană, C., "Marketing Industry in the Digital Era", Cairo, Egypt, 2008, WSEAS
Press, ISBN: 978-960-474-045-1, ISSN: 1790-5095, pag. 28-31, CD, ISBN: 978-960-474-044-4
40. Duguleană, L., Duguleană, C., “Some Aspects concerning the Equality of Income Distribution in
Romania and in Some Developed Countries, at the End of the Second Millennium”, WSEAS Press,
Houston, USA, 2009, ISBN: 978-960-474-073-4, ISSN: 1790-2769, pg. 139-141
41. Dwyer,R, Schurr, P. / Oh, S. (1987): Developing Buyer-Seller Relationships, in: Journal of Marketing,
Vol. 51, S. 11-27.
42. Edwards, Lionel D. et al. (2007): Principles and Practice of Pharmaceutical Medicine, 2 nd ed., Wiley
43. EPIA, PhRMA, vfa 2008 in Verband forschender Arzneimittelhersteller
44. European Federation of Pharmaceutical Industries and Associations, Pharmaceutical Research and
Manufacturers of America, Verband forschender Arzneimittelhersteller, 2009
45. Evans, F. (1963): Selling as a Dyadic Relationship- a new approach, in: Bearden, J. (Hrsg.), Personal
selling, New York, S. 213-238.
46. Evans, F. (1964) Dyadic Interaction in Selling- A New Approach, Chicago.
47. Fischer L. / Wiswede, G. (1997): Grundlagen der Sozialpsychologie, München.
48. Fischer, G. H. (1981): Verkaufsprozesse mit Interaktion- vom Monolog zum Dialog, Gernsbach.
49. Fithen, G. (1989): Die Einbeziehung der Apotheker in das pharmazeutische Marketing, in: Dichtl, E. /
Raffée, H. / Thiess, M., Innovatives Pharma- Marketing : Marktorientierung als Erfolgsstrategie der 90er
Jahre, Wiesbaden, S. 397-417.
50. Freytag, J. (1996): Apotheken- Marketing- Kundenbindung durch Beratung als strategischer
Erfolgsfaktor, Mering.
51. Friske, J. E.(2003): Mehr Markt und Wettbewerb in der deutschen Arzneimittelversorgung?: eine
gesundheitsökonomische Untersuchung im Spiegel amerikanischer Markterfahrungen, Bayreuth.
52. Gassmann, Oliver; Reepmeyer, Gerrit; von Zedtwitz, Maximilian (2004): Leading Pharmaceutical
Innovation - Trends and Drivers for Growth in the Pharmaceutical Industry, Springer
53. Ghiselli, E. E. (1966): The Validity of Occupational Aptitude Tests. New York.
54. Goehrmann, K. (1984): Verkaufsmanagement, Stuttgart u. a..
55. Greene, J.N., and R.E. Plank, 1983 "Industrial Sales Effectiveness: Aggressive versus Assertive Sales
Presentations," Review of Business, 5 (1), 3-8.
56. Hartmann, K. D. (1981): Der Verkaufsvorgang als Interaktionsprozess, in: Fischer, G. H. (Hrsg.),
Verkaufsprozesse mit Interaktion- vom Monolog zum Dialog, Gernsbach, S. 251-273.
57. Heigl, A. (2003): Gesundheitsmarkt 2013, München.
58. Hennig-Thurau / Thurau (1999): Sozialer Kompetenz als vernachlässigter Untersuchungsgegenstand des
(Dienstleistungs-)Marketing. Einsatzmöglichkeiten und Konzeptualisierung, in: Marketing ZFP, Vol. 21,
No. 4, S. 297-311.
59. Hillestad, Steven G.; Berkowitz, Erc N, (2004): Health Care Market Strategy – From Planning to Action,
3rd Edition, Jones and Bartlett Publishers, page 125
60. Hohensohn, H. (1998): Patientenorientierten Pharmamarketing: Kommunikation und
Entscheidungsverhalten am Markt für verschreibungspflichtige Medikamente, Wiesbaden.
61. Homburg, Ch. / Schäfer, H. / Schneider, J. (2003): Sales Excellence, 3. überarb. Aufl., Wiesbaden.
62. House of Commons Health Committee (2004): The Influence of the Pharmaceutical Industry – Fourth
Report of Session 2004-05, Volume 2
63. IMS Health (2005): Deutsche Pharmamarkt (DPM) 12 /2005
64. IMS Health (2010): Pharmamarkt Analyse
44

65. Jacobsen, Thomas M; wertheimer Albert, I. (2010): Modern Pharmaceutical Industry, S. 221
66. Jones, E. / Gerard, H (1967): Foundations of Social Psychology, New York.
67. Kaapke, A. / Hüsgen, U. (2004): Neue rechtliche Rahmenbedingungen für die Preispolitik in Apotheken,
in: Handel im Fokus- Mitteilungen des IfH II /04, S. 134-144.
68. Kaapke, A. / Wilke, K. (2005): Kooperationen im Apothekenmarkt- Theoretische Überlegungen und
empirische Ergebnisse, Köln.
69. Kahn, R. et al. (1964): Organizational stress, New York.
70. Kellner, H. ( 2002): Verkaufsmentalitäten und Verkaufsstile, in: Pepels, W. (Hrsg.), Handbuchvertrieb,
München, Wien, S. 187-199.
71. Kepper, G. (1999): Methoden der Qualitativen Marktforschung, in: Homburg, Ch. / Herrmann, A. (Hrsg.),
Marktforschung: Methoden, Anwendungen, Praxisbeispiele, Wiesbaden, S. 159-202.
72. Kirchler, E. (1999): Wirtschaftspsychologie, 2. überarb. und erweiterte Aufl., Göttingen.
73. Kotecki, J. (2002): Factors related to Pharmacists´ Over-the-Counter Recommendations, in: Journal of
Community Health, Vol. 27, No. 4, S. 291-306.
74. Kotler, P. / Bliemel, F. (2001): Marketing Management, 10.überarb. Aufl., Stuttgart.
75. Kotler, Philipp; Roberto, Ned; Lee, Nancy (2002): Social Marketing: Improving the quality of life; 2nd
edition, Sage Publications
76. Kotler, P. et. al. (2003): Grundlagen des Marketing, 3.überarb. Aufl., München.
77. Kotler, Philipp (2005): Principles of Marketing; Prentice Hall, 11th Edition,
78. Krech, D. / Crutchfield, R. / Ballachey, E. (1962) Individual in Society, New York.
79. Kroeber-Riel, W./ Weinberg, P. (1996): Konsumentenverhalten, München.
80. Kunz, A. (2001): Alternative Distributionswege für pharmazeutische Produkte : eine empirische Analyse
nachfragerelevanter Entscheidungskriterien, Wiesbaden.
81. Kuß, A. (1991) Käuferverhalten, Stuttgart.
82. Lasswell H.D. (1960): The Structure and Function of Communication in Society, in: Scharm, W. (Hrsg.),
Mass Communications, 2nd. Ed., Urbana, S. 117-130.
83. Levy, M. / Weitz, B. A. (2004): Retailing Management, 5th. Edition, Ney York.
84. Manolis, Ch. / Harris, M. / Whittler, T. (1998): Expectancy Effects Between Exchange Partners, in:
Journal of Consumer Psychology, 7(1), S. 49-78.
85. Mathews, H. L. / Wilson, D. / Monoky, J. (1972) Bargaining Behavior in a Buyer- Seller Dyad, in:
Journal of Marketing Research, Vol. IX, S. 103-105.
86. Mayring, P. (1996): Einführung in die qualitative Sozialforschung: Eine Anleitung zum qualitativen
Denken, 3. Aufl. München.
87. MacLennan, Janice (2004): Brand Planning for the Pharmaceutical Industry, Gower Publishing Company
88. Merkle – Integrated Customer Marketing (ICM): A New Prescription for the Pharmaceutical Industry,
2009
89. Meffert, H. (2000): Marketing: Grundlagen marktorientierter Unternehmensführung, überarb. u. erw.
Aufl., Wiesbaden.
90. Meuser, M / Nage, U. (2002): Experteninterviews – vielfach erprobt, wenig beachtet: Ein Beitrag zur
qualitativen Methodendiskussion, in: Bogner, A. / Littig, B. / Menz, W. (Hrsg.): Das Experteninterview:
Theorie, Methode, Anwendung, Opladen, S. 71-93.
91. Molitor, H. (2000): Absatzsystem, Wettbewerb und Marktbearbeitungsalternativen bei
verschreibungspflichtigen Arzneimitteln, Berlin.
92. Müller, S. (1999): Grundlagen der Qualitativen Marktforschung, in: Homburg, Ch. / Herrmann, A.
(Hrsg.), Marktforschung: Methoden, Anwendungen, Praxisbeispiele, Wiesbaden, S. 127-157.
93. Munroe et al. (1997): Economic Evaluation of Pharmacist Involvement in Disease Management in a
Community Pharmacy Setting, in: Clinical Therapeutics, Vol. 19, No.1, S. 113-123.
94. Nerdinger, F. (1994): Zur Psychologie der Dienstleistung, Stuttgart.
95. Nerdinger, F. (2001): Psychologie des persönlichen Verkaufs, München.
96. Nerdinger, F. (2003): Kundenorientierung, Göttingen.
97. Newman, E / Hanus, P. (2001): Improved Bone Health Behavior Using Community Pharmacists as
Educators, in: Disease Management & Health Outcomes Vol. 9, No. 6, S. 329-335.
98. Nieschlag, R. / Dichtl, E. / Hörschgen, H. (2002): Marketing, 19 überarb. und erg. Aufl., Berlin.
99. Ossenberg- Engels, J. (2002): Kundenbindung durch Exzellenz in Marketing und Logistik: die GEHE
Pharma Handel, in : Zentes, J. / Swoboda, B. / Morschett D., B2B Handel: Perspektiven des Groß- und
Außenhandels, 1. Auf., Frankfurt am Main, S. 197-219
100. Ostendorf, F. (1990): Sprache und Persönlichkeitsstruktur, Regensburg.
101. Ott, R. (2003): Marketing für Apotheker, Stuttgart.
45

102. o.V. (2005a): Kooperationen- eine Zwischenbilanz, in: Apotheker Zeitung, Nr. 24 (13.06.2006), S. 9-
12.
103. o.V. (2005b): Kooperationen- eine Zwischenbilanz, in: Apotheker Zeitung, Nr. 25 (20.06.2006), S. 9-
12.
104. Peter, U. (1991): Psychologie der Marketingkommunikation, Savosa.
105. Pharma Marketing News, 2010-09-22
106. Plank, R. / Reid, D. (1999) The mediating role of sales behaviours an alternative perspective of sales
performance and effectiveness, in. Journal of personal selling and sales management, Vol. 14, No. 3, S.
43-56.
107. Plank, R. / Green J. (1996): Personal construct psychology and personal selling performance, in:
European Journal of Marketing, Vol. 30, No. 7, S. 25-48.
108. Prinz, A. / Vogel, A. (2003): E-Commerce im Arzneimittelhandel, Gütersloh.
109. Psychonomics AG / Acxiom Deutschland GmbH (Hrsg.) (2005): Healthcare Monitoring,
Halbjahresreport Sommer 2005, Köln, München.
110. Ross, B (1990): Die Funktionsfähigkeit des Wettbewerbs auf den Arzneimittelmärkten der
Bundesrepublik Deutschland: eine Analyse auf der Basis des Koordinationsmängelkonzepts, Münster.
111. Salcher, E. F. (1995): Psychologische Marktforschung, 2. Aufl., Berlin.
112. Salvatore, Dominick (2006): Managerial economics in a global economy, 6th edition, Oxford
University Press
113. Sawyer, A. G. / Deutscher, T. / Obermiller, C. (1980): Can Seller / Customer Interaction and Influence
be Studied in the Laboratory?, in: Advances in Consumer Research, Vol. 7, Issue 1, S. 393-399.
114. Schnell, R. / Hill, P. B. / Esser, E. (1999): Methoden der Empirischen Sozialforschung, Aufl., München.
115. Schoch, R. (1969): Der Verkaufsvorgang als sozialer Interaktionsprozess, Winterthur.
116. Schwab, R. (1983): Der Persönliche Verkauf als kommunikationspolitisches Instrument des Marketings,
Frankfurt a. M.
117. Sempora Management Consultants (2005): Der Gesundheitsmarkt im Umbruch – 15 Monate nach der
Gesundheitsreform, Bad Homburg.
118. Sheth, J. (1976): Buyer- Seller Interaction: a conceptual Framework, in: Anderson, B. B. (Hrsg.),
Advances in Consumer Research, Cincinnati, S. 382-386.
119. Specke, H. (2005): Gesundheitsmarkt in Deutschland, 3. vollständige überarb. Aufl., Bern.
120. Spiro, R. / Weitz, B. (1990): Adaptive Selling: Conceptualization, Measurement, and Nomological
Validity, in: Journal of Marketing Research, Vol. 27, S. 61-69.
121. Stanowsky, J. / Schmax, S. / Sandvoß, R. (2004): Gesundheitsmarkt- ein Wachstumsfaktor?, Economic
Research Allianz Group Dresdner Bank, Working Paper Nr. 17.
122. Sterzel, A. (2002): Deregulierung des Arzneimittelvertriebs in Deutschland- Versandhandel als
Reformoption?, Berlin.
123. Tebbe, C. (1999): Erfolgsfaktoren des persönliches Verkaufsgespräches, Frankfurt a.M.
124. Tucker, W. (1964): The Social Context of Economic Behaviour, New York.
125. Tyagi, P. (1985): Work Motivation Trough the Design of Salesperson Jobs, in: Journal of Personal
Selling and Sales Management, S. 41-51.
126. Van der Spiegel, Stefaan Unit F5, Competitiveness in the Pharmaceuticals Industry and Biotechnology,
DG Enterprise and Industry
127. Vinchur, A. J. et al.(1998): A metaanalytic Review of Predictors of Job Performance for Salespeople,
in: Journal of Applied Psychology, 83, S. 586-597.
128. Walker, Orville C., Jr., Gilbert A. Churchill, Jr., and Neil M. Ford. 1977. "Motivation and Performance
in Industrial Selling: Present Knowledge and Needed Research." Journal of Marketing Research 14
(May): 156-168.
129. Weitz, B. A. (1978): Relationship between Salesperson Performance and Understanding of Customer
Decision Making, in: Journal of Marketing Research, Vol. XV (November 1978), S. 501-516.
130. Weitz, B. A. (1981): Effectiveness in sales Interactions: A Contingency Framework, in: Journal of
Marketing, Vol. 45, S. 85-103.
131. Weitz, B. A. / Sujan, H. / Sujan, M. (1986): Knowledge, Motivation and Adaptive Behavior: A
Framework for Improving Selling Effectiveness, in: Journal of Marketing, Vol. 50, S. 174-191.
132. Weitz, B. A. / Sujan, H. / Sujan, M. (1988): Increasing Sales Productivity by Getting Salespeople to
Work Smarter, in: Journal of Personal Selling & Sales Management, August 1988, S. 9-19.
133. Weitz, B. A. / Bradford K.D. (1999): Personal Selling and sales management: A Relationship Marketing
Perspective, in: Journal of the academy of Marketing Science, Vol. 27, S. 241-254.
46

134. Williams, K. / Spiro, R. (1985): Communication Style in the Salesperson- Customer Dyad, in: Journal
of Marketing Research, Vol. 22, S. 434-442.
135. Williams, K. / Spiro, R. / Fine, L. (1990): The customer- Salesperson Dyad: An Interaction/
Communication Model and Review, in: Journal of Personal Selling & Sales Management, Vol. 10, S.
29-43.
136. Wilson, D. (1976): Dyadic Interaction: An Exchange Process, in: Advances in Consumer Research,
Advances in Consumer Research; 1976, Vol. 3 Issue 1, S. 394-397
137. Witte, A / Zur Mühlen, D. (2004): Apotheken-Management: Kosten senken- Ertrag steigen- Zukunft
sichern, Stuttgart.
138. Woodside, A. / Davenport, J.W. (1974): The Effect of Salesman Similarity and Expertise on Consumer
Purchasing Behaviour, in: Journal of Marketing Research, Vol. 11, S. 198-202.
INTERNET SOURCES
1. BARMER (2005): Pressemeldung- Hausarzt-Programm Mein Hausarzt. Meine Hausapotheke,
http://www.barmer.de/barmer/web/Portale/Versichertenportal/Presse-
2. Center/Themeneinstieg_20Archiv__2005/ 050301_20einschreibung/ content_
20aachenCID__65384.html (Abruf am 2005-06-20)
3. Sanicare (2005): www.sanicare.de (Abruf am 2005-11-12)
4. Schuchert-Güler, P. (2005): http://www.wiwiss.fu-berlin.de/w3/w3kuss/web/ Forschung/
Projekte/FunktionenPersVerkauf.htm (Abruf am 2005-12-15)
5. www.fortunes.mallbusiness.com/magazines/fortune/fortune500/2010/industries/21/index.
6. www.phagro.com
7. www.phagro.de
Curriculum Vitae
Informatii personale:
Nume, Prenume: Hafemeister, Thiemo
Data si locul nasterii: May 2nd, 1967 in Kiel
Stare civila: Casatorit; 1 copil
Adresa de resedinta: Stindestrasse 18, 12167 Berlin
Educatie:
Scoala primara: August 1973 – July 1977
Scoala gimnaziala: August 1977 – July 1984
Exchange program: 84 -85 Fort Worth Texas; diploma de absolvire
Liceu: Absolvirea liceului Max Planck School, Kiel 1988 (Abitur)
Indeplinirea cerintelor pentru admiterea la universitate
Facultate: Admitere octombrie 1989, Christian-Albrechts-Universität, Kiel
Sectia Administrarea afacerii
Specializare Finante si Organizare
Lucrarea de absolvire – Abordarea organizational a conceptului de
pensionare in Germania - schimari, provocari si solutii
Absolvire decembrie 1994 (Diploma de Economist)
Media generala 2,2
Master in Administrarea Afacerii, Schiller International University, absolvit in iulie 2000
Program de management avansat, Universitatea Mannheim, absolvit in mai 2004
Stagiu militar:
Perioada: July 1988 – September 1989
Responsabilitati: Navigator pe o nava antimina in Marea Nordului
Limbi straine: Engleza si franceza, fluent, scris si vorbit
Locuri de munca in cadrul companiei Pfizer:
2007 – prezent Director de achizitii cu statul German
2002 – 2007: Manager de proiect:
♦ Dezvoltarea si implementarea initiativelor strategice in
Germania si cu Europa
47

♦ Activitati conexe
♦ Externalizarea si initiative de optimizare
2000 – 2002 Manager financiar la divizia germana de farmaceutice din cadrul
firmei Pfizer:
♦ Coordonator de rezultate in termini de vanzari si profit
la sediul european pentru raportare si planuri de
operare/previziuni
♦ Coordonator de taxe si documente legale la
departamentul de taxe si documente legale, dar si cu
consultati externi
♦ Imbunatatirea managementului contabilitatii
2000 Pfizer & Warner Lambert – responsabil cu fuzionarea (merger) – aflata
pana atunci in sediul german Pfizer
1998 -2000 Manager financiar in OTC (over-the-counter market) pentru Warner
Lambert, responsabil pentru Germania, Austria, Elvetia and estul
Europei (Polonia, Cehia/ Slovacia, Ungaria, EE)
♦ Dezvolatrea planurilor de operare, stabilirea masurilor
pentru atingerea tintelor de profit
♦ Actualitate vs. Planificare - comparatii
♦ Raport lunar, semestrial si anual de operare si obiective
statutare
♦ Coordonator raportare statutara cu auditorii
♦ Analize de investitii si control
♦ Activitati de joint-venture
1997 Analist la departmental de costuri de contabilitate in principal cu
proiectele de imbunatatire a productiei
1996 Experienta international de lucru la sediul din New Jersey
1995 -1996 Trainer financiar la Warner Lambert, Freiburg, Germany
Curriculum Vitae
Personal Information:
Name, First Name: Hafemeister, Thiemo
Date of Birth/ Place: May 2nd, 1967 in Kiel
Father: Leader of the finance department
Marital Status: Not married
Residence: Oberwaldstr. 23
D 76227 Karlsruhe
Education:
Elementary School: August 1973 – July 1977
High School Germany: August 1977 – July 1984
Exchange Program: 84 -85 Fort Worth Texas; US High School degree
High School Germany: Graduation Max Planck School, Kiel 1988 (Abitur)
Requirement to university admission met
Army:
Duration: July 1988 – September 1989
Responsibility: Navigator on a mine sweeper in the North Sea
University:
Start: October 1989
University Kiel: Christian-Albrechts-Universität Kiel
Study field: Business Administration
Majors: Finance and Organization
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6 month thesis: Organizational approach of the German retirement concept –
changes, challenges issues and solutions
Graduation: December 1994 (Diplom Kaufmann)
Grad Point Average: 2,2
Schiller International Master of Business Administration
University: in International Business
Graduation: July 2000
University Mannheim: Advanced Management Program
Successfully terminated in May 2004
Languages: English & French fluent in word and written
Employment with Pfizer (current first):
2002 – today: Working as international Project Manager:
♦ Development & implementation of strategic initiatives
in Germany and within Europe
♦ Merger activities
♦ Outsourcing & optimization initiatives
2000 – 2002 Working as Finance Manager within the German
pharmaceutical sector for Pfizer:
♦ Co-ordination of results in terms of Sales, profit with
European Headquarter for actual reporting and
Operating Plans/ Forecasts
♦ Co-ordination of tax and legal issues with internal tax
and legal department and external consultants
♦ Improvement of Management Accounting
2000 Pfizer & Warner Lambert Merger - located since then in the
German Pfizer Headquarter
1998 -2000 Working as Finance Manager in the OTC business for Warner
Lambert with responsibility for the Germany, Austria,
Switzerland and East Europe (Poland, Czech/ Slovak, Hungary,
EE)
♦ Development of Operating Plans, agree measures to
ensure targeted profit
♦ Actual vs. Plan comparisons
♦ Monthly, quarterly and year-end reporting for operating
& statutory purposes
♦ Co-ordinate statutory reporting with auditors
♦ Investment analysis and control
♦ Joint Venture Activities
1997 Working as analyst in the Cost accounting department mainly
within production improvement projects
1996 Working experience in the world wide headquarters New Jersey
1995 -1996 Starting as Finance Trainee for Warner Lambert in Freiburg,
Germany
Academic Life – publications (current first):
2005: Internet pharmacies – a constant threat or an opportunity for pharmacists – Pfizer paper
2004: Radical changes within the pharmaceutical environment in Europe – Pfizer paper
49

2001: Euro – what are the main challenges of the new currency – Pfizer paper
2000: Various case studies and analysis within the MBA program which were part of the regular
studies, but not officially published
2000: Shareholder value – a Management concept for the future - MBA paper
2000: International Monetary and Banking System – Research Project – MBA paper
1999: Internal publication for year 2000 activities, key issues and solutions – Pfizer paper
1999: Selected problems of International Economics – Monetary and fiscal policy – MBA paper
1996: EVA – a new monthly key performance indicator Warner Lambert publication
1995: Retirement alternatives and challenges from a psychological perspective as Co Author for
Prof. Martin Kleinmann
1993: Publication of Retirement challenges, implications from an organizational perspective;
thesis paper 150 pages for the Kiel University
Academic Life – major activities (current first):
2003 -2004 Advanced Management Program initiated and conducted by the University of
Mannheim composed of 6 modules:
♦ Marketing and Sales - Prof. Homburg
♦ Business Finance - Prof. Franz
♦ Marketing and Sales - Prof. Homburg
♦ Organizational Change - Prof. Stock
♦ Corporate Strategy - Prof. Perlitz
♦ Mangerial Dec. Making - Prof. Weber
2003 Certificate in International Accounting (CINA) certified by Prof. Leibfried Head of
Academy for International Accounting Standards
2000 Graduation from Schiller International University with the degree MBA. The program
consists of 15 modules, which all have to be successfully terminated:
♦ Organizational Behavior
♦ Managerial Accounting
♦ Managerial Finance
♦ International Marketing
♦ Multinational Business Management
♦ Production and Operations Management
♦ International Monetary and Banking Systems
♦ Business, Government and International Economy
♦ Comprehensive Business Management Seminar
♦ Human Resource Management
♦ Selected Problems of International Economics
♦ International Business Law
♦ Managerial Statistics and Quantitative Methods
♦ Recent Trends in Information Technology
♦ Methods of Research and Analysis
50