Case study

Launch Plan: Monocryl Plus

On a warm Monday afternoon in August 07, Amit Goswami the marketing manger synthetic absorbable sutures in the Ethicon Business of J&J Medical India was worried about a new product launch. Waiting outside the MDs office he was reviewing his pitch to New Brunswick managers that was to be cleared with the MD of J&J Medical India first. Background: J&J Medical is into many invasive and non invasive diagnostic and healthcare solutions providing businesses. (See annexure 1) New Brunswick (Global J&J headquarters) wanted a quick plan for launch of Monocryl plus, a new innovation in the existing Monocryl suture. Sutures primarily are closure products used to close incisions made by surgeons and/or accidental wounds. The Monocryl suture was launched some ten years back for skin closure and had not been as successful in India as it was in other parts of the world. Though ready with the plan, Amit was worried what would happen to the brand extension of a product which had already received a lukewarm response from Indian Surgeons. This plan had been prepared with help of external consultants. For the purpose of this case, kindly assume that you are that consultant. The task: To prepare a quick launch plan for the new Monocryl Plus suture. Nuts and bolts: Ethicon has been the global leader in the wound closure business and India was no different. But as of the last 10 years sutures were fast becoming a commoditized category. Many new compromised quality/low cost producers had entered into the market. The compromised quality raw material (threads and needles) was easy to produce and due to low internal quality benchmarks/ low overheads the competition was able to sell the finished goods at nearly half the price of Ethicon products. There had also been an additional problem of Chinese Imports hitting Indian hospitals. The mainstay brand Vicryl (contributing to 40% of Suture top line) was under threat. Then three years back a new innovation Vicryl Plus with additional antibacterial coating had been launched. In 3 years Ethicon team had converted 18% of Vicryl users to plus. This was Ethicons reply to the low cost threat to Vicryl. Move the surgeon higher on the benefit ladder rather than competing on cost and hence keeping the value intact. Said Amit Goswami. 1

The whole sales team is really upbeat about the plus platform due to the recent success of Vicryl plus. Having taken the credit (and a good bonus) for Vicryl Plus success Amit was thinking whether the same strategy would work for Monocryl. Market realities for Vicryl and Monocryl were very different. Vicryl was a 80 crore product and Monocryl had just reached 3 crores in 10 years. Also Vicryl was used for many layers closure (Skin,fat,fascia) in nearly every specialty and Monocryl was popular only with plastic surgeons for great cosmetic effect on skin during aesthetic surgery. With a smaller playing field even if we upgrade 100% of existing Monocryl users, will a 3 cr topline justify a new product? We need new applications/new markets/new surgical specialties for this product, said Amit talking to himself. Vicryl had been popular across private hospitals, government hospitals and nursing homes. Amit had to make a choice of which segment to choose for Monocryl plus.(See Annexure 4). From the specialty lens there were many segments in the market. General Surgeons(20,000), Gynaecs(25000), Plastic(1000), cardiac (500), Orthopaedic ( 6000). Whilst he could pitch this product on all of them or one of them, the fact holding him back was that Monocryl is only indicated for skin closure. Hmmm.. I wish this product could be used for more than one layer of closure wished the thoughtful marketing manager. Till then let me see if I can make it a multi specialty product for skin closure. Currently 60% of surgeons were using silk, nylon, Vicryl etc for skin closure. Surgery being very skill driven, it was difficult to make a surgeon shift from one material to other. Therefore professional education (teaching surgeons how to use) had been the mainstay of J&J medicals worldwide strategy. In terms of willingness to upgrade the latest Trigger and barrier research on sutures named CV surgeons as the quickest to upgrade, followed by Ortho, General surgeons and then Gynaecs. Whilst thinking about the promo plan Amit remembered the constraint of not being able to advertise in mainline media as these were ethical/prescription products and not OTC. Surgical conferences, newsletters, surgical journals, one on one meetings were the options that traditionally people had been using. During lunch Amit told the consultant on how impressed he was by marketing people in other categories using digital media successfully and how he wished medical device marketers could do the same. Just before he was about to leave office he received the plus suture essential prescribing information.(Annexure 3). Promptly Amit handed it over to the consultant. Lets discuss this tomorrow morning. 2

Tomorrow you have to present your plan to Amit and then the MD. You may use Internet to do some more data mining if you like. The expectation is to present a refreshing strategic direction supplemented with implementation plan on the new product launch.

Annexure 1: Information about J&J businesses active in India

JOHNSON & JOHNSON MEDICAL

ETHICON Wound Closure & Tissue Repair Products (Sutures & Mesh)

CORDIS Cardiology & Endovascula r products (Stents)

DEPUY Orthopedic Implants (Knee & Hip Replacemen t)

ASP Advanced Sterilization & Infection Prevention Products

LIFESCAN Diabetes Management Solutions (Glucometer)

ETHICON ENDO SURGERY Minimal access surgical products

Cordis Since its establishment in 1959, Cordis Corporation has been a pioneer in circulatory disease management. Dedicated to helping physicians and other healthcare professionals enhance the lives of patients suffering from cardio vascular disease, Cordis is driven to transform the future of vascular care through its commitment to R&D. In India, Cordis has four specializations: Cardiology, Endovascular, Neurovascular and Electrophysiology. DePuy Over one in ten people above the age of 55 suffer from Arthritis. DePuy aims to empower sufferers by increasing awareness about arthritis and its management on the one hand and training surgeons to increase the 3

specialist pool on the other. DePuy Orthopaedics Inc., a subsidiary of Johnson & Johnson, is a company that designs, manufactures and distributes orthopedic devices and supplies including hip, knee, extremity, trauma, orthobiologics, and operating room products. A market leader in the joint replacement sector, DePuy has always stayed ahead of the curve with its speed to market the latest technology products. With this, DePuy aims to serve patient needs and restore the joy of motion. Ethicon Innovation is a key factor that drives business at Ethicon, one of the worlds most respected brands in surgical and health care. Today Ethicon has a range of over a thousand products in the area of wound closure, womens health and urology and cardiovascular solutions. On an average Ethicon products touch the lives of 11 million patients in a year making it one of the largest surgical product brands across product categories. Ethicon Endo-Surgery Minimally invasive surgery is the way of the future. Ethicon Endo-Surgery markets advanced medical devices for minimally invasive and open surgical procedures. Focusing on procedure-enabling devices for the interventional diagnosis and treatment of conditions in general and bariatric surgery, as well as gastrointestinal, gynaecology and surgical oncology. JJHS Popularly called the "Hospital Division of J&J", Johnson & Johnson Hospital Supplies helps healthcare providers touch, save and improve countless patient lives across the country, by saving blood and preventing infections. Its range of infection prevention products, are used for environmental disinfection inside hospitals, for disinfection and sterilization of surgical and endoscopic instruments, and skin disinfection of surgeons and patients. Passionate to improve the safety of patient, environment and healthcare workers, the company is dedicated to protecting patients, healthcare workers and the environment with products that focus as much on safety as they do on efficacy and cost-effectiveness. Lifescan Dedicated to improving the quality of life for people with diabetes by developing, manufacturing and marketing a wide range of glucose monitoring systems and software for use by people with diabetes and by health care providers, Lifescan, Inc. The ONETOUCH Brand of consumer and institutional products includes portable electronic meters and disposable reagent test strips to provide accurate, less painful glucose readings and the

software tools to transform this information into actionable health care decisions. Ethicon Institutes of Surgical Education Ethicon Institutes of Surgical Education (EISE), at Delhi, Mumbai (Bombay) & Chennai (Madras), symbolizes the commitment of Johnson & Johnson Medical, India towards the field of Professional Education. Dry and Animate Labs for hands-on experience form an integral feature of courses at EISEs. These state-of-the-art Institutes house modern operating theaters equipped with latest patient monitoring and life support equipment to simulate real life situations. The conference rooms are ergonomically designed with the latest audio-visual aids including equipment for distance learning. EISEs are recognized by the Royal College of Surgeons, Edinburgh, U. K., as centers of excellence for conducting their Basic Surgical Skills Courses in India. Business Knowledge Centre An Asia Pacific initiative, the Business Knowledge Centre is a state of the art, scalable, captive model. Established in 2006, at a tech park in Pune, India; it is based on the time-proven concept of Regional Planning. It aspires to support, with a long-term view, various initiatives, in areas of Operational Excellence, Global Process Outsourcing and Knowledge Development. BKC adds value, by bringing operational excellence and in depth industrial and functional knowledge to JJM affiliates' critical business processes. It provides high-quality execution of these processes, monitors them against multiple performance metrics, and seeks to improve them on an ongoing basis. BKC achieves its objectives, by providing service based on the five verticals of: Business Analytics, Distribution Analytics, Financial Analytics Regional Information Technology and Information Technology Strategic Sourcing

Annexure 2: Suture market

Volume share 61% Total suture market = 3.42 MM doz MM Value 74% Total suture value = Rs. 2184

ETHICON 50%

Centenial 10%

ETHICON 54%

B Braun 5% Centenial 13%

Others 10%

Tyco 10% SI 10% B Braun 10%

Others 9% Tyco 5%

SI 14%

Annexure 3
About Sutures: Essential Prescribing Information Vicryl Type of suture
Synthetic Absorba ble Polyglactin 910

Vicryl Plus
Synthetic Absorba ble Antibacterial coated Polyglact in 910 All tissue layers

Monocryl
Synthetic Absorba ble Poliglecaprone 25 Ideal for skin tissue, Bowels Monofilament suture Most smooth suture of all

Monocryl Plus
Synthetic Absorbab le Antibacterial coated Poligleca prone 25 Ideal for skin tissue, Bowels Monofilament suture Most smooth suture of all Antibacterial coat prevents bacterial colonizat ion Offers very good cosmetic results on skin Less risk of Surgical site infection

Material Usage Occasi ons Key Produ ct featur e

All tissue layers

Braided suture Predictable absorpti on behavior

Braided suture Predictable absorpti on behavior Antibacterial coat prevents bacterial colonizat ion Offers easy handling by surgeon Less risk of Surgical site infection General surgeons & Cardiac surgeons Cardiac tissues, Neuro tissues

Key Benefit

Offers easy handling by surgeon

Offers very good cosmetic results on skin

Current high users Contraindic ated for

All surgical specialti es Cardiac tissues, Neuro tissues

Plastic surgeons, OBGYN surgeons , General surgeons Deeper layers (fascia), Cardiac tissues, Neuro tissues

Deeper layers (fascia), Cardiac tissues, Neuro tissues

MONOCRYLPlusAntibacterial (Poliglecaprone25) Suture VIOLET MONOFILAMENT SYNTHETIC ABSORBABLE SUTURE, USP, EXCEPT FOR DIAMETER INDICATIONS MONOCRYL Plus Antibacterial sutures are indicated for use in general soft tissue approximation and/or ligation, but not for use in cardiovascular or neurological tissues, microsurgery or ophthalmic surgery. ACTIONS MONOCRYL Plus Antibacterial suture is a monofilament that elicits a minimal acute inflammatory reaction in tissues and in growth of fibrous connective tissue. Using zone of inhibition studies, Irgacare MP (triclosan) in MONOCRYL Plus Antibacterial Suture has been shown to inhibit colonization of the suture by Staphylococcus aureus, Staphylococcus epidermidis, Methicillin Resistant S. aureus, Methicillin Resistant S. epidermidis, Escherichia coli, and Klebsiella pneumoniae which are microorganisms known to contribute to surgical site infections. Animal studies have demonstrated that MONOCRYL* Plus inhibits bacterial colonization of suture after direct in vivo challenge with bacteria. CONTRAINDICATIONS This suture, being absorbable, should not be used where extended approximation of tissue under stress is required. MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan). WARNINGS Users should be familiar with surgical procedures and techniques involving absorbable sutures before employing MONOCRYL Plus Antibacterial suture for wound closure, as risk of wound dehiscence may vary with the site of application and the suture material used. Physicians should consider the in vivo performance (under ACTIONS section) when selecting a suture for use in patients. The use of this suture may be inappropriate in elderly, malnourished, or debilitated patients, or inpatients suffering from conditions that may delay wound healing. 8

Information for Use

Do not resterilize. Discard opened packages and unused sutures. As with any foreign body, prolonged contact of any suture with salt solutions, such as those found in the urinary or biliary tracts, may result in calculus formation. As anabsorbable suture, MONOCRYL Plus Antibacterial suture may act transiently as a foreign body. Acceptable surgical practice should be followed for the management of contaminated or infected wounds. As this is an absorbable suture material, the use of supplemental nonabsorbable sutures should be considered by the surgeon in the closure of the sites which may undergo expansion, stretching or distention, or which may require additional support. PRECAUTIONS Skin sutures which must remain in place longer than 7 days may cause localized irritation and should be snipped off or removed as indicated. Subcuticular sutures should be placed as deeply as possible to minimize the erythema and induration normally associated with absorption. Under some circumstances, notably orthopedic procedures, immobilization of joints by external support may be employed at the discretion of the surgeon. Consideration should be taken in the use of absorbable sutures in tissue with poor blood supply as suture extrusion and delayed absorption may occur. In handling this or any other suture material, care should be taken to avoid damage from handling. Avoid crushing or crimping damage due to application of surgical instruments such as forceps or needle holders. MONOCRYL Plus Antibacterial suture knots must be properly placed to be secure. Adequate knot security requires the accepted surgical technique of flat and square ties with additional throws as warranted by surgical circumstance and the experience of the surgeon. The use of additional throws may be particularly appropriate when knotting monofilaments. Avoid prolonged exposure to elevated temperature. To avoid damaging needle points and swage areas, grasp the needle in an area one-third (1/3) to one-half (1/2) of the distance from the swaged end to the point. Reshaping needles may cause them to lose strength and be less resistant to bending and breaking. Users should exercise caution when handling surgical needles to avoid inadvertent needle sticks. Discard used needles in "sharps" containers. ADVERSE REACTIONS Adverse effects associated with the use of synthetic absorbable sutures include wound dehiscence, failure to provide adequate wound support in closure of the sites where expansion, stretching, or distension occur, failure to provide adequate wound support in elderly, malnourished or debilitated patients or in patients suffering from conditions which may delay wound healing, infection, minimal acute inflammatory tissue reaction, localized irritation when skin sutures are left in place for greater than 7 days, suture extrusion and delayed absorption in tissue with poor blood supply, calculi formation in urinary and biliary tracts when prolonged contact with salt solutions such as urine and bile occurs, and transitory local irritation at the 9

wound site, as well as allergic reaction to Irgacare MP (triclosan).Broken needles may result in extended or additional surgeries or residual foreign bodies. Inadvertent needle sticks with contaminated surgical needles may result in the transmission of bloodborne pathogens. See Package Insert for Full Prescribing Information. *Trademark

Annexure 4: Traditional market segments Nursing Homes

50,000 nos Entrepreneurial Untapped, Profit Driven Fragmented

Private Hospitals
850 nos Trust/Private ownership High sales coverage Group based buying very high buyer power Low profit realizations KSF: Relationship with KOLs, Customers, Buyers

Government Hospitals
4750 nos Government owned Good sales coverage Slow-burn tenders, change after 1-2 years Very low realization KSF: Tender management

Buy at MRP KSF: Mass communication abilities, product availability

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KSF: Key Success Factor KOL: Key Opinion Leader

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Annexure 5: Pricing Matrix

Average Price of 1 Vicryl Suture = Rs.280

Vicryl Vicryl Plus Vicryl Rapide Monocryl PDSII

Price Index

100

120

90

110

115

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Rules for Submission

Your launch plan can be submitted in a word document (not exceeding 10 pages) Please submit a 5-6 slide Powerpoint presentation capturing the essential points of your Launch plan along with your Word document Though there is no maximum limit to the number of words or slides special credits will go to the strategists for clear, concise communication

Evaluation Criteria
For Round 1 Selections: Criteria of evaluation Ability to arrive at core business issue, marketing issue & final objective Ability to provide succinct solutions Analytical ability in problem solving Demonstration of clarity of thinking Process followed in arriving at final solution

For Final Presentation: Criteria of evaluation Verbal & Written Presentation skills Demonstration of clarity of thinking Any decisions pertaining to the judging of the competitors by the panel of judges from Johnson & Johnson will be held final. It cant be contested on any account.

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