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Pharmaceutical marketers, like their counterparts in other industries, are under constant pressure to justify their sales and marketing budgets. But in the United States, pharma marketers must also beat back accusations that advertising for their products is ineffective. For example, a recent (September 2008) study by Harvard researchers, which suggested that direct-to-consumer (DTC) ads do not improve drug sales, generated a great deal of coverage and controversy.
(DTC) drug advertising in the United States Like many others, we disagree with the conclusions of that study. The research used French Canadians as a control group, compared them to English-speaking Canadians who were exposed to some American DTC spillover, and concluded, based on retail prescription data for three drugs, that DTC advertising may not work. Because the study’s flaws have been fully explored elsewhere, we will simply reiterate the oft-stated observation that the conclusion cannot be justified by the research design. The research was conducted in a country with a national healthcare system and different drug pricing and prescribing restric-tions than the United States. The media spillover was not measured, and no account was made for the quality of the creative or the number of people who saw the advertising that were actually among the target audience for the drug. Therefore, the study cannot possibly shed any light on the effectiveness of DTC While we will always be eager to review research that has unexpected or essary conflicts between controversial findings, we feel that the question the Harvard study attempted to address has already been definitively answered through our own research as well as that of other companies. The success of DTC advertising in the United States, as measured against a number of outcomes, cannot be disputed. In spite of having to clear additional hurdles beyond what is required of most advertising, DTC ads have been shown to have a clear and measurable impact on sales when studies are conducted using proper target audiences. Sound research and pretesting, which take into account the ways in which DTC adver-tising is both similar to and different from ads for other types of products, have no doubt helped pharma marketers refine their approach to satisfying regula- tory guidelines while building awareness and strong brand associations.
While pharmaceutical marketers do face special challenges, in fairness to others we must say that marketers of all kinds of goods and services sometimes confront skepticism about the efficacy of advertising. An overview of results from sales modeling suggests that only around 10 percent of ads pay back in the short term. Angela Federici
Managing Director MBNA Healthcare Practice Therefore, marketers who know that the true value Figure 1: Awareness vs TRPs for New Pharma Brand of brand communication is revealed over time must constantly remind and educate those in charge of businesses of the importance of building brand equity Brand-building is especially critical for prescription drugs, as many of the brand “purchase” decisions require a behavioral or emotional commitment that may evolve over many months. Our research indicates that purchase may lag advertising by up to a year for preventative or maintenance therapies such as those for contraception, hypertension, or cholesterol. For brands that are not first-line therapies (such as Enbrel for rheumatoid arthritis, cited in the Harvard study), In addition to establishing awareness and some degree advertising can help to build emotional connections of brand knowledge, advertising needs to help con- that can be accessed when such a therapy may sumers connect to the brand emotional y. Just as for other types of brands, marketing communication for pharmaceuticals needs to establish brand associations, In spite of having to clear additional hurdles both to dif erentiate the brands from competitors and to insulate them against generic products. U.S. brands beyond what is required of most advertising, that have achieved notable success in this area include DTC ads have been shown to have a clear Nexium (the healing purple pil ) and Advair (treats the two components of asthma). For drug brands that have unique positioning, DTC ads can drive very strong asso- ciation of the brand with the key message. An example The process of brand-building and the role of adver- tising within that process are the same for prescrip-tion drugs as they are for other types of products. The basic requirement is to build awareness. Because pharma marketers don’t have access to traditional point-of-purchase tactics such as shelf facings, end caps, price promotion, and packaging, they must rely Our data clearly shows that DTC campaigns raise awareness for new pharma brands. What else could account for steep gains in awareness like that shown in 20Figure 1? In fact, the correlation between advertising and brand awareness is tighter and more direct in pharma than in any other category. On average, three 250 months after a launch, brands with little or no prior 0 M J J A S O N D J F M A M J J A S O N D J F M A M J J A awareness achieve brand awareness levels of almost 50 percent among relevant targets.
correlation between cumulative DTC spend and NRx is 0.96, significant at the 99 percent confidence level. It The role of a patient’s emotional affinity to a brand is clearly apparent that advertising has accelerated the cannot be discounted. Not only does it insulate a brand against generics and formulary coverage, but it can also aid persistence and compliance among patients, The “feel good factor” generated by DTC who are more likely to respond positively when a doctor ads is higher than in any categories except prescribes a drug with which they already feel familiar. household products and automobiles. An analysis of our copy-testing database, which in-cludes over 500 DTC ads, reveals that DTC advertising generates strong positive emotions. On average, posi- DTC ads do face challenges above and beyond those tive emotional connections are generated among 73 for consumer goods and durables. Not only do they percent of the target viewers, a level equal to that of have to stand out from the other ads in a cluttered advertising for food, beverages, cars, and household commercial break, they must do this while conforming products, and exceeding that of ads for telecoms or to a litany of regulatory restrictions. The fact that DTC financial services. The “feel good factor” generated by ads have achieved such success in the face of these DTC ads (a measure of the overal positive connection) challenges suggests that in the 10+ years since DTC is higher than in any categories except household prod- advertising first appeared on television in the United States, research has helped DTC marketers hone their Awareness + Associations + Affinity = Increased For example, in the early days of DTC advertising, The results of DTC marketing for treatments of symp- viewer interest used to wane during the mandatory tomatic lifestyle conditions, such as erectile dysfunc- discussion of risks and side effects that is known tion and restless leg syndrome, are usually readily as “fair balance.” It didn’t seem to matter where this apparent. Figure 3 shows the contribution of DTC disclosure was placed in the ad; interest consistently advertising to new prescription volume (NRx) during the launch of a drug for this type of condition. The In our experience testing and tracking DTC ads, we observed that the manner in which fair balance was communicated had an effect on viewer engagement, which in turn had an effect on the degree to which risk Figure 3: Contribution of Advertising to NRx and benefit information was recalled and understood. As the fair balance information has become more effectively integrated into the creative, DTC ads are doing a much better job of maintaining viewer inter- est regardless of the medication type, the condition being treated, or the severity of the risks and side ef- fects being conveyed. We see high levels of recall and understanding of the risk information (80 percent and 92 percent, respectively) without a negative impact on These improvements could have come about simply education. A demonstration of how a drug works – its because viewers have become familiar with the format mode of action – can be both attention-grabbing and of DTC ads and therefore expect the disclosures. But memorable. Executions that explain a disease and vali- we believe that they are a direct result of DTC ads date a viewer’s symptoms can also be a powerful force becoming more engaging in the past few years. In fact, for growing awareness and establishing relevance. In despite mandatory inclusion of risk information, DTC fact, DTC advertising can spark action through educa- ads are as enjoyable and engaging as ads for most tion without even mentioning a brand name, though other product categories. DTC ads are also among the in the United States the level of unbranded disease most persuasive of any product category. advertising has been on the decline in recent years. In countries such as Mexico, however, where branded drug advertising is prohibited, pharmaceutical com- An examination of our Millward Brown databases panies have made effective use of ads that mention a (both copy-testing and tracking) makes it clear that brand’s maker or that refer viewers to a Web site for the most successful DTC campaigns share a number of common elements. It also becomes apparent that most of the basics of good advertising apply to the DTC Empowers Both Consumers and Marketers While DTC advertising may be prohibited or restricted in many places, the widespread availability of infor- • Creativity – White coats and talking heads blend mation on the Internet has, for good or ill, forever into the canvas, while creative devices such as changed the balance of power between doctors and the VESIcare pipe people, the Enablex balloons, consumers of healthcare. Consumers want more and Treximet people removing their heads lead knowledge and control, and they are exerting greater influence over their treatment plans. DTC ads are just one of the information sources they have to draw on.
• Brand icons – Recognizable brand icons such as the Imitrex monster and the Cialis tubs aid From the point of view of pharmaceutical market- ers, DTC ads present the best opportunity to reach consumers directly, establish the relevance of their • A compelling point of difference – A unique and products, and build brand affinity. Therefore, these ownable brand positioning helps to differentiate marketers must continue to work to educate those who manage their businesses on both the established effectiveness of DTC advertising and the specific roles • Controlled messaging – Pharma ads are no differ- DTC advertising can play in building prescription vol- ent than others; there is a limit to the number of messages that can be succesfully integrated into the ads. To read more about DTC marketing, visit www.mb-blog.com. • Communication of the end benefit – Rational messages must be seeded, but must also then “ladder up” to an emotional benefit.
In addition to these factors that are common to successful ads in all categories, there are a few other elements that are seen much more often in DTC ads than in ads for other products. Topping the list is

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