Pharma stores in India & USA

This post provides my perspective of the retail pharmaceutical industry in India and the USA. Even though the ultimate goal is to make medicine available to the end customer, it is done in slightly different ways in the two countries.

Pharma Industry in India
Organized retail pharmacy is still in its infancy. Popularly called pharmacy or medical stores, numerous pop & mom stores dot the busy streets of any city or town. Most of them just sell the packaged medicine in its original packaging and do not make any medicine.

The Business Model
In most the cases, the prescription is not recorded by the physician's office or hospital. Wait a minute, did I say you can go to any medical stores? There is a catch in it. The doctor/hospital, medical stores and pharmaceutical companies operate in a closed loop triangle model. The Pharmaceutical Company first sells the "medicine" idea to the doctor, then to the medical stores who has to invest in stocking the item. If the sales volumes are not met, the pharma sales person will make a "co-ordination" effort to increase the sales otherwise offers alternatives or the competitive products take over. Sometimes the competition in the "special"(read expensive) medicines category is so intense, if you plan to purchase the medicine like 5-10 miles away from doctor's location, you may not find it!. So the pharma sales cycle is customized to city/locality/street(?) level that it has not gained international attention!. Compare to the US, big box retailers are investing millions of dollars
in customizing their outlets suiting to local residents needs and preferences, a concept which is called Customer Centricity. Some medical stores sponsor the prescription stationary for the neighborhood doctors and in the bottom of the prescription is the medical stores address!!.

Some important Observations:
Doctor's Handwriting in Prescription: There exists some encryption logic which only the doctor & the pharmacist can understand. Common people try hard & fail to decipher these cryptic notes. May be the doctors got bored of writing prescriptions all their life or they want just the pharmacists to understand what they write.

Inventory Management:
Mostly manual, occasionally some shops have computerized sale & inventory transactions. Most of the inventory, sale transactions are recorded offline in a notebook or human brain!. It's really amazing how a pharmacist searches for a medicine in the maze of shelves containing numerous medicine packets, small carton boxes, bottles, etc. The prescriptions are filled on a first cum first serve basis and are done in a remarkably less time. Most of these guys do multi-tasking like work with 1 or 2 customers at a time. Vendor's sales representatives also help sometimes in inventory management & replenishment. Wait a minute, this is called Vendor Managed Inventory in the informed world and this concept is followed quietly in Indian pharmacy stores for so many years!

Customer Service: Being a competitive industry, store owners try to build a good relationship, trust and offer value added services like recommending the best OTC, Occasional discounts, product samples, door delivery, etc. A customer with a good rapport can negotiate exchange unused medicine with alternate medicine, soaps or other consumables.

Pharma Industry in USA
Unlike India, Retail Pharmacy is a niche industry and some of the big box retailers like WalMart, Target, WalGreens, CostCo, SamsClub offer OTC (Over the Counter) medicines & pharmacy services. The OTC department is the first stop for picking up medicine for common ailments. The prescription written by the doctor is documented in the physician/hospital records. The pharmacy stores take away the prescription and provide the prescribed quantity of the medicine (for tablets, capsules) in the small plastic bottles. Refills, if required are decided by the doctor, additional refills need to be authorized by the doctor. Pharmacy provides a detailed write up on the medicine which includes constituents, effects, side effects and allergy symptoms. The doctors generally do not oversubscribe to avoid overdose, any risk of wrong treatment or legal implications.

Business Model:
Looks more organized and not much is visible to the common man. I have seen medical representatives dressed in crisp suites calling on doctors towards the end of the morning or evening rush hours. From there on, I have no clue as to how the business model operates!

Customer Service: Professional, Pharmacist works with one customer at a time. Even though they provide excellent customer service, first time prescription filling time is significant because it involves checking the insurance details, recording the sale transaction in the system, preparing the medicine, etc. Refills are relatively easier and faster, however takes at least 10-15 minutes. Refills can also be ordered ahead by phone and picked up later. The OTC medicines offer a wide choice of medicines for common ailments. Branded medicines are expensive and some pharmacies offer alternate generic medicine which is quite economical.

Independent India - After 60 years

I am writing this after India celebrated 60th birthday as an Independent nation. No doubt, India still lacks in many areas, but we need to also appreciate our journey so far. Here I am orchestrating a positive outlook about some of our achievements which in some ways may be similar to the views already expressed or may be different too!

a) Expect less: We are still 60 years old as a independent country and still need a lot of time to put together people, process, technology and common mindset to achieve higher goals. Diverse cultures, languages and regional priorities are few of the large set of things that we need to work with. Bottom Line: Have Patience

b) Remarkable Progress:
Thanks to the public sector undertakings which generated millions of jobs and generated a rich pool of labor force. Some of the talented people from the public sector are today instrumental in running some of the successful private engineering, mechanical companies. Also, an offshoot from the main stream industry resulted in creation of the IT industry, which we know is reaching newer heights by the day. Also significant efforts in agriculture & food packaging have been made.

c) Resource Pool of Qualified People; India has generated(still) a huge resource pool of qualified engineers, doctors, scientists, skilled labor and other specialists. Look around the IT companies in the US, Europe, Australia and the oil industry in the Gulf ..They are all beaming with Indian techies and engineers. Off late the nurses from Kerala are the most sought after people in USA!. Ten years back, who imagined nursing industry had so much potential? However, some changes are inevitable in future to avoid oversupply of resources in few areas like engineering, medicine, etc. Indians need to look beyond IT, Engineering to explore areas like aviation, medical services, life sciences, etc

d) Economic Improvements: Early 90s saw the elimination of some red tape and some radical improvements in the economic front.

e)HealthCare: India has an amazing pool of qualified doctors and the medical staff to cater to the burgeoning population. In the 1970s, most of the middle class and upper middle class population was born in the government hospitals. It is just
that increased population, lack of focus in government hospitals, corruption and the higher affordability levels, which have made govt.hospitals to look like poor cousins. However, please note most of the current day famous doctors ( in the age group of 50 and above) had prior govt.hospital experience where they gained immense experience handling a variety of complex medical cases

g)Infrastructure: Believe it or not, we are not doing that bad. Any city has at least a decent network of at least one mode of public transport. Railways have been innovative enough to make profits and offer strong competition to the emerging aviation industry.

h)Retail Power: Look around any major Indian city and you will realize the increase in the number of shopping malls. Some of the malls in Bangalore have visitors of about 1,00,000 per week. A good retail performance is the indicator of many factors like income & spending levels, also generating the direct & indirect employment in the services and hospitality industry.

Coming to America

Coming to America for Work is a challenging, joyful and the eventful experience. I am sharing my experiences & observations through a series of posts, with the focus on the typical experiences encountered by people who come from India to USA on long term / near-long term work permit (read H1-B or L1). Coming to America is all about the first time traveler's experience in making the trip, this involves typically three phases;

1. Before Travel
2. During Travel, Arrival in USA
3. Initial Days

Before Travel: No doubt, the first step is filing for H1 petition followed by subsequent steps of interview and stamping. Since part of the resource pool is always "visa" ready, the real travel plans take some shape upon finalization of a customer project. Some projects or opportunities show up overnight. Sometimes an unplanned customer interview or skill matching exercise will lead to immediate travel. Most of the companies conduct regular travel briefings to provide travel / visa / other information related to international travel. This overfeed sometimes boosts the confidence of the traveller or makes him or her completely confused. The travel schedule is then broadcast to near & dear ones. Before the travel, some employers provide adequate briefing & training regarding traveling, living & working in the US to their employees. At this time, our first time traveler starts gathering information on his US destination from known sources and internet. The person will be deluged with lots of solicited / unsolicited advices regarding what to carry, how much to carry, how to tackle the typical travel hassels, etc. Planning & Shopping continue till leaving up to boarding the aircraft. It is a common sight in bangalore airport to catch young folks pick up their fav coffee from the coffee day outlet..

During Travel,Arrival in USA; .. The journey kicks off after bidding good bye to the near & dear ones in the airport. The travel briefing details are very much in memory and our first time traveller goes through the formalities as though following a written script. At each checkpoint, care is taken to follow / over follow all the rules. Guys generally look forward to talk to some fellow passengers travelling to the US .In the flight, vegans think they are going through a difficult phase of their life as they suspect every meal to contain chicken, fish or meat. Some how almost all the meals and snacks are consumed. The immigration interview at the US port of entry is taken very seriously and our traveller would have all (additional) the information required to enter the country. Some companies care to provide initial hotel stay, food and conveyance. Later on, peers and internet sources are handy in finding a suitable accommodation. Fighting jet lag and adapting to new work culture, people are a challenge for the first few days or weeks after which things start falling in place.

Still to come: First few months in US, Settle down and Enjoy Life.

Dish Washing Strategy(DWS)

Back in India, dish washing was not a big deal. We had a servant maid and other family members stepped in whenever required. We were introduced to dish washer in the US. However dish washer is rarely used at my place, except during the Get-togethers or parties which leave mountains of dishes. So at our house, dishes are normally hand washed. Even though dishwasher has its own advantages, according to us ( me and wife) it has got its own limitations in terms of loading capacity(need to have sufficient dishes), time involved, energy consumed and the sound it creates.

Now that I made a case for manual washing, here are the main factors which influence manual dish washing;
a) Sink size constraints the number of dishes it can hold. Any overflows land up on the counter tops there by creating clutter and is visually discouraging to see so many of them
b) Size of the dishes and utensils: Yes that matters. Whether you have one big utensil or 10 eating plates?
c) Amount of time you have and your patient level (variable, depending on the day).
d) Some more...just cutting short here..

I have devised myself a Dish Washing Strategy(DSW) to effectively address this requirement;
a)Focus on big oversized utensils and dishes - Once you finish off with them, you get lot of empty sink space
b)While doing (a), pour out ( rinse) the soap water in to the small dishes. This way, conserving water apart, you are directing to your mind to a playful act
c)Pick your fav song and sing aloud...or listen to ipod, mp3, etc
d)Work on the small dishes
e)Having accomplished these steps, simply step out of the kitchen and do something else

What did you notice?
a)At the end of the exercise all the dishes are washed "One at a time", no matter what strategy you adopt: Going from big utensils to small dishes or vice versa. It's just a matter of prioritizing / guiding (or diverting) ourselves to do the important daily chore
b) Why walk out of the kitchen? Because the act of washing dishes is a recurring process and never stops. So take a break until the next batch accumulates for washing!

This works for me...Do you have any better strategy?

Home made Ice Cream!

Today's lunch time discussions took my memory back by 15 years when I and brother attempted to make ice cream at home. Note, these experiments started and ended within first month of buying the refrigerator. The ice cream mix from the store had just about 5 instructions!. Since we felt it was so easy, we immediately set off again to the store, this time to buy milk and other ingredients. However we did not have 2 ingredients and it did'nt bother us much. After making the stuff per instructions, we put that in the freezer for one hour ( as instructed). The stuff remained in the same state for couple of hours and only after 4 hours it still looked like a thick milkshake. We had no patience to wait further...the stuff was consumed in the as is form and who's complaining ...we planned to have ice cream but had a excellent milk shake.

After learning the mistakes, next time we followed all the instructions till mid way. Then we had a small fight upon who should carry out the next preparation steps. It was a hard decision and we argued a lot till we smelt something burning. Milk and other stuff on the stove was gradually burning off and we immediately worked together to complete the other prep steps.. Guess what we landed with this time? The final product looked 50% similar to the store ice cream, however it was smoky!. Having spent over 2 hours in the project, we did not complain. We finished off the stuff within half an hour and closed the ice cream making project forever :)

Real Problems we faced: Standard instructions apart, expert ice cream makers had their own recipe and the list of ingredients would vary depending on who you would talk to. Also, since we did not have a telephone then, we could not connect with "experts" for instant help, instead fix the problem ourselves. Anyway it was a lot of fun experimenting!

Consumer Electronics: Some Thoughts!

The fast paced developments in the consumer electronics is hard to neglect. As always in any industry, few companies and geographic locations lead the market. In Consumer Electronics, USA, Japan, Singapore, some parts of Europe are the launching pads for cutting edge techy products. Market performance in these regions will define its further life in other geographic locations. Some companies are known for their innovation and come up with new products regularly, example: Sony, Canon, Panasonic, Nikon, Dell, Apple, etc. In my opinion, the hot product categories are cameras (including camcorders), portable audio, TV and cell phones. The market changes so fast that what is cutting edge technology today becomes "ordinary" within a short span of time. The new products are always sold at premium targeting heavy purses. After a while, prices normalize and gradually taper off due to market dynamics.

Indians living in America get carried away with the innovative electronics products. It is a status symbol to own & display high end stuff. Also, the urge for peer recognition and “competition” makes a person stretch his budget and get a decent product. Few factors which make Indians go after high tech stuff could be
a) We develop intimate relationship with the electronics products and don’t throw away the stuff even if it breaks. Repair costs in India are cheap compared to investing on the new product b) Innovation Vs Price: Until few years back, Indian electronics marketplace was sluggish and not so very innovative. Even if so, the newly introduced stuff was very expensive.
c) Few years back, some of the electronics stuff like big screen TVs, home theaters, etc did not figure in a common man’s wish list.
d) There could be few more reasons…you let me know

Given the above, when an average Indian comes over to the USA, he/she is awed with the electronics marketplace because of the range of products, availability and the price. It is quite natural for such a person to splurge on something that brings happiness and change to the daily life!

Note: I hear that Indian consumer electronics market has redefined itself in the last couple of years. Products launched in US or Japan become available in India within a short span of time and there is no significant price difference between the Indian make and the imported ones!. Could this mean travel bags to India will get lighter?

Bangalore City Bus: My travel experience

I always liked traveling in the Bangalore city buses. They used to be called BTS ( Bangalore Transport Service). I started traveling from sixth grade from koramangala to my primary school located at Wilson Garden. Mine was the last stop at Koramangala, that meant only few passengers would travel until the last bus stop. During those days, we knew most of the conductors &drivers. One of my friend's uncle was a conductor and he looked like late kannada cinema comedian Narasimharaju. Few bus routes like 171, 163(A),166 connected Koramangala to the outside world. 171 was the most popular and busiest route because it connected the Bangalore City's main bus terminal(Kempegowda Bus Terminus). This apart, there were few long bus routes from the rural areas to the city market area. It was very common to find the Koramangala's rich &famous kids travelling in the buses, side by side with other kids.
I gained more bus travel experience when I went to high school in Jayanagar 4th Block. I had to change buses in Wilson Garden till the BTS introduced a direct route from koramangala to Jay.4th block. Wilson Garden police station stop used to be like a transit center for koramangala kids because most of the educational instutions were located in basavanagudi & jayanagar areas. Boarding koramangala bound buses at Wilson Garden stop was always a challenge. The buses would be already full and the drivers would pull up 50-100 meters ahead of the assigned stop, just to avoid additional passengers. We would chase down the bus all the way and get in. Also bus travel served as a perfect place for networking and we made lot of friends in other schools.
My bus travel continued through my pre-university and degree education. However, sometimes I used to borrow my brother's moped too!. During my degree education, I had flexibility of choosing either the rural or the regular routes. The rural buses ferried lot of villagers while the regular routes had city crowd and some nice looking girls!. Inspite of this attractions, we were forced to take mofussil buses because of the faster commute times. By now, Koramangala had added a lot of residents and businesses. So naturally there were more people in the buses and off course new bus routes were introduced. Bus travel gradually tapered off once I started working. Due to my job requirements and the flexibility with the two wheeler, I gave up full fledged city bus travel. However, whenever possible I've used the city bus to get around in Bangalore. All these years ( even now) I hear Bangalore residents complaining about poor bus facilities in terms of schedules, seating capacities, etc. No doubt, the state run organization is not run like a business, it definetly is a life line for millions of people. Unlike other cities, majority of the Bangalore's middle income group do not travel by bus. Instead of simply blaming the traffic jams, if at least few people switch to bus travel, not only will they save some money but also help reduce the pollution around.

Trip to Leavenworth & Apple Capital of the World

We finally opened our road trip account for this year and with my little daughter around, we decided to try with a 3 hour drive to Leavenworth, see surrounding places & stay at Wenatchee. The interesting part of this trip was the travel through the scenic places like Snoqualmie pass and the Stevens Pass. After driving about 2.5 hours, we were very hungry headed to the first rest area to feed on Puliyogare and Curd rice. Because we were so hungry, food which was supposed to last for a full day was consumed in just one meal!. Rest of the onward journey took us through the scenic mountains and plains and we saw a lot of apple and cherry orchards. We bought some cherries from a road side stand. After cooling off in the hotel room, we briefly explored Leavenworth in the night.

Wenatchee:Apple capital of the world- I knew little about apple connection with Wenatchee. The brochures and other reading material in the hotel told me Wenatchee’s contribution is around 60% of the world's apple produce. That’s way this place is still called Apple capital of the world. Apart from apples, lots of cherries and berries are grown in this region. Some of the famous brands like Fuji, Washington red apple, gala and others come from this place :). According to Internet sources, significant portion of India’s apple imports come from Washington state and Tamil Nadu is the largest importer of apples!

Coming back to the trip, Leavenworth is built in the lines of a old Bavarian village and its layout is typical of any crowded Indian city with the businesses operating out of the cellars, 2nd and 3rd floors. There are so many wineries and gourmet restaurants and one needs a lot of time for detailed exploration. But one thing is evident, there is “German” ambiance everywhere starting with the neon signs, menu descriptions, dress, people and the architecture. One can see lots of floral arrangements in the restaurants and shops.

We visited the near by “Applets and Cotlets” factory. Man, they make one of the most delicious candies in the world. Please try them when you get a chance. The other place we briefly stopped over was “Rocky Reach Dam”. Typical dam attractions apart, this one has a museum in which lots of details / artifacts belonging to the native Indians are displayed.

My post trip research on Wenatchee, worldwide apple fruit market has enough material for a full fledged post – plan to do it shortly.

Time out without Cellphone

It was very warm & sunny last evening and we decided to go and cool off in a near by store. On the way I realized I was not carrying my cell phone! It is something which rarely happens and I resisted the temptation to go back and fetch it. I was curious to see the impact of not carrying the cell phone for one evening.

Flashback: Summer is normally mild in Seattle and the mercury peaks only for few days or weeks. So air conditioners are absent in most of the Seattle area apartments and independent homes.

Coming back to the story- While we enjoyed the evening out, thoughts of missing cell phone kept coming back. Even though I did not expect official calls, you never know when some one needs you. What if any of my friends are trying to reach us? What if my vehicle breaks down and if I have to call for any help? We even thought of visiting a friend’s place and but gave up because we did not know his evening plans or if he was busy. I was bit nervous, anxious till we reached back home. I was relieved and disappointed J to find no missed calls or voice messages. Even though I don’t doubt the benefits of carrying the cell phone everywhere, I felt it’s possible to live without it – at least for a short duration

Flashback – 30 years ago, Place: India - Bangalore: During those days, let alone cell phone, we did not even have a land phone at our house. My dad had access to telephone only during office hours and during this time he was the single point of contact to receive / send emergency information to the external world. Many of our relatives and friends did not have telephone. However in case of emergency, our friends and relatives with telephone would build an improptu channel and pass the information over to the required person or family. During those days, we visited friends and relatives without making prior appointments. Our success rate of finding people in their homes was very high and very rarely encountered locked houses. That’s because we used to plan our visits based on the lifestyle patterns of each family like working couple with kids in school, families active in social work or those having retired / elderly people at home, weekend preferences, etc. It was a status symbol to have a telephone at home. Due to limited penetration of the telephone, there were only few advantages it did not offer significant benefits like today

Current Situation, Place: India – Key decisions are made over land lines and cell phones. People spend more time on the cell phone than personal talking. On a lighter note, our government might introduce a law where every new born child is associated with a unique cell phone number (like Social Security Number in USA). So in future, population census might mean counting cell phone subscribers across various networks. That way our population counts is most update :)

787 Dreamliner Premiere

Being in Seattle, it was difficult to miss the run-up leading to the unveiling of the Boeing 787 Dreamliner. Over the last couple of weeks, this new flying bird was in news all over the print & electronic media. The premiere at Boeing's plant at Everett was witnessed by over 15,000 people including employees and delegates from all over the world. Another 25,000 employees, retirees and their guests watched this event on the giant screens at Qwest Field, the home of Seattle Seahawkers Football team. This event was broadcast live to over 100 countries in 6 different languages.

We were invited to watch this event at Qwest Field, starting at 3PM. Our plan to meet with other friends at the stadium was not successful because we reached different points of the stadium. There was no time to go about searching each other. We collected the complimentary 787 gliders (2 per person!).Once inside the stadium, we again got in touch with our cell phones and we were seated exactly across the stadium. At last, we were lucky to get one friend & his family who were looking for seats near us!

Unlike a typical event in India, this one was different with the absence of any film stars or a battery of politicians। Qwest field events started off with the band from one of the local schools followed by a brief address of 2-3 mins by the Governor of Washington State. Later on, video clippings of the existing airplane models and their comparison with 787 were shown. The host asked people who worked in each airplane model to stand up when the respective video was played. It was good to see number of elderly people stand up proudly when their respective airplane video came up. 787 video clippings provided lot of information about the airplane, its uniqueness and the partners involved in this process. By this time, the seating areas in the stadium were significantly occupied and the focus shifted to the unfolding events at the Everett plant near Seattle. A number of airline customers, flight attendants had descended on the Everett plant. Being the first to place the order, ANA (All Nippon Airways of Japan) received significant attention in the premiere. After the brief congratulatory notes from some key suppliers & customers, the CEO introduced the new airplane and the leader of the 787 program did the final honors in unveiling the airplane.

In all, it was a wonderful event and we took a lot of pictures. We got an opportunity to be with the Boeing community during this launch. Also, for the first time got a chance to see the football stadium in the USA. Compared to our cricket stadiums back home, this one made the visitor comfortable with abundant car parking space,good seating options, giant screens at either end of the playing area and off course the refreshment stalls and the convenient location of the rest rooms.

787 Dreamliner - My thoughts: With the order book of 677 airplanes as of 07/08, this one's definitely a market winner. Against popular belief, 787 is not the biggest aircraft from the Boeing family. It is a mid size, long haul aircraft set to redefine the intercontinental travel. 787 will reshape our travel itineraries to some extent as it enables non-stop flying from point to point location across continents. As far as India-US travel is concerned, Air India is already planning to start direct flights from cities like Bangalore, Hyderabad, etc that would land in Seattle, Houston, etc. Boeing's order book is full until 2013, that does not mean they cannot service new orders. I saw the CEO in the TV mentioning that additional orders will be accommodated through the leasing agencies and also by adding more production capacities. Meanwhile AirBus is bringing in their competitive model, A350 which will fly by 2013. With the addition of these 2 aircrafts, there will be a definite boost in the air travel. Tickets are likely to get competitive and we might see significant increase in the international travel.