Daybreak - From managing migraines, to treating IBS — why thousands are choosing devices over drugs

Episode Date: January 28, 2025

Nothing can dampen a vacation like a chronic migraine. Sunayani Sarkar, a 22-year-old biotechnology student learnt this the heard way during a trip to the Andaman and Nicobar islands last year. A month of terrible migraines later, her doctor suggested she try out a wearable device called Nerivio, developed by Pharma major Dr Reddy's through a partnership with an Israeli bio tech firm called Theranica Bio Electronics. The device connects to an app via Bluetooth and controls the electronic pulses sent to the arm. It also stores the patient’s data to track migraine episodes over a period of time. It seemed simple enough and Sunayani’s migraines weren’t getting any better, so she decided to give it a go. She isn’t alone. Turns out in the last few years, the market for devices to treat and manage chronic and non communicable diseases has been blowing up. Despite its high costs, thousands of Indians are opting for digital therapeutics to manage their migraines better and monitor heart health. And company's like Dr Reddy's and Lupin are making the most of it. And why wouldn't they? After all, it opens the doors to bundled products, robust patient data and a chance to be pioneers in global healthcare. Tune in. Daybreak is now on WhatsApp at [phone]. Text us and tell us what you thought of the episode!Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first studio. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. Nothing can dampen a vacation like a chronic migraine. Sunani Sarkar, a 22-year-old biotechnology student, learned this the hard way during a trip to

the Andaman and Nicobar Islands last year. Her most vivid memory of the trip was suddenly feeling a sharp persisting pain at the back of her head. And when the pain didn't go away, even after she returned from the vacation and took fistfuls of prescribed pills, she knew she needed something more. So her doctor suggested she try out something called Nerevio. Now, this is a small migraine management device launched by pharma major Dr. Reddy's through a partnership with an Israeli biotech firm called Theranica Bioelectronics. It looks a little bit like a bandaid around the arm and how it works is it sends electrical signals

to the nerves to reduce pain. The device connects to an app via Bluetooth and controls the electronic pulses sent to the arm. It also stores the person's data to track migraine episodes over a period of time. It seemed simple enough and Suneni's migraines weren't getting any better so she decided to give it a go.

Turns out she isn't alone. In the last few years, the market for devices to treat and manage chronic and non-communicable diseases has been blowing up. And with it, we're seeing all sorts of digital therapeutics and devices entering the scene. Nirivio, the device Sunaina was prescribed, is part of Dr. Reddy's newly formed digital therapeutics portfolio. Besides the device, it has also launched an app to treat irritable bowel syndrome called Daily Bloom. These two offerings may be a speck in the company's vast product portfolio, but they're indicative of things to come.

Because you see, it isn't just Dr. Reddy that has been dipping its toes into this market. Several other pharmaceutical companies have invested in digital therapeutic products in the last few years for managing chronic and non-communicable diseases. Lupin Digital Health, for instance, launched Life, which is a cardiac care management app back in April. The app tracks the user's health data, think things like blood pressure, pulse rate, even an electrocardiogram. and then lets them connect with emergency responders and doctors if and when needed. Why? Well, the Ken reporter Soudeshina Ray spoke to several health analysts and people in the pharma space,

one of whom said that this is one viable way for pharma companies to differentiate themselves from each other. Think about all the other ways pharma companies could innovate. They could either license patented drugs for India or develop new molecules, both of which are very saturated and, well, naturally. difficult to do. So this is a new avenue that these companies are going all out to explore. You see, while drug-free products means long-term care for patients without the side effects of pills, there's also a lot at stake for these companies because it opens doors to bundle products, robust patient data and a chance to be pioneers in global healthcare.

Welcome to Daybreak, a business podcast from the Ken. I'm your host Rahil Filippos and I'll be joining Snigta Sharma every day of the week to bring you one business story that is worth understanding and worth your time. Today is Wednesday, the 29th of January. Consider this. Today, as many as 270 million people in India suffer from migraines. Just take the case of Suneni. Within a few months of being diagnosed with migraines, she had taken the SOS pill so frequently that it just stopped working. Which is when her doctor had to increase the dosage. And as a result of all of that, she ended up gaining 10 kilograms in one year. So when her doctor suggested Nerevi-O, she immediately bought three of them in a buy-to-get-one offer. Each device cost

$14,000 and last for 18 sessions of 45 minutes each. So one device will work for around a month, more or less. Like I said, millions of people across the country deal with migraines. So there have been several non-pharmacological treatments that have popped up over the years for people like Suneni. For instance, just a decade ago, Gujarat-based Everest Health Care became a distributor for cephali, a Belgium-manufactured battery-powered migraine band worn across the forehead. It cost about $25,000 back then. There were also others like Gamacord, which was a nerve stimulator developed by a US-based

medical tech firm. The list goes on. But despite some positive responses and results, these never really took off in India. Ashi Sharma, a neurologist, from Bilaspur in Himachal Pradesh told Sadiqna that was because most of these devices worked well for acute diseases but couldn't really handle preventive care. Now that has changed. Nerevio and products like it sell because they help prevent the severity and frequency of episodes. And despite the high investment required, patients in Tier 2 and 3 cities also seem to be open to trying them out, according to Dr. Sharma.

He says it is an obvious choice when you look at the other options available for chronic migraine management. You can either go for injectables from Switzerland-based pharma major novartis or Botox shots. Now, the first option costs anywhere between 20 to 32K, while Botox shots have to be injected at 35 places in the head, and that has to be done once every three months or so. So both are rather inconvenient options. Sunani ran through all of her devices within six months. So she started spacing out her sessions in the last four months to once a week as opposed to every other day.

And a month after she stopped, she told Sudeshna that she hadn't had a single migraine. Now, Lupin's product has also seen similar takers. The services that the app provides cost around $2,500 to $20,000 to $20,000, depending on the duration one opts for. On average, people buy a three-month plan for about $10,000. Nearly 50,000 people have downloaded the app so far, and almost half of them have repurchased the subscription after using it for the initial three months or after their condition was managed.

But most pharma companies that are dealing in products like these can't sell them like they sell their regular drugs. The approach is completely different. More on that in the next segment. Now, over the years, pharma companies have realized that rolling out treatments for chronic conditions is more useful for people than for acute ailments like pain or infections. At least until a month ago,

pharma companies were focused on products that treat acute conditions. But there's been a gradual shift towards making products to treat non-communicable and chronic conditions like cardiovascular, diabetes and central nervous system related issues, which is where digital therapeutics, which often use drug-free treatments, come into play. even though there are takers for Dr. Reddy's products to treat irritable bowel syndrome, the company wants to keep its focus on neurology for now.

Meanwhile, Lupin is doubling up on its remote cardiac rehab product. You see, the big challenge for these pharma companies is figuring out how to get these products to the end users, consumers, people with chronic illnesses. Most of these companies have built their digital therapeutics businesses differently than their drug businesses. So in the case of Lupin, typically they partner up directly with either hospitals or insurers. This, they found, was a great way to showcase the benefits of the products on offer. And it also gives the company a direct channel to its end user. Now, tie-ups with insurance companies work out well for both parties. Because if digital therapeutics for patients means going off pills, for insurers,

it's a shot at shrinking the number of claims they receive. In the case of hospitals, the story is quite. different. Siddharas Siddharin, the chief executive of Lupin Digital Health, told Sudeyshna that typically hospitals purchase and include their products as part of their larger angioplasty care package. The incentive is not to lose out on the patient as a long-term value customer once the acute symptoms fade away. So, Lupin doesn't directly approach patients, it appeals to doctors and insurers first. Meanwhile, Dr. Redis has a different approach. It sells its products like Niravio directly through e-commerce marketplaces like Amazon and e-farmacies like Tata 1MG.

Now, beyond all of that, one of the upsides of digital therapeutics is the real-time data that both practitioners and pharma companies can look into. Stay tuned. Dr. Sharma from Bilaspur has prescribed Niravio to 160 of his patients and he now plans to do a study of his own based on the data these devices collected. He told Sudejana that the devices facilitate very very richly. reliable data collection. It's essentially an electronic headache diary and it gives Sharma some crucial information, data that generally patients miss out on during consultations. The diary is also

relevant to see the history of a new patient to understand their condition better and the care that they may need. From his data set, Sharma told the Ken that over 100 of his patients experienced up to a 50% reduction in the severity of migraine episodes and the number of headaches, all within a month of switching to the device. Now, for pharma companies, being early to the digital therapeutics race is a complete game changer. Mv Ramana, CEO of branded markets at Dr. Reddy's, told Svald, that it could translate to multi-fold gains in the next decade, which is probably why these companies are leaning

on local clinical trials to understand the efficacy of their products. Lupin, for instance, studied the patterns of 86 patients for a period of six months. and among them, the group that used life had significantly higher blood pressure control compared to the ones who didn't use the app. The company also found a significant improvement in the quality of life among life users. Now, the company is using the data to improve the product for higher efficiency. But what about people who aren't comfortable with apps and technology? Well, these companies are figuring out workarounds there too.

For instance, life's key features are integrated with water, as a complete replacement of the app. So this essentially means that one doesn't have to manually feed data from a prescription or a blood report. Instead, they just have to take a photo of the same on WhatsApp. So naturally, the next step for these companies would be to take this niche segment to other semi-regulated markets, at least once they figured out a better standard of care here in India. Now, what that means for people like Sunenny is a future of pain-free and pill-free vacations. Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform.

What you're listening to is just a small sample of our subscriber-only offerings. A full subscription unlocks daily long-form feature stories, newsletters and podcast extras. Head to the ken.com and click on the red subscribe button on the top of the website. Today's episode was hosted by Rahil Filippo's and edited by Rajiv Sien.