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Tom McKillop, CEO of AstraZeneca, faced the classic quandary of large pharmaceutical firms. The firm's patent for Prilosec (active ingredient omeprazole) was expiring. Severe cost-based competition from generic drug manufacturers was inevitable. Patent expirations were nothing new for the US$15.8 billion in revenues drug firm, but Prilosec was the firm's most successful drug franchise, with global sales of US$6.2 billion. How could the company innovate its way around the generic cost-based competition and avoid the drop in revenues associated with generic drug market entry? AstraZeneca had other follow-on drugs in the pipeline—namely Nexium, an improvement on the original Prilosec molecule. Additionally, the company had the opportunity to introduce its own version of generic omeprazole, hence becoming the first mover in the generic segment, and/or introduce an OTC version of omeprazole that might tap into other markets. Ideally, AstraZeneca would like to move brand-loyal Prilosec customers to Nexium. In this market, direct-to-consumer advertising has remarkable efficacy. Classical marketing challenges of pricing and promotion need to be resolved for the Nexium launch as well as possible product and place challenges for the generic or OTC opportunity. Which combination of marketing options will allow the firm to best sustain the value of the original omeprazole innovation?

The central objective of the case is to teach students how marketing variables can be used by first movers with diverse product portfolios to fend off severe price competition. These variables include pricing, promotion, product, and place (distribution) options as considered in the context of branded, generic, and OTC pharmaceutical market segments.

This case uses the concept of social entrepreneurship to analyze the entrepreneurial journey of Mr Suraj Prakash and his social enterprise, the Swasth Foundation. It further deepens our understanding of strategic decision-making by exploring the successful use of pivots.

The case was primarily developed through a series of interviews with the leadership team over a year. Secondary sources included literature about Swasth Foundation available on the internet and those shared by the founder.

In 2008, Suraj Prakash left McKinsey & Company after six and half years in the health and development sector as an engagement manager. Along with his friends, Aman Paul and Ankur Sharma, he established Swasth with the goal of building an ecosystem that delivered high-quality, affordable and accountable health services to low-income communities in India. Right from its inception, Swasth went through many fundamental shifts in terms of its business model, team composition and even the nature of its existence; however, this did not deter Suraj from pursuing his goal.

The case brings into focus the health-care system of India, especially in the context of the urban poor and the challenges they are facing, followed by the initiatives taken by Swasth Foundation and the impact it is trying to create. The remainder of the case delves into Suraj’s entrepreneurial journey and the three pivotal decisions that changed the course of his organization over 11 years. It will also provide a transpicuous view of the entrepreneurial decision-making process through the lens of pivoting. As Suraj and his team are trying to bring about the required changes through the third pivot, there remain some challenges that need to be addressed for a successful implementation.

The case is written for business management students and can be used in general management, entrepreneurship and strategy classes. The case can be used for discussions on leadership, social entrepreneurship and strategic decision-making. It is suited for both undergraduate and postgraduate levels.