本研究以台灣安進藥品有限公司於骨質疏鬆症藥品市場之產品組合策略為個案,探討在台灣健保主導且自費市場並存的制度環境下,企業如何透過 4C 策略行銷架構重構醫師與病人在治療決策過程中的交易成本,進而形成競爭優勢。骨質疏鬆症隨高齡化社會加速而成為重要公共衛生議題,其治療亦由傳統單一藥物選擇,逐步轉向風險分層、目標導向治療與序列治療模式,使藥品競爭從單品比較延伸至治療路徑與長期管理。
本研究採單一個案研究法,結合次級資料分析與半結構式訪談,訪談對象涵蓋產品經理、醫藥學術部人員、業務代表及臨床醫師,並以 C1 外顯單位效益成本、C2 資訊搜尋成本、C3 道德危機成本與 C4 專屬陷入成本作為分析架構。研究發現,在健保制度限制下,產品療效、安全性與便利性雖為處方決策基礎,但 C1 差異化空間受到給付條件與院內流程壓縮;相對地,醫師對臨床證據之理解、對安全性與治療後果之信任,以及病人對治療價值與支付負擔之接受,成為影響產品採用的關鍵。
個案公司透過 Evenity 與 Prolia 分別布局骨生成治療與抗骨質再吸收治療,形成跨治療階段之產品組合。Evenity 在臨床指引與風險分層觀念下常被定位於極高骨折風險患者之起始強化治療,但在台灣健保給付實務中亦受到較後線使用條件影響;Prolia 則主要對應後續維持治療、長期骨折風險控制與停藥後接續管理。個案公司並透過醫藥學術部之證據生成與轉譯、醫療專業人員之教育活動、臨床指引與專家共識之證據支持、產品經理之市場定位、業務代表之第一線互動與回饋,以及病人支持計畫、醫療院所內衛教、與大眾疾病衛教等作法逐步形成「臨床價值建立、證據與資訊轉譯、採用信任形成、治療路徑黏著」之成功機制。
本結論指出,骨質疏鬆症藥品之成功因素,應由企業能否系統性降低醫師與病人在決策過程中的交易成本加以理解。4C 架構應用於處方藥市場時,可從靜態成本分類延伸為動態交易成本重構工具,並為醫藥產業之產品組合策略、醫學事務定位、自費市場推動,以及健保實務下之治療路徑設計提供管理啟示。

This study examines the product portfolio strategy of Amgen Taiwan Ltd. in the osteoporosis pharmaceutical market. It explores how a firm reconstructs the transaction costs faced by physicians and patients during treatment decision-making through the 4C strategic marketing framework under Taiwan’s National Health Insurance-dominated system, where a self-pay market also exists. As population aging accelerates, osteoporosis has become an important public health issue. Its treatment has gradually shifted from traditional single-drug selection toward risk stratification, goal-directed treatment, and sequential therapy. As a result, pharmaceutical competition has extended from individual product comparison to treatment pathways and long-term disease management.
This study adopts a single-case study approach, combining secondary data analysis with semi-structured interviews. Interviewees include product managers, Medical Affairs personnel, sales representatives, and clinical physicians. The analysis is structured around four dimensions: C1, explicit unit benefit cost; C2, information search cost; C3, moral hazard cost; and C4, specific incurred cost. The findings indicate that, under the constraints of Taiwan’s reimbursement system, product efficacy, safety, and convenience remain the foundation of prescribing decisions; however, the room for C1 differentiation is compressed by reimbursement criteria and institutional processes. In contrast, physicians’ understanding of clinical evidence, their trust in product safety and treatment outcomes, and patients’ acceptance of treatment value and financial burden have become key factors influencing product adoption.
The case company builds a cross-stage osteoporosis treatment portfolio through Evenity and Prolia, which respectively represent bone-forming therapy and antiresorptive therapy. Under clinical guidelines and risk-stratified treatment concepts, Evenity is often positioned as an initial intensive treatment for patients at very high fracture risk, while its actual use in Taiwan is also shaped by later-line reimbursement requirements. Prolia mainly corresponds to subsequent maintenance therapy, long-term fracture risk control, and transition management after discontinuation. Through evidence generation and translation by Medical Affairs, healthcare professional education, evidence support for clinical guidelines and expert consensus, market positioning by product managers, frontline interaction and feedback by sales representatives, as well as patient support programs, in-hospital patient education, and public disease education, the company gradually develops a success mechanism consisting of clinical value establishment, evidence and information translation, adoption trust formation, and treatment pathway stickiness.
This study suggests that the success factors of osteoporosis drugs should be understood through a firm’s ability to systematically reduce the transaction costs faced by physicians and patients during treatment decision-making. When applied to prescription drug markets, the 4C framework can be extended from a static cost classification model to a dynamic tool for transaction cost reconstruction. The findings provide managerial implications for product portfolio strategy, the strategic role of Medical Affairs, self-pay market development, and treatment pathway design under Taiwan’s reimbursement environment.

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