Insights from Economist Pharma Summit - Finding New Directions

Pharma Summit, London. Here are some insights that are “sign posts” of Pharma 3.0 where the patient is in the middle, not the product and the focus is on delivering health outcomes to individuals at an economic benefit for health systems and society.

• GSK CFO, Simon Dingeman, observed that in emerging markets most medicines are paid for “out of pocket” by individuals. This reality has spurred a different business model by more closely integrating the Consumer, Pharmaceutical and Vaccines businesses to focus on ultimate customer.

• Bruno Strigini, Merck President of Europe/Canada — reflected on the demise and bankruptcy of Kodak and observed that in hindsight the trends were visible to all but changing a business model is exceedingly hard. This is quite analogous to the pharma industry where it has to move to delivering outcomes. For Merck this includes increasing innovative partnerships with non traditional players like food and IT companies and building solutions and services.

• Managing Director of GAVI, Nina Schwalbe, discussed that every two minutes a woman dies of cervical cancer but now, based on the system working together, there is a vaccine for this.

• Stephen Whitehead, CEO ABPI, and Bruno Strigini, Merck President Europe/Canada — Fascinating conversation about value and outcomes. Everyone agrees that today there is not a common definition of what is the optimal health outcome with payors, patients, doctors and pharma having different perspectives. All stake holders have a role in the measures to assess value. And this can include a range of interventions to innovations. For example, if a pill can be taken once a day instead of 4 times a day could increase patient adherence and is therefore a valuable intervention.

• Patrick Flochel, EY, observed that we are in the health business not the sick business. The HC system needs to put the patient in the middle. And the HC system will be shifting to health care everywhere - beyond the two pillars of the doctors office and hospital to the “the third place(s)” —wherever the patient/health care consumer is.

• Theresa Heggle, Shire: A shift from provider to payor with the patient at the center has helped Shire shift their focus to the needs and value to the patient. Working with rare and orphan diseases, Shire works closely with patient organizations and families, possibly a model for the future of “personalized” medicines. There are already 300-350 drugs for orphan disesases and over 7000 such diseases.

• John Pottage, ViiV: HIV is a good example of patient at the center model where patients literally took an activist part to become equal partners in innovation and regulatory process. Relationships, incentives, roles and responsibilities, data transparency etc were redefined. Now, ViiV is an example of a business model where the focused resources of two large companies contributed to a new company that is focused on just one disease with extensive partnerships and collaborations, from medicine to delivery with the patient at the center.

• Wendy White, Siren Interactive. Patients and caregivers with rare disorders are now frequently the primary drivers of diagnosis and treatments given their active use of internet and mobile technology to get educated. Their activity can be predictors for future innovations as innovation happens at the margins.

• Fascinating conversation about the value of transparency and data. For example everyone publishes what IS working in clinical trials but there is a wealth of insights in the data of what didn’t work but those data are not published in an easily accessible way.
  
  On Social media —notwithstanding the regulatory constraints using social media in interactions with doctors and patients, pharma companies are beginning to dip their toe in by listening. However, there are challenges —in part due to the quick response expectations that don’t leave time for appropriate reflection and educated deliberations. Building trust is key to the industry so missteps in social media would be a real setback for the industry.

• Discussion around the role of behavioral change in improving health http://ow.ly/8Y0z8

• Sir Andrew Dillon, Chair of NICE — the trend of value-based pricing will continue. This is a growing trend that will touch both developed and developing markets. Sir Andrew encourages pharma companies to not “run away” from the developed markets to find countries without this approach as there will eventually be a NICE-like agency in China and India etc. The future will have funders, providers, innovators and users working more closely together earlier and earlier in the process to come up with good decisions. There will always be tensions but they can be creative tensions that produce value for health systems and better outcomes for patients.

• Anders Ekbloom AZ - it was interesting to hear his perspective on what the innovators need from the payers:
  *reward value that medicines contribute to the overall cost of health
  *create trust by considering all the relevant data and being transparent in rules for decision making
  *insure rigor in how decisions are made to insure they reflect the needs of the population
  *justify decisions with clarity and give innovators opportunity to reflect and react
  *go faster as sometimes it takes payers up to a year after approval to agree on price but the IP clock is ticking
  
  In the end, innovators have a long lead time and are making big investments. The more harmonized, clear and transparent rules and decision making across boundaries are with respect to reimbursement, the greater the win for all.

• Reflections upon listening to Brian Griffin, CEO Medco International on Patient Data and how it will transform the Pharma Industry:
  
  Many of the health systems strategies around bending the cost curve through cutting prices has not been effective and the focus is turning to increased adherence which will be driven in part by better data —integrated, actionable and accessible to stakeholders, including investors.

Facts in Europe. — 50% of patients don’t take medicines. This is made up of 1/3  don’t fill their prescriptions; 1 in 10 stop taking their pills; 1/2 forget to finish regimen and 1/4 of all patients don’t take recommended dose. This costs pharma companies in Europe $125B and causes 200,000 premature deaths per year.

Focusing on real of use patient data and offering an integrated medication support package with a suite of adherence services can make a real difference and provide the base line improvements that support demonstration of value. These real use data will also provide key insights on patient behavior that will help build incentives and interventions to improve adherence and safety.

• Freda Lewis-Hall, Chief Medical Officer Pfizer and HBA 2011 Woman of the Year, spoke on The Future of Medicines - The Disruptive Innovators. As usual, Freda had compelling perspectives of the future from the patient perspective and the need to approach this with a sense of urgency. She made the point that disruptive innovation is only disruptive in hindsight. Pharma can’t lower performance or be all things to all people - ie better, faster, cheaper - given the imperative to move to targeted precision therapies. More important that we start asking disruptive questions like 1) how to best characterize diseases, and 2) how do we streamline the matching of therapies to disease to increase precision and 3) how do we create 21st century science by upgrading 1950’s funding.