Three Pathways to Patient Centricity and Win-Win Stakeholder Outcomes
A round up of a panel discussion at Reuters Events: Pharma 2023, featuring insights from - GSK, Accord Healthcare, Boehringer Ingelheim, CSL Behring, and the Council of Europe
In the pharmaceutical industry, the stakes are always high and complexities run deep. However, as the healthcare industry looks ahead to 2024 there is growing pressure on all stakeholders to find innovative ways to navigate some of the challenges. At key challenge is what the 2022 World Health Organization (WHO) report has described as the “alarming stagnation” in the provision of universal healthcare.
Pharma holds a unique position that touches multiple aspects of healthcare, but as the panel discussed there are a myriad of commercial realities – from agreeing appropriate pricing and reimbursement measures; to delivering robust evidence from real-world data and meeting technology standards as R&D costs soar, and the regulatory rules are rewritten.
Yet in spite of these challenges, all panelists could agree on thing: that the patient is the most important stakeholder, and meeting patient needs their common goal. Setting the scene moderator Sally Chung, Vice President, Head of Market Access & Pricing Europe, GsK, all companies need “to grow together for the sake of human health”.
1. Engage early, educate and build true partnerships
If the industry is to harness innovation, drive true patient centricity and better human health outcomes, it will require partnership, stakeholder commitment and stronger engagement at all levels.
Lorenzo Mostasio, Senior Scientific Officer, at human rights organization Council of Europe, stressed that the patient must be the primary focus for regulators and companies in the pre-competitive stage. “When the product is ready to enter the market, it’s too late to ask for cooperation or dialog,” he said.
Johnny Bane, Head of Market Access, at global pharmaceutical company Accord Healthcare, agreed that “engaging really early” was the only route to improved patient outcomes, and elevating certain disease pathways and patient groups to a level where the regulator recognizes there is “an unmet need”. Even if regulatory interventions are sometimes flawed, Bane said it was incumbent on pharma companies to engage early and provide honest feedback.
According to Isabel Torres, VP, Global Head of Healthcare Affairs and Market Access at German headquartered Boehringer Ingelheim, patients given better information and greater control of their data were more engaged in clinical trials. She continued that it had also brought “medicines faster to the same patients”.
Lara Pippo, Head of Market Access & Government, Affairs, CSL Behring, which develops medicine for rare and serious diseases, called “culture of anticipation”. Her organization has worked with the Italian Institute for the Future and she said patient associations valued how expertise can help patients “imagine how their need will be covered by the new therapies”.
2. Move beyond pricing, communicate better, win trust
Mostasio was clear that when it comes to patient access to healthcare and medication, “no discrimination was acceptable”. However, while Covid-19 proved that widening the scale and scope of access is possible, the 2022 index of the Access to Medicine Foundation finds that “progress remains uneven across low-and middle-income countries (LMICs)”. But even in developed markets disparities exist. According to Bane, ten miles between two patients in the UK could equate to “a decrease in life expectancy of 10 to 12 years”.
Tackling healthcare inequities, stressed Bane, “is not about corporate social responsibility, it is about a win-win”. In other words, pharma would have to increase access to medicines while enlarging the patient pool, and it would need to demonstrate value internally and externally.
In resource-constrained emerging markets, Torres saw public-private partnerships as a route to resilient, sustainable markets. Without this, delivering even free drugs would be impossible, she said.
For Hippo, a move beyond pricing would require “communication and trust”. Helping clinicians, patients, and also payers, to “speak the same language” would be a first step. Improved capabilities to make the whole system more sustainable, was another factor “because we know resources are limited and it is not only a matter of drug cost or drug price,” she said. The removal of silos and a shift in mindset to viewing drugs as an investment rather than an expense would aid greater understanding.
Overall, Bane saw a “unique opportunity” for pharma to be “true partners” to payers and regulators and bring forth, not just interventions, but “value-added solutions that can support diagnostics and the whole pathway”.
3. Find ways to define and drive sustainable innovation
Real-world evidence can drive better patient outcomes but to understand the barriers to access requires more data about the specific problems, needs and possible solutions. In Italy, Hippo sees a “huge hole” in the capabilities to read, interpret and make strategic decisions from evidence. Furthermore if innovation is defined as “innovative therapies”, it goes hand-in-hand with uncertainty, and “if there is uncertainty, there is no investment”, she said.
For Monstrasio, an added complication is that the definition of innovation, varies between stakeholders, as do the priorities. The European Medicines Agency, for example, defines an innovative product as containing an active substance that has never been authorized. Therefore, its priority is on marketing authorization, quality assessments, efficacy and safety. Payers, on the other hand, have no fixed definition of innovation but require robust evidence and value-add in respect to other products. Meanwhile, patients define innovation as the extent to which it is relevant to their health needs.
As Torres highlighted, aligning on the meaning of innovation is not always possible because between regulators, payers and patients, “sometimes it's really not the same”.
On whether EU regulation on Healthcare Technology Assessment (HTAs) could improve equality across the region, Vane pointed to recent moves by the UK government. This year it awarded the Medicines and Healthcare Products Regulatory Agency (MHRA) £10 million to look at mutual recognition pathways as a way to increase access for patients. “There is something there where we can collaborate, where HTA's and regulators work together to increase those efficiencies,” he said.
A more aspirational view to partner with governments and shape tenders came from Chung who would like tender specifications to incorporate a sustainability score to show how medicines are manufactured, for example.
The panel agreed that pharma must demonstrate impact across the entire value chain. However, while the patient perspective has to be top of mind and the common ground for all stakeholders, Vane concluded, “we still need to be able to say, ‘what's in it for us’ to different stakeholders?”