Best of Both Worlds

Can pharma deliver both patient value and shareholder value?



Patient-centricity has reshaped pharma. It is front and center in every company‘s mission statement, indeed, pretty much every statement, period. In spite of all the rhetoric, however, it would be stretching credulity to say that pharma has universally accepted the concept and is embedding ‘patient value’ in every part of its business.

Yet, focusing on patients has clear commercial imperatives; in fact, it has the potential to solve some of the most stubborn challenges facing pharma. Patient engagement can aid and speed trial recruitment, patient advocates can be supremely helpful with regulatory or HTA approval as well as HCP education, all of which have positive financial implications.

Yet, will pharma realize this potential or is patient-centricity destined to remain in the ‘nice to have’ camp? Is it possible to provide real value for both patients and shareholders? The answer is a confident ‘Yes’ for Andy Schmeltz, Senior VP, Patient & Health Impact, at Pfizer. “These two elements are not divergent, they’re fully aligned,” he says. “In fact, companies that can translate a patient-centric approach and patient value into shareholder value are the companies that will be successful.”

A DIFFERENT QUESTION?

The question needs to be reframed, says Julie Gerberding, Chief Patient Officer and Executive Vice President, Strategic Communications, Global Public Policy and Population Health, at Merck. “I don’t think it’s possible to deliver shareholder value without simultaneously delivering value to patients,” she says. “These two vectors are increasingly becoming parallel as we move into an environment where value of care – not so much the volume of care – is the determinant of success.”

Following the logic down its natural path, you reach an important question – what if patients want something that pharma is unable or unwilling to deliver, for example a different trial or endpoint? “I would argue that there might not be an initial saving in terms of study delivery, but you will deliver a medicine that is more meaningful at the end of the day,” says Guy Yeoman, Vice President, Patient Centricity, at AstraZeneca. “If patients are more likely to engage with the medicine, you are more likely to end up with a more successful medicine than if you hadn’t talked to patients at the beginning.”

The voice of the patient leads directly to commercial success in drug development, says Gerberding. “Maybe a better-designed study enrols patients faster, gets the answer quicker, gets the drug approved more readily,” she suggests. “All of these things are operating in an environment where efficiency means better business, better value to shareholders, where speeding outcomes and finding a product that better meets the patient needs not only benefits the company, obviously, but puts us in an environment where we’re much more likely to get that product used – and ultimately results in some commercial value as well.”

TANGIBLE RESULTS

Yeoman points to a lupus study in which patients were taken to an investigator site and asked for their thoughts; 24 recommendations were made, 16 of which were adopted into the study. “An hour was shaved off some of the visit duration for patients and over a million dollars of costs were stripped out as a direct result of a patient simulation – these are immediate and tangible results,” he says. “That study is now delivering in advance of its anticipated recruitment and delivery timelines, so there is clear value from that patient-engaging activity.” AZ’s development team has now mandated that patient insight must be incorporated before a protocol is finalized.

The issue of a drug’s value must be put into the mix as soon as possible, says Kate Knobil, Chief Medical Officer, Pharmaceuticals, at GSK. “How do you bring that value to life, even at earlier stages of development, so that you’re not getting to a registration endpoint and then wondering what to do with this medicine?” she asks. “You’re really bringing the patient insight, the physician insight, the needs of the healthcare systems and the payers in early so you have those questions early on. That creates a medicine which patients want, which healthcare systems want, and allows you to stop development if it doesn’t meet that expectation.” All of this should be of benefit to shareholders too.

Schmeltz highlights work Pfizer has been doing with the Parkinson’s and Michael J Fox Foundations. “We have relationships with them so that we’re thinking at a higher level about, ‘okay, what are the measurements you need?’,” he explains. “When you get into a specific program and you’re designing a specific study we can link up patients with our clinical leads that are designing the protocols, and kind of have them part of our protocol review process, so it’s not just a token.”

COMMERCIAL SENSE

Going beyond embedding the patient in drug development, Pfizer has made a conscious decision not to develop ‘me too’ drugs. “We can only be working on medicines that are either novel mechanisms, first in class, that offer a distinct benefit, or something that’s best in class, not with incremental advantages but things that are an order of magnitude differentiated,” says Schmeltz.

This approach benefits both patients and the business. “We don’t claim to have the silver bullet, we’re learning as we go, but we’re getting better.”

As the head of a business unit that brings together market access, HEOR, payer and market access organization and the strategy group, Schmeltz’s brief is to “provide meaningful value to patients” and to think about the company’s relationship with payers, providers and regulators. “It doesn’t have to be an antagonistic approach, where we’re pushing our commercial organization to generate demand and the system is set up to restrict access,” he says. The company has a ‘patients first’ aspiration, which he believes will deliver wins for the patient, healthcare systems, and, ultimately, for the company itself.

ECONOMIC NECESSITY

Producing medicines that deliver value to society – through superior outcomes or reducing overall costs – will become increasingly important in an outcomes-driven healthcare ecosystem, argues Schmeltz. In turn, it provides the rationale for companies to embrace the provision of value for patients as a means for creating value for shareholders. “At the end of the day, the major players are all for-profit entities and we have to operate in a way that makes sense given our scarce resources,” he says.

So, the message from these pharma companies is clear – that their increasing focus on patient value will improve their bottom lines, and not just in the short-term. “As we start embedding patient engagement practice, we will decrease the number of assumptions we make and get tangible evidence that will translate into a value equation,” says Yeoman. As Schmeltz puts it: “We don’t claim to have the silver bullet, we’re learning as we go, but we’re getting better.”


This article first appeared in Trends in Patient-Centricity. For more articles on patient engagement, and to download this publication for free, visit www.eyeforpharma.com/patient/trends


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