Focus on the Patient and Everyone Wins

Pharma is fluent in the language of patient-centricity but through its Patients First commitment, Pfizer seeks to embed the concept in its operational model



The pharmaceutical industry has a window of opportunity to act on patient-centricity, says Andy Schmeltz, ‎Senior Vice President, Patient & Health Impact, at Pfizer.

“There are so many trends and dynamics in play right now, from rising healthcare costs to the huge opportunities to focus on real patient outcomes to the rise of patient empowerment anchored in the digital revolution,” he says. “Patients link together the interests of pharmaceutical companies, healthcare systems and society. If we can align around what’s best for the patients, everyone wins.”

The desire to bring about this change already exists, he says. “We are all in this business because we want to devote our lives and careers to making a tangible difference for society. Our medicines must deliver value to the patients that need them, to society and our healthcare systems, whether that’s superior outcomes or cost offsets to reduce the overall cost of healthcare. But we also have to operate in a way that makes business sense given our responsibility to shareholders.”

Pfizer’s solution is its Patients First commitment, says Schmeltz, a concept that streams through the company’s approach to research, development and commercialisation. “We have always been about the patients, but this is a redoubling of our commitment. I call it the triple win – to only pursue strategies and initiatives that are a win for patients, a win for healthcare system and society, and a win for companies, although the first win must always be for patients.”

For Schmeltz, new medicines that offer only incremental advantage are no longer acceptable. “It used to be the case that if you had a new molecule that was different from current treatment and met regulatory requirements, then you were in the game. That no longer works. We can only work on medicines with novel mechanisms, so first-in-class, and those that offer a distinct benefit, or best-in-class. We need medicines that are many orders of magnitude differentiated.”

He cites an example from Pfizer’s research work. “We’re very excited about the promise of gene therapy – taking diseases that are treated as chronic conditions today, such as haemophilia or muscular dystrophy, and being able to cure them with a single intervention. That’s transformative medicine and we want that to be the norm not the exception.”

Pfizer is taking the tough decisions to axe programs that do not meet these new criteria, he says. “In the past, pharma has invested heavily in categories with a lot of ‘me-too’ medicines, but that’s not the future and that’s not where we want to invest. As a result, six months ago we decided to discontinue our PCSK9 inhibitor, bococizumab, in phase III because we saw that bococizumab wouldn’t provide value to patients beyond what was already available on the market.”

Abandoning this tried-and-tested approach to drug development comes with some risk, admits Schmeltz. “When the science bubbles in one area, it bubbles for everyone not just a single company, also, just because you are a leader in phase I doesn’t mean your program will survive. However, we cannot wait for the risk and uncertainty to resolve as society is not going to pay for the fourth or fifth drug in a category. It’s not a good use of our capital so we must be disciplined and make the tough decisions early on. Pharma is a long lead-time business so only time will tell if this becomes the new standard for everyone but Pfizer is absolutely committed to it.”

In common with other companies, Pfizer also seeks to embed the patient in the drug development process. “It is essential that patients review protocols and to think about what data are being collected in a study and how it impacts them and their journey. We need to think more about endpoints that are meaningful to patients; these endpoints may not necessarily be the ones regulators or payers have top of mind but, in the long run, if you have evidence that’s relevant to the people with a disease, it will bode well for the future. Industry has done this well in some therapeutic areas, like HIV, but it’s critical that the patient voice is incorporated across all programs and early in the development,” he says.

Schmeltz cites Pfizer’s new medicine for atopic dermatitis, Eucrisa, which came from its 2016 acquisition of Anacor. “By talking to patients, we know that a debilitating aspect of eczema is itching, yet there’s no metric for ‘reduction in bother’ of itch or frequency. We didn’t get approved on this endpoint but we knew it would really resonate with patients and ultimately with payers, if we can show that we can reduce the bother of itch more than other therapies. We’re going through the process to validate the tools right now.”

Patient-centric approaches are becoming more commonplace in R&D but what about the commercial space? “Historically, this has been all about the healthcare professional and the field force, with all marketing initiatives aimed at the HCP, plus there has been DTC in the US. With the advent of digitalisation, we have opportunities to engage not only with the patient but with the patient’s network. For example, we have an initiative called the Quitter’s Circle in support of Chantix, our smoking cessation medicine, which allows a person to engage their social networks to provide support in their attempt to quit smoking. Putting the patient at the centre of our marketing is the future.”

Schmeltz heads a new group in Pfizer, Patient and Health Impact – a merging of market access, health economics and outcomes research, and the strategy group – which has a two-fold mandate. “Firstly, we want to elevate our capabilities and provide meaningful value to patients by linking together patient value with the value that society is looking for. But, the second part is about evolving the business model to stay ahead of the changing environment. Our vision is to align around common ground – the patient. At Pfizer, we’d love to get to the point where we are partnering with our stakeholders in new ways to to transform global health on patient at a time. To that end, we’re exploring new approaches, piloting and experimenting as a leader in this space to help address the challenges in our system.”


Andy Schmeltz will be a keynote speaker at eyeforpharma Philadelphia on 20 April.


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