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Latin America: The Growing Pains Of Patient-Centricity
US and European markets are steering the ship on patient-centricity. But where is Latin America in this space?
As we highlighted recently in our white paper, Patient-Centricity Works, while most companies agree patient-centricity should be part of their DNA, even the most advanced are only at the start of their journey in making that a reality. What does not seem to be at issue is health authorities’ openness to the concept. However, the white paper highlights that in Latin America there is some suspicion from payers and other stakeholders that patient-centricity is simply a neat means for pharma companies to demand more money for their products.
“One of the challenges for our region, in systems that are socialised, where one of the main stakeholders is the public sector, is what does ‘patient-
centricity’ mean?” says Antonio Arce, Regional Corporate Affairs & Communications Head for Novartis in Latin America and Canada. “When we compare health systems to the US or Europe it adds a layer of complexity.”
In LatAm, this means some authorities are actively wary of initiatives that seek to be ‘patient-centric’. Juan Carlos Trujillo de Hart, International Policy & Operations Director for FIFARMA (the Latin-American federation for the pharma industry), says there are governments in the region which believe patients are, in effect, simply parroting what pharma wants them to say. In other words, they feel as if the patient voice has been captured by pharma for the industry’s own ends.
Alessandra Durstine, Principal of Catalyst Consulting Group, works with governments, international organizations and NGOs on ways of better serving patients in LatAm – but warns there is a real need to tread carefully. “In these countries more than 50% of the population gets healthcare from the government,” she explains. “There is a tension between what pharma wants and what governments want to pay for. ‘Patient centricity’ is not a word you hear outside of pharma: you’d never use that word with a government official.”
According to Trujillo de Hart, there is a willingness on the part of pharma to embrace a more patient-centric approach. “But there are different degrees of implementation, regionally, locally and with different stakeholders,” he acknowledges. For Novartis, a move towards outcomes-based solutions underpins the company’s efforts going forward, says Arce. “The biggest challenge is how do we measure outcomes. We have identified that there are more stakeholders in the value chain, and a clear need to engage with public officials, doctors and patients as we are developing these therapies.”
Still, a large part of the problem comes back to perception, believes Durstine. “From an institutional perspective, there are many patient groups which receive more than 50% of their revenue from pharma – and governments use that against them when they advocate,” she explains. “Patient-centricity is about individual need: we should do everything we can to get that patient a treatment – but most governments don’t think that way because they have to make decisions about millions of people. Patient groups are good at advocating one on one, but governments are not patient-centric. They see ‘patient-centricity’ as a way of hijacking a macro budget for a micro problem.”
The LatAmregion faces specific challenges compared to other territories. “By definition, LatAm is still in a very non-patient centric mode,” comments Durstine. “Unlike in Europe, where in the HTA process there will be a patient voice, by and large that doesn’t exist. The doctor is still king: they prescribe what they want. We don’t have empowered patients in LatAm. The pharma industry is talking up patient centricity – but they are doing it in a void.”
Arce is sure there is an appetite for the industry to engage more to secure better outcomes. “Some countries and systems are trying to be more patient-centric, but it is just not happening fast enough,” he says. “It’s a cultural shift. The percentage of GDP that different countries dedicate to health varies – they are often dealing with basic challenges. Patient groups are trying to make an impact, but they are swimming against the current.”
While it is understood that scientific innovation has the potential to offer patients more options and better outcomes, payers may have competing demands on their coffers. “The pressures governments are under depend on their economies,” concludes Durstine. “If the oil price is low, Brazil and Venezuela are going to do something different on health. Governments do not have infinite amounts of money – so the last thing they want is empowered patients knocking down the door. But having said that, the horse has left the barn: we are definitely at the beginning of the process.”
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