Pharma's Moment To Shine
President of Lilly Bio-Medicines, Christi Shaw, shares her personal experience of the US Healthcare system and how it changed her perspective on pharma’s road ahead
If a loved one fell sick with a serious disease, would you be able to navigate the healthcare system on their behalf? Would you be confident of achieving the best outcomes?
For one senior pharma executive, this question hit home when caring for her sister, who suffers from acute Multiple Myeloma. Christi Shaw, SVP and President of Lilly Bio-Medicines, found the long and difficult experience laid bare woeful inadequacies – and fundamentally altered the way she considers her responsibilities in pharma.
“Given that I’ve been working in this industry for nearly 30 years, you’d think I’d have been able to navigate the system easily. But it was extremely tough. My sister had end-stage cancer and she couldn’t even get her medication every month. So I can’t even imagine what it is like for patients who don’t have that knowledge, or a caregiver,” says Shaw. “It has opened my eyes.”
The lack of coordination was a key issue. “If you’re at an academic institution, as my sister was, you might have ten different doctors visit in a single day. They all ask the same questions – and don’t talk to each other. So there is a risk that the patient gets the wrong information. This happened often – one time, she was told she needed surgery to place a rod in her arm; then two days later they said she just needed radiation – but then, when they actually did the PET scan, there was nothing wrong.
“This trauma and emotional torture that families go through is not unique. I’ve been through it with my father and now with my sister, and I hear it from everyone.”
Now, Shaw believes, it’s time for pharma to become part of the solution.
“When I joined the industry, I never imagined that part of our job would be to help patients to do this kind of thing. We thought we were only in the business of making innovative medicines, [but] we must now spend a lot of effort helping patients in this way,” she says.
“This comes with a lot of extra cost that you have to manage and justify for your shareholders, but in the complex environment we live in, we must do everything we can to ensure that patients who are prescribed our medicines get access to them as quickly as possible. And that often requires out-of-the-box thinking.”
This change reflects pharma’s wider role within a changing healthcare system, she says. “In supporting patients through the system, pharma companies are doing what insurance companies or doctors’ offices used to do in the past. But those organisations simply don’t have the time to handhold patients anymore.”
For Lilly Bio-Medicines, it’s not just about providing extra resource. The first step is to fully understand the true patient experience. “The ‘patient journey’ means very different things to different companies and in different disease states. A journey through cancer is mostly about getting a medicine that keeps you alive longer, but in a chronic disease in a specialty marketplace, for example with rheumatoid arthritis, the journey is very different. We used to focus on physician-patient interaction, but now we need to look at the entire journey.”
In this way, Shaw and her team are identifying key moments where they should focus their activities. “An example is our work on the migraine patient journey, where we have identified three important moments of truth,” she says of a disease area where Lilly now has treatments in development but has suffered two decades without any new medicines. “We know that many people with migraine think they just have a headache until it gets so severe they worry they might have a neurological problem. So they end up getting a brain scan and being prescribed all sorts of different medications, but the realization that it’s not just a headache; it’s a serious disease.”
Yet, for other patients, this realization is not taken seriously, as family members may not believe they have a disease; that it’s just a headache. “There’s a similar stigma to what we see with depression,” Shaw said.
Treatments are also not straightforward. “Patients often cycle through different medicines and many either fall off medication or accept that they have to lose parts of their lives – for example, they might not be able to work or be able to participate in their children’s birthday parties. One of our own employees would go down to a locker room and lie under a table for four hours when she had a migraine.”
Access all areas
Understanding the human experience is vital, yet it is not enough to ensure your drug reaches patients. “We’ve had some very big successes in defining moments of truth in the early stages of protocol development. However, there have also been some not-great situations where patients can’t get access to your medicine post-approval because we haven’t thought fully through the access and payer piece. We must walk in step with the outside world, not just the doctor and the patient, but the payer and the regulatory system, to ensure that when you’re designing the study from the outset, you have the data you need to provide the most help to the patient.“
While the patient journey is central to commercial activities and access, they have a role to play well before launch as well. “On the development side, our phase IIIb and IV trials are all focused on the moments of truth. For a new indication or disease state like migraine, these studies are aimed at helping patients – so we ask, ‘What real-world evidence do we need to generate to help these patients, and help their physicians to care for them?’ You have to build it into the protocols.”
Yet, she warns, there is a risk of trying to do too much in crucial registration studies. “Your first goal is to get approval on a safe and effective drug. If you get too complex, if get really good at real-world evidence and secondary endpoints, the packages you hand over to a regulatory system are bigger, broader and more complex. This isn’t necessarily rewarded as it can take much longer to achieve access.”
In the pursuit of improving patient outcomes, enlisting the help of other industries could be a viable solution. “As one example, I look at some of the things companies like Amazon are doing, and it makes you wonder whether we can work together to really reach an outcomes-based system, which I think is something we all want; to be judged on our merits. If a company like Amazon worked with a health system, if it brought its understanding of customer experience and data to bear, we could focus on outcomes and stop this finger-pointing about who is responsible for the increase in healthcare costs. Imagine a patient using Amazon to book a telemedicine doctor’s appointment, then getting their prescription mailed to them without leaving their homes. It’s a system people are used to using every day, but applying it to healthcare would revolutionize the way patients are treated – it would be magic!”
Christi Shaw will be elaborating on her experience at the eyeforpharma Barcelona 2018 event in March
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