Making the Right Match
Disruptive firm myTomorrows points way towards cheaper drugs and healthier patients.
Getting the right drug to the right person is a constant source of friction in pharma, whether for payers, manufacturers or, crucially, the patients themselves. In particular, those who suffer from life-threatening or debilitating diseases are often interested in drugs which are still in development – but getting access to these is fraught with difficulties.
Matching up patients in desperate need with the products which could help – but which are not yet on the market - is a headache for a variety of reasons. However, Amsterdam-based myTomorrows believes it may have the answer. It has developed an open database onto which pharma companies are encouraged to put relevant pipeline drugs, allowing physicians to see what is potentially available and making the whole process of accessing them more transparent and simpler for patients.
The company’s co-founder Ronald Brus explains the way the model is set up. “We have created a two-sided medical marketplace,” he begins. “Drug developers can put their products out there and doctors and patients who have exhausted other treatment options can see what programs are available – therefore facilitating early access to them. It is much more user-friendly.”
Around 30,000 users a month now visit the site, looking for uniform information on medical conditions, related clinical trials and expanded access programs. The search data itself - for instance on the rare diseases that people are looking at - is, of course, very valuable: among other things, the internet can be a giant patient sub-population/disease matching tool.
Put like this, myTomorrows sounds a little like a dating website – but the science and analytics behind it are complex, and there is also a deeply personal story at its heart. Brus had enjoyed a successful career in biotech as co-founder of Galapagos and CEO of Crucell. But then his father was diagnosed with lung cancer and Brus called on the contacts he had built up over decades in the industry to find out what new developments might be likely to make a difference.
“People were saying to me: ‘We have great data in Phase II’,” he recalls. “I tried to get those drugs.” However, even his specialized knowledge of what was possible – and the insider help he could call on – were no use against the grinding wheels of bureaucracy. In the eight months or so it took him to make headway, his father died. But Brus knew how fortunate he was to have been able to try: given that most people in a similar position would not know where to begin, he was determined that they should be given as much help as possible - and myTomorrows was born. “This is not going to happen to other sons and daughters,” he insists.
Red tape is one of the main problems at present. “For patients and doctors it’s an absolute nightmare,” says Brus. “It’s a very long journey to find out what kind of drug they might like to have.” Even after finding the relevant product, there is then no guarantee that the manufacturer will agree to release it. Authorities might be minded to approve limited use on compassionate grounds, but only if they can be convinced there is a good case for it – and there is no guarantee of that.
Brus suggests this could represent a great deal of wasted work for a physician trying to do the right thing for his or her patient. The point of MyTomorrows is to ensure that this effort is rewarded. It is often the case with drug development that information is scanty, so making the best of what is available is important – as is ensuring that the right information is presented in ways which can easily be absorbed. “We assist with requests to the relevant authorities, in a form that they understand,” says Brus.
Some doctors argue that patients in such pressing need will have the chance to participate in ongoing clinical trials. “But 97% of patients will never do that,” he goes on. “They don’t live close to the hospital, they don’t fit the criteria.” They may not, of course, even be on the same continent as the trial taking place.
“We get pharma interested in listing their drugs – we look at the data, the stage of development – but we don’t want to disappoint anyone,” Brus continues. “Maybe the drug is not a good fit for compassionate use.” This is a key point, since criteria for this differ from region to region – and these differences create roadblocks. “The ideas of compassionate use are shared by every country in the western world,” Brus says. “But the way it works is different in all 18 countries we operate in.”
To make things easier for its users, myTomorrows’ website takes these geographical differences into account – for instance, whether a particular authority will allow reference to a brand name, or chemical name, et cetera. “The computer does that for us,” he says.
But this does not iron out all the wrinkles. “Fifteen years ago, once a drug was approved it got reimbursed,” he says. This is not the case now. Some European and Latin American countries offer reimbursement as soon as a drug is allowed for compassionate use while other states “leave it more open – this can be more of a challenge”. “Not all of them have thought this through,” Brus continues. “It’s weird that countries don’t reimburse.”
Things are improving, he believes, citing the fact that no reimbursement was possible in the US from off-label use 5-10 years ago, whereas “today that’s entirely different”. “Great drugs were sometimes not used in the indication they were designed for,” he points out.
The tipping point for this is, he says, the fact that clear, compelling data can be collected, offering authorities an unanswerable case for funding. The tsunami of information created by the rise of Big Data – overwhelming to many in pharma – is a godsend for myTomorrows. “A drug is going to be reimbursed if the data supports it,” he says. “No insurance company pays for efficacy in a controlled study - they pay for real-world evidence.”
Data is, therefore, at the center of it all: Brus’ team looks, for example, at whether doctors are prescribing a drug and – perhaps more importantly - whether they are keen to prescribe it then to second or third patients. People are beginning to understand the importance of data analytics and aggregation far better than they did a decade ago, he thinks, and this is partly because of the sheer volume of information which is now available quickly and cheaply.
“Five years ago, no-one had data from 60,000 lung cancer patients,” he says. “It’s a new thing and benchmarking has become key.” Datasets can be compared, conclusions can be drawn, persuasive arguments can be presented.
If we continue to follow the historical route of the last ten years, drug prices will be outrageous. Also, solutions for cancer will not come because they will require combinations of overly-expensive drugs.
Although myTomorrows is not in the business of promoting drugs, its expert panel looks at key elements such as dose and mechanism of action in a product. This allows the company to assess whether the development drug could be a game-changer before allowing the product onto its site. “We also ask: ‘What’s the intended market price?’” Brus continues. This does not always elicit the most realistic answer: “Sometimes companies have weird ideas and we say ‘it’s not going to fly’.”
Not every pharma company is even capable of matching the demands which success would put upon it. “We always do due diligence to see whether smaller companies can produce commercial quantities,” Brus explains. “We look at facilities, quality and so on, and we may decide not to go ahead after that.”
But where myTomorrows does find matches, Brus believes that the ultimate end will be nothing less than to lower drug prices in future. He makes the point that a drug’s composition does not change for most of the decade or more that it takes to get to market: it is essentially the same product in year two as it is in year 11 – so why not allow patients to get the benefit early? “If we continue to follow the historical route of the last ten years, drug prices will be outrageous,” he suggests. “Also, solutions for cancer will not come because they will require combinations of overly-expensive drugs.”
Far better that patients get the benefit of products which would otherwise remain on a research bench for another few years – and, above all, a new approach will provide clarity. This is something that all of us, steeped in recent ideas of what customer experience should be, are coming to expect as a matter of course whether we are booking a hotel room, checking out flights – or finding a new drug which could make a massive difference to our health. “There isn’t a TripAdvisor for something where your quality of life – and your life – depends on it,” Brus says. “We try to help patients and physicians as much as possible.”
That being the case, myTomorrows could be seen as the Uber of pharma – the taxi firm was a disruptive entrant to a relatively fixed industry, finding a new way of giving customers what they want. You suspect that Brus would be happy to be thought of in that way and that his father would definitely approve.
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