Influence in the pharma industry does not necessarily bear a human face: institutions—in fact, entire countries—can exert
the same impact. Sweden is a good example, where the pharmaceutical industry association, LIF, has a long record of working
closely with the government and other stakeholders to move the needle forward in changing the competitive dynamic, in a way
that forces the rest of the world to take notice.
Garbo gets it ...
On health system decentralization, regulatory convergence, drug detailing, promotion, patient information, the environment,
value-based pricing, and the pursuit of cost-effectiveness, the Nordics have been true innovators over the past decades, with
many ideas subsequently emerging as common practice in Europe and around the globe. A good example is the "professionalization"
of the sales force, where almost all companies in the region have adopted the Swedish model of relying on far smaller groups
with superior scientific credentials to execute a more structured relationship with clinicians. Executives who claimed this
approach might work in Sweden but not elsewhere are now eating their words, as the industry—at least in the mature markets—trims
down. And decades ago, Sweden organized and led efforts by the Nordic countries to harmonize drug registration and approval
rules that helped spur a much wider international effort that is now bearing fruit today.
Another useful precedent is the Swedish approach to patient information, where it has largely avoided the rhetoric and ideology
that has hampered progress in the rest of Europe in keeping up with the expanding accessibility of health information. In
1983, the industry, with support from the government, launched Patient-Fass, its printed directory of medicines. FASS began
to gather real momentum when it debuted online in 2001; www.fass.se is now the country's most popular health-related website,
with over 4 million unique visitors per month. Pharma companies provide their own product information for FASS, but only approved
information is featured. Elsewhere in the EU, where real direct-to-patient reform discussions have been effectively deadlocked,
the site is the envy of many. As Richard Bergstrom, LIF's Director-General from 2002 to 2009, tells Pharm Exec: "It is as close as you can get to direct-to-consumer advertising in Europe. But our argument is different than that—the important
thing for us as an industry is to help to make individual patients powerful. This was always central to our negotiating approach."
FASS is also home to Sweden's national database for classifying pharmaceuticals according to their environmental risks. Again,
this is an area where the country has taken the lead in raising expectations about the role of medicines. Stockholm established
a regional system of environmental classification for drugs, JanusInfo, in 2003. When it proved a local success, LIF cooperated
with the government to extend it nationally. The database now lists well over 1,000 substances, and all patients, prescribers,
and researchers can search for a drug's environmental impact 'rating' by logging on to fass.se. The concept has been extended
to the point that if a new medicine can establish that it will be manufactured, processed, and used with a minimal environmental
footprint, then its reimbursement status can be positively affected.