Can you quantify whether good evidence increases access, particularly as the price point for new cancer treatments leads to
payer "sticker shock?"
Protopapas: Access in oncology today is a complex proposition. Though it is critical, evidence alone will not move market share. There
is an additional premium required in interpreting and explaining the evidence. Millennium has put significant resources into
recasting our sales force to make it an informative source of case-relevant information and expertise; physicians see our
reps because they need to or want to, not because they happen to have a free moment. As the accompanying table shows, every
year since the launch of Velcade in 2003 we have had important new data to share around the drug's indications and clinical
performance. We see this as an educational investment in market uptake. What good is a great medicine if the community lacks
any awareness of its merits?
And we have metrics to prove a return on that investment. Independent third party surveys put our reps at the top of the league
in obtaining access to practicing prescribers; that access is secured through the informative, accessible data we generate
around our products. Millennium actually scores better in building relationships with cancer specialists than rival pharma
players with more medicines to sell and a bigger name recognition in oncology.
Who is behind the trend toward raising the bar on data and evidence as a condition for approval – and reimbursement – of
oncology medicines? Is government driving the process or is your main concern what is happening on the private payer side?
Protopapas: The pressure to quantify value is coming from multiple fronts. Private and non-profit insurers, PBMs and managed care providers
are no longer complacent, third party participants in a system where costs are simply passed on to others. Patients are bearing
more of the direct cost of care, so they too expect an explicit connection between investment and outcome. As for government,
its influence around the value debate is variable; in Europe, public authorities play a dominant role as the basic underwriter
of health care services, while here in the US it is still an evolving player in a mixed public-private system. But we are
clearly heading in the European direction.
Millennium is prepared to work closely with any regulator or government that seeks to better understand the ways our medicines
create value for the health system. This commitment extends to cooperation at the very earliest stages of the drug approval
process, where we deliberately seek out the FDA and EMA, as well other agencies, for advice in the design of our trials. The
biology around cancer is novel and unprecedented, so quite often our scientists are designing protocols that have not been
done before. It's a matter of self-interest to do so, but nonetheless we are finding these interactions are very collaborative
and constructive. The contacts were instrumental in obtaining, in October 2012, European registration and subsequently local
reimbursement for Adcetris as indicated for one type of Hodgkin's lymphoma and refractory/relapsed anaplastic large-cell lymphoma [ALCL]. It's another
example where our investment in generating the right kinds of evidence really pays off.
What professional attributes do you look for in recruiting sales staff? Does science trump marketing?
Protopapas: Experience in the oncology area is what distinguishes our sales team. A very high percentage of them have been with the company
since the launch of Velcade 10 years ago. We want to avoid a culture that looks at selling as something driven by quarterly results, where sales staff
come and go too quickly to develop roots with the customer. In oncology, a strong ongoing relationship with physicians is
a competitive differentiator. Consistency in these relationships is the best way to deploy our human capital. We want to retain
people whose careers develop in tandem with our products.