What other key drivers of change can you identify from the time you entered the industry?
Gerianne DiPiano, FemmePharma Health Care: My area, women's health, is a reflection of changes that have dramatically altered the position of patients in relations with
providers. Social media platforms have empowered patients to make their own therapy choices. Nine out of 10 consumers access
information on the web before they see a primary care practitioner. Buying decisions are made every time a patient looks his
condition up on Wikipedia. Yet industry research indicates that half of the top 50 biopharmaceutical companies in the US lack
a strategy to address this change, such as through active involvement in these online community networks.
John Furey, Baxter Health Care: Based on my 20 years in the biopharma and vaccines business, I can point to three transformative changes. The first is the
shift in the science, from classic chemistry to biology. This has significant implications for the business, because when
you are managing a biologics enterprise, how you manufacture and supply the product is as critical as marketing and market
access. Securing the supply chain is a function that traditional managers did not need to focus on—you were just trained to
sell doses. The product turned up. Today, a more holistic approach is required. Knowledge of the process is vital.
The second big change is the necessity to think beyond the home market, to emerging markets and the globalization of most
functions in the biopharma enterprise. This change makes it all the more important to understand the patient, in all his/her
diversity. In fact, patients in emerging countries have embraced social media more proactively than in the US, largely because
there are few institutions to advance their view; many people feel disenfranchised from the health systems. New digital technologies
provide an outlet.
Despite the high profile being given to the patient, our industry has far to go to before we are truly "patient centric."
Market access is the hot field in big Pharma today because it reflects our adjustment to the ascendency of payers. Market
access is designed to give payers a front row seat in the design of our R&D pipelines. But shouldn't we first be asking what
is most important to patients? The huge financial bets on the next generation of biologics demand that we have a better understanding
of just how the patient will use the product. This is not a question that can be answered with a reimbursement strategy. You
have to dig deeper and determine the conditions under which a patient will use a drug: are there structural or institutional
hurdles to integration of the new medicine in the patient's system of care?
The third transformation is around the talent needed to succeed in a very complex business environment, where there is no
fixed blueprint for success. The road to the "c suite" is no longer one of starting out "carrying the bag" in sales, then
advancing to commercial operations and eventually leading a business segment. Rather, it's all about earning multiple assignments
in different aspects of the business, and in varied geographies. You want to be the person who can readily see how all these
activities are interconnected. There is a war underway for talent that has a fuller understanding of the business and the
capability to operate on the basis of a global point of view.
Each of these three drivers depends on the ability of the industry to stay innovative. Such an outcome is not guaranteed.
In the average big Pharma R&D budget, a significant portion of funding can be devoted to fixed costs and life cycle management
of existing products. It raises a serious issue of how much money is really available to fund the next wave of innovation.
Everyone is looking for novel, low-risk vehicles to generate investable ideas, such as in-house VC operations.
Helen Bourret, Amarin Biopharmaceuticals: My career has been entirely in sales. When I joined the industry 15 years ago, it was the land of good and plenty. Products
were approved, regularly and on time. The product was automatically covered and reimbursed; formulary listing was not an issue.
It was an environment uniquely suited for the blockbuster phenomenon. Today, we face an entirely different situation. Generics
are dominant in nearly every class, so by default we have had to become experts in formulary positioning and politics. Sales
and commercial teams must be conversant in dozens of managed care plans, most of which operate on the basis of strict prescribing
guidelines that accord generics status as first-line treatment. These plans define "new products" as anything up to 5 years
On the relationship side, which is critical to those engaged in selling anything, contacts with physicians and providers are
controlled to the point where, assuming you get access, the conversation has to be treated like a script. And when you have
the meeting, more than three quarters of all physicians will limit it to two or three minutes. What do you say in two minutes?
You can count the words; each one had better carry value. The strategy must be to identify the physician's incentives under
the benefit plans he or she works with. For example, if you can show how prescribing a therapy will raise the practice's patient
satisfaction score within that plan, then the physician will listen. And you have to build other contacts—with the nurses,
community health workers, and others who pull the patient's charts.
Basically, the sales professional today is seen as redundant. The challenge is to overcome that perception by showing physicians
how you can help them meet their obligations to the PBMs and payers. Being able to differentiate your product in a world of
"me too" medicines is equally vital.
Given the consensus that the business climate today is markedly tougher, can we cite instances where a change proved disruptive
to your commercial model? How did you respond and what was the outcome, in terms of shaping your own career?
Truitt: Prior to my current position, I was given responsibility to position an orphan drug for launch. What I quickly figured out
was that, for this launch, engaging the patient was going to dramatically influence the success of the launch. This was a
disruptive, eye-opening development, as it contrasted to my previous exposures on the commercial side. It took us awhile to
figure how to move the focus to the patient, but we succeeded. We put a product manager in place whose sole assignment was
to work with patient groups. We sought out patients in focus groups, listened how they wanted to receive therapy, and incorporated
their ideas in the contracts we negotiated with our specialty distribution partners. We actually served as a concierge in
a "high touch" approach to drug delivery.
I would summarize our learnings from the process as follows. Pay attention to the disease community. Show them that what you
have is clinically distinctive, advances the standard of care in a way that is tangible to the patient experience, and is
appropriately priced. Acting by example, prove that patient expectations identified through the trial phase will be incorporated