How current barriers can affect prescriptions in precision medicine

	The value of precision medicine, which relies on identifying biomarkers to treat particular conditions, is clear. And its prevalence to treat disease-especially cancer-is only expected to grow. According to an October 2019 report by The Insight Partners, the global cancer biomarkers market could reach $31.2 million in 2027.

	Yet despite such a strong current, the biopharmaceutical industry faces a number of barriers along the pathway between biomarker testing and drug prescribing. These include how physicians order diagnostics, how samples are transported to the lab, how results are returned to healthcare professionals (HCPs), how doctors interpret reports, and regulatory and reimbursement issues surrounding the entire process.

	In these areas, something seems to be getting lost in the flow between laboratory professionals and physicians, and pharma would benefit from stepping in to offer support before the issues grow exponentially along with the field.

	Many precision drugs require tests called companion diagnostics. These differ from complementary diagnostics, which may not be required per the label but may be ordered by physicians at their discretion to use in therapeutic decision-making.

	When developing a drug that requires a companion diagnostic, development of the diagnostic should ideally be run in parallel, and the drug and test should be available at the same time. However, as many precision drugs are fast-tracked by regulators, these medicines are leaving diagnostics in their trail. When a test does not progress at the same pace, FDA has been approving the drug with post-marketing commitment, so as to not limit access to a life-changing drug.

	“I think we have to look at those situations and understand what is the risk-benefit of putting the drug out there and having it available to these patients,” says Jordan Clark, chief technical officer, Diaceutics, a diagnostics data analytics and implementation services provider for global pharmaceutical companies. “[Bayer cancer drug]Vitrakvi has a 91% response rate in pediatric cases. That’s a wonder drug. And delaying that by a year or two just because the test isn’t available, in my view, it’s probably not ethically right.”

	To ensure there was a diagnostic available for Vitrakvi, Loxo Oncology and Bayer supported using laboratory-developed tests (LDTs) and worked with big institutes and independent labs to make sure testing was available without an approved companion diagnostic.

	According to Diaceutics, almost 75% of oncology testing in the US is provided using such LDTs. These tests take the place of commercially developed, FDA-approved tests and, says Clark, are “perfectly fine” in the US under the Clinical Laboratory Improvement Amendments (CLIA) regulation framework.

But physicians often don’t realize substitutions are being made. When ordering a test where there is no approved diagnostic, it is the lab that generally decides which LDT to use. And a lack of education often leads clinicians to leave choices up to the labs.

	“What we find is the physicians just order a biomarker-so they’ll say, I want an EGFR test, or I want a PD-L1 test-they don’t specify a methodology or an FDA-approved test,” says Clark. “This can be confusing for physicians, particularly if you look at a Quest, LabCorp, or NeoGenomics test menu. They may have two or three different tests that cover the same biomarker. Physicians are not aware of the differences, and the advantages and the disadvantages between those. In many cases, the lab is not giving that information for them to make an informed decision. I wouldn’t purely put it at the physician’s feet; labs could be better there as well.”

	Without a requirement for FDA clearance, labs are free to develop their own tests, either alone or in partnership with pharma, which is creating market competition. “Now you’re a physician hearing from 10 different laboratories as to why you should use their assay over others,” says Jeff Ellis, co-founder and managing director of Crosstree Capital Partners. “I can’t imagine how challenging it is for physicians to keep up with the latest and greatest, because there’s constantly three new things coming out, which are the latest and greatest, arguably, so it’s a challenging landscape for physicians.”

	To address this confusion, pharma companies could reach out to physicians to keep them informed of current research that might prove insightful. They could also improve engagement through providing online diagnostic tools to assist in HCP decision-making.

	But it goes beyond educating the physician. As new biomarkers come to light, the importance of multidisciplinary teams should play a bigger role.

	“It’s fairly hard for one treating physician to keep up to date with all of the latest advances,” says Clark. “We really should be thinking about this as a team effort and having particular specialties [such as the oncologist, radiographer, and pathologist] involved in order to ensure those patients are tested in the most appropriate manner. There’s a really key role there for pathologists to educate.”

	Logistics can be another hurdle. Many of these specialized tests aren’t available locally, meaning samples oftentimes need to be transported. “As we look at some of our newer tests in precision medicine, particularly around liquid biopsy testing and gene therapy testing, those logistics can become more complicated,” says Clark. “We may have to get samples to a lab within four hours, or we may have to use specific tubes, or we may have to use ultra-cold temperature (dry ice) logistics. Those things make it more complicated than perhaps a routine tissue sample and EGFR-type of mutation testing.”

	Turnaround time of lab results is another area that could be improved. A delay in reading results could prolong a physician’s treatment decisions.

	“One of the biggest areas of patient leakage is the interpretation of the results and making sure that result is given to the physician at the right time,” says Clark. “Here, the clarity of reporting is very important-actionable reports that allow physicians to understand and interpret the result into a clinical and/or therapeutic decision. Making sure that they’re getting that at the right time is key.”

	For example, Clark points out that most acute myeloid leukemia patients will be treated within three days of their diagnosis. Glioblastoma patients however, who just had open brain surgery to remove a tumor, don’t need those biomarker test results for multiple weeks, until they recover before going on any systemic therapy. “So understanding the disease and the urgency is really important as well,” he says.

	Much of the sample input and data output falls on the laboratory, but there can be other gaps that cause problems, such as basic technology.

	“An important KPI for laboratories is the time between when the sample or order comes in-receiving-and when they report the result out-lab turnaround time,” says Clark. “But there is time on either side of that, that is not within the laboratory’s control, which is not measured very well. [For example,] in Europe, we actually see that 

fax machines are still being used for reporting, and that adds a day or two to when that result is available to when the physician actually sees it in front of them. If you don’t use a well-integrated [electronic medical record] system, then sometimes there can be delays in that reporting aspect of it.”

	Pharma should look to the laboratory as a valued communication conduit to physicians. “You can educate the laboratory around tests and around eligibility for therapy, which then can be used as an information channel from that laboratory to physicians,” says Clark. “We often talk about the physician-lab interface as an untapped communication channel, whereas if we educate the laboratory, they can disseminate that information at the right time when a physician is needing to make treatment decisions.”

	Pharma also could benefit from investing in education and training of physicians when it comes to understanding lab reports. Explaining how to interpret genetic information and then how to communicate its meaning to patients along with any treatment implications could improve the process.

	Though oftentimes genetic counselors are used for this role, the better informed HCPs are, the better they can work with patients to make life-changing decisions.

	“Last year, [a study by] Flatiron and Foundation Medicine said even when patients received the right test and they had the report in front of them, the physician still didn’t put them on a targeted therapy,” says Clark. “That was in lung cancer, and it ranged from around 60% to 70% in EGFR/ALK, but down at 33% for NCCN [National Comprehensive Cancer Network] biomarkers and therapies with lower prevalence. So even if you get everything right in that testing journey, your physician may still not give you a targeted therapy even though the guidelines support that. I think that talks a lot to the education needs of those oncologists.”

	Ellis believes that one of FDA’s biggest challenges is trying to regulate the diagnostics market.  “It’s a huge task for the FDA,” he says. “I think we’ll continue to see more progress toward definition for reasonable ways for diagnostic tests to get approval and benefit patients in the end, but I think we still have a good ways to go before

 there’s a structure in place that everyone feels comfortable with.”

	Ellis does think regulators have made significant strides in trying to adapt to the changing landscape. “Look at Foundation Medicine-owned by Roche-and their comprehensive genomic panel diagnostic test,” he says. “They worked with the FDA to expedite. The FDA set up a program wherein a company like that, if they make the requisite investment and develop a diagnostic test, they can have a pretty unique market position in the end. So the FDA are taking the right steps, but the landscape is changing so fast, and patient needs and innovation are advancing so quickly that it is hard for the FDA to keep up.”

	Issues around treatment reimbursement also exist. For example, some healthcare insurance plans may require a patient to undergo conventional chemotherapy before they can access a targeted therapy, even though the guidelines state that those patients should go on targeted therapies beforehand.

	“Sometimes, it’s not just the physician, but it’s the reimbursement systems around them and their practice within their institute or their managed care, where they have local guidelines to reduce costs, which actually might be inhibiting precision medicine,” says Clark.

	A recent study by Diaceutics uncovered a loss of 77,856 patients per year to therapy and a revenue loss of $8.3 million per year to pharma in the US. These losses amounted to an estimated 30% of the oncology patient market and more than $16 billion per year in the US alone.

	“Some pharmaceutical companies [still] have not fully embraced diagnostics,” contends Clark. “They still think of it as a barrier, which they really shouldn’t do, because it’s that important for the success of their drug. Diaceutics

 has shown that every dollar spent in your diagnostics strategy has a return of investment of around 30 times. It really is that gatekeeper to those patients, and it is as simple as if you have a targeted therapy and don’t get the test, you don’t get the therapy.”

	As precision medicine continues to explode, Ellis echoes the importance of further cohesion and alignment between pharma and diagnostics and medical laboratories. “The more lockstep pharma and diagnostics are there, the clearer the message will be to physicians in their decision-making and the hope it will benefit patients in the end,” he says.

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How current barriers along the roadway between biomarker testing and drug prescribing can affect decision-making for precision medicines.

Improving the Link from Lab to Physician

	While pharmaceutical marketers are well aware of the changes in engaging with younger physicians and healthcare professionals (HCPs), the saying “don’t throw the baby out with the bathwater”-probably a generationally relevant idiomatic expression-applies. While a brand team’s methods to reach HCPs should incorporate the tried and true, it should be experimenting with new ideas to engage with a younger audience.

	Market research firm InCrowd recently conducted a microsurvey to gain deeper insight into physicians’ online habits by age. According to Philip Moyer, InCrowd vice president of crowd operations, the study data, which is to be regarded as directional only (total n=123), is based on responses from:

		Primary care physicians (PCPs) and specialists in practice for fewer than 10 years, n=62

		PCPs and specialists in practice for more than 20 years, n=61

	For social media channels used for professional purposes, Doximity (63%), Facebook (49%), and LinkedIn (49%) are the top choices for all physicians surveyed. However, though both generations of respondents still use Doximity as a first choice, older physicians preferred LinkedIn over Facebook. Moyer noted that younger physicians use social media to crowdsource clinical questions, seek informal advice from peers, and learn from cases.

	And while social media is used for professional connections in these examples, the personal connections are ones that physicians are justly wary of. Moyer noted that HCPs prefer to communicate with patients in a limited capacity, and using social media or texting is very limited. “Examples of doctors doing that are few and far between. They have to be careful what they say online and they don’t want to be cast in a negative light,” says Moyer. “Though younger physicians may be online more, many don’t want to go beyond communicating directly through their CRM (customer relationship management). Part of this is about privacy and comfort. But it’s also about protecting their own time and limiting the way they are connected to work outside of office hours.”

	However, InCrowd did find that younger physicians generally embrace the use of new technology to communicate with patients more than their older counterparts do. For instance, younger HCPs are more comfortable pulling up an app or searching for information while in the room with a patient.

	In addition, older physicians are more likely to reach out to patients by phone, whereas younger doctors have higher comfort levels in using electronic medical records (EMRs) to communicate with patients and share articles or other resources.

	While the InCrowd survey did find that there was “a level of consciousness about not posting controversial opinions online,” there are anecdotal observations around social media that some are taking to those platforms to raise concerns.

	For example, Murray Aitken, executive director of IQVIA Institute, who reported the Institute’s findings on the oncology landscape to the 

 Editorial Advisory Board, said, “Oncologists are becoming more aware and more vocal as to whether all of these new drugs are really breakthrough even when the FDA tags them as breakthrough drugs. And if you follow Twitter, there is a very active debate among leading oncologists around the quality of the evidence, and that’s not something we saw too much of five years ago. So I think that scrutiny is worth watching.” While this is not controversial nor personal (except in that it is a person sharing their opinion), it is an area of social media use that may change in the future.

	But as for the use of social media outside of the personal purview, most believe pharma is hesitant, though many pharma companies do maintain corporate social media accounts, and on Twitter some promote progress on public health initiatives, innovation, and patient stories.

	The IQVIA Commercial Compliance division plans, on average, 130,000 HCP meetings and engagements per year. According to Frank Spender, its senior director, compliance services, and Staci Hutchinson, director, global client services, the use of social media for pharma to engage or communicate to physicians is still in its very early stages for a variety of reasons, mostly related to trust and the wariness factor.

	“Pharma wants trustworthy sources, and to be able to guide the conversation, which is difficult with social media,” says Spender.

	However, that concern doesn’t limit what the IQVIA team is experimenting with in other technologies to engage with the younger HCP. “We see a shift away from email and phone and a shift toward things that are quicker, as well as text,” says Hutchinson. “That is playing out in the type of events people are interested in. We see virtual and e-learning more popular with the younger HCPs, so high-tech solutions to be able to participate in e-learning is grabbing the attention of pharma.” For example, Hutchinson says holograms, which might seem far out there, is something drugmakers are exploring.

	Use of video is also transforming the younger HCP engagement. Hutchinson notes that events can shift from entirely live interactions, to possibly a blend of live studio broadcast with members available via video conferencing and viewed on a panel wall, or speaker trainings that are virtual with a video component.

	In a nutshell, Spender and Hutchinson agree that all the technologies that the public is exposed to in general life-exemplified by how far smartphone capabilities and video/audio conferencing has come in a very short time-are reflected when engaging the younger HCP. “We see that technology changes with engagement will be significantly different in the next two years,” says Hutchinson.

	As noted, there is a level of skepticism and trust among all parties involved with new technologies-be they digital or social media. Eli Phillips, Jr., vice president of insights and engagement, Cardinal Health, says that newer HCPs are still looking for guidance and mentorship in their practice and seek the expertise of those who have been around the block.

	“We think about how we put channels together for these new practitioners,” says Phillips. “And what that looks like is a mix of podcasts, webcasts, and on-demand recordings with KOLs (key opinion leaders) that the younger HCPs can easily access and use as a trusted source.” Phillips notes that KOLs have adapted to the use of digital technology and social media because they recognize that is where the world is going and continue to take leadership roles in these mediums as well.

	The InCrowd survey did find, however, that both older and younger physicians see KOLs as having diluted clout in the current environment of readily available information, and shared these sentiments on reasons why KOL impact seems diminished:

		Access to information has changed the “authority” of KOLs.

		It’s easier today than ever to get a broad range of information.

		It’s harder for any single voice to break through the noise.

		It’s more difficult to tell today who are the actual KOLs.

		Some feel that KOLs are less experts and more pharmaceutical spokespeople than they used to be-perhaps related to wider societal distrust of institutions.

	Moyer did say that the role of the KOL will always be important, because their interpretations can help filter out the noise and best translate data. Another factor is that most information online still comes from KOLs and leaders at academic institutions-it just doesn’t feel so closely attached to a KOL when the HCP is reading the source online rather than hearing that person speak from the lectern at a conference.

	Another generational finding from the InCrowd survey was that older physicians pride themselves on still reading physical books and physical journals. If they see an interesting summary or comment on an article online, they are more likely to read the primary literature rather than be “spoon-fed” high-level summaries. In that regard, they felt that residents and students know their way around online apps, but they also can tend to latch onto the first answer that catches their eye rather than spending time developing a broader perspective.

	Phillips believes that more novice practitioners do have a propensity to not want to read journals or articles at that stage of their careers.

	“New practitioners have just spent all their time on education and learning, and now they want to focus on patient care,” explains Phillips. “So it’s not engaging for them to go back to print and read a journal article. They want easy online access…maybe clinical decision tools, algorithms…and they really want to be with patients.”

’s Editor-in-Chief. She can be reached at 

Amid the growth but still-cautious embrace of social media and other digital marketing channels, appealing to the younger physician requires a nuanced approach-mixing proven expertise with fresh ideas.

Engaging the New HCP in the Digital World

Pharm Exec speaks with veteran industry leader Jay Galeota, currently president and CEO of Inheris Biopharma, Inc., who shares perspectives from a diverse, off-the-beaten-path journey-one driven today by his mission to align pharma’s risk-taking approach across the entire drug life cycle

	When Jay Galeota entered the pharma industry through the doors of Merck & Co. in 1988, he questioned whether he belonged with this group of smart, over-achieving co-workers at then the world’s Most Admired Company, which was changing the practice of medicine globally and improving people’s lives. But Galeota felt blessed to be a part of Merck and surrounded by intellectual, quality individuals trying to do the right thing. This formed the basis for his career path and foundation for how he viewed what pharmaceutical companies and their leaders should aspire to be.

	Galeota wasn’t so far out of his element, though he might have felt that way at the time. Clearly, Merck saw something in Galeota beyond his biology degree and four-year Air Force ROTC training, which in a world of best-laid plans, would have landed him a pilot seat in an F-16. An eyesight issue instead led Galeota down the road into a seat in the C-suite.

	Galeota had heard it was harder to get into Merck than Harvard Business School, and he felt fortunate to come into the pharmaceutical industry when it was in its prime. Galeota describes a hallway at Merck’s research laboratory headquarters in Rahway, NJ, where the molecular structures of many of the world’s greatest medicines that came out of Merck’s lab through the 1940s, ’50’s, ’60’s, to today, hang above the hall.

	He says, “I had the opportunity frequently to walk down that hallway and each time I did I was struck, really awestruck, by the magnitude of these medicines that had such dramatic impact on the health and wellness of humankind worldwide, and grateful that I had the good fortune of helping to bring many of these life-changing 

	And for 28-odd years, Galeota worked his way up at Merck, not in a step-wise fashion, but in roles that allowed him to step out of his comfort zone. “I’m most effective when I’m learning,” he says. “I find that when I’m comfortable, I’m not learning as much as when I’m uncomfortable. I was fortunate to take some off-the-beaten-path assignments that, traditionally, people would have viewed as risky, but in my mind, they were opportunities to trailblaze and try new things.”

	With each role-from entry-level sales representative to President of G&W Laboratories and, today, President and CEO of Inheris Biopharma, Inc.-a new perspective, an insight, an intriguing observation came to shape Galeota’s vision for what constitutes the best-of-the-best of pharma and its teams.

	The following are some highlights of Galeota’s roles and perspectives, sampled from his full professional pedigree.

		A sales rep at Merck, where “carrying the bag” gave Galeota an understanding of how healthcare is delivered, which is locally, in geographic communities. This has been and remains the case, not just in the US, but globally. How the pieces fit together and where the goals and objectives of the involved stakeholders are aligned, as well as conflicted, is an experience Galeota applied to his broader roles at Merck. He says that made him more effective at recognizing opportunities to positively influence care delivery and more mindful of how medicines were brought into various healthcare paradigms.

		 In his multiple roles in primary care, including Executive Director, Atherosclerosis Franchise, and Senior Vice President and General Manager, Diabetes and Obesity Franchise, Global Human Health, Galeota learned about many different primary care therapeutic areas, and, again, how they affect the way medicine is practiced on the ground, and how Merck could impact patients’ lives on a large scale.

		As Integration Leader, Global Human Health, Galeota led the integration of the pharmaceutical and vaccine businesses when Merck and Schering-Plough merged in 2009. This was another assignment where Galeota went out of his comfort zone, and learned a lot in the process. Leaving the highly successful diabetes group, Galeota thought he lacked experience to lead an integration of this scale, but the results proved he had the instincts and requirements to be successful.

		Senior Vice President, Strategy and Business Development, Global Human Health, tasked Galeota with building two new functions and new capabilities within the commercial part of the now much larger post-merger Merck. He again became a student, learning the disciplines of business development and strategy in the process of creating the new organization.

		As Merck President, Hospital and Specialty Care, Global Human Health, a large business line that comprised 27 different products in seven therapeutic areas, which were all new to Galeota, the role gave him another significant opportunity to learn and work through improving the business through hard decisions.

		Chief Strategy and Business Development Officer and President, Emerging Businesses, was Galeota’s last role at Merck, and brought corporate-wide responsibility for strategy and business development, along with leadership of multiple new business and Merck’s corporate venture fund. This positioned Galeota for his next move to President of G&W Laboratories, a 100-year-old, family-owned specialty generics company.

	After 28 years at Merck, Galeota thought he knew a lot about the pharma industry. But, again, he found

 himself with a tremendous learning opportunity. “The majority of the pharma industry in the US is not innovative pharma, it’s generics; that is a very different business model,” he says. “It’s a complex and really difficult one. The chance to lead at G&W was a great opportunity from which I gained a lot of insights to carry forward and inspired a commitment to ensuring affordable access to medicines for those who need them.”

	Galeota’s business decisions and professional trajectory were never far removed from his foundational view of science, and the hallway of innovation at Merck. “I feel passionate about the value of the pharmaceutical industry to humankind,” he says. “I feel like every discovery that these brilliant scientists have gifted us with are really gifts to humanity that must be guided in ways that ensure their full potential to improve human health is realized.”

	Achieving this, Galeota believes, is the industry’s obligation. “The role of a responsible, innovative pharmaceutical company is to do just that-to be the guardian of these jewels, these gifts, not act as the owners of them,” he says. “And that is an important distinction because there are, rightfully, many stakeholders with legitimate, relevant interests in how these special innovations are applied to society.”

	To carry that philosophy then into the role of the C-suite executive, believes Galeota, is to ensure that when those meaningful opportunities to improve human life appear, the executive does everything possible to bring them to patients. And do so in ways that ultimately convey the maximum benefit to humankind, while reflecting the true value of the therapy.

	Galeota acknowledges that he came into the pharma industry in its golden age, shaped by a time when its new medicines and vaccines were quite literally changing the way medicine was practiced and impacting

 millions of lives in positive ways. He believes that pharma is on the cusp of another wave of meaningful advance and that, with the right kind of leadership, the industry can experience a resurgence in image that more accurately reflects the positive impact it has on humankind. However, Galeota observes, “In many ways, I think some companies lost their way, and some of that belief in the purpose of our industry and the value it brings to the world got clouded by other considerations.”

	If executives stick to a compass that comes from doing the right thing for patients and stakeholders-and keeps that focus front and center to the business-then the profits will come, Galeota contends. “And the profits will come in abundance if it’s done the right way,” he says. “It’s a formula that is often taken for granted or even shortcutted in our industry, and it’s a disservice to the industry when that happens.”

	One could view Galeota as a risk-taker. Who else would knowingly get into a 49.3’ x 16.7’ fighter plane, with speeds capable of 1,500 mph, fly a straight vertical up 18,000 feet in the air, roll upside down, and then skim the surface of South Jersey at 600 mph, 500 feet above the ground? Sounds like a risk-taker; Galeota, however, says no. “I think of myself as somebody that imagines the possibility of things, but I am also very thoughtful about analytics and assessment and trying to understand the plausibility and probability of things.”

	The willingness to think originally and experiment in new environments does not necessarily equate with risk in Galeota’s mind.

	“Investing heavily in intelligence, and I don’t mean the kind that’s between your ears, provides one with unique insights that frequently lead to unfair advantage when a new trail is being blazed,” he says. “The ability to accurately sense and assess probabilities helps minimize the riskiness of being out of one’s traditional comfort zone. Using the fighter plane metaphor, accurate radar, sensors, and intelligence are as important as creative agility in the art of surprise and outmaneuver in combat. The three Ps-possibility, plausibility, and probabilit 

-are components of balance that I try to always bring to bear on decisions.”

	That balance in Galeota’s own approach to risk is not one he sees operating at innovative pharma companies.

	“At the industry level-and this has always intrigued me-is the existing dichotomy in pharma where we take enormous risk and make extraordinary investments over multiple years, on sometimes very little data, and organizations, within this industry, we are comfortable accepting this risk,” he says. “Yet, when it comes to things like business models, go-to-market strategies, pricing approaches, supply and distribution, and policy issues, we are traditionally very conservative, unwilling to experiment and unwilling to take chances, by and large. I think that’s why we are in the same paradigm that we have been in for decades with respect to those functions of the business.”

	To take that unbalance, the extraordinary appetite for risk on the research, discovery, and development side, and apply the same desire for innovation in commercial, manufacturing, and go-to market models to more effectively get medicines to the people who need them, is something Galeota would like to change. It’s one ideal that he and his team at Inheris Biopharma were heavily committed to when the company was formed.

	The composition of a pharma company is its people, and they are, ideally, as Galeota first noted in the 90s, smart, achieving, professional, concerned, and ethical. In those early days at Merck, Galeota never feared that others had ulterior motives; he trusted his co-workers to have his back. Again, a moment in time that shaped Galeota’s views early on for the types of people he preferred to work with, and as he moved up the ranks, the people he preferred to manage and develop and choose for his teams.

	“I look for people who start a sentence with ‘what if…,’ are positive and resilient, tell it like it is, have diversity of perspective and experience, but an absolute commonality around ethics and ethos, and who also enjoy the journey,” explains Galeota.

	Being very careful around fit is an important attribute that executives and team leaders need to be cognizant of, he adds. “I heard years ago, and it’s stuck with me, that in the end, leaders are remembered for three things: who they hire, who they fire, and who they promote,” says Galeota. “It might be a trite statement, but there’s a lot of truth in it because it is what leads to extraordinarily high-performing teams. They are rare, but when we see them, they all tend to have similar characteristics, and it’s always around not only the skills, but also the chemistry of the people involved. Superior skills are expected, it’s the price of admission, but the chemistry-how individuals work together-is the spark that differentiates extraordinary from simply above average.”

	There is also the secret sauce from “super teams,” and Galeota says he has been fortunate to have been on a number of them. The team Galeota led that brought Januvia and Janumet to market, and ushered Merck into the diabetes space, he attributes to the experience of people with different expertise-clinical, regulatory, early development, marketing, legal, and manufacturing-that came together and aligned on a common purpose and succeeded beyond expectations. “That’s the measure of a super team,” says Galeota. “When you’ve exceeded what others or even you thought was possible for yourself as an individual and the team as a group, that’s magic.”

	This dynamic also played out in the integration of Merck and Schering, according to Galeota. “It was the result of this super team-the chemistry, the magic that excited us all about what we were doing, and the prospects of the unique opportunity that we had,” he says. Galeota adds that good leaders should look for that chemistry when gathering a team around a table. Is the dynamic just mechanistic, or is there a spark or reaction among members that could result in something that is greater than the sum of the parts?

	Another super team Galeota was involved in was Merck’s Hospital and Specialty Care leadership team. When first formed, it needed to understand which of those seven businesses the company could win in, which they could improve upon, and which they may have lost competitive advantage in. “We had to fundamentally reshape the business in a way that enhanced growth, but it meant exiting some businesses that were led by members of our leadership team,” says Galeota.

	But in doing so, those leaders stuck to what was right for the team and the enterprise. Galeota says each one, ultimately, ended up in better positions afterwards because they were focused on doing the right thing for the business and doing it the right way-and other leaders wanted people like that on their teams.

	“For leaders, there is a fine line between belief in a path to success that others don’t see and ... folly. There can be a pet project, a view, an opinion that someone just won’t let go of,” says Galeota. “And the leader has to make the call to address that. Frequently, that is something a lot of leaders shy away from and, as a result, teams get stuck in mediocrity for too long.”

	Mediocrity of individuals or teams can also lurk in another fine line between constructive vs. destructive discourse, says Galeota. While he’s a big believer that diversity of experience and the ability to voice an alternative opinion is a positive, with the best leaders instinctively seeking this out among their teams, sometimes discourse can drift to the negative.

	“In those circumstances, you have to identify it and then work with the individual or individuals who are bringing the team down,” says Galeota. “And if they aren’t able to be coached into a contributory role, then in my experience, you have to make some changes.”

	He adds of those decisions: “A lot of times it should happen sooner than it does. Many times teams linger at suboptimal composition because leaders are hesitant to make the change, and, frequently, I’ve seen once the change is made, the level of the team’s performance is remarkably impacted almost always to the positive.”

	Reinforcing again the importance of balance, it is Galeota’s belief that the people who maintain that approach make the strongest leaders, and having balance in life and drawing on diverse experiences outside of work helps bring broader thinking to their business. For example, volunteering frequently brings fresh perspectives to individuals, as well as benefit to society. Just as appropriate work and life balance usually enables people to make more natural, creative, and considerate choices. While a 70-plus hour work week, for instance, is often equated with the road to professional success, Galeota disagrees.

	“We all work hard, but balanced, thoughtful, diverse thinking is what separates the good from the great, and that’s frequently enhanced by balance in life, not how much time you spend in the office,” he says.

	Galeota believes this balance-time for volunteering, time with family, time for activities that provide personal fulfillment-must be modeled from the top, or it just becomes rhetoric. The employees won’t trust that it is a principled and desired behavior, unless their leaders walk the talk themselves, and model the way.

	Honoring science. Believing pharma can operate both dutifully and profitably. Leading super teams and shaping employees. Innovation in all aspects of the business, not only the labs. Trust and balance. These are many of Galeota’s beliefs that have come together over decades of varied experiences. He saw a chance to build a new company reflective of these beliefs when Inheris was formed as a CNS-focused spin-out from Nektar Therapeutics last year.

	“What swayed me the most to take this on was the quality of the people I met at Nektar,” says Galeota. “I was impressed with their leadership and science focus from the start, along with their clear desire to do things the right way. It seemed like an ideal fit.”

	Galeota is optimistic about the future of pharma and the role that principled leadership will play in its continued impact on the world. But the challenge is great. The industry’s reputation has never been worse, he contends, which is disheartening for those who are dedicated to improving the quality of human life. Something is fundamentally wrong when an industry exists for the good of others, yet is viewed so poorly.

	“The opportunity to innovate has never been greater, and innovation now moves beyond the discovery at the bench to how that brilliance is applied in practice in ways that maximize the potential benefit conveyed to people who are suffering,” says Galeota. “The creativity we each bring, and enable in others, matched with thoughtful assessment and analysis, will undoubtedly enable a new golden age of pharma if we focus on doing the right things the right way.”

Veteran pharma leader Jay Galeota shares learnings and perspectives from an off-the-beaten-path career rise-one driven today by a mission to align the industry’s risk-taking approach across the entire drug life cycle.

Jay Galeota: A Better Way to Pharma

The advent of data analytics in pharma marketing automation

	In marketing to physicians, the days of “spray and pray” are, if not totally behind us, then definitely numbered. The spray and pray approach saw marketers complete their market research, create the message they wanted to send, and then fire out an email to everyone on their list, with no attempt to personalize the messages. The uptake of artificial intelligence (AI), however, in targeting and personalizing messages has been changing this practice. Now, when marketers send out an email, says Pratap Khedkar, managing principal, ZS Associates, “they can actually tell who opened it, when they opened it, whether they clicked through to the second page or click on any of the links.” Accordingly, the ability to use these data and insights to understand what customers need, what kinds of information they want, and how they want to consume is driving a marked improvement in the way pharma engages with physicians.

	For James Anderson, chief customer officer at Aktana, a company providing AI-enabled decision support for the global life sciences industry, “the growth in this area has been insane.” Aktana’s biggest challenge, he says, “is keeping up with the increase in customers we have.” While the use of AI in marketing is not a new concept, what has changed over the last couple of years, explains Paul Shawah, senior VP of commercial strategy at Veeva, is the ability “to bring data together from multiple different sources and in a way that’s ready for AI to generate insights and guidance on messaging for specific customers.” Anderson agrees: “Ten years or so ago, pharma companies were starting to get their data warehouses together. Now the 

large companies, especially, have a lot of data that is ready to use. Combine that with the advances in AI, analytics, our ability to compute things quickly, and that leads to the big rush we’re seeing now.”

	For Khedkar, harmonizing the way the marketing channels are managed has become a crucial factor. “The job of sending these things out channel by channel used to be outsourced. You had an email vendor-all the emails got sent to them along with the target list and they managed it.” But with another party dealing with, say, iPhone alerts and another dealing with the reps, there were two or three other channels being managed independently.

	“Companies have realized that you have to harmonize, which means one entity has to be in control of all these different channels to the same doctor,” says Khedkar. This is where AI is beginning to help, he adds. “The technology has given pharma back the control of how it can actually modulate when different channels get used, and in what order they get used with the same doctor. You cannot harmonize manually, because you don’t know what type of cadence, what type of timing, what type of sequences actually work with this particular HCP-that’s all data driven.”

	With healthcare practitioners increasingly composed of millennials-for whom digital technology has long been not just a tool of work but, in many respects, a way of life-it should perhaps follow that the new developments in messaging are met with more active engagement by the younger generation than the baby boomers of old.

	Khedkar has found, however, that “it’s much more about how many years the physician has been in practice, rather than the physician’s age.” Anderson adds, “I know physicians who are older and more tech savvy than me; I know younger physicians who aren’t as tech savvy. It all comes back to the individual preference. And we’re getting to the point where you don’t have to use proxies like age to figure those things out.”

	A more digitally savvy audience is by no means an “easier” one, however. According to Krishna Kadiyala, vice president, head of commercial operations and innovation at therapeutic antibody company MorphoSys, “customers have raised expectations in terms of how they consume and how they disseminate knowledge.” The explosion of digital and social media channels, he says, is forcing companies to redefine their engagement strategies and shaping how they can be better partners to their customers.

	Khedkar has observed variances in specialty more than in the ages of healthcare professionals (HCPs). “For example, rheumatologists and dermatologists remain very accessible to sales reps,” he says. “On the flip side, oncologists are much less accessible. They are much more likely to open emails and much less inclined to talk to sales reps.” Khedkar notes that dermatologists are still “very open to talking to sales reps, but their email open rate is only around 4.9%.” He adds: “AI and data has to be able to exploit all this information.”

	Sales reps may be relieved to hear that certain specialty physicians still very much value their physical presence. Indeed, in the face of increasingly sophisticated automated marketing, reports of the sales rep’s death have been greatly exaggerated. Large pharma is getting more comfortable with the idea that this technology is helping to make the rep more effective, says Khedkar.

	While sales rep numbers have dropped compared with a decade ago, he doesn’t see any further major disruption to the numbers. “The access situation has stabilized, and the number of reps now is about 70,000,” explains Khedkar. “The peak used to be about 103,000, so it has come down a lot. I don’t think the numbers will continue to drop-the 60,000–70,000 is here to stay.” But with AI’s mark on the sales and medical field teams  proving to be an indelible one, the rep role will have to evolve. “Not by leaps and bounds,” Khedkar goes on. “Maybe 20% to 30% of the reps will not be able to do their job all that well. But I think the majority of them will have to adopt this technology so they can use it as an additional arrow in their quiver.”

	Indeed, at the heart of the pharma–physician relationship, the rep’s role will remain vital. Khedkar points to a statistic about emails sent to doctors. If the email is forwarded to a doctor by a rep-with the rep’s email address and signature-instead of a third party, the doctor is six times more likely to open it.

	For Shawah, AI is having two big, positive effects on the sales role. One is the “reinforcing of good

 behaviors.” He explains, “The AI initiatives that have sprung up over the last four to five years have generally coincided with field teams having access to more digital ways of engaging with their customers, like remote meetings. Before that, most field personnel did not engage with their customers digitally. AI has reinforced the use of these new channels and when to use them, how to use them, and how they become part of their customer engagement process.”

	The second impact is where AI surfaces insights that the customer account team “would never have known,” says Shawah. As an example, “a key account manager may not be aware of something that has happened with their customer, or even the patient; perhaps they get an alert that patients associated with a particular specialty pharmacy are delayed receiving their medications because of a reimbursement issue. Using AI to surface those insights, the account manager can then intervene and becomes more of a trusted advisor.”

	Salvatore Paolozza, director of sales operations at Antares Pharma, agrees. “Basically, the intelligence that we’re giving to our reps is a lot further advanced than it was before,” he says. Antares is an adopter of Andi, Veeva’s AI application for customer relationship management. “What the application brings,” Paolozza explains, “is greater flexibility and greater interoperability between sources. It completes the picture, if you like.” Crucial here is AI’s ability to learn, he says. “We’re moving out of a coding environment to more of a learning environment. These applications can learn with time what they should and shouldn’t surface up.”

	To stay in tune with the advances and possibilities of new applications and algorithms, pharma is keeping a close eye on the activities of the big tech companies.

	No one can attend a conference on using technology to communicate with HCPs without hearing about Netflix, Amazon, Apple, Google, or, to a lesser extent, Facebook. Pharma is some way behind these digitally native companies, of course; says Khedkar, “that’s partly why the industry is looking to them. The question is, what else can it adopt?”

	Some of the algorithms coming into pharma marketing and medical communications are indeed being adopted from Netflix and the like. Khedkar points to an algorithm called collaborative filtering, which is the way Netflix figures out what movie to recommend to individual viewers. “We took that algorithm, which is in the public domain, and modified it to work for pharma to identify specifically what type of content to send to a particular physician,” he says. “As well as figuring out which channel you like, it’s crucial to figure out what content to send. Should you send an efficacy message? An affordability message? A safety message?”

	The problem with adopting such an approach, however, is that pharma “has gotten spoiled with sales data; they think that if they don’t have 90% of the data right, then nothing can be done,” says Khedkar. This is a mindset that needs to change, the executive believes. “What data do you think Netflix has?” he says. “When Netflix looks at the ratings from people who watched a certain movie, they have 2% of the data. What they’re doing is extrapolating the 98% they don’t know from the 2% they do know.”

	Pharma has to get more comfortable working with “poorer or incomplete data,” says Khedkar, and let AI do its work. “The AI team is important because the data is not going to be perfect. Pharma needs to be a little bit more courageous in using AI on the data it has, because AI will compensate for the holes in the data.”

	Of course, pharma marketers are dealing with a considerably smaller audience than Netflix, maybe a pool of 10,000 physicians rather than millions of viewers. But for Khedkar, the “spray and pray” approach that turns physicians off is a much bigger risk in the smaller pool. “Both extremes are bad-hesitating and not doing anything because it’s a limited pool or opting for spray and pray,” he says. “You have to avoid both extremes and find the happy medium, which is where AI and data comes in.”

	While attempting to emulate some of the Netflix or Amazon methods is ambitious, pharma can look to other, more regulated industries for a more cautious approach. Says Shawah, “We often look to financial services because they are one of the best industries at identifying really valuable, high-net-worth customers and then managing them through the relationship life cycle.”

	He adds that in the telecom industry, the wireless service providers, for example, have a wealth of information about a customer before that customer walks into a physical store. “They know everything the customer’s been doing on their phone; they may know if the customer is at risk of moving to a different carrier, or whether the customer is over or under his or her data limits,” says Shawah. “They’re able to use that information to have very targeted conversations.”

	Some industries are not always relevant, adds Shawah, “but it’s important to look outside of life sciences as much as we like to look inside of the life sciences,” he points out. “There’s no monopoly on good ideas and where they come from.”

	All the advancing algorithms and technologies notwithstanding, the pharma industry must remain mindful of “the human being in the middle.” In engaging HCPs, drugmakers are not dealing with a machine-to-machine interface; it is machine to human. “Because of this linkage, the data, the interactions, and the nuances will never be perfectly captured,” contends Khedkar. AI provides “just a different model.”

	There will always be an element of complexity and imperfection, he adds. “It’s about balancing the personal and the non-personal.”

	The key to success in using AI to engage physicians is making that marriage more fruitful.

’s European and Online Editor. He can be reached at 

Exploring the advent of data analytics and pharma marketing automation in guiding targeted messaging and brand engagement.

Surfacing Insights: AI and the Physician

	At the end of this month, February 28, we will close the nomination process for the 11th 

 Emerging Pharma Leaders (EPL) recognition. As you won’t be reading this until mid-February online, I encourage you now to nominate the person you know who is headed for the C-Suite. Or you can nominate yourself! Go to our judging platform

	It’s not a coincidence that James (Jay) J. Galeota, Jr., president and CEO of Inheris Biopharma, is our featured February 

 Editorial Advisory Board Member and was recognized as an Emerging Pharma Leader in our first class of 2008. At that time, Jay was SVP, general manager, diabetes and obesity at Merck. Since then, Galeota led Merck’s pharma and vaccine integration of Schering-Plough; served as SVP, global human health, strategy & BD; was president, hospital & specialty care; and was chief strategy & BD officer, president, emerging business, all at Merck. He then moved on to become president of G&W Laboratories, before taking the position as CEO of Inheris Biopharma.

	When I reached out to Jay to participate in the executive profile, the timing seemed perfect. We were opening the EPL nominations, he is a former selection, a well-accomplished executive, and Inheris Biopharma was nearing FDA review action on NKTR-181, the potential first new molecular entity opioid in over 30 years with a target profile of less unwanted side effects while delivering effective pain relief. Potentially timely indeed for the tens of millions of people suffering from chronic pain in the midst of the current opioid crisis. 

	But, like many best-laid plans, Galeota is now facing what many CEOs and executives in the life sciences have faced, reflecting the inherent and extraordinary risk in our industry-a situation that requires a new plan.

	How Galeota navigates through to the next step will build on the skills, qualities, experiences, and vision that has guided his career through to this point.

	And Galeota’s story also connects with what we ask of your nomination for the next class of Emerging Pharma Leaders. Like Galeota, do they have what it takes to make the tough decisions that will continue to face 

manufacturers in the coming years? Can they navigate the commercial, financial, scientific, R&D, marketing, sales, and/or market access landscapes with leadership and inspiration? Do they have what it takes to get to the next level?

	The 2020 EPL winners will be announced at 

 in mid-April, showcased on the cover and inside of 

c’s May issue, and featured on episodes of the 

	As Galeota emphasized in his interview, there is tremendous opportunity to take advantage of the current convergence of technology, biology, and engineering to change the trajectory of the more conservative paradigms that currently exist in the pharmaceutical industry. “The opportunity to innovate has never been greater, and innovation now moves beyond the discovery at the bench to how that brilliance is applied in practice in ways that maximize the potential benefit conveyed to people who are suffering,” he says.

	Where ultimately the future of pharma goes depends on leaders, emerging and otherwise.

	We look forward to featuring the future of pharma leadership.

From the Editor

With the nomination period for our latest Emerging Pharma Leaders selections in full swing, it's a good reminder that the industry's future path ultimately depends on its leaders, emerging and otherwise. 

Becoming a Pharma Industry Leader

	While the agencies that pay for medicines continue to struggle with the inadequacies of external reference pricing (ERP) systems that many of them rely on, parallel attempts to pry open the black box of managed entry agreements (MEAs) seem even more unproductive. A panel of experts working with the richest countries in the world has just been obliged to admit failure in its search for an easy key to unlock the secrets held by deals on payment for results or population-level coverage.

	“It is difficult to assess to what extent performance-based MEAs have so far been successful,” conclude the authors of a study for the Organization for Economic Cooperation and Development (OECD), because “little information is currently shared,” particularly on the products for which MEAs are in place, on the design of MEAs, or on their results, and there is a consequent “lack of evidence.”

	Advocates of tougher pricing controls on medicines will find little comfort in the findings of the OECD study, because it confirms what European discussions of ERP during 2019 already made clear: that as long as confidentiality remains the norm in pricing negotiations between drug firms and national payers, information and evidence is always going to be in short supply. The ambitions of European national payers to leverage a shift in focus from list prices to net prices are evident in the burgeoning regional groupings now emerging along the lines of the Beneluxa model, and were at the heart of last year’s ERP discussions in their Euripid grouping too (which this column covered in May 2019

). So far, the ambitions remain a long way from fulfilment.

	That is not to say that the concept of MEAs is called seriously into question in the study. These agreements between firms and healthcare payers can, in principle, allow for coverage of new medicines while managing uncertainty around their financial impact or performance, it concedes. And at least two-thirds of OECD countries and EU member states have made use of financial agreements designed to reduce prices and/or budgetary impact of medicines in OECD countries and EU member states without linking them to product performance.

	Many of them have also used performance-based agreements that link to payments or rebates, it says. The most common designs for agreements are patient-level payment-by-result (PbR), paying firms only for treatments to which patients respond, and population-level coverage with evidence development (CED), which aim to reduce uncertainty around comparative effectiveness or cost effectiveness.

	The problem is that it is hard to say whether these agreements do what they are intended to do. Few countries have formally evaluated their experience. And the confidentiality that surrounds these agreements is a permanent barrier to independent evaluation.

	There is little evidence in the public domain, admit the authors of the study-and such information as is available, including from expert interviews they have conducted-indicates that CED agreements have so far had a poor track record of reducing uncertainty around the performance of medicines, and PbR agreements “do not always generate evidence on product performance because data used for triggering payments are not always aggregated and analyzed.”

	As a result, some countries have recently reformed CED schemes, and some are discontinuing CED agreements altogether in favor of alternatives, notably with restricted or conditional coverage without an MEA, and with coverage initially restricted to certain indications or patient groups and only broadened if and when additional evidence becomes available.

	Where the advocates of tougher pricing controls may find more comfort-and pharmaceutical executives may entertain more reservations-is in the study’s suggestions that the situation is not without some hope of remedy. One of the avenues that the report recommends for exploration is “ensuring a minimum level of transparency of content, limiting confidentiality to those parts of MEAs that may be commercially sensitive (e.g., prices).” It also urges sharing information on results of MEAs, and how performance of products is measured within them.

	According to the study, this would benefit payers. It says it would reduce duplication of effort between countries; it would allow payers to learn from experience elsewhere to inform their negotiations with firms; and it could reduce uncertainty over results from small patient samples in the case of rare diseases. Greater transparency over the performance of products would also “be useful for other stakeholders with legitimate interests and the general public,” it says.

	The study also raises a hitherto less remarked issue. It suggests that reticence over the outcome of MEAs could have a dimension beyond the strictly technical. “The potential non-disclosure of results of clinical studies conducted under performance-based MEAs raises ethical concerns, as available information on the effectiveness of medicines could be withheld from the public.” 

	The ways forward that the study recommends amount to a radical change in current practice. If MEAs are to be more useful, “payers would need to change their policies in negotiations with pharmaceutical firms to ensure that information on future MEAs is not confidential,” it says-somewhat glibly, since abandoning confidentiality is not entirely within the exclusive gift of payers; companies would have to agree to it too.

	“There is significant interest in sharing of information on the existence of MEAs, on how product performance is measured, and in decisions made as a result of MEAs,” it continues. “Payers could agree on which information to share, in which form, and through which mechanism.

	Various mechanisms of information exchange are possible, including publishing information on existing websites, establishing new central repositories, and using existing initiatives for sharing of information on medicines and health technologies.”

	In what sounds like a belated-and even then possibly inadequate-acknowledgement that it does indeed take two to tango, the study does recognize that “further assessments might be necessary to determine which information is commercially sensitive and ought therefore to be protected.”

	But its optimistic attitude still seems to rather miss the point: “Changes to legislation might not be necessary in most countries to achieve greater transparency.” Legislation is unlikely to deliver the transparency aspired to. As this column has observed in the past, industry-and many national authorities who benefit from confidential agreements-are resistant to the extensive transparency that more radical commentators are mulling. And drug firms are on the record as saying that if they are forced to disclose net prices, they will stop making agreements that involve discounts, and provide their products only at list prices.

	Similarly, pricing authorities who currently obtain discounts in return for confidentiality agreements say they will not be able to afford the acquisition of expensive medical treatments if they are available only at list prices. It is hard to see the legislation that-in Europe at any rate-could compel either side to enter into agreements that they were strongly opposed to.

	So despite the meticulous engagement of the OECD’s researchers, the black box of MEAs remains almost as hermetic and opaque as ever. Something more than an academic review may be needed to advance meaningful discussion on revealing its innermost secrets.

Reflector is Pharmaceutical Executive’s correspondent in Brussels

https://www.oecd-ilibrary.org/social-issues-migration-health/performance-based-managed-entry-agreements-for-new-medicines-in-oecd-countries-and-eu-member-states_6e5e4c0f-en

http://www.pharmexec.com/new-flare-europes-external-reference-pricing-debate

Columns

New OECD study doesn’t shed much light on the effectiveness of managed entry agreements for drug access.

Unlocking the Black Box of Pharma Pricing in Europe

	With more new drugs and biologics gaining FDA approval based on accelerated research and review strategies, concerns have emerged about whether such innovations raise added risk for long-term product safety and efficacy. FDA officials maintain that they are not compromising the agency’s traditional “gold standard” for testing new medical products, and that it should utilize opportunities to efficiently address

 unmet medical needs of very ill patients.

	An added benefit of FDA flexibility in clinical trial design and speedy reviews may be to reduce the cost of drug development, which could translate into less expensive treatments for patients. So far, though, many critical new drugs have set high launch prices despite expedited FDA vetting, clouding the sense of gain from these regulatory innovations and maintaining support for drug price control legislation.

	In a report on Innovation in Drug Approvals of 2019, the Center for Drug Evaluation and Research (CDER) outlines an impressive record for expediting development and oversight of important new drugs last year. The report cites the use of expedited programs to advance access to 60% of 48 novel drugs approved last year, many to treat rare diseases and deadly cancers.

 While last year’s approval numbers for new molecular entities (NMEs) fall below FDA’s record 59 approvals in 2018, the latest list includes numerous first-in-class therapies and advances in care across a range of conditions, from heart disease, macular degeneration, osteoporosis, and migraine, to sickle cell disease, Parkinson’s, multiple sclerosis, and blood disorders. The report also cites multiple approvals of indications for expanded uses and additional patient populations, as well as new dosage forms for already marketed medicines.

Weighing new strategies to accelerate biomedical product development.

Pharmaceutical Executive-02-01-2020

Improving the Link from Lab to Physician

Engaging the New HCP in the Digital World

Jay Galeota: A Better Way to Pharma

Surfacing Insights: AI and the Physician

Becoming a Pharma Industry Leader

Unlocking the Black Box of Pharma Pricing in Europe

The Risks and Rewards of Expedited Review

Using Service to Drive Commercial Value

The Roots and Rise of Cell and Gene Therapy

Pharmaceutical Executive, February 2020 Issue (PDF)

Pharma Outsourcing: Keys to Productivity in 2020s

Country Report: Hungary