Start the fanfare: we're moving beyond the era of patient-centric pharma. Companies are now truly patient-centric. That's right - 'truly'. There are evidently different levels of patient-centricity and we're reaching a golden era. Does anyone believe it? Probably not.
Pharma's operating model remains as it was in yesteryear; companies chase profit, mobilise their workforce to meet aggressive sales targets, and wrap it up with altruistic claims of doing good and changing patient lives. It's a cynical and unfair view but one that sadly resonates with the wider public. The industry does do incredible good - but its reputation is frequently punctured by unhelpful media exposés that imply companies put profit before patients.
So perhaps we should go back to basics and revisit a message first delivered in 1950:
“Medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.”
George Merck's profound declaration is embedded in pharma's ethical tapestry. But in a corporate environment driven by shareholder value, has its essence permeated 21st century operations, or are we paying lip service to the notion of patient-centricity? The reality is that companies genuinely believe they put patients first. Yet by maintaining traditional approaches to commercialisation, many appear configured to put wealth ahead of health.
Start with a why
We all know that pharma is a business, but there has to be a better way. So how can the industry manage the transition and live the promise of patient-centricity? The problem starts at the very beginning - and the solution begins with a 'why'.
“Although it may sound corny, the pharma industry definitely does contribute to healthcare and changes patients' lives. We should never lose sight of that,” says Dennis O'Brien, CEO, Lucid Group. “However, what often happens is that companies invest considerable resources in bringing great medicines through – and then they commercially fight to get them used. That's a start, but we can do more and we need to start by considering how we can improve patient care beyond medicine. We need to get to a place where we're committed to developing strategies that improve outcomes rather than simply drive revenues. That's about starting with the 'why'. Thinking deeply about why we are coming to work, defining our purpose. I believe that our purpose needs to be demonstrating a difference to patient outcomes, and our medicine development and commercialisation should have this at its heart. We have to believe that if we focus effectively on the right areas, with the right activities, the patient outcomes will come without us needing to chase profit.”
Our purpose needs to be to demonstrate a difference in patient outcomes
The ethos is a nod to the wise words of George Merck. However, balancing commercial and clinical imperatives is clearly a challenge for pharma. “You have to be able to align business objectives and patient outcomes. Yet historically the industry has struggled to do this,” says Nick Broughton, Ethics and Compliance Consultant. “Most companies say that their first thought is always the patient. But nobody really believes it. What's more, with brand plans that largely centre around targets and growth, the evidence-base suggests that organisations focus more on commercial objectives than patient experience. Patient-centric roles are increasing in volume but, in many companies, patient-centricity remains peripheral to strategic plans. Pharma must realise that the best way to make money is to look after the patient.”
A patient experience
It would, however, be disingenuous to suggest that companies aren't striving to put patients at the heart of their strategies. “Patient-centricity may have become a larger part of the conversation in recent years but at Janssen it's been part of our belief system for over 70 years,” says Adam Roach, Business Unit Director, Janssen, the pharmaceutical division of Johnson & Johnson. “Our credo - which was written by General Robert Wood Johnson in 1943 - states that our first responsibility is to our patients. This is more than just rhetoric - our credo is used every day in discussions and decision-making. Right from R&D, one of the key determining factors about where we choose to invest and explore innovation is whether there is unmet clinical need. By definition, that's patient-centric - and it comes right at the start of our discovery process.
[Patient-centric means]... that our first responsibility is to our patients
“Beyond that, we do a lot to engage patient organisations and act on what patients tell us is important– from trial design and clinical development through to services and support. We are working harder to understand what constitutes a good outcome from a patient's perspective. We try to put ourselves in the patient's shoes so we can provide them with the best possible experience. It's no longer enough to bring good products to market - our primary focus is for patients to be given faster and earlier access to the best innovative medicines and to ensure they get meaningful outcomes from those medicines. That's being patient-centric.”
But not everyone approaches it in such a co-ordinated fashion across the product life cycle. “In today's world, I don't believe it's enough to get patient insight and understanding how the disease affects patients, we should be identifying what interventions we can make to change how patients can be treated better,” says Dennis. “Patient-centricity should be about companies determining what impact they can make in a disease area and what difference they can make for patients. Some companies are doing it and it can be exciting when pharma really partner with a unit to make a difference to care. It's not just about the medicine - it's about committing to other programmes and services that all focus on patient outcomes. If we think that pharma's contribution to better healthcare is simply its drug, we're misguided. Is it commercial enough? I believe that companies that demonstrate better outcomes will make more money.”
In a challenging global health economy, demonstrating value is a critical success factor. This ultimately translates as patient outcomes - and delivering them is the only direction of travel for pharma. “We're only going to be commercially successful if we deliver patient-centred outcomes. The two are interdependent - but the latter drives the former.” says Adam. “It's why patient outcomes have become our new currency. With today's affordability challenges, payers are no longer willing to pay for incremental innovation, they'll only pay for products that deliver good outcomes. At Janssen we're exploring partnerships, offering risk-share agreements and pay-for-outcome models where the NHS only pays where there has been apositive patient outcome. This demonstrates innovation in managing the challenge of affordability - and has patient-centricity at its core.”
Other companies are also redesigning their operations to meet the demands of the value-based economy. GSK, for example, has discarded sales targets and replaced them with a compensation programme that rewards sales employees based on HCP feedback, technical knowledge and the quality of the service they deliver to support patient care. This represents a major change in incentivising workforce and is another welcome step towards genuine patient-centricity. The most significant behavioural change, however, may need to be an overhaul of traditional brand planning.
The patient plan
“Pharma should be writing patient-centric brand plans,” says Nick. “Typically, brand plans are shareholder-driven. Companies identify targets for organisational growth and then divide responsibility for it between individual brands. This cascades to brand teams who develop proposals to deliver their contribution. It's the wrong approach. Companies should develop plans that link growth targets to the delivery of relevant outcomes in an agreed number of patients. By clearly outlining ambitions to help specific volumes of patients, the plan becomes the blueprint for communications to reach those target patients. In the process, revenues become a natural by-product of driving appropriate outcomes, rather than focusing on the money first and then finding the patients later.”
Nick continues: “A key part of this approach is for pharma to rethink its definition of 'the customer'. The customer is the patient. HCPs and payers are just intermediaries you have to deal with in a system where pharma isn't allowed to speak directly to its true customers. Like every business, pharma has to look after its customers - but it doesn't do this enough. If pharma companies want successful brands they must consider patients their only customers. If you look after them and focus on their interests, the revenue will inevitably follow.”
If the industry's aspiration is to be 'truly' patient-centric, the best way to approach it is to start with the 'why'. The answer was laid out back in 1950: “Medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.”
If pharma follows George Merck's long-established edict, it may at last be considered patient-centric. Truly.