Shaping healthcare

Spring is finally showing signs of overtaking winter when I travel to Bayer’s UK and Ireland headquarters in Reading, some 40 miles west of London, although the line of trees that  shield the office from the nearby  M4 motorway have yet to regain their leaves.

But Lars Bruening says that when they do appear and screen from view the stream of cars, the office has an uninterrupted rural view of the Berkshire fields that the stretches into the distance. It’s quite a change for the company, which only last year left its long-standing, town-centre base in nearby Newbury.

For Lars the change is newer still as he only moved from Berlin to Reading in September 2017, swapping his role as head of global market access at Bayer Pharma for the CEO post at Bayer UK and Ireland. Clearly enamoured with the UK, he’s nevertheless diplomatic enough to note that “London is as thrilling as Berlin”.

Bayer’s Reading base is also home to the German pharma firm’s first ‘Baylab’ in the UK. The free laboratory for schools is designed to be in-line with the national curriculum and offers hands-on experiences that would often be difficult for schools to arrange themselves. Since opening its doors in April 2017 more than 2,500 children have passed through the Baylab doors and had their eyes opened to a new perspective on what science can offer. So it seems appropriate to be sitting down with Lars during British Science Week and we start by looking back on his career to date.

Looking back at your previous roles, what would you say were the key things you’ve learnt?

One came from my time leading Bayer in China. What really matters is understanding how the people within the company tick and how they orientate themselves towards the right targets and objectives. It’s the people that make the difference between dealing with the system in the right way or the wrong way.

Your time in China didn’t coincide with GSK’s well-publicised problems there, which came later, but with your knowledge of the country, what impact do you think that had?

It changed a lot the way of dealing with expectations in the market. The market was just used to things happening that were not supposed to happen and each and every company needed to find their own way to change that. This has changed a lot in the industry all across the globe, but challenges can still be there, and we are seeing that with Novartis in Greece.

And the other things you’ve learnt?

For the last five years before coming here I was head of market access globally for Bayer Pharma. The clear learning for the pharma industry there is that just having a new active ingredient isn’t enough if there is no higher benefit with it. Innovation no longer consists of just having a new chemical formula - it needs to lead to better outcomes.

That transition of thinking is still ‘in process’, through all the various phases of the life cycle, and it’s a huge re-orientation for the industry.

Can pharma come to an absolute definition of value or will it always be an evolving dialogue with society?

The fundamentals are pretty clear. The issue that we now have, as an industry and as healthcare systems, is that there is a pretty ‘stringent’ value concept as demonstrated by NICE. It’s not accepted and adopted in the same way in all countries, but
it’s pretty clearly established and it follows a very stringent logic.

From the perspective of your previous global market access role, in which country did you encounter the most difficulties?

The UK is among the countries [giving us] the biggest problems. It’s a very organised and clear approach now, but it gives us huge headaches, particularly in oncology. It’s a huge challenge. Germany and France aren’t easy either. They don’t do the cost-effectiveness approach, at least not with the same consequences as the UK, but their therapeutic effectiveness approaches also lead to very difficult discussions.

The systems all differ; they’re all challenges. Perhaps the biggest challenge is that sometimes it’s difficult to make the right development decision that would satisfy them all.

In February, when you were appointed vice-chair at the European Medicines Group, you said you were looking forward to ‘shaping’ the healthcare environment. With the next version of the UK’s Pharmaceutical Price Reimbursement Scheme (PPRS) due to be negotiated this year, how does the environment need to be shaped?

We, as EMG, feed into the ABPI’s negotiations with the government on the next PPRS agreement. The key element we need to look at is to make sure the system supports patients’ needs, that the rebates we pay - and are likely to continue to pay in some form in the future - are used for enabling access to innovation.

Do you know how the rebates are currently used and where they end up?

They do not go directly back to the NHS, they go to the Department of Health and then I don’t know. But they are not handed back into the decision-making process on drugs in the NHS; they’re kept separately. And that’s one of the key things that we need to change.

The new PPRS is due to be in place by the end of this year. Given that there is so much happening politically at the moment in the UK, is there enough time to meet that December 2018 deadline?

You ask a very valid question! I’m not impressed by the speed of this, the negotiations are basically in the start-up phase. I share the worry, that you express in your question, that time is flying. Basically we need fundamental agreements in the summer time, so there is not so much time left.

How is Bayer in the UK preparing for the unknown quantity that is Brexit?

Brexit is a separate topic [from what we’ve been speaking about]. It, of course, interferes with the other topics and it’s dominating the political agenda, but it’s not dominating our day-to-day business. Our day-to-day business is to continue to do what we do well.

Of course we need to prepare, and the nastiness of the situation  is that we really need to prepare for the unknown. So we may need  to take steps now that - in three weeks, in 20 seconds, in two  weeks, I don’t know - we learn  are not necessary. We have no other choice than  to prepare for a ‘no deal’ scenario on 29 March 2019 that sees us leave the EU, with no other rules than WTO rules for doing our business, and that has some implications.

And we also have uncertainty about the logistics situation in that very moment about what happens  at the border. So we’ll look at increasing our stock levels in the country, which hopefully we will never need, but we have to do it. It is doable, but it’s nasty, and it takes too much focus and money away from the other things that we would want to do.

Then the big question is what, regulatory and customs-wise,  will be the end situation?  Regulatory alignment, from a  patient perspective for the UK  and for the EU27, is absolutely important. I know Europe says ‘we can’t have cherry-picking from the UK’, understandably so, but  the one topic where this should  not be the prevailing perspective  is patients’ needs.

Coming back to value, how do  you measure Bayer’s impact on the healthcare system and on patients in the UK?

When you look at our products, [with] Xarelto, since its launch in  its major indications, we have prevented about 13,000 strokes.
So, you could look at it as almost a city-sized dwelling of people that have the potential to live happy lives because they haven’t been impacted by stroke. Or with our other big growth product Eylea, a VEGF treatment for the retina, we have 80,000 patients under treatment as we speak. That’s a Wembley Stadium full of people who, because of the treatment, can follow the match. It’s a good reason to get up in the morning.