Immuno-oncology agents have made a space for themselves as the ‘fourth pillar’ of cancer therapy with some stunning clinical results.
Questions remain about long-term, real-world outcomes, the ability of systems to support sustained payment and access, and the ability of companies to pick up multiple indications, but it’s still reasonable to assume that over the next few generations of agents, the outcome for many patients will be a cure.
How then, once a landscape is populated with multiple products that potentially offer a ‘cure’, does a company differentiate? Put another way, when safety/efficacy is the price of entry and no longer a primary differentiator, how does a company stand out? Interestingly answers to the challenges created by these most innovative of therapies may come from a space where innovation is completely absent.
In recent years, biosimilars (highly similar copies of biologic medicines) have taken large shares of many markets. By definition, their efficacy and safety profiles are not different from those of the reference product, yet many have managed to differentiate. They come with a reduced price, which could offer a very substantial point of differentiation, but then so do many other biosimilars in the field, so differentiation has to come from somewhere beyond just patient outcomes and cost. The most successful companies have realised that service provision and user-experience can provide one of the most powerful ways to stand above a crowd. This is a now classic model for the most successful retail companies, but has been much less widely adopted by pharma. Understanding the user experience and pain points and being able to quickly solve them has allowed many companies to successfully disrupt some very well-established industries, and it follows that pharma should adopt a similar approach once traditional factors no longer set you apart. These enhancements to user experience come in the form of value-added services, such as very practical assistance with, for example, storage or logistical issues, through to the ability to give very tailored information and insights that, just like the therapies in question, are personalised to the exact needs of the physician.
When Novel Oral Anticoagulants (NOACs) entered the market some years ago for the prevention of stroke in atrial fibrillation, the potential for market disruption was clear. Specialist clinics, required to safely manage the potentially tricky long-term use of warfarin, were well-established and represented a significant drain on NHS resources. NOACs were far safer for patients and did not have anywhere near the same amount of monitoring requirements (and associated costs) of warfarin therapy. But wholesale switch from an older, cheaper medicine to a newer, more expensive one – certainly with respect to acquisition cost – was never going to be palatable to the NHS.
Thus, manufacturers of these newer treatments were obliged to actively drive the debate around service redesign – to be part of a solution to a ‘problem they helped create’. Considerable effort was directed towards medicines optimisation and building an evidence base for the wider use of NOACs in appropriate patients. Despite this, uptake of these innovative medicines lagged behind warfarin for far too long – in large part due to the entrenched thrombosis clinic system that employed thousands of healthcare professionals.
Arguably, these efforts could and should have begun far sooner if the full potential of such innovations – to both patients and healthcare budgets – was to be realised. The NOAC example also shows how the uptake of new medicines can become a social and political question as well as a medical one which requires a broader approach to identifying solutions.
Taking the long view, this could be seen as a very logical evolution of the pharma/physician relationship and a shift from ‘sales’ relationships to medically-driven information exchanges via MSLs, offering increasingly personalised and practical assistance that enhances user experience. It follows that the next generation of relationship holders, representing very expensive but ultra-personalised medicines like CAR-Ts (which are based on patients’ own cells) will be concierge-like, offering highly personalised ‘trusted-advisor’ type services to a much broader range of stakeholders on a much wider range of challenges. The question is, how quickly will manufacturers respond to this need and how quickly will they be able to implement the necessary shift?
Cross-functional insight provided by Phil Ford, Managing Director of Litmus Medical Communications, a Syneos Health company and Andrew Thomas, Head of Integrated Communications, Europe at Syneos Health
