Focus More To Create Patient-Perceived Value of Brand Outcomes

Posted on November 1, 2021 by Tapan Ray

Healthcare providers, including many drug companies aim to create a beneficial effect on patients with their respective products and services. However, and more importantly, these benefits need to be such that recipients are able to sense, feel, and perceive as they expect – or may often go much beyond their expectations.

In this endeavor, when the perceived value of health care offerings exceeds the perceived cost of the products or services, the beneficiaries get naturally delighted. Conversely, when the perceived cost of the product weighs more than the perceived benefits, especially when it is incurred in lieu of some other essential living expenses, the patients accept the benefits grudgingly – without having any choice, or alternatives. The situation often fuels growing healthcare activism, across the globe and more involving expensive patented products.

Such expectations of many customers have increases manifold during Covid-19 pandemic, as many studies highlight. Thus, creating a win-win situation while aiming for a beneficial effect on patients, would call for in-depth understanding of the complex changes in the value delivery process. This is critical for all in the health care environment, and particularly the pharma marketers.

In today’s article, I shall dwell on some recent developments in this area, beginning with the basic need for in-depth understanding of the complex changes in the value delivery process. This process flows from ascertaining what have and have not changed in pharma industry’s new normal. The core intent is to find an answer to the key question: Should markers now need to focus much more on creating patient-perceived value of brand outcomes to business excellence?

Understanding complex changes in the value delivery process:

In today’s scenario – amid expressive customers, to get to know the needs, wants and expectations of the target audience, pharma marketers would need to listen to them carefully, and capture the same as they are – in an organized way. In-depth analysis of the data, thus captured, would help marketers chart a cutting-edge strategic pathway – converting data into actionable insights, in pursuit of excellence.

Covid-19 pandemic expanded digital media use even by older age group:

Many studies have shown, since the onset of Covid-19 pandemic, the use of digital media for various purposes, including health care products ad services, has increased among older age groups, more than ever before.

One such April 2021 Press Release of AARP Research was captioned, ‘Tech Usage Among Older Adults Skyrockets During Pandemic.’ It reported, technology enabled older adults, to better weather – the isolation of the pandemic, started using digital platforms and social media, from ordering groceries to telehealth visits to connecting with loved ones.

More specifically, in the present context, the study found, among others - ‘50+ use of smartphones increased dramatically. For instance, use for ordering groceries grew from 6% to 24%; use of personal health increased from 28% to 40% for activities like telehealth visits, ordering prescriptions, or making appointments; use of health and fitness information increased 25% to 44%; and use of financial transactions increased 37% to 53%.’

Another AARP publication on September 2021 was captioned: ‘Personal Tech and the Pandemic: Older Adults Are Upgrading for a Better Online Experience.’ It also articulated: ‘Texting, email, social media, and video chatting have become commonplace as the COVID-19 pandemic has forced people to remain home, separated from friends and family. More than 80% of those 50-plus said they use technology in some form to stay connected, many on a daily basis.’

I hasten to add that the above study, although was conducted in the United States, the overall trend is expected to be similar in India – of course, with varying numbers. Be that as it may, the new opportunity of listening to customers from their reach, use, interactions, and conversations through digital channels, and sieving out relevant information from the same, needs to be adequately leveraged.

This space could provide high-quality data, when used in a structured manner, for in-depth understanding of the pandemic-triggered changes in customer dynamics. No wonder, why some major pharma players’ greater focus on listening intently to healthcare customers’ conversation is assuming increasing criticality, today. This process would also help immensely while delivering value of affordable access to contemporary innovative drugs.

Increasing criticality of affordable access to contemporary innovative drugs:

Alongside the pre-Covid 19 ailments, new disease complications in the pandemic – or, now, in endemic-prone areas, would enhance manifold the criticality of the value of access to innovative drugs – for all to be up and running. This area, was well articulated in a similar context in the article, published in the Pharmaceutical Executive on September 20, 2021.

The authors reiterated, ‘Patient affordability and access enablement, along with health system sustainability and affordability, are critical factors that impact current patient access to these innovations as well as sustained future access to new innovations.’

Many pharma companies, who have both resources and knowledge to develop and supply new and innovative medicines at scale, are already talking about it, even in the new normal. But, they would now need to walk the talk with a greater sense of inclusivity that can be seen and felt by all. Let me cite a very recent example in this area from the Covid-19 perspective.

A recent example in this area from Covid-19 perspective:

An encouraging recent development about affordable access to innovative drugs was reported by The New York Times on October 27, 2021. It reported: ‘Merck has granted a royalty-free license for its promising Covid-19 pill to a United Nations-backed nonprofit in a deal that would allow the drug to be manufactured and sold cheaply in the poorest nations, where vaccines for the coronavirus are in devastatingly short supply.’

More, such examples, also involving treatment in other critical disease areas, would have a salutary effect, even on the public image of the concerned pharma innovators. The ball seems to have started rolling in this direction, as evident from the key findings of the ‘2021 Access to Medicine Index’.

‘2021 Access to Medicine Index’ elucidates the point:

The ‘2021 Access to Medicine Index’, published by the Access to Medicine Foundation, on January 26, 2021, reiterates the increasing criticality of affordable access to contemporary innovative drugs. It adds, with the resources and the knowledge to develop and supply new medicines at scale, pharma players have a responsibility to ensure these are made available to people regardless of their socioeconomic standing.

The key findings of the report include the following:

Eight companies adopt processes to systematically address access to medicine for all new products
Less than half of key products are covered by pharma companies’ access strategies in poorer countries.
R&D for COVID-19 has increased, yet another pandemic risk goes unaddressed.

In sync with other experts, the report further emphasizes, ‘Pharmaceutical companies have the power to address affordability by refining their access strategies; and the ability to strengthen supply chains and support healthcare infrastructures. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play in improving access to medicines.’

Why affordable access to innovative drugs is more critical in India:

The much-deliberated issue of why affordable access to innovative drugs is so critical in India, was aptly analyzed in an article, published by Brookings on March 03, 2020. The backdrop of the discussion was the W.H.O data on global health expenditures that compares out-of-pocket expenditure (OOPE) as a proportion of current health expenditure.

It revealed, India does much worse in comparison to the world average of OOPE. This was 65% for India versus the world average of around 20%, in 2016, with a similar scenario as compared to other Asian countries. It specified, Thailand and China have reduced the proportion of OOPE over time, while Sri Lanka and Bangladesh witnessed an increase over time.

Conclusion:

The current healthcare spectrum of possibilities to address these issues haven’t changed significantly, since then. Interestingly, this is despite the increasing need of innovative drugs that’s keeping pace with the complexity in the health care environment since the onset of Covid-19 pandemic.

Thus, the criticality of affordable access to contemporary innovative drugs in the new normal, deserves an out of the box solution. Even today, OOPE continues to remain very high in India, and mostly for outdoor patient treatments. Thus, it is imperative that pharma marketers should focus more to create greater patient-perceived (not self-perceived) value of brand outcomes, in an innovative way – for business excellence in the new normal.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Why Pharma Need To Connect Better With Patient Organizations Now?

Posted on August 9, 2021 by Tapan Ray

A good number of patients (63%), especially those with chronic ailments would look for Patient Support Services, revealed a survey by Human Healthcare Systems, released on February 25, 2020. Alongside, drug companies are also, reportedly, investing billions of dollars in every year, for several types of patient support programs, according to the Fierce Pharma article of July 06, 2021, on this subject. It emphasized: ‘Pharma companies spend more than $5 billion on patient support programs every year.’

Thus, it will be interesting to explore – when patients are looking for Patient Support Services (PSPs) and pharma companies are also trying to deliver the same, what’s really happening on the ground? Today’s article will focus on this area to help pharma marketers to get a ringside view of this area, and take necessary action in this area to make this investment more productive.

The aim is to help create a cutting-edge marketing strategy, while delivering best patient value and outcomes in the new normal. Let me start by recapitulating what exactly is a PSP to ensure that we all are on the same page, during this discussion.

Patient Support Services (PSPs):

According to IQVIA, a key challenge in deliberating with PSPs is that they have broad definitions, and consequently, may often give rise to multiple interpretations, misunderstandings and even bias. Be that as it may, IQVIA defines PSP as ‘An umbrella term to describe initiatives led by pharmaceutical companies to improve access, usage, and adherence to prescription drugs. These programs can have a financial component, support clinical investments, focus purely on education, or a combination.’

As we also see around, such programs include – disease awareness campaigns, helping patients use their drugs at the right dose for the right duration for best outcomes, to help patients use their drugs with disease education, financial support and more.

Relevance of PSP in the new normal:

Although PSPs aren’t a new concept, studies unfold – value that PSPs deliver to the community is so significant that when created with a clear understanding of motivators and drivers of patient behavior, can fetch equally significant return on investments for the pharma players.

A recent IQVIA White Paper concludes by noting: ‘One of the major trends seen from the COVID-19 global pandemic, is an increase telehealth. As the point of enrolment into a patient support program goes digital, PSP programs need to adjust.’ This seismic shift in the way we seek and receive treatment will require companies to revisit and potentially update their actionable insight in this space, The paper further notes: ‘With an increase in digital enrolment there are now more opportunities to capture data points and utilize technology.’

Thus, I reckon, it will be worthwhile to fathom, when patients are looking for health care support services and pharma companies are also spending considerably towards the same, what exactly is happening on the ground.

Interestingly, according to the 2021 findings of Phreesia Life Sciences, which surveyed nearly 5,000 patients checking in for doctors’ appointments during the past February and March, found, ‘just 3% were using patient support programs (PSPs).’

Some key highlights of the survey findings:

The support programs in the above survey of Phreesia Life Sciences, broadly includes, services, such as, financial assistance, disease education and specifics about medicine – offered by pharma companies. Based on these, some of the key findings of the study were as follows:

Just 3% of eligible patients are currently using support programs, and 8% have used them in their lifetimes.

59% of patients have little to no knowledge of patient support programs.

61% of patients feel that patient support programs of pharma companies would be “somewhat,” “a little,” or “not at all helpful” for them.

Most patients who had used support programs, used them either at first diagnosis, or when starting medication.

Only 10% of patients said they had learned about support programs online, but 44% said they’d like to learn about support programs online

Further, as one of the senior officials involved in this research, reportedly, said, ‘nine out of 10 qualified patients were not using the brand’s copay card—even though more than half (53%) said they would likely use one if they had it.’ Moreover, ‘two out of three patients reported it was the first time they were learning about it.’

Likely reasons for low usage of pharma’s PSPs:

Some of the most likely reasons for low usage of pharma’s PSPs were deliberated in another article of Fierce Pharma dated December 04, 2020. A domain expert commented there, ‘pharma companies simply have missed the mark in developing useful, durable tools for patients. Elaborating this point further, she said, ‘Focusing just on specific adherence tasks, like medication reminders, isn’t providing enough value for patients over a long period of time.’

Another contributing factor could be, patients suffering from multiple diseases and those who are on multiple medications of different pharma companies, are unlikely to download four different apps to track each one.

One more reason could well depend on patients’ generally preferred sources to avail such services, which may not necessarily be pharma companies.

Patients generally preferred sources for patient services:

This point was discussed in the Accenture study – ‘Uniting pharma companies and patient organizations,’ published on August 07, 2019. This survey was done on 4000 patients and some broad findings of this study include the following:

Patients generally prefer services from patient organizations over those from pharma companies.

Patients feel that patient organizations have a better understanding of their emotional, financial, and other needs than many pharma companies.

Patients also want pharma companies to coordinate with patient organizations to provide better care.

The survey also captured details of patient preferences regarding availing required services from patient organizations, rather than the drug companies, as below:

Over 50% of patients have greater trust in and better experiences with patient organizations.

64% of patients are willing to share their health data with patient organizations to get better care.

52% of patients are willing to share their health data with patient organizations to get better care.

72% of surveyed patients call or talk to someone at patient organizations on the phone.

58% of patients attend in-person events hosted by patient organizations.

Are PSPs commercially useful to pharma companies?

The very fact that drug companies are currently spending over $5 Billion annually for PSPs, reflects their direct and indirect influence in pharma’s branding strategy and image building process. Otherwise, why would they spend so much? That said, the above survey details send a clear message to pharma marketers to maximize their marketing investments on PSPs, more than ever before. Consequently, the question arises, how to achieve that goal?

Maximize marketing investments on PSPs:

Echoing and paraphrasing some points from the above IQVIA White Paper, let me highlight, especially for the marketers, 3 clear steps for maximizing returns from pharma’s investments on PSPs, as follows:

A. Gain beforehand deeper insights of patients’ PSP need and expectations:

37% of patients surveyed said, pharma companies with actionable insights, will better understand their needs through collaboration with Patient Organizations (PO), leading to meaningful engagement in a more personalized way and more frequently.

B. Deliver patient expected value thorough close coordination with the POs:

This is because, 84% of patients think pharma companies – with closer coordination with, at least, a couple of influential patient groups or organizations (PO), will deliver greater value. This will also create a seamless and more cohesive patient experience, while filling gaps in the patient treatment process, to enhance end-to-end customer experience - in an unbiased way.

C. Creating and delivering new and seamless patient experiences:

The newness is important – not just to delight the patients, but also for strategic differentiation in this ball game. This is possible by working closely with Patient Support Groups (PSGs) as partners, seeking ways to rethink for creating and delivering a unique patient experience from patients’ perspective, and outcome first basis.

Use of data, analytics and insights will be essential while creating care experiences that will better meet the patients’ needs, and would also help measure the impact of PSPs on an ongoing basis.

PSGs are helping to transform health care also in India:

Some PSGs are helping to transform healthcare with prudent use of PSPs in India, as they raise awareness about diseases, help people recover psychologically, and more, have been captured by Indian media, as well. One such report titled, How patient support groups are revolutionizing health care’ says: ‘Because of these networks, patients and their families have become better organized, and are equipped to handle emergency situations and advocate for access to treatment.’

Conclusion:

Echoing the ZS article, published on August 17, 2020, I too concur that COVID-19 has pushed the drug companies to define new ways to deliver care and reach patients. It is quite possible that patient organizations are moving faster in this direction than many pharma companies. Which is why, more patients, reportedly, prefer PSPs from patient organizations, over those from pharma companies.

Further, a course-correction in PSP, would also offer pharma marketers an additional opportunity. Because, PSPs have hidden potential to create an exceptional patient support base that marry brand’s key attributes with the new reality of patients, living with their conditions in the new normal.

Pharma companies will, therefore, need to move from typical reactive support programs – to delivering proactive patient experiences in a post-COVID-19 world, in partnership with PSGs. To ensure maximum number of patients use PSPs, it’s critical for pharma marketers to redefine – the “new normal” patient journey, and meet their current unmet needs in this space. That’s why, I reckon, to succeed in this ball game, pharma would need to effectively connect with patient organizations, more than ever before.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

India Not To Vaccinate All For Covid Control: Upsides And Unknowns

Posted on December 7, 2020 by Tapan Ray

With 9.46 million cases and 137,621 deaths, India has currently the world’s second-highest number of coronavirus infections, behind only the United States, reported Reuters on December 01, 2020.

Fathoming seriousness of rapidly unfolding Covid induced all round disruptions across the nation, on October 17, 2020, the Indian Prime Minister issued a clarion call. He called for full preparedness of the country to ensure speedy access to Covid vaccines for every citizen.

However, the above view was subsequently changed. On December 02, 2020, quoting Union Health Ministry of India, it was reported, ‘the Government has never spoken about vaccinating the entire country.’ The Director General of the Indian Council of Medical Research (ICMR) said, “the Indian government is of the opinion that vaccination against the deadly pandemic may be needed only to the extent of ‘breaking the chain.’ If we’re able to vaccinate a critical mass of people and break virus transmission, then we may not have to vaccinate the entire population.”

Why the PM said ‘Covid vaccines for every citizen’ at that time?

In my view, what the PM said made perfect sense at that time. This is also vindicated by a fact-based interesting discussion in The Wire on July 16, 2020, carrying a title – ‘How Effective Does a Vaccine Need to Be to Stop the Pandemic? It quoted an in-depth study concluding, “a vaccine with an efficacy as low as 60% could still stop the pandemic and allow society to return to normal. However, most, if not all of the population would have to be vaccinated.”

This research article, titled ‘Vaccine Efficacy Needed for a COVID-19 Coronavirus Vaccine to Prevent or Stop an Epidemic as the Sole Intervention,’ was published in The American Journal of Preventive Medicine (AJPM) on July 15, 2020. The study found that the vaccine has to have an efficacy of at least 70% to prevent an epidemic and of at least 80% to largely extinguish an epidemic without any other measures (e.g., social distancing).

The PM’s observation will make even better sense, while taking into account the draft ‘Regulatory Guidelines for Development of Vaccines with Special Consideration for Covid-19 vaccine in India. This guidance document for vaccine developers was issued by the Central Drugs Standard Control Organization (CDSCO), and was reported by the media on September 23, 2020. It also says, among other specifics, a COVID-19 vaccine candidate should show at least 50 per cent efficacy during phase III of clinical trials for it to be widely deployed.”

Why health ministry’s current plan of not vaccinating all, also makes sense:

Indian Health Ministry’s latest assessment that vaccination against the deadly pandemic may be needed only to the extent of ‘breaking the chain,’ also makes sense in the rapidly emerging contemporary scenario.

It makes sense, considering, even the World Health Organization (WHO) experts have, reportedlypointed to a 65%-70% vaccine coverage rate as sufficient to reach population immunity, based on scientific reasons. This raises the subsequent question of who in India will get priority for vaccination.

The priority group for Covid vaccination in India:

As reported on November 26, 2020, according to the Principal Scientific Advisor of India, about 300 million people will be part of the first ‘wave’ to receive Covid vaccines in India. This number includes, health care workers, totaling 30 million, police personnel and those above 50 and those younger with underlying illnesses that make them vulnerable. However, everything in this area doesn’t seem to be as clear or straight forward as is widely expected. India’s Covid vaccination plan still seems to be a work in progress.

India’s Covid vaccine plan is still a work in progress:

This is evident from many reports, such as one of December 01, 2020. This report says, experts still believe that the government should spell out whether the vaccination should be confined to only uninfected individuals or encompass everyone. These reports may vindicate the murmur in the corridors of power that many details of Covid vaccination in India are yet to crystallize.

Let me quote the Indian Prime Minister in this regard, as he is not only the head of the current Government, but is also the national voice on all contemporary issues in the external world.

Interestingly, on November 24, the Prime Minister himself acknowledged: ‘Will go by scientific advice on Covid vaccine, don’t have many answers yet.’ He made it clear that he did not yet have answers to:

Vaccine dosage
Pricing or sourcing

Although, his Government has been in touch with local and global vaccine developers, nations and multilateral institutions to ensure vaccine procurement, the PM added.

Curiously, unlike what the Principal Scientific Advisor of India, reportedly articulated on November 26, 2020, just a couple of days before that, on November 24, 2020, the PM has put it quite differently.He then said, priority groups for vaccine administration would be fixed based on state inputs and added that additional cold storage must be created by states. These confirm, India’s final plan on Covid vaccination is still a work in progress.

The Covid vaccination plan is still evolving in India:

Interestingly, on December 04, 2020, in an all-party meeting chaired by the Prime Minister, it was further announced - the first set to receive the Covid -19 vaccine will be about one Crore frontline health workers and the next will be two Crore armed forces, police, and municipal personnel. Besides, around 27 Crore senior citizens, too, would be receiving the vaccine. Thus, the Government’s vaccination plan seems to be still evolving. Meanwhile, something sensational happened in the global race for having a Covid vaccine for a country’s population.

Curiously, much before the commencement of Covid vaccine prioritization discussion in India, on September 14, 2020, it was reported that China is also not going for its entire population. They are prioritizing frontline workers and high-risk populations in its fight against the new Coronavirus.

The first emergency-use authorization for a Covid-19 vaccine happened:

On December 02, 2020, both the local and global media, such as The Wall Street Journal (WSJ) reported: ‘The U.K. became the first Western nation to grant emergency-use authorization for a Covid-19 vaccine, clearing a shot developed by Pfizer Inc. of the U.S. and BioNTech SE of Germany to be distributed in limited numbers within days.’

In the war against Covid pandemic, it also marks a key milestone in efforts to translate a promising new vaccine technology into a widely available shot, the report highlighted. It was developed, tested and authorized and is now poised to be distributed amid a pandemic that has sickened tens of millions of people and killed more than 1.4 million around the world, the news article added.

Interestingly, the U.K could make it happen, even before the United States, where this vaccine is now being reviewed by the USFDA, where a similar authorization could come later this month and a rollout before the end of the year. It’s noteworthy that the USFDA Commissioner has defended the pace of review of Pfizer’s COVID-19 vaccine on the grounds that a thorough assessment is needed to reassure a skeptical public.

NIAID director of the US also believes so, and has claimed, “We have the gold standard of a regulatory approach with the FDA.” This brings us to the question – will Pfizer’s Covid vaccine be available in India soon?

Will Pfizer’s Covid vaccine be available in India soon?

Just a day after U.K’s emergency approval of Pfizer’s Covid vaccine to be rolled out to the public early next week, Pfizer, reportedly, said, the Company is in discussions with many governments around the world, and “… will supply this vaccine only through government contracts based on agreements with respective government authorities and following regulatory authorization or approval.”

However, as reported on December 06, 2020, Pfizer has now sought approval from the DCGI for emergency use authorization of its Coronavirus vaccine. In its application dated December 4, Pfizer India has sought approval to “import the vaccine for sale and distribution in the country, besides waiver of clinical trials on Indian population in accordance with the special provisions under the New Drugs and Clinical Trials Rules, 2019.”

It’s worth noting, conducting Phase III clinical trials on Indian volunteers has, so far, been a pre-requisite for the DCGI to give authorization to a particular investigational Covid vaccine. For example, AstraZeneca-Oxford vaccine is, reportedly being tested in a phase-3 trial on over 1,600 subjects in India by Serum Institute. So is the Sputnik V, developed by Russia, and touted as the world’s “first registered Covid-19 vaccine” after it received Russian regulatory approval in early August 2020.

Further, the head of the Indian National Task Force on COVID-19, had also said the arrival of the Pfizer vaccine in India might take some months. This is, reportedly for two reasons. One, the vaccine has stringent temperature requirements (-75 degree Celsius), which make it unviable for the current cold-chain logistics in India. And the second, could possibly be, its Indian clinical trial requirements, as has been the practice of even Russia approved Sputnik V vaccine.

Thus, it appears, India is now looking at the vaccines being developed by Oxford-AstraZeneca or Bharat Biotech against the pandemic, as these are expected to complete clinical trials and seek a regulatory approval at an early date.

Upsides and unknowns of the current status of Covid vaccines in India:

Along the obvious upsides, such as – not all in the country needs to be vaccinated and, at least, one Covid vaccine is widely expected to come shortly that is being manufactured in India, there are several critical unknown factors, too. For example, apace with several similar articles, the research paper titled, ‘Will covid-19 vaccines save lives? Current trials aren’t designed to tell us,’ published in The BMJ on October 21, 2020, also raised this issue.

It pointed out: “Ideally, you want an antiviral vaccine to do two things . . . first, reduce the likelihood you will get severely ill and go to the hospital, and two, prevent infection and therefore interrupt disease transmission.” Yet the current phase III trials are not actually set up to prove either, it emphasized. None of the trials currently underway are designed to detect a reduction in any serious outcome, such as hospital admissions, use of intensive care, or deaths. Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus.

Conclusion:

As of December 06, 2020 morning, India recorded a staggering figure of 9,644,529 of new Coronavirus cases with 140,216 deaths. The threat of subsequent waves for further spread of Covid infection now looms large in many states. The Prime Minister of India is also intimately involved in search of a meaningful solution to end the pandemic.

In this scenario, that a Covid vaccine is coming so soon, is a very good news, undoubtedly. There are several obvious upsides of this development, alongside many critical unknown areas, including how long the immunity will last after administration of a Covid vaccine. Incidentally, ‘Moderna vaccine-induced antibodies last for 3 months’ says NIAID study. Even in India a ‘Minister tested positive after the first dose of vaccine.

I am sure, the right answers will surface as the research will progress. Meanwhile, there doesn’t seem to be any other alternative sans vaccines, to kick start the globalized world – for a holistic and inclusive long-term progress, economic prosperity and, if not survival with dignity, for all.

By: Tapan J. Ray

With ‘Cutting Corners’ Going North, Pharma Reputation Dives South

Posted on January 15, 2018 by Tapan Ray

Just a few months ago, on October 24, 2017, ‘New Jersey Law Journal’ came out with an eye-catching headline – “Sanofi Set to Pay $ 61M Settlement in Antitrust Suit Over Vaccine Bundling.” The suit says: “Sanofi-Pasteur allegedly suppressed competition for its pediatric meningococcal vaccine, Menactra, by charging physicians and hospitals up to 35 percent more for its product, unless they agreed to buy Sanofi’s pediatric vaccines exclusively. Sanofi-Pasteur is the vaccines division of French drug manufacturer Sanofi.”

Nevertheless, a statement from the company said: “Despite Sanofi’s strong defenses, Sanofi recognizes that continued litigation is likely to be extraordinarily expensive and time-consuming and thus has agreed to enter into this Settlement Agreement to avoid the further expense, inconvenience, risk and distraction of burdensome and protracted litigation. Sanofi is finally putting to rest this case by obtaining complete dismissal of the action and a release by settlement class members of all released claims.”

When such incidences – of various scales and dimensions, continue being reported by both the global and local media, over a long period of time, one can fathom the potential of their cumulative impact on public and other stakeholders. Severely dented image and reputation of pharma, in general, before the eyes of so many, across the world, is a testimony to this phenomenon. Considering these as ‘cutting corners’ syndromes, I shall discuss in this article, how fast is pharma reputation diving South, with incidences of ‘cutting corners’ keep going North.

‘Cutting Corners’:

The Oxford dictionary defines ‘cutting corners’ as: ‘Doing something perfunctorily so as to save time or money’. Putting it in the context, I reckon, legally or ethically questionable actions with a deliberate intent of making quick profits, if not profiteering, can be termed as ‘cutting corners’ or business malpractices.

‘Cutting Corners’ going North:

This is no way a recent phenomenon. Gradually increasing number of new reports on pharma’s alleged malpractices are not uncommon, either. On the contrary, these keep coming rather too frequently – baffling many industry watchers and its well-wishers, for different reasons.

The details of 20 largest settlements in this area reached between the United States Department of Justice and various pharmaceutical companies from 1991 to 2012, as available from Wikipedia, provide a glimpse to its magnitude and dimension. The settlement amount reportedly includes both the civil (False Claims Act) settlement and criminal fine. Glaxo’s US$ 3 billion settlement is apparently one of the largest civil, False Claims Act settlement on the record, and Pfizer’s US$ 2.3 billion settlement includes a record-breaking US$ 1.3 billion criminal fine. A federal court also recognized all off-label promotion as a violation of the False Claims Act, leading to a US$ 430 million settlement during that period, as this report highlights.

In one of my articles, titled ‘Big Pharma Receives Another Body Blow: Would Indian Slumber End Now?’, published in this blog on May 19, 2014, I quoted a few more examples from 2013 and 2014, as well. A few of these are as follows:

In March 2014, the antitrust regulator of Italy reportedly fined two Swiss drug majors, Novartis and Roche 182.5 million euros (U$ 251 million) for allegedly blocking distribution of Roche’s Avastin cancer drug in favor of a more expensive drug Lucentis that the two companies market jointly for an eye disorder.

Just before this, in the same month of March 2014, it was reported that a German court had fined 28 million euro (US$ 39 million) to the French pharma major Sanofi and convicted two of its former employees on bribery charges.

In May 2013, Sanofi was reportedly fined US$ 52.8 Million by the French competition regulator for trying to limit sales of generic versions of the company’s Plavix.

Pharma reputation dives South:

That pharma reputation is diving south, is well captured in the ‘Business and Industry Sector Ratings’ by Gallup, dated August 2-7, 2017. According to this public rating, the top 5 and bottom 5 industries came up as follows:

Top 5:

Industry	Total Positive %	Neutral %	Total Negative %	*Net positive or negative %
Computer	75	15	8	+67
Restaurant	72	21	7	+65
Farming and agriculture	70	17	12	+58
Grocery	60	23	17	+43
Internet	59	21	18	+41

The bottom 5, including the federal government:

Industry	Total Positive %	Neutral %	Total Negative %	*Net positive or negative %
Airline	41	20	35	+6
Oil and gas	38	21	40	-2
Healthcare	38	18	45	-7
Pharmaceutical	33	16	50	-17
Federal Govt.	29	19	52	-23

*Net Positive is % Positive minus % negative (in percentage points)

Image rejuvenation campaign not yielding results:

Arguably, the richest and the most powerful pharma industry lobby group in the largest pharmaceutical market of the world, is incurring a mind-boggling sum of expenditure to mend the severely dented collective reputation and image of its members.

Vindicating this point, a January 18, 2017 media report articulated that a major pharma industry lobby group – PhRMA, is gearing up for a new image building campaign by spending in the “tens of millions” each year to drum up support for the reputationally challenged pharma industry. Such initiatives by PhRMA, as I understand, are not totally new, but rather ongoing. Be that as it may, as the Gallup survey confirms, pharma reputation keeps diving South, unabated.

Mending pharma’s reputation surfaces as one of the top concerns of the pharma industry. It, therefore, demands commensurate priority in working out a meaningful strategic plan, and its effective implementation on the ground, collectively. More so, when the POTUS – Donald Trump, has also emerged as a vocal pharma critic. He has already proclaimed that drug companies “are getting away with murder,” – as the above media report highlights.

Where is this campaign going off the mark?

On this subject, an article of September 5, 2017, published by Ars Technica – a technology news publication aptly epitomized, what is happening today with these campaigns, against what should have happened, instead. The column carries a headline ‘Big Pharma hopes research spending – not reasonable pricing – will improve image’.

The columnist wrote: “To scrub down their filthy reputations, drug makers could try lowering prices, a public mea culpa, or pledging to make pricing and marketing more responsible and transparent. But they seem to have taken a different strategy.” On this score, a relevant example, out of several others, was of Biogen introducing a drug in 2016, for a rare spine disorder and priced it at an eye-popping US$ 750,000 for the first years’ worth of treatment.

In pharma image revamp campaign, the focus on R&D spending or drug innovation, including blatant self-serving demands, such as strictest product patent and data exclusivity provisions, is rather overwhelming. It is understandable that all this fits in well with various pharma lobby group’s mission and mandate, but is unlikely to deliver what consumers would consider good behavior on the part of drug companies.

Is Indian pharma out of this loop?

The answer to this question is an emphatic – ‘No’. Alleged ‘dubious product quality’ related ongoing saga, is known today by all concerned. This had often culminated into US-FDA import bans of many drugs, manufactured by several Indian drug manufacturers – starting from the very top. Nonetheless, that’s not ‘the all’ or ‘end all’ in the ballgame of ‘cutting corners’ in India, as I explained above.

On September 26, 2017, a media report flashed: ‘The Income Tax (IT) investigation wing claims to have unearthed a nexus between a leading pharmaceutical company and doctors, and the evidence showing payments running into Crores to the latter for prescribing the company’s medicines.’

Close on the heels of ‘compromised drug quality standard’, such malpractices come as a double whammy for patients. But, the saga continues. In my article, titled ‘Healthcare in India And Hierarchy of Needs’, published in this blog on November 06, 2017, I mentioned about the October 31, 2017 public notice of the State Attorney General (AG) of Connecticut. The notice cited several instances of alleged drug price fixing in the United States. Interestingly, this lawsuit includes name of several large Indian companies, such as Dr. Reddy’s Laboratories, Emcure, Glenmark, Sun Pharma, and Zydus Pharma. The expanded complaint also names two individual defendants, one among them is the promoter, the chief executive officer and managing director of a large Indian pharma manufacturer.

Further, as I wrote before, the Maharashtra government’s recent announcement on enactment of a new law called the “Cut practices in Medical Services Act, 2017”, casts a darker shadow, not just on the doctors’ reputation, but also over the health care industry, in general, including pharma.

Today’s patients are more informed:

In today’s world, wider access to the Internet for a large number of global population has a profound implication in every sphere of life. News, discussions, opinions, comments and a plethora of other information on various industries, including pharma, are available from different credible websites, just as anything else.

Additionally, the social media, collectively, have made exchanges and interpretations of such information within various groups and communities, as fast as these could be. Just as many other different things, wrongdoings or malpractices, if any, of various industries, also get quickly captured and shared by the Netizen with ease and élan. These include incidences of ‘cutting corners’ by constituents of the pharma industry too.

Conclusion:

The Public Relationship campaigns of pharma lobby groups, with a hope to bridging the industry’s ‘trust deficit’, have been reported from the United States and other countries. However, any such campaign for the pharma industry in India hasn’t arrested my attention, as yet.

It’s beyond any reasonable doubt or debate that the pharma industry, in general, has saved and is still instrumental in saving more lives, in every nook and corner of the world. Ironically, the same industry, for its own deeds prompted mostly by the self-serving needs, has been suffering a massive collateral damage.

The industry’s long unblemished image and reputation have been severely tarnished, requiring rejuvenation with an inclusive approach. This may call for a mindset, at least, nearer to the same of George W. Merck – the legendary President and Chairman Merck & Co., Inc. He articulated a vision – “Medicine Is For The Patient, Not For The Profits”, and practiced it religiously. In today’s context, this may sound rather utopian in letters, but surely not in its spirit… be that as it may….

Pharma lobby groups hope to reverse the current trend by focusing only on R&D spending, drug innovation and strictest patent protection and data exclusivity ecosystem is apparently a non-starter. That ongoing multi-million-dollar pharma image revamp campaigns haven’t yet captured any tangible positive outcomes – not even in the United States, is possibly a testimony to this fact.

The status quo is expected to continue. More so, when ‘reasonable pricing’ of drugs is one of the top most demands of patients, patient groups and even many governments – and that’s exactly where the buck stops in pharma business.

In my view, pharma reputation restoration process isn’t merely a one-sided communication issue, as it appears today. A strategic blue print of this critical industry need, deserves to be drawn on a much broader canvass with a patient-serving mindset, instead of just a self-serving one. Otherwise, with incidences of ‘cutting corners’ going North, pharma reputation will keep diving South… till it finds its very bottom.

By: Tapan J. Ray