Joseph Jimenez, CEO, Novartis, Reimagining Medicine - Pharmaceutical Engineering MagazineThe article, Reimagining Medicine, was published in the July/August 2016 edition of Pharmaceutical Engineering® Magazine.

The final installment of this three-part series from Joseph Jimenez, CEO, Novartis, wraps up the final parts of Novartis’ mission of reimagining medicine.

The third piece is how we demonstrate the value our medicines provide.

The aging population is putting enormous pressure on national health care budgets, and we expect this trend to only continue as new innovations reach the market. As budgets continue to shrink, governments and other payers are increasingly linking spend on drugs to demonstrated real world outcomes. These outcomes help payers assess the level of value our products deliver compared to other treatments and inform reimbursement decisions.

As an industry, we need to develop long-term and sustainable solutions. We need to demonstrate the value of our medicines bring to patients, payers and society, and collaborate more than in the past.

For the past several years, we at Novartis have been moving away from the industry’s traditional business model of simply selling pills, toward delivering positive patient outcomes. We’re developing a number of innovative pricing models, including risk-sharing models, integrated care programs to help improve the overall health of a patient, and social ventures to help expand access in the developing world.

In the U.S., we’ve developed pay-for-outcomes agreements with health insurance companies including Aetna and Cigna. If our products don’t work as we expect them to, we’ll reduce the price to payers. Take our heart failure drug Entresto®, for example. If the hospitalization of patients on Entresto exceeds a prespecified threshold, Novartis will reduce its price to payers. This is attractive to payers because heart failure is a growing public health concern that costs the world economy over $100 billion annually. On our drug Entresto, patients are 21% less likely to be hospitalized. Entresto also reduces mortality by 20% compared to those given the current gold-standard treatment. We’ve reached similar agreements linked to clinical outcomes for our cancer drug Tasigna® and Gilenya® for multiple sclerosis.

Outcomes-based contracting models are a promising way to support access while demonstrating the real-world benefits of innovative medicines. By collaborating with payers on solutions-oriented approaches to reimbursement, we believe we are doing our part to shift the paradigm of pricing in our health care system.

Another way we’re doing this is by creating integrated care programs, which offer broader, more holistic solutions “beyond the pill” that can improve overall health, such as physical rehabilitation and medical counseling. For instance, with our multiple sclerosis treatment Gilenya, we’re considering the entire patient experience and offering additional support, such as interactive, patient-friendly web-based tools and educational online platforms. Another example is our work in Brazil for the last decade through our program called Vale Mais Saúde, which supports patients and physicians in overcoming adherence challenges. This program provides educational materials to patients, as well as tools such as a virtual help line and medication reminders through text messages. We also offer significant discounts on a large portfolio of products to improve access. Four million patients have taken advantage of this program across 40 products.

We must scale up our operations so that we can meet the growing demands of the future

We realize that we cannot neglect those patients in low- to middle-income countries, so we have established social ventures that expand access to health care by helping bolster infrastructure, strengthen distribution channels, and build local capabilities. In India an estimated 65% of the population does not have access to health care, especially in rural areas. Novartis created Arogya Parivar (“healthy family” in Hindi) to expand access to care in these areas. Through the program, Novartis recruits and trains locals to become health educators who inform communities about healthy behaviors. Local teams work with doctors to organize health camps in remote villages to provide access to screening, diagnosis, and treatment.

In addition, we recently launched Novartis Access, a new program that provides a portfolio of 15 on- and off-patent medicines that address key noncommunicable diseases such as cardiovascular conditions, diabetes, respiratory illnesses and breast cancer to low-and middle-income countries. The program launched in Kenya and Ethiopia in 2015, and we expect to introduce the program to five additional countries in 2016.

The final piece is how our industry conducts business. Lack of trust is still a major issue for our industry, and one that we must work together to overcome. I personally spend a lot of time talking with physicians about the topic of trust. Many have told me that they have become disillusioned with some companies about the pricing of medicines. These physicians—among other stakeholders—expect us to help make the world a better place. We share that expectation. We invest in high risk activity to discover new medicines, and most of the time we are not successful. When we are, we must earn a return for this cycle of investment and discovery to continue.

Society has also raised its expectations of our industry. At Novartis, we are making changes to ensure we lead with integrity and demonstrate the highest standards of ethical business conduct. One example is how Novartis is approaching medical education, including congress attendance. From January 2017, the company will offer doctors support to attend medical conferences based on their active participation in the event. Novartis will also sponsor physicians to speak on its behalf in clearly defined instances, for example, when a new product becomes available, a new indication is added to an existing product, or significant new clinical data are released. On these occasions, doctors are best equipped to brief their peers on how a drug can be used safely and effectively—a crucial step in ensuring that the right patients can benefit from advances in treatment. At the same time, Novartis is investing more than ever before in developing and adopting innovative digital communication tools that will provide a growing number of doctors around the world with important information about the safety and efficacy of its products. Finally, Novartis is also working to incentivize associates—including our field force—based on the values and behaviors we want to encourage. This is a cultural journey for our company. We have to make sure that our associates, no matter the situation they’re facing, will act with integrity and do the right thing.

Another way we can change the way our industry conducts business is by strengthening our collective focus on patients, ensuring we do everything we can to improve their lives. At Novartis, we want all of our employees to share this patient-focused mindset through meaningful engagement with our mission. That is why we launched Long Live Life a few years ago, an internal program to rally our people around our mission, and celebrate the fact that a normal life is extraordinary. Because when someone is sick, all they want to do is get back to normal. We asked associates to share photos, stories, and ideas to engage with our mission and explain what it means to them. Long Live Life has since become nothing short of a movement led by our people. It has become a collective expression of what we stand for and believe in. As a result, engagement with our mission has increased at all levels throughout the company, which I believe translates into better business performance and ultimately better medicines for people who need them.

Conclusion

As we look to the future, it’s clear that today’s health care environment demands that we reimagine how we operate at every junction, from the lab bench, to the manufacturing floor, and to the way we sell our drugs. We must work to build trust in our industry, while reminding ourselves of how important our work is and the impact it has on society. As we reimagine medicine, let us work together to build a stronger industry that will deliver the best medicines and cutting-edge innovation.

By:  Joseph Jimenez, CEO, Novartis

Catch up on part one and two of this series:

Hear Joseph Jimenez speak at the 2016 ISPE Annual Meeting & Expo in Atlanta, GA on 18 – 21 September 2016.  Jimenez will give his perspective on pharmaceutical industry trends and invite discussion with attendees on the future of the industry.  Register today!

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