Pharma ‘could have done a bet­ter job’ ex­plain­ing drug costs

Modern Healthcare - - Q & A -

Since De­cem­ber 2013, Al­bert Bourla has served as group pres­i­dent of vac­cines, on­col­ogy and con­sumer health­care busi­nesses at Pfizer.

Un­der his lead­er­ship, Pfizer, with rev­enue of $49.6 bil­lion and net in­come of $9 bil­lion in 2014, re­ceived ac­cel­er­ated ap­proval from the Food and Drug Ad­min­is­tra­tion for Ibrance, the first new medicine ap­proved in more than a decade for post­menopausal women with cer­tain types of ad­vanced breast can­cer. Pfizer Con­sumer Health­care is a ma­jor over-the-counter health­care-prod­uct busi­ness, mar­ket­ing Advil, Centrum and Nex­ium 24HR. Pfizer re­cently an­nounced its $160 bil­lion merger with Ir­ish drug­maker Al­ler­gan, which will cre­ate the world’s largest drug­maker by sales and re­duce Pfizer’s cor­po­rate tax rate. Bourla, a vet­eri­nar­ian who holds a doc­tor­ate, pre­vi­ously served as pres­i­dent and gen­eral man­ager of Pfizer’s es­tab­lished prod­ucts busi­ness unit, where he led strate­gic de­vel­op­ment for Pfizer’s off-patent drug port­fo­lio. Mod­ern Health­care re­porter Steven Ross John­son re­cently spoke with Bourla about his com­pany’s re­search and de­vel­op­ment strate­gies, how Pfizer is re­spond­ing to con­sumer-di­rected health­care and the con­tro­versy over high drug prices. This is an edited tran­script.

Mod­ern Health­care: Where do you see Pfizer’s role within the cur­rent health­care land­scape?

Al­bert Bourla: Our role is to de­velop and de­liver health­care prod­ucts that sig­nif­i­cantly im­prove pa­tients’ and con­sumers’ lives. So far, we have made sig­nif­i­cant strides. We have a lead­ing port­fo­lio of prod­ucts and medicines that sup­port peo­ple at ev­ery stage of life.

How­ever, bring­ing new medicine to mar­ket is a com­plex and lengthy jour­ney where the prob­a­bil­ity of suc­cess is less than cer­tain. In­vest­ments will bring prod­ucts that can chal­lenge diseases like Alzheimer’s or can­cer. Our role is to con­tinue in­vest­ing in R&D.

MH: How might that evolve?

Bourla: Dur­ing the 25 years of my ca­reer, I have wit­nessed tremen­dous changes in health­care, from new data tools to di­ag­nos­tic in­stru­ments. But noth­ing com­pares to the trans­for­ma­tion cur­rently hap­pen­ing. We are in the mid­dle of a sci­en­tific re­nais­sance. The health­care en­vi­ron­ment of the fu­ture will oc­cupy en­tirely new di­men­sions.

Peo­ple are tak­ing a more ac­tive role in their own health man­age­ment. In­creas­ing con­sumer re­spon­si­bil­ity, choice, and dig­i­tal and so­cial me­dia are trans­form­ing health­care. Pfizer needs to proac­tively adapt to stay ahead of the game. Also, big data will open new pos­si­bil­i­ties, from drug dis­cov­ery and de­vel­op­ment to us­ing re­al­world data to col­lect prod­uct-user trends.

MH: Where do you see the great­est op­por­tu­ni­ties for growth in the vac­cine mar­ket?

Bourla: We are fo­cused on two things: The first is saving and ac­cel­er­at­ing our adult vac­ci­na­tion pro­gram, while pro­tect­ing and grow­ing our pe­di­atric one. The sec­ond is es­tab­lish­ing and build­ing our menin­gi­tis fran­chise.

We have a sep­a­rate fo­cus on the most promis­ing ar­eas of vac­cine re­search. One is pro­phy­lac­tic vac­cines. We have ac­tive pro­grams for staphy­lo­coc­cus au­reus and clostrid­ium dif­fi­cile, diseases that do not cur­rently have any vac­cine so­lu­tion. We are work­ing on ma­ter­nal vac­cines that could pro­tect against Group B strep­to­coc­cus and RSV and CMV, im­por­tant in­fant diseases. Also, we have very ac­tive im­muno-on­col­ogy pro­grams that in­clude vac­cines against can­cer.

MH: What are the big­gest op­por­tu­ni­ties in the can­cer mar­ket?

Bourla: We have two growth plat­forms: Ibrance and im­muno-on­col­ogy.

Ibrance is our treat­ment for metastatic breast can­cer. About 1 mil­lion breast can­cer pa­tients are ER-pos­i­tive, HER2neg­a­tive, which is an area where Ibrance is ac­tive. We are work­ing to build a broad fran­chise around breast can­cer, start­ing with first­line metastatic breast can­cer, mov­ing then to re­cur­rent metastatic breast can­cer, and then go­ing to early breast can­cer. We are run­ning stud­ies in non­breast can­cer tu­mor types with Ibrance.

The sec­ond growth pil­lar is im­muno-on­col­ogy. We are well po­si­tioned to be a strong player, par­tic­u­larly in the com­bi­na­tion space. Re­cently, the FDA granted or­phan-drug des­ig­na­tion

“We are in the mid­dle of a sci­en­tific re­nais­sance. The health­care en­vi­ron­ment of the fu­ture will oc­cupy en­tirely new di­men­sions.”

and fast-track des­ig­na­tions for Avelumab, with which we are part­ner­ing with Merck KGaA, the Euro­pean Merck, to treat a rare and ag­gres­sive form of skin can­cer.

The first po­ten­tial com­mer­cial launch for Avelumab is an­tic­i­pated in 2017, and we ex­pect to have at least one or more ad­di­tional launches each year through 2022.

Also, by the end of this year, we ex­pect to have five im­muno-on­col­ogy com­pounds in clin­i­cal sta­tus. All of them could po­ten­tially pro­vide, through in­tel­li­gent com­bi­na­tions, great ther­a­peu­tic so­lu­tions for a va­ri­ety of tu­mors. And we ex­pect to have up to 10 dif­fer­ent im­muno-on­col­ogy com­pounds in the clinic by the end of 2016.

MH: Why in­te­grate vac­cines, on­col­ogy and con­sumer health­care into a sin­gle unit?

Bourla: Each of those global in­te­grated busi­nesses is unique. They have dis­tinct spe­cial­iza­tions, go-to-mar­ket strate­gies, R&D pri­or­i­ties and op­er­at­ing mod­els. There are only a few mean­ing­ful op­er­a­tional syn­er­gies, as for ex­am­ple, in R&D. There is an in­ter­sec­tion be­tween vac­cines and on­col­ogy by har­ness­ing the power of the im­mune sys­tem to fight tu­mors with can­cer vac­cines.

But all three busi­ness units are poised for strong or­ganic growth, and al­though smaller in size, they’re ex­tremely valu­able, given the growth per­for­mance. This struc­ture al­lows us to pro­vide th­ese busi­nesses with a growth cul­ture and the ded­i­cated re­sources that are re­quired to fur­ther strengthen them to be mar­ket lead­ers.

The vac­cine-on­col­ogy-con­sumer (VOC) unit is ex­ceed­ing expectations. Our op­er­a­tional growth for the first nine months of this year was 52% for VOC, as com­pared to 3% for Pfizer as a whole.

MH: What can be done to ad­dress pub­lic con­cerns about the high costs of new spe­cialty drugs?

Bourla: Given next year’s elec­tions, it will con­tinue to be de­bated. Medicines are among the most ef­fec­tive uses of pri­vate and pub­lic health­care dol­lars. They rep­re­sent around 10% of to­tal health­care costs, and that per­cent­age is ex­pected to re­main the same over the next sev­eral years.

It’s dif­fi­cult when in­di­vid­u­als can­not af­ford in­creases in their co­pays when their treat­ment is on a spe­cialty tier.

Our po­si­tion is that no in­di­vid­u­als should have to bear the full cost of their treat­ment when they be­come sick. The in­sur­ance in­dus­try hasn’t evolved with the rest of the field.

Medicines are now the least-in­sured ben­e­fit. On av­er­age, pa­tients pay out of pocket nearly 20% of their to­tal prescription-drug costs, com­pared with 5% of hos­pi­tal costs.

Hav­ing an af­ford­able health­care sys­tem re­quires in­cen­tives through which in­sur­ance plans can be suc­cess­ful when they in­vest in long-term health, and providers are suc­cess­ful by in­sur­ing well­ness rather than treat­ing sick­ness. To sus­tain the most vi­brant, in­no­va­tive bio­phar­ma­ceu­ti­cal in­dus­try in the world, we must pre­serve the mar­ket-based sys­tem that en­ables us to con­tinue to de­velop break­through treat­ments and cures.

MH: Have drug com­pa­nies done a good job of con­vey­ing a mes­sage to the pub­lic about what it costs them to de­velop in­no­va­tive drugs?

Bourla: The pharma in­dus­try could have done a bet­ter job in ex­plain­ing that.

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