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Trend
Report
Driving Precision Performance:
Capitalize on Your Commercial Potential
with the Right, Relevant Data
Contents
Contents
2 Driving Precision Performance
Introduction
3 Targeting the Right Markets:
Portfolio optimization
17 Identifying the Right Influencers:
Provider alignment
26 Making the Right Connections:
Precision engagement
36 Reaching the Right Patients:
Patient population potential
48 Conclusions on Commercial Performance Best Practices:
Precision insights and applications you can use
54 Endnotes, Expert Contributors
To maintain the integrity and consistency of data and resulting
analysis, all references to IMS data or QuintilesIMS data have
been retained with mention of the IQVIA name as appropriate.
1
Introduction
Introduction: Driving Precision Performance
If the challenge of precision healthcare involves the proper treatment for a specific patient,
the corresponding challenge for life science is focusing on the precise commercial
approach to improve your performance. The right markets, the right physicians with the
right communications, as conduits to the right patient populations.
Continuously changing and widely varying environments are generating unprecedented
complexities in pharmaceutical markets around the globe. No longer is there one national “… the corresponding challenge
market or single definition of stakeholder. Global and local dynamics are always moving, for life science is focusing on the
technologies constantly improving, and the pace of change only accelerating.
precise commercial approach to
While not a full compendium of solutions available to commercial life sciences users, this
report is intended to provide a path to advancing precision and performance based on four improve your performance. The
commercial drivers and the evolving trends of each. We’re constantly adding to the world’s
right markets and the right
largest curated healthcare data source. And, included here are many examples of how
ongoing data investments are providing deeper, more precise perspectives into emerging physicians, with the right
markets, evolving channels, new stakeholders and better answers to more questions.
connections, as conduits to the
Our goal is to help global, regional and local pharmaco leaders keep pace with these
right patient populations.…”
changes—and with additional trends to be explored in the future. Here, we provide insights
into what really matters to you, improving commercial strategies, tactics and performance.
We hope this report offers familiarity with the expanded information available to advance
your commercial performance today and tomorrow.
Kevin Knightly
President, Information and Technology Solutions
IQVIA
*More Real World Insights (RWI) are available from IQVIA beyond that included in the reference patient data throughout this report.
2
Targeting the
Right Markets:
Portfolio optimization
3Distribution Fragmentation
Slower global
spending Shifts to control costs by
THE
growth 9%
RIGHTMARKETS product types, therapy,
delivery, etc.
In the UK, hospital share
Hospital
10-year
growth rate
4-7% Current trends are varying demand is growing while retail
13% 2007- 2016
for medicines and shifting the pharmacy is stalling 1%
Globally, declining Retail
importance of markets at all levels. Pharmacy
to 4-7% by 2021
2015 2016 2017 2018 2019 2020 2021
Regional & local variances
Multinational Share: China Provinces & Municipalities
Pharmerging 4% Oncology, diabetes 350
$290B-$335B 325
markets slow & autoimmune 15 provinces/
Beijing
300 Tianjin
diseases municipalities =
Shanghai
Major therapy areas drive
275
250 ~ 75% of China’s -2.5%
Q4 2016
6
spending growth in Zhejiang have
225
pharma market
developed markets MNC share:
For top 3 therapy areas in $186B
200 Fujian
≥ 24%
aggregate, expect rise of 175
Guangdong
$104B - $149B by 2021. 2016 2017 2018 2019 2020 2021 *country-wide share Q1 2017
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Product Portfolio Evolution
Biosimilar development actively pursued by many companies Global specialty 1,000 Niche HOWEVER,
900 20%
market trends population
%
54
800 18%
17 Sales and Growth 16% and
Sales, LCUS$ Bn
adalimumab 700
registered, Marketed)
Growth LCUS$
(Phase III, Pre-reg /
600 14%
12%
orphan
500
insulin glargine 5 10% drug
Specialty Sales 400
8% markets of orphan
300
Traditional Sales 6%
surge diseases
etanercept 17 200 4%
Specialty growth 100 2%
have gaps in the pipeline
infliximab 8 Total Global 0 0% and no drugs on market.
pharma growth 2012 2016
4
Source citations for all of the above may be found in the IQVIA report Driving Precision Performance, module Targeting the Right Markets, Dec 2017
4Targeting the Right Markets: Portfolio optimization
The Right Markets
While each geography is different, fluid market dynamics are changing the relative importance of regions, countries and markets—and
requiring precise commercial strategies based on specificity and granularity to capitalize on shifting trends, therapies and markets.
Evaluating and re-evaluating continuously Variation in Spending and Volume Growth Across Global Markets
shifting markets at the national, sub-national 1,600 10% Exhibit M-1:
and local level requires precise intelligence. 9% Spending and growth have shifted focus to
volume-driven growth in pharmerging
To asses and act on a myriad of competing 8% markets and specialty medicines. In the
Growth Constant US$
1,200
opportunities and challenges, you need 7% US, patent expiries and biosimilars will
Spending US$Bn
play a key role in the decline in spending
increasing levels of detail specific to brands, 6% growth. However, the next five years
sales territories and markets of interest. 800 5% expect a continued boom in innovation
Yet demand for medicines varies across a range of diseases.
4%
significantly across and within markets, 3%
depending on trends in: 400
2%
• Economic conditions 1%
• Therapy areas 0 0%
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
• Drug composition and Source: QuintilesIMS Market Prognosis,
Spending Growth Sept 2016; IQVIA (QuintilesIMS) Institute, Oct 2016
• Distribution, amongst other things.
Given emerging and shifting trends such Top 20 Pharmerging Markets Forecast Growth Dynamics
as these, precise information with the 14
Forecast CAGR (2016-21)
Exhibit M-2:
right, relevant detail is critical to reaching 13
Bubble Size proportional to 2016 LCUS$ Sales Bangladesh BRICTM
Leading pharmerging markets have seen
your full potential and improving 12 $100bn Pakistan Egypt GDP growth slow over the past decade,
Turkey Pharmerging Tier 3
commercial performance. 11 India
resulting in a wide dispersion in growth as
$20bn the CAGR overall falls into single digits.
10 Kazakhstan
$7bn Nigeria Russia The outlook for spending growth is
Slow Demand, Pharmerging Growth 9 Vietnam expected to moderate from 10% CAGR
8 Indonesia over the past five years to 6% - 9%
Though the US remains the world’s largest 7 South Africa Algeria China through 2021.
Pharmerging
market, pharmerging countries will make 6
Mexico Chile Brazil Forecast
Philippines CAGR: 7.4% Notes: At ex-manufacturer price levels,
up nine of the top 20 markets by 2021, 5
Saudi Arabia
Colombia
not including rebates and discounts.
with China continuing as number two. 4 Poland Contains audited and unaudited data;
Current pharmerging markets include Brazil, 3 Argentina excluded due to hyperinflation.
Pharmerging Historic
2 CAGR: 10.8%
Russia, India, Mexico, Turkey, Bangladesh, Source: QuintilesIMS Market Prognosis,
1
Chile, Kazakhstan and the Philippines. 2 4 6 8 10 12 14 16 18 Historic CAGR (2011-16)
Mar 2017
5While global spending will reach $1.5 Therapy Focus, Oncology-Driven Changing Product Profiles specialty, niche and orphan medicines,
The Right Markets
trillion by 2021, global spending growth is while emerging nations find value in less
Spending growth in developed markets will Drug manufacturers have very different
slowing from 9% in 2015 to 4% - 7% over expensive brands and options.
be propelled by innovations in oncology portfolios today than in previous decades,
the next five years (Ex. M-1). Spending
(specifically immuno-oncology), diabetes requiring precise granularity previously Continued portfolio evolution is expected as
growth will be driven by increased
and autoimmune therapies (Ex. M-3). unavailable in some regions. Portfolios will pharmacos seek opportunity driven by a few
pharmerging market volume, but the
Diabetes treatments will evolve with more continue to evolve as gene editing key developments:
slower growth illustrates a direct
convenient formulations, combinations and techniques, microbiome use, regenerative • Specialty medicines and new
correlation between medicine usage and
delivery. Treatments for autoimmune cell therapies and the like advance into biologics surge
affordability in some countries.
diseases, including rheumatoid arthritis, the future. • Biosimilars and non-originals increase
By volume, medicines consumed globally psoriasis, ulcerative colitis, Crohn’s disease
R&D pipelines and demand in developing • Future cell and gene therapies advance
will increase 3% annually through 2021, and related disorders will continue to rise in
usage, with spending growth up 11% - 14%.
countries suggest continued movement to • Niche population & orphan drug rise
but volume growth is slowing too. Since
2011, pharmerging market volume grew
37.5% over five years as prosperity
accelerated—verses 2% in the same Leading Therapy Areas Spending and Growth to 2021 (Constant US$Bn)
period in all other markets.
Exhibit M-3:
Spending 2011–16 Spending 2016–21
Pharmerging market growth is expected Therapy Areas Key therapy areas driving spending and
2016 CAGR 2021 CAGR growth over the next five years will be led
to slow to 4% through 2021, based on by oncology, reaching $120 – $135 billion
declines in China’s economy. Countries Oncology 75.3 10.9% 120–135 9–12% in spending in major developed and
pharmerging markets.
projected to accelerate spending over the Diabetes 66.2 16.4% 95–110 8–11%
next five years are Turkey, Mexico and
Poland (Ex. M-2). Romania, Argentina AutoImmune 45.1 18.2% 75–90 11–14% Note: Includes 8 developed and 6
pharmerging countries: US, EU5, Japan,
and Colombia are expected to grow by Canada, China, Brazil Russia, India,
less than 5% through the year 2021. Pain 67.9 7.1% 75–90 2–5% Turkey, Mexico
Though growth in developed markets will Cardiovascular 70.5 -2.5% 70–80 0–3%
be driven by patented brands and Respiratory 54.4 3.4% 60–70 2–5%
scientific advances, pharmerging markets
will continue to be pushed by non-original Antibiotics & Vaccines 54.4 2.5% 60–70 2–5%
brands (NOBs), accounting for 91% of
pharmerging market volume and 78% Mental Health 36.8 -5.0% 35–40 -1–2%
of spending. HIV 24.6 11.5% 35–40 6–9% Source: QuintilesIMS Therapy Prognosis, Sept
2016; IQVIA (QuintilesIMS) Institute, Oct 2016
Antivirals EX-HIV 33.2 38.1% 35–40 0–3%
6Specialty Medications Surge Specialty Medicines Share of Spending Through 2021 (constant US $)
The Right Markets
Specialty’s share of spending continues to US EU5 Other major developed Pharmerging Exhibit M-4:
rise from less than 20% ten years ago, to 50% Specialty spending will approach half of
total spending in the US and Europe by
30% in 2016 and 35% by 2021. While the US 2021. In pharmerging markets, specialty
still leads growth in specialty drugs, roughly 40% medicines continue but at lower shares—
82% of specialty sales growth is shared by 5% - 20% of spending.
seven developed countries and China. 30%
Globally, specialty medicines—more than
50% of which are small molecule—are 20%
increasing (Ex. M-4, M-5, M-6).
10%
Though prioritization may be based on
commercial potential versus composition, 0%
it’s curious to note the coming five-years will
2011
2013
2015
2017
2019
2021
2011
2013
2015
2017
2019
2021
2011
2013
2015
2017
2019
2021
2011
2013
2015
2017
2019
2021
see small molecules become increasingly
important and biologics entering indications US US GermanyEU5 Italy Other major developed
Australia Japan Others Brazil
China
UK Spain Canada Russia India
France South Korea Other Pharmerging Source: IQVIA (QuintilesIMS) Institute, Oct 2016
Specialty Growth in Key Markets: Specialty Spending Growth Rising Faster than Total Global Market
Percentage Growth 2015/16 Global specialty market trends Specialty:
Sales and Growth Region Market Share 2016
1,000 20%
US Exhibit M-5: Exhibit M-6:
900 18%
12.5% A few pharmerging countries In the last five years, specialty medicines
JP DE also see growth in specialty 800 16% 16% have grown seven times faster than
13%
21.6% 7.2% sales, e.g. Turkey 20.1%, traditional therapies, with Hep C
700 14%
Sales, LCUS$ Bn
Brazil 17.2%, China 8.3% medications driving significant growth in
7%
Growth LCUS$
and Mexico 4%. Of the top 600 12% 2014/2015. Specialty growth is heavily
ES 30 markets, Poland is the 500 10% 4% concentrated in developed markets, and
CA
13.0% only country with zero although re-balanced in 2016, it continues
10.1% specialty growth. 400 8% 4% to grow.
300 6% 1%
200 4% 1%
AU FR
8.5% 100 2%
58.6% 54%
0 0%
UK IT 2012 2013 2014 2015 2016
15.5% 26.1% USA EU5
Source: QuintilesIMS MIDAS, MAT Q4 2016
ALL OTHERS JAPAN
Source: QuintilesIMS MIDAS, Specialty Sales Specialty growth ASIA / AUSTRALIA CHINA
Positive Growth MAT Sept 2016 Traditional Sales Total Global pharma growth LATIN AMERICA AFRICA / MIDDLE EAST
7typically treated by small molecules. To Specialty Biologics and Small Molecules Today and in the R&D Pipeline
The Right Markets
date, the small molecule versus biologics Global Pipeline (Jan 2017)
Global Specialty Sales (2011-16)
mix is relatively even. Yet, small molecules bn LCUS$
are more than half of expected future Biologic Small Molecule Exhibit M-7:
CAGR % Today, the majority of specialty drugs are
approvals (Ex. M-7). (2011-16) Preclinical 817 950 biologics, but looking at the pipeline,
biologics make up less than half of all
Phase I expected new medicines. Moreover, more
Biosimilars & Non-Original Biologics +13% 484 614
53% than a quarter of the global pipeline is
While the biosimilars market in the developed designated as orphan drugs.
Phase II 582 809
world has been somewhat subdued, new
opportunities exist for biosimilars and non- 59% Phase III 204 341
original biologics (NOBs). 47% (56%)
Pre-reg/Reg 92 164
As patent expiries in developed markets 41%
contribute to slower growth, areas attracting 2011 2016 Top 10 companies
interest include monoclonal antibody share of specialty
2016 Source: QuintilesIMS Market Prognosis Q4 2016;
oncologics, modern insulins and anti-TNF Specialty Biologic Specialty Small Molecule Total pipeline is 43% biologics
IQVIA (QuintilesIMS) Institute Feb 2017
mAbs (a therapy area larger than all
previous therapy areas with biosimilar Biosimilar Development is Being Actively Pursued by Many Companies
competition put together) (Ex. M-8).
Number of Biosimilar Companies
Approval pathways for biosimilars, cleared 2016 Global Sales US$Bn (Phase III, Pre-reg / registered, Marketed)
over the past decade, will continue to offset Exhibit M-8:
branded growth and add to the credibility of adalimumab 18.7 17 Biosimilars are attracting companies, large
biosimilars across major markets. The US, and small, based on global sales of greater
insulin glargine 12.5 5 than $4.9 billion in 2016. Investments will
EU5 and Japan currently support biologic accelerate market growth, with product
expenditures and will be key for biosimilar etanercept 10.2 17 positioning and pricing as some of the
most critical challenges.
new opportunity. infliximab 8.6 8
Additionally, biosimilars will be available for
rituximab 6.9 18
several of the leading autoimmune products
by 2021, potentially allowing wider use with bevacizumab 6.4 13
lower spending. Two developed regions,
trastuzumab 6.2 12
Japan and Europe, make up 92% of
biosimilar sales currently, with uptake pegfilgrastim 4.9 19
slower in some major European markets.
epoetin alfa 2.9 19 Source: QuintilesIMS MIDAS, Dec 2016
Seen by many as the start of a new wave,
filgrastim 1.0
infliximab biosimilars have had inconsistent 16
8impact following launch. Uptake so far A gene-editing technique, more powerful, Biosimilar Uptake, the Nordics Versus the UK
The Right Markets
has been cautious in most European rapid and less expensive than any
infliximab biosimilar uptake, % share of volume in terms of treatment days
countries—with exception of the Nordics previously invented, CRISPR-based
(Ex. M-9). Tender systems in the Nordics therapies are expected to accelerate in the 100%
Exhibit M-9:
have led a to rapid uptake (up to 98% market in the next decade. In the case of In the Nordics, clinician acceptance has
penetration) of biosimilars in comparison these completely new technologies, it is 80%
been high, meaning safety and efficacy
evidence for switching has largely been
to EU5 countries. difficult to determine the impact each will accepted. Price reductions also became
have on the specialty category. significant quickly and patients have not
However, as biosimilars take their place in 60% objected to being asked to switch or start
the industry landscape, commercial models CRISPR-based therapeutics and other on a biosimilar.
for biosimilars need to adapt. Since they regenerative technologies could stretch 40%
have the same clinical profile as branded (and potentially break) the current
medicines, drug manufacturers need to better definitions of pharmacotherapy, having
educate prescribers on the clinical benefits, device- or procedure-like characteristics
20%
while focusing payers and funding entities and potentially creating a new class of
on potential cost-savings. therapeutic, with its own regulatory, 0%
financing and delivery challenges.
Future Cell and Gene Therapies
The speed of movement in the field also Norway Denmark Sweden Finland UK
For high unmet need diseases, cell and means that very rapid development
gene therapies are driving investments, should be expected in the next 5-10 years, infliximab as % of total anti-TNFs
signaling confidence in newer technologies. with major pharmaco investments and 60%
increasing numbers of companies involved.
The first cell therapy cancer vaccine has
been launched in the US and the first gene While offering huge potential, regenerative
therapy treatment has been approved for technologies also pose significant
use in Europe. Launching in August 2017, regulatory challenge. They could trigger 40%
the first CAR-T treatment has also been competition between countries and
approved in the US to treat children and institutions in terms of location of highly
young adults with a recurrent form of the specialized centers of excellence,
blood cancer, acute lymphoblastic leukemia. funding for these technologies and how 20%
commercial return is realized.
In addition to these new treatments, we’ll Source: IQVIA (QuintilesIMS), European Thought
leadership - Biosimilar tracker, Jun 2017; IQVIA
likely see the continued evolution of new While there will be further cell and gene (QuintilesIMS), Market Access, Biosimilars:
platforms such as CRISPR, microbiomes therapy launches through the decade, 0%
Learning from Europe, Mar 2016
and regenerative cell therapies. companies may find navigating valuation,
9reimbursement, sales and manufacturing Potential in Niche and Orphan Drugs is Complex and Dynamic
The Right Markets
challenging as these therapies pose
unique questions for players. High prices, Clinical Landscape for EU Orphan Indications with 1-10/20,000 prevalence
reimbursement, market access, sales and Total 243 Indications
training approaches and more will require
strong and novel commercial models Exhibit M-10:
Orphan disease drug approvals have
which may be ambitious and complex to Only one approved treatment (e.g. increased dramatically in the EU, focused
navigate. Hunter syndrome, Pompe disease, on oncology indications. Over a quarter of
paroxysmal nocturnal hemoglobinuria) 20% the entire late stage pipeline is focused on
the development of oncologics.
Niche Population & Orphan
Drug Focus Gaps in the pipeline and no
5% drugs on the market (e.g.
Orphan drugs are on the leading edge of “Clustering” where multiple 54% congenital hypothyroidism or
the specialty medicines trend, thus driving treatments exist for the same
9% osteochondritis dissecans)
even further need for precision and detail. indication (e.g. PAH, CML, CF)
With 6,000 to 8,000 rare diseases in
existence and 30 million1 people in 11%
Europe alone suffering from a rare Will start to see competition from Source: OrphaNet, SMA, IMS Health R&D Focus
disease, collectively, rare diseases are not other ODs (e.g. Idiopathic Pulmonary June 2015, OD: Orphan Drugs, MA: Marketing
Authorization (only including those with orphan
really rare. Fibrosis, Multiple Myeloma, DMD) designation), PAH, pulmonary arterial
hypertension; CML: chronic myeloid leukemia;
Of this 11% in the pipeline, 31%* of products have 2+ CF: Cystic Fibrosis, DMD: Duchenne muscular
These populations offer opportunity as products per indication, e.g. Uveitis, Ovarian Cancer, dystrophy; products for the most prevalent orphan
indications (1-10/20,000)
only 5% of orphan diseases have an Gastrointestinal Cancer, Pancreatic Cancer
approved drug treatment option (Ex.
M-10). They are also a commercially No Pipeline/No MA Pipeline Only MA (with Pipeline) MA (without Pipeline) Not Druggable or Asymptomatic 1http://www.eurordis.org/about-rare-
attractive area due to patient advocacy, diseases
medical breakthroughs, regulatory
delivery options incentives and venture number of orphan drug approvals— Fragmented Distribution These include:
capital investment. because together they represent a large
Shorter shelf lives, cold supply chain • Different models for different product
share of the medicines budget.
In addition, many orphan drugs are requirements, parallel trade regulations and types and patient segments, with some
biologics, which are less likely to have However, orphan drugs are increasingly other issues are requiring more flexible bypassing wholesalers entirely
immediate competition from generic subject to price scrutiny and will require distribution across the globe. Several issues
equivalents after patent expiration. Thus, strong justification for high price tags • New channels, including direct to patient
are giving way to more fragmented channels,
despite the relatively small market available moving forward. and adding to the precise metrics and • Increasing specialty drugs and
for orphans, there has been a surge in the complexity of demand by distribution channel. delivery options
10In some markets, such as Italy’s blood Italy’s Blood Coagulation Market: Distribution Variances by Region
The Right Markets
coagulation market, distribution by product
type has been implemented with some Direct Traditional Traditional
Exhibit M-11:
Valle D'Aosta Regions DPC2 In Italy, 70% of blood coagulation drugs go
success. Within Italy, regional Local Health Distribution1 Hospital Retail
directly to patients via LHA access. Within
Authorities (LHA) have taken control of Trento Italy’s 20 regions, high variability exists,
Abruzzo 81-100% 0-20% n/a 0-20%
distribution, creating new models, impacting with some adopting direct channels more
readily than others.
patient access to medicines, especially Piemonte Lombardia
Bolzano
Friuli Basilicata 81-100% 0-20% n/a 0-20%
Venezia
more costly drugs, and driving highly Giulia Bolzano –
variable adoption rates among regions. Veneto Provincia 61-80% 0-20% n/a 0-20%
Autonoma
Liguria
The need for precision in distribution can Emilia Calabria 0-20% 0-20% 81-100% 0-20%
be seen in both Calabria’s DPC channel Romagna
Campania 81-100% 0-20% 0-20% 0-20%
and Sardegna’s Direct Distribution where
differing paths are used to bypass Emilia Romagna 81-100% 0-20% n/a 0-20%
Toscana
wholesalers in an attempt to control costs. Friuli Venezia
0-20% 0-20% 81-100% 0-20%
DPC and Direct Distribution in Italian Marche Giulia
markets are both options for implementing Umbria
Lazio 0-20% 0-20% 81-100% 0-20%
“Direct to Patient” distribution, yet each has
Liguria 81-100% 0-20% 0-20% 0-20%
a very different drug flow (Ex. M-11). Lazio
Abruzzo
Lombardia 81-100% 0-20% n/a 0-20%
A longer-term shift to hospital distribution
is the result of not only medical need, but Molise
Marche 81-100% 0-20% n/a 0-20%
continuing efforts to control specialty
Campania Paglia Molise 0-20% 21-40% 61-80% 0-20%
prescribing. Across Europe as in Italy, Sardegna
budget concerns are driving efforts to Piemonte+Valle
81-100% 0-20% n/a 0-20%
D'Aosta
avoid wholesalers and pharmacy margins, Basilicata
Source: IQVIA (QuintilesIMS) Regional
Paglia 81-100% 0-20% n/a 0-20% Integrated Dataview, 2016
and gain greater influence in negotiating
discounts and driving growth for hospital- Sardegna 81-100% 0-20% n/a 0-20%
prescribed markets (Ex. M-12). 1Direct Distribution indicates distributing drugs
Sicilia 81-100% 0-20% n/a 0-20%
directly to patients through hospital pharmacies or
Calabria
dispensing structures managed directly by LHAs
In other hospital markets, such as in China, Toscana 61-80% 21-40% 0-20% 0-20% and bypassing intermediaries to control costs.
growth rate and share are highly varied 2 DPC is also direct to patient distribution on
Trento - Provincia behalf of LHA, however drugs price and quantity
by therapy area. Oncology maintains the Sicilia Autonoma
81-100% 0-20% n/a 0-20%
are defined via tender offers between
highest growth rate of key therapeutic areas manufactures and LHA without wholesalers or
intermediaries, with distribution through
Umbria 61-80% 0-20% n/a 0-20%
there—as in many developed countries retail channels.
(Ex. M-13). Veneto 61-80% 21-40% 0-20% 0-20%
11In certain specialty therapies, using Hospital Pharmaceutical Sales Market Share vs. 10-year Value Growth (2007-2016)
The Right Markets
oncology again as an example, retail to Hospital Prescribed Share 2016
patient channels are growing. Consider
Exhibit M-12:
Australia, where approximately 45% of Austria 4% 9% 31%
GROWTH GROWTH Longer-term shifts to hospital channels,
oncologics are distributed directly to retail specifically in Europe, are shown in the
pharmacies for patients. This requires the evolution of hospital prescription values
across country markets.
patient to assume responsibility for storage Belgium 1% 6% 38%
GROWTH GROWTH
and transport to the care delivery site and
brings with it additional considerations in
France 0% 4% 36%
pricing, reimbursement and safety for GROWTH GROWTH
pharmaceutical manufacturers.
Germany 5% 5% 14%
Delivery options also include precise and GROWTH GROWTH
differing channels within a given country. In
Brazil, where Pharmacy Benefit Managers Italy -1% 12% 61%
are considered a channel, a significant GROWTH GROWTH
decline related to economic slowdown
has caused manufacturers to review Spain
0% 10% 51%
GROWTH GROWTH
investments in discount programs,
sometimes eliminating them completely or
1% 13% 49%
reducing the number of products in the UK
GROWTH GROWTH
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Source: IQVIA (QuintilesIMS), at ex-manufacturer
Retail Hospital Value market share price levels, not including discounts and rebates,
Growth % = 10-year growth rate (2007-2016) MAT Sept 2016
20%
China Hospital Market: MAT2017Q1 Share
Exhibit M-13:
Value Share and Growth 14% MAT2017Q1 Growth Rate Key therapeutic areas account for 65% of
Rate by Therapy Area 15% China’s hospital market.
11% 11%
9%
10% 8%
6% 5%
5%
5%
4% 4% 2%
3%
Source: QuintilesIMS, Hospital Audit
(>=100 beds), 17M4
0%
12programs. Also high unemployment is Brazil Distribution Fluctuations
The Right Markets
reducing the number of people insured, Q2 2016 Q3 2016 Q4 2016 Q1 2017
therefore lives covered in these programs, 0%
Exhibit M-14:
-3%
thus reducing PBM demand (Ex. M-14). -4% In Brazil, PBM tracking for specific
-9% products and markets provides unique
-5%
In some regions distribution is a function of -12% views of non-visible physicians (+ range)
only seen within granular prescription data
local versus multinational manufacturer for this country.
-10%
(MNC). In China, MNCs have more market
share contribution in municipalities and Source: QuintilesIMS, at ex-manufacturer price
-15%
coastal developed provinces. Of the PBM
levels, not including discounts and rebates, MAT
Sept 2016
Chinese provinces, 15 provinces/
municipalities, coastal plus the land-locked China’s Local and Multinational Company Share by Region and by Therapy
Chongqing province, account for more than
65% of the country’s pharma market. Exhibit M-15 & M-16:
LOCAL Across China’s provinces, MNC market
Therapeutic focus across China is also share continues to creep upward year over
MNC
varied by MNC and local companies (Ex. M- year, from 23.8% in 2016 to 24.1% for the
same Q1 period 2017, with variances in
15, M-16). growth rate by therapy focus.
Regardless of the manufacturer or
MNC share:
distribution channel, success in complex 24.1%
markets requires precision insights—sub- Q1 2017
national views, regional intelligence and
local detail to manage demand and ensure
the right products reach the right people at
25%
the right type of care setting. MAT Q1 2017 MNC/Local
20%
15%
10%
5%
0% Source: QuintilesIMS, Hospital Audit
(>=100 beds), 17M4
-5%
-10%
-15%
TA MAT17Q1 Share in Local TA MAT17Q1 Share in MNC TA Growth Rate in Local TA Growth Rate in MNC
13TARGETING THE RIGHT PHARMERGING MARKET: Indonesia
The Right Markets
The challenges of this unique Asian market and its new healthcare policy, combine with its increasingly elderly population,
a high prevalence of infectious diseases and growing incidence of chronic diseases to boost Indonesia’s pharmaceutical
sector. However, diversity abounds throughout this island nation as do requirements for precise market information.
Indonesia, the world’s fourth most populous human, economic and geographic diversity. market (+7.49% year-to-year, according to However, the ranking of key attributes
country, is also one of the most ambitious in Today, 150 million people are packed into 2016 IQVIA market indicators). differs by city. Thus, local geography and
terms of healthcare. In 2012, the central Java, an island with the size of England, specialty play a role as expectations differ
This concentration has ongoing implications
government declared it would provide while the remaining 100 million Indonesians within countries and across markets. When
for pharma commercial models locally as
affordable healthcare to all of its 250 million are spread across some 7,000 islands over assessed according to specialty, GPs,
well. Saturated physician schedules require
citizens within seven years. Known as the a distance of 3,000 kilometers. Thus, Internist and Pulmonologist, say honesty is
every minute spent during a medical
Jaminan Kesehatan Nasional, this effort healthcare access is significantly limited for the most important attribute, though GPs
representative visit to count. In urban
was launched in 2014 with the potential to the majority of Indonesians in rural areas. also want pharma representatives to be
Indonesia, honesty and product knowledge
become the world’s largest social health “Updated with the most recent information.”
While this dynamic was identified years ago are seen as important attributes of a pharma
insurance program. Anesthesiologists want reps to be
and supposedly addressed with compulsory field representative, as reported in a
“Knowledgeable on the disease area,” and
The clock is ticking and turning the plan service and other incentives, it continues QuintilesIMS medical representative
“Knowledge on own product” is the most
from will to reality presents particular and has resulted in intensified competition satisfaction survey in late 2016.
important attribute for Oncologists.
challenges in a country of tremendous within the steadily growing pharmaceutical
Urban Indonesia: Location Impacts Physician Requirements on Pharma Medical Representatives
Jakarta Bandung Surabaya Semarang Medan
Exhibit M-A:
87 100 98 100 83 Medical representatives are one of the most
Honest, does not oversell
important assets for pharmacos across
95 62 83 90 Indonesia, yet it is becoming more difficult
Knowledgeable on own products 100
to gain attention due to intensified
competition. Thus honesty, follow up and
100 66 79 66 97
Always follows up on agreed actions/reliable product knowledge are now differentiators
and are generally most important to
The best possible level of service 80 88 86 78 63 physicians in urban Indonesia.
Deliver key information within limited time 93 53 88 62 100
Source: QuintilesIMS, Medical Representative
Satisfaction Survey, Dec 2016
Knowledgeable on disease area 61 78 94 73 82
Updated on latest information 74 57 77 82 86
14Portfolio Optimization:
The Right Markets
Implications & impacts for life sciences management
Addressing commercial challenges by market requires increasing depth, precise dimensions
and granular measures across geographic breadth and segment depth. Here are a few things
to consider in assessing and adopting differing strategies for each market.
Global / Regional / HQ
Brand / Franchise / Marketing Sales Operations Leaders Market Research Director /
Directors and Leaders and Sales Directors Business Intelligence
1) Weigh pharmerging markets with granularity. It’s easy to 1) Harmonize sub-national with national insights. Sales 1) Recognize that not all markets are represented equally.
recommend balancing geographic markets, yet difficult in operations, targeting, territories and more, are specific to Data used routinely in developed countries are seldom
practice. Strategies that work in one emerging market may regions, cities or other local geographies. Using the right available in all countries equally, and not all regions within a
not work in another, and not all regions of a country grow at national and sub-national data is important, yet local given country react similarly. Understand the local nature of
the same rate. It may be better to define precise thresholds views should roll up to harmonize global and local the data you need and look to a partner who can help you
by market level or therapy area on volume growth, performance with minimal discrepancies and with resources and insights that enable informed decisions.
regulation elements, competitive landscape, etc., to maximum accuracy.
maximize profitability. 2) Utilize secondary insights to make PMR go further.
2) Align incentive compensation design and strategy. Data Supplement or substitute primary market research (PMR)
2) Drive market precision. Aim for local specificity as niche and metrics should incent the behavior you want. Matching with secondary or syndicated information to guide and
populations, orphans drugs, specialty medicines and pricing data granularity with incentives can increase the consistency improve primary results. PMR coupled with secondary data
options require insights regarding sub-national anomalies in how territory and national sales performance is reported can help better define research requirements and focus on
and intricacies. Appropriate data can help track, trend and and can lead to greater confidence in home office or efficiency and efficacy in attaining results.
size opportunities, but local views should harmonize headquarters’ views.
with global. 3) Leverage data and analytic expertise. As a resource for
3) Build networks and partnerships that leap beyond internal operations, MR and BI can provide greater impact
3) Prioritize product profiles. Winning strategies depend internal hurdles. Local players can act as the commercial by moving well beyond descriptions and interpretations of
on precisely the right information for your R&D pipeline, arm to leverage distribution and sales capabilities that past performance by entering the realm of predictive and
geographic presence, appetite for risk and willingness to deliver strong top-line results. Research options of existing prescriptive analytics. Look for these embedded with rich
invest. At the highest level, you need information that helps entities (affiliations, partners or M&As) to build geographic data assets to enable advanced forecasting, specialty and
prioritize countries, set portfolio priorities and evaluate cover and portfolio breadth that ensures the right balance of therapy level understanding, machine learning and other
investments in commercial structures to support your assets and expertise. advanced analytics.
company’s current and future products.
+ Country or Local Directors and Leaders
15Sales & Prescription Data Availability by Region
The Right Markets
Precision data can positively impact global, regional and local markets and business results
EUROPE Sales & Prescription
ARMENIA DENMARK ITALY NORWAY SWEDEN Data Types
AUSTRIA ESTONIA KAZAKHSTAN POLAND SWITZERLAND
AZERBAIJAN FINLAND KYRGYZSTAN PORTUGAL TURKEY
BELARUS FRANCE LATVIA ROMANIA UK
Retail, dispensed Rx
BELGIUM GEORGIA LITHUANIA RUSSIAN FED UKRAINE
BOSNIA GERMANY LUXEMBOURG SERBIA UZBEKISTAN Dispensed Rx at
BULGARIA GREECE MACEDONIA SLOVAKIA
NORTH AMERICA CROATIA HUNGARY MOLDOVA SLOVENIA
prescriber level
CZECH REP IRELAND NETHERLANDS SPAIN
CANADA Movement of packs
PUERTO RICO
USA
and prescriptions
All major channels: Retail,
Mail, Hospital, Clinics,
Long-term Care, HMOs,
Others
MIDDLE EAST & AFRICA
Sourced from pharma,
ALGERIA LEBANON
wholesalers, institutions
EGYPT MOROCCO
FR. WEST AFRICA*
ASIA-PAC
SAUDI ARABIA
LATIN AMERICA GHANA SOUTH AFRICA AUSTRALIA NEW ZEALAND Direct & indirect sales
JORDAN TUNISIA BANGLADESH PAKISTAN
ARGENTINA DOMINICAN REP. KENYA UAE CHINA PHILIPPINES
BRAZIL ECUADOR KUWAIT Daily, weekly, monthly,
HONG KONG SINGAPORE
BOLIVIA MEXICO
CENTRAL AMERICA PERU
*FRENCH WEST AFRICA: Benin, Burkina Faso, INDIA SRI LANKA quarterly frequencies
Cameroon, Chad, Congo, Gabon, Guinea, INDONESIA TAIWAN
CHILE URUGUAY Ivory Coast, Mali, Niger, Senegal, Togo
JAPAN THAILAND
COLOMBIA VENEZUELA
KOREA VIETNAM National, sub-national
*CENTRAL AMERICA: Costa Rica, El Salvador, MALAYSIA
Honduras, Guatemala, Nicaragua, Panama
Multiple attributes
16Identifying the
Right Influencers:
Provider alignment
17New faces drive treatment Specialists concentrate by market
Quebec and Atlantic provinces show higher prescribing
THE
RIGHTINFLUENCERS
4 10
rates from non-traditional writers than national PHYSICIANS IN BALTIC REGION
per capita average of 0.57 PRACTICE IN
OF 8 SPECIALTIES
Broad changes are impacting healthcare
Pediatrics, Obstetrics & Gynecology, Cardiology, Neurology,
professionals globally—though how Psychiatry, General Surgery, Ophthalmology, Orthopedics
these play out depend largely
NFL
0.73 on the local landscape.
ESTONIA 38% IN 8
SPECIALT IES
QC PEI US Nurse Practitioners &
1.02 0.73 Physician Assistants
NB
NS
doubled Rxs written in the LATVIA 36% IN 8
SPECIALT IES
0.94 past 5 years.
x2
0.66
& = 22% of LITHUANIA 38% IN 8
NP PAs US HCPs SPECIALT IES
Canada’s non-traditional prescribers expanding (healthcare professionals)
5yrs.
New influences abound Transparency & compliance intensifying HCPs are on the move
Physicians in Turkey and Tunisia illustrate
Increasing regulations ensure ethical interactions
IMS Health Confidential rapid and regular shifts in care delivery sites
67% physicians with physicians
74% hospitals
Q1 2016
41 DISCLOSURE
TEMPLATES
Global growth in
Disclosure Reporting
vs
Integrated Delivery Networks affiliated with majority
of US providers
Q1 2017
72 DISCLOSURE
TEMPLATES Tunisia ~17% Shift in 1 year period (2015 to 2016) Turkey ~19%
18
Source citations for all of the above may be found in the IQVIA report Driving Precision Performance, module Identifying the Right Influencers, Dec 2017 18The Right Influencers
Identifying the Right Influencers: Provider alignment
Across the globe, the profiles of healthcare professionals are fluctuating significantly over relatively short time periods, requiring precision
information and alignment with the right prescribers. While healthcare delivery depends on a country's structure, economy and politics, a
few common trends are changing the faces of prescribers globally—though how these play out depend largely on the local landscape.
For those delivering care on the front lines, • Regulatory compliance and transparency Canada’s Expanded
change is not new. Yet, it underscores a is spreading, requiring precise depth and Non-Traditional Prescribing Practices
complex challenge for those attempting to breadth to manage specificity in a manner
precisely track the details and definitions of that harmonizes both.
this quickly shifting group. Based on our
experience with healthcare professional The Changing Definition of
(HCP) data in more than 100 countries, Healthcare Professional
including more than 15 million HCPs, the Safe, appropriate medication traditionally YT
NFL
following trends are having pronounced NT
requires treatment by a physician. However NU 0.73
impact on pharmaco commercial models emerging markets often have a pronounced
and are making precision alignment with the lack of doctors in some regions, and even
right HCPs an imperative. developed markets are experiencing
physician shortages. BC MB PEI
• Definitions of healthcare professional 0.51 AB 0.22 QC 0.73
are broadening. The definition of care 0.31 SK
As a result, many countries have 1.02
0.63 ON
delivery has expanded to embrace new introduced legislation expanding 0.41
types of clinicians as the global physician prescribing authority to non-physician NB NS
shortage grows, patients demand more HCPs. These non-traditional prescribers 0.94 0.66
and technology alternatives take hold. (NTPs), including nurses, pharmacists,
• HCPs are on the move. In response to physician assistants, paramedics, midwives
policy and market forces, physicians and and others, are filling the demand and
other HCPs are switching affiliations and showing marked growth in many countries. NTP
specialties in growing numbers, creating Prescriptions
an increasingly dynamic marketplace. In Canada, an evaluation of NTP growth per Capita
• New influences abound. New shows differing provincial legislation is 0.9 - 1.0
Exhibit O-1:
stakeholders, policy makers, payers and resulting in a varied landscape. In Ontario, 0.7 - 0.8
Quebec NTPs have the highest written prescriptions average at just
organizations are increasingly mandating nurses are drivers of NTPs. While in over one (1.02) per capita. The Atlantic provinces (NFL, PEI, NB, 0.5 - 0.6
what doctors can prescribe, yet HCPs Quebec, pharmacists have seen the largest NS) have higher per capita NTP prescribing than the national 0.3 - 0.4
average of 0.57, reviewing July 2015 –June 2016 MAT.
are asked to take a more active and NTP growth (Ex. O-1). 0 - 0.2
Source: IQVIA (QuintilesIMS) OneKey, Jun 2016
accountable role than they have in the past.
19The Right Influencers
In the US, Nurse Practitioners (NPs) and continue and be seen in other EMEA US Liberal and Limited Prescribing Practices by State
Physician Assistants (PAs) have more than countries as well (Ex. O-3). Exhibit O-2:
doubled the prescriptions written over the 25% 24%
In the Asian region, Indonesia’s HCP High / Med NP
Prescribing Authority
Low NP
Prescribing Authority
Many US states have expanded
past 5 years. Nationally, NPs and PAs make prescribing authority for Nurse
concentrations are geographic in nature, Practitioners (NP), especially those with
up 22% of the HCP workforce, however not
challenging the central government’s 20% 19% significant HCP shortages. More than 17%
with equal prescribing authority in all states. of states have fully expanded prescribing
proposal to provide universal healthcare to its authority to NPs, though in some states
The expansion of US prescribing authority 16%
citizens by 2019. National coverage presumes prescribing remains restricted.
has also begun in other HCP types, e.g.
physicians will be co-located with patients. Yet 15% 13%
psychologists, pharmacists and naturopaths 12% 12%
across Indonesia, the distribution of doctors is
(Ex. O-2). 10% 10%
highly unequal, with specialists concentrated 10%
10%
On the other side of the Atlantic, in the largest cities. Comparing the doctor 8%
7%
e-prescriptions and generics are impacting ratio of 5:1 for general practitioners and 25:1 6%
doctors’ prescribing power and increasing the for specialists in Bali versus Jayapura 5%
role of pharmacists especially for reimbursed illustrates the inequity. Thus healthcare MS
NM AZ AL
drugs across Europe. In the Baltic region, access is significantly limited for the majority DC LA
0% Source: US Census Bureau, Dec 2015; IMS
Lithuanian pharmacists play a leading role in of rural Indonesians. Health, Xponent, Jan 2016; Healthcare
Relational Services, IQVIA (QuintilesIMS)
deciding which product is actually dispensed.
Looking at representative countries where NP % of TRxs Written NP % of Healthcare Professional Workforce Institute, Mar 2016; HSRA, Dec 2015
And in Latvia, generics only are prescribed for
the percentage of HCP movement is in the
newly diagnosed patients.
double digits shows significant shifts in a Concentration of Specialties in the Baltic Region
relatively short time. Notably, nearly 25% of
HCP Shifts and Concentrations 25% Exhibit O-3:
physicians in the Baltic region have shifted
Though overall stability holds given the
Given healthcare reform across the globe, over a one year period, with others in the
ESTONIA 38% in number of specialists versus traditional
it’s not surprising physicians and HCPs EMEA region also showing considerable 8 Specialties physicians over the past five years, deeper
insights show concentration in eight
are looking to medical specialties for movement (Ex. O-4). While physicians 37% specialties. In the coming years, the role of
professional development, as well as move the most, nurses, pharmacists, specialists in the Baltics will likely continue
stability and quality of life. midwives and dentists shift with regularity. 30% to increase as a result of increasing patient
populations and innovative therapies.
In terms of specialty concentrations, the As these represent only year-over-year LATVIA
36% in
8 Specialties Family / Internal
numbers in the Baltics illustrate a growing deltas, it is reasonable to assume changes Medicine
will compound with time, and therefore 34%
trend. Though Estonia has roughly half the 8 Specialties =
population of Lithuania, both have nearly 4 in increase the requirements for precision 32% Pediatrics, Obstetrics
and Gynecology,
10 physicians concentrated in eight specialty alignment with HPCs and their Cardiology, Neurology,
organizations. LITHUANIA 38% in Psychiatry, General
areas. This leaves Lithuania with a little over 8 Specialties Surgery,
Ophthalmology,
one-quarter of its physicians in all other Orthopedics Source: IQVIA (QuintilesIMS) OneKey. Apr 2017
specialities combined—a trend expected to 29% All other specialties
20The Right Influencers
Healthcare Influences Grow Although these can be overruled by Most US states have seen HCPs in certain regions of the US, where they are
individual doctors, often usage and increasingly affiliated with IDNs since 2010 expanding to payer roles as they become
While individual patients and physicians
treatment patterns vary from region to (Ex. O-5). Ten states have experienced powerful catalysts for change.
may still make treatment decisions, they do
region, providing evidence of influence from growth in HCP/IDN affiliations of 10% or
so now under the influence of multiple Outside western countries, HCP affiliations
regional provider administrators, policy greater in the last five years. In the US, 67%
stakeholders—many of whom are growing are less structured, but links to hospitals,
makers, pharmacy benefit managers and of all physicians are part of an IDN, as are
considerably in number and clout. clinics and practices illustrate local
payers (both private and public). Entities, 74% of all US hospitals. IDNs influence
intricacies. In a Baltic example again, half of
Physicians have options when prescribing such as Accountable Care Organizations protocols with direct “class level” prescribing
all Latvian doctors work in Opencare Clinics
treatments, however recommended protocols, and Integrated Delivery Networks (IDNs) in controls and indirect bottom-up conditions
and an additional 21% practice in both clinics
pathways and formularies rely on top-down the US, are shifting power and requiring the that impact brand pull through. IDNs often
and hospitals. Yet, Estonia’s hospital-only
administrative mechanisms. industry to better align commercial vary influence by disease and differ in
doctors are the highest portion in the region.
approaches with these new influencers. “control” levels across the regions the central
Meaning, a large and growing number work
IDN serves. Some IDNs are more prevalent
Percentage of HCPs on the Move in One Year (2015/2016) Affiliations of HCPs with Integrated Delivery Networks
Sample of High Change Rate Data Continues to Grow in Most US States
Exhibit O-4: Exhibit O-5:
Baltic Median 2015 55% Affiliated to IDNs
All HCPs (LV, LT, EE) Tunisia Turkey Greece Looking at just year 20% Looking at a five-year
over year data, the
change, 76% of US
Physician 24.15% 17.08% 18.77% 14.90% movement of HCPs is VT
MT states increased the
sizeable and most 15% MS
ND level of HCP affiliation
significant within the CT AR
Nurse 18.66 1.10 2.04 6.46 WV ME to IDNs. This growth
% Change in IDN Affiliation, 2010 to 2015
ID
physician category.
WY
supports IDN efforts to
This constant WA
Pharmacist 8.67 2.45 2.21 5.41 10% increase negotiating
movement produces an MO DC
power with insurers,
increasingly dynamic IN
Midwife 14.97 7.22 1.33 2.68 PA OH leverage economies of
marketplace for life 5% CO KY
OK KS scale and drive pay for
science companies NJ GA NY I
Dentist 10.58 5.74 10.63 3.14 NCNE IA performance initiatives.
MD DE
focusing on VA SC NH MA
AZ CA HI
professionals in TN FL OR MI
Paramedic 8.21 0 2.49 3.11 0% WI
changing markets. AL RI
NM
NV UT SD MN
Administrative 0.64 11.46 0.72 7.79 LA
-5% TX AK
Other 5.40 0 0.47 3.26
Source: IQVIA
Veterinary 0.00 - 9.22 0.21 -10% (QuintilesIMS) Healthcare
35% 45% 55% 65% 75% 85% Organizational Services;
Source: IQVIA (QuintilesIMS) IQVIA (QuintilesIMS)
TOTAL MKT SHIFT 19.26% 13.25% 12.35% 10.60% OneKey, Mar 2017 Institute, Mar 2016
% of HCPs Affiliated to IDNs, 2015
21The Right Influencers
only where specialty therapies are used and Practice Location Differences Across Growth in Disclosure Reporting:
patient access is often limited (Ex. O-6). the Baltic Region Increased Geographical Coverage and Templates
In other developed markets, stakeholder 80
72
Estonia Countries Templates
influences are extremely complex as noted 70 64
Estonia 40% 39% 19% 3%
in this UK example (Ex.O-7). For a
60
pharmaco building a business case for an Japan Canada
intravenous iron anemia service, the Latvia 50 44
Latvia 50% 25% 21% 4% 41 39
37 37 38
difficulty was discovered in trying to follow the 40
payment flow within the National Health 30
Service (NHS). Lithuania
Lithuania 44% 31% 22% 2% 20
Following primary market research, efforts 10
uncovered that it wasn’t clear which NHS 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
0
entity was responsible for paying for Only Opencare Clinics Only Hospital Q1 2016 Q2 2016 Q3 2016 Q4 2016
different elements of the service. Influencer Opencare Clinics and Hospital Other
Mapping highlighted the need to precisely Exhibit O-8:
Exhibit O-6: The evolution of countries and templates over the past 12 months shows transparency
identify the key stakeholders and From one-quarter to more than one-third of Baltic region physicians practice only in mandates growing significantly. Templates list the required information manufacturers must
influencers of these health services to hospitals settings, influencing patient therapy starts and follow up. disclose on the transfers of value between the healthcare industry and HCPs/HCOs.
maximize the probability that therapeutic Source: IQVIA (QuintilesIMS) OneKey, Mar 2017 Source: IQVIA (QuintilesIMS) OneKey, Mar 2017; AggregateSpend360
interventions would reach patients.
UK NHS Institutional & Professional Stakeholders: Intravenous Anemia Service
Transparency in HCP / HCO Reporting
Regional payer Local health economies Exhibit O-7:
Across the globe, regulatory and compliance bodies
Clinical Commissioning Groups (CCGs) Within the single-payer system of the
requirements stem from similar universal CCG Lead Decision making on
NHS, the influence of newly generated
cost effectiveness,
goals of ensuring ethical contact and CCG leads commission services from provider NHS Trusts affordability constraint stakeholder entities or empowered
professional groups can change rapidly
interaction with HCPs and Healthcare Local healthcare NHS Hospital trusts
balanced against
and be difficult to follow. Often payer
patient outcomes at a
Organizations (HCOs). provider
population level bodies make the final determination on
Formulary Committee Chief Pharmacist funding of services within the NHS.
Though mandates differ by country, as do Chief pharmacists shed light on following the money between the Trust and CCGs
policy change frequency, interactions with Internal NHS Trust
Blood Transfusion Clinical Lead
HCPs/HCOs increasingly require tracking, hospital
departmental Lead Clinical Scientists straddle across the decision making domains between
monitoring and reporting with both local management the patient and business process levels for anaemia clinics
specificity and regional breadth. A quick
Patient-level health
view of the past four quarters shows how professional
Anaesthetists Haematologist Decision making in
Collaboration and respect to direct
significantly the number of required interactions Anaesthetists are often named influence decisions Key stakeholder for determining patient care Source: IQVIA (QuintilesIMS) UK Market Access
anaemia leads at NHS Trusts selection of therapy internal analysis, Jun 2017
templates has grown and indicates the
increasing number of countries requiring Key decision making body Decision making for reimbursement Decision making for market access Influencer of prescribing Prescribers
disclosure reporting (Ex. O-8).
22IDENTIFYING THE RIGHT RUSSIAN INFLUENCERS: Local provider turmoil in action
The Right Influencers
The Russian National Healthcare system has experienced upheaval since the move from the old
Soviet Union's system. National changes have driven HCP turnover, by facility and by specialty.
Morphing still, physicians continue to deal with government regulations and this shifting infrastructure.
Post-Soviet 1990s Russian healthcare was began to experience financial troubles leading In 2015, another new regulation required As Russian HCPs become more outcome-
financed by federal and regional budgets that to the “May 2012 Decrees,” providing for patients to align to a medical institution focused, medicine choice, prescribing and
reimbursed hospitals, but did not cover costs. privatization of state health services and and doctor (or a paramedic in rural areas). treatment recommendations will evolve as
The bulk of reimbursements went to doctors physician salary increases by as much as In this move to manage mergers, closures well. However, as patient alignment
as state employees. However, incentives for 200% by 2018. or expansions based on patient flow, increases, physician time has become
performance improvement and efficiency— hospitals and clinics were financed on a precious—allowing about 12 minutes per
The majority of Russia’s regions were
and improved population health—were per capita basis and physician payment patient per visit. This is reducing medical
required to take unpopular measures,
lacking given the low per capita health based on the number of people “attached” representative access to HCPs and
resulting in elimination of 35,000 beds, and
spending (and physician salaries) in to each physician. increasing the number of physicians
closure of 76 clinics and 306 hospitals.
comparison to developed countries. refusing rep visits. Thus, global and local
Other actions included out-staffing, creating With 97% of insured Russians attached to a
life sciences organizations are looking to
By 2011, the Russian healthcare system was specialty hospitals, merging clinics and doctor, the Ministry of Health now believes
remote detailing technology and other
converted to single-channel insurance, with reducing staff, resulting in significant its groundwork is strengthening doctor
communication channels they had
no government financing. Hospitals soon turnover in the Russian HCP base. responsibility for patient health outcomes.
previously avoided.
Shifting HCPs in Russia Based on Government Restructure
%HCPs on the
Russia: Top 5 HCP Specialties Exhibit O-A:
move (1 year) 8,000 Exhibit O-B:
As a result of system upheaval, many GPs
dismissed in 2013/2014 switched to a By 2014, general practitioners and
Child and Youth Allergology 16.69% 6,000 pediatricians began finding new
specialty. By 2015, a new pattern
emerged, though specialties continue to employment, though not at a rate that
shift even today. 4,000 matched earlier dismissals. Only
Angiology 15.38% specialists found employment at a higher
rate than previous dismissals.
2,000
Dialysis 14.57%
0
2013 2014 2015
Urology 13.57% -2,000
Source: IQVIA (QuintilesIMS) OneKey, Jun 2017 Source: IQVIA (QuintilesIMS) OneKey, Apr 2016
Child Gastroenterology 13.25% -4,000
GP Pediatricians Specialists
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