THE PHARMACEUTICAL MARKETING SOCIETY

THE PHARMACEUTICAL MARKETING SOCIETY

Welcome

Agenda:

About PM Society

The PM Society The PM Society was established over 40 years ago as a not for profit organisation to serve the needs of the pharmaceutical industry and its service agencies. We believe that excellent healthcare communications leads to better outcomes for patients. Our purpose is: Supporting organisations and people working in healthcare Providing education and development Recognising excellence and promoting best practice

What does the PM Society do? Awards The PM Society Awards and the Digital Awards where we recognize excellence and promote best practice across the industry. Both sets of awards are constantly being updated and improved to reflect the latest industry trends The PM Society Awards being the largest annual event in the UK industry calendar The Digital Awards being the only dedicated digital focused Awards scheme in the healthcare arena. Judging is undertaken by expert members of the industry and its customers make sure you enter to be recognized as industry leading by your peers! PriMe Training Running for over 10 years Constantly expanding and evolving to reflect the latest industry trends. Aimed at both pharma and agency personnel at all levels and run by experts in their fields, the programme ranges from Pharmaceutical Marketing for non-marketers to Mastering Launch Excellence. PriMe can be tailored to create a bespoke workshop covering specific challenges or training needs get in touch to discuss further. There is a PriMe course for you whatever you need to focus on to ensure your personal development and skills keep pace with the ever-changing environment!

Interest Groups Patient Engagement Digital Market Access The Society has four active Interest Groups aligned to the current challenges and issues facing today s marketers Industry- Agency Relationships

Get involved! As a not for profit organization we re run mainly by volunteers from the pharmaceutical and life sciences sectors Supported by a core team based at the Horsham office, which provides project support and strategic oversight across the different PM Society work streams. We rely on input from members across both the industry and agency sides and there are varying ways in which you can get involved from being an Advocate for the PM Society in your company and sharing information around events, awards and training to actively joining an Interest Group to work on specific area projects. Please get in touch if you d like to get involved! @PMSociety #marketaccess

Medicines Optimisation THE PHARMACEUTICAL MARKETING SOCIETY

Medicines Optimisation Overview Medicines optimisation differs from medicines management in a number of ways but most importantly it focuses on outcomes and patients rather than processes and systems. This focus on improved outcomes for patients is likely to help ensure that patients and the NHS get better value from the investment in medicines. 4 guiding principles of medicines optimisation to help support patients get best outcomes from their medicine use: 1. Aim to understand patient s experience 2. Evidence based choice of medicines 3. Ensure medicine use is as safe as possible 4. Make medicines optimisation as part of routine practice Medicines optimisation looks at how patients use medicines over time. It may involve stopping some medicines (deprescribing) as well as starting others, and considers opportunities for lifestyle changes and non-medical therapies to reduce the need for medicines. By improving safety, adherence to treatment and reducing waste, the medicines optimisation approach will help to ensure that by working together we support patients to get the best outcomes from their medicines There is an increasing focus on using the medicines optimisation principles as part of formulary reviews. References https://www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.pdf https://www.nice.org.uk/guidance/ng5/evidence/full-guideline-6775454 https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

Medicines Optimisation Overview Using the 4 principles of medicines optimisation to help improve quality of life and outcomes for patient: Patient experience how disease affects their lifestyle, what medicines are prescribed and how they are taken (or not). Evidence-based choice of medicines Ensure medicines are Safe & effective Medicines optimisation as part of routine practice Optimising drug choices for individual patients requires that both prescriber and patient are involved in decisions and have the right information to make an informed decision. References https://www.rpharms.com/promoting-pharmacy-pdfs/helping-patients-make-the-most-of-their-medicines.pdf

Regional Medicines Optimisation Committees The Accelerated Access Review: Interim Report (October 2015) highlighted the need to reduce unnecessary barriers to patients receiving the medicines they need. A long held concern is how new medicines, or some new indications of existing medicines, which are not evaluated by the National Institute for Health and Care Excellence Technology Appraisals (NICE TA) programme, are instead evaluated many times across the NHS. NHS England has committed to achieving best value and patient outcomes from all medicines by helping to eliminate unnecessary duplication of effort from area prescribing processes, and refocus scarce resources towards implementation activities, through implementation of medicines optimisation as part of the NHS RightCare programme. To achieve this goal, NHS England is committed to the establishment of four Regional Medicines Optimisation Committees (RMOCs), operating together as part of a single system to eliminate duplication of activities. Copyright Visions4Health Ltd

Optimising the Use of Cancer Medicines Rob Duncombe Director of Pharmacy The Christie NHS Foundation Trust

The Christie

Medicines Optimisation Aim to Understand the Patients Experience An Evidence base As Safe as Possible Improved Outcomes Part of Routine Practice Monitoring and Measuring

What have we done.. Dose banding of Chemotherapy Introduction of Bio similars Cost Effective Dispensing Routes Cancer Vanguard meds opt programme

What s next Patients Experience We need to understand the patient experience more PROM s and PREM s Home delivery Putting patients right at the very heart of the process

What s next. The evidence base The evidence base Personalised medicine / Precision medicine What will future treatments be How much longer will we be using conventional chemotherapy

What s next Safety Methods of delivery Understanding and managing complications of new therapies SACT in an Older Population

What s next.. MO as part of everything we do Challenge existing ways of doing things Patient engagement Only treat when we know it will work???/

Conclusions Medicines optimisation is here to stay A lot more to do Ultimate Aim is to improve Outcomes

Access to Medicines: challenges and opportunities Diar Fattah Associate Director of Medicines Optimisation, NHS Dartford, Gravesham and Swanley CCG and Swale CCG

Past, present, and future Strategic Health Authorities Centralised Fund Holding Primary Care Groups Primary Care Trusts Clinical Commissioning Groups Accountable Care System Five Year Forward View 5YFV Focus on boosting primary care of patients Prevention Prevention Prevention Whole system Approach (think value) Combined budgets, holistic thinking Industrial strategy Accelerated access review

NHS Challenges Defining value for money (conflicts) Cost effectiveness vs affordability Fragmented structure disease pathways Many committees (APCs, DTCs, RMOCS, NICE, Royal Colleges..) Primary vs Secondary vs Tertiary interface issues Impact of federations? Speed of TAs (maybe FTAs will help?)

The last hurdle TA implementation STA 90 days FTA 30 days Variable, by technology, clinicians and location finding funding within a resource-constrained system Local clinician involvement and strong financial systems are important Heavy influence of real world evidence Ultimately everyone looses: Patient access to new interventions Clinicians to new interventions NHS to more cost effective interventions

Examples PCSK9 Inhibitors: Positive TA Poor uptake, struggling to identify patients (FH) NOACs: Rivaroxaban initially dominated market, Apixaban now dominating market due to RWE Data collection vital post TA

Market access for high cost therapies Innovative and curative therapies with high costs E.g. Kymriah/$475k and Yescarta/$373k Growing pipelines Early conversations with payers Sustainable funding and innovative contracting key Utilisation of RWE to mitigate clinical uncertainty and financial risk

International example Strimevlis (GSK) in Italy (AIFA) Strimvelis is the first ex-vivo stem cell gene therapy to treat patients with a very rare disease called ADA-SCID (Severe Combined Immunodeficiency due to Adenosine Deaminase deficiency), a rare disorder caused by the absence of an essential protein called adenosine deaminase (ADA), which is required for the production of lymphocytes. Reported list price, one off cots EUR 594,000 Problem Cost High one off cost EUR 594k Cost Travel/accommodation costs to specialist EU centre 25k/pt Outcomes risk not sure if curative for all patients Outcomes - Uncertainty of outcomes long term Solution Mortgage annual payments accompanied with initial payment Patient and caregiver support via NFPO (Fondazione Telethon) Pay for performance full refund by GSK if patient requires other treatments (e.g. enzyme replacement) after receiving Strimevlis Patients enrolled onto long term registry, GSK ensures patients and caregivers comply with follow up visits Abbreviated from Akshay Kumar popewoodhead

Opportunities ICS encourage holistic thinking Clear definition of value Innovative contracting Shift from stakeholders to partners Transparency Innovation in contracting Early engagement

PM Society Market Access Interest Group THE PHARMACEUTICAL MARKETING SOCIETY

The Market Access Interest Group Market access is central to the success of the healthcare industry and to patient outcomes. The term means something different to each of these stakeholder groups and equally to individual companies, health providers or patient organisations, according to their size and needs. The MAIG seeks to address the growing need for multiple stakeholders to understand their role in market access.

Our core aims: Learning and education Providing an opportunity to exchange ideas and network Celebrating best practice Membership of the group is open to anyone with an interest in market access in its broadest sense, but the Society is particularly keen to hear from industry representatives.

MAIG Survey Outcomes Hassan Chaudhury, Health IQ Ram Patel, Brainsell Ltd THE PHARMACEUTICAL MARKETING SOCIETY

Why run a survey? Different perspectives Attempt to form a baseline of the Market Access Landscape from an Industry perspective Low consensus

Objectives Understanding of MA Challenges & Trends Needs & Interests MA definition

Participants (N=104) Employer / sector Currently working in Market Access? 5% Pharmaceutical Company 41% 50% Medical Device Company CRO Agency 47% 42% Yes No, but I would like to work in Market Access No Other 11% 2% 2% A few data limitations..

Outcomes Understanding of MA Pharma participants rated their understanding of MA higher than Agency participants Challenges & Trends Budget / pricing pressures Access to key decision makers Constantly changing NHS structures Inertia within NHS Needs & Interests Training and career pathways Resource: larger teams & specialised roles Greater & earlier strategic involvement Develop better payor networks MA definition 93 definitions offered, all were different Ranging from 3 to 87 words

Definition of Market Access MA definition: aggregated mean from survey responses Ensuring patients receive appropriate treatment at the right time and right price, working with the local/regional NHS and their processes based on value MA definition: already accepted by PM Society Principally market access involves preparing a positive environment which supports uptake of your product and demonstrating the value of your product to the range of customers who influence uptake. Strategically, market access is about packaging data in the right way, for the right customer at the right time

How MAIG can help Education + Training + Celebrating Excellence Impact of changing NHS & priorities Creating value proposition for patients, providers and company Current and future challenges in the field HTA submissions for specific therapy / disease areas Specialised Commissioning and relationship with NICE Career paths within Market Access and skills required How to implement partnerships / working together Debate between Medicine Management and secondary care with clashing agendas Potential speaker types DoH / Policy and Govt Departments NHSE / NHS Confederation CCGs, NICE, IQWiG and similar institutions Key national figures Senior Market Access directors of the industry Pathway redesign leads Market Access specialists

The next survey End June 2018 Please engage Come forward with any questions you would like included Take part / raise awareness

Integrated Care Systems THE PHARMACEUTICAL MARKETING SOCIETY

THE PHARMACEUTICAL MARKETING SOCIETY Q&A Hosted by Mark Duman Director, MD Healthcare Consultants Ltd