Horizon scanning: What’s on the agenda for healthcare in 2019 and what does this mean for pharma?
NHS Forward View
As we enter into a new world post Brexit, our 70-year-old NHS continues to evolve and thrive to become a world class service by adapting to the external environment.
The New NHS 10-Year Plan promises to deliver next generation efficiencies with a new structure of governance and financial controls in place within seven distinct areas and NHS England working in tandem with NHS Improvement.
Integrated care will become the model of care throughout localities with a focus on local leadership and governance to ensure services are joined up with an aim to treat neighbourhoods and create a model for population health.
The continuing focus on spend and affordability will remain a key focus as medicine optimisation models of care drive some of the inefficiencies in the system.
New models and approaches by the National Institute for Health and Care Excellence will play a key role in speciality, rare and ultra rare conditions as assessments become more fitting, as well as commercial arrangement on managed access.
The role of digital will play a key role, as the new funding made available begins to re-shape the priority centres and digital exemplars to ensure better sharing of data.
What can pharma do?
There is a clear call for pharma to change the way it interacts with the NHS to reflect an understanding of the changing structure and its need. This comes at a time when it is becoming increasingly difficult to generate the positive return on investment that the industry needs to fund ongoing research and development in the continued search for life improving treatments. Cost and time to commercialisation is increasing, the time left to commercialise within patent protection is decreasing, specific labelling is reducing the population to be served, and there is persistent downward pressure on pricing.
In effect, the industry is being asked to deliver results with less and innovate at the same time: the new models of care and integrated approach means pharma is required to adapt and ensure alignment, not just for new product launches, but any commercialised product in the changing and challenging UK market.
Market access is not an event that is followed in serial fashion by traditional promotion; market access and continued access to medication is an integral part of the product life cycle that needs to be intertwined with local promotional support. However, areas should inform each other reciprocally if industry and the NHS are to work together to truly deliver on population outcomes.
Just like in any good business plan, working with an NHS partner requires insights, planning, delivery and feedback to inform the next cycle of planning and execution.
In understanding how to adapt, we first need to identify the population need we are trying to answer. Collaboration with key stakeholders across these integrated models of care is critical; taking time to uncover how our different biopharma offerings align with their goals.
Whilst at first sight it may seem counterintuitive in a challenging economic market to invest more in good market research upfront – not just on marketing messages and core claims but critically investing in the ‘what’ and ‘how’ of delivery – it can be the best means of optimising the use of the valuable resources available and help to reduce wasted effort.
- Key account managers, healthcare team and medical science liaisons need to operate as one team and align to local priorities for any given geography.
- Additional value-added services to these local teams are vital to ensure integration of primary and secondary care support.
- Marketing, medical and patient access teams should also align objectives internally with the ability to flex at local level.
- Relationships with the academic community via bodies like academic health science networks are critical to drive the innovations needed, as highlighted in Sir John Bell’s Life Science Sector Deal.
Pressures on industry
As the environment continues to change structurally in the NHS, with extra pressure on affordability and medicine optimisation, pharma is feeling the pinch.
As well as the extra charges for the health technology assessment process and the newly-announced pharmaceutical price regulation scheme payments, it is not surprising that global pharma colleagues are questioning the viability of the UK.
The backdrop of Brexit has added extra pressure and resource to ensure ‘no deal’ scenarios are played out and costed out with little support from the Government.
However, the UK remains one of the early launch countries as well as holding its position as one of the leading research centres in the world. The new £700m Francis Crick Institute in London is testament to that*, as well as the UK being home to four of the world’s top 10 leading universities**.
As treatments become better and life expectancy increases, novel ways to co-create solutions with the NHS in a collaborative way will become necessary in terms of pricing and value add. The introduction of therapies, such as the CAR-Ts, has meant a re-think on costs over and above just drug costs, ensuring the decision is made collectively across different stakeholders, including pharma.
Whether it is effective launch planning and delivery or optimising the availability of currently available medicines in a volatile environment – for example through the phenomenon of Brexit or more generally the inexorable increasing pressure on costs – we need to build our plans on partnership, insight, joined up tailored delivery and above all else the ability to remain flexible.
The Sector Deal
The second Life Sciences Sector Deal announced in Dec 2018 highlights how industry continues to show confidence in the UK’s R&D strengths, building on UK’s world leading research and data assets and AI leadership, with £1.2 billion of new inward investment announced as part of the deal.
Supporting the UK Government, NHS and life sciences in achieving better treatment value and greater access to medicines, IQVIA has committed a transformative investment package, opening a fourth UK clinical research Prime Site facilitated by the National Institute for Health Research, and announcing a significant partnership with Genomics England.
Paul Simpson is Head of Contract Sales and Medical Solutions, IQVIA.
Santoke Naal is Head of Market Access, IQVIA.
Go to www.iqvia.com