Interview with Christoph Stoller: How pharma can contribute to ensuring health systems are sustainable and inclusive

23rd June 2015

The pharma industry, with its close relationships to patients, clinicians and payers can play a pivotal role in promoting future efficiency of health systems, says Christoph Stoller, Senior Vice President Generics and Commercial Operations, Europe at Teva. The contribution will reach well beyond supplying medicines

Complex issues such as Europe’s ageing population and the increase of chronic diseases are challenging existing healthcare models. Confronted by years of economic recession, health systems are being asked to do more with less. As a result, the sustainability, accessibility and quality of patient healthcare services in Europe are coming under increasing pressure, says Christoph Stoller, SVP Generics and Commercial Operations, Europe at Teva Pharmaceutical Industries.

“With the most comprehensive portfolio of molecules and generics across every major therapeutic area, we are already a direct and major contributor to the health system sustainability and access in Europe” said Christoph Stoller before pointing to the way in which Teva is also helping to address the burden of chronic disease management in neurodegenerative and respiratory diseases though medicines, devices and services. Such conditions are a burden on the patient, but as chronic conditions they also create an ongoing concern for healthcare givers and payers.

For these patients, maintaining a normal, active life is not only dependent on the clinical efficacy of the medication they take, but also on helping them to realise their potential, every day. “It requires an integrated approach, driven by individual needs, where pharmaceutical intervention, physician intervention and policy management are joined-up,” Stoller says.

Industry role in disease prevention and health promotion

Teva and the industry have a role beyond reacting to a patient’s sickness, Stoller believes. Current health delivery systems focus largely on the treatment of illness, and are increasingly placing the burden of care on stretched hospitals and staff, while short term efforts to drive efficiencies have concentrated heavily on pharmaceutical cost cutting. “This cannot solve the problem in the long term. Health delivery models are too compartmentalised, sometimes inefficient and only able to address waste piecemeal,” Stoller says, noting the WHO has estimated that as much as 20 percent of health budgets are wasted due to various inefficiencies – in some cases, perhaps as high as 40 percent.

One clear example of such inefficiency is the slow penetration of generics and biosimilars in some Member States. “Europe cannot afford wasting money any longer and this kind of situation should be addressed” Stoller says. “But this is not all; new approaches are also needed if we hope to offer universal access to high quality services for the generations to come. We need to be part of a sea-change move from a focus on sickness, to health and wellness planning that helps to support the patient’s journey.” Finding new cost effective ways to deliver the same or better health outcomes to patients is part of the solution, and that includes prevention and health promotion.

Going digital

Digital technologies will be an integral part of future healthcare delivery and identifying new approaches to improve outcomes of new or existing treatments, expanding the use of technologies – such as connected device but also electronic health records, m-health and cloud computing.

“These are all part of disruptive solutions that our European health systems need, says Stoller. “Imagine how convenient it would be to have your health data on your iPhone or tablet, or even your watch, being able to check how well your body is doing at any time, to have the opportunity to receive alerts ahead of an emerging problem, to be directly put in touch with a healthcare professional in case you have questions or have a face time consultation anywhere.”

A prime example is respiratory disease, with around 23 million people in the EU suffering from asthma, and 45 million from chronic obstructive pulmonary disease. In these diseases, patients can experience exacerbations that may lead to hospitalisation, and in some cases, can be fatal. Consequently, management of asthma and COPD is associated with high healthcare and societal costs.

The goal, of course, is to help patients manage their condition better, and the key to this does not have to be expensive research into marginal clinical improvements. “Simply using technology to create a more intuitive inhaler device, helping the patient take their medicine effectively, is perhaps the biggest single improvement to managing these two diseases,” Stoller says. “We have made a start with better inhaler devices; but it’s not hard to envision future stages where the technology can educate patients better.”

Empowering and supporting patients

Improving inhaler devices is but one illustration of how really putting the patient at the centre improves the efficiency of health systems. “Teva touches the lives of millions of people every day, and when they need healthcare interventions or medications, we want to make sure their experience responds to their needs. Our job is to facilitate this through ongoing innovation,” says Stoller. Given this, patient-centred approaches influence everything from product design to packaging, treatment initiation, monitoring and adherence.

“But we go further, for example through online patient support programmes for those suffering from multiple sclerosis.” In the UK for example, there is support for those who have to inject their medicine each day. “We provide further information, personalised programmes and nurse services when required, and have a European Patient solutions team that is dedicated to understanding patient issues, and exploring how we can best address them,” Stoller says.

Fostering stronger and more equitable systems

With health care systems facing the challenges of an ageing population, the rise in non-communicable diseases and constrained finances, a new approach is needed to preserve the sustainability, access and quality. “We shouldn’t have to choose between access and innovation, but enable European patients to benefit from both, and this can be possible if we accelerate efforts to tackle costly inefficiencies across the patient journey,” says Stoller.

Leading health advocates in Europe must unite their strengths and build on the shared ambition to create a more integrated, patient centric ecosystem that delivers better health outcomes and more sustainable healthcare systems.

“As an example to get there, I think we should clearly stimulate the drivers of generic and biosimilar penetration, notably in countries where penetration is slow and low. Europe has an industry which is producing these products under strict regulatory standards, creating jobs and growth and able to deliver the same health outcomes for less” said Stoller.

The gaps in existing health delivery models should also go under the microscope, especially in areas where answers to inefficiencies in care pathways already exist, Stoller believes. “European decision makers should encourage our industry to develop solutions that deliver better outcomes to patients and healthcare systems, including for existing treatments with known molecules, as this will contribute to preserving healthcare budgets rather than wasting them,” he says. “I believe that the constant search for better outcomes will run into a dead end if pricing and reimbursement frameworks are not oriented around a holistic view of the patient journey and unless there are incentives to help deliver that.”

There is a need to shift the mind-set from a cost focus to an outcomes focus, and therefore to improve the current way of assessing a new patient-centric innovative approach.

Clear market access pathways should be tailored to recognise the added value that technology is providing and where real life data will be needed. Some countries are already on the move, but not all, Stoller notes. Structural funds should be used to support countries to develop the right capabilities.

Promoting patient safety

One other consequence of the financial crisis has been a rise in parallel trading of medicines, and – more alarmingly – an increase in counterfeiting, with a consequent threat to patient safety. As Stoller notes, quality is a must to ensure patient safety, and the patient deserves the right to trust the medicine they take.

The manufacture of both generic and innovative drugs is strictly regulated and follows the same relevant good manufacturing practices and standards, and at no point should these achievements be compromised by parallel traders and counterfeiters. “The Falsified Medicines Directive includes provisions that are going in the right direction to ensure that the safety of patients and the quality of our products are protected,” says Stoller. “Teva is committed to implement safety features on our product packaging to ensure authentication and verification in pharmacies before the medicines are dispensed to patients.”

But that leaves hanging the question of whether the technology used to secure medicines boxes will be preserved throughout the supply chain or not. “In that sense, parallel trade presents a key challenge and patients should know when their products have been opened and repackaged,” Stoller says.

While at one level, improved packaging sounds like a minor detail, it is also a great example of measures that are innovative and increase equity of access to high-quality medicines. “But as with the theme throughout, it won’t work if the focus is only on one part of the supply chain – it needs all parts of the healthcare system, working in partnership, to make a difference to the patient,” Stoller concludes.