Moves towards greater patient-centricity are beset by barriers, but with empowered patients eager to engage, the incentive to act has never been greater, argues Ana Nicholls
Few in the pharma industry now argue with the idea of putting patients rather than products at the centre of their businesses. As health payers look to control costs and increase efficiency, they are moving away from a focus on treatment to a focus on outcomes. If companies are to compete in this environment and protect product revenues, then they need to mirror that shift at every stage of the process.
In the post-blockbuster era, a clearer view of patient needs and market gaps is essential in order to guide drug discovery. With patient empowerment increasing, companies need to reach out to patient groups as well as doctors to raise awareness of their products. To improve the chances of reimbursement, they also need to improve the cost-effectiveness of their drugs by supporting treatment and encouraging adherence. Then, crucially, they need to meet new pharmacovigilance rules by tracking patients' response to treatment, including any worrying side effects.
Unfortunately, they are likely to discover barriers at every step. In the past, perhaps the biggest barriers were internal ones; for example, pharma research – led by the R&D department – traditionally left the job of finding profitable target indications for a drug surprisingly late in the process. This silo mentality has changed over the past decade or so, with companies now seeking out areas of unmet need. The explosion in orphan drugs and breakthrough therapy designations is one proof, albeit encouraged by regulatory incentives.
Even so, drug development still tends to revolve around a portfolio of existing products, with companies keen to extend indications or develop combination therapies. The marketing of drugs too still revolves around brands or products in many companies, despite efforts to reorganise around disease groups. Shifting away from this traditional organisational set-up means reorganising departments and reallocating resources, although companies are moving carefully to avoid disrupting existing business too much.
The biggest area of progress has been in gathering and analysing patient data. The push here is the increased focus on outcomes by payers, while the pull is the development of better IT systems and data collection. Although privacy concerns remain important, patients are increasingly willing to hand over personal information for their own or others' benefit. In return, they can hope for better treatment as pharma companies use the opportunity to find out more about how their own products work in practice.
However, there are still barriers outside the company when it comes to working with providers and patients to improve treatment and generate feedback. Despite debates about liberalisation and the development of internet forums, direct-to-consumer marketing remains highly restricted everywhere but the US. Even there, regulations surrounding contact with physicians have become stricter, forcing companies to modify their traditional sales rep approach. Companies need to tread cautiously to avoid falling foul of regulations while building relationships.
Nevertheless, they do have an increasing incentive to cut out the barriers between themselves and the patient. After all, many patients now know more than their doctors about their disease; they are also likely to know more than the company about the treatment and how well it works. Why wouldn't pharma companies want to tap into that knowledge?
Ana Nicholls is chief healthcare analyst at the Economist Intelligence Unit