Ahmed Mostafa, country manager of Amgen in Egypt and Iran, explains how the affiliate has been growing by providing end-to-end solutions. He also gives his take on the Egyptian government’s prioritization of healthcare and highlights that there are still improvements needed for bringing biosimilars to Egypt.
How would you describe Amgen’s position in the market when you joined the company in 2014, and what would you highlight as your main achievements since you took over?
Amgen has been a representative office at the start of 2014, so our activities were limited, as we were operating through distributors. Hence, we have established a scientific office in the country and developed a marketing and sales services entity. The next step has been to transfer market authorizations to the domestic scientific office. This has been one of our major milestones and we were able to launch around one to two products every year since then, which have been established as the market leader in its therapeutic area. Amgen brings a great opportunity to many patients in Egypt, as we are specialized in therapeutic areas which are in high demand and difficult to treat. We have been a great partner of public institutions, such as the National Health Insurance and hospitals, providing technology and improving treatments.
What is the strategic significance of Egypt for Amgen?
The size of Amgen’s business in Egypt is still small, due to our recent establishment and the low drug prices in the country. Moreover, the therapeutic areas, we are working in, are very specialized, while the Egyptian market is still very focused on general medicine. The reason for this is the high out-of-pocket expenditure for medicine. However, we are growing faster than the market and have a great potential in Egypt, as the number of patients that are benefitting from our medicine is still low and the treatment duration is short. So, with smaller improvements in the economic status of the patients, we will see big improvements of Amgen’s performance in the market. In 2016, we had 100 percent growth and 2017, after the devaluation of the currency, we still posted a 25 percent growth rate. We were able to do so mainly due to new launches and the optimization of our operations, while also providing solutions rather than only medication, offering a total package for patients and physicians.
Globally, Amgen’s portfolio spans onco-hematology, cardiovascular, inflammation, nephrology and bone health. How is this reflected at the local level?
We currently have all our products available, apart from our biosimilar portfolio. At present, there is still a few products marketed by other companies, but we are planning to incorporate these soon. Amgen has a strong presence in nephrology, osteoporosis, oncology, supportive care and more recently in cardiovascular. Chronic diseases are on the rise in Egypt, while the general medicine market for anti-inflammatories and anti-biotics is also growing. While the specialty treatment areas are becoming more important, their share is not as significant to have a major impact on the market development yet. Another growth driver is the new Health Insurance Law established: in the last two years difficult diseases have been treated more frequently than before.
Given the pricing pressures we have seen in the last three years, how do you ensure your commitment to Egyptian patients by avoiding drug shortages while also keeping up with the growth targets set by the HQ?
The most important point is to collaborate with our distributors for our local supply chains to be in place. Moreover, we need to have a mutual understanding of how economic challenges, like the evaluation, affects our businesses. It is obvious that the current pricing situation is not ideal for the industry now, but what gives us hope is that the government seems to have understood the problems we are facing. We are in close collaboration with the authorities and try to reflect the companies’ opinion to reach a decent price, that can help the patients here and while not being rejected by the industry. Progress has been made, as some of our products have seen a price increase, so I am sure we are on the right way. On the other hand, we were only able to survive during this time by managing our expenses rigorously.
Amgen is bringing many innovative products to the Egyptian market. What do you see as the role of the managing director in fostering market access and reimbursement in Egypt?
It is crucial to understand the market to see, if a product is a priority for the Egyptian patient or if there are any substitutes or alternatives. Collaborations with key hospitals in Egypt help us to understand the needs and the market better. It is important to see that it is not a one-way lane of us selling products but also learn from each other. Amgen is not an opportunistic but a collaborative company, that is keen to build trust between the different stakeholders.
On the other hand, Amgen has distinguished itself internationally by its strong biosimilars portfolio. What are the prospects for, one day, introducing these therapies to the Egyptian market?
The concept of biosimilars in Egypt is not very well developed yet, as there is still a misperception between generics and biosimilars. Amgen and other companies will need to lead this initiative in the market, as proper education for the authorities is needed in this area. This includes classification and evaluation of biosimilars to avoid the risk of having inferior biosimilars on the Egyptian market. The situation is not like in Europe, where biosimilars are already well established and the right regulatory framework is in place. Despite the improvement of the healthcare system in Egypt, 70 percent of patients pay out-of-pocket, and for biosimilars, this is not a feasible way of financing. Therefore, the groundwork needs to be done to introduce biosimilars to the system, by speaking to authorities and doctors, to motivate them to prescribe biosimilars. Currently, Egyptian doctor do not need to prescribe a high-quality biosimilar, they can prescribe anything from the original brand to inferior biosimilars, so clearly, education is needed. Overall, biosimilars will have great importance for Egypt, as they will help authorities to contain costs and reduce the erosion of the budget, while still offering high-quality medication.
Ischemic heart diseases are still the leading cause of death in 2017 at 35.7 percent in Egypt. Why is there such a high prevalence of cardiovascular diseases in Egypt?
The lifestyle in Egypt is certainly an issue, with high stress, smoking and bad dietary habits increasing the prevalence. Cardiovascular diseases are a combination of several diseases together, as it includes Diabetes, hypertension and other heart diseases. Moreover, the compliance rate amongst the population is low, as there is only limited funding for the products. In Egypt, patients only receive medication for two months, which does not guarantee proper treatment. Nevertheless, the issue cannot be only addressed by medication, but patient education is also essential.
You have introduced Repatha® (evolocumab) to the Egyptian market in November 2018. How has the drug been perceived so far?
It is a highly effective drug, which has been acknowledged, however, the price is still perceived as very high, as not every patient can effort it yet. We have received positive feedback from Egyptian physicians using the product, but we are still working on giving access to a bigger share of the population. This will be achieved through patient support programs and helping doctors to select adequate patients.
The government has outlined its plan of completely transforming the Egyptian healthcare ecosystem. What would you highlight as the most interesting developments and initiatives launched as a result of the government’s focus on healthcare?
We see two main trends in Egypt, the first one being the significant improvement of health insurance. There is a real will by the government to drive this initiative forward and there are already positive results, as new treatment areas like osteoporosis are now reimbursed and oncology treatment protocols have improved. The second trend is that national needs are prioritized by President El-Sisi and the government, which resulted in fantastic programs, for example, the 100 Million Seha campaign. This initiative has been a great success due to the availability of the tests, which are spread out in hospitals and even malls all other the country. Hepatitis C has been a major problem in Egypt five years ago, which was very difficult to eradicate with medication at that time. However, the scientific progress has made better treatment options available, which also increased the interest of the government to screen citizens and provide the treatment needed to fight the disease. If there is a top-down approach for these initiatives, they have proven to be very successful.
Both the public and private stakeholders have highlighted the responsibility of international companies in supporting national campaigns. How does Amgen support the different national campaigns of the government?
If one of our therapy areas is part of these national campaigns, we are definitely supporting them. Amgen worked with the Egyptian Cardiovascular Society, raising awareness amongst the Egyptian population for heart diseases and how to prevent them. In oncology, we organized rallies and launched initiatives for better access to funding. One of our more recent key priorities is our Osteoporosis campaign, as the awareness level of women is very low in Egypt, which has dramatic implications. The patient usually does not know it until they suffer from a fracture.
How do you want Amgen to be recognized and positioned in Egypt?
I would like Amgen to be recognized as one of the most innovative companies in Egypt, that works hand-in-hand with the government to improve patients’ lives. We want to achieve this not only by our medications but our full package solutions. Our vision is to be the leader in all our therapeutic areas.