Cecilia Radu of Novo Nordisk Romania shares her tumultuous four years that have seen declining market share and have culminated in launching the company’s first new product onto the market in several years. She reveals that the perception of diabetes in Romania is skewed, as more than 50 percent of the population believes that it is a curable disease, revealing a systemic lack of education around the subject. She shares her insights on how Novo Nordisk’s call to action in Romania has triggered the first Diabetes Forum to be hosted as well as the passing of a law regulating the national diabetes prevention program.
How have the first four years of leading this affiliate been for you?
It has been a challenging but rewarding journey. Novo Nordisk is a global leader; however, the affiliate has lost its leadership many years ago. After six years of declining market share and not providing new molecules to the market, in 2017 the organisation started to grow anew. In 2018, the first product was launched and this year we are planning to bring three new medicines to Romanian patients. Several important Novo Nordisk brands are making their way to Romania and two of them will be added to our portfolio within the next three years.
Our portfolio is slowly being refreshed and in addition to the new activities in the market, we aspire to reclaim the leadership position in Romania. It was a dream in 2016, but now it is slowly becoming a reality.
How is the global portfolio reflected on the local market?
Novo Nordisk Romania has antidiabetic products which represent 80 percent of the portfolio and 20 percent are haemophilia products. Diabetes is where the growth of the affiliate is coming from and out of the three launches that are planned this year, two will be in diabetes.
The global diabetes portfolio is expected to be present in Romania by 2022. The affiliate will also follow the global trend of Novo Nordisk, by incorporating obesity as a therapeutic focus. Obesity is a leading cause of diabetes, and before we can address this chronic disease, a proper system of care against diabetes and its complications needs to be in place first.
How significant is the affiliate for Novo Nordisk’s regional presence?
Until 2016-2017, Romania was seen as a country with a low potential given the market access uncertain timelines and political volatility. After 2019, the Romanian affiliate is considered to have the highest growth potential, as diabetes care is still one of the lowest in the region; hence the big ambitions we have.
Despite the delays with the product launches, the affiliate grew in high-single digits and grew in market share. Nevertheless, despite unfavourable odds Novo Nordisk grew, and this is setting us up for a good year ahead, as the products will launch this year.
How would you assess the state of care for patients in Romania?
In Romania, the prevalence of diabetes is in line with the rest of Europe. In 2013, an epidemiological study – named PREDATORR – was conducted, and it estimated that 11 percent of Romanians live with diabetes. If we apply this to the current population, this will translate to 1.75 million patients. The National Health Insurance House has 832,000 Romanians registered as treated diabetes patients, which is in line with the “Rule of Halves” in diabetes. This rule of thumb, states that half of the people with diabetes are diagnosed, half of the diagnosed patients are treated, and that half of the treated patients will reach their therapeutic goals. Hence, we extrapolate the numbers in Romania and estimate that only 7 percent of the diagnosed patients with diabetes, are achieving their therapeutic goals.
The patients in Romania are quite well treated in terms of access, as there is a national diabetes program and the treatments are fully reimbursed. They have access to most of the newest products, which is not very common in other therapeutic areas. There are not very restrictive guidelines on treatment lines, and the doctor has the power to choose what is the best for the patient. Diabetes does not have clear symptoms and in Romania, patients are mostly diagnosed at a later stage. This late diagnostic leads to many health complications. Cardiovascular complications are common with diabetic patients – over 50% of diabetes patients die of cardiovascular complications; therefore, innovations are now targeting to extend diabetic patients’ life expectancy by incorporating cardiovascular treatments.
However, access to innovation in Romania is still quite poor, and on average it takes 43 months long after the European Medicines Association (EMA) authorization to market a new medicine. Consequently, this is the reason why only this year was the affiliate able to introduce innovations, even though the approval process started four years ago.
The lack of specialists in Romania is a challenge, as there are only 1,000 diabetologists for nearly 900,000 patients. Their distribution is also an issue, as a third of them reside in Bucharest. This leads to poor screening and management of diabetic patients.
What is the perception of diabetes in Romania?
In 2016, Novo Nordisk decided to order a public opinion research study to understand what Romanians’ perceptions about diabetes are, in partnership with a local think-tank group called InoMed and a research company called IMAS. According to this research, more than 50 percent of the Romanians considered diabetes curable and even 10 percent of the population considered it to be a contagious disease. Hence, there is poor education about diabetes and its consequences in Romania, and the study found that interviewees respected the prevalence of diabetes: 10-11 percent of them had been diagnosed with diabetes.
With this data, we started to go to the authorities and explain that more than just medicines is required to bend the curve of diabetes in the country. We continued this way the educational mission we started seven years ago when we launched a complex education and training program for young diabetologists called NEEDiT.
How can Novo Nordisk, as an agent of change, be a partner to key stakeholders in improving the current situation?
Education is a major conduit to bringing change in Romania, this also applies to the authorities. In 2017, Novo Nordisk conducted a health economics study regarding the cost of the cardiovascular complications of diabetes. Annually, the government spends approx. EUR 270 million (USD 301.6 million) to treat diabetes patients in Romania. If the clawback tax were to be included, the cost would rise well above EUR 335 million (USD 374 million). Two consultants analysed all available data from public institutions and found that the direct cost of treating only cardiovascular complications of diabetic patients amounted to EUR 581 million (USD 649 million). And this figure does not include societal costs, such as medical leave, early retirement, or productivity losses.
This study, and others conducted by the organisation, were a catalyst to create a coalition for the prevention for diabetes. Additionally, in the Romanian Association of Innovative Medicines Manufacturers (ARPIM), Novo Nordisk spearheaded a diabetes working group, to which 8 other companies with diabetes portfolio responded very positively and we got engaged together in a journey to improve the lives of people with diabetes.
On November 14th, 2018, on World Diabetes Day, the Diabetes Association signed a memorandum of collaboration in response to the ARPIM Diabetes Working Group’s call to action, which was the basis for the Romanian Diabetes Forum. In April 2019, Romania was the first country in Europe to launch a Diabetes Forum, and one of the priorities identified by all participants was the need for a diabetes prevention framework. As a result of a full year of consultation, debates, and stakeholder engagement, on February 24, 2020, a draft law regulating the national diabetes prevention program was introduced on the Parliament’s agenda, which is great news for Romanian patients suffering from the disease or having a risk of developing diabetes in the future. Novo Nordisk’s initial call to action culminated, thanks to the efforts of all the relevant stakeholders, to a major milestone for diabetes management and prevention in this country.
What are your objectives for 2020?
Novo Nordisk is on the right path to becoming the leader in the market once more. However, to turn this dream into reality, the affiliate needs to grow in absolute numbers and grow internally the culture of the organisation.
In 2016-17 we started a significant organisational change, to adapt the company to the new realities. This year, we had an internal audit which took the pulse of our organizational culture and we were extremely satisfied regarding the feedback we received. I would like to keep developing among my colleagues the pride of working for Novo Nordisk and to continue to bring more Novo Nordisk innovative medicines to the Romanian patients.
What has been your proudest moments while leading this affiliate?
It is hard to pinpoint single events, especially after such a tumultuous journey. However, the registration of the prevention draft law, the launch of our first new molecule, receiving reimbursement for our innovative products, and meeting patients’ associations representatives who see Novo Nordisk as their family during the World Diabetes Day, have been moments that stood out for me.
