Christopher Cuniasse, managing director of Fagron France, sheds light on the specialty area of pharmaceutical compounding and its link with personalized medicine, noting the benefits it can deliver to health professionals, patients, the pharma industry, and healthcare systems. As a newly implemented leader tasked with growing the affiliate and developing its activities in France, Cuniasse goes on to explain how he is taking on this challenge through strong reprioritization and communication efforts.
Please begin by introducing the specialized niche of pharmaceutical compounding in which Fagron operates and the current market environment in France.
Pharmaceutical compounding is the activity of preparing personalized medicines on-demand. Both hospital and retail pharmacies are active in the compounding process to be able to provide patients with personalized medicines. Unlike the US or other European markets, the French pharmaceutical compounding market still has a conservative image and is mainly known for dermatological treatments.
The value proposal of pharmaceutical compounding for the patient is the large number of available options to adapt a treatment to the appropriate dosage, galenic form or mix of active ingredients for specific patients. Compounded medicine is personalized to the specific needs of a patient, resulting in fewer side-effects and greater patient compliance, while also improving the quality of life of the patient.
As a group, Fagron is a listed company with EUR 471.1 million sales and an EBITDA of EUR 99.1 million for 2018. Headquartered in Nazareth (Belgium) and Rotterdam (The Netherlands), Fagron has affiliates in Europe, the Americas, South Africa and Australia. The company was founded in 1990 as an active pharmaceutical ingredients (API) supplier. Over the past 30 years, we have developed into a vertically integrated player covering all aspects of the compounding process. The purpose of Fagron is create the future of personalized medicine, together with pharmacists, prescribers, universities and patients.
There are different ways for Fagron to develop its activities in France.
The first development path is through Fagron Genomics. Recently launched in Spain, Fagron Genomics specializes in the development, production and marketing of innovative genetic tests. Fagron Genomics’ genetic tests allow the prescriber to prescribe the most suitable personalized therapy to their patients. We are starting with alopecia treatment but will develop soon in ageing, nutrition, hormonal diseases and pain management.
The second development path is the solutions (vehicles) that Fagron has developed to facilitate the dosage, intake, or efficiency of active ingredients. As an example, we have a solution for pediatricians that turns capsule treatments into liquid galenic form more convenient for children.
The third path is Fagron’s capacity to source complex APIs with the highest quality standards and in the required conditioning. Industry customers can benefit from our extensive know-how and product offer of over 2,300 different APIs.
In a nutshell, Fagron is now addressing doctors as new partners in France to help them find the most appropriate personalized treatment for their patients and thus, expand the market.
What value can pharmaceutical compounding bring to healthcare systems?
Pharmaceutical compounding is the only way to produce a personalized treatment for patients. As soon as a patient needs a different dosage or galenic form, suffers from intolerances, or does not have access to the appropriate treatment through finished pharmaceutical products, compounding brings value and offers a solution.
In real life and as an example, patients are often asked to take fractions of pills. This may lead to inappropriate intake of the product as dosage, bioavailability is not guaranteed and there is a risk of cross contaminations. For this population of patients, pharmaceutical compounding reduces their health risk. For the healthcare system, this may have an impact on costs by decreasing the potential adverse events and expensive patient complications.
Additionally, this same idea can be applied to patients with complex medical needs who require treatments which may not exist on the market. Compounding puts the prescriber in the position to determine flexibly what treatment regimen will be most beneficial for patients.
Last but not least, compounding can not only benefit the health system and patients through the adaptation of dosage, but it can also be a solution to the issue of drug shortages and discontinuations – a problem that France is often faced with. While the cost is higher, this is not a replacement of the medication but a short-term solution to ensure that patients who need their medications can have continued access to treatment.
Personalized medicine is a hot topic throughout healthcare today. How can Fagron take a role in driving this trend forward?
Personalized medicine is a buzzword in many conversations, but few players are actually taking part in this fully. A mass producer can develop a more niche product and determine which patients are eligible for the medication. Fagron’s value proposal is slightly different: we create a medical solution unique to each patient individually. With our Fagron Genomics capacity, Fagron can help doctors determine which APIs will be efficient for a patient and compounding is the way to produce personalized treatments.
Pharmaceutical compounding is a relatively underdeveloped market in France compared to other European countries or the US. What are the challenges the affiliate faces in the country and how are you overcoming these hurdles?
A big challenge for Fagron is that we must have the right partners in order to meet demand and deliver our medicines as soon as possible to the patient. We work with retail pharmacists who have developed their own production capacity – which are few in France. In France, we collaborate with healthcare professionals and pharmacists to explain to them what compounding is and how it can play a role in the future of the system. Fagron trains and educates both pharmacists and prescribers on compounding, the possibilities, trends, added value and innovations we bring to the market.
To build this market in France, Fagron has recently launched an initiative to better communicate with doctors. We are working together to develop tests to analyze the effects that APIs have on the human genetic level to determine patient’s reactions to certain APIs through Fagron Genomics. This is being applied to areas such as ageing, dermatology and nutrition. Our next big ambition will be on hormonal diseases affecting fertility, menopause, and endometriosis for example. In the long term, we are looking to apply these genomic tests to pain treatment as well.
This service we sell to physicians and pharmacists will allow them to better know and treat their patients on a personalized level. From here, Fagron can recommend tailormade treatments for patients in major pathologies.
How do you feel the French healthcare authorities and overall life sciences ecosystem value this business and how exactly are you raising awareness on the many benefits of compounding?
As of now, the business of compounding is a B2B market with suppliers and pharmacists who buy APIs, vehicles, equipment and other innovative products to produce personalized medicine on demand. The vast majority of compounded products are not reimbursed by the French Social Security and French patients are not used to paying for their health. As soon as Fagron is able to demonstrate added value for the patients, the situation may evolve in France. This is a discussion we may have with the healthcare authorities because although the initial costs may be high, compounding can play a key role in reducing the financial burden of healthcare. If we can determine the best treatments for each patient, we can reduce hospital visits and drug expenditure trying to find what works.
We are evolving the image of compounding from the traditional perception of simple products to a professionalized industry. However, many pharmacists are not trained or experienced in such activities and most doctors are not aware of such solutions for their patients. Therefore, Fagron is working with hospitals, universities and healthcare professionals’ associations to educate stakeholders about compounding as the only way for personalized medicine.
You joined Fagron last September with the mission of evolving the French affiliate into a recognized leader within the market. What motivated you to join the organization and what have been your initial priorities?
Fagron is a company that has a strong culture and put values like entrepreneurship and speed of execution in the heart of its development. This is a very autonomous and flexible organization.
Before joining Fagron I had entrepreneurial experiences in the e-Health industry and I was looking for a new challenge. The value proposal of Fagron is unique and creating the future of personalized medicine together with French healthcare professionals. It is like entering the blue ocean: we create a new market.
My first priority has been to restructure the organization. We are a very small company of 12 full-time employees working in a start-up mode: people in the organization are key. Then, we need to collaborate with pharmacists, prescribers, hospitals and industrial partners to create the future of personalized medicine. Therefore, we had to assess and value the kind of talent being brought into Fagron.
Last but not least, Fagron has a strong track record in acquiring companies and expanding its footprint. We are looking for such opportunities in France.
What final message would you like to deliver on behalf of Fagron and the pharmaceutical compounding market?
Even if we are leading in creating the market for personalized medicine, Fagron will not be able to do this alone. We will need to have strong relationships with healthcare professionals like pharmacists and prescribers, universities, manufacturers, and maybe even some larger pharmaceutical companies. Pharmaceutical compounding is key to creating the future of personalized medicine.
