Aki Kasvi and Mindaugas Plieskis of Janssen Baltics discuss their strategic priorities, acting as a strategic partner within the region, and ensuring that patients can access their innovative latest-generation therapies
Mr Kasvi, you were nominated to head up Janssen’s Lithuanian office back in November 2017. What was the strategic mission assigned to you when taking over the reins of the affiliate?
Aki Kasvi (AK): Right now, we have the entire Janssen portfolio represented across the Baltics, but we are striving to go beyond just being a provider of innovative products to the three markets. Our vision is to become a genuinely transformational partner of healthcare. This means engaging with the different institutions on an altogether higher level and working alongside them to enhance health outcomes and enhance accessibility to latest generation medicine, while maintaining the financial sustainability of the public health system.
Johnson & Johnson happens to be the biggest healthcare company in the world and spans not just pharmaceuticals, but medical devices and diagnostics. That means that Janssen, through the other Johnson & Johnson divisions, can have much more of a holistic, comprehensive view than most pharmaceuticals developers. We can bring something extra to the table that surpasses merely being a purveyor of pills. We can really have an impact in the sense of facilitating the growth of an innovation ecosystem whereby therapies are evaluated according to the added value that they deliver.
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Mindaugas Plieskis (MP): Essentially we are seeking to become a much more proactive partner with government and patients in shaping how healthcare is received, not just in Lithuania, but right across the Baltics. We believe that it is the responsibility of contemporary pharma companies to play a part in identifying solutions that are not just commercially lucrative, but simultaneously benefit society and are sustainable over the long run. We very much see it as our responsibility to ensure not just that latest generation therapies are available on the market, but that they are being consumed in the optimum manner and are actually generating the sort of end outcomes that we expect them to in terms of recovery of the patient. The time has come for constructive dialogue and shared solutions among all stakeholders and it is very much our ambition to become an agent of change for this sort joined-up action.
Are there any areas in which you already playing this role of transformative partner locally?
AK: Most definitely. If we take the example of multi drug-resistant tuberculosis, you will see that this dynamic is already happening. We were able to launch one of the first products in 40 years for this niche. The Baltics is, of course, a hotspot for incidence of drug-resistant strains of TB and it was logical that governments would turn to us as the obvious counterpart and partner of choice. Through our highly acclaimed product, Bedaquiline, which is not really a commercial venture, we are able to play a highly active role in countering this threat. Our vision, though, is to take this form of engagement to the next level and position ourselves as transformational partner of health in a broader sense across all therapeutic areas and product lines.
From a regional perspective, what is the strategic relevance of the Lithuanian affiliate within Janssen’s Baltics’ presence?
AK: In an ideal world, the Baltics present the sorts of markets where we can experiment with novel approaches. It can be a blessing to be small. In theory, these tiny, comparatively uncomplicated markets lend themselves very well to being a testing ground for innovative ideas and prototypes, before scaling them up across other regions of EMEA. In practice, however, we are always competing for finite resources against larger markets within the region and this can sometimes have the effect of tempering our ambitions.
That said, the Baltic markets are notable as a growth engine, given our development trajectory that has, in many respects, mirrored the rapid overall expansion of the local markets. As such, we have come to be seen as a benchmark and standard for the rest of EMEA in terms of business development and execution. Before I came the region, this was very much how the EMEA management board perceived the Baltic affiliates and, now that I am here, I can immediately see that this perception was justified and validated.
MP: We are very committed to making maximal use of markets like Lithuania as laboratories to test our innovative approaches and processes, which can them be deployed as showcase examples and exported to other affiliates in more unwieldy, complex contextual environments. Gene mapping or participating in the e-health and digitalization agenda in Estonia could be areas where Janssen affiliates in the Baltics could potentially be first movers. We are also looking at some of the innovative start-ups here in the Baltics and facilitating their connections with our J&J Innovation hubs.
We have already built up a reputation in EMEA for being quite creative and pioneering. We have even managed to turn the constraints on resources into a virtue. Across the three Baltics affiliates you will find many managers wearing multiple hats and working cross-functionally. We have developed an in-built flexibility and versatility in which each one of the three offices will be able take the lead for a specific issue and will receive ready support from the other two.
What are your most highly performing products right now locally? And how has demand been evolving over time?
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AK: We’ve been witnessing terrific growth in our hematology and oncology business lines, but the bedrock in the Baltic markets has traditionally been neuroscience and, even today, that particular therapeutic area remains a significant contributor to our top line. Currently, in Lithuania, we are very eager to develop our immunology presence. We are confident this will be a very good strategic bet for the coming years.
MP: We’ve recently seen quite a bit of market fizz in Lithuania in hematology, with demand gathering pace for better kinds of treatment solution that are more patient centric. This is the sort of area where we believe we can make a big contribution going forwards. We are confident we can provide considerably better value for money spent and come up with improved solutions that are subsequently reflected in enhanced top line and growth. We thus see this as a highly dynamic area to be operational in.
Meanwhile, we possess a well established local reputation in psychiatry and neuroscience where we have long been regarded as being a to-go-to partner, but even there, we have refrained from resting on our laurels and have actively sought out incremental improvements in areas such as delivery mechanisms. For schizophrenia, for instance, we are now offering 4-times per year injections in place of the traditional mechanism of an injection per month. Not only does this substantially improve the patient experience, by minimizing disruption to patient’s lives, but it also increases drug adherence and lessens the burden for the public healthcare apparatus. Naturally this particular solution has met with a great reception from both patients and healthcare providers alike.
You refer to the concept of “patient centricity” which has become quite a buzzword within the industry. What exactly does patient centricity mean to you? And how you go about measuring your performance on this score?
AK: For us, “patient centricity’ goes beyond specific activities and describes a mindset whereby Janssen competes for patients as opposed to prescriptions. It takes us back to this idea of delivering not products, but beneficial health outcomes that cause minimal stress and disruption to the patient. Attentiveness to being patient centric has penetrated our overarching corporate culture and impacts how we go about defining our metrics and KPIs. It manifests itself in even the most elemental parts of our organization. Rather than focusing on chasing the next dollar, it gives us a real sense of mission in which the patient comes first.
MP: There are multiple dimensions of patient centricity. At the EMEA–level, patient centricity can be about ensuring that patients are properly consulted and that their preferences are included at the both the initial R&D stage and subsequent clinical development. At the level of the local affiliate, it can mean engaging with the patient associations, gathering feedback on the experiences of end users and familiarizing ourselves with their concerns and priorities. What we have learned in Lithuania is that the local patient associations are highly organized and knowledgeable about the science. The advent of the Internet and digital information sharing has empowered them to a point unthinkable only a couple of decades ago. There is no place for the paternalistic approach of old. Nowadays, patients’ representatives tend to be both highly informed and well mobilized so it is logical that they should be much more involved in the drug development process.
What is your assessment of the ease of market access in Lithuania when it comes to introducing innovative, latest-generation medicines?
AK: Currently, different stakeholders perceive value in different ways. There is a lack of shared common understanding about what actually constitutes real value when assessing the likely impact of a new therapy. Janssen is very eager to sit down with the authorities, payers and healthcare providers to establish an agreed framework where the value of our overall contribution is properly appreciated. We believe that, as a company, we can simultaneously deliver not only considerable benefit to patients by way of clinical outcomes, but also savings to payers, employers and society at large. Right now, value is being calculated in a very piecemeal fashion, molecule by molecule, whereas we would like to be judged more by our overall contribution to the country.
MP: Lithuania is becoming friendlier towards innovation and we have seen some noticeable improvements in ease of market access. A case in point has been the recent legislation changes surrounding generics, which are a step in the right direction. If you want to ensure that the most innovative products are reaching the market in the proper fashion then expenditure on generics has to be trimmed. This is not a question of discriminating against generics, but rather about rationalizing health spending and leveraging generics in the correct manner as an important part of the toolbox.
Janssen is sympathetic to a government that has to make difficult decisions and we accept that the funds available are limited. There is a pressure from the public to have innovative medicine both available and reimbursed and yet that is juxtaposed with an unwillingness and inability to pay for it. The right balance must therefore be struck. Again it goes back to the need to factor in the notion of value that we bring.
What distinguishes the different Baltics markets from one another?
AK: Each of the markets possesses their own idiosyncrasies. Estonia is rightly characterized at being right at the forefront and cutting edge of digitalization. Latvia meanwhile is still debating what should be the proper role of public healthcare to taxpayers and citizens and how that is perceived. Meanwhile, support from the pharma companies to the individual doctor in terms of education and awareness is prohibited. Lithuania, for its part distinguishes itself by having the appropriate market access tools in place to set up performance based agreements. The upshot is that it is necessary to adapt and tailor make our offering closely to match each respective ecosystem. A one-size fits all, cookie cutter approach would not be helpful.
What are your main priorities looking forward?
AK: The primary objective of mine is to escalate Janssen from a provider of goods to a relevant discussion and sparring partner with the authorities and payers not just in Lithuania, but all across the Baltics. The immediate struggles will be around how we go about positioning the industry as true and credible partner to the political and financial institutions. Aside from that, I want to really leverage local potential as a test-ground and pioneer, and to see Janssen participating more in clinical research. The recruitment speed and quality of output in clinical trials is very appealing out here and we are keen to relay this information back to our global management.
