Interview: Ana Tsakova – Managing Director, Merck Bulgaria; General Manager Biopharma

Ana Tsakova, managing director at Merck Bulgaria, emphasizes the duty of the industry to raise the bar of treatment quality in the country and shows the commitment of Merck in this regard to collaborate with both physicians and patients in key therapeutic areas such as oncology, fertility, multiple sclerosis, diabetes, and thyroid diseases.

Could you please introduce yourself and your professional career to our international audience?

“As in any pharmaceutical company, the right product portfolio is a key factor to successfully navigate in the market, but it needs to be supported by the right talented people.”

Just like most of my peers in the industry, I was educated as a medical doctor in Bulgaria. I entered the pharma industry back in 2000 as a sales representative for MSD, and I have followed the traditional track of career development ever since. I feel very grateful for having had the opportunity to develop my professional knowledge about generics and originators from global leaders in the pharmaceutical sector, companies like MSD and Actavis. Then, in 2011, I had the chance to join Merck’s team in Bulgaria, and after spending time in their Biopharma division, I had the privilege last year of taking over the lead of Merck Biopharma as general manager, and head the entire affiliate as its managing director. Working in such a volatile and complex environment as the healthcare business is very challenging, and requires a sense of urgency, the ability to focus, and top performance. Leading the local affiliate of a 350-year old family company is a really great opportunity, but bears responsibilities as well.

You have more than 17 years of experience in the Bulgarian pharmaceutical market. What would you highlight as the most significant changes to the market?

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Many changes have taken place in the Bulgarian pharmaceutical sector, especially in the last decades. One of the most remarkable improvements has been the increase of patients’ access to treatments as a consequence of the implementation of the National Health Insurance Fund (NHIF) back in 2000 and a number of other positive developments since the country joined the EU.

However, it is important to mention that the Bulgarian reimbursement system does not cover 100 percent of all health expenses as it is constructed on different levels, which is related to the high level of co-payments on behalf of patients. There are some national health burdens that are indeed fully covered, like oncology for instance, but at the same time, other diseases with a strong footprint in the country such as diabetes and heart diseases are only partially covered. In my opinion, there is still a long way to go in order to ensure patients’ access to proper treatment but, certainly, the achievements of the national health system deserve recognition.

Merck has been in Bulgaria since 1992, which is quite long in comparison to other pharmaceutical multinationals in the country. What has been the historical presence of Merck in Bulgaria?

At the beginning of those years, Merck was operating in Bulgaria through a distribution agreement, and it was not until 2009 when Merck decided to initiate direct operations in the country. Obviously, that strategic change has led to a totally different performance over the last seven years, with consistent positive results thanks to the combination of the right product portfolio, and the talented and enthusiastic team that we have in place.

Talking about history, it is worth mentioning the fact that, having been founded as early as 1668, Merck is the oldest pharmaceutical and chemical company in the world. The Merck family has remained the majority owner to this very day. Our people at Merck, including the Bulgarian team, are united by their passion for new ideas, the possibilities of technology, and the potential to make a difference in the world.

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Focusing on yourself, Ms. Tsakova, you were appointed as general manager of Merck Biopharma in Bulgaria last June 2016; what have been the main priorities on your agenda for your first year of tenure?

My current priorities are channelled into three major streams, and can be summarized as follows. In the first place, to ensure that Merck has the best prepared, most competitive, and motivated team to spearhead its operations in Bulgaria. This means developing the professional qualities of our people both in terms of garnering in-depth knowledge of the industry and insights into future developments. It also means improving their soft skills by means of various trainings, cross-functional collaborative meetings, and encouraging their personal and team accountability.

Secondly, to discover the right channels that will bring our medications closer to the patients. We invest primarily in such activities as those accumulating knowledge in the therapeutic areas we have most expertise in. Finding opportunities beyond the conventional scope of our business is the biggest challenge lying ahead, in order to reach our customers and patients at the right time, with the right information.

And thirdly, to assess various approaches to enhance the efficiency and agility of Merck’s operations. Our market is highly dynamic and very competitive, and we are constantly seeking improvements in efficacy through enhancing our digital capabilities both internally and externally. Digitalization and innovation are some of the key drivers of our success nowadays.

How do you adapt Merck’s product portfolio to the Bulgarian needs? In which therapeutic areas is Merck strongly positioned in Bulgaria?

Merck’s products portfolio is fully focused on the prescription arena. Globally, as a leading science and technology company, Merck is committed to deliver products that are sustainable, and with a track record of helping create, improve, and prolong the life of people – and this is fully reflected in the work of our affiliate. In fact, I am proud to say that Bulgarian physicians trust our medicines due to their high quality and proven efficacy in the course of many years, and we are committed to further grow this trust by ensuring the launch of new products in the market.

Expanding on our offering in Bulgaria, Merck is well positioned, and provides treatment solutions to most of the national healthcare burdens such as cancer, multiple sclerosis, infertility, cardiovascular and metabolic diseases – all of them facing high unmet needs. We have established good reputation in the field of hypertension, diabetes and thyroid disorders. Along with the traditional medicines we are expanding our presence in biotech areas as well, along with highly innovative solutions. In oncology for example – and especially for colorectal, head and neck cancers – many others are also forthcoming. In multiple sclerosis, we are excited to have the opportunity to create history with a new era of treatment by launching a new product, which was recently granted marketing authorization by EMA.

As to your second question, we are strongly positioned across all therapeutic areas, but especially in cardiovascular diseases, with our star product, being one of the top 10 medicines in the Bulgarian market.

One of the therapeutic areas in which Merck is uniquely strong is fertility. However, CEE countries are not well educated about such a topic, and it is often associated with societal stigmas. How do you feel this situation is reflected in Bulgaria?

I have to say that Bulgaria is positively advancing in the fertility treatment being one of the countries at the forefront of the CEE region in this respect. Indeed, the Bulgarian government already reimburses three In Vitro Fertilization (IVF) cycles, and it has recently announced the willingness to reimburse an additional one. Even though there is always room for future developments, the evidence of the government’s commitment in the fertility arena are there. Infertility is a major concern in Bulgaria since its population has been consistently decreasing over the past years.

My vision as a leader is to maintain Merck’s position as the preferred partner in the fertility area. Aligned with this objective, we are already closely collaborating with physicians and patients to raise the bar concerning the treatment’s quality and knowledge.

Most of your industry peers have addressed the issue of market access of new medicines as one of the primary challenges in Bulgaria. What are your conclusions about this issue in Bulgaria?

On one side, a lot of amendments have been done in that respect, and somehow, they have made the entire reimbursement process lengthier and more complicated. The introduction of Healthcare Technology Assessment (HTA) has not only created a burden for companies to really introduce their products in the reimbursement list but it has also delayed the patients’ access to the latest treatments. As a new process it will be further developed.

On the other side, the development of a better system is highly needed since the government has to properly evaluate the efficacy of all the treatments that are being financed by the National Health Insurance Fund (NHIF). HTA is an important part of evidence-based health decision-making in most EU countries, and it was a natural step of authorities to introduce it locally.

Looking ahead, I believe that both government and industry should work in cooperation to find the point in the middle on how to simplify the process for new entries and make sure the efficacy of all products are transparently assessed, and the timelines as well as processes are as lean as possible for the industry.

What type of constructive dialogues are you developing with the public healthcare institutions to advances in this regard?

The industry in general, through the Bulgarian Association of Research-Based Pharmaceutical Manufacturers (ARPharM), is really active in discussing and partnering with government institutions about various ways to enhance the national health system. One of the main topics discussed, as already mentioned, is the pricing and reimbursement process but there are also other key subjects on that round table such as referral prices and the claw back system, and patients’ access to innovative products.

Your industry peers have shared strong satisfaction about the level of professionalism and loyalty of their teams in Bulgaria. How easy or complicated have you found to build up the best team here in Bulgaria?

As in any pharmaceutical company, the right product portfolio is a key factor to successfully navigate in the market, but it needs to be supported by the right talented people. People are the most valuable asset on Merck’s balance sheet. They are the ones who make a difference, and who ensure the quality of Merck’s operations – this is the reason why keeping the team strong is one of my top priorities as managing director of the affiliate. Personally, I totally agree with the level of loyalty as well as the professionalism in Bulgaria, but this talent needs to be located – to attract, retain, and develop the best team is one continuous responsibility of any managerial position, and it is not an easy task by any means.

What is your vision of the healthcare sector in Bulgaria for the next years and what is the role that Merck will play in it?

Being a medical doctor, my vision is to have a better healthcare system in the country, and it can happen only if all stakeholders are united behind its constant development. The industry has the duty to raise the bar of treatment’s quality in Bulgaria in that respect, by providing better and innovative treatment solutions, and supporting medical and patients’ associations to improve the knowledge, early diagnosis and on-time treatment, as well as shaping the polices in a partnership with the authorities. Even though Bulgarian physicians are competitive in terms of their extensive academic knowledge and specialty skills, this can be further developed by placing emphasis on their continuous medical education combined with traditional, as well as the modern tools and capabilities offered by global digitalization and high technologies. I strongly believe that pharmaceutical companies play a crucial role in developing the access of physicians to science, which ultimately ends not only in better health delivery to patients, but in minimizing the cost of treatment as well.

To put it shortly, Merck has always been committed to significantly invest in developing more collaborative efforts along with physicians to improve the quality of healthcare in the country. In addition, as commented above, Merck is working closely with patients’ associations to support different types of public campaigns to increase awareness about the diseases across the therapeutic areas where we have an established presence. We are proud to be the company supporting a large number of initiatives related to cardio-metabolic disorders, and not only to them. I would like to share some key figures to show the relevance of these health burdens. Not many of us know that 60 percent of all diabetes and thyroid cases are only identified at a late stage (or not identified at all), which is translates in higher costs of the treatment, and lower quality of life for the patients. This is exactly where we can provide support to the authorities, healthcare professionals and patients in order to make a change.

In conclusion, as a legal representative of Merck, a global specialty innovative company, we at Merck Bulgaria are dedicated to further collaborate and work “as one” with all stakeholders to ensure better healthcare service capable of making all the difference in the lives of patients.

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