Boriss Birmans, country manager of Santen Latvia, discusses the company’s focus on patient-centricity in the country, its ambition to bring in more preservative-free drugs for glaucoma patients and how its

market share in Latvia is one of the highest in the entire EU.

Can you walk us through Santen’s history in Latvia?

Santen has been present in Latvia for many years. We started operating here through a Finnish company, having a tradition for quality, for respect and solid foundations. Nowadays, we are a Japanese company which strives to become the market leader worldwide in ophthalmology. While we have not yet succeeded in our mission, Santen ranks three in ophthalmology globally and in Latvia we are number two. We are actively working on changing our focus hoping that we will be market leaders in a couple of years.

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In terms of the restructuring that we underwent, Santen is no longer managed by Finland and it is a fully integrated Japanese company. Our Japanese management is currently located in Europe and we follow the same guidelines as the headquarters in addition to being in line with the global financial strategies, e.g. putting patients in the focus of all our activities. After having spent almost two decades in the industry, I am happy that Santen has done a phenomenal job in putting patients first in whatever they do and this is very much in line with my believes.

What is it like to work for a Japanese company and how does it change in the way of operating?

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Recently, I watched the film ‘fear and trembling’ – the title is said in the film to be the way the Japanese must behave when addressing the emperor. This is not true for Santen! Japanese culture is very much about careful and thoughtful decision-taking, as well as putting this decisions into actions. While we see more and more Japanese companies penetrating the US market, they have taken their time to come to Europe. Santen is profoundly different and arrived in Europe first and is only now establishing its footprint overseas. I very much admire the way things are handled and managed – it is about taking prompt actions.

How would you describe the significance of the Latvian operations relative to what else Santen is doing in Europe?

Latvia is one of the smallest countries in Europe and it can, therefore, by no means impact European results. Being part of a huge market called European Union offers us many examples on how to provide the best-in-class quality of delivery. Nowadays, what we do is not only about results, it is also about processes. While we cannot impact revenue-wise, we can however be considered a real standard of quality that everyone else in the industry can take as an example – as a result our market share in Latvia is one of the highest in the entire EU.

Can you talk us through your product portfolio by highlighting what is generating most of your revenues?

Santen is bringing the best-in-class therapy for glaucoma patients and this is our very mission. We are the undisputed leaders in preservative-free therapy. Chemical preservatives are often used in eye drops to ensure sterility of the drops in multidose bottles. When used in short-term treatments, they are mostly well tolerated. For long-term use, e.g. in chronic conditions such as dry eye and glaucoma, more and more doctors recommend preservative-free products, as the preservatives may possibly cause you allergic reactions or symptoms of irritation. At the moment we have three such products in the market and this year we are bringing one more. Two thirds of our product portfolio is, in a way, reimbursed – I saw in a way because on 1 January our National Health Service applied benchmarking of product prices for drugs that could not be substituted. We believe this benchmarking is neither justifiable with medical evidence, nor fair to patients. We are working with the Ministry of Health to solve this misunderstanding and return to patients with medical needs access to appropriate treatment soon.

How would you assess the evolution and demand of the local market that might make it different from your neighbouring countries?

In terms of capitalization, healthcare is highly underfunded. While Latvia is a small country, people have a very diverse set of values. For instance, the elderly generation has still strong soviet standards – this category of people thinks that no matter the means, the patients should be treated with anything, because this anything is better than nothing. Accordingly, some state officials shows the very same mindset regardless of age. There is the tendency to think of healthcare as a cost rather than an investment in people.

I’m sure that my country will overcome this difficult heritage soon and will provide to its people with appropriated cost-effective standards of care.

At Santen, we are working for patients that could become blind if they are not properly treated, but there is some sort of resistance on behalf of regulators to have a long-term view.

When the system is so undercapitalized, there is the tendency to go for cheaper products. How do you make the payers understand the value of your drugs?

We can provide payers with data of our research and development activities, the clinical trials as well as pharmaco-economic statistics.

I’m bringing my even own patient story. I know what means different efficacy of treatment, side-effects profile and frequency, efforts to keep adherent to treatment, as well as public and private costs.

What have been your main priorities since being appointed one year ago?

To restructure the organization and to bring the concept of preservative-free medicines to the attention of Latvian authorities. I would like to believe that we have been very successful as we are bringing such drugs to twice as many patients as last year. We try to deliver qualitative medicines and educational programs to healthcare providers and patients.

We work for patients and, accordingly, we focus our efforts towards coming up with education programs and campaigns for doctors and other medical professionals.