Ekaterina Karpuzova, country commercial lead pharmaceuticals at Bayer Bulgaria, explains how the national healthcare system has evolved over the last few years as well as demonstrates the commitment of Bayer Bulgaria to supporting the impact and quality of its solutions through value-based evidence.
After starting in Bayer Bulgaria, you went to Germany and Slovakia in 2011 and came back last year in 2016. How has the Bulgarian pharmaceutical sector changed during those five years?
The Bulgarian healthcare system has gone through several major changes since 2011. First of all, it has been strongly institutionalized; creating a clearer picture of the structure as well as resources allocation across the public procurement process.
Secondly, the development of oncology treatment in Bulgaria deserves recognition. It is important to consider that approximately 32 percent of the National Health Insurance Fund (NHIF) targets oncology and, as a benchmark of its development, in 2011 cancer only represented around 12 percent of the public health fund. As a result, oncology patients’ access to high quality as well as innovative treatments has drastically improved.
Thirdly, Healthcare Technology Assessment (HTA) legislation came up in 2015, which aims to assess the medical value of a medicine versus its cost and its impact to the NHIF. It has created a fair base of how new molecules are entering the market. I believe that, even though it has slowed down the launch of innovative medicines in Bulgaria, it has helped to gain transparency of the overall process with the right framework and better predictability. Looking ahead, this process needs to be further optimized in order to reduce the long lead times but it is certainly the right direction.
Additionally, the public healthcare authorities are really open to find better ways to optimize and improve the national healthcare system. This ensures that, despite the long way to go, Bulgaria will continue advancing towards the right direction.
What are the things you have found about Bayer that always stay the same, and the ones are different Bulgaria?
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I am proud to confirm that our global philosophy “Science for a better life” has not changed over the course of the years. This motto is lived and breathed globally and it is also the case in Bulgaria.
What is quite unique of the Bulgarian affiliate versus the rest of the players in the market is our early move in terms of open collaboration with public health institutions, medical centres, and universities. I am happy to see that this is now an industry practice and such openness gives us very valuable insights as well as feedback that we can rapidly incorporate in our operations.
The company has an unique history in Bulgaria with initial roots in 1914, quite different to any pharmaceutical multinational in the country. What has been the historical presence of Bayer in Bulgaria?
It is really interesting that the first company and the first product that come up to Bulgarians when you ask them about pharmaceuticals are Bayer and Aspirin®. We are really grateful to Bayer’s history in this country and the consistency as well as investment that the Bulgarian affiliate has received from its headquarters. Hence, this unique legacy has strongly contributed to Bayer’s reputation as a very solid and reliable partner for pharmacists, patients, and authorities.
Bayer is ranked as top 10 player in the Bulgarian market. How has the affiliate performed in the last year and what are the key facts that explain the current positioning?
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In terms of performance, Bayer has had quite steady and sustainable growth rates over the last years. The first cornerstone behind this positioning is the high satisfaction of our patients and healthcare practitioners. This satisfaction is a result of the broad portfolio of Rx and OTC solutions that we market here to target cardiology, haematology, oncology, ophthalmology, and others. Indeed, I am personally delighted to confirm that Bulgaria has the same medical portfolio as any other Bayer European affiliate such as France and Spain.
How are you fitting Bayer’s product portfolio to the Bulgarian needs and which therapeutic areas do you see as the strongest growth drivers for the affiliate?
Before launching any product on the Bulgarian market, we conduct deep market research to understand the need and its size as well as the patients’ profile and their fit with our product specifications. So far, all our drugs in Europe have been suitable to the Bulgarian population and the only concern whether to launch or not a medicine in the market has been Bayer’s impact in such niche. We only launch solutions in those areas in which we can create major healthcare breakthroughs.
Specifically, we are currently strongly positioned in cardiology. Indeed, we have a really long history in this arena and we have brought significant solutions to Bulgaria in this regard.
Oncology and cardiology are the two main pillars of Bayer and this needs to be also reflected here. Concretely, we see a lot of potential in oncology and I believe that this therapeutic area will drive our growth in the future. Globally, Bayer is strongly investing in oncology and, consequently, we expect next year to bring two new molecules to target oncology in Bulgaria. Furthermore, I am personally really delighted to see that oncology and innovative treatment in general is perceived as a key therapeutic area by the Bulgarian government.
Despite the healthcare breakthroughs from biotech, such innovative drugs have a smaller eligible patient population. How do you collaborate with health stakeholders in order to ensure that the right patients get access to the right drugs?
This is a shared responsibility of any company and institution that plays a role in the healthcare system.
On one side, the industry has the duty to ensure that doctors are perfectly educated to treat patients with the existing medicines in the market according the drugs specifications and the patients’ profile. This is very much reflected in our activities and we address the challenge through a combination of promotion and scientific information, which ensures that our doctors fully understand our products.
On the other side, public authorities must do a proper follow up of who has prescribed a medicine and what have been the benefits out of such prescription. In this sense, the government has recently released a legislation to track clinical outcomes and it is expected to be fully in place by 2019 – this will enhance the transparency and it will also help the whole healthcare system to regulate itself in a better way.
Bayer is an R&D driven company with a strong focus on innovation. What is the importance attached to clinical trials in Bulgaria as part of this process and how involved is Bayer in this arena?
As an innovative player, we are very much committed to developing clinical research and Bulgaria plays a key role in the global clinical research of Bayer due to its clinical expertise, fast patients’ enrollment, and strict clinical follow. In fact, Bulgaria is positioned by Bayer in the top tier in absolute numbers conducting not only in-house but also outsourced clinical trials. Personally, I am really proud to see that Bulgaria is very well acknowledged in the international frame of Bayer’s clinical research.
We have been told that collaboration with patients in Bulgaria is particularly positive. Do you agree with this and how does it influence the way you work in the country?
Patients’ centricity is not an expression without “substance” in Bulgaria. Indeed, patients are a truly stakeholders and they play, through patients’ organizations, a key role in shaping the national health system. As an example of this representation, the National Patients’ Organization (NPO), which is the official umbrella organization for all patents’ associations, is member of the supervisory board of the NHIF. As a result of this great inclusion of patients in the healthcare decisions, the patients’ overall survival in Bulgaria has drastically increased since 2011.
Out of the pure business, we are actively collaborating with patients to develop disease awareness programs and prevention campaigns. In addition, patients organizations in general and the NPO in particular are positively contributing to the way medicines are reaching patients – they give us really valuable insights to ensure market access when copayment is too high for the patient or the public health funds are not enough.
What are your main priorities in order to continue driving the pharmaceutical division’s success?
The main priority on my agenda is to showcase the high quality of our medicines through accurate scientific data that we provide to healthcare professionals. The insights that flow from Bayer to the market and vice versa have to be reliable in order to ensure proper insights and results in terms of patients’ life quality.
Secondly, I want to enlarge my product portfolio through bringing our top-notch innovative products to Bulgaria in a quicker way. This needs further dialog with stakeholders in Bulgaria and Germany.
Last but not least, I want Bayer to be perceived not just as a drugs manufacturer but also as a company with solid social commitment adding value through innovative solutions and corporate social activities.
