Jeroen Weites, South-East Europe

Cluster head General Medicines and country chair Bulgaria at Sanofi, gives an overview of the company’s leadership in the country and highlights the urgency of developing a healthcare masterplan beyond any political mandate to ensure the sustainability as well as predictability of the Bulgarian healthcare system.

Besides your functions as Country Chair for Bulgaria, you have been appointed as “Cluster Head General Medicines South-East Europe” this August 2017. What does this position entail and how important is exactly this cluster for Sanofi?

To share some background, Sanofi is a global healthcare leader, present in more than 100 countries, with industrial sites in more than 40 countries and is globally structured into five business units: Diabetes and Cardiovascular diseases (DCV), Consumer Health Care (CHC), Sanofi Pasteur (vaccines), Sanofi Genzyme (Multiple sclerosis, Rare diseases, Immunology and Oncology), and General Medicines (generics and established products). I am proud to underline that Sanofi Bulgaria is holding 4th place on the Bulgarian market among the other pharma companies in terms of market share. Concretely, General Medicines (GenMed) represents more than 39 percent of Sanofi’s overall business in Bulgaria and, looking at the South-East Europe, such business unit represents 37 percent of the overall turnover of the region. In addition, despite the existing challenges such as the reference pricing system and claw-backs, General Medicines division has managed to sustainably grow in volume and value in the cluster.

Having said that, my new position as Head of GenMed of the entire SEE cluster – which embeds 13 countries – entails a huge responsibility in terms of business relevance. When it comes to strategy, we decided to treat the different countries in the South-East European region as one sole market with one clear regional strategy supported by regional functions located across the different countries. I am proud to confirm that, so far, we have been quite successful in this front and, in fact, we have experienced strong double-digit growth in some affiliates – which is quite impressive for established products.

I believe that the right way, but not easy path, to continue driving this performance relies on a team fully aligned with the Sanofi’s strategy in the SEE, which avoids operating as individual teams by country but as one sole organization towards the same goal – overcoming any challenge and seizing all opportunities.

What are the common objectives amongst the countries within your region?

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When talking about established products, Sanofi is really strong with its cardiovascular solutions and, therefore, we aim to be positioned as the regional leader in this therapeutic area.

The second objective, and somehow strategically related to the first one, we are looking to develop digital capabilities in our commercialization strategy. We have perceived that doctors in the region are eager to receive more information than the traditional sales pitch on a specific product and I believe that digital tools are a great mechanism to fulfill their need in this front – this not only concerns information about our medicines but about the therapeutic areas in general. There is still a lot to be done in this regard but I can say that Sanofi is at the forefront of this commercial strategy shift in the region through the so-called “omni-channel” initiative, which was started 1.5 years ago.

Sanofi is ranked as top 4 player in the Bulgarian market. How has the affiliate performed under your tenure and in which areas have you focused in order to maintain this leadership position?

Sanofi has been present in Bulgaria since 1992, which is quite a long history in comparison to most of the MNCs in the country. This long legacy has certainly played a role in our current positioning in the country being highly recognized by the Bulgarian stakeholders.

As business philosophy, we have always looked to financial sustainability and compliance throughout all our operations and this approach has helped us to give continuity to our performance.

On top of that, we are present in Bulgaria with all our five business units and this has enabled us to offer a broad spectrum of healthcare solutions. Within that we are able also to offer some innovative medications in helping the patients to tackle their chronic healthcare issues. I am happy to confirm that we are growing in all five business units.

As one of the Big Pharma companies with the largest portfolios, what therapeutic areas will you focus on developing to generate new sources of growth and value-creation?

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As said, we are present here with a large product portfolio in established products, covering cardiovascular diseases, anti-infectives, CNS & neurology, rheumatology and anti-thrombotic diseases.

Our innovative business unit or “Sanofi Genzyme” is one of the main drivers of growth in Bulgaria. We have been continuously launching new drugs and therapeutic approaches in the country over the last years in the field of rare diseases and the brand-new solution in auto-immune diseases, such as multiple sclerosis, rheumatoid arthritis and severe atopic dermatitis. Nevertheless, there is still a huge unmet need in this arena and, therefore, Sanofi is fully committed to continue bringing new solutions to Bulgarian patients.

Our vaccine business or “Sanofi Pasteur” is also a key pillar in our Bulgarian operations, providing vaccines for the national immunization calendar and unique vaccines in the public market. We are also active in launching new vaccines and, indeed, we have recently launched in the country a new tetra valent vaccine against flu called VaxigripTetra®. Just to share a figure of the room of development in this area: only 2-3 percent of Bulgarian citizens are vaccinated in comparison to other countries like the Netherlands and UK in which approximately 75 percent of the at-risk groups are vaccinated. There is a lot to be done in this front and the capacity of growing our vaccines division is huge but, at the same time, it needs an industry effort in terms of medical education and patients’ support initiatives.

Our CHC business is growing with interesting recent product launches and some others coming up in the near future. In early 2017, this business line certainly got reinforced after the business unit swap in which Sanofi acquired Boehringer Ingelheim’s CHC unit in exchange for Sanofi’s animal health business. I would like to highlight that we are developing a unique commercial strategy in this arena embedding not only patients but also doctors, since in Bulgaria the latter stakeholder plays a key role in the recommendation of CHC solutions. This is something quite unique in comparison to any other European market I have worked in the past. I’m proud to underline that recently the CHC business unit have received the innovation award “Voted Product of the year” for its product Magne B6 Good Night. They received also the recognition of the Bulgarian pharmaceutical union.

Looking at our established products, we are putting strong efforts in enlarging Bulgarian patients’ access to our affordable medicines. Again, there are several unmet needs in this front and, concretely: from all cardiovascular patients that should be on medication, only 25 percent are treated. On top, these treated patients are not achieving the treatment target, because of restriction of physician choice. Thus, there is room for improvement and here all parties should play a role: Sanofi is offering medical education and awareness campaigns to the physicians and their patients.

Can you expand on the most recent as well as future product launches that will take place in Bulgaria and what are your best practices to succeed in this front?

We have recently launched medicines to target multiple sclerosis as well as flu and, looking ahead, we will launch more products in severe auto-immune diseases, rare diseases and familiar hypercholesterolemia.

In terms of best practices in launching new medicines, pre-launch activities and creating the right environment play a crucial role in obtaining access. Hence, in my opinion, alignment of public affairs, market access, and clinical expertise is crucial to successfully launch any medicine in the market.

How would you assess market access in Bulgaria?

On one hand, Bulgaria has done drastic advancements in comparison to any other country in Europe in terms of adopting innovation already registered in other markets. But, on the other hand, innovative medicines normally enter in Bulgaria approximately 2-3 years later than once such drugs are launched in key markets. It is a consequence of the existing “the lowest price” rule in Bulgaria of which negatively affects the business sustainability of certain medicines in the country and even force some companies to pull out some drugs from the market. I believe that the industry has the duty in front of patients to maintain the availability of a drug in the market when there are not any substitutions–especially if it is a life-saving medicine. Also, the co-payment for patients (Bulgaria is the highest in Europe!) is putting a burden on them for having access to proper treatment.

We have heard a lot of discussions regarding the potential introduction of alternative payment models by the National Health Insurance Fund (NHIF); what are your thoughts regarding these discussions?

There is a systemic deficit gap in the healthcare budget in Bulgaria since the government is yearly spending more than forecasted. Furthermore, the government is trying to close such gap leveraging on the industry through ensuring minimum prices, claw-backs and additional discounts. All the aforementioned points pose significant challenges for pharmaceutical companies to sustainably navigate in the market – the industry is looking for predictability as well as sustainability and the current situation in Bulgaria is far away from these ambitions.

The current pharmaco-economic model in Bulgaria is mainly based on economic arguments and I believe that such approach is not optimal. In my opinion, a national healthcare system needs to use value-based criteria with real-life data for new INN launches. Access to new innovative treatment options will enhance the patient quality of life.

However, a lot of structural changes would need to be implemented to arrive to the aforementioned point. All healthcare stakeholders, from government to associations and industry, should deeply assess the current system and create a completely new master plan longer than any political mandate with more predictability and patients’ focus. There are some initiatives in this direction but none of them are structural changes but rather ideas created upon the existing system, like introducing additional discount on top of current mandatory claw-back.

Hence, the current approach is not solving anything in the longer run because the current initiatives are not targeting the source behind the problem. I believe that, in order to successfully advance in this direction, all stakeholders should do a joint effort beyond any individual goal.

Looking ahead, what are the main objectives that you would like to accomplish in the future?

Firstly, one of my main objectives is to ensure the right access of our current and future product portfolio developing value-based criteria when entering in the reimbursement list. Despite the recently introduced HTA agency, the health system is not enough developed to embrace this innovative approach.

Secondly, I aim to position Sanofi as not simply a pharmaceutical manufacturer but also as an entity with strong social purpose behind and beyond-drugs mission. In this sense, we have implemented several interesting awareness campaigns such as the educational campaign “Honestly for Vaccines”, and “Honestly For Diabetes” – in which we are demonstrating that our social responsibility is not a one-time action but rather a continuous commitment; and my ambition is to see Sanofi perceived in this way by the Bulgarian society.

Thirdly, I want to develop my team of highly qualified professionals to support the quality of Sanofi’s operations in the country. Concretely, I aim to create an entrepreneurial and out-of-the-box spirit amongst my team since I want them to lead the change of the industry.