Kuuno Vaher, market access director Baltics and country lead of AstraZeneca Estonia, discusses the liberal attitude towards innovative and highly needed medicines of Estonian regulators and the crucial importance of closer collaboration with payers, which has led the thriving affiliate to have its portfolio reimbursed in the country.
Can you begin by briefly walking our readers through AstraZeneca’s history in Estonia?
We are celebrating AstraZeneca’s 25th anniversary in Estonia. If you compare it against the global operations it is not much, but if you consider that we have been independent for only 27 years it is a rather long time. In Estonia, you do not find many MNCs with the same solid legacy in the country as AstraZeneca. Here, we have always had that risk-taking mentality trying new ways of working which has led us to rank number three in the local market. Sales in the Estonian affiliate account for only about EUR 15 million. However, ranking high or increasing our sales is not our aim – we strive to provide Estonian patients with the best possible treatments. We are here to ensure that reimbursement takes place and that medicines are available in collaboration with payers. What is very high on our agenda is the so called ‘electronic risk sharing’ on which patients get specific prices based on the progression of the diseases and the type of results they receive. We are trying to find different ways to enhance patients access to medicines.
When we met Martynas, of the Lithuanian affiliate, he told us that AstraZeneca has new drugs coming in for diabetes, respiratory and biologics for severe asthma to be approved by the EMA. What about Estonia?
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In Estonia, all the products that we launched are also reimbursed by the government. The ease of market access and the overall process is significantly longer in Estonia than in countries like Sweden or Denmark, but it has worked out very well up until now. It is crucial to collaborate with all stakeholders in HC to create quality criteria’s to treat patients in the best possible way. Estonia’s regulators are very open-minded and as long as we have good ideas it is very easy to get a seat at their table and discuss.
In terms of therapeutic areas, we are aligned with the global directives. In Estonia specifically, we focus on lung and ovarian cancer and hematology. At the moment, for instance, we have extensive discussions to find an agreement to have our latest lung cancer treatment reimbursed. We are doing this by including a great variety of stakeholders, trying to find solutions suitable for all.
Could you expand on what solutions the industry can provide to the government to continue reducing these gaps in patient access?
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There are a lot of data that the health insurance has at its disposal. In hospitals, for instance you can view every single bill and every single injection per indication. These data can be accessed and visualized by doctors. This is exactly what is needed in Estonia to render the system even stronger and efficient. This obviously also enhances prevention which, by definition, leads to a more sustainable healthcare system. Prevention should be executed through data and not by levering only on facts such as ‘eating too much is bad or smoking is awful’.
How do you evaluate your relationship with the authorities?
I have worked in the pharmaceutical industry for many years and as I mentioned above I believe that between industry and payers there is basic trust. This is why it is very important to be collaborative and be part of a unified voice.
How would you assess Estonian patients’ access to innovative and highly-needed medicines, and how is this different from the other Baltics states?
I believe that to a certain extent it is better in Estonia than in Latvia and Lithuania. However, we are not comparing with the other two Baltic states. We compare with countries whose net GDPs is similar to ours – I am thinking of countries like Slovenia, Portugal and Slovakia. We are somehow trying to push to have medicines policy document and Estonia’s goal should be at EU’s average level. The issue at the moment is that the reimbursement process is too long – it can take up to five years – and I believe we should actively work to reduce this time.
You have had experience in the Estonian pharmaceutical market for more than 15 years. What have been the most significant changes t over the last five years?
There is a significant shift towards specialty care. This results in companies not hiring many sales reps and allocating the portfolio to one single person who, in turn, works on one product half of her time and the remaining one on the other. This requires a high level of experience and professionalism. A change that, conversely, I hope will come is a better use of existing data on behalf of the health insurance fund. To be able to do so in the most effective way, a lot of brainpower is required. The head of the health insurance fund comes from Microsoft, so I hope he will bring some additional progressist approach and open-minded thinking in the use of health data.
How important is corporate social responsibility for AstraZeneca and what are its main impacts on Estonian patients?
In Estonia, we try to act based on global guidelines and this is the value that we are bringing to the Estonian healthcare system. This is also partly the reason why we are so strict in terms of compliance. AstraZeneca has been pioneering in compliance rules. Furthermore, we have quite a significant amount of investments in Estonia via our AstraZeneca funded clinical studies which is attracting doctors back to the country. Estonia, at the end of the day, is a small but developed country and therefore can be used as a testing ground for new ideas. I would like to see more global companies investing in local gene bank and other developments in Estonia – this is one of our country’s selling point.
“Be a great place to work” is one of the global strategic guidelines of AstraZeneca. How do you motivate your employees on a daily basis?
Our thinking process is very innovative. For instance, in our Estonian office, half of the employees are working for Nordics and Global. This a motivation for every person who does not want to travel abroad, but to work with interesting and wider projects. Estonia is small, innovative and comfortable. We closely collaborate with HR to improve the working environment, but the abovementioned feature is the key motivation.
